An Assessment of Global Neurotrauma Prevention and Care Delivery: The Provider Perspective.

BACKGROUND: Neurotrauma is a leading cause of morbidity and mortality around the world. Assessment of injury prevention and prehospital care for neurotrauma patients is necessary to improve care systems. METHODS: A 29-question electronic survey was developed based on the Enhancing the Quality and Transparency Of health Research (EQUATOR) checklist to assess neurotrauma policies and laws related to safety precautions. The survey was distributed to members of World Health Organization regions that were considered to be experienced medical authorities in neurosurgery and traumatic brain injury. RESULTS: There were 82 (39%) responses representing 46 countries. Almost all respondents (95.2%) were within the neurosurgical field. Of respondents, 40.2% were from high-income countries (HICs), and 59.8% were from low- and middle-income countries (LMICs). Motor vehicle accidents were reported as the leading cause of neurotrauma, followed by workplace injury and assault. Of respondents, 84.1% reported having a helmet law in their country. HICs (4.38 ± 0.78) were ranked more likely than LMICs (2.88 ± 1.34; P = 0.0001) to enforce helmet laws on a scale of 1-10. Effectiveness of helmet laws was rated as 3.94 ± 0.95 out of 10. Measures regarding prehospital care varied between HICs and LMICs. Patients in HICs were more likely to use public emergency ambulance transportation (81.8% vs. 42.9%; P = 0.0004). All prehospital personnel having emergency training was also reported to be more likely in HICs than LMICs (60.6% vs. 8.7%; P = 0.0001). CONCLUSIONS: When injuries occur, timely access to neurosurgical care is critical. A focus on prehospital components of the trauma system is paramount, and policymakers can use the information presented here to implement and refine health care systems to ensure safe, timely, affordable, and equitable access to neurotrauma care.

Reflection on the enactment and impact of safety laws for regenerative medicine in Japan.

Japan's Act on the Safety of Regenerative Medicine (ASRM) created an innovative regulatory framework intended to safely promote the clinical development of stem cell-based interventions (SCBIs) while subjecting commercialized unproven SCBIs to greater scrutiny and accountability. This article reviews ASRM's origins, explains its unprecedented scope, and assesses how it envisions the regulation of SCBIs. This analysis is used to highlight three key insights that are pertinent to the current revision of the ASRM: clarifying how the concept of safety should be defined and assessed in research and clinical care settings; revisiting risk criteria for review of SCBIs; and taking stronger measures to support the transition from unproven interventions to evidence-based therapies. Finally, the article reflects on lessons drawn from Japanese experiences in dealing with unproven SCBIs for international endeavors to regulate SCBIs.

Potential injuries and costs averted by increased use of evidence-based behavioral road safety policies in North Carolina.

OBJECTIVE: The purpose of this study was to estimate the potential injuries and costs that could be averted by implementing evidence-based road safety policies and interventions not currently utilized in one U.S. state, North Carolina (NC). NC consistently has annual motor vehicle-related death rates above the national average. METHODS: We used the Centers for Disease Control and Prevention's Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS) tool as a foundation for examining the potential injuries and costs that could be averted from underutilized evidence-based policies, assuming a $1.5 million implementation budget and that income generated from policy-related fines and fees would help offset costs. We further examined costs by payer source. RESULTS: Model results indicated that seven interventions should be prioritized for implementation in NC: increased alcohol ignition interlock use, increased seat belt fines, in-person license renewal for ages 70 and older, license plate impoundment, seat belt enforcement campaigns, saturation patrols, and speed cameras. Increasing the seat belt fine had the potential to avert the greatest number of fatal (n = 70) and non-fatal (n = 6,597) injuries annually, along with being the most cost-effective of the recommended interventions. Collectively, the seven recommended evidence-based policies/interventions have the potential to avert 302 fatal injuries, 16,607 non-fatal injuries, and $839 million annually in NC with the greatest costs averted for insurers. CONCLUSIONS: This study demonstrates the utility of the MV PICCS tool as a foundation for exploring state-specific impacts that could be realized through increased evidence-based road safety policy and intervention implementation. For NC, we found that increasing the seat belt fine would avert the most injuries, and had the greatest financial benefits for the state, and the lowest implementation costs. Incorporating fines and fees into policy implementation can create important financial feedbacks that allow for implementation of additional evidence-based and cost-effective policies/interventions. Given the recent uptick in U.S. motor vehicle-related deaths, analyses informed by the MV PICCS tool can help researchers and policy makers initiate discussions about successful state-specific strategies for reducing the burden of crashes.

Machine Learning Systems Applied to Health Data and System.

The use of machine learning (ML) in medicine is becoming increasingly fundamental to analyse complex problems by discovering associations among different types of information and to generate knowledge for medical decision support. Many regulatory and ethical issues should be considered. Some relevant EU provisions, such as the General Data Protection Regulation, are applicable. However, the regulatory framework for developing and marketing a new health technology implementing ML may be quite complex. Other issues include the legal liability and the attribution of negligence in case of errors. Some of the above-mentioned concerns could be, at least partially, resolved in case the ML software is classified as a 'medical device', a category covered by EU/national provisions. Concluding, the challenge is to understand how sustainable is the regulatory system in relation to the ML innovation and how legal procedures should be revised in order to adapt them to the current regulatory framework.

When Do Governments Support Common Goods for Health? Four Cases on Surveillance, Traffic Congestion, Road Safety, and Air Pollution.

Common goods such as air, water, climate, and other resources shared by all humanity are under increasing pressure from growing population and advancing globalization of the world economy. Safeguarding these resources is generally considered a government responsibility, as common goods are vulnerable to market failure. However, governments do not always fulfill this role, and face many challenges in doing so. This observation-that governments only sometimes address common goods problems-informs the central question of this paper: when do governments act in support of common goods? We structure our inquiry using a framework derived from three theories of agenda setting, emphasizing problem perception, the role of actors and collective action patterns, strategies and policies, and catalyzing circumstances. We used a poll of experts to identify important common goods for health: disease surveillance, environmental protection, and accountability. We then chose four historical cases for analysis: the establishment of the Epidemic Intelligence Service in the US, transport planning in London, road safety in Argentina, and air quality control in urban India. Our analysis of the collective evidence of these cases suggests that decisions to advance government action on common goods require a concisely articulated problem, a well-defined strategy for addressing the problem, and leadership backed by at least a few important groups willing to cooperate. Our cases reveal a variety of collective action patterns, suggesting that there are many routes to success. We consider that the timing of an intervention in support of common goods depends on favorable circumstances, which can include a catalyzing event but does not necessarily require one.

Small Animal Veterinarians' Perceptions, Experiences, and Views of Common Dog Breeds, Dog Aggression, and Breed-Specific Laws in the United States.

Dog aggression directed towards humans is a common and serious behavioral and public health issue. This cross-sectional study was designed to gain insights into U.S. small animal veterinarians' views and experiences with the most common dog breeds in the U.S., dog aggression, and breed-specific legislation. An electronic survey was distributed via email to an online veterinary community, and responses were summarized and compared by means of χ2 and Cochran-Mantel-Haenszel tests. Most respondents were concerned about the risks of dog bite injuries, but the majority were not in favor of banning specific breeds of dogs in order to enhance public safety. When participants rated the perceived bite risk associated with popular dog breeds, Chow Chows were perceived as the highest risk, with pit bull types categorized as a moderate risk. Golden Retrievers were seen as the most appropriate for families with children. Public education about animal behavior was the most frequently endorsed policy intervention to increase public safety. These findings suggest that most veterinarians feel that banning an entire dog breed is not an effective way to ensure human safety. Instead, most respondents endorsed alternative initiatives, such as public education and stricter leash laws, to reduce the risk of dog bites.

Review of average sized male and female occupant models in European regulatory safety assessment tests and European laws: Gaps and bridging suggestions.

There are two parts to the aim of this study. The first part comprised reviewing how men and women are represented in regulatory tests conducted to assess adult occupant safety in vehicles in Europe. This part also contains an overview of some differences between females and males that may influence dynamic responses in a crash. Based on the results of the review an outline for how to better represent the adult population in regulatory tests has been suggested. The second part was to reflect on these issues from a specific critical legal perspective, that is from a Gender Legal Studies point of view, focusing on the European legal framework that governs the tests of adult occupant safety in vehicles in Europe. Since the beginning of the 1970s legal scholars have shown in several areas of law that there is a gap between superior legislation and practice, but also between gender equality as a superior legal principle and subordinate legal rules that govern safety requirements. The same pattern can be discerned in the area of Transportation Law. The results of the review of the ECE regulations shows that the average sized male represents the adult population and that the average sized female has been excluded from regulations assessing the protection of adult vehicle occupants. The fundamental values, on which the Union is founded, including the overarching goals of the Union, seem to be rendered invisible in the laws and critically impact the safety of women in everyday life. According to the gender system theory, the interests and priorities of men are continuing to shape the law. Consequently, the law neglecting the safety of women on roads has implications on the development of society. The lack of legal provisions that demand female crash test dummies representing the female part of the population, means that there is no incentive for car manufacturers, authorities or other stakeholders to develop test methods and female crash test dummies in ways that promote political objectives expressed in legal form, i.e., the legal values expressed in general provisions and principles stated in the Treaty on European Union and the Treaty on the Functioning of the European Union, such as gender equality between women and men as well as non-discrimination This study highlights the undeniable gap between the legal framework and legal requirements with regard to occupant safety for the whole adult population. It would be attainable to bridge this particular gender gap by providing equal representation for the female part of the population with regard to vehicle safety, as that males benefit from.

Leveraging the broad powers of legislators to accelerate action to reduce road traffic casualties.

This is an editorial highlighting the power that legislators have in improving global road safety and the failure of the road safety community in optimizing the existing capital of this resource. It argues that legislators must prioritize and adopt laws to improve road safety in their own countries and allocate resources for their enforcement. It also emphasizes the need for legislators to act through regional and global parliamentary bodies to accelerate the adoption and enforcement of laws on a broad scale and on a wide range of topics (such as funding, lead agencies, vehicle regulations), not only on regulating road user behaviour.

Government roles in regulating medical tourism: evidence from Guatemala.

BACKGROUND: Regulation of the medical tourism and public health sectors overlap in many instances, raising questions of how patient safety, economic growth, and health equity can be protected. The case of Guatemala is used to explore how the regulatory challenges posed by medical tourism should be dealt with in countries seeking to grow this sector. METHODS: We conducted a qualitative case study of the medical tourism sector in Guatemala, through reviews and analyses of policy documents and media reports, key informant interviews (n = 50), and facility site-visits. RESULTS: Key informants were critical of the absence of effective public regulation of the emerging medical tourism sector, noting several regulatory gaps and the importance of filling them. These informants specifically expressed that: 1) The government should regulate medical tourism in Guatemala, thought there was disagreement as to which government sector should do so and how; 2) The government has not at this time regulated the medical tourism sector nor shown great interest in doing so; and 3) International accreditation could be used to augment domestic regulation. CONCLUSIONS: The intersection of domestic and international regulation of medical tourism has been largely unexplored. This case study advances new research in this area. It highlights the need for and dearth of regulatory protections in Guatemala and lessons for other, similarly situated countries. National regulatory models from Israel and Barbados could be adapted to the Guatemalan context. Global governance could help to protect national governments from any competitive disadvantages created by regulation. Underlying the concerns over growth in medical tourism, however, is how it contributes to the ongoing privatization of health care facilities worldwide. This trend risks undermining efforts to reach targets for Universal Health Coverage and exacerbating existing inequities in the global distribution of health and wealth.

Willingness to pay for mortality risk reduction for traffic accidents in Myanmar.

The dramatic increase in vehicle ownership in Myanmar over the past few years has resulted in an alarming increase in traffic accidents. Thus, road safety at the national level needs to be improved urgently in order to reduce the costs associated with traffic accidents and to assist policy makers in making economically efficient resource allocation decisions for road safety improvements. This research was conducted to determine the costs related to fatality risk reductions using a willingness to pay (WTP) approach for motorcyclists, car drivers, and bus passengers in Myanmar. Face-to-face interviews with contingent valuation (CV) and a payment card questionnaire approach was employed for the data collection; multiple linear regression analyses were conducted to determine the factors influencing WTP. The resulting median and mean for the value of statistical life (VSL) were found to be MMK 118.062 million (US$ 98,385) to MMK 162.854 million (US$ 135,712), respectively. Therefore, the total cost of death was estimated to range from MMK 594.681 billion (US$ 495.567 million) to MMK 820.296 billion (US$ 683.580 million) in 2015. In addition, the WTP was found to be significantly associated with age, family status, education, occupation, individual income, household income, the vehicle used, exposure to traffic, drunk driving, personal experiences, and the perceived risk of traffic accidents. This study might be helpful in prioritization of road safety related projects to get greatest benefit by choosing most cost effective projects. This study might assist the decision-making for road safety budget allocations and policy development.

Are government-approved products containing new psychoactive substances perceived to be safer and more socially acceptable than alcohol, tobacco and illegal drugs? Findings from a survey of police arrestees in New Zealand.

INTRODUCTION AND AIMS: In July 2013, New Zealand passed the Psychoactive Substances Act (PSA), which established a legal regulated market for government-approved products containing new psychoactive substances (NPS). One of the aims of the PSA was to separate the market for approved NPS products from unapproved products and illegal drugs. The aim of this study was to explore perceived health risks and social acceptability of government-approved NPS compared to unapproved NPS and other drugs. DESIGN AND METHODS: About 834 police arrestees were surveyed about the health risks and social acceptability of regularly using nine drug types, including approved and unapproved synthetic cannabinoids (SC) and 'party pills' (PP) under the interim PSA regime. Statistical analyses included fitted analysis of variance and logistic ordinal regression models. RESULTS: Approved SC were considered riskier to health than (natural) cannabis, alcohol, approved and unapproved PP, tobacco and ecstasy, but safer than unapproved SC and methamphetamine. Younger participants (16-29 years) were more likely than older participants (30+ years) to give approved SC a high health-risk score. Approved SC were considered less socially acceptable than alcohol, tobacco and cannabis, but more socially acceptable than methamphetamine, unapproved SC and unapproved PP. Frequent SC users were more likely to rate the social acceptability of approved legal SC higher than other drug users. Approved PP received more positive health and social acceptability scores than approved SC. DISCUSSION AND CONCLUSIONS: The PSA was partially successful at separating approved NPS from other drugs. High health-risk and low social acceptability scores for approved SC may reflect the absence of product testing during the interim PSA market.

Financing of forensic psychiatry in view of treatment quality and threat to public safety. / Finansowanie psychiatrii sadowej a jakosc leczenia i zagrozenie bezpieczenstwa publicznego.

Stay in a psychiatric hospital of persons who committed the gravest criminal acts while in a state of insanity aims to ensure their effective treatment (therapeutic function), but above all to prevent the repetition of prohibited acts of significant harm to the community (preventive function). Forensic patients are provided with suitable medical, psychiatric, rehabilitation and resocialization care. The court imposes an indefinite detention. In view of the dual purpose of the stay in a psychiatric hospital, both therapeutic and preventive, the treatment costs generated by forensic wards are higher than those of general psychiatric wards. This prompts person from outside psychiatry, who do not understand the nature of preventive measures, to call for continuing reductions in the expenditure on forensic psychiatric care. It is, therefore, worth analyzing the possible meaning and results of the attempts to economizeforensic psychiatry, to find savings and to manipulate financing system under the pretence of economic incentive to improve treatment quality. In this paper, the authors address and discuss the above and other issues.

Law Enforcement and Gun Retailers as Partners for Safely Storing Guns to Prevent Suicide: A Study in 8 Mountain West States.

OBJECTIVES: To examine the extent to which law enforcement agencies (LEAs) and gun retailers are willing to offer voluntary, temporary storage as a part of an overall suicide prevention effort. METHODS: We invited all LEAs and gun retailers in 8 US states to respond to questionnaires asking about their willingness to offer temporary gun storage and their recommendations to gun owners about safe storage. RESULTS: We collected data in 2016 from 448 LEAs and 95 retailers (response rates of 53% and 25%, respectively). Three quarters of LEAs (74.8%; 95% confidence interval [CI] = 72.1, 77.5) indicated they already provided temporary storage compared with 47.6% (95% CI = 39.2, 56.0) of retailers. LEAs were most willing to provide storage when a gun owner was concerned about the mental health of a family member. Retailers were more receptive than were LEAs to providing storage when visitors were coming or for people wanting storage while traveling. Both groups recommended locking devices within the home, but LEAs were slightly more favorable to storing guns away from the home. CONCLUSIONS: Law enforcement agencies and gun retailers are important resources for families concerned about suicide.