Road not taken: lessons to be learned from Queen v. Gillett

Following the decision in the Gillet Case it may no longer be safe to rely on the Austroads guidelines when considering fitness to drive. This paper examines the case and its implications. Although the Guidelines claimed '... the identification and application of world best-practice...', they were disregarded by the court in Gillet. Both expert witnesses testified that on disclosure of epilepsy the accused would have been endorsed as fit for a licence application to the Roads & Traffic Authority, on the basis of 10 years of only nocturnal seizures, in accordance with the guidelines. The Court rejected this evidence and interpreted failure to disclose epilepsy as recognition of perceived risk and the previously undiagnosed sleep apnoea as the basis for that risk, despite being diagnosed after the accident. There needs to be greater certainty in the application of the guidelines, with legislative intervention and licenses should display a bold statement advising drivers of their responsibility to notify authorities of illnesses that could potentially affect driving.     

Measurements of occupational exposure to switched gradient and spatially-varying magnetic fields in areas adjacent to 1.5 T clinical MRI systems

PURPOSE: To determine if magnetic field exposure close to two clinical 1.5 T magnetic resonance imaging (MRI) scanners during image acquisition and when moving in the spatially-varying static magnetic field is compliant with European Union (EU) Directive 2004/40/EC (the Directive). MATERIALS AND METHODS: Using commercially available equipment we measured the magnetic flux density around the scanners during two clinical pulse sequences. The data was compared with frequency-dependent limits that will limit occupational exposure following transposition of the Directive into national law in 2008. The static magnetic field was measured around the scanners and the exposure from movement within this field was simulated. RESULTS: The whole-body exposure experienced when standing close to the face of the magnet exceeds the limits in the Directive on the two scanners tested during clinical sequences. Simulation of movement toward the scanner shows that speeds must be restricted to 1/5 of normal walking speed to comply with the Directive. CONCLUSION: EU Directive 2004/40/EC will have a major impact on the current use and future development of MRI due to limitations on exposure to time-varying gradient fields and movement within the spatially-varying static field. This will make interventional work impossible and routine MRI use impracticable in Europe.     

生物医学研究中的动物福利立法问题探讨

生物医学研究中伤害、虐待实验动物的问题日益突出。我国实验动物福利立法的现状显示,我国动物保护立法的范围窄,数量少;针对实验动物保护的立法层次较低,受地域限制;实验动物管理标准与国际公认的动物福利标准还有很大差距。因此,从理论研究上、观念转变上、立法实践上均应加强研究,推动动物福利立法的进程。     

Impact of Canadian federal methamphetamine precursor and essential chemical regulations on methamphetamine-related acute-care hospital admissions

Background

In response to its domestic methamphetamine problems and an emerging international consensus that methamphetamine precursor and essential chemicals should be controlled, Canada regulated its import/export of ephedrine and pseudoephedrine (precursor chemicals) in January 2003, its domestic distribution of those chemicals in July 2003, and its import/export and manufacturing of essential chemicals (e.g., toluene) in January 2004. This study examines the regulations’ impact on the problem of methamphetamine-related hospital admissions in Canada.

Methods

ARIMA-based intervention time-series analysis was used to assess impacts on monthly counts of Canada's methamphetamine-related acute-care hospital admissions (04/1996 to 03/2005). Cocaine-, heroin/opioid-, and alcohol-related hospital admissions were examined as quasi-control time-series.

Results

No impact was found for the January 2003 regulation. The July 2003 and January 2004 regulations were associated with 20% and 21% increases, respectively, in methamphetamine-related admissions. No impacts on the quasi-control time-series were found.

Conclusions

This study indicates that Canada's regulations were not associated with reductions in methamphetamine-related hospital admissions. The January 2003 regulation's focus on imports/exports rather than domestic distribution may help explain its lack of impact. In contrast, the two other regulations had salient domestic foci – domestic precursor sales (July 2003) and domestic essential chemical manufacturing (January 2004). Both regulations, however, were associated with increases in admissions, rather than declines. Government reports indicate that a shift in methamphetamine production, from smaller-scale operators to more sophisticated crime organizations (groups better able to circumvent the regulations), occurred around the times of the regulations. Such a shift could increase supply and possibly admissions.     

Orphan drug legislation: lessons for neglected tropical diseases

In the last 20 years, orphan drug legislation (ODL) has been adopted in several countries around the world (USA, Japan, Australia, and the European Union) and has successfully promoted R&D investments to develop new pharmaceutical products for the treatment of rare diseases. Without these incentives, many life-saving new drugs would have not been developed and produced. For economic reasons, the development of medicines for the treatment of diseases prevalent in the developing world (or tropical diseases) is lagging behind. Among several factors, the low average per-capita income makes pharmaceutical markets in developing countries appear relatively unprofitable and therefore unattractive for R&D-oriented companies. The case of ODL may offer some useful insights and perspectives for the fight against neglected tropical diseases. First, the measures used in ODL may also be effective in boosting R&D for neglected tropical diseases, if appropriately adapted to this market. Second, small-sized companies, which have played a successful role in the development of orphan drugs for rare diseases, may also represent a good business strategy for the case of tropical diseases.     

质量文化建设与医疗质量管理

结合对医疗质量管理研究实践,提出对医疗行为和质量管理特征的再认识,阐述了质量文化建设和法人理念的关系;提出质量立法、提高现代标准意识的重要性;对转变职能管理为流程导向管理做了深入探讨,并附典型案例评析.     

我国居民对执业药师立法支持度现状及其影响因素:一项全国范围大样本横断面研究

目的:了解中国居民对执业药师立法的支持度及其影响因素。方法:通过问卷对抽取的120个城市的居民进行横断面研究,采用多重线性回归分析居民对执业药师立法意愿得分的相关因素。结果:中国居民对于执业药师立法支持度平均得分为69.04分。本科及以上学历(β＝0.04)、轻度焦虑(β＝0.03)、重度压力(β＝0.05)居民对执业药师立法支持度较高,P均＜0.01;中重度抑郁(β＝－0.02,P＜0.01)居民对执业药师立法支持度较低。家庭健康状况(β＝0.30)、自我健康感觉(β＝0.25)、自我管理能力(β＝0.13)、健康素养(β＝0.12)和领悟社会支持(β＝0.09)均对居民执业药师立法支持度得分产生显著的正向影响(P＜0.01)。结论:文化程度、焦虑、压力、抑郁、家庭健康状况、自我健康感觉、自我管理能力、健康素养和社会支持均是影响居民对执业药师立法态度的主要因素。     

上海市闵行区职业卫生服务结合健康教育的研究

目的：为评价《上海市职业病防治条例》实施一年多后的效果。方法：以闵行区３０７家接触有毒有害工业企业为调查对象，同时开展对企业领导、工人和基层卫生人员加强职业卫生专业知识培训以及《条例》内容的学习。结果：实施前后，粉尘、毒物、物理因素的合格率分别上升到８０．６８％、７８．８５％和５７．１４％，接触这些有害因素职工的体检率分别上升到９６．２８％、９７．５７％和９４．５４％，对职业卫生法规的了解上升比例达４０．７９％，比实施前有统计学显著差别。结论：《条例》实施后职业健康教育的加强对职业卫生工作质量的提高有非常重要的意义