The World Health Organization was born as a normative agency: Seventy-five years of global health law under WHO governance.

The World Health Organization (WHO) was born as a normative agency and has looked to global health law to structure collective action to realize global health with justice. Framed by its constitutional authority to act as the directing and coordinating authority on international health, WHO has long been seen as the central actor in the development and implementation of global health law. However, WHO has faced challenges in advancing law to prevent disease and promote health over the past 75 years, with global health law constrained by new health actors, shifting normative frameworks, and soft law diplomacy. These challenges were exacerbated amid the COVID-19 pandemic, as states neglected international legal commitments in national health responses. Yet, global health law reforms are now underway to strengthen WHO governance, signaling a return to lawmaking for global health. Looking back on WHO's 75th anniversary, this article examines the central importance of global health law under WHO governance, reviewing the past successes, missed opportunities, and future hopes for WHO. For WHO to meet its constitutional authority to become the normative agency it was born to be, we offer five proposals to reestablish a WHO fit for purpose: normative instruments, equity and human rights mainstreaming, sustainable financing, One Health, and good governance. Drawing from past struggles, these reforms will require further efforts to revitalize hard law authorities in global health, strengthen WHO leadership across the global governance landscape, uphold equity and rights at the center of global health law, and expand negotiations in global health diplomacy.

The impact of international health worker migration and recruitment on health systems in source countries: Stakeholder perspectives from Colombia, Indonesia, and Jordan.

INTRODUCTION: To address domestic shortages, high-income countries are increasingly recruiting health workers from low- and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan. METHOD: We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature. RESULTS: All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not substantially aggravating existing health workforce availability challenges. This is due to the fact that all three countries are faced with health worker unemployment grounded in unwillingness to work in rural areas and/or overproduction of certain cadres. Respondents, however, pleaded against targeting very experienced and specialised individuals. While observing little harm of health worker migration at present, stakeholders also noted few benefits such as brain gain, describing how various barriers to skill enhancement, return, and reintegration into the health system hamper in practice what may be possible in theory. CONCLUSION: Improved availability of data on health worker migration, including their potential return and reintegration into their country of origin's health system, is urgently necessary to understand and continuously monitor costs and benefits in dynamic national and international health labour markets. Our results imply that potential benefits of migration do not come into being automatically, but need in-country supportive policy and programming, such as favourable reintegration policies or programs targeting engagement of the diaspora.

Counter-contestation in global health governance: The WHO and its member states in emergency settings.

Is the contestation of international institutions always a one-sided process that originates from nation-states? In research to date, there has been little discussion of the extent to which international institutions endure, or even form counter-reactions to national contestation strategies. This study examines the reasons for which WHO engages in counter-contestation vis-à-vis its member states. The paper analyzes the evolution of global health governance by relating a principal-agent approach and contestation considerations. The WHO (agent) wants to reshape the principal-agent relationship with the member states (principals) in order to maximize its autonomy and eventually ensure stronger independence. The WHO pursues its efforts to become more independent on the basis of its own logic of action: To achieve this autonomy from member states, WHO on the one hand uses a strategy we call counter-contestation. On the other hand the member states want their interests to be represented by the WHO and ensure this goal through the logic of action known as contestation. Four international health crises are used to show how different the logics of action are and what effects they have. This study explores how and to what extent WHO actively engages in the political exchange of diplomatic moves and manoeuvres, creating contestation as a mutual game between states and International Organizations.

The Multilevel Dimension of Rules-Based Disease Surveillance beyond the State.

The timely availability of accurate information on disease outbreaks with a potential for cross-border spread is a global public good, allowing for a more effective preparedness and response. An ensuing question for national public health authorities is how such information is attained when it is gathered in territories beyond their jurisdiction. International and regional law norms emerge as an option for providing such a global public good. Therefore, the current article examines existing legal frameworks for ad hoc disease surveillance beyond the state at the international and regional levels, namely: the World Health Organization's International Health Regulations of 2005; Regulation (EC) No. 851/2004 and Decision No. 1082/2013/EU in the European Union; the Statute of the Africa Centres for Disease Control and Prevention within the African Union; and the Protocol from the Economic Community of West African States, which created the West African Health Organisation. The comparison offers broader insights on the role of rules as a vehicle for securing prompt and reliable information of new and re-emerging communicable diseases, such as Covid-19.

[National Nursing Consensus on management of severe traumatic brain injury in children]. / Consenso Nacional de Enfermería sobre el manejo del niño con lesión cerebral por traumatismo de cráneo grave.

The nursing professional who treats critically ill children with cerebral injury is a key element within the pediatric intensive care team, since, through exhaustive assessment, plans nursing care in an integral manner aimed at the child and the family, and plays an essential role in the care of patients mainly at the hospital level (as well as at home). Therefore, the role played by nursing in the care of children with severe brain trauma is crucial. This guide offers nursing recommendations on neurocritical care, focusing on a systemic view based on nursing diagnoses according to the North American Nursing Diagnosis Association.

El profesional de enfermería que atiende a niños críticamente enfermos con lesión cerebral es un miembro clave dentro del equipo intensivista pediátrico, ya que, mediante la evaluación exhaustiva, planifica cuidados de enfermería de manera integral dirigidos al niño y a la familia. La enfermería como una profesión que entiende la salud de la persona humana desde una mirada integral cumple un rol esencial (indispensable) en el cuidado de los pacientes, principalmente, a nivel hospitalario (como domiciliario). Por ende, el rol que juega la enfermería en la atención de un niño con traumatismo encéfalocraneano grave es crucial en la gestión del cuidado infantil. Esta guía ofrece recomendaciones de enfermería sobre los cuidados neurocríticos focalizando una mirada sistémica basada en diagnósticos de enfermería según la Asociación Americana de Diagnósticos de Enfermería.

Sentinel Node in Oral Cancer: The Nuclear Medicine Aspects. A Survey from the Sentinel European Node Trial.

PURPOSE: Nuclear imaging plays a crucial role in lymphatic mapping of oral cancer. This evaluation represents a subanalysis of the original multicenter SENT trial data set, involving 434 patients with T1-T2, N0, and M0 oral squamous cell carcinoma. The impact of acquisition techniques, tracer injection timing relative to surgery, and causes of false-negative rate were assessed. METHODS: Three to 24 hours before surgery, all patients received a dose of Tc-nanocolloid (10-175 MBq), followed by lymphoscintigraphy. According to institutional protocols, all patients underwent preoperative dynamic/static scan and/or SPECT/CT. RESULTS: Lymphoscintigraphy identified 723 lymphatic basins. 1398 sentinel lymph nodes (SNs) were biopsied (3.2 SN per patient; range, 1-10). Dynamic scan allowed the differentiation of sentinel nodes from second tier lymph nodes. SPECT/CT allowed more accurate anatomical localization and estimated SN depth more efficiently. After pathological examination, 9.9% of the SN excised (138 of 1398 SNs) showed metastases. The first neck level (NL) containing SN+ was NL I in 28.6%, NL IIa in 44.8%, NL IIb in 2.8%, NL III in 17.1%, and NL IV in 6.7% of positive patients. Approximately 96% of positive SNs were localized in the first and second lymphatic basin visualized using lymphoscintigraphy. After neck dissection, the SN+ was the only lymph node containing metastasis in approximately 80% of patients. CONCLUSIONS: Best results were observed using a dynamic scan in combination with SPECT/CT. A shorter interval between tracer injection, imaging, and surgery resulted in a lower false-negative rate. At least 2 NLs have to be harvested, as this may increase the detection of lymphatic metastases.

Sentinel node biopsy versus elective neck dissection. Which is more cost-effective? A prospective observational study.

OBJECTIVE: The aim of this prospective not randomized observational study was to determine the costs and outcomes of sentinel lymph node biopsy (SNB) vs elective neck dissection (END) among patients with early oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Seventy-three consecutive patients were divided according to neck staging method. Patients took the decision themselves after receiving detailed information of both suggested treatment tools. False negative (FN) and negative predictive value (NPV) were assessed. Log-rank test was used to compare disease-free survival (DFS) and overall survival (OS). Only direct costs were analysed. Cost information derived from volumes for hospital stay, surgery and neck outcome were obtained from an internal database of tertiary health care center. RESULTS: Thirty-two patients underwent SNB and 41 underwent an END (levels I-III). Average follow-up time was 48.2 months (range 7-80). Five neck recurrences were recorded in the SNB group (range 11-21). Seven neck recurrences occurred in the END group (range 9-16). No significant differences were found in DFS or OS. True negative patients in SNB group incurred in 42% less costs than END group. FN regardless of radiotherapy, was also lower in the SNB group. However, pN+ patients generated 23% more costs in the SNB group. CONCLUSION: In this not randomized observational study with an average follow-up period of 48.2 months, SNB appear to confer less cost than END, with similar prognosis.

Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer.

PURPOSE: Optimum management of the N0 neck is unresolved in oral cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis. The object of this study was to establish whether the technique was both reliable in staging the N0 neck and a safe oncological procedure in patients with early-stage oral squamous cell carcinoma. METHODS: An European Organisation for Research and Treatment of Cancer-approved prospective, observational study commenced in 2005. Fourteen European centres recruited 415 patients with radiologically staged T1-T2N0 squamous cell carcinoma. SNB was undertaken with an average of 3.2 nodes removed per patient. Patients were excluded if the sentinel node (SN) could not be identified. A positive SN led to a neck dissection within 3 weeks. Analysis was performed at 3-year follow-up. RESULTS: An SN was found in 99.5% of cases. Positive SNs were found in 23% (94 in 415). A false-negative result occurred in 14% (15 in 109) of patients, of whom eight were subsequently rescued by salvage therapy. Recurrence after a positive SNB and subsequent neck dissection occurred in 22 patients, of which 16 (73%) were in the neck and just six patients were rescued. Only minor complications (3%) were reported following SNB. Disease-specific survival was 94%. The sensitivity of SNB was 86% and the negative predictive value 95%. CONCLUSION: These data show that SNB is a reliable and safe oncological technique for staging the clinically N0 neck in patients with T1 and T2 oral cancer. EORTC Protocol 24021: Sentinel Node Biopsy in the Management of Oral and Oropharyngeal Squamous Cell Carcinoma.

Implications of a positive sentinel node in oral squamous cell carcinoma.

BACKGROUND: The role of sentinel node biopsy in head and neck cancer is currently being explored. Patients with positive sentinel nodes were investigated to establish if additional metastases were present in the neck, their distribution, and their impact on outcome. METHODS: In all, 109 patients (n = 109) from 15 European centers, with cT1/2,N0 tumors, and a positive sentinel lymph node were identified. Kaplan-Meier and univariate and multivariate logistic regression analysis were used to identify variables that predicted for additional positive nodes and their position within the neck. RESULTS: A total of 122 neck dissections were performed in 109 patients. Additional positive nodes were found in 34.4% of cases (42/122: 18 same, 21 adjacent, and 3 nonadjacent neck level). Additional nodes, especially if outside the sentinel node basin, had an impact on outcome. CONCLUSIONS: The results are preliminary but suggest that both the number and the position of positive sentinel nodes may identify different prognostic groups that may allow further tailoring of management plans.

Oroantral communications. A retrospective analysis

Objetive. To analyze characteristics, clinical evolution and surgical techniques of oroantral communication(OAC).Study Design. We included all patients operated at the University Central Hospital (Oviedo, Spain) between 1996and 2007. The variables assessed were age, sex, medical history, OAC size, sinus disease, surgical technique, durationof hospitalization and post-surgical evolution.Results. We analyzed 12 patients (7 men and 5 women) with an average age of 47.5 years. The most frequent causeof oroantral communication was the extraction of the first upper molar. The average size of fistula was 0.9 cm.Buccal flap repair was used in 7 patients, palatal rotation-advancement flap in 4 patients and buccal fat pad in onlyone patient. Suture dehiscence was observed in one patient treated with a palatal flap, but no additional surgerywas required. Three OAC recurred; all of them following a buccal flap procedure. All recurrences spontaneouslyclosed between one and four months following the procedure.Conclusion. OACs are rare complications and treatment should be individualized to avoid further complications (AU)

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Primary de novo intraosseous carcinoma: Report of a new case

Primary de novo intraosseous carcinoma of the jaws has been rarely reported. We present a new case of this unusualtumour and discuss its histopathological and clinical aspects. The subject was a 76-year-old man who wasseen due to complaints of pain and the presence of gingival changes in the left mandible. A panoramic radiographand computed tomography revealed a large mandibular radiolucency. A segmentary mandibulectomy was performedand histopathologic examination proved that the tumour was an intraosseous squamous cell carcinoma.Surgeons should appreciate the aggressiveness of this tumour, despite adequate surgical treatment (AU)

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Use of cultured human epithelium for coverage: A defect of radial forearmfree flap donor site

The radial forearm free flap has been popular in many areas of reconstructive surgery. Despite the many attributesof this flap in maxillofacial reconstruction, one of the disadvantages has been the morbidity of the donor site. Allogeneiccultured epidermis has been successfully applied on large second degree burns and on chronic leg ulcers.Autologous human keratinocytes and fibroblast equivalents can be cultured in-vitro from a small skin sample inorder to produce a sufficient amount of epithelial autografts to cover the large defects of third-degree burn wounds.Interestingly, transplanted cultured epidermis retains characteristics of the original donor site. We report a case ofa patient who underwent skin replacement by cultured epithelial autograft after wound breakdown occurred in theforearm donor site during the early postoperative period. This method could represent an auspicious alternativeto conventional grafting methods for forearm free flap reconstruction. To the best of our knowledge, skin replacementby cultured epithelial autografts in this region has not been extensively described in the literature (AU)

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Oroantral communications. A retrospective analysis.

OBJECTIVE: To analyze characteristics, clinical evolution and surgical techniques of oroantral communication (OAC). STUDY DESIGN: We included all patients operated at the University Central Hospital (Oviedo, Spain) between 1996 and 2007. The variables assessed were age, sex, medical history, OAC size, sinus disease, surgical technique, duration of hospitalization and post-surgical evolution. RESULTS: We analyzed 12 patients (7 men and 5 women) with an average age of 47.5 years. The most frequent cause of oroantral communication was the extraction of the first upper molar. The average size of fistula was 0.9 cm. Buccal flap repair was used in 7 patients, palatal rotation-advancement flap in 4 patients and buccal fat pad in only one patient. Suture dehiscence was observed in one patient treated with a palatal flap, but no additional surgery was required. Three OAC recurred; all of them following a buccal flap procedure. All recurrences spontaneously closed between one and four months following the procedure. CONCLUSIONS: OACs are rare complications and treatment should be individualized to avoid further complications.

Use of cultured human epithelium for coverage: a defect of radial forearm free flap donor site.

The radial forearm free flap has been popular in many areas of reconstructive surgery. Despite the many attributes of this flap in maxillofacial reconstruction, one of the disadvantages has been the morbidity of the donor site. Allogeneic cultured epidermis has been successfully applied on large second degree burns and on chronic leg ulcers. Autologous human keratinocytes and fibroblast equivalents can be cultured in-vitro from a small skin sample in order to produce a sufficient amount of epithelial autografts to cover the large defects of third-degree burn wounds. Interestingly, transplanted cultured epidermis retains characteristics of the original donor site. We report a case of a patient who underwent skin replacement by cultured epithelial autograft after wound breakdown occurred in the forearm donor site during the early postoperative period. This method could represent an auspicious alternative to conventional grafting methods for forearm free flap reconstruction. To the best of our knowledge, skin replacement by cultured epithelial autografts in this region has not been extensively described in the literature.

Primary de novo intraosseous carcinoma: report of a new case.

Primary de novo intraosseous carcinoma of the jaws has been rarely reported. We present a new case of this unusual tumour and discuss its histopathological and clinical aspects. The subject was a 76-year-old man who was seen due to complaints of pain and the presence of gingival changes in the left mandible. A panoramic radiograph and computed tomography revealed a large mandibular radiolucency. A segmentary mandibulectomy was performed and histopathologic examination proved that the tumour was an intraosseous squamous cell carcinoma. Surgeons should appreciate the aggressiveness of this tumour, despite adequate surgical treatment.