RESUMO
El presente artículo es el resultado de una revisión documental de prensa sobre la situación actual en materia de salud mental en Uruguay a partir de la implementación de la Ley 19.529. Los textos tomados en consideración fueron difundidos durante el período comprendido entre enero de 2022 y diciembre de 2023. Tomando como criterio de elegibilidad las publicaciones que informaron a cerca de la realidad de la población con padecimientos mentales en el territorio nacional. La indagación se realizó mediante el motor de búsqueda Google y del total de la información recolectada se seleccionaron 20 artículos. Luego se realizó una descripción objetiva y sistemática del contenido de las publicaciones. El estudio de los resultados se realizó en base al objetivo de la revisión que propuso analizar la salud mental en Uruguay a partir de la implementación de la Ley19.529 desde la visión de la prensa. Como conclusión de los hallazgos presentados, se estableció un avance significativo en el replanteo de la gestión pública sobre salud mental. A pesar de esto se puede apreciar una brecha entre lo que el Estado promueve a través de sus políticas públicas en materia de salud mental y lo que las personas con este tipo de padecimiento reciben. Todo esto refleja que aún cuando se ha dictado una ley en materia de salud mental y su instrumento de aplicación, esta no responde a los verdaderos problemas que padecen los enfermos. Revelando en varios artículos de prensa las deficiencias del sistema sanitario e instituciones psiquiátricas uruguayas. Por otro lado, cabe destacar, que se evidencia una alerta en relación al aumento de casos de trastornos mentales en niños y adolescentes y en la tasa de suicidios en el país luego de la crisis sanitaria originada por el COVID -19.
This article is the result of a press documentary review on the current situation regarding mental health in Uruguay since the implementation of Law 19.529. The texts taken into consideration were published between January 2022 and December 2023. Taking as eligibility criteria, the publications that reported about the reality of population with mental illnesses in the national territory. The investigation was carried out using Google Research and from the total information collected, 20 articles were selected. Then an objective and systematic description of the content of the publications was made. The study of the results was carried out based on the objective of the review, which proposed to analyze mental health in Uruguay based on the implementation of Law 19,529 from the perspective of the press. As a conclusion a significant progress was established in the rethinking of public management on mental health. Despite this, there is a gap between what the State offers through its public policies on mental health and what people with this type of condition receive. All of this reflects the fact that even when regulations and execution plans have been issued, they do not respond to the real problems suffered by patients. Revealing in several press articles the deficiencies of the Uruguayan health system and psychiatric institutions. On the other hand, it should be noticed that there is evidence of an alert in relation to the increase in cases of mental disorders in children and adolescents and in the suicide rate after the health crisis caused by COVID -19.
Este artigo é resultado de uma revisão documental de imprensa sobre a situação atual da saúde mental no Uruguai desde a implementação da Lei 19.529. Os textos considerados foram divulgados no período entre janeiro de 2022 e dezembro de 2023. Tomando como critérios de elegibilidade as publicações que relatassem a realidade da população com doenças mentais no território nacional. A investigação foi realizada por meio do mecanismo de busca Google e foram selecionados 20 artigos do total de informações coletadas. Em seguida foi realizada uma descrição objetiva e sistemática do conteúdo das publicações. O estudo dos resultados foi realizado com base no objetivo da revisão, que se propôs analisar a saúde mental no Uruguai a partir da implementação da Lei 19.529 sob a perspectiva da imprensa. Como conclusão dos achados apresentados, constatou-se um avanço significativo no repensar da gestão pública em saúde mental. Apesar disso, percebe-se uma lacuna entre o que o Estado oferece por meio de suas políticas públicas de saúde mental e o que recebem as pessoas com esse tipo de condição. Tudo isto reflecte que mesmo quando foram emitidos regulamentos e planos de execução, estes não respondem aos problemas reais sofridos pelos pacientes. Revelando em diversos artigos de imprensa as deficiências do sistema de saúde e das instituições psiquiátricas uruguaias. Por outro lado, cabe destacar que fica evidente um alerta em relação ao aumento dos casos de transtornos mentais em crianças e adolescentes e na taxa de suicídio após a crise sanitária causada pela COVID -19.
Assuntos
Humanos , Saúde Mental , Assistência à Saúde Mental , Política de Saúde , Legislação Médica , UruguaiRESUMO
In this Medical News article, JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, and Alondra Nelson, PhD, the Harold F. Linder Professor at the Institute for Advanced Study, discuss effective AI regulation frameworks to accommodate innovation.
Assuntos
Inteligência Artificial , Pesquisa Biomédica , Política de Saúde , Invenções , Legislação Médica , Educação de Pós-Graduação em Medicina , Medicina , Inteligência Artificial/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Invenções/legislação & jurisprudência , Pesquisa Biomédica/legislação & jurisprudênciaRESUMO
A escassez e a má distribuição geográfica de médicos no país (Stralen et al., 2017; Póvoa; Andrade, 2006; Scheffer et al., 2023), sua tradição de autonomia com múltiplos vínculos como profissionais liberais (Greer, 2008; Luiz; Bahia, 2009; Ney; Rodrigues; 2012) e os baixos salários praticados no setor público (Brasil, 1961, 2008b) estabeleceram uma realidade de disseminada inobservância ao cumprimento da jornada de trabalho definida pela nova legislação do Sistema Único de Saúde (Brasil, 1988, 1991, 2000, 2008a), gerando insegurança jurídica a gestores e médicos, com potenciais prejuízos na qualidade assistencial e na saúde ocupacional desses profissionais. A presente tese, na forma de três artigos, busca descrever e analisar esse cenário nacional, trazendo o estudo de caso de uma experiência municipal de nova legislação trabalhista (Praia Grande, 2015a) criada para o enfrentamento do problema. Em um primeiro artigo, investiga-se 20 anos de decisões exaradas nas bases informatizadas públicas dos Tribunais de Contas Estaduais das diversas regiões brasileiras, verificando-se que a adoção de medidas coercitivas ao descumprimento de jornada de trabalho médica no SUS está associada à formas de contratação irregular sem concurso público (p < 0,001), menor relação per capita de médicos (p = 0,003), menor porte populacional (p = 0,02) e distância dos centros urbanos da região sudeste do país (p < 0,0001). No segundo artigo, descreve-se os resultados de uma pesquisa etnográfica a usuários, gestores e trabalhadores do município objeto de estudo (Praia Grande, 2015b) colhendo-se, em 1012 min de entrevistas, a percepção dos atores sociais presentes na comunidade a respeito da nova legislação municipal (Praia Grande, 2015a). Finalmente, no terceiro artigo, analisa-se o cenário de contradição em âmbito nacional à luz da Teoria Histórico Cultural da Atividade (Leontiev, 1978) e apresenta o ciclo expansivo de reconceptualização da jornada de trabalho do ambulatório de especialidades médicas do município de Praia Grande/SP, sob a perspectiva da Teoria da Aprendizagem Expansiva (Engeström, 1987) e do modelo teórico-metodológico de Zona de Desenvolvimento Proximal (Engeström, 1987; Vygotsky, 1978)
The scarcity and uneven geographic distribution of physicians in the country (Stralen et al., 2017; Póvoa; Andrade, 2006; Scheffer et al., 2023), their tradition of autonomy with multiple professional affiliations as independent practitioners (Greer, 2008; Luiz; Bahia, 2009; Ney; Rodrigues; 2012), and the low salaries practiced in the public sector (Brazil, 1961, 2008b) have created a reality of widespread non-compliance with the work schedule defined by the new legislation of the Brazilian Unified Health System (Brazil, 1988, 1991, 2000, 2008a), leading to legal uncertainty for both managers and physicians, with potential implications for the quality of care and occupational health of these professionals. This thesis, in the form of three articles, aims to describe and analyze this national scenario, presenting a case study of a municipal experience with new labor legislation (Praia Grande, 2015a) designed to address the issue. In the first article, a 20-year investigation of decisions recorded in the public computerized databases of State Audit Courts across Brazilian regions is conducted. It is observed that the adoption of coercive measures against the non-compliance with medical work day in SUS is associated with forms of irregular hiring without public tender (p < 0.001), lower per capita physician ratios (p = 0.003), smaller population size (p = 0.02), and distance from urban centers in the Southeast region of the country (p < 0.0001). The second article presents the advantages and disadvantages identified in an ethnographic study of a municipal experience (Praia Grande, 2015b), which led to the retention of professionals and diversification of the offering of specialized medical services, receiving favorable feedback from the involved community. Finally, in the third article, the national contradictory scenario is analyzed in the light of the Cultural-Historical Activity Theory (Leontiev, 1978), and the expansive cycle of reconceptualization of the work schedule for the medical specialties outpatient clinic in the city of Praia Grande/SP is examined from the perspective of the Expansive Learning Theory (Engeström, 1987) and the theoretical-methodological model of the Zone of Proximal Development (Engeström, 1987; Vygotsky, 1978).
Assuntos
Jornada de Trabalho , Sistemas Nacionais de Saúde , Distribuição de Médicos , Jurisprudência , Legislação Médica , Sistema Único de Saúde , Brasil , Saúde OcupacionalRESUMO
In this Medical News article, 13 physicians and health care experts spoke with JAMA about the increasing efforts to criminalize evidence-based medical care in the US.
Assuntos
Atenção à Saúde , Médicos , Humanos , Atenção à Saúde/legislação & jurisprudência , Instalações de Saúde , Médicos/legislação & jurisprudência , Médicos/organização & administração , Estados Unidos , Legislação MédicaAssuntos
Buprenorfina/uso terapêutico , COVID-19 , Prescrições de Medicamentos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pandemias , Padrões de Prática Médica/legislação & jurisprudência , Telemedicina/legislação & jurisprudência , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Cobertura do Seguro , Legislação Médica , Masculino , Medicare Part C , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/uso terapêutico , Estados Unidos , Adulto JovemAssuntos
Barreiras de Comunicação , Pessoas Mal Alojadas , Legislação Médica , Transtornos Mentais , Pessoas Mentalmente Doentes , Psicofarmacologia , Doença Crônica , Necessidades e Demandas de Serviços de Saúde , Pessoas Mal Alojadas/legislação & jurisprudência , Pessoas Mal Alojadas/psicologia , Humanos , Legislação Médica/ética , Legislação Médica/organização & administração , Legislação Médica/normas , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoas Mentalmente Doentes/legislação & jurisprudência , Pessoas Mentalmente Doentes/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Psicofarmacologia/ética , Psicofarmacologia/métodos , Problemas Sociais , Responsabilidade Social , Estados UnidosRESUMO
Tweetable abstract Health economics and ELSI can be better integrated to consider the family impacts of genetic and genomic testing.
Assuntos
Economia Médica/organização & administração , Ética Médica , Família , Testes Genéticos/métodos , Legislação Médica , Análise Custo-Benefício , Testes Genéticos/economia , Humanos , Pesquisa InterdisciplinarRESUMO
United States law recognizes adult reproductive liberty and many states view surrogacy services through that lens. During the COVID-19 pandemic in March, 2020, New York State enacted the Child-Parent Surrogacy Act (CPSA) into law, after feminists and their allies had caused its defeat in 2019. Just before approval of the CPSA, a group of legislators introduced the Alternative Surrogacy Bill (ASB). This article is a case study that examines how the CPSA and not the ASB became law, examining surrogate rights, the best interests of the child, and the ethical issues related to adult donor-conceived and surrogacy born children's rights to information about their ancestry.
Assuntos
Comércio/legislação & jurisprudência , Direitos Humanos , Legislação Médica/ética , Técnicas Reprodutivas/legislação & jurisprudência , Controle Social Formal , Mães Substitutas/legislação & jurisprudência , Acesso à Informação , Adulto , COVID-19 , Criança , Proteção da Criança , Comércio/ética , Infecções por Coronavirus/epidemiologia , Dissidências e Disputas , Família , Feminino , Humanos , Indústrias/ética , Indústrias/legislação & jurisprudência , Mães , New York/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Gravidez , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/ética , Direitos da MulherRESUMO
The coronavirus pandemic, referred to here as Covid-19, has brought into sharp focus the increasing divergence of devolved legislation and its implementation in the United Kingdom. One such instance is the emergency health and social care legislation and guidance introduced by the United Kingdom Central Government and the devolved Governments of Wales, Scotland and Northern Ireland in response to this pandemic. We provide a summary, comparison and discussion of these proposed and actual changes with a particular focus on the impact on adult social care and safeguarding of the rights of citizens. To begin, a summary and comparison of the relevant changes, or potential changes, to mental health, mental capacity and adult social care law across the four jurisdictions is provided. Next, we critique the suggested and actual changes and in so doing consider the immediate and longer term implications for adult social care, including mental health and mental capacity, at the time of publication.several core themes emerged: concerns around process and scrutiny; concerns about possible changes to the workforce and last, the possible threat on the ability to safeguard human rights. It has been shown that, ordinarily, legislative provisions across the jurisdictions of the UK are different, save for Wales (which shares most of its mental health law provisions with England). Such divergence is also mirrored in the way in which the suggested emergency changes could be implemented. Aside from this, there is also a wider concern about a lack of parity of esteem between social care and health care, a concern which is common to all. What is interesting is that the introduction of CVA 2020 forced a comparison to be made between the four UK nations which also shines a spotlight on how citizens can anticipate receipt of services.
Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Legislação Médica/tendências , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/legislação & jurisprudência , Pneumonia Viral/epidemiologia , COVID-19 , Internação Compulsória de Doente Mental/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Transtornos Mentais/terapia , Irlanda do Norte/epidemiologia , Pandemias , SARS-CoV-2 , Reino Unido/epidemiologiaAssuntos
Tomada de Decisão Compartilhada , Participação do Paciente/legislação & jurisprudência , Participação do Paciente/tendências , Relações Médico-Paciente , Democracia , França/epidemiologia , Humanos , Legislação Médica/economia , Legislação Médica/estatística & dados numéricos , Legislação Médica/tendências , Participação do Paciente/economia , Participação do Paciente/estatística & dados numéricos , Satisfação do Paciente/legislação & jurisprudência , Satisfação do Paciente/estatística & dados numéricos , Política , Saúde Pública/economia , Saúde Pública/legislação & jurisprudência , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendênciasRESUMO
In 2015, the Supreme Court of Canada struck down the criminal law prohibiting physician assisted death in Canada. In 2016, Parliament passed legislation to allow what it called 'medical assistance in dying (MAID).' The authors first describe the arguments the Court used to strike down the law, and then argue that MAID as legalized in Bill C-14 is based on principles that are incompatible with a free and democratic society, prohibits assistance in dying that should be permitted, and makes access to medically-assisted death unnecessarily difficult. They then propose a version of MAID legislation ('Ideal MAID') that gives proponents and opponents of MAID everything they can legitimately want, contend that it is the only way to legalize MAID that is compatible with a free and democratic society, and conclude that it is the way to legalize MAID in Canada and other similarly free and democratic societies.
Assuntos
Médicos , Suicídio Assistido , Canadá , Humanos , Legislação Médica , Assistência MédicaRESUMO
PURPOSE: In the general context of medical judicialization, spine surgeons are impacted by the part that medical responsibility and the risk of malpractice play in their actions and decisions. Our aim was to evaluate possible shifts in practices among private neurosurgeons who are highly exposed to this judicial risk and detect alterations in their pleasure in exercising their profession. We present the first national survey on French physicians' perception of surgical judicialization and consequences on their practice. METHODS: An online survey was submitted to the 121 members of the French Society of Private Neurosurgery, who represent 29.1% of the total number of spine surgeons and perform 36.0% of the national total spine surgery activity. The French law (no-fault out-of-court scheme) significantly impacts these surgeons in the event of litigation. RESULTS: A total of 78 surveys were completed (64.5% response rate): 89.7% of respondents experienced alteration of doctor-patient relationship related to judicialization and 60.2% had already refused to perform risky surgeries. Fear of being sued added negative pressure during surgery for 55.1% of respondents and 37.2% of them had already considered stopping their practice because of this litigation context. CONCLUSION: The increasing impact of medical liability is prompting practitioners to change their practice and perceptions. The doctor-patient relationship appears to be altered, negative pressure is placed on physicians and defensively, some neurosurgeons may refuse high-risk patients and procedures. This situation causes professional disenchantment and can ultimately prove disadvantageous for both doctors and patients.
Assuntos
Seguro de Responsabilidade Civil/estatística & dados numéricos , Imperícia/legislação & jurisprudência , Neurocirurgiões/estatística & dados numéricos , Coluna Vertebral/cirurgia , Adulto , Idoso , Medicina Defensiva , Feminino , França , Humanos , Satisfação no Emprego , Legislação Médica , Responsabilidade Legal , Masculino , Pessoa de Meia-Idade , Neurocirurgiões/economia , Relações Médico-Paciente , Inquéritos e QuestionáriosRESUMO
The genetic tests for "non-rare thrombophilias" (TNR) were introduced into clinical setting immediately after the identification of genetic variants in the mid-90s to predict and prevent venous thromboembolism (VTE). Although being a rare example of a genetic test of susceptibility for complex diseases that has been integrated in medical routine, it is the most widespread post-natal genetics inquiry in France nowadays. Yet, determining whom to test and how to use the results is still controversial. This article outlines the trajectory of its clinical regulation and illustrates the importance of the context of use to understand its diffusion. This analysis is intended to feed a more general reflection on the issues raised by the clinical integration of genetic surveys for common diseases, particularly with regard to the clinical utility of a test (statistical vs. biological), the subjects to be tested (the case index and/or her/his relatives), and the criteria underlying access to these tests (modalities of medico-economic assessment).
TITLE: Des tests génétiques pour prédire des maladies communes. ABSTRACT: Introduit au lendemain de l'identification des « thrombophilies non rares ¼ (TNR), au milieu des années 1990 afin de prédire et de prévenir la maladie thromboembolique veineuse (MTEV), le bilan génétique pour ces thrombophilies est un exemple assez rare de test génétique de susceptibilité pour une maladie complexe, à avoir franchi le pas d'un véritable usage de routine en clinique. Bien que ce test soit le plus répandu des tests de génétique post-natale en France, son usage (À qui proposer le test ? Que faire des résultats ?) fait encore l'objet de débats. Cet article analyse la trajectoire de régulation clinique de ce test et illustre l'importance du contexte spécifique d'usage pour comprendre sa diffusion. Cette analyse vise à nourrir une réflexion plus générale sur les enjeux que pose l'intégration clinique des tests génétiques pour les maladies communes, en considérant notamment les modalités de définition de l'utilité clinique d'un test (statistique versus biologique), des sujets du test (le cas index versus ses apparentés), et des critères en sous-tendant l'accès (modalités des calculs médico-économiques).
Assuntos
Testes Genéticos , Trombofilia/diagnóstico , Trombofilia/genética , Acesso à Informação/legislação & jurisprudência , Revelação/ética , Revelação/legislação & jurisprudência , França/epidemiologia , Predisposição Genética para Doença , Testes Genéticos/ética , Testes Genéticos/legislação & jurisprudência , Testes Genéticos/métodos , Acessibilidade aos Serviços de Saúde/ética , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , História do Século XXI , Humanos , Recém-Nascido , Legislação Médica , Futilidade Médica/ética , Futilidade Médica/legislação & jurisprudência , Triagem Neonatal/ética , Triagem Neonatal/legislação & jurisprudência , Triagem Neonatal/métodos , Padrões de Prática Médica/ética , Padrões de Prática Médica/legislação & jurisprudência , Padrões de Prática Médica/tendências , Valor Preditivo dos Testes , Trombofilia/epidemiologiaRESUMO
This article explains and gives examples of the importance of political advocacy for hand surgeons at the federal and state levels. Two health care leaders who are also hand surgeons, one now serving as a state Senator and one a former President of the American Medical Association, give their perspective on participation in the political process. The article covers avenues for advocacy for hand surgeons as individuals and as members of medical organizations, including suggestions about effective communication with legislators. There is discussion of the unique role of the American Society for Surgery of the Hand in representing hand surgeons.
Assuntos
Legislação Médica , Manobras Políticas , Ortopedia , Papel do Médico , Preços Hospitalares/legislação & jurisprudência , Humanos , Cobertura do Seguro , Política , Cirurgiões , Estados UnidosRESUMO
Medical assistance in dying (MAID) legislation in Canada followed much deliberation after the Supreme Court of Canada's ruling in Carter v. Canada Included in this deliberation was the Special Joint Committee on Physician Assisted Dying's recommendation to extend MAID legislation beyond the inclusion of adults to mature minors. Children's agency is a construct advanced within childhood studies literature which entails eliciting children's voices in order to recognise children as active participants in constructing their own childhoods. Using this framework, we consider the possible extension of MAID legislation to most minors. We highlight important questions regarding how insights from children's voices could be mobilised in the life or death context of MAID. We conclude that children's voices have the potential to help determine their eligibility for MAID; however, incorporating children's voices in the context of MAID requires careful consideration due to the complexity of voice.
Assuntos
Médicos , Suicídio Assistido , Adulto , Canadá , Criança , Humanos , Legislação Médica , Assistência Médica , Menores de IdadeRESUMO
The COVID-19 pandemic poses unprecedented challenges for the German health care system. What is already the case in some other countries, may occur in Germany in the near future also: Faced with limited ICU resources, doctors will be forced to decide which patients to treat and which to let die. This paper examines the legal implications of such decisions. It takes up arguments from the general discussion on prioritization in medicine. A constitutional hurdle for the application of utilitarian criteria (in particular patients' age or social role) comes from the principle that every human life is of equal value and must not be traded off against others ("life value indifference"). However, the limits that the Grundgesetz (German Basic Law) sets for state actions do not apply directly to doctors. According to the Musterberufsordnung (professional code of conduct), doctors act based on their conscience and the requirements of medical ethics and humanity. The implications of this normative standard for the prioritizing in an exceptional situation as the COVID 19 pandemic have not been sufficiently clarified. This uncertainty leads to emotional and moral burdens for doctors. The authors conclude that the German law grants a limited freedom of choice that allows physicians to apply utilitarian criteria in addition to purely medical decision algorithms.
Assuntos
Infecções por Coronavirus/mortalidade , Tomada de Decisões/ética , Ética Médica , Pneumonia Viral/mortalidade , Alocação de Recursos/ética , Betacoronavirus , COVID-19 , Infecções por Coronavirus/terapia , Efeitos Psicossociais da Doença , Atenção à Saúde/legislação & jurisprudência , Alemanha , Humanos , Legislação Médica , Pandemias , Médicos/ética , Médicos/normas , Pneumonia Viral/terapia , Alocação de Recursos/legislação & jurisprudência , SARS-CoV-2 , Valor da VidaRESUMO
The direct-to-consumer genetic testing (DTC-GT) market has been developing for about twenty years now, raising various debates, even controversies. But what about the regulation of these so-called "innovative" devices, but whose medical status is ambiguous? A first regulatory aspect is depending on the market itself, since the latter is currently subjected to a strong structuring process. A second regulatory aspect, more classical, is the legal one. While the DTC-GT status has long been unclear on European scale, a new text (a Regulation, not a Directive) is modifying the situation. It encourages regulation "by the market" rather than "by the medical profession", which does not imply that the latter will have no (indirect) impact on the DTC-GT market.
TITLE: Les tests génétiques en libre accès - Régulation par le marché, ou régulation médicale ? ABSTRACT: Le marché des auto-tests génétiques se développe depuis une vingtaine d'années, non sans soulever des débats, voire des controverses. Qu'en est-il de la régulation de ces dispositifs dits « innovants ¼, mais dont le statut médical est ambigu ? Un premier aspect régulatoire vient du marché lui-même, puisqu'il est en cours de forte structuration. Un second aspect régulatoire relève plus classiquement du juridique. Alors que le statut des auto-tests a longtemps manqué de clarté à l'échelle européenne, un nouveau texte (un Règlement, et non une Directive) change la situation. Il encourage une régulation « par le marché ¼, plutôt que « par la profession médicale ¼, ce qui n'implique pas que cette dernière n'aura aucun impact (indirect) sur le marché des auto-tests.
Assuntos
Triagem e Testes Direto ao Consumidor/legislação & jurisprudência , Testes Genéticos/legislação & jurisprudência , Setor de Assistência à Saúde/legislação & jurisprudência , Legislação Médica , Triagem e Testes Direto ao Consumidor/ética , Triagem e Testes Direto ao Consumidor/métodos , Triagem e Testes Direto ao Consumidor/normas , Europa (Continente) , União Europeia , Aconselhamento Genético , Testes Genéticos/economia , Testes Genéticos/ética , Testes Genéticos/métodos , Regulamentação Governamental , Política de Saúde/legislação & jurisprudência , Humanos , Legislação Farmacêutica , Marketing de Serviços de Saúde/legislação & jurisprudênciaRESUMO
BACKGROUND AND OBJECTIVES: Globally, contemporary legislation surrounding traditional health practitioners (THPs) is limited. This is also true for the member states of the Southern African Development Community (SADC). The main aim of this study is to map and review THP-related legislation among SADC countries. In order to limit the scope of the review, the emphasis is on defining THPs in terms of legal documents. METHODS: This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methods. Two independent reviewers reviewed applicable legal definitions of THPs by searching the Southern African Legal Information Institute (SAFLII) database in April 2018 for legislation and bills. To identify additional legislation applicable in countries not listed on SAFLII and/or further relevant SADC legislation, the search engines, Google and PubMed, were used in August 2018 and results were reviewed by two independent reviewers. Full texts of available policy and legal documents were screened to identify policies and legislation relating to the regulation of THPs. Legislation was deemed relevant if it was a draft of or promulgated legislation relating to THPs. RESULTS: Four of 14 Southern African countries have legislation relating to THPs. Three countries, namely South Africa, Namibia and Zimbabwe, have acknowledged the roles and importance of THPs in healthcare delivery by creating a council to register and formalise practices, although they have not operationalised nor registered and defined THPs. In contrast, Tanzania has established a definition couched in terms that acknowledge the context-specific and situational knowledge of THPs, while also outlining methods and the importance of local recognition. Tanzanian legislation; thus, provides a definition of THP that specifically operationalises THPs, whereas legislation in South Africa, Namibia and Zimbabwe allocates the power to a council to decide or recognise who a THP is; this council can prescribe procedures to be followed for the registration of a THP. CONCLUSIONS: This review highlights the differences and similarities between the various policies and legislation pertaining to THPs in SADC countries. Legislation regarding THPs is available in four of the 14 SADC countries. While South Africa, Tanzania, Namibia and Zimbabwe have legislation that provides guidance as to THP recognition, registration and practices, THPs continue to be loosely defined in most of these countries. Not having an exact definition for THPs may hamper the promotion and inclusion of THPs in national health systems, but it may also be something that is unavoidable given the tensions between lived practices and rigid legalistic frameworks.