Legal themes concerning obesity regulation in the United States: Theory and practice

Despite national health objectives to reduce the incidence of obesity to 15% of the population by 2010, public health data suggest that the incidence of obesity in the United States is actually increasing. The U.S. recognizes that it (like other industrialized countries) faces an epidemic of obesity and related health conditions. How can U.S. jurisdictions (federal, state, and local) and the private sector respond to this epidemic through laws and policies that are directly or indirectly designed to address obesity? This article analyzes the theoretical and practical roles of law as a tool to curb obesity in the U.S. It proffers ten major legal themes to address obesity among the U.S. population, including: (1) use of incentives to encourage healthier behaviors; (2) use of financial disincentives to discourage unhealthy behaviors; (3) requirements to improve food quality, diversity, or availability; (4) compensation for injured persons seeking recourse; (5) restriction of access to unhealthy foods; (6) regulations aimed at influencing consumer choices; (7) control of marketing and advertising; (8) creation of communities that support healthy lifestyles; (9) physical education/fitness requirements; and (10) insurance coverage mandates

<資料>広島県における医療経営変革の実態

本研究は, 病院管理責任者各々の病院経営に対する現状認識の共通性やズレ, 各部門の病院経営改善への取り組みの実態を把握し分析することを目的に実施した。調査協力を得られた施設は, 広島県下100床以上の一般病院111施設中15施設(13.3%)で, 経営指標の回答のあった13施設のうち, 医業収支比率100%未満の病院は4施設, 100%以上の病院は9施設であった。病院が経営改善に向けて実行した新規事業の内容は, 介護保健の施行を見据えた, 療養型病床群への転換・拡充, 在宅介護支援センターの新設, 訪問看護ステーションの新設, 病院内のアメニティーの充実などであった。病院経営に関連する入院患者数・外来患者数の変化を認識している管理責任者は事務部長, 病院長, 看護部長の順であった。病院経営・医療サービスに向けて病院全体で取り組む中長期目標, 最優先取り組み, 次年度目標に対しても, 各々の部門の管理責任者3者が一致していたのは3者ともに回答のあった13施設中4施設のみであった。今回の調査より, 病院経営に対する管理責任者の認識の不一致と職務内容や職能上の立場が優先する病院組織の実態の一部が明らかになった。The purpose of this study is to understand and analyse common or different awareness of the actual conditions of hospital administration among the management of hospitals, and the present state of approaches of each department to improvement of hospital administration. The institutions that supported this research are 15 out of the 111 general hospitals with more than 100 beds in them in Hiroshima Prefecture (13.3%). Among 13 institutions that have provided data to the management index, the hospitals under 100% revenue and expenditure rate of medical practice are 4,and the institutions more than 100% are 9. The contents of new projects that the hospitals have carried out toward improving their administration include, consideration of changes in the administration of nursing care insurance, changing into or enlarging into convalescent hospitals, the establishment of home care support centers, founding visiting care stations and upgrading amenities in hospitals. With regard to levels of awareness of the effect of changing numbers of inpatient and outpatient on hospital administration, head office directors are first, directors of hospitals second and then directors of nursing. he number of institutions where all three directors of departments gave answers is 13. In four out of the 13 institutions, the three directors all agree on medium and long term aims, the efforts to be given highest priorities and the aim for the next year of their hospital administration/medical service. This research shows clearly differing levels of awareness, which very depending on differing job specifications and professional functions within the actual circumstances of hospital systems.国立情報学研究所で電子

Estimating health workforce needs for antiretroviral therapy in resource-limited settings

BACKGROUND: Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. METHODS: We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. RESULTS: We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1–2 physicians, 2–7 nurses, <1 to 3 pharmacy staff, and a much wider range of counsellors and treatment supporters. We estimate from these data that the equivalent of 20 000 to 100 000 physicians, nurses, pharmacists and other core clinical staff will be needed to meet the WHO target of treating 3 million people by the end of 2005. The total number of staff, including counsellors, administrators and other cadres, could be substantially higher. DISCUSSION: These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up

The double-design dilemma : political science, parliamentary crisis and disciplinary justifications

Two separate, but inter-linked, dilemmas have highlighted the importance of design-led thinking. First, the crumbling physical fabric of the Palace of Westminster has prompted a multi-billion rebuilding project, which will require the parliamentary studies specialism to engage with questions of design, space, and architecture. Separately, political science more generally has been challenged to utilize the insights of design-thinking and design-practice: a challenge to which it is culturally and methodological ill-equipped. This article considers what a design-led approach to political science looks like in theory, and in practice, in the case study of the Restoration and Renewal of the Palace of Westminster. This represents a first attempt at how such a fusion could be beneficial for both politics as theory and politics as practice. The main conclusion is that although design-orientated political science is not a panacea for the challenges of modern democratic governance – in intellectual or practical terms – it does appear to offer significant potential in terms of theoretically-informed but solution focused research

Liberal conservatism, ‘boardization’ and the government of civil servants

Drawing inspiration from the loosely coupled genre of studies of governmentality, this article explores the emergence in Britain during the early years of the millennium of a distinctive liberal conservative scheme for the government of civil servants. The term ‘boardization’ has been used to characterize the trend to reproduce the technology of the board of directors in central government. Conservatives currently assign a distinctive role to the work of departmental ‘boards’ in the effective management of the Civil Service. Intimating the costs and risks of the Conservatives’ programme, we explore the role of diverse governmental forces in the emergence of the boards of the Civil Service as an object for action and intervention during the early years of the new millennium. We explore a mutation in the application of practices and techniques drawn from the domain of the business enterprise to the organization of the Civil Service. </jats:p

Exposure Assessment Approaches for Engineered Nanomaterials

Products based on nanotechnology are rapidly emerging in the marketplace, sometimes with little notice to consumers of their nanotechnology pedigree. This wide variety of nanotechnology products will result (in some cases) in unintentional human exposure to purposely engineered nanoscale materials via the dermal, inhalation, ingestion, and ocular pathways. Occupational, consumer, and environmental exposure to the nanomaterials should be characterized during the entire product lifecycle—manufacture, use, and disposal. Monitoring the fate and transport of engineered nanomaterials is complicated by the lack of detection techniques and the lack of a defined set of standardized metrics to be consistently measured. New exposure metrics may be required for engineered nanomaterials, but progress is possible by building on existing tools. An exposure metric matrix could organize existing data by relating likely exposure pathways (dermal, inhalation, ocular, ingestion) with existing measurements of important characteristics of nanoscale materials (particle number, mass, size distribution, charge). Nanomaterial characteristics not commonly measured, but shown to initiate a biological response during toxicity testing, signal a need for further research, such as the pressing need to develop monitoring devices capable of measuring those aspects of engineered nanomaterials that result in biological responses in humans. Modeling the behavior of nanoparticles may require new types of exposure models that individually track particles through the environment while keeping track of the particle shape, surface area, and other surface characteristics as the nanoparticles are transformed or become reactive. Lifecycle analysis could also be used to develop conceptual models of exposure from engineered nanomaterials.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79200/1/j.1539-6924.2010.01446.x.pd

Elephant poaching and the ivory trade: The impact of demand reduction and enforcement efforts by China from 2005 – 2017

African elephants are iconic species threatened by poaching and China was considered as one of the main destinations for illegally sourced ivory. In this article we combine two surveys of ivory carving enterprises with other data sets, including Chinese government seizure statistics, market prices for illegal ivory and substitute goods, to understand the impact of enforcement and demand reduction measures on ivory prices and poaching. Our analysis indicates the strong enforcement measures to combat ivory smuggling temporarily suppressed the tendency of illegal trade while stimulating a steep rise in illegal ivory prices thereafter. Peaking in 2012–2013, prices thereafter fell due to government measures to reduce demand under China's ‘Ecological Civilization’ programme and the announcement of ‘The Eight-point Regulation of the Centre’. Our survey suggests that most Chinese carving enterprises were intending to close or to diversify their business activities away from ivory carving as a result of the total ban on domestic ivory trading by 31st December 2017. And China had banned domestic ivory trade for over half a year and all ivory carving enterprises closed their ivory business activities since this domestic ban. In order to prevent ivory demand in other countries that may undermine Chinese efforts, we argue that other countries now also need to adopt multifaceted actions to curtail their domestic ivory trade

Challenges towards renewable energy : an exploratory study from the Arabian Gulf region

Considering the importance of energy for social and economic development, access to clean, affordable and reliable energy has been adopted as one of the United Nations sustainable development goals that all countries aim to achieve by 2030. However, much of the world's energy is still produced from fossil fuels and thus the progress towards clean and renewable energy is slow. This paper explores the key challenges towards renewable energy in Gulf Cooperation Council countries blessed with plenty of oil and gas reserves. The key challenges identified through literature review were ranked using a quantitative approach through the data collected from a selective sample across the six countries. These challenges in order of importance were found to be policies and regulations, manpower experience and competencies, renewable energy education, public awareness, costs and incentives for renewable energy and government commitment. The findings could be helpful to decision makers and government organisations in the region to develop strategies to overcome these identified challenges