An Interrupted Time-series Evaluation of the Association Between State Laws Mandating Prescriber Use of Prescription Drug Monitoring Programs and Discontinuation of Chronic Opioid Therapy in US Veterans.

BACKGROUND: Most states have recently passed laws requiring prescribers to use prescription drug monitoring programs (PDMPs) before prescribing opioid medications. The impact of these mandates on discontinuing chronic opioid therapy among Veterans managed in the Veterans Health Administration (VA) is unknown. We assess the association between the earliest of these laws and discontinuation of chronic opioid therapy in Veterans receiving VA health care. METHODS: We conducted a comparative interrupted time-series study in the 5 states mandating PDMP use before August 2013 (Ohio, West Virginia, Kentucky, New Mexico, and Tennessee), adjusting for trends in the 17 neighboring control states without such mandates. We modeled 25 months of prescribing for each state centered on the month the mandate became effective. We included Veterans prescribed long-term outpatient opioid therapy (305 of the preceding 365 d). Our outcomes were discontinuation of chronic opioid therapy (primary outcome) and the average daily quantity of opioids per Veteran over the following 6 months (secondary outcome). RESULTS: We included 250 monthly cohorts with 225,665 unique Veterans and 3.4 million Veteran-months. Baseline discontinuation rates before the PDMP mandates were 0.4%-2.7% per month. Kentucky saw a discontinuation increase of 1 absolute percentage point following its PDMP mandate which decreased over time. The other 4 states had no significant association between their mandates and change in opioid discontinuation. There was no evidence of decreasing opioid quantities following PDMP mandates. CONCLUSION: We did not find consistent evidence that state laws mandating provider PDMP use were associated with the discontinuation of chronic opioid therapy within the VA for the time period studied.

Text Mining of United States Obesity-Related Public Policies: Systematic Document Search.

BACKGROUND: Obesity has become a worldwide health problem, caused by multiple and complex factors. To face this challenge, governments have played a central role in combating its rise. Considering this, public policies are introduced or enacted for the benefit of whole populations, taking into account the perspective of multiverse social stakeholders based on solid scientific fundamentals. OBJECTIVE: The aim of this study was to examine obesity-related public policies in the United States and the District of Columbia, in order to understand their scientific basis. METHODS: We analyzed the public policies implemented in the United States from 2003 to 2013, during which time the largest number of obesity-related public policies were introduced, using text mining. RESULTS: In total, 1592 obesity-related public policies were retrieved from the Centers for Disease Control and Prevention. Multidisciplinary policies were predominant in the documents analyzed (533/1592, 33.5%), followed by health sciences (454/1592, 28.5%), social sciences (330/1592, 20.7%), life sciences (240/1592, 15.1%), and physical sciences (35/1592, 2.2%). Throughout the country, most policies were community oriented (1082/1865, 58.0%) and many of them were related to school and family environments (447/1865, 24.0%), early care and education (75/1865, 4.0%), hospitals (63/1865, 3.4%), and workplaces (47/1865, 2.5%). CONCLUSIONS: The contents of obesity-related public policies were generally uniformly framed across the United States. They were generally based on scientific references, in which there was a predominance of multidisciplinary research. These findings are consistent with what is known about the multiple factors causing obesity and about the methods being developed to control the epidemic.

Historic tobacco legislation in Israel: a moment to celebrate.

BACKGROUND: Israel was once a leader in tobacco control, but fell behind other countries, particularly during the past decade, as smoking rates stagnated. TEXT: Landmark tobacco control legislation, which banned advertising (with the exception of the print press) and limited marketing, was passed in Israel on Dec. 31rst, 2018. The changes occurred following years of attempts which culminated in successful last-minute efforts to promote the legislation just before the early disbanding of the 20th Knesset (Israeli Parliament). Regulations concerning marketing and advertising were substantially strengthened to address all tobacco, nicotine and smoking products. Digital media was included for the first time. Electronic cigarettes, which were previously largely unregulated, now fall under existing tobacco legislation. The changes overcame intense opposition from the tobacco lobby, and occurred despite the fact that the basic elements for prevention policy postulated by the Richmond model were not in place. CONCLUSIONS: This legislation represents an important and long-awaited change in Israeli tobacco control policy. Many deficiencies in existing tobacco control regulation were overcome, and some measures went beyond current international regulations. The cohesive partnership between legislators, public health organizations and professionals, advocacy groups, academia, and leading journalists was critical to this success. The progress was lauded by the World Health Organization with its highest award for tobacco control, which was presented to Smoke Free Israel. This case study provides important lessons for up-to-date tobacco control policy, in the age of rapid global changes in the tobacco, vaping and nicotine landscape.

Opioid Abuse Prevention and Treatment: Lessons From South Carolina.

CONTEXT: Opioid-related overdoses in the United States have increased by 33% over the past 5 years. America's opioid crisis is increasing across demographic groups and spreading geographically. South Carolina is one of the states in the southern region of the United States that experiences an unusually high rate of opioid-related deaths. In 2016, 616 deaths occurred in South Carolina from drug overdoses from prescription opioid drugs, up 9% from 2015. South Carolina residents filled nearly 4.5 million opioid prescriptions in 2015, which is greater than 1.5 times the national average. IMPLEMENTATION: In 2017, the governor of South Carolina declared a statewide public health emergency in response to the growing opioid crisis. In response, a committee of the South Carolina House of Representatives released a report in January 2018 on its opioid abuse prevention study and made recommendations on ways to reduce the number of opioid-related deaths. EVALUATION: This article examines the strengths and weaknesses of South Carolina's state action plan to combat opioid-related deaths in the context of what other states have done to address opioid abuse, as well as the scientific literature on pain management. Several state opioid action plans, including South Carolina's and West Virginia's, were identified and evaluated. DISCUSSION: This article describes (1) several legislative and nonlegislative strategies being considered in South Carolina for addressing the crisis, (2) an assessment of the strengths and weaknesses of these proposals and how they compare with other states that have also implemented response plans, and (3) an examination of the scientific literature to determine best practices for treating patients who are currently taking opioids, as well as discussing alternative approaches to pain management. The authors make several recommendations to improve upon South Carolina's opioid abuse prevention plan, such as engaging communities and encouraging multistakeholder collaboration to expand access to treatment, particularly among the most vulnerable populations.

Health issues and informal caregiving in Europe and Italy.

Informal caregivers are the unpaid persons who take care of a not self-sufficient family member, due to old age or chronic illness or disability. As in all the European countries, the demand for informal cares is further increased as a result of the ageing societies and the social and political fallout of informal caregiving is a very current and important issue. We have overviewed some international scientific literature, with the aim of understanding the key research objectives to be firstly pursued to address this problem. In particular, we focused on the psycho-physical health differences in informal caregivers, subjected to long lasting load and prolonged stress, as compared to non caregiver persons. We also underlined the relationship between caregiver health differences and stress, gender type, kind of the care recipient (autism) and social and political situation in Europe and Italy. The collected data indicate the necessity to prevent caregiver psychological and physical health by appropriate laws, especially supporting women, often most involved in care activities.

'To die, to sleep' - assisted dying legislation in Victoria: A case study.

BACKGROUND: Assisted dying remains an emotive topic globally with a number of countries initiating legislation to allow individuals access to assisted dying measures. Victoria will become the first Australian state in over 13 years to pass Assisted Dying Legislation, set to come into effect in 2019. OBJECTIVES: This article sought to evaluate the impact of Victorian Assisted Dying Legislation via narrative view and case study presentation. RESEARCH DESIGN: Narrative review and case study. PARTICIPANTS AND RESEARCH CONTEXT: case study. ETHICAL CONSIDERATIONS: This legislation will provide eligible Victorian residents with the option to request access to assisted dying measures as a viable alternative to a potentially painful, protracted death. FINDINGS: This legislation, while conservative and inclusive of many safeguards at present, will form the basis for further discussion and debate on assisted dying across Australia in time to come. DISCUSSION: The passing of this legislation by the Victorian parliament was prolonged, emotive and divided not only the parliament but Australian society. CONCLUSION: Many advocates for this legislation proclaimed it was well overdue and will finally meet the needs of contemporary society. Protagonists claim that medical treatment should not provide a means of ending life, despite palliative care reportedly often failing to relieve the pain and suffering of individuals living with a terminal illness.

Experts' Insights into eHealth-Legislation: Comparing Switzerland and Germany.

This prospective longitudinal study aims at better understanding eHealth success factors in different European nations, esp. the role of eHealth-legislation in Switzerland and Germany. Qualitative interviews with 39 matched experts from a large variety of institutions in both nations were conducted. The individual statements in the interviews and the overall satisfaction rating indicate a clear trend for a more optimistic attitude towards the law in Switzerland than in Germany. This result is not surprising given the history of a telematics infrastructure in Germany. Cross-country learning topics for German politicians are the inclusion of the inpatient sector and the focus on one major application. In a next step, interview results from Austria will be included and with that the scope of study findings enriched.

OSHA and elongate mineral particles.

The United States Occupational Safety and Health Administration (OSHA) was established to provide guidance to protect workers from hazards in the workplace. After broadly adopting extant health and safety standards, OSHA promulgated an expanded standard for regulation of asbestos. This standard provided for regulation of six named minerals and practices to be followed. Since the initial establishment of asbestos regulation by OSHA, other elongate particles have been considered for evaluation. This discussion describes the evolution of the OSHA regulations for asbestos, what they cover and how other materials might be regulated if they are found to pose a health risk.

Endocrine Disruption: Current approaches for regulatory testing and assessment of plant protection products are fit for purpose.

The ongoing debate concerning the regulation of endocrine disruptors, has increasingly led to questions concerning the current testing of chemicals and whether this is adequate for the assessment of potential endocrine disrupting effects. This paper describes the current testing approaches for plant protection product (PPP) active substances in the European Union and the United States and how they relate to the assessment of endocrine disrupting properties for human and environmental health. This includes a discussion of whether the current testing approaches cover modalities other than the estrogen, androgen, thyroid and steroidogenesis (EATS) pathways, sensitive windows of exposure, adequate assessment of human endocrine disorders and wildlife species, and the determination of thresholds for endocrine disruption. It is concluded, that the scope and nature of the core and triggered data requirements for PPP active substances are scientifically robust to address adverse effects mediated through endocrine mode(s) of action and to characterise these effects in terms of dose response.

Academic Medical Centers as Innovation Ecosystems: Evolution of Industry Partnership Models Beyond the Bayh-Dole Act.

Innovation ecosystems tied to academic medical centers (AMCs) are inextricably linked to policy, practices, and infrastructure resulting from the Bayh-Dole Act in 1980. Bayh-Dole smoothed the way to patenting and licensing new drugs and, to some degree, medical devices and diagnostic reagents. Property rights under Bayh-Dole provided significant incentive for industry investments in clinical trials, clinical validation, and industrial scale-up of products that advanced health care. Bayh-Dole amplified private investment in biotechnology drug development and, from the authors' perspective, did not significantly interfere with the ability of AMCs to produce excellent peer-reviewed science. In today's policy environment, it is increasingly difficult to patent and license products based on the laws of nature-as the scope of patentability has been narrowed by case law and development of a suitable clinical and business case for the technology is increasingly a gating consideration for licensees. Consequently, fewer academic patents are commercially valuable. The role of technology transfer organizations in engaging industry partners has thus become increasingly complex. The partnering toolbox and organizational mandate for commercialization must evolve toward novel collaborative models that exploit opportunities for future patent creation (early drug discovery), data exchange (precision medicine using big data), cohort assembly (clinical trials), and decision rule validation (clinical trials). These inputs contribute to intellectual property rights, and their clinical exploitation manifests the commercialization of translational science. New collaboration models between AMCs and industry must be established to leverage the assets within AMCs that industry partners deem valuable.

Policy and Legal Protection for Breastfeeding and Incarcerated Women in Canada.

Most incarcerated women in Canada are mothers. Because women are the fastest growing population in carceral facilities, protecting the rights of incarcerated women to breastfeed their children is increasingly important. There is considerable evidence that incarcerated women in Canada experience poor physical and mental health, isolation, and barriers to care. Incarcerated women and their children could benefit significantly from breastfeeding. This Insight in Policy explores policy and legal protection for breastfeeding in Canada as it relates to carceral facilities, considers key cases regarding breastfeeding rights among incarcerated women, and presents recommendations for policy development and advocacy. The Canadian Constitution and human rights legislation across Canada prohibits discrimination on the basis of gender and includes pregnancy and the possibility of becoming pregnant as a characteristic of gender. Some provinces note that breastfeeding is a characteristic of gender. Women's Wellness Within, a nonprofit organization providing volunteer perinatal support to criminalized women in Nova Scotia, conducted a scan of all provincial and territorial correctional services acts and the federal Corrections and Conditional Release Act: none mention breastfeeding. Protocols for breastfeeding during arrest and lockup by police were not available in any jurisdiction across Canada. International law, including the Convention on the Rights of the Child, the Nelson Mandela Rules, and the Bangkok Rules, have application to the rights of incarcerated breastfeeding women. The Inglis v. British Columbia (Minister of Public Safety) (2013) and Hidalgo v. New Mexico Department of Corrections (2017) decisions are pivotal examples of successful litigation brought forward by incarcerated mothers to advance breastfeeding rights. Improved application and understanding of existent law could advance breastfeeding rights.

Avances hacia una regulación de la gestación por sustitución en España en base al modelo regulado en el Estado de California / No disponible

La Ley 14/2006, de 26 de mayo no ha autorizado la gestación por sustitución. Ello implica la exclusión injustificada del uso de las técnicas de reproducción humana asistida a los hombres y mujeres con incapacidad para gestar y, por ello, de la posibilidad de crear su familia a través de dichas tecnologías. Este problema se resolvería en la medida en que se regulase en el Derecho español un modelo de gestación por sustitución bajo la condición de que fuera respetuoso con los derechos de las partes intervinientes en dicho proceso. Para contribuir al avance hacia la eventual regulación en España de esta técnica reproductiva, hemos tomado como referencia el modelo establecido en el Californian surrogacy Law

The Law 14/2006 of 26 may has not authorized the surrogacy. This implies the unjustified exclusion of using human assisted reproduction techniques for women and men unable to gestate and, therefore, to create their family through these techniques. This problem could be solved if a model of surrogacy were regulated in Spanish Law emphasizing the respect for the rights of the parties involved in the process. In contributing to the progress towards the eventual regulation in Spain of the surrogacy reproductive technique, we have taken as reference the model established in the Californian Surrogacy Law

An Analysis of the Massachusetts Healthcare Law.

Healthcare in the United States has been one topic of the debates and discussion in the country for many years. The challenge for affordable, accessible, and quality healthcare for most Americans has been on the agenda of federal and state legislatures. There is probably no other state that has drawn as much individual attention regarding this challenge as the state of Massachusetts. While researching the topic for this article, it was discovered that financial and political perspectives on the success or failure of the healthcare model in Massachusetts vary depending on the aspect of the system being discussed. In this article the authors give a brief history and description of the Massachusetts Healthcare Law, explanation of how the law is financed, identification of the targeted populations in Massachusetts for which the law provides coverage, demonstration of the actual benefit coverage provided by the law, and review of the impact of the law on healthcare providers such as physicians and hospitals. In addition, there are explanations about the impact of the law on health insurance companies, discussion of changes in healthcare premiums, explanation of costs to the state for the new program, reviews of the impact on the health of the insured, and finally, projections on the changes that healthcare facilities will need to make to maintain fiscal viability as a result of this program.