Mandating indoor air quality for public buildings.

If some countries lead by example, standards may increasingly become normalized.

Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol.

BACKGROUND: Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. METHODS: The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. CONCLUSIONS: NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. TRIAL REGISTRATION: ACTRN12622001583730.

Guiding Genomic Research: Australia's National Statement on Ethical Conduct in Human Research.

With advances in genomic research playing an important role in the development of clinical applications, it is important that ethical guidance for researchers is contemporary and relevant. In this article we analyse the relevant provisions in Australia's National Statement on Ethical Conduct in Human Research (revised in 2018) and consider the guidance it provides for contemporary genomics research. We analyse four key areas: genomic information; biobanking and use of human tissue; consent to participation in genomic research, including specific issues related to participation by children; and return of findings. We conclude that Australia's National Statement is well-placed to provide guidance to Australian researchers on issues relating to genomics, although there is scope for additional guidance on some issues related to consent.

Compassion, Law and COVID-19.

Levels of personal anxiety are inevitably escalating in response to the COVID-19 pandemic, including individual fear of infection, grief at the loss of loved ones and reactive depression related to loss of employment and livelihood. This article considers the importance of compassion in a range of contemporary and emerging contexts during a time of pandemic. These include: exposure of medical and care professionals to the acute demands of overstretched institutions resulting in adverse mental health outcomes and compassion fatigue; attitudes towards the burgeoning cohort of welfare recipients; and particularly vulnerable groups such as the elderly, and those who are homeless. The article considers how we ought to conceive of compassion in these contexts and makes some suggestions for building future compassion interventions and training.

Law, Global Health, and Sustainable Development: The Lancet Commission on the Legal Determinants of Health.

In 2019 the Lancet Commission on the Legal Determinants of Health set out the important role that law can play in supporting global health. The Report sets out four legal determinants of health which address the role of law in supporting sustainable development; law's role in strengthening national and international governance; the importance of evidence-based public health laws; and the importance of building legal capacities for health. This Editorial provides an overview of the Report and its recommendations.

Profile of the most common complaints for five health professions in Australia.

Objective The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results There were 545283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20935 dentists, 101066 medical practitioners, 363040 nurses/midwives, 28370 pharmacists and 31872 psychologists. During the study period there were 12616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P<0.01), age (P<0.01) and country of birth (P<0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject? Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add? This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners? Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints.

Technology, ageing and human rights: Challenges for an ageing world.

Technology can be used to support healthy ageing and to support those who are living with disabilities. With the ageing of populations globally there is increasing interest in the role that technology can potentially play in supporting older persons. This paper analyses the role of technology in supporting everyday living, social engagement, and mobility by older persons, including those living with dementia. It argues for a human rights-based approach to assessing the role that technology can potentially play, arguing for a consideration of: decision-making in relation to use of technology; whether the technology protects privacy, dignity and liberty; whether it fosters mobility and social engagement; and whether it is accessible to all who need it on an equitable basis.

Health care complaint journeys for system comparison.

PURPOSE: The "patient journey" technique is one that has been used by health care providers to investigate the strengths and weaknesses of their service delivery. The purpose of this paper is to discuss the experience of adapting this approach for use in an atypical context - the comparison of two systems for managing health care complaints and notifications. It highlights a number of relevant considerations and provides suggestions for similar studies. DESIGN/METHODOLOGY/APPROACH: The design and methods of the study are described, with commentary on the success of key aspects and challenges encountered. To enable comparison between the two systems, this study had a "paired" design, in which examples were selected from each system so that they matched on basic, prescribed, criteria. Data about each matter's journey were then collected from administrative records. FINDINGS: While, overall, the technique provided rich data on the processes of the systems under investigation, the type of data collected (related to administrative/communicative events) and the study's comparative purpose required consideration and management of a number of issues. These included the implications of using administrative records and the impact of differences between the systems on the paired design. ORIGINALITY/VALUE: This paper describes an attempt to apply the "journey" approach in a context that is uncommon in two ways: first, in its focus on regulatory processes (complaint/notification handling), rather than care provision to an individual patient; and second, in its objective of comparing two different systems. It is hoped this account will assist in further development of this technique.

Survey of Quasi-Judicial Decision-Makers in NSW and The National Registration Scheme for Health Practitioners.

This study is part of a larger, Australian Research Council-funded project studying comparative analyses of complaints and notification handling between the NSW system and National Registration and Accreditation Scheme (2010). This article explores the assessments and decisions made by Tribunal and other quasi-judicial decision-makers involved in the two schemes, including the key decision-management stages during a disciplinary process. Respondents recruited from both systems completed an online questionnaire comprising a series of closed and open-ended questions to case vignettes. While we found no significant difference between jurisdictions in relation to their decision-making processes in this case, the article provides insights into the rationales for their decisions and the outcomes or sanctions selected by decision-makers as being appropriate to the circumstances presented.

Future-proofing global health: Governance of priorities.

The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of 'global' health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.

Assistive technologies for people with dementia: ethical considerations.

The sustainable development goals (SDGs) adopted by the United Nations in 2015 include a new target for global health: SDG 3 aims to "ensure healthy lives and promote well-being for all at all ages." Dementia care of good quality is particularly important given the projected increase in the number of people living with the condition. A range of assistive technologies have been proposed to support dementia care. However, the World Health Organization estimated in 2017 that only one in 10 of the 1 billion or more people globally who could benefit from these technologies in some way actually has access to them. For people living with dementia, there has been little analysis of whether assistive technologies will support their human rights in ways that are consistent with the United Nations Convention on the Rights of Persons with Disabilities. The aim of this paper is to examine the relevant provisions of the convention and consider their implications for the use of assistive technologies in dementia care. Assistive technologies can clearly play an important role in supporting social engagement, decision-making and advance planning by people living with dementia. However, concerns exist that some of these technologies also have the potential to restrict freedom of movement and intrude into privacy. In conclusion, an analysis of the implications of assistive technologies for human rights laws is needed to ensure that technologies are used in ways that support human rights and help meet the health-related SDG 3.

Les objectifs de développement durable (ODD) adoptés par les Nations Unies en 2015 intègrent un nouvel objectif de santé mondiale: l'ODD3, qui vise à « permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous, à tout âge ¼. Une prise en charge de bonne qualité de la démence est particulièrement importante, compte tenu des projections d'augmentation du nombre de personnes atteintes. Plusieurs technologies d'assistance sont proposées pour contribuer à une bonne prise en charge de la démence. Néanmoins, en 2017, l'Organisation mondiale de la Santé a estimé qu'à l'échelle mondiale, parmi le milliard de personnes -voire plus- susceptibles de bénéficier de ces technologies, seule une personne sur 10 peut effectivement y avoir accès. Peu d'analyses ont été réalisées pour déterminer si l'utilisation des technologies d'assistance pour les personnes atteintes de démence peut contribuer à l'application des droits de l'homme au sens de la Convention des Nations Unies relative aux droits des personnes handicapées. L'objectif de cet article consiste à examiner les dispositions pertinentes de cette convention et à considérer leurs implications pour l'utilisation des technologies d'assistance dans la prise en charge de la démence. Il est clair que les technologies d'assistance peuvent jouer un rôle important pour aider à l'implication sociale, à la prise de décision et à la planification anticipée des soins chez les personnes atteintes de démence. Mais des doutes existent aussi sur le potentiel de certaines de ces technologies à restreindre la liberté de mouvement et à enfreindre la vie privée. En conclusion, il est nécessaire d'analyser les implications de l'usage des technologies d'assistance à la lumière des législations sur les droits de l'homme, afin de s'assurer que ces technologies soient employées de manière à contribuer à l'application des droits de l'homme et à atteindre l'ODD3 lié à la santé.

Los objetivos de desarrollo sostenible (ODS) adoptados por las Naciones Unidas en 2015 incorporan un nuevo objetivo para la salud mundial: el ODS 3 tiene como objetivo "garantizar vidas sanas y promocionar el bienestar para todos y para todas las edades". Una atención a la demencia de buena calidad es especialmente importante dado el aumento previsto en el número de personas con dicha enfermedad. Se ha propuesto una gama de tecnologías de asistencia para apoyar la atención a la demencia. Sin embargo, la Organización Mundial de la Salud estimó en 2017 que solo una de cada 10 personas de los mil millones de habitantes o más que hay en el mundo que podrían beneficiarse de tales tecnologías en cierto modo realmente pueden acceder a ellas. Para las personas con demencia, se han realizado pocos análisis de si las tecnologías de asistencia apoyarán sus derechos humanos de forma coherente con la Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad. El objetivo de este artículo es examinar las disposiciones más importantes de la convención y considerar las consecuencias del uso de tecnologías de asistencia para la atención a la demencia. Sin duda, estas tecnologías pueden tener un papel importante a la hora de apoyar el compromiso social, la toma de decisiones y la planificación adelantada por parte de las personas que sufren demencia. Sin embargo, existen temores de que algunas de estas tecnologías puedan limitar la libertad de movimiento e invadir la privacidad. En conclusión, es necesario realizar un análisis de las consecuencias de las tecnologías de asistencia sobre las leyes de derechos humanos para garantizar que se utilicen las tecnologías de forma que respalden los derechos humanos y ayuden a lograr el ODS 3 relacionado con la salud.

Public Health Emergencies of International Concern: Global, Regional, and Local Responses to Risk.

The declaration in 2009 that the H1N1 pandemic constituted a public health emergency of international concern (PHEIC) was the first such declaration under the revised International Health Regulations that were adopted in 2005. In the period since then PHEIC have been declared in relation to polio, Ebola, and Zika. This article evaluates initiatives that have been introduced globally, within the Asia-Pacific region, and within Australia, to strengthen preparedness for public health emergencies. Through analysis of evolving conceptualisations of risk, surveillance of zoonotic diseases, and development of public health capacities, the article argues that to date the global community has failed to make the necessary investments in health system strengthening, and that without these investments, global public health emergencies will continue to be an ongoing challenge.

Corrigendum to: Approaches to management of complaints and notifications about health practitioners in Australia.

In 2005, the Australian Productivity Commission made a recommendation that a national health registration regimen and a consolidated national accreditation regimen be established. On 1 July 2010, the National Registration and Accreditation Scheme (NRAS) for health practitioners came into effect and the Australian Health Practitioner Regulation Agency (AHPRA) became the single national oversight agency for health professional regulation. It is governed by the Health Practitioner Regulation National Law Act (the National Law). While all states and territories joined NRAS for registration and accreditation, NSW did not join the scheme for the handling of complaints, but retained its existing co-regulatory complaint-handling system. All other states and territories joined the national notification (complaints) scheme prescribed in the National Law. Because the introduction of NRAS brings with it new processes and governance around the management of complaints that apply to all regulated health professionals in all states and territories except NSW, where complaints management remains largely unchanged, there is a need for comparative analysis of these differing national and NSW approaches to the management of complaints/notifications about health professionals, not only to allow transparency for consumers, but also to assess consistency of decision making around complaints/notifications across jurisdictions. This paper describes the similarities and differences for complaints/notifications handling between the NRAS and NSW schemes and briefly discusses subsequent and potential changes in other jurisdictions.

Health complaints and regulatory reform: Implications for vulnerable populations?

Complaints and disciplinary processes play a significant role in health professional regulation. Many countries are transitioning from models of self-regulation to greater external oversight through systems including meta-regulation, responsive (risk-based) regulation, and "networked governance". Such systems harness, in differing ways, public, private, professional and non-governmental bodies to exert influence over the conduct of health professionals and services. Interesting literature is emerging regarding complainants' motivations and experiences, the impact of complaints processes on health professionals, and identification of features such as complainant and health professional profiles, types of complaints and outcomes. This article concentrates on studies identifying vulnerable groups and their participation in health care regulatory systems.

Approaches to management of complaints and notifications about health practitioners in Australia.

In 2005, the Australian Productivity Commission made a recommendation that a national health registration regimen and a consolidated national accreditation regimen be established. On 1 July 2010, the National Registration and Accreditation Scheme (NRAS) for health practitioners came into effect and the Australian Health Practitioner Regulation Agency (AHPRA) became the single national oversight agency for health professional regulation. It is governed by the Health Practitioner Regulation National Law Act (the National Law). While all states and territories joined NRAS for registration and accreditation, NSW did not join the scheme for the handling of complaints, but retained its existing co-regulatory complaint-handling system. All other states and territories joined the national notification (complaints) scheme prescribed in the National Law. Because the introduction of NRAS brings with it new processes and governance around the management of complaints that apply to all regulated health professionals in all states and territories except NSW, where complaints management remains largely unchanged, there is a need for comparative analysis of these differing national and NSW approaches to the management of complaints/notifications about health professionals, not only to allow transparency for consumers, but also to assess consistency of decision making around complaints/notifications across jurisdictions. This paper describes the similarities and differences for complaints/notifications handling between the NRAS and NSW schemes and briefly discusses subsequent and potential changes in other jurisdictions.

Updating Australia's pandemic preparedness: the revised Australian Health Management Plan for Pandemic Influenza (AHMPPI).

In 2014, Australia updated its health management plan for pandemic influenza. This updated plan builds upon the lessons from the 2009 influenza pandemic and revised guidance from the World Health Organization. The 2009 pandemic highlighted the need for flexibility in responding to pandemics so that responses can be tailored according to the severity of a pandemic. Recognition of the need for flexibility is a key feature of both the revised WHO guidance and the revised Australian plan. This column provides an overview of the updated WHO guidance and of the revised Australian Health Management Plan for Pandemic Influenza.

Planning for Pandemics: Lessons From the Past Decade.

It is now 10 years since the disease we now know as SARS--severe acute respiratory syndrome--caused more than 700 deaths around the world and made more than 8,000 people ill. More recently, in 2009 the global community experienced the first influenza pandemic of the 21st century--the 2009 H1N1 influenza pandemic. This paper analyses the major developments in international public health law relating to infectious diseases in the period since SARS and considers their implications for pandemic planning.

Regulating healthcare complaints: a literature review.

PURPOSE: The purpose of this paper is to explore approaches to the regulation of healthcare complaints and disciplinary processes. DESIGN/METHODOLOGY/APPROACH: A literature review was conducted across Medline, Sociological Abstracts, Web of Science, Google Scholar and the health, law and social sciences collections of Informit, using terms tapping both the complaints process and regulation generally. FINDINGS: A total of 118 papers dealing with regulation of health complaints or disciplinary proceedings were located. The review reveals a shift away from self-regulation towards greater external oversight, including innovative regulatory approaches including "networked governance and flexible or "responsive" regulation. It reports growing interest in adoption of strategic and responsive approaches to health complaints governance, by rejecting traditional legal forms in favor of more strategic and responsive forms, taking account of the complexity of adverse health events by tailoring responses to individual circumstances of complainants and their local environments. ORIGINALITY/VALUE: The challenge of how to collect and harness complaints data to improve the quality of healthcare at a systemic level warrants further research. Scope also exists for researching health complaints commissions and other "meta-regulatory" bodies to explore how to make these processes fairer and better able to meet the complex needs of complainants, health professionals, health services and society.