The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries—Argentina,Jordan, and South Africa (2017–2018)

IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.     

初次吸毒者与复吸者戒毒期间生活质量比较

目的:了解包头市初次吸毒者与复吸者戒毒期间的生活质量。方法:用QOL-DA2.0量表对戒毒人员的生活质量进行调查。结果:初次吸毒者与复吸者各纬度进行t检验显示躯体功能纬度(t=10.51)、心理功能纬度(t=5.94)、症状及毒副作用纬度(t=6.41)、社会功能纬度(t=10.47)和总分(t=10.48)均有统计学意义(P<0.001),表明戒毒期间初次吸毒者的生活质量高于复吸者。结论:在戒毒期间初次吸毒者的生活质量较复吸者易改善。     

改良泪道探通术治疗新生儿泪囊炎

新牛儿泪囊是婴幼儿常见病，作者应用自制的泪道探通冲洗针对28例新生儿泪囊炎进行了泪道探通冲洗治疗观察．疗效满意．报告如下。     

Obstetrician-gynecologists as primary care physicians: The Oregon experience—Early perceptions regarding the effects of legislative action

OBJECTIVE: Our purpose was to assess whether legislative action influenced the role of obstetrician-gynecologists as primary care physicians. STUDY DESIGN: An observational study was performed on the basis of a questionnaire sent to 410 obstetrician-gynecologists and 27 medical directors of managed-care organizations. RESULTS: Of 67% of obstetrician-gynecologists and 96% of medical directors who responded, there was agreement as to the content of primary care, but a minority (38%) of obstetrician-gynecologists identified themselves as primary care providers. A minority of medical directors (35%) felt that obstetrician-gynecologists should serve in that role. Both obstetrician-gynecologists and medical directors felt that legislation had little impact. CONCLUSION: The reticence of obstetrician-gynecologists to assume a major role in primary care appears to be the result of an uneasiness with accepting a more comprehensive role in patient management and gatekeeping. They appear comfortable with the more traditional roles but feel that training and experience has not prepared them well for the management of more complex medical problems. (Am J Obstet Gynecol 1998;178:1222-8.)     

Comparison of regulations on occupational carcinogens in several industrialized countries

Regulations controlling the manufacture and use of carcinogens in the industrial setting of various countries are examined. In addition, the occupational exposure limits (OEL) of chemicals known or suspected to be carcinogenic in humans are listed, and criteria for the establishment of OELs are discussed. It is also stressed that control measures should not be confined to a few developed countries, and it is hoped that attracting attention to their unevenness will contribute to the implementation of a more efficient primary prevention of cancer.     

The gap between legal rules and practice in advertising non-registered pharmaceutical products : A new method of analysis

The market of non-registered pharmaceutical products is growing fast in number and overall costs, not only in the Netherlands, but also in other European countries. These products often give the impression that the consumer may expect 'an effect as from a drug'. Legally, there is a clear distinction between 'drugs' and 'commodities' in the Netherlands; the question is whether legislation and practice concur. In an investigation we analysed texts of advertisements for non-registered pharmaceutical products published in a popular magazine. A method was developed, based on the legal definition of a drug and jurisprudence, to determine in a qualitative and quantitative way the application of medicinal claims. It transpired that in 65% of the analysed advertisements explicit or implicit claims were made. These products should therefore be subject to drugs legislation. Thus, in the Netherlands there is a gap between legislation and practice in advertising non-registered pharmaceutical products.     

Regulation and selection of patients

During the past decades health legislation and regulation have been on the increase in most industrialized countries. The growing role of government in the provision and financing of health care, the need to correct given aspects of health care and the mandate to protect the underprivileged have been some of the many reasons for increased regulation. Different regulatory approaches and their respective advantages and disadvantages are reviewed in this paper. Particular attention is given to the crucial issue of how to regulate the access to scarce resources and how to cope within a legislative approach with the resulting patient selection.     

提高成人高护班护理心理学教学效果的探讨

针对护理心理学的学科属性和成人高等护理教育的特点,结合8年来护理心理学的教学经验,总结出了教学应强调专业教育和素质教育相结合,努力提高护理心理学教育的整体水平。     

Comments on 'the great legalization debate'

The debate over the legalization of drugs should be encouraged so that an appropriate and acceptable strategy can be formulated. Any policy should be based on the available data which should not be used selectively to establish an ideological position. Ultimately, the policy should be determined by what outcomes are considered to be the most desirable, taking into account both short term and long term objectives.     

四种内生真菌对金线莲无菌苗生长及多糖含量的影响

 目的　研究离体培养时 4种菌根真菌对金线莲生长及多糖含量的影响。方法　纯培养的菌根真菌分别与金线莲无菌苗共生培养 ,观测对金线莲生长和多糖含量的影响。结果　与对照相比 ,接菌根真菌MF1 5菌可使每瓶金线莲干重提高29.3%(P <0.05) ,MF23可使其提高49.5 %(P <0.01);MF18显著增加了金线莲气生根数量达42.9%(P <0.01);4种真菌对金线莲基生根的数量均无显著影响 ;MF15,MF18,MF23和MF24种真菌均可提高金线莲的多糖含量,分别提高93.5%,100%,89.7%和55.1%。结论在离体培养条件下,选择适当的真菌与金线莲共生培养能促进金线莲的生长 ,提高多糖的含量。