State Laws Restricting Abortion: The Need to Document Their Impact

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151887/1/milq12401_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151887/2/milq12401.pd

The global challenge of ascertaining the impact on mortality from natural disasters: The experience of Puerto Rico’s hurricane Maria

Background. The practice of accounting for deaths from disasters due to natural hazards was critically challenged after Hurricane Maria hit Puerto Rico when societal-observed mortality rates were higher than official estimates. To confront the controversy, the Governor commissioned George Washington University to conduct an independent estimate of excess mortality, evaluate the death registration practice and assess the communication process. Methods/Approach. We present the difficulties in carrying out multiple empirical analyses in the face of the complex social and political realities in a USA territory. In any setting, the precise assessment of mortality is a methodologic challenge, complicated by limited official guidelines for certifying deaths and uneven application, and the worldwide lack of standardized methods to document deaths that are indirectly caused by natural disasters. Results. We discuss our six-month findings, the excess mortality and age and socioeconomic inequities. We identified the lack of a culture of preparedness, and issues with communication and coordination across the local, Puerto Rico and federal governments. We discuss the actions that Puerto Rico is undertaking to prepare for future storms. We address the experience of releasing the report and the responses from the local government and civil society, as well as the amplified reaction by the federal authorities. We provide an update of current initiatives in the US to establish a standardized procedure for accounting the mortality impacts from natural disasters. We discuss its policy, epidemiologic and capacity-building implications. Conclusions. There is need for agreed-upon principles and adherence to rigorous methodologic standards in order to produce credible impact assessments. Only by understanding the full magnitude of such impacts will we be able to demonstrate the importance of intervening in a proactive and protective manner; this requires capacity-building for monitoring and analysis of deaths after disasters

Regulatory Elements on Marijuana, for the Effective Population Health Protection

When discussing the public health approach to the use of marijuana, the complexity of rigorous regulatory interventions for population protection is omitted. Using the experience of governments where these practices already exist, regulation is introduced as an essential public health function, spelling out seven purposes for controlling marijuana. The technical elements of institutional capacity -including the technical and financial capacity- and of governance that must be covered by any rigorous regulation of its use are detailed below. The difficulty of regulating psychoactive substances is addressed when considering the capacity to control other legal substances manifested with their increased consumption. It is concluded that for an effective regulation of marijuana, the need for strengthening the institutional and governance aspects of the regulatory authority should not be minimized

The association between lead exposure and crime: A systematic review

Prior research has demonstrated an association between lead exposure and criminal behavior at the population-level, however studies exploring the effect of lead exposure on criminal behavior at the individual-level have not been reviewed systematically. The intent of this study is to complete a systematic review of all studies assessing individual-level exposures to lead and the outcomes of crime and antisocial behavior traits. We included peer reviewed studies that were published prior to August 2022 and were classified as cohort, cross-sectional, or case-control. Studies measuring the outcomes of crime, delinquency, violence, or aggression were included. The following databases were searched using a standardized search strategy: ProQuest Environmental Science Database, PubMed, ToxNet and the Public Affairs Information Service (PAIS). Seventeen manuscripts met our inclusion criteria. Blood lead was measured in 12 studies, bone lead in 3 studies, and dentine lead levels in 2 studies. This systematic review identified a wide range of diverse outcomes between exposure to lead at multiple windows of development and later delinquent, criminal and antisocial behavior. A review of all potential confounding variables included within each study was made, with inclusion of relevant confounders into the risk of bias tool. There is limited data at the individual level on the effects of prenatal, childhood, and adolescent lead exposure and later criminal behavior and more evidence is necessary to evaluate the magnitude of the associations seen in this review. Our review, in conjunction with the available biological evidence, suggests that an excess risk for criminal behavior in adulthood exists when an individual is exposed to lead in utero or in the early years of childhood. The authors report no conflict of interest and no funding source. Clinical trial registration: PROSPERO ID: CRD42021268379

Aspectos básicos de la vigilancia en salud pública para los años noventa

In this paper we propose a wider scope for public health surveillance in order to incorporate demographic and health systems monitoring along with activities conventionally associated with epidemiologic surveillance. This new conception stems, in turn, from a revised definition of public health, which describes-not a sector of activity or a type of health service-but a level of aggregation based on the population at large. In our review of the ideas that lead to the institutionalization of health surveillance, we stress the broad concepts developed by such pioneers as Graunt and Petty. Their original concepts emerged from their active concerns for the public's health at a time when no scientific theory of contagion was available-let alone any knowledge about how to treat persons for the major diseases that affected them. Later on, and largely as the result of impressive advances in biomedical knowledge, surveillance activities tended to specialize and to concentrate predominantly on disease outbreaks and on salient adverse health conditions. Health surveillance became closely associated with epidemiologic surveillance, which in turn became associated with the ability to respond promptly to adverse health outcomes. Recently, we have witnessed a gradual broadening of both the concepts and the practice of health surveillance. Paradoxically, the newer proposals tend to recapture part of the spirit and scope of earlier definitions, prompted perhaps by such thoughtful historic parallels as the newly emerging health problems for which we have no clear-cut solution. If one element has to be stressed to promote the objectives of health surveillance today, it is the need to anticipate health outcomes and not just respond to them. This, in turn, requires an increased attention to the surveillance of risk factors, and a greater understanding of the complex causal relationships that those factors -including behavioral, lifestyle, and environmental ones -with adverse healt outcomes and disability. Needless to say that, the first and foremost aim of health care-and of modern surveillance-is to promote the well-being of individuals by improving their health