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2.
Epidemiol Psychiatr Sci ; 29: e101, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32029018

RESUMEN

Against the backdrop of mounting calls for the global scaling-up of mental health services - including quality care and prevention services - there is very little guidance internationally on strategies for scaling-up such services. Drawing on lessons from scale-up attempts in six low- and middle-income countries (LMICs), and using exemplars from the front-lines in South Africa; we illustrate how health reforms towards people-centred chronic disease management provide enabling policy window opportunities for embedding mental health scale-up strategies into these reforms. Rather than going down the oft-trodden road of vertical funding for scale-up of mental health services, we suggest using the policy window that stresses global policy shifts towards strengthening of comprehensive integrated primary health care systems that are responsive to multimorbid chronic conditions. This is indeed a substantial opportunity to firmly locate mental health within these horizontal health systems strengthening funding agendas. While this approach will promote systems more enabling of scaling up of mental health services, implications for donor funders and researchers alike is the need for increased time commitments, resources and investment in local control.


Asunto(s)
Salud Global , Política de Salud , Servicios de Salud Mental/organización & administración , Salud Mental , Prestación Integrada de Atención de Salud , Países en Desarrollo , Humanos , Calidad de la Atención de Salud , Sudáfrica
15.
Int J Gynaecol Obstet ; 148(1): 127-132, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31677270

RESUMEN

This article celebrates the remarkable changes which have occurred in the provision of abortion care in Ireland following the vote to remove the restrictive Eighth Amendment to the Constitution of Ireland in May 2018. However, it also identifies ways in which the emerging legal, ethical and clinical landscape is still impeding the conscientious provision of abortion care. It argues that in order to address these impediments, more attention needs to be paid to the ethical context for conscientious provision. This requires political leadership as well as ongoing leadership by professional bodies to develop both the clinical and the ethical guidance for conscientious provision.


Asunto(s)
Aborto Legal/ética , Aborto Legal/psicología , Actitud del Personal de Salud , Femenino , Política de Salud , Humanos , Irlanda , Masculino , Embarazo , Negativa al Tratamiento/ética
16.
Br J Sports Med ; 54(1): 8-12, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31326919

RESUMEN

The use of systemic glucocorticoids (GCs), as well as local injections, continues to be a controversial issue in the sport/anti-doping community. There is widespread and legitimate use of GCs for numerous health conditions, yet there are concerns about side effects and the possibility of enhanced athletic performance in limited settings. This is compounded by the uncertainty regarding the prevalence of GC use, mechanisms underlying physiological effects and complex pharmacokinetics of different formulations. While WADA continues to promote research in this complex area, some international sporting federations, major event organisers and professional sports leagues have introduced innovative rules such as needle policies, mandatory rest periods and precompetition guidelines to promote judicious use of GCs, focusing on athlete health and supervision of medical personnel. These complementary sport-specific rules are helping to ensure the appropriate use of GCs in athletes where overuse is a particular concern. Where systemic GCs are medically necessary, Therapeutic Use Exemptions (TUEs) may be granted after careful evaluation by TUE Committees based on specific and strict criteria. Continued vigilance and cooperation between physicians, scientists and anti-doping organisations is essential to ensure that GC use in sport respects not only principles of fairness and adherence to the rules but also promotes athlete health and well-being. The purpose of this narrative review is to summarise the use and management of GCs in sport illustrating several innovative programmes by sport leagues and federations.


Asunto(s)
Doping en los Deportes , Glucocorticoides , Rendimiento Atlético/fisiología , Conducta Competitiva/efectos de los fármacos , Doping en los Deportes/legislación & jurisprudencia , Glucocorticoides/efectos adversos , Glucocorticoides/farmacocinética , Glucocorticoides/farmacología , Glucocorticoides/uso terapéutico , Política de Salud , Humanos , Sustancias para Mejorar el Rendimiento/efectos adversos , Sustancias para Mejorar el Rendimiento/farmacocinética , Sustancias para Mejorar el Rendimiento/farmacología , Detección de Abuso de Sustancias
17.
BMC Infect Dis ; 19(1): 1011, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31783803

RESUMEN

BACKGROUND: Antibiotics remain the cornerstone of modern medicine. Yet there exists an inherent dilemma in their use: we are able to prevent harm by administering antibiotic treatment as necessary to both humans and animals, but we must be mindful of limiting the spread of resistance and safeguarding the efficacy of antibiotics for current and future generations. Policies that strike the right balance must be informed by a transparent rationale that relies on a robust evidence base. MAIN TEXT: One way to generate the evidence base needed to inform policies for managing antibiotic resistance is by using mathematical models. These models can distil the key drivers of the dynamics of resistance transmission from complex infection and evolutionary processes, as well as predict likely responses to policy change in silico. Here, we ask whether we know enough about antibiotic resistance for mathematical modelling to robustly and effectively inform policy. We consider in turn the challenges associated with capturing antibiotic resistance evolution using mathematical models, and with translating mathematical modelling evidence into policy. CONCLUSIONS: We suggest that in spite of promising advances, we lack a complete understanding of key principles. From this we advocate for priority areas of future empirical and theoretical research.


Asunto(s)
Política de Salud , Modelos Teóricos , Antibacterianos/farmacología , Toma de Decisiones , Farmacorresistencia Microbiana/efectos de los fármacos , Humanos
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