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1.
Acad Med ; 96(3): 375-380, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33661849

RESUMO

A critical shortage of physicians is looming in the United States. The situation in Kentucky is especially dire, especially in rural areas. Class size constraints have resulted in the University of Kentucky College of Medicine (UK COM) unable to admit over 100 qualified Kentuckians each year. This article describes how leadership at University of Kentucky committed to addressing the state physician shortage while simultaneously strengthening relationships with critical partners through the establishment of two 4-year UK COM regional medical campuses. Based on criteria (such as a commitment to educating physicians, ample patients, sufficient willing physician preceptors, etc.), partners selected were Med Center Health, the leading health care system in southwestern Kentucky, and St. Elizabeth Healthcare, the predominant health care system in northern Kentucky. These regional campuses allow UK COM to expand its class size to 201 and total enrollment to 804, increasing from historically 70 to currently 120 graduates per year expected to practice in Kentucky. Critical to the success of this expansion is the buy-in of leadership and the Admissions Committee to consider students with a wider range of Medical College Admission Test scores. The regional clinical partners have substantially increased their teaching opportunities, with a greater ability to attract physicians. Both partners have made substantial financial contributions in support of the regional campuses. These relationships have energized UK COM engagement with its area alumni and have resulted in fewer Kentuckians referred out of state for advanced specialty care. Partnerships are also occurring with UK COM to increase graduate medical education offerings at the regional sites, fulfilling the vision of "training Kentuckians in Kentucky to practice in Kentucky."


Assuntos
Centros Médicos Acadêmicos/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Política Pública/legislação & jurisprudência , Centros Médicos Acadêmicos/provisão & distribução , Redes Comunitárias , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Kentucky/epidemiologia , Médicos/provisão & distribução , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/tendências , População Rural/estatística & dados numéricos , Especialização/estatística & dados numéricos , Planejamento Estratégico/normas , Estados Unidos/epidemiologia
5.
Nat Med ; 27(2): 239-243, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33479500

RESUMO

Substantial global effort has been devoted to curtailing the tobacco epidemic over the past two decades, especially after the adoption of the Framework Convention on Tobacco Control1 by the World Health Organization in 2003. In 2015, in recognition of the burden resulting from tobacco use, strengthened tobacco control was included as a global development target in the 2030 Agenda for Sustainable Development2. Here we show that comprehensive tobacco control policies-including smoking bans, health warnings, advertising bans and tobacco taxes-are effective in reducing smoking prevalence; amplified positive effects are seen when these policies are implemented simultaneously within a given country. We find that if all 155 countries included in our counterfactual analysis had adopted smoking bans, health warnings and advertising bans at the strictest level and raised cigarette prices to at least 7.73 international dollars in 2009, there would have been about 100 million fewer smokers in the world in 2017. These findings highlight the urgent need for countries to move toward an accelerated implementation of a set of strong tobacco control practices, thus curbing the burden of smoking-attributable diseases and deaths.


Assuntos
Política de Saúde/legislação & jurisprudência , Política Pública/legislação & jurisprudência , Fumar/legislação & jurisprudência , Tabaco/efeitos adversos , Adolescente , Adulto , Feminino , Política de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Política Pública/economia , Fumar/economia , Fumar/epidemiologia , Fumar/psicologia , Impostos , Organização Mundial da Saúde/economia , Adulto Jovem
6.
Medicina (Kaunas) ; 57(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429930

RESUMO

Background and objectives: To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of children and parents. Surrogacy is a form of medically-assisted procreation (MAP) in which a woman "lends" her uterus to carry out a pregnancy on behalf of a third party. There are pathological conditions, such as uterine agenesis or hysterectomy outcomes, that may prevent prospective mothers from becoming pregnant or carry a pregnancy to term; such patients may consider finding a surrogate mother. Many issues relating to surrogacy remain unresolved, with significant disagreements and controversy within the scientific community and public opinion. There are several factors called into play and multiple parties and stakeholders whose objectives and interests need to somehow be reconciled. First and foremost, the authors contend, it is essential to prioritize and uphold the rights of children born through surrogacy and heterologous MAP. Materials and methods: To draw a parallel between Italy and the rest of the world, the legislation in force in twelve European countries was analyzed, eleven of which are part of the European Union (France, Germany, Italy, Spain, Greece, Netherlands, Belgium, Denmark, Lithuania, Czech Republic and Portugal) and three non-members of the same (United Kingdom, Ukraine and Russia), as well as that of twelve non-European countries considered exemplary (United States, Canada, Australia, India, China, Thailand, Israel, Nigeria and South Africa); in particular, legislative sources and legal databases were drawn upon, in order to draw a comparison with the Italian legislation currently in force and map out the evolution of the Italian case law on the basis of the judgments issued by Italian courts, including the Constitutional and Supreme Courts and the European Court of Human Rights (ECHR); search engines such as PubMed and Google Scholar were also used, by entering the keywords "surrogacy" and "surrogate motherhood", to find scientific articles concerning assisted reproduction techniques with a close focus on surrogacy. Results: SM is a prohibited and sanctioned practice in Italy; on the other hand, it is allowed in other countries of the world, which leads Italian couples, or couples from other countries where it is banned, to often contact foreign centers in order to undertake a MAP pathway which includes surrogacy; in addition, challenges may arise from the legal status of children born through surrogacy abroad: to date, in most countries, there is no specific legislation aimed at regulating their legal registration and parental status. Conclusion: With reference to the Italian context, despite the scientific and legal evolution on the subject, a legislative intervention aimed at filling the regulatory gaps in terms of heterologous MAP and surrogacy has not yet come to fruition. Considering the possibility of "fertility tourism", i.e., traveling to countries where the practice is legal, as indeed already happens in a relatively significant number of cases, the current legislation, although integrated by the legal interpretation, does not appear to be effective in avoiding the phenomenon of procreative tourism. Moreover, to overcome some contradictions currently present between law 40 and law 194, it would be appropriate to outline an organic and exhaustive framework of rules, which should take into account the multiplicity of interests at stake, in keeping with a fair and sustainable balance when regulating such practices.


Assuntos
Política Pública/legislação & jurisprudência , Técnicas de Reprodução Assistida/legislação & jurisprudência , Mães Substitutas/legislação & jurisprudência , Altruísmo , Austrália , Criança , Bem-Estar da Criança/ética , Bem-Estar da Criança/legislação & jurisprudência , Comércio , Europa (Continente) , Feminino , Humanos , Israel , Itália , Japão , Turismo Médico/ética , Turismo Médico/legislação & jurisprudência , Gravidez , Técnicas de Reprodução Assistida/ética , Federação Russa , Problemas Sociais , Tailândia , Ucrânia , Estados Unidos
7.
Acta Med Port ; 33(11): 733-741, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33160423

RESUMO

INTRODUCTION: Portugal took early action to control the COVID-19 epidemic, initiating lockdown measures on March 16th when it recorded only 62 cases of COVID-19 per million inhabitants and reported no deaths. The Portuguese public complied quickly, reducing their overall mobility by 80%. The aim of this study was to estimate the initial impact of the lockdown in Portugal in terms of the reduction of the burden on the healthcare system. MATERIAL AND METHODS: We forecasted epidemic curves for: Cases, hospital inpatients (overall and in intensive care), and deaths without lockdown, assuming that the impact of containment measures would start 14 days after initial lockdown was implemented. We used exponential smoothing models for deaths, intensive care and hospitalizations and an ARIMA model for number of cases. Models were selected considering fitness to the observed data up to the 31st March 2020. We then compared observed (with intervention) and forecasted curves (without intervention). RESULTS: Between April 1st and April 15th, there were 146 fewer deaths (-25%), 5568 fewer cases (-23%) and, as of April 15th, there were 519 fewer intensive care inpatients (-69%) than forecasted without the lockdown. On April 15th, the number of intensive care inpatients could have reached 748, three times higher than the observed value (229) if the intervention had been delayed. DISCUSSION: If the lockdown had not been implemented in mid-March, Portugal intensive care capacity (528 beds) would have likely been breached during the first half of April. The lockdown seems to have been effective in reducing transmission of SARS-CoV-2, serious COVID-19 disease, and associated mortality, thus decreasing demand on health services. CONCLUSION: An early lockdown allowed time for the National Health Service to mobilize resources and acquire personal protective equipment, increase testing, contact tracing and hospital and intensive care capacity and to promote broad prevention and control measures. When lifting more stringent measures, strong surveillance and communication strategies that mobilize individual prevention efforts are necessary.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Emergências/epidemiologia , Epidemias/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Política Pública/legislação & jurisprudência , Quarentena/métodos , Ocupação de Leitos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Cuidados Críticos/estatística & dados numéricos , Epidemias/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/transmissão , Portugal/epidemiologia , Quarentena/estatística & dados numéricos
13.
J Am Med Dir Assoc ; 21(7): 888-892, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674814

RESUMO

To provide policy recommendations for managing Coronavirus 19 (COVID-19) in skilled nursing facilities, a group of certified medical directors from several facilities in New York state with experience managing the disease used e-mail, phone, and video conferencing to develop consensus recommendations. The resulting document provides recommendations on screening, protection of staff, screening of residents, management of Coronavirus 19 positive and presumed positive cases, communication during an outbreak, management of admissions and readmissions, and providing emotional support for staff. These consensus guidelines have been endorsed by the Executive Board of the New York Medical Directors Association and the Board of the Metropolitan Area Geriatrics Society.


Assuntos
Doenças Transmissíveis Emergentes/terapia , Infecções por Coronavirus/epidemiologia , Assistência de Longa Duração/organização & administração , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Cuidados Semi-Intensivos/organização & administração , Idoso , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/terapia , Gerenciamento Clínico , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New York , Pandemias/estatística & dados numéricos , Pneumonia Viral/terapia , Formulação de Políticas , Política Pública/legislação & jurisprudência
15.
J Appl Gerontol ; 39(7): 690-699, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380891

RESUMO

New York City is currently experiencing an outbreak of COVID-19, a highly contagious and potentially deadly virus, which is particularly dangerous for older adults. This pandemic has led to public health policies including social distancing and stay-at-home orders. We explore here the impact of this unique crisis on victims of elder mistreatment and people at risk of victimization. The COVID-19 outbreak has also had a profound impact on the organizations from many sectors that typically respond to protect and serve victims of elder mistreatment. We examine this impact and describe creative solutions developed by these organizations and initial lessons learned in New York City to help inform other communities facing this pandemic and provide guidance for future crises.


Assuntos
Infecções por Coronavirus , Vítimas de Crime/psicologia , Serviços de Saúde para Idosos , Pandemias , Pneumonia Viral , Política Pública , Isolamento Social/psicologia , Idoso , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Doença Crônica/epidemiologia , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Maus-Tratos ao Idoso/economia , Maus-Tratos ao Idoso/legislação & jurisprudência , Maus-Tratos ao Idoso/prevenção & controle , Maus-Tratos ao Idoso/psicologia , Feminino , Serviços de Saúde para Idosos/normas , Serviços de Saúde para Idosos/tendências , Humanos , Masculino , Mortalidade , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Política Pública/legislação & jurisprudência , Política Pública/tendências , Medição de Risco
16.
J Addict Med ; 14(4): e4-e5, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433363

RESUMO

: The United States is currently in the midst of 2 public health emergencies: COVID-19 and the ongoing opioid crisis. In an attempt to reduce preventable harm to individuals with opioid use disorder (OUD), federal, state, and local governments have temporarily modified law and policy to increase access to OUD treatment and divert some individuals at high risk away from the correctional system. In this Commentary, we briefly describe how people with OUD are at increased risk for COVID-19, discuss existing policy barriers to evidence-based prevention and treatment for individuals with OUD, explain the temporary rollbacks of those barriers, and argue that these changes should be made permanent. We also suggest several additional steps that federal and state governments can urgently take to reduce barriers to care for individuals with OUD, both during the current crisis and beyond.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Transtornos Relacionados ao Uso de Opioides , Pandemias , Pneumonia Viral , Política Pública , Controle Social Formal/métodos , Controle de Doenças Transmissíveis/legislação & jurisprudência , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Regulamentação Governamental , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Política Pública/legislação & jurisprudência , Política Pública/tendências , Estados Unidos/epidemiologia
17.
Glob Public Health ; 15(7): 925-934, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32396447

RESUMO

Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self-employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Global , Pneumonia Viral/epidemiologia , Política Pública/legislação & jurisprudência , Licença Médica/economia , Licença Médica/legislação & jurisprudência , Adulto , Betacoronavirus , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/transmissão , Salários e Benefícios , Nações Unidas
19.
BMC Public Health ; 20(1): 527, 2020 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-32306928

RESUMO

BACKGROUND: Indonesia shoulders a significant tobacco burden, with almost two million cases of tobacco-related illnesses and more than two hundred thousand tobacco-related deaths annually. Indonesian tobacco control is progressing but lags behind other countries. Our study evaluates factors that contribute to the slow progress of tobacco policy change in Indonesia from the perspective of tobacco control experts (TCEs). METHOD: We conducted qualitative interviews with four international and ten national TCEs, who have been active in tobacco control for at least 5 years. Our interview guideline included questions on the current tobacco control situation in Indonesia and explored reasons why tobacco control is progressing so slowly. The interviews were conducted either in English or Bahasa Indonesia, recorded and then transcribed verbatim. We conducted a thematic analysis based on five core causal factors for policy adoption: institutions, networks, socio-economic factors, agendas and ideas. RESULTS: The multistage delay of tobacco policy adoption is principally due to political structures and policy hierarchy, complex bureaucracy, unclear roles and responsibilities, and a high degree of corruption. The low bargaining position and lack of respect for the Ministry of Health also contributes. There are contrasting frames of tobacco as a strategic economic asset and tobacco control as a sovereignty threat. There is an imbalance of power and influence between well entrenched and resourced tobacco industry networks compared to relatively young and less established tobacco control networks. The policy agenda is likely influenced by the privileged position of tobacco in Indonesia as a socially acceptable product with high consumption. There are constraints on transferring ideas and evidence to successful policy adoption. CONCLUSION: Tobacco companies have substantially influenced both policy decisions and public perceptions, signifying a power imbalance within the government system and broader networks. Acceding to and enforcing the World Health Organization- Framework Convention on Tobacco Control (WHO-FCTC) would enable the Indonesian government to shift the power imbalance towards public health stakeholders. Tobacco control advocates must enhance their network cohesion and embrace other community groups to improve engagement and communication with policymakers.


Assuntos
Política de Saúde/legislação & jurisprudência , Política Pública/legislação & jurisprudência , Fumar/legislação & jurisprudência , Indústria do Tabaco/legislação & jurisprudência , Produtos do Tabaco/legislação & jurisprudência , Prova Pericial , Humanos , Indonésia , Pesquisa Qualitativa , Prevenção do Hábito de Fumar/legislação & jurisprudência , Organização Mundial da Saúde
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