A influência da resposta dos EUA à COVID-19 no contexto da Saúde Global / The influence of the U.S. response to COVID-19 in Global Health

Resumo A resposta americana à pandemia envolve um proeminente volume de recursos federais, em especial destinados ao desenvolvimento e aquisição de produtos no uso interno, como diagnósticos ou vacinas. As justificativas para esse desembolso se baseiam em mecanismos de investimentos e aspectos históricos. Assim, a construção social do nacionalismo na formação na sociedade americana prejudica o acesso a tecnologias em saúde. A revisão desses aspectos demonstra como os Estados Unidos (EUA) garantiram compra de grande quantitativo de produtos em potencial, inclusive assegurando excessiva produção local. Essa política externa unilateral tem influenciado outros países ou blocos regionais e prejudicado a cooperação e a solidariedade global com impacto na saúde coletiva de diversas nações.

Abstract The American response to the pandemic involves a prominent volume of federal resources, especially for developing and acquiring products for internal use, such as diagnostics or vaccines. Investment mechanisms and historical aspects justify this expenditure. Thus, the social construction of nationalism in American society hinders access to health technologies. The review of such aspects shows how the United States (U.S.) secured a large number of potential products, ensuring excessive local production. This unilateral foreign policy has influenced other countries or regional blocs and undermined global cooperation and solidarity, affecting the collective health of several nations.

Duración de la gestión ministerial y logros en salud en el Perú

Los periodos breves en la gestión de un ministerio de salud pueden poner en riesgo la implementación y la efectividad de políticas de Estado por cambios en la orientación de la gestión, por un proceso natural de aprendizaje, o por otros factores. El propósito de este artículo fue determinar y comparar la duración de la gestión ministerial en salud en Perú, describir sus características y discutir su relación con los logros en salud pública. Entre 1935 y 2021, la media de duración de la gestión fue de 13,7 meses y la mediana fue de 11 meses, siendo la más extensa de 67 meses, de Constantino Carvallo, y la más breve de un día, de Javier Correa. La duración de la gestión ministerial en el Perú tiene un amplio rango de variación (1día hasta 67 meses), es menor comparada con la de otros países, y está disminuyendo desde el 2016. Si bien, una duración mayor a la encontrada no sería suficiente para garantizar los logros en salud, podría contribuir en el sostenimiento de las acciones de salud y tener un efecto positivo en las políticas de largo plazo.

Short administration periods of a health ministry can jeopardize the implementation and effectiveness of state policies due to changes in management orientation, altering the natural learning process, or other factors. The aim of this article was to determine and compare the tenure length of the ministry of health in Peru, describe its characteristics and discuss its relationship with public health achievements. Between 1935 and 2021, the average tenure was of 13,7 months and the median was 11 months, the longest was found to be 67 months, by Constantino Carvallo, and the shortest was one day, by Javier Correa. The length of ministerial tenure in Peru has a wide range of variation (1 day up to 67 months), it is shorter compared to that of other countries and is decreasing since 2016. Although longer tenures would not be sufficient to guarantee health achievements, it might contribute to the sustainability of health-related actions and have a positive effect on long-term policies.

Regulatory reliance to approve new medicinal products in Latin American and Caribbean countries / Utilización de decisiones de autoridades regulatorias de otras jurisdicciones para aprobar nuevos productos medicinales en países de América Latina y el Caribe / Uso de decisões regulatórias de outras jurisdições para aprovação de novas especialidades farmacêuticas em países da América Latina e Caribe

ABSTRACT Objective. To describe the current status of regulatory reliance in Latin America and the Caribbean (LAC) by assessing the countries' regulatory frameworks to approve new medicines, and to ascertain, for each country, which foreign regulators are considered as trusted regulatory authorities to rely on. Methods. Websites from LAC regulators were searched to identify the official regulations to approve new drugs. Data collection was carried out in December 2019 and completed in June 2020 for the Caribbean countries. Two independent teams collected information regarding direct recognition or abbreviated processes to approve new drugs and the reference (trusted) regulators defined as such by the corresponding national legislation. Results. Regulatory documents regarding marketing authorization were found in 20 LAC regulators' websites, covering 34 countries. Seven countries do not accept reliance on foreign regulators. Thirteen regulatory authorities (Argentina, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Mexico, Panama, Paraguay, Peru, Uruguay, and the unique Caribbean Regulatory System for 15 Caribbean States) explicitly accept relying on marketing authorizations issued by the European Medicines Agency, United States Food and Drug Administration, and Health Canada. Ten countries rely also on marketing authorizations from Australia, Japan, and Switzerland. Argentina, Brazil, Chile, and Mexico are reference authorities for eight LAC regulators. Conclusions. Regulatory reliance has become a common practice in the LAC region. Thirteen out of 20 regulators directly recognize or abbreviate the marketing authorization process in case of earlier approval by a regulator from another jurisdiction. The regulators most relied upon are the European Medicines Agency, United States Food and Drug Administration, and Health Canada.

RESUMEN Objetivo. Describir el estado actual de la utilización de las decisiones de autoridades regulatorias de otras jurisdicciones en América Latina y el Caribe mediante la evaluación de los marcos regulatorios nacionales para la aprobación de nuevos medicamentos y establecer los organismos regulatorios extranjeros que se consideran autoridades regulatorias confiables para cada país. Métodos. Se realizaron búsquedas en los sitios web de las autoridades regulatorias de América Latina y el Caribe para identificar las regulaciones oficiales para la aprobación de nuevos medicamentos. La recopilación de datos se llevó a cabo en diciembre del 2019 y se completó en junio del 2020 para los países del Caribe. Dos equipos independientes recopilaron información sobre el reconocimiento directo o los procedimientos abreviados para la aprobación de nuevos medicamentos y los autoridades regulatorias de referencia (confiables) así definidos en la legislación nacional correspondiente. Resultados. Se encontraron documentos regulatorios sobre la aprobación de nuevos productos en los sitios web de veinte organismos regulatorios de América Latina y el Caribe, que abarcaban 34 países. Siete países no aceptan la utilización de decisiones de autoridades regulatorias extranjeras. Trece autoridades regulatorias (Argentina, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, México, Panamá, Paraguay, Perú, República Dominicana, Uruguay y el sistema regulador único para quince Estados del Caribe) aceptan de manera explícita confiar las decisiones para aprobación de nuevos medicamentos emitidas por la Agencia Europea de Medicamentos, la Administración de Alimentos y Medicamentos de Estados Unidos y Salud Canadá. Diez países aceptan también utilizar las autorizaciones para la comercialización de Australia, Japón y Suiza. Argentina, Brasil, Chile y México son autoridades de referencia para ocho autoridades regulatorias en la región. Conclusiones. La utilización de las decisiones de autoridades regulatorias de otras jurisdicciones se han convertido en una práctica común en América Latina y el Caribe. Trece de veinte autoridades regulatorias reconocen directamente o abrevian el proceso de aprobación de nuevos medicamentos en caso de que hayan recibido previamente la aprobación por parte de un organismo regulatorio de otra jurisdicción. La Agencia Europea de Medicamentos, la Administración de Alimentos y Medicamentos de Estados Unidos y Salud Canadá son las autoridades regulatorias de otras jurisdicciones en las cuales los reguladores de América Latina y el Caribe confían más.

RESUMO Objetivo. Descrever a prática atual de uso de decisões regulatórias de outras jurisdições na América Latina e no Caribe (ALC) mediante avaliação os marcos regulatórios dos países para aprovação de novos medicamentos e verificar, para cada país, quais entidades reguladoras estrangeiras são consideradas autoridades reguladoras de confiança por cada país. Métodos. Foi realizada uma pesquisa nos sites das autoridades reguladoras da ALC para identificar as regulamentações oficiais para aprovação de novos medicamentos. A coleta de dados foi feita em dezembro de 2019 e concluída em junho de 2020 para os países do Caribe. Dois grupos independentes coletaram informações sobre o reconhecimento direto ou o procedimento abreviado para aprovação de novos medicamentos e as autoridades reguladoras de referência (de confiança) definidas como tal pela respectiva legislação nacional. Resultados. Documentos regulatórios relacionados à aprovação de novos produtos foram obtidos de 20 sites de órgãos reguladores da ALC, abrangendo 34 países. Sete países não admitem o uso de decisões regulatórias de entidades reguladoras externas. Treze autoridades reguladoras (na Argentina, Colômbia, Costa Rica, El Salvador, Equador, Guatemala, México, Panamá, Paraguai, Peru, República Dominicana, Uruguai e o Sistema Regulador do Caribe unificado para 15 Estados caribenhos) admitem explicitamente a admissibilidade de decisões regulatórias para aprovação de novos medicamentos de outras jurisdições, quais sejam: Agência Europeia de Medicamentos (EMA), Agência Reguladora de Alimentos e Medicamentos (FDA) dos EUA e Health Canada. Dez países também aceitam decisões para autorização de comercialização da Austrália, Japão e Suíça. Argentina, Brasil, Chile e México são autoridades de referência para oito agências reguladoras. Conclusões. O uso de decisões regulatórias de outras jurisdições tornou-se prática comum na América Latina e Caribe. Treze das 20 agências reguladoras reconhecem diretamente ou abreviam o procedimento de aprovação de novos medicamentos no caso de tal aprovação já haver sido concedida por uma autoridade reguladora de outra jurisdição. A EMA, a FDA e a Health Canada são as autoridades estrangeiras nas quais as agências reguladoras da América Latina e Caribe mais confiam.

The value of MRI in early diagnosis of dysbaric osteonecrosis / 中华劳动卫生职业病杂志

Objective@#To investigate the value of MRI in the early diagnosis of diagnosis of dysbaric osteonecrosis.@*Methods@#Labor hygiene investigation and occupation health were examined on 52 high pressure operating personnel, were selected for the examination of both shoulders, hips and knees with X-ray and CT scan.@*Results@#The cystic sign in dysbaric osteonecrosis as an important imaging feature, which perform in the MRI examination for T1W I sequence showed low or slightly low signal and T2W I sequence showed high signal, and X-ray and CT have a lower detection rate than MRI. The Kappa consistency test showed a high consistency with the two methods. At the same time MRI examination also can discover the bone marrow cavity necrosis early pathological change.@*Conclusion@#MRI is an effective method for the diagnosis of early dysbaric osteonecrosis, which can improve the early diagnosis rate of dysbaric osteonecrosis.

A comprehensive evaluation of intervention effects on workplace health promotion in 10 government agencies / 中华劳动卫生职业病杂志

Objective@#To evaluate the comprehensive workplace health promotion intervention effects on workplace health promotion in 10 government agencies. @*Methods@#A prospective self-controlled design was employed. Baseline evaluation and effectiveness evaluation were both conducted by questionnaire investigation. @*Results@#The intervention results showed that most effectiveness indicators were significantly improved including health behaviors, psychosocial work environment, and health status. After the intervention, the prevalence of passive smoking and physical inactivity decreased from 70.3% and 38.7% to 44.1% and 30.5%, respectively. The scores of job control and social support at work increased by 0.30 and 0.05, respectively. The prevalence of good self-rated health and good mental health raised from 68.3% and 68.8% to 75.6% and 85.6%, respectively. However, the scores of job demand increased by 0.4. Furthermore, the prevalence of occupational stress increased significantly from 45.8% to 65.5%. @*Conclusion@#After implementing workplace health promotion, the physical and mental health of the staff have been promoted. However, the occupational stress of government officials still need to be improved.

Evaluation on tobacco control strength at or below county-level governments of Zhejiang Province / 中华健康管理学杂志

Objective To evaluate the strength of tobacco control at or below county-level governments of Zhejiang Province,to explore the strategies and measures on tobacco control,and promote a smoke-free government.Methods By multistage stratified random sampling method,12 government ageucies were selected in 4 counties.The information of tobacco control strength and smoke-free environment creation was collected by interview and field observation,and the scores were calculated by using the percentage assignment method.An intercept suuvey was carried out in four counties and there were 405 civil servants under investigation.The data were analyzed by frequency statistic and correlation analysis.Results The smoking rate of civil servants was 17.8％,and the secondhand smoking rate was 61.9％;84.7％ of civil servants adnmitted the harm of smoking and 96.8％ admitted the harm of secondhand smoking.Support for forbidding the cigarette advertisements was highest and increasing the cigarette price was the weakest.The scores of smoke-free environment creation of project counties showed that the average score was 50.60,Zhuji and Luqiao got a maximum score of 57.14,Haiyan got a minimum score of 42.86.The scores of tobacco control strength showed that the average score was 82.35,Zhuji got a maximum score of 92.16,followed by Luqiao,Jiande and Haiyan counties,82.35,80.39 and 74.51 respectively.The scores of tobacco control strength,include policy,political will,capacity,and tobacco control efforts were the highest in Zhuji county.The results of correlation analysis showed that the total score of tobacco control strength had significant association with the score of smoke-free environment creation,smoking rate of civil servants,and approval rate of anti smoking in public places (P＜0.05).Conclusion The overall situation of tobacco control strength at or below county-level governments of Zhejiang province is good,but there is a relative shortage of smoke-free environment creation.Civil servants master the knowledge related to tobacco and support tobacco control policy.We should further promote the construction of smoke-free government.More effective smoking control measures should be conducted in order to raise the strength of tobacco control and finally implement the tobacco control legislation.

System design of Shenzhen public hospitals management system reform / 中华医院管理杂志

Shenzhen public hospitals management system reform implemented the strategies that separated the functions of government agencies from public institutions and separated the hospital management from hospital regulation.The reform also established the medical management center and promoted the autonomous operation management of public hospitals.This articles described the disadvantage of current public hospitals management system,introduced the basic framework and major implementations of Shenzhen public hospitals management system reform program,and analyzed the characteristics and effect of this program.

Medical support in Recovery phase after an earthquake in Bam / 国際保健医療

A major earthquake in Bam, Iran, which occurred on 26th of December,2003, claimed more than 26,000 deaths and most of the medical facilities were destroyed or left inoperative.<br>Although many relief organizations left Bam after the initial stage of the disaster, the necessity of medical support continued with the condition of many victims still desperate. Therefore, medical assistance was provided by HuMA in the recovery phase, and four prefabricated buildings were donated to an Urban Health Center (UHC) for use as a clinic. Essential medical equipment was provided to emergency centers in Bam. In addition, surveillance study was conducted to investigate how environmental health conditions could be improved and effective assistance be given during the recovery phase of the disaster. From monitoring of onsite disaster relief in Bam, it is concluded that the donor agencies should make efforts to continue their activities not only in the acute phase but also in sub-acute and recovery phase and if necessary to cooperate among different agencies according to their capability. Furthermore, it is suggested that close cooperation between NGOs and government agencies would lead to much faster and much more effective disaster relief for victims.