Caracterização da microbiota de queijos artesanais provenientes da Serra da Canastra - MG e da cultura iniciadora natural utilizada em sua produção / Microbiota characterization of artisanal cheeses from Serra da Canastra - MG and their endogenous starter culture

O queijo Canastra possui grande importância na cultura e economia local, é parte do Patrimônio Imaterial do Brasil (IPHAN, 2014) e recebeu o selo de produto com designação de origem em 2012 (INPI, 2016). Sua produção utiliza leite, sal, coalho e uma cultura iniciadora natural, chamada popularmente de pingo. Esse estudo visou a caracterização da microbiota presente no queijo maturado da Serra da Canastra e no pingo utilizado em sua produção utilizando técnicas avançadas de sequenciamento em larga escala para identificação das bactérias e fungos ali presentes. Nossos dados da microbiota bacteriana foram comparados com dados da microbiota de outros queijos brasileiros e do mundo disponíveis na literatura. As principais bactérias encontradas em amostras de pingo pertencem aos gêneros Lactococcus (45.6%), Streptococcus (30.3%), Staphylococcus (5.1%), e em amostras de queijo aos gêneros Lactococcus (22.5%), Streptococcus (27.2%), Corynebacterium (18.8%), Staphylococcus (13.6%), Leuconostoc (6.3%) e Weissella (6%). Os principais gêneros de fungos encontrados nos queijos foram Debaryomycesa (78.6%), Trichosporona (7.8%). Nosso estudo foi capaz de separar a microbiota dos queijos produzidos na Serra da Canastra de outros queijos na Europa e América do Norte, sendo o pH um possível fator de segregação. Também foi observada uma diferença entre a microbiota do queijo Canastra com outros queijos Brasileiros. Além disso, visualizamos que a distância geográfica entre produtores e a sazonalidade possuem um efeito sobre a microbiota dos pingos e queijos. A partir da análise de todos os microrganismos encontrados na microbiota bacteriana, foram detectados táxons que discriminam produtores por suas aplicações de boas práticas de fabricação e por sua infraestrutura. Observamos proporções menores de um táxon de Kocuria Kristinae nos pingos e um de Streptococcus nos queijos e proporções maiores de um táxon de Staphylococcus nos queijos. Também pudemos observar uma diminuição nas proporções de táxons de Debaryomycesa e aumento na proporção de táxons de Trichosporona na composição fúngica dos queijos, possivelmente devido a transição sazonal do período seco para o chuvoso. Usando técnicas moleculares de sequenciamento em larga escala, demonstramos que há uma diferença na microbiota presente em diferentes áreas da Serra da Canastra, um possível efeito da sazonalidade na composição fúngica e bacteriana. E evidenciamos que táxons de Streptococcus, Staphylococcus e Kocuria estão correlacionados às boas práticas de produção e elucidamos a conexão existente entre a microbiota do pingo e a do queijo. Estes resultados podem influenciar o desenvolvimento de métodos de rastreamento de sub-regiões específicas da Canastra e auxiliar os produtores na produção de queijos de boa qualidade, mantendo as características específicas de sua região

The Canastra cheese has great importance for the local culture and economy, being part of the Intangible Heritage of Brazil (IPHAN, 2014). It has received the protected designation of origin certification in 2012 (INPI, 2016). It's made using milk, salt, rennet and a endogenous starter culture, popularly called as "pingo". This study aimed to characterize the microbiota present in the Serra da Canastra's cheese and the pingo used in its production. In order to conduct this research we used next generation sequencing to identify the bacteria and fungi present there. Our bacterial microbiota dataset was compared with microbiota datasets from other Brazilian and world cheeses available in the literature. The main bacteria found were Lactococcus (45.6%), Streptococcus (30.3%) and Staphylococcus (5.1%) in the endogenous starter samples and Lactococcus (22.5%), Streptococcus (27.2%), Corynebacterium (18.8 %), Staphylococcus (13.6%), Leuconostoc (6.3%) and Weissella (6%) in cheese samples. The main fungi found in the cheeses were Debaryomycesa (78.6%) and Trichosporona (7.8%). We were able to separate the microbiota from Serra da Canastra cheeses and other cheeses in Europe and North America, being the pH a possible segregation factor. Furthermore, a difference was also observed between the microbiota of Canastra and other Brazilian cheeses. In addition, we observed that the geographical distance between producers and the seasonality could be affecting the pingos and cheeses microbiota. We found bacterial taxa that could discriminate producers by their good manufacturing practices and their local infrastructure. Low levels of good manufacturing practices (GMPs) were assigned to bigger proportions of a Kocuria Kristinae taxon in the pingos and a Staphylococcus taxon in the cheeses. Also, higher levels of GMPs were assigned to smaller proportions of Streptococcus taxons in the cheeses. Furthermore We could observe a decrease of Debaryomycesa and an increase of Trichosporona proportions in the fungal composition of cheeses. This could be due to a climate transition: from the dry season to the rainy season. Using large-scale sampling coupled with molecular sequencing techniques, we observe a connection between pingo and cheeses microbiota. We show that the microbiota of different areas in Serra da Canastra is different, also, there is a possible effect of seasonality on fungal and bacterial composition. Furthermore, we could see that Streptococcus, Staphylococcus and Kocuria taxons are correlated with good practices. These results may influence the development of tracking methods for specific Canastra subregions and assist producers to manufacture good quality cheeses while maintaining the specific characteristics of their region

Acreditación de los laboratorios de Andrología en la República Argentina / Accreditation of Andrology laboratories in Argentina / Credenciamento dos laboratórios de Andrologia na República Argentina

La acreditación de laboratorios especializados en Andrología tiene como objetivo promover, mejorar y asegurar la calidad del servicio. Las especialidades requieren de la participación de expertos que asesoren a los organismos autónomos que efectúan las auditorías de tercera parte. El objetivo del trabajo es comunicar la experiencia de trabajo cooperativo llevado a cabo por una sociedad científica, la Sociedad Argentina de Andrología (SAA) y el Programa de Acreditación de Laboratorios (PAL) de la Fundación Bioquímica Argentina (FBA) para el aseguramiento de la calidad de la prestación bioquímica en el área andrológica. Con tal fin se firmó un convenio marco y específico de colaboración para la acreditación de laboratorios especializados en Andrología. La FBA llevaría a cabo la logística del proceso, con su plantel de auditores, aplicando como instrumento el Manual de Acreditación MA3 y la SAA proveería asesoramiento científico. Junto con las autoridades del PAL se elaboró un documento que especifica los apartados correspondientes al MA3 capítulo Nº 4 Anexo Nº 4, "Estándares para la acreditación de laboratorios especializados". Se realizó capacitación para la elaboración de la documentación y formación de los auditores en la especialidad. Esta experiencia demuestra que el trabajo cooperativo entre organizaciones permite alcanzar logros a favor de la seguridad del paciente.

Laboratory accreditation aims to promote, improve and ensure the quality of the service. The specialties require the participation of experts who advise the autonomous bodies that carry out third-party audits. The objective is to communicate the experience of cooperative work carried out by a scientific society, the Sociedad Argentina de Andrología (SAA) (Argentine Society of Andrology) and the Laboratory Certification Programme (PAL for its name in Spanish) of Fundación Bioquímica Argentina (FBA) (Argentine Biochemistry Foundation) for quality assurance of the biochemical work in the andrology area. To reach this goal, a framework and specific collaboration agreement was signed for the certification of specialized laboratories in Andrology. The FBA will carry out the logistics of the process, with its auditors' staff, applying the MA3 Accreditation Manual as an instrument, and the SAA will provide scientific advice. Together with the PAL authorities, a document was drawn to specify the sections corresponding to the MA3 chapter No. 4 Annex No. 4, "Standards for the certification of specialized laboratories". Training was carried out to prepare the documentation and the auditors in the specialty were trained as well. This experience has proven that cooperative work between organizations can achieve results favouring the patient's safety.

O credenciamento dos laboratórios visa promover, melhorar e garantir a qualidade do serviço. As especialidades requerem a participação de profissionais que assessoram os órgãos autônomos que realizam auditorias de terceiros. O objetivo é comunicar a experiência do trabalho cooperativo realizado por uma sociedade científica, a Sociedade Argentina de Andrologia (SAA) e o Programa de Credenciamento (PAL) da Fundação Bioquímica Argentina (FBA) para garantir a qualidade do trabalho bioquímico na área andrológica. Para esse fim, foi assinado um acordo-quadro e específico de cooperação para o credenciamento de laboratórios especializados em Andrologia. A FBA iria executar a logística do processo, com a sua equipe de auditores, por meio do Manual de Credenciamento MA3 como instrumento e a SAA como um instrumento e a SAA forneceria assessoramento científico. Junto com as autoridades do PAL foi elaborado um documento especificando as seções relativas ao MA3 capítulo Nº 4 Anexo Nº 4, "Normas para a credenciamento de laboratórios especializados". O treinamento foi realizado para a elaboração da documentação e formação dos auditores na especialidade. Essa experiência tem demonstrado que o trabalho cooperativo entre organizações permite atingir resultados positivos para a segurança do paciente.

Certificación de establecimientos de atención médica en México: análisis de los incentivos para su continuidad / Certification of medical care facilities in Mexico: analysis of the incentives for its continuity

Resumen: Objetivo: Analizar el posible efecto de los modelos de certificación y de los incentivos implementados en la participación de establecimientos de atención médica (EAM) en la certificación del Consejo de Salubridad General entre 1999-2017. Material y métodos: Se colectaron documentos oficiales, impresos y en línea, sobre la certificación de EAM y se solicitó información a diversas instancias relacionadas mediante mecanismos de transparencia. Se analizó la participación de EAM en los períodos político-administrativos entre 1999-2017. Resultados: El promedio anual de participación entre 1999-2000 fue de 259.5 EAM; entre 2013-2016, de 72.5. La participación de EAM públicos es decreciente. En 2017, los EAM certificados eran <1%. Conclusiones: No se identificaron efectos positivos ni sostenidos de ajustes al modelo, ni de los incentivos implementados. Se observa disminución de la participación en los distintos periodos político-administrativos. Debe evaluarse profundamente el Sistema Nacional de Certificación de EAM y su posible efecto en la calidad clínica.

Abstract: Objective: To analyze the possible effect of certification models and healthcare organizations' (HOs) participation incentives in the General Health Council certification process in the 1999-2017 period. Materials and methods: Official printed and online documents about HOs' certification were collected. Information from instances related to the process was requested through transparency mechanisms. Health organizations' participation in political-administrative periods between 1997-2017 was analyzed. Results: The annual average participation in the certification process during the 1999-2000 period was 259.5 HOs; during the 2013-2016 period, the average was 72.5. Public units' participation in this process has been decreasing. In 2017, certified HO were <1%. Conclusions: No positive effects of adjustments to the certification model or the incentives applied were identified. Conversely, there is decreasing participation in the different political-administrative periods. The National HO Certification System and its possible effect on clinical quality must be thoroughly evaluated.

Lineamientos para emisión de certificados de habilitación de establecimientos de atención para la salud, públicos y privados: unidad técnica normativa 2019 / Guidelines for the issuance of certificates of authorization of health care establishments, public and private: normative technical unit 2019

El objetivo del documento es la normalización de los criterios mínimos que deben cumplir los establecimientos de salud para su funcionamiento. Además, es un modelo básico para ser certificado, previo a solicitar la licencia sanitaria. Contiene unos fundamentos legales, así como las definiciones de rigor en torno al tema central. Incluye las indicaciones a seguir, para la solicitud de inspección, previo a la certificación. Incluye el anexo: "Guía de inspección de condiciones de habilitación de establecimientos de atención para la salud" (anexo A). También, "Modelo de certificación de habilitación" (anexo B). "Categorías de establecimientos regulados por DRACES" (anexo C). El anexo D y último, contiene todo el fundamento legal que deben conocer quienes soliciten ser habilitados.

Revalidación de títulos médicos extranjeros: eficacia y eficiencia de un examen colaborativo y estandarizado / A collaborative objective structured clinical examination for title revalidation by foreign medical graduates in Chile

Background: Title revalidation of foreign medical graduates to practice medicine in Chile is a complex and expensive process. According to the legislation they are required to approve the Unique National Exam of Medical Knowledge (EUNACOM), which has a theoretical and a practical section. Aim: To demonstrate that a collaborative and standardized examination of the practical section of EUNACOM is more effective and efficient than traditional practical examinations. Material and Methods: The faculties of Medicine of the Catholic University of Chile, University of Chile and University of Concepción were associated to implement an examination proposal, framed in the legislation. The EUNACOM board supported and funded the initiative which consisted in the implementation of Objective Structured Clinical Examination (OSCE) for each basic specialty of medicine, applied to 40 designated candidates. This format was selected because of the wide experience and evidence at the international level in the certification of medical professionals. Results: A collaborative and standardized OSCE reduces to less than half the time spent by examiners, providing more evidence of validity, reliability and objectivity. It also allows to visualize the real costs per applicant, which proved to be higher than those currently charged by EUNACOM, but comparatively lower than the examination used in the United States. Conclusions: A collaborative OSCE responds to the ethical principle of justice by being more valid, reliable, objective and cost efficient.

¿Es tiempo de modificar la vinculación pregrado postgrado en la educación médica chilena? Reflexiones sobre una vía de doble titulación Médico cirujano/Doctor en ciencias médicas / Time to change the graduate-postgraduate liaison in Chilean medical education? Reflections about a double certification as Physician and Doctor in medical sciences

In the last 150 years, scientific research has produced extraordinary discoveries in Medicine and there is no doubt that research will continue contributing substantially in the future but there is no the same conviction regarding how to provision such capacities in medical graduates. In Chile, the Faculties of Medicine created several doctorate programs in Medical Sciences (Ph.D.) to strengthen medical research. However, the low number of physicians who apply to these programs is a caveat. These programs provide the advanced third-cycle competencies expected by students aspiring for an excellence research certification and their incorporation into academia. Universities stand out in their capacity to adapt themselves to educational needs, developing programs designed to fill specific gaps. Ph.D. programs intercalated to the medical career show that this is the correct approach. The development of specific doctorate programs for the small number of physicians interested in research and for medical students with a strong interest in research could be an innovative solution to motivate and encourage them to develop a career in clinical investigation. Using this approach, Medical Schools and Doctorate in Medical Sciences programs would jointly stimulate the training of medical scientists.

Relación entre el desempeño en el examen de ingreso a la residencia y en el de especialización en pediatría en la ciudad de Buenos Aires / Correlation between results of the residency admission test and of pediatric certification test in Buenos Aires, Argentina

En la Ciudad de Buenos Aires (CABA) los ingresantes al sistema de residencia en pediatría lo hacen mediante un examen unificado y, al finalizar, rinden su examen de especialización en la Universidad de Buenos Aires (UBA). Existe evidencia de que el desempeño en determinadas evaluaciones podría predecir el rendimiento posterior. El objetivo de este estudio es evaluar si existe relación entre el examen de ingreso a la residencia (EIR) y el de especialización (EE) en pediatría. Se trata de una investigación transversal que incluye todos los sujetos que aprobaron el EIR de pediatría en CABA en 2004-2009 y que rindieron EE de pediatría en la UBA. Se obtuvo el puntaje de cada sujeto en ambos exámenes y se calculó la correlación correspondiente. Las notas fueron divididas en quintiles, calculando la proporción de alumnos que mejoró su ubicación en el segundo examen con respecto al primero. Se obtuvieron datos de 303 participantes. El examen de ingreso (calificación máxima de 60 puntos) mostró una mediana de 45.0 puntos (IIC: 43.0-48.7) y el examen de especialización (calificación máxima de 10 puntos) mostró una mediana de 6 puntos (IIC: 6-8), verificándose una correlación significativa entre la calificación del EIR y la del EE (r = 0.37, p < 0.001). En relación al quintil de referencia, 43.8% de los alumnos mejoró su ubicación en el EE respecto de la obtenida en el EIR, sin que se registraran diferencias entre residentes de hospitales pediátricos y de hospitales generales (45.6 vs. 31.5%; p = 0.1).

In the city of Buenos Aires (CABA), pediatric residents enter the residency program after taking a unified admission test. After completion of the program and passing a final test, the Universidad de Buenos Aires (UBA) provides a professional certification. The objective of this study is to determine if the results obtained in the residency admission test (RAT) and those of the professional certification test (PCT) correlated. This is a cross-sectional study, that included all subjects who passed the pediatrics RAT in CABA in 2004-2009, and that attended the pediatric PCT of the UBA. The score for each subject in both tests was obtained and the corresponding correlation was calculated. Results were divided in quintiles, and the proportion of subjects who improved their position in the PCT with respect to the RAT was calculated. Data from 303 subjects was obtained. The RAT showed a median of 45.0 (over 60 maximum) (IC-range: 43.0-48.7), and the PCT showed a median of 6 points (over 10 max.)(IC-range: 6-8). A significative correlation between results in RAT and PCT was observed (r = 0.37, p < 0.001). Based on their position in the RAT, 43.8% of subjects improved their position in the PCT, without differences between residents attending pediatric and general hospitals (45.6 vs. 31.5%; p = 0.1). In the case of pediatric residents, results of the residency admission test correlate with those obtained in the professional certification test.

Fortalezas e fragilidades do curso técnico de enfermagem no Instituto Federal de Santa Catarina / Fortalezas y fragilidades del curso técnico de la enfermería en el Instituto Federal de Santa Catarina / Strengths and weaknesses of the nursing certificate program at the Instituto Federal de Santa Catarina (Federal Institute of Santa Catarina)

RESUMO Objetivo Analisar as fortalezas e as fragilidades encontradas no processo de implantação do curso Técnico de Enfermagem no Instituto Federal de Santa Catarina, Florianópolis/SC, na década de 2000. Método Pesquisa sócio-histórica com abordagem qualitativa. História oral como método-fonte para coleta dos dados, entre junho/setembro de 2015, com análise temática. Sete profissionais participaram do estudo, resultando em três categorias: Reconhecimento do curso Técnico de Enfermagem pela comunidade e pelo mercado de Trabalho; Fragilidades enfrentadas pelo curso; Fortalezas no período de implantação do curso. Resultados O curso foi aceito pelo mercado de trabalho, o que se reflete na procura ampliada pelo curso. Como fragilidades destacaram-se: materiais e estrutura insuficientes, poucos professores, oferta bianual e não compreensão dos estágios pela instituição. Como fortalezas destacaram-se: o comprometimento dos professores, o apoio da direção e o incentivo à pesquisa. Considerações finais Apesar das fragilidades, as fortalezas contribuíram para que a implantação do curso Técnico de Enfermagem superasse os desafios, garantindo melhoria na formação profissional.

RESUMEN Objetivo Analizar las fortalezas y debilidades encontradas en el transcurso proceso de implementación del curso Tecnico de Enfermería en el Instituto Federal de Santa Catarina, en Florianópolis / SC, Brasil, en la década de 2000. Método Investigación sociohistórica con el enfoque cualitativo que utiliza la historia oral como un método de origen para la recolección de datos, de siete profesionales de salud entre junio/septiembre de 2015. Resultados Como fragilidad se destacaron: materiales y la estructura insuficiente y pocos profesores para llevar a cabo el curso, oferta del curso cada dos años de la oferta y no entender el funcionamiento de la formación práctica en la institución de enfermería. Como una fortaleza se destacó el compromiso de los profesores que participan en el curso, el apoyo a la gestión y el conocimiento de incentivos a la investigación dadas por las enfermeras. Consideraciones finales A pesar de las deficiencias existentes, los puntos fuertes contribuyeron para que la implantación del curso Técnico de Enfermería superase los desafíos garantizando mejora en la formación profesional.

ABSTRACT Objective To analyze the strengths and weaknesses found in the implementation process of the Nursing Certificate Program at the Instituto Federal de Santa Catarina (Federal Institute of Santa Catarina), in the 2000s. Method Socio-historical research with a qualitative approach. Oral history as a method source for data collection between June/September 2015, with thematic analysis. Seven professionals participated in the study, resulting in three categories: Recognition of the Nursing Certificate Program in the community and work market; Weaknesses faced by the course; Strengths during the implementation of the course. Results The course was accepted by the labor market, resulting in an increased demand. As weaknesses: insufficient materials and structure, few teachers, course is offered every two years and no understanding of the stages by the institution. As strengths: commitment of teachers, management support and incentives to perform research. Final considerations Despite the weaknesses, the strengths contributed to the implementation of the Nursing Certificate Program overcoming challenges, ensuring improvement in vocational training.

Não conformidades encontradas nas auditorias oficiais do SISBOV realizadas em Minas Gerais / Non-compliances found in the official audits of SISBOV held in Minas Gerais

Objetivou-se realizar o levantamento das não conformidades encontradas durante as auditorias oficiais do Sistema Brasileiro de Identificação e Certificação de Origem Bovina e Bubalina (SISBOV) em Minas Gerais, entre 2009 e 2010. Na pesquisa qualitativa foram coletados dados referentes às principais não conformidades encontradas que levaram à suspensão ou cancelamento da certificação do estabelecimento rural aprovado no SISBOV (ERAS). Em 2009 foram realizadas 484 auditorias, sendo que 141 foram consideradas não aptas para inclusão na Lista Traces. Em 2010 foram realizadas 310 auditorias em ERAS, sendo que 55 tiveram resultado negativo. O conjunto de dados analisados foi obtido em uma amostra de 64 relatórios não conformes no ano de 2009 e de 27 relatórios não conformes em 2010. Em 2009 foram constatadas 168 não conformidades, sendo que as principais foram: erro no preenchimento das Planilhas de Identificação e no preenchimento dos Comunicados de Entrada e checagem do rebanho incorreta. Em 2010 foram encontradas 58 não conformidades, sendo que as principais foram: erro no preenchimento das Planilhas de Identificação, no preenchimento dos Comunicados de Entrada e no preenchimento dos Comunicados de Saída. Conclui-se que as principais não conformidades encontradas se devem ao preenchimento incorreto de documentos. Tais erros podem ser evitados, desde que certificadoras e produtores deem mais atenção e maior importância ao preenchimento da documentação.(AU)

The objective of this research was survey the non-compliances found during the official audits of the Brazilian Beef and Buffalo Identification and certification System (SISBOV) in Minas Gerais, Brazil, between 2009 and 2010. In the qualitative research, data concerning the main non-compliances found in these reports were collected, which led to the suspension or cancellation of the SISBOV approved rural enterprise certification (ERAS). In 2009, 484 audits were conducted, 141 being considered unsuitable for being included in the in Traces list. In 2010, 310 ERAS audits were performed and 55 of them had a negative result. The data set analysed was obtained from a sample of 64 non-compliance reports in the year 2009 and 27 non-compliance reports in 2010. In 2009 there were found 168 non-compliances, the main ones being: mistakes in filling in the Identification Spreadsheets and the Entrance Reports; and incorrect herd checking. In 2010, 58 noncompliances were found, the main ones being: mistakes in filling in the Identification Spreadsheets, Entrance and Exit Reports. It is concluded that the main non-compliances found are due to the incorrect filling of documents. Such mistakes can be avoided, provided that certifying entities and breeders pay more attention and give more importance to filing documents.(AU)

Human resources in health: an analysis of costs of training, certification requirements & migration issues in Belize

INTRODUCTION: The terms of reference required, inter alia, an analysis of the dynamics of the formation of health professionals in Belize, including available information on the immigration and emigration of these personnel into Belize and the resultant impact on HRH production, deployment, absorption, retention, performance and motivation. METHODS: To undertake the study, it was initially required to focus on the existing clinical science training institutions locally to obtain completion rates for health care professionals, the costs of training, the systems for certification of these professionals and issues regarding migration as a prime determinant of the existing stock of these health care professionals. Acknowledging that there are multiple categories of health care workers, the study focused mainly on nurses and doctors. The former are trained locally at the University of Belize in Belmopan, where after a four year course of study conservatively costing some $20,000 and sitting a regional examination, a student qualifies to practice as a nurse in Belize. Being a national university in receipt of a government subsidy that forms the single largest component of its budget, UB's student fees are deliberately maintained at below market costs. These costs exclude ancillary costs related to academia, such as boarding and lodging, which are substantially more market determined, and when included, costs are easily doubledthe various school fees. Doctors are not trained at UB, though Government does provide scholarships for locals to study medicine at the University of the West Indies, a regional institution also supported by GOB due to its membership in CARICOM. Globally, the market for health professionals is fluid, unregulated and largely undocumented, and Belize is impacted by its fluidity. Belizeans have a long history of emigrating mainly to the USA and while it is believed that health professionals have been among the migrants, there is a paucity of data in this regard. For these professionals immigrating into Belize though, a CSME Skills Certificate must be sought if the person is from any CSME country and if not, then a work permit must be sought. CONCLUSIONS: Most recent data from the Labour Department indicate that various categories of health professionals from as many as twelve countries spanning four continents are an integral component of Belize's existing health workforce. The reasons for the migration of health professionals continue to be many and varied, and there is an active and targeted recruitment programme in the USA. While the migration of these professionals must be regarded as a loss of much needed and scarce human resources in health, there are some positives. Capacity strengthening canoccur as the local health system can be enhanced by partnerships that contribute in specific areas, for example the DangrigaCancer Centre is owned and operated by a Belizean doctor who practices in the USA and occasionally brings fellow specialists to provide treatment services at minimal costs. Acknowledging though that health workers have an inherent right to migrate, the Government of Belize is advised to adopt the WHO's 2010 Code of Practice on the International Recruitment of Health Personnel. The Code of Practice seeks to regulate the migration of health personnel in a way that mitigates the damage to developing countries such as Belize. Other main recommendations focus on increasing the production of HRH. This can be accomplished via the provision of bursaries to students in these areas. Retention strategies are also required to provide pathways for these health professionals. Also being recommended is technical assistance to the Ministry of Health, the Belize Medical and Dental Council and the Nurses and Midwives Council to strengthen the regulatory framework so that they are all able to better keep abreast in tracking their members. At the present time, should a nurse or a doctor leave public employment, the Ministry of Health is not mandated to inform the respective council. Under a strengthened regulatory framework, this would be mandatory. Also mandatory would be the health professional informing in writing the respective council of any changes to his/her employment status or location of employment. This would greatly assist in tracking private doctors and nurses as they relocate to other areas of the country as well as if they migrate abroad. Finally, given Belize's focus on a primary health care model as the basis of its health care system, some consideration ought to be given to further strengthening of the Community Health Workers. These health volunteers are at the base of the local health system and are the most widely dispersed health worker. Consideration is justified because these unheralded workers are most unlikely to migrate since destination countries are selective in their recruitment efforts and exclusively require credentialed professionals as migrants. (AU)

A study on appraisal of effectiveness of the MCCD scheme.

Medical Certification of Cause of Death [MCCD] scheme was proposed by WHO as an imperative tool to obtain scientific and reliable information in terms of causes of mortality. It was accepted by the Government of India with suitable incorporations made in The Registration of Births and Deaths Act, 1969[1]. A cross sectional study was done with an objective to appraise the completeness and accuracy in filling up of these certificates as per the prescribed guidelines and subsequently assess the success of the MCCD training scheme. Information was collected on the various components of the cause of death certificate in all cases brought for autopsy over a period of two year and statistical analysis done. Results of the study reflected that there was a conflict of opinion and understanding as to the meaning of the terms „causes of death‟, „modes of death‟, and „manners of death‟ among the doctors. Extra effort needs to be put forth to educate and generate awareness regarding complete and accurate filling of the forms and to make them understand the very purpose of MCCD scheme, else it won’t serve the very purpose for which it was introduced. Also the lacunae in the scheme that exist need to be addressed.