[Regulation of the online sale of medical products: experiences and strategies for Latin AmericaRegulamentação da venda de produtos médicos pela internet: experiências e estratégias para a América Latina]. / Regulación de la venta de productos médicos por Internet: experiencias y estrategias para Latinoamérica.

The objective of this special report is to present the advances in Latin America on regulation of the online sale of medical products and to offer guidance to national regulatory authorities (NRAs) on planning and implementing strategies to regulate and oversee the e-commerce of medical products. The regulatory advances and the programs and initiatives implemented in four Latin American countries to control the online sale of medical products are presented, including complementary reviews of the literature and reviews of e-commerce control programs of agencies of reference. Based on this review, the following strategies are proposed: strengthening the regulatory and policy framework; strengthening the capacity for oversight; collaboration with national and international authorities and other key players; and communication and awareness-raising with the community and health care professionals. Each of these strategies should be accompanied by specific actions that can serve as guidelines for NRAs in the Americas and in countries with similar contexts, to strengthen their regulatory frameworks and patient and consumer protections.

O objetivo deste relatório especial é apresentar os avanços na regulamentação da comercialização de produtos médicos pela internet na América Latina e oferecer orientações às Autoridades Reguladoras Nacionais (ARN) sobre planejamento e execução de estratégias de regulamentação e fiscalização do comércio eletrônico de produtos médicos. São apresentados avanços regulatórios e programáticos, bem como iniciativas realizadas por quatro países latino-americanos para controlar a venda de produtos médicos pela internet, incluindo revisões complementares da literatura e programas de controle do comércio eletrônico por agências reguladoras de referência. Com base nesta revisão, propõem-se as seguintes linhas estratégicas: fortalecimento do marco regulatório e normativo; fortalecimento da capacidade de fiscalização; colaboração com autoridades e outros atores-chave nacionais e internacionais; e comunicação e sensibilização da comunidade em geral e dos profissionais de saúde. Cada uma dessas estratégias deve ser acompanhada de ações específicas, que podem servir de diretrizes para as ARN das Américas ­ e de países com contextos semelhantes ­ para fortalecer seus marcos regulatórios e a proteção de pacientes e consumidores.

Health care professionals' preference for a fully liquid, ready-to-use hexavalent vaccine in Spain.

Vaccination is an effective health intervention for the prevention of infectious diseases. This study aims to evaluate the response provided by nurses toward the use of ready-to-use (RTU) formulations of hexavalent vaccines and measures to prevent errors during the vaccination process. This observational, descriptive, cross-sectional study took place from March to May 2018. It included 201 interviews with nurses from health centers in Madrid (70), Murcia (59), and Andalusia (72), who had administered RTU vaccines in the last 12 months. Approximately 91.6% of nurses provided a positive feedback for the use of RTU vaccines. The most significant concerns experienced by nurses were during the preparation and administration of vaccines; 84.1% versus 18.9% of nurses felt that the risk of making mistakes was lower while using RTU vaccines compared with non-reconstituted (lyophilized) vaccines, and 74.1% versus 22.4% of nurses felt ease at preparing RTU vaccines compared with lyophilized vaccines. A total of 66.7% of nurses believed that there were risks associated with the preparation of lyophilized vaccines (administration risk [42.8%] and risk of needle injury [42.3%]). Risk percentages reduced to 4% and 9.5%, respectively, with the use of the RTU vaccines. Therefore, nurses adopted an average of seven steps to reduce the risk of errors. The average time saved during the administration of the vaccines was 1.1 min. In summary, nurses highlighted the need for administering vaccines using RTU formulations for ensuring the safety of the recipients, preventing errors, and saving time during the vaccination process.

Regulación de la venta de productos médicos por Internet: experiencias y estrategias para Latinoamérica / Regulation of the online sale of medical products: experiences and strategies for Latin America / Regulamentação da venda de produtos médicos pela internet: experiências e estratégias para a América Latina

RESUMEN El objetivo de este informe especial es presentar los avances en Latinoamérica sobre la regulación de la venta de productos médicos a través de internet y ofrecer orientación a las Autoridades Reguladoras Nacionales (ARN) en la planificación y ejecución de estrategias para la regulación y fiscalización del comercio electrónico de productos médicos. Se presentan los avances regulatorios y de programas, e iniciativas efectuadas por cuatro países de América Latina para el control de la venta de productos médicos a través de Internet, incluyendo revisiones complementarias de la literatura y de programas para el control del comercio electrónico de agencias de referencia. A partir de esta revisión, se proponen las siguientes líneas estratégicas: fortalecimiento del marco regulatorio y normativo; fortalecimiento de la capacidad fiscalizadora; colaboración con autoridades y otros actores clave nacionales e internacionales; y comunicación y sensibilización con la comunidad y los profesionales de salud. Cada una de estas estrategias deben ir acompañadas con acciones específicas, que pueden servir como orientaciones para las ARN de las Américas, y de países con contextos similares para el fortalecimiento de sus marcos regulatorios y la protección de los pacientes y consumidores.

ABSTRACT The objective of this special report is to present the advances in Latin America on regulation of the online sale of medical products and to offer guidance to national regulatory authorities (NRAs) on planning and implementing strategies to regulate and oversee the e-commerce of medical products. The regulatory advances and the programs and initiatives implemented in four Latin American countries to control the online sale of medical products are presented, including complementary reviews of the literature and reviews of e-commerce control programs of agencies of reference. Based on this review, the following strategies are proposed: strengthening the regulatory and policy framework; strengthening the capacity for oversight; collaboration with national and international authorities and other key players; and communication and awareness-raising with the community and health care professionals. Each of these strategies should be accompanied by specific actions that can serve as guidelines for NRAs in the Americas and in countries with similar contexts, to strengthen their regulatory frameworks and patient and consumer protections.

RESUMO O objetivo deste relatório especial é apresentar os avanços na regulamentação da comercialização de produtos médicos pela internet na América Latina e oferecer orientações às Autoridades Reguladoras Nacionais (ARN) sobre planejamento e execução de estratégias de regulamentação e fiscalização do comércio eletrônico de produtos médicos. São apresentados avanços regulatórios e programáticos, bem como iniciativas realizadas por quatro países latino-americanos para controlar a venda de produtos médicos pela internet, incluindo revisões complementares da literatura e programas de controle do comércio eletrônico por agências reguladoras de referência. Com base nesta revisão, propõem-se as seguintes linhas estratégicas: fortalecimento do marco regulatório e normativo; fortalecimento da capacidade de fiscalização; colaboração com autoridades e outros atores-chave nacionais e internacionais; e comunicação e sensibilização da comunidade em geral e dos profissionais de saúde. Cada uma dessas estratégias deve ser acompanhada de ações específicas, que podem servir de diretrizes para as ARN das Américas - e de países com contextos semelhantes - para fortalecer seus marcos regulatórios e a proteção de pacientes e consumidores.

Why do rich countries prefer free trade over free migration? The role of the modern welfare state.

"According to traditional trade theory (Heckscher-Ohlin), free trade and free migration are equivalent measures of economic integration leading both to an equalization of factor prices. This prediction is in sharp opposition to the observed preference of rich countries for free trade over free migration. We provide an explanation for this inconsistency: the redistribution policies in the countries. Social welfare in countries with a relatively small number of low-skilled native workers is higher with free trade than with free migration due to redistribution of income towards immigrating workers."

Economic integration and labor flows: stage migration in farm labor markets in Mexico and the United States.

"This article examines the probable effects of the North American Free Trade Agreement (NAFTA) on migration from Mexico to the United States, disputing the view that expansion of jobs in Mexico could rapidly reduce undocumented migration. To the extent that NAFTA causes Mexican export agriculture to expand, migration to the United States will increase rather than decrease in the short run. Data collected in both California and the Mexican State of Baja California show that indigenous migrants from southern Mexico typically first undertake internal migration, which lowers the costs and risks of U.S. migration. Two features of employment in export agriculture were found to be specially significant in lowering the costs of U.S. migration: first, working in export agriculture exposes migrants to more diverse social networks and information about U.S. migration; second, agro-export employment in northern Mexico provides stable employment, albeit low-wage employment, for some members of the family close to the border (especially women and children) while allowing other members of the family to assume the risks of U.S. migration."

International labor movements, trade flows and migration transitions: a theoretical perspective.

"This article presents a theoretical analysis of how the processes of industrialization and development interact with international trade in goods or services to influence a country's turning point from labor exporter to labor importer. It is concluded that trade in goods complements capital movements but substitutes for labor movements, whereas trade in services and labor movements complement each other. The proposed analytical framework suggests that both international trade and migration may contribute to, but cannot lead to, a development process that brings about a migration transition in surplus labor economies."

Implications of AFTA on Philippine labor export.

"After summarizing the major features of the ASEAN labor market and patterns of labor migration in Asia, the article describes the origins and current status of the ASEAN Free Trade Area (AFTA) and its main mechanism, the Common Effective Preferential Tariff (CEPT) Scheme." Possible trends in the migration of skilled and professional Philippine workers throughout the Asia-Pacific region are discussed.

Remittances, trade and the Philippine economy.

"The relationships between trade, remittances from overseas workers and the domestic economy are examined for their implications for labor and trade policy [in the Philippines].... The limited use of remittances for real reproductive investments at the household level is associated with length of migration, reliance on overseas workers as a source of foreign exchange, and a failure to correct the structural imbalances of the economy."

Birds of prey and birds of passage: the movement of capital and the migration of labour.

PIP: This paper highlights the relationship between Canada's restructuring activities and changes in its immigration policies by focusing upon the creation of a migrant worker's program. Immigration policy is understood as being integrally shaped by the state's response to the restructuring strategies of capital investors. It is argued that the implementation of a migrant worker's program in Canada can be accounted for by placing it within the context of the state's efforts to attract capital investment, capitalists' concern with disciplining workers and increasing their return upon investment. The author shows that by restricting the freedom of a growing number of migrant and immigrant workers, Canada has more closely connected immigration with labor market policy and created 2 separate categories of (im)migrants, those who enter as temporary workers and are labeled "non-immigrants" and those who enter as permanent residents. Studying only the non-immigrant category of (im)migrant recruitment which admits people if they work in an unfree employment relationship while in the country, the author argues that (im)migrant workers forced to work in such relationships have increasingly been made available to employers by the Canadian state as an attempt to attract or retain capital investment. As capitalist restructuring has proceeded, the use of unfree labor has expanded in Canada.^ieng

Caracterización de aspectos relacionados con la utilización de los medicamentos fiscalizados en droguerías y farmacias-droguerías de Medellín y el Área Metropolitana / Characterization of aspects related to the use of controlled drugs in Drugstores and pharmacies-drugstores in Medellin and the Metropolitan Area

Resumen Introducción: Los fallos prevenibles en la cadena del medicamento se relacionan con los Problemas Relacionados con la Utilización de Medicamentos, y están asociados a errores de medicación (prescripción, dispensación, administración o uso), incluyendo los fallos en el Sistema de Suministro de Medicamentos (disponibilidad y calidad). Objetivo: Identificar información básica de los Establecimientos Farmacéuticos (EF), caracterizar algunos procesos relacionados con la utilización de medicamentos fiscalizados (MF), incluyendo cumplimiento de la normatividad, y determinar el nivel de percepción del riesgo y las necesidades de educación continua del personal farmacéutico (PF). Metodología: Se realizó un estudio de corte transversal. Se utilizó un cuestionario sobre los procesos enfocados en la utilización de MF, durante mayo a septiembre de 2016. Resultados: Se visitaron 700 establecimientos y se encuestaron a igual cantidad de PF. El 88% (617) de los establecimientos eran de estratos socioeconómicos bajo y medio. Los MF más dispensados fueron: amitriptilina 91,4% (640), tramadol 90% (630) y trazodona 60% (419). El 71,6% (501) de los encuestados consideró que el expendedor de drogas es el personal más idóneo para dispensar MF. El 25% (177) de los encuestados percibieron como muy deficiente a regular el proceso de información y educación que ellos brindan, y el 32% (223) con igual percepción en la responsabilidad que tienen con el uso y resultados en salud de los pacientes. Conclusiones: Se identifica la información general de los establecimientos, al igual que de los procesos relacionados con la utilización de MF. La percepción de los encuestados sobre el personal idóneo para la dispensación correcta de MF podría ser inadecuado. Un alto porcentaje del PF percibe falencias de educación enfocada en la utilización correcta de los MF.

Abstract Introduction: Preventable failures in the drug chain are related to Drugs Problems Related Use and are associated with medication errors (prescription, dispensing, administration or use by the patient or caregiver), including failures In the Medication Supply System (availability and quality). Objective: Recognize basic information of the Pharmaceutical Establishments (PE), to characterize some processes related to the use of controlled drugs (CD), including compliance with the regulations, and determine the level of risk perception and the continuing education needs of the staff pharmacy. Methodology: A cross-sectional, epidemiological study was performed. A questionnaire was used on the processes focused on the use of CD, between May to September of 2016. Results: 700 PE were visited and an equal number of staff pharmacy were interviewed. Eighty-eight percent (617) of PE are socioeconomic low and medium status, and have an average of 15.3 years of operation (SD 13.6 years). The most favored CD were: mitriptyline 91.4% (640), tramadol 90% (630) and trazodone 60% (419). 76.6% (536) of the respondents considered that the Pharmacy Technician is the most suitable personnel to dispense CD. 25% (177) of the respondents perceived as very poor to regulate the process of information and education that they provide, and 32% (223) with equal perception in the responsibility that they have with the use and results in patients' health. Conclusions: It identifies the general information of PE, as well as of processes related to the use of CD. The perception of respondents about the SP that is suitable for the correct dispensing of CD may be inadequate. A high percentage of the SP perceives educational failures focused on the correct use of CD.

[Trade policy and international migration in the short and medium term]. / Politique commerciale et migration internationale a court et moyen terme.

PIP: "In this paper, the author presents three scenarios and related models to explain the complementarity between migration and trade in a South-North context. The first one incorporates migration costs as a constraint, the second one considers factor specificity, and the third one examines the fact that the most protected sectors in a number of reforming LDCs are labor intensive. The results, especially those of the first scenario, suggest that the impact of NAFTA may very well be to increase migration rather than to reduce it." (EXCERPT)^ieng

The welfare effects of labour force growth with internationally mobile capital.

"This paper examines some economic effects of population growth, due to natural increase and immigration.... An objective is to assess how immigration and natural labour supply growth impact on international equilibrium when trade in produced inputs is induced by population changes. For the most part our analysis is based on theories on international factor mobility.... Natural population growth will be analysed as a byproduct of the factor mobility studies."

Bangladesh.

PIP: The population of Bangladesh was 104 million in 1986, with an annual growth rate of 2.6%. The country's infant mortality rate is 12.1%, and life expectancy stands at 54 years. The literacy rate is 29%. The work force of 34.1 million is distributed among agriculture (74%), industry (11%), and services (15%). The gross domestic product (GDP) is US$15.3 billion, with a real annual growth rate of 3.6% and a per capita GDP of $151. As one of the world's poorest and most densely populated countries, Bangladesh must struggle to produce domestically and import enough food to feed its rapidly increasing population. The country's transportation, communications, and power infrastructure is relatively poorly developed. Since 1971, an emphasis has been placed on developing new industrial capacity and rehabilitating the economy. The statist economic model, including nationalization of the key jute industry, had resulted in inefficiency and economic stagnation. At present, rapid population growth, inefficiency in the public sector, and restricted natural resources and capital continue to impede economic development. On the other hand, economic policies aimed at encouraging private enterprise and investment, denationalizing public industries, reinstating budgetary discipline, and mobilizing domestic resources are beginning to have an impact. Underemployment remains a serious problem, and there are growing concerns regarding the ability of the agricultural sector to absorb additional manpower. To reach the goal of 10% annual industrial growth for the 1986-89 period, the government is aggressively seeking foreign investment.^ieng

[[Population and industrial development]].

"Concurrent with the decline in population growth rate in the 1980s, Thailand experienced an unprecedented rate of economic growth....Such phenomenal economic growth has generally been attributed to the internationalization of the Thai economy through the rapid expansion of exports, foreign investment and tourism. However, industries in the manufacturing sector...tend to be resource-based and labour-intensive. Moreover, foreign investment in export-oriented industries tends to use Thailand as a base for assembling rather than producing goods and has been attracted primarily by cheap labour cost. All these may contribute to the employment of [a] nonskilled, lowly-paid labour force, but not the development of scientific/technology based industries, the foundation for permanent and lasting economic development." (SUMMARY IN ENG)

[Regional demographic trends in France: an examination at the level of the "zones d'emploi"]. / Regionale Bevolkerungsentwicklung in Frankreich: eine Untersuchung auf der Ebene der zones d'emploi.

"The paper studies the regional demographic trends in France from 1968 to 1990.... The study follows two main objectives: (1) Analysis of the main regional migration and population trends over the three census periods from 1968 to 1990. (2) Analysis of the growth trends of different types of regions on the basis of typifying the ¿zones d'emploi' (labour market regions) according to economic criteria and settlement structure criteria. The large-scale patterns of the population and migration trends seem to be relatively stable in comparison to the massive change in the general economic and political framework in France and Western Europe.... The different region types, however, show more distinct changes." (SUMMARY IN ENG AND FRE AND RUS)

America's immigration "problem.".

PIP: Immigration has traditionally aroused strong passions in the US. Though Americans profess pride in their history as a nation of immigrants, each new wave of immigrants is met with strenuous opposition. Sassen points out that this opposition underestimates the US's capacity to absorb more people and fails to appreciate the political and economic forces that give rise to immigration. The outcry over rising illegal immigration culminated in the 1986 Immigration Reform and Control Act. So far, the law's effectiveness has been limited. 1.8 million immigrants applied to regularize their status. However, there is growing evidence that the employer sanctions program is resulting in discrimination against minority workers who are US citizens, and in various abuses against undocumented workers. Meanwhile, illegal immigration continues to rise. The 1986 law, like earlier laws, is based o a faulty understanding of immigration causes. The US played a crucial role in the 1960s and 1970s in developing today's global economic system. This system contributed to the creation of pools of potential immigrants and to the formation of links between the industrialized and developing countries. In sum, foreign investment and promotion of export-oriented growth i the US in developing countries has served to increase immigration to the US. A workable US immigration policy would be based o the recognition that the US bears a certain amount of responsibility for international labor migrations. The precise features of a fair immigration policy will have to be elaborated. However, it is clear that US immigration policy will continue to be counterproductive as long as it places the responsibility for the formation of international migrations exclusively upon the migrants themselves.^ieng

[The creation of the informal sector in urban areas]. / Pembinaan sektor informal di kota

PIP: The development of the informal sector of the economy in urban areas of Indonesia is analyzed. The author notes that this sector is dominated by high rates of migration from rural areas, limited employment opportunities for the unskilled in the modern sector, and a demand for low-priced services and products from the informal sector. (summary in ENG)^ieng

St. Lucia.

PIP: The population of St Lucia was 123,000 in 1986, with an annual growth rate of 2%. The infant mortality rate stands at 22.2/1000 live births, and life expectancy is 70.3 years for males and 74.9 years for females. The literacy rate is 78%. St Lucia's labor force is allocated as follows: agriculture, 36.6%; industry and commerce, 20.1%; and services, 18.1%. The gross national product (GNP) was US$146 million in 1985, with an annual growth rate of 3% and a per capita GNP of $1071. St Lucia is a parliamentary democracy modeled on the British Westminster system. The island is divided into 16 parishes and 1 urban area (the capital, Castries). St Lucia is currently a politically stable country, although the high level of youth unemployment is a cause for concern. Ongoing stability may depend on the government's ability to provide services such as jobs and housing. The economy has evolved from a monocrop sugar plantation type to a diversified economy based on agriculture, industry, and tourism. Agriculture, dominated by the banana industry, is characterized by the participation of a large number of small and medium-sized enterprises. Industry is being encouraged through the provision of incentives such as tax rebates. The government is attempting to maintain a sound investment climate through a tripartite dialogue with the private sector and trade unions. Overall economic policy is predicated on the attraction of sound investments, by both local and foreign entities, to accelerate the rate of economic growth, solve the unemployment problem, and generate a solid balance-of-payments position.^ieng

Labour migration from South and South-East Asia: some policy issues.

PIP: The rise in migration for employment since the mid-1970s has had serious consequences for many Asian countries. This discussion examines the issues raised by the migration abroad of thousands of skilled workers and the efforts that sending countries have made in recent years to bring the effects of labor migration more closely into line with their development objectives. It also considers several problem areas requiring the attention of policymakers and authorities responsible for the administration of overseas employment policies. It is estimated that between 1976-81 annual labor migrant flows from the 8 major sending countries in Asia increased sevenfold, from a mere 146,400 to over 1 million. The Asian migrant workers tend to be young, male, married (with dependents in the sending country), and better educated than the average home population. Most of them come from rural areas and are predominantly employed in construction and labor. The most distinctive feature of these workers is their concentration in a few blue collar occupations--carpenters, masons, electricians, plumbers, lorry drivers, mechanics, and heavy equipment operators. These production and trnasport workers outnumber the professional and technical workers by anywhere from 3 to 1 (Philippines) to 17 to 1 (Pakistan and Sri Lanka). At the aggregate level labor emigration affects the sending country's economy through its impact on the labor market, on the financial market, and on the market for goods and services. It can be argued that the outflow of a significant proportion of the labor force should lead directly to a rise in labor projectivity in the sending country since capital per worker among those left behind will increase, yet it can also be argued that since migration sifts out the most skilled and experienced workers there will be an erosion of the country's human captial resources. Specific measures have been adopted in most labor sending Asian countries to protect the welfare of migrant workers, to regulate conditions of employment abroad, to restrict the outflow of scarce skills, and to secure new overseas markets for nationals. Despite the efforts of governments to ensure that workers have satisfactory contracts on going abroad, many cases of "contract substitution" have been reported. The present attitude of many governments toward private recruiters seems to reflect both an acknowledgement of their effectiveness in finding job placements overseas and a growing concern to regulate their activities. The present trend seems to be to allow private agencies easier access while exercising greater supervision over those permitted to operate. The impact of labor migration on the labor markets of sending countries has not been uniformly damaging, but most of the countries have adopted 1 kind of policy or another to reduce the outflow of scarce skills. The use of material and other incentives for retaining workers in the country has obvious advantages but is not very widespread.^ieng