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2.
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
3.
J Law Med ; 26(4): 764-785, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31682356

RESUMEN

Contemporary public health literature contains an increasing emphasis on the commercial determinants of health including the influence of unhealthy food, beverage and tobacco industries on government harm prevention policy agendas and global sustainable development goals. Effective capture by the industries of the crucial legislative process associated with the harm prevention initiatives would have a detrimental impact on public health. This article proposes a qualitative multi-spectrum prototype legislative capture test with broad application to a range of industries and jurisdictions at all levels of government where legislative capture may be suspected. It is predicated on a finding of significant encroachment of the public interest (PI) by special interest groups and reciprocating beneficial conduct between the lawmakers and the group. The test is populated from a critical case study of key New South Wales (NSW) alcohol industry statutory amendments within a doctrinal and social inquiry/power framework. It relies upon parliamentary records and secondary data to analyse critically the 2015 "fit for purpose" (FFP) reforms to NSW alcohol supply laws and their consistency with the PI and other constitutional safeguards. It aligns the reforms with other research relating to the magnitude of alcohol and gambling industry political donations and the operation of the alcohol outlet post reform approval process. The application of the test to the case study finds that the 2015 FFP amendments are indicative of legislative capture and associated clientele corruption - critical new considerations in the commercial determination of health. It also identifies the commodification of the PI.


Asunto(s)
Salud Pública/legislación & jurisprudencia , Juego de Azar , Política de Salud , Humanos , Nueva Gales del Sur , Salud Pública/economía , Industria del Tabaco
4.
Lancet ; 394(10209): 1668-1684, 2019 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-31668410

RESUMEN

The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.


Asunto(s)
Monitoreo de Drogas/métodos , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Psicotrópicos/efectos adversos , Salud Pública/legislación & jurisprudencia , Adolescente , Adulto , Comercio/legislación & jurisprudencia , Recolección de Datos , Control de Medicamentos y Narcóticos/métodos , Femenino , Humanos , /legislación & jurisprudencia , Masculino , Persona de Mediana Edad , Motivación , Psicotrópicos/clasificación , Trastornos Relacionados con Sustancias/epidemiología , Adulto Joven
7.
Rev. bioét. derecho ; (47): 129-140, nov. 2019.
Artículo en Inglés | IBECS | ID: ibc-184870

RESUMEN

The European Union recommends unpaid blood donation because it deems this to be the safest way of collecting blood and the best way of respecting the dignity of the donor as well as certain ethical principles relating to the availability of human-origin products. However, the risk of suffering shortages of blood has led EU law to authorize the importation and consequent circulation across EU territory of blood from countries where the law allows donors to be paid. This paper analyses the inconsistency this represents and mentions the alternative of blood donation becoming a civic duty. This would allow the necessary amounts of blood to be collected in a more consistent way for EU regulation than the situation as it currently stands


La Unión Europea recomienda la donación no remunerada de sangre por considerar que este tipo de donación es el método más seguro para obtener sangre y sustancias derivadas de la misma, y el que mejor respeta la dignidad del donante así como algunos principios éticos relativos a la disposición de productos de origen humano. Sin embargo, el riesgo de sufrir escasez de sangre y de otros hemoderivados, ha hecho que el Derecho comunitario autorice la importación, y consiguiente circulación por el territorio comunitario, de productos sanguíneos provenientes de países en los cuales la ley permite remunerar a los donantes. Ante esta situación, se analiza la incoherencia que supone y se alude a la alternativa de que la donación de sangre sea considerada un deber cívico a cargo de los ciudadanos, lo que permitiría obtener las cantidades necesarias de sangre y derivados de forma más coherente y menos problemática para la regulación comunitaria que la situación en la que se encuentra en la actualidad


La Unió Europea recomana la donació no remunerada de sang per considerar que aquest tipus de donació és el mètode més segur per a obtenir sang i substàncies derivades d'aquesta, i el que millor respecta la dignitat del donant així com alguns principis ètics relatius a la disposició de productes d'origen humà. No obstant això, el risc de sofrir escassetat de sang i d'altres hemoderivats, ha fet que el Dret comunitari autoritzi la importació, i consegüent circulació pel territori comunitari, de productes sanguinis provinents de països en els quals la llei permet remunerar als donants. Davant aquesta situació, s'analitza la incoherència que suposa i s'al•ludeix a l'alternativa que la donació de sang sigui considerada un deure cívic a càrrec dels ciutadans, la qual cosa permetria obtenir les quantitats necessàries de sang i hemoderivats de forma més coherent i menys problemàtica per a la regulació comunitària que la situació actual


Asunto(s)
Humanos , Medicamentos Hemoderivados , Donantes de Sangre/legislación & jurisprudencia , Derechos Civiles/legislación & jurisprudencia , Personeidad , Salud Pública/legislación & jurisprudencia , Planes de Seguro sin Fines de Lucro/legislación & jurisprudencia , Derechos Civiles/normas
8.
Lancet ; 394(10208): 1580-1590, 2019 10 26.
Artículo en Inglés | MEDLINE | ID: mdl-31657733

RESUMEN

We assess the current and describe possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. First, we describe global patterns of cannabis use and their most probable adverse health effects. Second, we summarise evidence regarding the effectiveness of cannabinoids for medicinal use and describe approaches that have been used to regulate the use of medicinal cannabis and how these approaches might have affected medicinal and recreational use and harms (eg, road crashes). Third, we describe how jurisdictions that have legalised recreational use have regulated production and sale of cannabis. Fourth, we evaluate the effects of cannabis legalisation on cannabis use and harms and on the use of alcohol, tobacco, and other drugs. Fifth, we use alcohol and tobacco policy examples to identify possible long-term public health effects of cannabis legalisation. Finally, we outline policy approaches that could minimise harms to public health arising from the legalisation of a commercial cannabis industry.


Asunto(s)
Cannabis , Uso de la Marihuana/epidemiología , Marihuana Medicinal/administración & dosificación , Salud Pública/legislación & jurisprudencia , Comercio/economía , Femenino , Humanos , Legislación de Medicamentos/economía , Masculino , Uso de la Marihuana/efectos adversos , Uso de la Marihuana/legislación & jurisprudencia , Marihuana Medicinal/efectos adversos , Trastornos Relacionados con Sustancias/epidemiología
9.
Malar J ; 18(1): 338, 2019 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-31581941

RESUMEN

Resistance threatens all our currently available anti-malarial drugs. Triple artemisinin-containing combination anti-malarial treatments (TACTs) combine an artemisinin derivative with two slowly eliminated partner drugs. TACTs are undergoing large-scale trials. If they prove safe, well-tolerated and efficacious then they should be deployed. This is in order to protect and extend the useful therapeutic life of the current generation of anti-malarial drugs, which are so essential for malaria control and elimination.


Asunto(s)
Antimaláricos/química , Artemisininas/uso terapéutico , Resistencia a Medicamentos , Malaria/tratamiento farmacológico , Combinación de Medicamentos , Humanos , Malaria/prevención & control , Salud Pública/legislación & jurisprudencia , Salud Pública/métodos
10.
Malar J ; 18(1): 339, 2019 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-31581951

RESUMEN

Managing multidrug resistant malaria can be problematic if currently available artemisinin-containing anti-malarial combination treatments are not used appropriately. Here, I debate that the best way to manage multidrug resistant malaria is to make best use of existing treatments and to develop new classes of anti-malarial drugs and not to make 'triple combination therapies' when there is already resistance to one or more proposed components.


Asunto(s)
Antimaláricos/química , Artemisininas/uso terapéutico , Resistencia a Medicamentos , Malaria/tratamiento farmacológico , Antimaláricos/economía , Artemisininas/economía , Combinación de Medicamentos , Humanos , Malaria/prevención & control , Salud Pública/legislación & jurisprudencia , Salud Pública/normas
12.
Georgian Med News ; (292-293): 134-139, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31560679

RESUMEN

The objective of the article is to determine the content and correlation of individual and joint interest within medical legal relations in Ukraine. To achieve this objective the authors have applied general scientific and special methods of cognition. The materials of research were statistical data on infectious diseases about the state of vaccinations in Ukraine, judicial practice, and national legislation. It has been concluded that individual and joint interest within medical legal relations are aimed at various objects: individual and public health. These objects are interconnected as general and special, since public health is a combination of individual health. It has been established that public and individual health does not have an economic content, cannot participate in the economic turnover, but have a social value. The prevalence of joint interest over the individual has been grounded. Individual interest within medical legal relations has been defined as the orientation of an individual to protect own health. It has been proved that joint (public) interest within medical legal relations is a set of individual (private) interests of individuals in the health care area. This interest is manifested in the formation of collective immunity, control over the spread of infectious diseases, the creation of conditions for affordable medical care, etc.


Asunto(s)
Prestación de Atención de Salud/legislación & jurisprudencia , Legislación Médica , Salud Pública/legislación & jurisprudencia , Humanos , Ucrania
13.
Artículo en Inglés | MEDLINE | ID: mdl-31546806

RESUMEN

Because both pollution emissions and production policies often are international in scope, it is necessary to find optimal coordination strategies for international production planning and pollution abating. Differential game models are developed for multiple neighboring countries to reach optimal decisions on their production planning and pollution abating under cap-and-trade regulations. Non-cooperative and cooperative differential games are presented to depict the optimal tradeoffs between production planning and pollution abating. Hamilton-Jacobi-Bellman (HJB) equations are then employed to analyze the asymmetric and symmetric feedback solutions. Numerical simulations are used to illustrate the results. Five different dividends are also discussed. With the proposed strategies, more improvement will be directed toward production supplies and environmental issues than ever before.


Asunto(s)
Salud Ambiental/legislación & jurisprudencia , Contaminación Ambiental/legislación & jurisprudencia , Contaminación Ambiental/prevención & control , Salud Global/legislación & jurisprudencia , Cooperación Internacional , Salud Pública/legislación & jurisprudencia , Toma de Decisiones , Política de Salud , Humanos
14.
BMC Public Health ; 19(1): 1269, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533693

RESUMEN

BACKGROUND: Several studies have demonstrated that smoke-free legislation is associated with a reduced risk of mortality from acute myocardial infarction (AMI). This study aimed to examine and quantify the potential effect of smoke-free legislation on AMI mortality rate in different countries. METHODS: Studies were identified using a systematic search of the scientific literature from electronic databases, including PubMed, Web of Science, ScienceDirect, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI), from their inception through September 30, 2017. A random effects model was employed to estimate the overall effects of smoke-free legislation on the AMI mortality rate. Subgroup analysis was performed to explore the possible causes of heterogeneity in risk estimates based on sex and age. The results of meta-analysis after excluding the studies with a high risk of bias were reported in this study. RESULTS: A total of 10 eligible studies with 16 estimates of effect size were included in this meta-analysis. Significant heterogeneity in the risk estimates was identified (overall I2 = 94.6%, p < 0.001). Therefore, a random effects model was utilized to estimate the overall effect of smoke-free legislation. There was an 8% decline in AMI mortality after introducing smoke-free legislation (RR = 0.92, 95% confidence interval (CI): 0.90-0.94). The results of subgroup analyses showed that smoke-free legislation was significantly associated with lower rates of mortality for the following 5 diagnostic subgroups: smoke-free in workplaces, restaurants and bars (RR = 0.92, 95% CI: 0.90-0.95), smaller sample size (RR = 0.92, 95% CI: 0.89-0.95), study location in Europe (RR = 0.90, 95% CI: 0.85-0.94), regional study area (RR = 0.92, 95% CI: 0.89-0.94), and no previous local smoke-free legislation (RR = 0.91, 95% CI: 0.90-0.93). However, there was not much difference in AMI mortality rates after the legislation between the longer (RR = 0.92, 95% CI: 0.86-0.98) and shorter follow-up duration subgroups (RR = 0.92, 95% CI: 0.89-0.94). CONCLUSION: Smoke-free legislation could significantly reduce the AMI mortality rate by 8%. The reduction in the AMI mortality rate was more significant in studies with more comprehensive laws, without prior smoke-free bans, with a smaller sample size, at the regional level, and with a location in Europe.


Asunto(s)
Infarto del Miocardio/mortalidad , Instalaciones Públicas/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Política para Fumadores/legislación & jurisprudencia , Fumar/legislación & jurisprudencia , China , Femenino , Humanos , Masculino , Infarto del Miocardio/prevención & control , Restaurantes/legislación & jurisprudencia , Factores de Tiempo , Lugar de Trabajo/legislación & jurisprudencia
15.
Artículo en Inglés | MEDLINE | ID: mdl-31454942

RESUMEN

The legality, recreational and medical use of cannabis varies widely by country and region but remains largely prohibited internationally. In October 2018, Canada legalized the recreational use of cannabis-a move many viewed as controversial. Proponents of legalization have emphasized the potential to eradicate the marijuana black market, improve quality and safety control, increase tax revenues, improve the availability of medical cannabis, and lower gang-related drug violence. Conversely, opponents of legalization have stressed concerns about cannabis' addictive potential, second-hand cannabis exposure, potential exacerbation of underlying and established mental illnesses, as well as alterations in perception that affect safety, particularly driving. This systematic review synthesizes recent international literature on the clinical and public health implications of cannabis legalization.


Asunto(s)
Cannabis , Internacionalidad , Legislación de Medicamentos , Marihuana Medicinal , Salud Pública/legislación & jurisprudencia , Humanos , Grupo Paritario
16.
Artículo en Inglés | MEDLINE | ID: mdl-31455009

RESUMEN

Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health.


Asunto(s)
Fumar Cigarrillos/legislación & jurisprudencia , Sistemas Electrónicos de Liberación de Nicotina , Política de Salud , Salud Pública/legislación & jurisprudencia , Vapeo/legislación & jurisprudencia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escocia
18.
Artículo en Inglés | MEDLINE | ID: mdl-31349618

RESUMEN

The Scottish Government launched a tobacco control strategy in 2013 with the ambition of making Scotland tobacco smoke-free by 2034. However, 17% of the adult population in Scotland smoke cigarettes. This study aimed to provide insight into why policies are successful or not and provide suggestions for future policy actions. Individual interviews with ten tobacco control experts were conducted and the results were analyzed using thematic analysis. Key successes included strong political leadership, mass media campaigns, legislation to address availability and marketing of cigarettes and tobacco products, and legislation to reduce second-hand smoke exposure. Challenges included implementing policy actions, monitoring and evaluation of tobacco control actions, addressing health inequalities in smoking prevalence, and external factors that influenced the success of policy actions. Key suggestions put forward for future policy actions included addressing the price and availability of tobacco products, maintaining strong political leadership on tobacco control, building on the success of the 'Take it Right Outside' mass media campaign with further mass media campaigns to tackle other aspects of tobacco control, and developing and testing methods of addressing inequalities in cigarette smoking prevalence. The findings of this study can inform future tobacco control policy in Scotland and have relevance for tobacco control policies in other countries.


Asunto(s)
Actitud Frente a la Salud , Mercadeo/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Prevención del Hábito de Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Fumar Tabaco/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Escocia
19.
Am J Public Health ; 109(9): 1171-1176, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31318585

RESUMEN

There has been a burst of research on immigrant health in the United States and an increasing attention to the broad range of state and local policies that are social determinants of immigrant health. Many of these policies criminalize immigrants by regulating the "legality" of their day-to-day lives while others function to integrate immigrants through expanded rights and eligibility for health care, social services, and other resources.Research on the health impact of policies has primarily focused on the extremes of either criminalization or integration. Most immigrants in the United States, however, live in states that possess a combination of both criminalizing and integrating policies, resulting in distinct contexts that may influence their well-being.We present data describing the variations in criminalization and integration policies across states and provide a framework that identifies distinct but concurrent mechanisms of deportability and inclusion that can influence health. Future public health research and practice should address the ongoing dynamics created by both criminalization and integration policies as these likely exacerbate health inequities by citizenship status, race/ethnicity, and other social hierarchies.


Asunto(s)
Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Inmigrantes Indocumentados/legislación & jurisprudencia , Humanos , Determinantes Sociales de la Salud , Estados Unidos
20.
Am J Public Health ; 109(9): 1179-1183, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31318598

RESUMEN

A successful quarantine requires a high rate of compliance by individuals with potential exposure to a communicable disease.Many individuals would be reluctant to comply with a quarantine because they fear that contact with government officials will place them in legal, personal, or economic jeopardy. These include undocumented immigrants and individuals with a substance use disorder. For a quarantine to succeed, individuals must be granted temporary immunity from arrest, deportation, or similar adverse consequences, but doing so will be politically unpopular.We argue that public health considerations must take precedence over politics in protecting the health of the public.


Asunto(s)
Cooperación del Paciente , Política , Salud Pública/legislación & jurisprudencia , Cuarentena/legislación & jurisprudencia , Inmigrantes Indocumentados/legislación & jurisprudencia , Humanos , Estados Unidos , Poblaciones Vulnerables/legislación & jurisprudencia
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