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3.
PLoS Med ; 16(12): e1002994, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31869328

RESUMEN

BACKGROUND: Vaccine hesitancy, the reluctance or refusal to receive vaccination, is a growing public health problem in the United States and globally. State policies that eliminate nonmedical ("personal belief") exemptions to childhood vaccination requirements are controversial, and their effectiveness to improve vaccination coverage remains unclear given limited rigorous policy analysis. In 2016, a California policy (Senate Bill 277) eliminated nonmedical exemptions from school entry requirements. The objective of this study was to estimate the association between California's 2016 policy and changes in vaccine coverage. METHODS AND FINDINGS: We used a quasi-experimental state-level synthetic control analysis and a county-level difference-in-differences analysis to estimate the impact of the 2016 California policy on vaccination coverage and prevalence of exemptions to vaccine requirements (nonmedical and medical). We used publicly available state-level data from the US Centers for Disease Control and Prevention on coverage of measles, mumps, and rubella (MMR) vaccination, nonmedical exemption, and medical exemption in children entering kindergarten. We used county-level data individually requested from state departments of public health on overall vaccine coverage and exemptions. Based on data availability, we included state-level data for 45 states, including California, from 2011 to 2017 and county-level data for 17 states from 2010 to 2017. The prespecified primary study outcome was MMR vaccination in the state analysis and overall vaccine coverage in the county analysis. In the state-level synthetic control analysis, MMR coverage in California increased by 3.3% relative to its synthetic control in the postpolicy period (top 2 of 43 states evaluated in the placebo tests, top 5%), nonmedical exemptions decreased by 2.4% (top 2 of 43 states evaluated in the placebo tests, top 5%), and medical exemptions increased by 0.4% (top 1 of 44 states evaluated in the placebo tests, top 2%). In the county-level analysis, overall vaccination coverage increased by 4.3% (95% confidence interval [CI] 2.9%-5.8%, p < 0.001), nonmedical exemptions decreased by 3.9% (95% CI 2.4%-5.4%, p < 0.001), and medical exemptions increased by 2.4% (95% CI 2.0%-2.9%, p < 0.001). Changes in vaccination coverage across counties after the policy implementation from 2015 to 2017 ranged from -6% to 26%, with larger increases in coverage in counties with lower prepolicy vaccine coverage. Results were robust to alternative model specifications. The limitations of the study were the exclusion of a subset of US states from the analysis and the use of only 2 years of postpolicy data based on data availability. CONCLUSIONS: In this study, implementation of the California policy that eliminated nonmedical childhood vaccine exemptions was associated with an estimated increase in vaccination coverage and a reduction in nonmedical exemptions at state and county levels. The observed increase in medical exemptions was offset by the larger reduction in nonmedical exemptions. The largest increases in vaccine coverage were observed in the most "high-risk" counties, meaning those with the lowest prepolicy vaccine coverage. Our findings suggest that government policies removing nonmedical exemptions can be effective at increasing vaccination coverage.


Asunto(s)
Política de Salud/legislación & jurisprudencia , Formulación de Políticas , Cobertura de Vacunación/legislación & jurisprudencia , Vacunación/legislación & jurisprudencia , Vacunas/economía , California , Niño , Preescolar , Humanos , Sarampión/prevención & control , Salud Pública/legislación & jurisprudencia , Instituciones Académicas/estadística & datos numéricos , Estados Unidos , Vacunación/métodos
5.
Am J Law Med ; 45(2-3): 130-170, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31722626

RESUMEN

In many areas of innovation, the United States is a leader, but this characterization does not apply to the United States' position in assisted reproductive technology innovation and clinical use. This article uses a political science concept, the idea of the "democratic deficit" to examine the lack of American public discourse on innovations in ART. In doing so, the article focuses on America's missing public consultation in health care innovation. This missing discourse is significant, as political and ethical considerations may impact regulatory decisions. Thus, to the extent that these considerations are influencing the decisions of federal agency employees, namely those who work within the U.S. Food and Drug Administration, the public is unable to participate in the decision-making process. This lack of a public discourse undermines the goals of the administrative state, which include democratic participation, transparency, and accountability. The United Kingdom, on the other hand, has had a markedly divergent experience with assisted reproductive technology innovation. Instead of ignoring the various ethical, social, and legal issues surrounding assisted reproductive technology innovation, the United Kingdom engaged in a five-strand public consultation on the topic of mitochondrial transfer, a form of assisted reproductive technology that uses genetic modification in order to prevent disease transmission. This article argues that after a multi-decade standstill in terms of the public discourse related to ethical issues associated with assisted reproductive technology and germline modification, it is time for the United States to institute a more democratic inquiry into the scientific, ethical, and social implications of new forms of assisted reproductive technology and ultimately, forthcoming medical innovations that involve genetic modification.


Asunto(s)
Democracia , Invenciones/legislación & jurisprudencia , Formulación de Políticas , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Participación de la Comunidad , Gobierno Federal , Fertilización In Vitro/ética , Fertilización In Vitro/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Humanos , Invenciones/ética , Técnicas Reproductivas Asistidas/ética , Responsabilidad Social , Participación de los Interesados , Gobierno Estatal , Encuestas y Cuestionarios , Reino Unido , Estados Unidos , United States Food and Drug Administration/legislación & jurisprudencia
12.
Environ Health Prev Med ; 24(1): 57, 2019 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-31521129

RESUMEN

Decision-making in environmental health policy is a complex procedure even in well-known conditions. Thus, in the case of uncertainty, decision-making becomes a hurdle race. We address scientific uncertainty, methods to reduce uncertainty, biomedical doubt and science communication, and the role of stakeholders, activists, lobbies and media that together influence policy decisions. We also consider the major responsibility and role of the medico-scientific community in this process. This community can and should teach the principle of scientific uncertainty to all stakeholders, advise policy-makers and underline the ethical issues, considering that our brains are not only the deposit of our humanity but also the route to environmental health and societal harmony.


Asunto(s)
Toma de Decisiones , Salud Ambiental/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Comunicación , Salud Ambiental/ética , Humanos , Medición de Riesgo , Ciencia , Participación de los Interesados , Incertidumbre
14.
Malar J ; 18(1): 322, 2019 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-31547828

RESUMEN

BACKGROUND: This paper outlines Zimbabwe's potential readiness in harnessing integrated vector management (IVM) strategy for enhanced control of vector-borne diseases. The objective is to provide guidance for the country in the implementation of the national IVM strategy in order to make improvements required in thematic areas of need. The paper also assesses the existing opportunities and gaps to promote and adopt the approach as a national policy. MAIN TEXT: Despite recent gains in combating vector-borne diseases, especially malaria, management of vector control programmes still remains insecticide-based and vertical in nature. Therefore, concerns have been raised on whether the current long-standing conventional vector control strategy still remains with sufficient action to continue to break the transmission cycle to the levels of elimination. This is so, given the continuous dwindling resources for vector control, changes in vector behaviour, the emergence of resistance to medicines and insecticides, climate change, environmental degradation, as well as diversity in ecology, breeding habitats, and community habits. Cognizant of all that, elements of a surveillance-driven IVM approach are rapidly needed to move vector control interventions a step further. These include advocacy, policy formulation, capacity building, public and private partnerships, community engagement, and increasingly basing decisions on local evidence. Understanding the existing opportunities and gaps, and the recognition that some elements of IVM are already imbedded in the current health programmes is important to encourage stakeholders to promptly support its implementation. Leveraging on the existing opportunities, combined with sufficient advocacy, IVM could easily be accepted by the Zimbabwe government as part of a wider integrated disease management strategy. The strategy could represent an excellent breakthrough to establish much needed intra and inter-sectoral dialogue, and coordination for improved vector-borne disease prevention. CONCLUSIONS: After synthesis of the opportunities and challenges clearly presented, it was concluded that it is imperative for Zimbabwe to adopt and implement IVM strategy that is informed by work already done, while addressing the bottlenecks. The significance of refocusing for improved disease prevention that has the potential to accomplish elimination of not only malaria but all vector borne diseases much earlier than anticipated under the existing vector control system is underscored.


Asunto(s)
Anopheles , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Malaria/prevención & control , Control de Mosquitos/métodos , Mosquitos Vectores , Animales , Zimbabwe
16.
J Leg Med ; 39(2): 121-136, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31503528

RESUMEN

Empowered to play a larger role in the delivery and administration of health care, a number of states are attempting to solve the pharmaceutical pricing crisis in creative and varied ways. This essay summarizes three particular states' more activist approaches, including states that have sought to empower their Medicaid programs to limit coverage of certain drugs based on price, attempted to use leverage to impose cost-efficiency requirements, and, in the most dramatic example, relied on new usage of "gouging" laws to bring down the costs of prescription drugs. Although all three approaches have met substantial resistance, they illustrate a new era of state experimentation in an effort to bring down the cost of prescription drugs.


Asunto(s)
Control de Costos , Costos de los Medicamentos/legislación & jurisprudencia , Honorarios Farmacéuticos/legislación & jurisprudencia , Medicamentos bajo Prescripción/economía , Gobierno Estatal , Costos y Análisis de Costo/legislación & jurisprudencia , Política de Salud/economía , Política de Salud/legislación & jurisprudencia , Legislación como Asunto , Maryland , Massachusetts , Medicaid/legislación & jurisprudencia , New York , Activismo Político , Estados Unidos
17.
Artículo en Inglés | MEDLINE | ID: mdl-31408935

RESUMEN

BACKGROUND: Alcohol use is a major risk factor in premature death and disability, especially among youth. Evidence-based policies to prevent and control the detrimental effect of alcohol use have been recommended. In countries with weak alcohol control policies-such as Lebanon, stakeholder analysis provides critical information to influence policy interventions. This paper assesses the views of stakeholders regarding a national alcohol harm reduction policy for youth. METHODS: We interviewed a total of 22 key stakeholders over a period of 8 months in 2015. Stakeholders were selected purposively, to include representatives of governmental and non-governmental organizations and industry that could answer questions related to core intervention areas: affordability, availability, regulation of marketing, and drinking and driving. We analyzed interview transcripts using thematic analysis. RESULTS: Three themes emerged: Inadequacy of current alcohol control policies; weak governance and disregard for rule of law as a determinant of the status quo; and diverting of responsibility towards 'other' stakeholders. In addition, industry representatives argued against evidence-based policies using time-worn strategies identified globally. CONCLUSIONS: Our findings indicate that alcohol harm reduction policies are far from becoming a policy priority in Lebanon. There is a clear need to shift the narrative from victim blaming to structural conditions.


Asunto(s)
Consumo de Bebidas Alcohólicas/legislación & jurisprudencia , Reducción del Daño , Política de Salud/legislación & jurisprudencia , Adolescente , Cerveza , Conducir bajo la Influencia , Agencias Gubernamentales , Humanos , Industrias , Líbano , Mercadeo , Organizaciones , Participación de los Interesados
18.
Artículo en Inglés | MEDLINE | ID: mdl-31373297

RESUMEN

Health care equity reflects an equal opportunity to utilize public health and health care resources in order to maximize one's health potential. Achieving health care equity necessitates the consideration of both quantity and quality of care, as well as vertical (greater health care use by those with greater needs) and horizontal (equal health care use by those with equal needs) equity. In this paper, we summarize the approaches introduced by authors contributing to this Special Issue and how their work is captured by the National Institute of Minority Health and Health Disparities (NIMHD) framework. The paper concludes by pointing out intervention and public policy opportunities for future investigation in order to achieve health care equity.


Asunto(s)
Equidad en Salud/estadística & datos numéricos , Política de Salud/legislación & jurisprudencia , Salud Pública/estadística & datos numéricos , Humanos
19.
Cien Saude Colet ; 24(7): 2701-2714, 2019 Jul 22.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31340287

RESUMEN

This research aimed to analyze the National Committee for the Implementation of the Framework Convention on Tobacco Control (CONICQ). The study covered the period from 2003 to 2015 and built on the referential analysis of public policies, considering structure and political process and Committee's agenda and performing capacity. Methodological strategies were documentary analysis, including Committee's minutes of meetings, direct observation of events and interviews with key stakeholders. The regular functioning and gradual expansion of the Committee was observed in the period, permeated by technical and political aspects that influence its structuring and the establishment of the agenda. Conflicts have been identified among CONICQ members and between these and external stakeholders, especially from the clashing opinions on economic and health-related viewpoints. Its capacity for action was limited by internal (from some government agencies) and external (from organizations linked to the tobacco industry and tobacco growers) resistance. CONICQ is a strategic instance to the Brazilian tobacco control policy. However, its activity as an intersectoral coordination mechanism is complex, given the different interests, stances and levels of engagement of agencies involved in tobacco control.


Asunto(s)
Política de Salud/legislación & jurisprudencia , Prevención del Hábito de Fumar/legislación & jurisprudencia , Fumar/legislación & jurisprudencia , Industria del Tabaco/legislación & jurisprudencia , Brasil , Gobierno , Humanos , Política
20.
Afr J Prim Health Care Fam Med ; 11(1): e1-e10, 2019 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-31296011

RESUMEN

BACKGROUND: The lesbian, gay, bisexual and transgender (LGBT) populations have unique health risks including an increased risk of mental health problems, high usage of recreational drugs and alcohol, and high rates of infection with human immunodeficiency virus (HIV). Healthcare workers' heteronormative attitudes compromise the quality of care to the LGBT population. AIM: The objective of this study was to provide an overview of documented evidence on South Africa interventions aimed at improving healthcare access for LGBT individuals using a systematic scoping review. SETTING: This is a secondary literature review. METHODS: An electronic search was conducted using the following databases: EBSCOhost, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Abstract and full article data were screened using inclusion and exclusion criteria by two researchers. Data extracted from the eligible studies were analysed using thematic analysis. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool, version 2011. RESULTS: Seventeen articles of the initial 151 hits were selected for review and an additional five files were identified through bibliographical search. Most studies had small sample sizes and focused on sexual health, targeting gay men and men who have sex with men in urban areas. Lesbians and bisexual women were not prioritised. DISCUSSION: It emerged from the review that LGBT issues were not covered in the healthcare worker curriculum. Further it was noted that there is a paucity of data on the South African LGBT population, as sexual orientation does not form part of the routine data set. The findings of this review indicate gaps in the literature, practice guidelines and policies in LGBT healthcare in South Africa.


Asunto(s)
Política de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Minorías Sexuales y de Género/legislación & jurisprudencia , Humanos , Masculino , Sudáfrica
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