A European framework to address psychosocial hazards

Over the past decades, emphasis has been placed on the changing nature of work and new forms of risk that could negatively affect employee health and safety. These are mainly associated with new types of occupational hazards that have been termed psychosocial. Issues such as work-related stress, bullying and harassment are now receiving attention on a global basis and efforts have been made to address them at the workplace level. However, it has been acknowledged that despite developments of policy in this area, there still appear to be a broad science-policy gap and an even broader one between policy and practice. The WHO Network of Collaborating Centers in Occupational Health has, since the late 1990s, been supporting a dedicated program of work on psychosocial factors and work-related stress. Part of the Network's work is currently focusing on the translation of existing knowledge into practice in the area of psychosocial risk management. This program has identified that the optimum way forward lies in the development of a European framework for psychosocial risk management. This framework will serve as the basis for coordination of research activities and preventive action with an emphasis on evidence based interventions and best practice on an international basis.     

The need to address legal ambiguity on conceiving saviour siblings in Malaysia

Conceiving a saviour sibling can be a vital treatment option for a child suffering from a haematological condition. However, the legality of this option may be called into question in countries where there is no clear law or policy regarding the use of preimplantation genetic diagnosis with HLA typing (PGD-HLA typing) or HLA typing alone for this purpose. In Malaysia for instance, there is no legislative framework governing the use of assisted reproductive technology and the only guidance appears to be provided by guidelines issued by the Malaysian Medical Council. In the absence of clear direction, broad guidelines or policy positions taken by such statutory bodies may heavily influence the practice or roll out of certain technologically advanced therapeutic interventions.Previous literature has construed this Guideline narrowly as prohibiting this practice. This paper argues that the narrow and traditional interpretation method used in previous literature is wanting and suggests a more meaningful approach to the interpretation of the Guideline and advocates that this interpretative method should be applied in similar instances involving technologically advanced treatment modalities in other similar situations. Such guidance documents should be interpreted in a manner which takes into account the nature of the technology, its implications and intended use.     

An integrated surveillance network for antimicrobial resistance,India

ObjectiveTo assess the preparedness of veterinary laboratories in India to participate in an integrated antimicrobial resistance surveillance network and to address gaps in provision identified.MethodsThe Indian Council of Medical Research and the Indian Council of Agricultural Research collaborated: (i) to select eight nationally representative veterinary microbiology laboratories whose capacity for participating in an integrated antimicrobial resistance surveillance network would be assessed using a standardized tool; (ii) to identify gaps in provision from the assessment findings; and (iii) to develop a plan, and take the necessary steps to address these gaps in consultation with participating organizations.FindingsThe main gaps in provision identified were: (i) a lack of dedicated funding for antimicrobial resistance surveillance; (ii) the absence of standard guidelines for antimicrobial susceptibility testing; (iii) a shortage of reference strains for testing and quality assurance; and (iv) the absence of mechanisms for sharing data. We addressed these gaps by creating a veterinary standard operating procedure for antimicrobial susceptibility testing, by carrying out a validation exercise to identify problems with implementing the procedure and by conducting capacity-building workshops for veterinary laboratories.ConclusionAntimicrobial resistance surveillance networks depend on the availability of accurate, quality-controlled testing. The challenges identified in creating an integrated surveillance network for India can be overcome by developing a comprehensive plan for improving laboratory capacity in human, veterinary and environmental sectors that is supported by the necessary funds. The study’s findings may provide guidance for other low- and middle-income countries planning to develop a similar network.     

Organ donation, the legal framework

Various factors influence the availability of post-mortem organs. The most important ones (systems to be applied for organ retrieval to be lawful, organizational and financial aspects, information of the public) are discussed. Because there will always remain some shortage of organs, the selection problem of recipients of an organ is also discussed. Its public acceptability and the possibility for scrutiny are pleaded for. Commercialization is rejected as being against the health interest of donor and recipient. A design for a European (legal) framework is given with a view to create optimal chances for a patient in need of an organ. Further cooperation in this field between the European Communities, the Council of Europe and the World Health Organization is recommended, which might result in the drawing up of a Convention on the subject matter.     

A framework for web based geographical information systems for country wide antimicrobial resistance monitoring

Drug resistance—arising from the misuse and overuse of antimicrobial agents—is becoming a major concern as new strains of resistant microorganisms are emerging and fewer new antimicrobial drugs are in development. This paper presents an idea of implementing a Real Time Web Based Information System to monitor changes in the antibiotic sensitivity of microorganisms, located at different areas and time periods based on data collected from accredited laboratories. This pattern can be mapped over geographical map of the area and can be interpreted by clinicians/policy makers. The authors demonstrate the use of such information system using cross sectional data obtained from a nasopharyngeal swab survey of 151 children affected with HIV. Such system can aid physicians to improve the choice of antibiotic to be administered using real time data.     

Designing an international policy and legal framework for the control of emerging infectious diseases: first steps.

As the pace of emergence and reemergence of infectious diseases quickens, the International Health Regulations, which have served as the legal and policy framework of epidemic control for 45 years, are being revised by the World Health Organization (WHO). In this article, we review the recent history, legal construction, and application of these regulations and related international treaty-based sanitary measures, especially the General Agreement on Tariffs and Trade and the Agreement on the Application of Sanitary and Phytosanitary Measures, and the history of applying the regulations in the maritime and aviation industries. This review indicates that revision efforts should address 1) the limited scope of disease syndromes (and reporters of these syndromes) now in the regulations and 2) the mismatch between multisectoral factors causing disease emergence and the single agency (WHO) administering the regulations. The revised regulations should expand the scope of reporting and simultaneously broaden international agency coordination.     

Field studies: legal framework and implementation

The Decree DL.vo no. 194/95 prescribes compliance with correctness and quality criteria in laboratory and field studies when experimental data on pesticides are to be submitted to the regulatory authority. The Decree requires that also field tests should be conducted in compliance with good experimental practice, by facilities officially authorized by the Ministry of Agriculture and Forestry (MIPAF) and regularly inspected to verify that the prescribed requirements have been implemented and the tests are conducted appropriately. The inter-Ministries Decree DM 37529/96 defines good experimental practice criteria and the requirements for authorization of field studies for the evaluation of pesticide efficacy and the collection of samples for subsequent laboratory tests on residues. The MIPAF has established a technical-scientific Committee named "Experimental field studies" (Decrees DM of 29 January 1997 and DM 36947/97) to deal with the complex issue of field studies and to examine the application for authorization made by test facilities performing field studies. On the basis of the work done by the Committee up to 30 April 2001, the MIPAF has issued 62 certificates of compliance to test facilities conducting field studies.     

Building communication networks: international network for the study and prevention of emerging antimicrobial resistance

The global nature of antimicrobial resistance and the failure to control the emergence of resistant organisms demand the implementation of a global surveillance program involving both developed and developing countries. Because of the urgent need for infection control interventions and for rapid distribution of information about emerging organisms, we initiated the International Network for the Study and Prevention of Emerging Antimicrobial Resistance (INSPEAR). Its main objectives are to serve as an early warning system for emerging antimicrobial-drug resistant pathogens, to facilitate rapid distribution of information about emerging multidrug-resistant pathogens to hospitals and public health authorities worldwide, and to serve as a model for the development and implementation of infection control interventions.     

Laboratory capacity to detect antimicrobial resistance, 1998

Emerging mechanisms of antimicrobial resistance have clinical, microbiologic, and infection-control implications for health-care providers. Antimicrobial resistant organisms include Staphylococcus aureus with reduced susceptibility to vancomycin (minimum inhibitory concentration [MIC] > or = 4 microg/mL), including vancomycin intermediate S. aureus (VISA; vancomycin MIC = 8-16 microg/mL) and Enterobacteriaceae that produce extended spectrum beta-lactamases (ESBLS), which result in resistance to a broad range of beta-lactam antibiotics. Detecting VISA and ESBLs-producing gram-negative pathogens can be difficult for clinical microbiology laboratories. Although CDC and the National Committee for Clinical Laboratory Standards (NCCLS) have published screening and confirmatory methods for these pathogens (Tables 1 and 2), the extent of use of these methods is unknown. This report summarizes results from a survey of microbiology laboratories that participate in the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program (EIP) Network to assess the capacity of clinical microbiology laboratories to detect VISA and ESBL-producing pathogens; findings indicate that despite adequate capacity for proper testing, many laboratories do not have appropriate methodology to detect these resistant pathogens.     

A macroeconomic approach to evaluating policies to contain antimicrobial resistance

Background

Antimicrobial resistance (AMR) is, at least in part, associated with high antimicrobial usage and causes increased morbidity, mortality and healthcare costs. However, policies to contain AMR focus on ‘micro’ interventions — typically in one institution (usually a hospital). Furthermore, in evaluating these interventions, economists tend to concentrate on the economic impact to the healthcare sector alone, which may give an incorrect estimation of the social costs and benefits of a disease or intervention.

Methods

This study outlines and illustrates a macroeconomic approach to tackling AMR through the evaluation of three ‘macro’ policies: regulation, permits and taxes/charges. In addition to effects on the healthcare sector, the effect of AMR (and these three policies to contain it) on labour productivity, GDP, household income, government transfers, tax revenues, unemployment, inflation and social services are estimated for the UK using the specific context of methicillin-resistant Staphylococcus aureus (MRSA).

Results

AMR is likely to have a far greater impact on the national economy than would be estimated by concentrating on the healthcare sector alone.

Conclusion

The permit system appears to offer the most efficient ‘solution’ to optimising antimicrobial consumption and, hence, reducing the development of resistance.     

感染控制与抗菌药物管理齐头并进有效遏制细菌耐药

细菌耐药(A MR)已经成为全球公共卫生安全危机,世界卫生组织要求全球各国积极行动,采取系统性措施遏制细菌耐药.此文从耐药细菌发生过程、危险因素和控制策略等方面进行阐述,表明A MR的发生和传播与抗菌药物使用、感染控制息息相关,提示控制A MR必须同时开展抗菌药物临床应用管理和感染控制,两者相互协同才能取得成功.     

常见细菌耐药率调查

目的 为临床医师合理使用抗菌药物提供参考依据，减少耐药菌株的产生。方法 采用回顾性调查的方法，对某院2001年1～12月从临床送检标本中培养分离的1143株病原菌的种类、感染部位及对药物的敏感性进行汇总、分析。结果 G^ 菌245株，占21．43％；G^-菌730株，占63．87％；真菌168株，占14．70％。G^ 菌对苯唑西林、红霉素、阿米卡星、链霉素耐药率较高，G^-杆菌对阿莫西林耐药率高。结论 临床医师要根据药物敏感试验结果正确、合理使用抗菌药物。     

临床分离革兰阴性杆菌对亚胺培南耐药性的变迁

目的调查十堰市革兰阴性杆菌对亚胺培南的耐药率变迁。方法对2009年1月-2010年10月从住院患者各种临床标本中分离的革兰阴性杆菌药敏结果进行回顾性调查。结果共分离出革兰阴性杆菌4658株,其中肠杆菌科细菌占36.7%;非发酵菌占63.3%;分离率占前5位的病原菌分别是铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌;肠杆菌科细菌对亚胺培南的耐药率为0.9%;嗜麦芽寡养单胞菌、洋葱伯克霍尔德菌、铜绿假单胞菌、鲍氏不动杆菌对亚胺培南的耐药率分别为100.0%、62.4%、30.5%、10.1%。结论亚胺培南对肠杆菌科细菌具有很强的体外抗菌活性,对非发酵菌的体外抗菌活性较差,铜绿假单胞菌、鲍氏不动杆菌对亚胺培南的耐药率呈较大幅度上升。     

国际健康影响评价的制度建设：从政策到法律

健康影响评价来源于环境影响评价，“健康的公共政策”运动促进其进一步发展。世界各国的健康影响评价工作主要由公共卫生部门、非政府组织或者国际组织主导，应用于政策、规划和项目三个层面，以系统地评价其带来的潜在健康风险。健康影响评价广泛涉及环境、产业、社会以及城市化等多种领域，是一种多学科、跨部门的影响评价工具。健康影响评价按时间顺序分为前瞻性健康影响评价、回顾性健康影响评价和和即时性健康影响评价。从国际经验来看，健康影响评价立法大致分为三类：一是国家宪法先行，如泰国。二是地方立法先行，如加拿大和澳大利亚。三是环境影响评价立法中包含健康影响评价的条款，这是美国等世界大部分国家通行的一种健康影响评价立法方式。建议我国健康影响评价立法，可以针对国家可持续发展议程创新示范区、高风险行业如火电等行业、重大影响的项目、规划或者政策开展。