Protecting participants in health research: The South African Material Transfer Agreement.

The need to transfer human biological materials (HBMs) across national boundaries has become increasingly important in view of increased biobank and commercial activities globally. In light of South Africa (SA)'s history of colonisation and racial discrimination, coupled with well-known instances of exploitation of research participants in the developing world, it is critical that the management of HBMs from and to other jurisdictions is explored and regulated. Material transfer agreements (MTAs) represent an important point of departure in such a process. This article explores the need for a uniform MTA in SA and discusses some aspects of the recently gazetted national MTA, which provides a framework that can serve as a safeguard for cross-border transfer of HBMs in the absence of the National Health Act's chapter 8 regulations in this regard.

[Data protection, radiation protection and copyright: Problems of transferring results in assessment practice]. / Datenschutz, Strahlenschutz und Urheberrecht: Probleme der Befundübermittlung in der Begutachtungspraxis.

In Germany, the medical assessor is subject to the law on contracts for work and services ("Werksvertragsrecht"). When a medical expert assesses a subject on behalf of a third party, there is no contractual relationship between them. In the field of private insurance law and in social insurance law, the medical expert is faced with various procedural requirements. Failing to meet these legal requirements often makes the assessment difficult or even impossible. The transfer of radiographs to the medical assessor is dealt with in the German X-ray regulations ("Röntgenverordnung"). The assessor, who is without doubt an examining doctor, has the right to have the radiographs temporarily made available (§ 28 et al.). Passing on the radiographs is all the more appropriate if by doing so additional X-ray examinations can be avoided. The right of access to medical data in the social security law, apart from X-ray regulations, is regulated by German Civil Code (BGB) § 810 and German Basic Law section 1 paragraph 1 in connection with section 2 paragraph 1 ("§ 810 BGB; Art. 1 Abs. 1, Art. 2 Abs. 1 GG"). In the absence of third party interest worthy of protection, the right of access to assessment records has to be granted to the subject, who will then authorize the examining medical expert to exercise this right. In private insurance law, only the private health insurance has its regulation concerning obtaining information about treatment or the access to medical assessments. In other types of insurance the medical assessor's right of access to medical examination data and/or the basis for medical findings can only be derived from secondary obligations as part of the insurance contract or directly from general constitutional personal rights.

Mortalidad reducible como indicador de efectividad de los servicios sanitarios en España antes y después de las transferencias / Amenable mortality as indicator of effectiveness of health care services in Spain before and after transferences

Objetivo. Describir la evolución de la mortalidad reducible por acción de los servicios sanitarios (MRASS) en España y evaluar si las transferencias sanitarias han supuesto algún cambio significativo. Métodos. La MRASS se definió a partir de una lista de causas utilizada en otros estudios. Se analizan tasas de MRASS ajustadas por edad y sexo en los períodos 1999-2001 y 2006-2008, justo antes y 5 años tras culminar el proceso de transferencias. Resultados. La MRASS representó el 24% de las defunciones en personas de 0-74 años. Descendió entre ambos períodos en mayor medida (19,4%) que el resto de causas (14,5%). El grupo de causas que más descendieron fueron: cardiopatía isquémica (28,0%), resto de enfermedades vasculares (26,8%), enfermedades quirúrgicas y errores médico-quirúrgicos (25,9%) y diabetes (22,5%). Aunque existieron diferencias entre comunidades autónomas (CCAA), no se apreció que estas diferencias ni la evolución de la MRASS se relacionaran con las transferencias. Navarra y Madrid presentaron las menores tasas de MRASS y Canarias, Asturias, Andalucía, Ceuta y Melilla, las mayores. Baleares fue la CCAA donde más disminuyó la MRASS. Conclusiones. La MRASS representa una importante proporción de la experiencia de mortalidad de personas de 0-74 años. Ha descendido en todas las CCAA, y aunque hay grandes diferencias entre ellas, no parece que el proceso de transferencias sanitarias influyera en su evolución en el período estudiado. Pese a limitaciones, la MRASS es un indicador que se debe considerar para monitorizar y detectar debilidades en la efectividad de los sistemas asistenciales(AU)

Objective. To describe the evolution of amenable mortality (MRASS) in Spain and to evaluate differences in trend patterns before and after health care services were tranferred to local authorities. Methods. MRASS was defined from a list of causes of death used in other studies. We analyzed the change in sex-age-standardized death rates of MRASS in two periods: 1999-2001 and 2006-2008, just before, and five years after, the health care transfers were completed. Results. MRASS represented 24% of deaths in persons from 0 to 74 years old. MRASS has seen a reduction (19.4%) between the two periods over and above other causes of mortality (14.5%). The group of causes of mortality which showed most reduction: ischemic heart disease (28%), other vascular disease (27%), surgical conditions and surgical-medical errors (26%), and diabetes (22.5%). Although there were differences between the districts, health care transfers have not created significant variations in MRASS. Navarra and Madrid showed lower rates of MRASS, and the Canary Islands, Asturias, Andalusia, Ceuta and Melilla had higher rates. The Balearic Islands showed the greatest reduction in MRASS. Conclusions. MRASS constitutes an important proportion of trends of mortality in persons between 0-74 years. It has declined in all districts. Even though there were large differences between districts, there does not appear to be any direct influence due to health care transfer in amenable mortality trends. In spite of limitations, MRASS is an indicator to be considered when monitoring and detecting weaknesses in the effectiveness of health care systems(AU)

Service user involvement in risk assessment and management: the Transition Inventory.

BACKGROUND: Drawing on self-prediction theory and the positive benefits of increasing health service user participation in risk assessments, the Transition Inventory (TI) was developed. It is an aid to the assessment of areas that people anticipate will be of difficulty in the next stage of transition, for example from open hospital to the community. AIMS: The aim of this paper is to determine reliability and convergent/discriminant validity data for the TI and its subscales, including behavioral impulsivity, social pressure, substance misuse, financial/employment, leisure, negative affect, interpersonal and family concerns and social alienation. METHODS: Eighty-eight male offenders coming towards the end of a period of imprisonment were asked to complete the TI. Their results were compared with the staff-rated Measures of Criminal Attitudes and Associates (MCAA) scale, alcohol blame and causation of crime items. Comparisons with the MCAA's antisocial intent scale, which is a future-orientated scale, and the associates scale allowed for convergent/discriminant validity to be examined with TI scales. With a community offender sample, TI results were used to predict researcher ratings. RESULTS: The TI scales demonstrated adequate internal consistency. Overall, the MCAA's antisocial intent scale had higher correlations with the TI than with a nonfuture-orientated scale. TI scales also demonstrated convergent validity with other measures and preliminary predictive validity with researcher ratings. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The TI provides a way to increase service user involvement in the assessments that determine when and how they transfer to settings where they will have more independence.

Psychiatric disorders among detained youths: a comparison of youths processed in juvenile court and adult criminal court.

OBJECTIVE: All 50 states and the District of Columbia have legal mechanisms to try juveniles as adults in criminal court. This study examined the prevalence of psychiatric disorders among youths transferred to adult criminal court and youths processed in the juvenile court. METHODS: Participants were a stratified random sample of 1,829 youths, ten to 18 years of age, who were arrested and detained in Chicago. Data from version 2.3 of the Diagnostic Interview Schedule for Children are presented for 1,715 youths, 13 to 18 years of age, including 1,440 youths processed in juvenile court and 275 youths processed in adult criminal court. RESULTS: Males, African Americans, Hispanics, and older youths had greater odds of being processed in adult criminal court than females, non-Hispanic whites, and younger youths, even after the analyses controlled for felony-level violent crime. Among youths processed in adult criminal court, 68% had at least one psychiatric disorder and 43% had two or more types of disorders. Prevalence rates and the number of comorbid types of disorders were not significantly different between youths processed in adult criminal court and those processed in juvenile court. Among youths processed in adult criminal court, those sentenced to prison had significantly greater odds than those receiving a less severe sentence of having a disruptive behavior disorder, a substance use disorder, or comorbid affective and anxiety disorders. CONCLUSIONS: Community and correctional systems must be prepared to provide psychiatric services to youths transferred to adult criminal court and especially to youths sentenced to prison. When developing and implementing services, psychiatric service providers must also consider the disproportionate representation of individuals from racial-ethnic minority groups in the transfer process.

Inter-facility transfer of patient information before and after HIPAA privacy measures.

OBJECTIVES: The study objectives were (1) to test whether interfacility communication of health information at the time of patient transfer changed as a result of implementation of US privacy protection measures (HIPAA) in April 2003, and (2) to examine patient, transfer, and illness characteristics correlated with interfacility transfer document completion. DESIGN: Observational study. PARTICIPANTS AND SETTING: Individuals transferred between a 514-bed urban nursing home and a 1171-bed academic hospital in New York City. MEASUREMENTS: Research staff reviewed medical records of patients transferred both ways between nursing home and hospital, examining interfacility transfer documents for 12 items important for continuity of care. Transfer document completeness equaled the percentage of items recorded and legible in transfer documents. Transfers were classified by direction (nursing home-to-hospital [NH-to-H] or hospital-to-nursing home [H-to-NH]), urgency (urgent or not), timing (weekday 9 am to 6 pm or other), and by whether they occurred before 12 am April 14, 2003 (pre-HIPAA), or after (post-HIPAA). RESULTS: Seventy-eight nursing home residents experienced 100 hospital admissions. NH-to-H transfer documents were more complete than H-to-NH documents (86.7% vs 69.0%; P = .002). There were no significant differences between content of transfer documents between pre- and post-HIPAA transfers in either direction of transfer, with and without controlling for patient and illness characteristics. Older age, female gender, dementia diagnosis, shorter duration of nursing home residence, and off-hours hospital transfer were associated with less complete NH-to-H transfer documents, and shorter hospital length of stay was associated with less complete H-to-NH transfer documents. CONCLUSION: There was no change in written health information communicated during patient transfer between an urban nursing home and an academic hospital before and after HIPAA privacy protection measures were implemented. This suggests that the rule's intent to not restrict the sharing of information needed to treat patients is being followed by providers at these sites in the situation of interfacility patient transfer.

Transfer of radiographs.

Dental radiographs constitute 25% of all exposures made in the UK and therefore in terms of radiation protection the population risk is not insignificant. Paragraph 11 of The Core of Knowledge in the Schedule to the Protection of persons undergoing medical examination or treatment (POPUMET) regulations specifies the importance of using existing radiological information, whether films or reports, about a patient. The Guidance Notes recommends that in order to reduce unnecessary radiographic examinations, there should be ready availability of previous radiographs. Access to previous radiographs is also commended by the National Radiological Practice Board (NRPB) and the Royal College of Radiologists (PCR) in their report on Patient Dose Reduction in Diagnostic Radiology. In addition to dose limitation, patient care is improved.