The normative competence in the face of new political actors: a case study of telemedicine / A competência normativa frente aos novos atores políticos: um estudo de caso da telemedicina

Resumo A regulação da prática de telemedicina no Brasil tem se mostrado tortuosa desde seu reconhecimento pela Resolução nº 1.643/2002, do Conselho Federal de Medicina (CFM), havendo questionamentos quanto à competência deste para inserção da prática. Em 2018, o conselho editou nova resolução, mas que foi revogada em função da repercussão negativa. A pandemia de covid-19 pressionou os serviços de saúde de tal forma que o Poder Legislativo Federal foi impelido ao conflito e editou a Lei nº 13.989/2020, permitindo a prática de telemedicina durante o período da crise sanitária. O art. 6º da lei delegou ao CFM a competência para regulação da prática pós-pandemia, acirrando ainda mais as discussões. Este trabalho constitui um estudo de caso sobre a regulação da telemedicina no Brasil, buscando identificar os conflitos jurídicos impostos pela atuação do CFM em substituição ao Poder Legislativo. Utiliza o modelo político de implementação de políticas públicas de William Clune como base da análise, empregando o método da pesquisa documental qualitativa. Conclui-se que a implementação da telemedicina deve considerar as forças políticas em atuação, compreendendo o papel do CFM no processo normativo, para que se obtenha, no texto legal, uma política pública compatível com a realidade e apta a ser implementada.

Abstract The regulation of telemedicine in Brazil has been tortuous since its recognition by the Resolution No. 1,643/2002, of the Federal Council of Medicine (CFM), with issues regarding its competence to insert this practice. In 2018, the council issued a new resolution but it was revoked due to negative repercussions. The covid-19 pandemic put pressure on health services in such a way that the National Congress was pushed into conflict and enacted the Federal Law No. 13,989/2020, which allowed the practice of telemedicine during the period of health crisis. The article 6 of the law delegated the competence to regulate the post-pandemic practice to the CFM, further intensifying the discussions. This work is a case study on the regulation of telemedicine in Brazil, seeking to identify the legal conflicts imposed by the action of CFM in substitution of the Legislative Power. It uses the political model of implementation of public policies by William Clune as the basis for the analysis, using the qualitative documentary research method. In conclusion, the implementation of telemedicine must consider the political forces involved, understanding the CFM's role in the normative process, to obtain, in the legal text, a public policy compatible with reality and capable of being implemented.

Titanium dioxide particles frequently present in face masks intended for general use require regulatory control.

Although titanium dioxide (TiO2) is a suspected human carcinogen when inhaled, fiber-grade TiO2 (nano)particles were demonstrated in synthetic textile fibers of face masks intended for the general public. STEM-EDX analysis on sections of a variety of single use and reusable face masks visualized agglomerated near-spherical TiO2 particles in non-woven fabrics, polyester, polyamide and bi-component fibers. Median sizes of constituent particles ranged from 89 to 184 nm, implying an important fraction of nano-sized particles (< 100 nm). The total TiO2 mass determined by ICP-OES ranged from 791 to 152,345 µg per mask. The estimated TiO2 mass at the fiber surface ranged from 17 to 4394 µg, and systematically exceeded the acceptable exposure level to TiO2 by inhalation (3.6 µg), determined based on a scenario where face masks are worn intensively. No assumptions were made about the likelihood of the release of TiO2 particles itself, since direct measurement of release and inhalation uptake when face masks are worn could not be assessed. The importance of wearing face masks against COVID-19 is unquestionable. Even so, these results urge for in depth research of (nano)technology applications in textiles to avoid possible future consequences caused by a poorly regulated use and to implement regulatory standards phasing out or limiting the amount of TiO2 particles, following the safe-by-design principle.

Citizen journalism reduces the credibility deficit of authoritarian government in risk communication amid COVID-19 outbreaks.

During the outbreak of an epidemic, the success in risk communications to make the public comply with disease preventive measures depends on the public's trust in the government. In this study, we aim to understand how media audiences update their trust in the government during the COVID-19 outbreak depending on the information they received. We conducted an online survey experiment in February 2020 in Hong Kong (n = 1,016) in which respondents were randomly provided with a government press release and an endorsement either from an official or a non-official source. This study shows that the information from a non-official source enhances the credibility of official government messages. Our findings imply that dictators can actually "borrow credibility" from their citizen journalists and even nondemocratic leaders can make themselves more trustworthy to potential dissenters through citizen journalism. Allowing information flow from non-official sources can be a practical measure for governments to address the problem of a credibility deficit during a pandemic.

Unnatural deaths, alcohol bans and curfews: Evidence from a quasi-natural experiment during COVID-19.

BACKGROUND: Coronavirus disease-19 (COVID-19) restrictions, particularly relating to the sale of alcohol and hours of curfew, have had a marked effect on the temporal pattern of unnatural deaths in South Africa. Methods. Death data were collected over 68 weeks from January 2020 to April 2021, together with information on the nature of restrictions (if any) on the sale of alcohol, and hours of curfew. Data were analysed using a simple ordinary least square (OLS) regression model to estimate the relative contribution of restrictions on the sale of alcohol and hours of curfew to the pattern of excess unnatural deaths. Results. The complete restriction on the sale of alcohol resulted in a statistically significant reduction in unnatural deaths regardless of the length of curfew. To the contrary, periods where no or limited restrictions on alcohol were in force had no significant effect, or resulted in significantly increased unnatural deaths. Conclusions. The present study highlights an association between alcohol availability and the number of unnatural deaths and demonstrates the extent to which those deaths might be averted by disrupting the alcohol supply. While this is not a long-term solution to addressing alcohol-related harm, it further raises the importance of implementing evidence-based alcohol control measures.

Fine-grained data reveal segregated mobility networks and opportunities for local containment of COVID-19.

Deriving effective mobility control measures is critical for the control of COVID-19 spreading. In response to the COVID-19 pandemic, many countries and regions implemented travel restrictions and quarantines to reduce human mobility and thus reduce virus transmission. But since human mobility decreased heterogeneously, we lack empirical evidence of the extent to which the reductions in mobility alter the way people from different regions of cities are connected, and what containment policies could complement mobility reductions to conquer the pandemic. Here, we examined individual movements in 21 of the most affected counties in the United States, showing that mobility reduction leads to a segregated place network and alters its relationship with pandemic spread. Our findings suggest localized area-specific policies, such as geo-fencing, as viable alternatives to city-wide lockdown for conquering the pandemic after mobility was reduced.

[MODERN UNIVERSITY: INTRACORPORATE SOCIAL CONTROL OF THE ORGANIZATION OF THE EDUCATIONAL PROCESS IN A PANDEMIC].

The article is devoted to the analysis of the capabilities of a modern university in the field of creating a system of social control and prompt response in a pandemic. The social responsibility of a progressive university for employees and students does not allow crisis situations to be left without proper and timely regulation, despite the stochastic nature of external risks. External challenges should reveal the adaptive potential of a successful educational corporation, create new tools for managing efficiency and internal environment. In this regard, an important element of management is the establishment of continuous feedback, control of important indicators of public assessment for making timely management decisions and optimizing the situation. The article proposes a system of such social control through the organization of monitoring, qualitative research, monographic and express measurements, offers as an example a number of important indicators of perception and assessment of the pandemic situation on the part of the student and teaching community, identifies management accents that are subject to analysis and dynamic control, as well as some solutions, adopted by a modern university to stabilize the situation.

Social control and nursing performance in defense of life in the COVID-19 pandemic.

OBJECTIVE: to reflect on social control in health and the contributions that nursing can make to cope with the COVID-19 pandemic. METHODS: this is a theoretical reflection, elaborated from discussions based on literature and the experience of authors' performance in social control and in Primary Care. It is divided into two topics: the first, related to aspects of institutionalized social control; the second, related to the perspectives for nursing in this space. RESULTS: limits and relevant aspects for nurses' role in social control are presented, contributing to a perspective of praxis in health based on their ethical-political commitment and their technical competence in the coordination and management of care to face the pandemic. FINAL CONSIDERATIONS: nurses' role in social control favors the strengthening of the struggle for the right to life above profits, especially through popular participation in the community context in Primary Care.

Realizing the Value of Nursing Through Innovative Regulation.

Nursing regulation is a specialty area of nursing practice that some may perceive as only performing licensing and disciplinary functions. However, highly effective boards strive to meet their mission of public protection through continuous innovation. This article describes several innovative programs initiated by a board of nursing. Among the examples include regulatory waivers during the pandemic, collaborations with stakeholder organizations, a resource for nursing peer-review committees, and an alternative remediation option for practice breakdown. With strong leadership and committed teams, regulation can both protect the public and play a part in actualizing the value of nursing.

Civil-military cooperation in the early response to the COVID-19 pandemic in six European countries.

BACKGROUND: The COVID-19 pandemic has presented many countries with significant health system and economic challenges. The role of civil-military cooperation in a health crisis of the magnitude presented by COVID-19 remains virtually unexplored. This review aims to detect and identify typologies, if any, of associations between security or military systems and the national response measures during the COVID-19, as adopted by six European countries during the early phase of the outbreak (January to March 2020). METHODS: We designed a structured qualitative literature review (qualitative evidence synthesis), primarily targeting open-source grey literature using a customised Google web search. Our target countries were UK, France, Spain, Italy, Belgium and Sweden. We employed a 'best fit' framework synthesis approach in qualitative analysis of the result records. RESULTS: A total of 277 result records were included in our qualitative synthesis, with an overall search relevance yield of 46%. We identified 19 distinct descriptive categories of civil-military cooperation extending across seven analytical themes. Most prominent themes included how military support was incorporated in the national COVID-19 response, including support to national health systems, military repatriation and evacuation, and support to wider public systems. CONCLUSION: Findings of this review show the significance of military systems in supporting an expansive response during the COVID-19 pandemic, and our proposed methodological approach for capturing military health data in a reproducible manner and providing a comparative view on common types of interventions provided by civil-military cooperation to inform lessons from the use of military capacities during current COVID-19 outbreak.

Socioeconomic Disparities in Community Mobility Reduction and COVID-19 Growth.

OBJECTIVE: To examine differences in community mobility reduction and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes across counties with differing levels of socioeconomic disadvantage. METHODS: The sample included counties in the United States with at least one SARS-CoV-2 case between April 1 and May 15, 2020. Outcomes were growth in SARS-CoV-2 cases, SARS-CoV-2-related deaths, and mobility reduction across three settings: retail/recreation, grocery/pharmacy, and workplace. The main explanatory variable was the social deprivation index (SDI), a composite socioeconomic disadvantage measure. RESULTS: Adjusted differences in outcomes between low-, medium-, and high-SDI counties (defined by tertile) were calculated using linear regression with state-fixed effects. Workplace mobility reduction was 1.75 (95% CI, -2.36 to -1.14; P<.001) and 3.48 percentage points (95% CI, -4.21 to -2.75; P<.001) lower for medium- and high-SDI counties relative to low-SDI counties, respectively. Mobility reductions in the other settings were also significantly lower for higher-SDI counties. In analyses adjusted for SARS-CoV-2 prevalence on April 1, medium- and high-SDI counties had 1.39 (95% CI, 0.85 to 1.93; P<.001) and 2.56 (95% CI, 1.77 to 3.34; P<.001) more SARS-CoV-2 cases/1000 population on May 15 compared with low-SDI counties, respectively. Deaths per capita were also significantly higher for higher-SDI counties. CONCLUSION: Counties with higher social deprivation scores experienced greater growth in SARS-CoV-2 cases and deaths, but reduced mobility at lower rates. These findings are consistent with evidence demonstrating that economically disadvantaged communities have been disproportionately impacted by the coronavirus disease 2019 pandemic. Efforts to socially distance may be more burdensome for these communities, potentially exacerbating disparities in SARS-CoV-2-related outcomes.

Alcohol controls in the aftermath of the COVID-19 pandemic in India: Commentary on Stockwell et al.

The COVID-19 pandemic and subsequent restrictions have resulted in additional challenges for persons with alcohol use disorders as well as for the effective operation of alcohol controls in different societies. The challenges are different in different systems and economies. Crises such as these often provide governments with opportunities to remake systems. We use the recent experience from India, which rapidly shifted between total countrywide prohibition of alcohol and unrestricted sales during this brief period, to argue against using the present crisis to bring about quick changes in alcohol policy in India. Instead, we advocate sustained, incremental pressure to develop and enforce alcohol control measures in public health delivery systems, in addition to demand reduction measures.

New York State Creates New Governance of Commercial Gestational Surrogacy.

United States law recognizes adult reproductive liberty and many states view surrogacy services through that lens. During the COVID-19 pandemic in March, 2020, New York State enacted the Child-Parent Surrogacy Act (CPSA) into law, after feminists and their allies had caused its defeat in 2019. Just before approval of the CPSA, a group of legislators introduced the Alternative Surrogacy Bill (ASB). This article is a case study that examines how the CPSA and not the ASB became law, examining surrogate rights, the best interests of the child, and the ethical issues related to adult donor-conceived and surrogacy born children's rights to information about their ancestry.