Advancing the Right to Health: The Vital Role of Law

Effective laws and an enabling legal environment are essential to a healthy society. Most public health challenges – from infectious and non-communicable diseases to injuries, from mental illness to universal health coverage – have a legal component. At global, national and local levels, law is a powerful tool for advancing the right to health. This tool is, however, often underutilized. This report aims to raise awareness about the role that public health laws can play in advancing the right to health and in creating the conditions for all people to live healthy lives. The report provides guidance about issues and requirements to be addressed during the process of developing or reforming public health laws, with case studies drawn from countries around the world to illustrate effective practices and critical features of effective public health legislation. Advancing the right to health: the vital role of law is the result of a collaboration between the World Health Organisation, the International Development Law Organisation (IDLO), the O’Neill Institute for National and Global Health Law, Washington D.C., USA, and Sydney Law School, University of Sydney. The Project Directors were: Professor Lawrence O. Gostin, Linda D. and Timothy J. O’Neill Professor of Global Health Law and University Professor, Georgetown University; Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University; Mr David Patterson, Senior Legal Expert – Health; Department of Research & Learning, International Development Law Organization; Professor Roger Magnusson, Professor of Health Law & Governance, Sydney Law School, University of Sydney; Mr Oscar Cabrera, Executive Director, O’Neill Institute for National and Global Health Law, Georgetown University Law Center; Ms Helena Nygren-Krug (2011–2013), Senior Advisor, Human Rights & Law, UNAIDS. The content and structure of the report reflect the consensus reached at the second of two international consultations in public health law that preceded the preparation of the report, hosted by WHO and IDLO in Cairo, Egypt, 26-28 April 2010. Part 1 introduces the human right to health and its role in guiding and evaluating law reform efforts, including efforts to achieve the goal of universal health coverage. Part 2 discusses the process of public health law reform. The law reform process refers to the practical steps involved in advancing the political goal of law reform, and the kinds of issues and obstacles that may be encountered along the way. Part 2 identifies some of the actors who may initiate or lead the public health law reform process, discusses principles of good governance during that process, and ways of building a consensus around the need for public health law reform. Part 3 turns from the process of reforming public health laws to the substance or content of those laws. It identifies a number of core areas of public health practice where regulation is essential in order to ensure that governments (at different levels) discharge their basic public health functions. Traditionally, these core areas of public health practice have included: the provision of clean water and sanitation, monitoring and surveillance of public health threats, the management of communicable diseases, and emergency powers. Building on these core public health functions, Part 3 goes on to consider a range of other public health priorities where law has a critical role to play. These priorities include tobacco control, access to essential medicines, the migration of health care workers, nutrition, maternal, reproductive and child health, and the role of law in advancing universal access to quality health services for all members of the population. The report includes many examples that illustrate the ways in which different countries have used law to protect the health of their populations in ways that are consistent with their human rights obligations. Countries vary widely in terms of their constitutional structure, size, history and political culture. For these reasons, the examples given are not intended to be prescriptive, but to provide useful comparisons for countries involved in the process of legislative review

Age and growth of the alfonsino Beryx decadactylus (Cuvier, 1829) from the Azores, Madeira and Canary Islands, based on historical data

Age and growth of the alfonsino Beryx decadactylus from the Azores, Madeira and Canary Islands were studied based on otolith readings. Alfonsino otoliths are thin and show clear annual growth rings. Specimens ranged in size from 21.0 to 50.0 cm fork length (aged 2 to 10 years) in the Azores, 20.0 to 45.0 cm fork length (1 to 11 years) in Madeira, and 21.0 to 44.0 cm fork length (0 to 9 years) in the Canary Islands. No significant differences in growth parameters were found between males and females in any of the three archipelagos. [...]

Idade e crescimento do boca-negra, Helicolenus dactylopterus dactylopterus (Delaroche, 1809) dos Açores

A idade e o crescimento de boca-negra, Helicolenus dactylopterus dactylopterus (Delaroche, 1809), foram estudadas pela observação dos otólitos (sagittae) esquerdos inteiros (n = 401) obtidos de exemplares (14-47 cm de comprimento total) capturados em águas Açoreanas. Enumeraram-se os anéis opacos observados na face anti-sulcal dos otólitos. Os intervalos de idades foram 3-14 anos para machos e 3-12 anos para fêmeas. Estimaram-se e compararam-se os parâmetros da equação de crescimento de von Bertalanffy, entre sexos e entre métodos (leitura directa de otólitos, retrocálculo e análise de distribuições de frequências de comprimentos). Não se verificaram diferenças importantes. Os resultados são diferentes da literatura publicada para a região. Discutem-se as causas e implicações dos resultados obtidos.ABSTRACT: Bluemouth, Helicolenus dactylopterus dactylopterus (Delaroche, 1809), age and growth were studied by whole-view examination of left sagittae (n = 401) obtained from specimens (14-47 cm in total length) caught off the Azores. Opaque rings observed on the anti-sulcal surface of sagittae were enumerated as age estimates. Ages ranged from 3 to 14 years in males and 3 to 12 years in females. The von Bertalanffy growth equation was fitted to average length at age data, and compared between sexes and methods (direct examination of otoliths, backcalculation and length-frequency analysis). No important differences in growth between sexes were found. Results are different from published literature for the region. The causes and implications of the results are discussed

Transdisciplinary transformative change: an analysis of some best practices and barriers, and the potential of critical social science in getting us there

Biodiversity experts now widely acknowledge that transformative change is best supported through transdisciplinary collaborations. Yet, such collaborations rarely successfully occur in major biodiversity research institutions and those that do rarely achieve the paradigmatic effects they aim to deliver. To gain some insight into this global phenomenon, we surveyed Swiss-based researchers and non-academic stakeholders addressing global change and biodiversity. In this article, we connect our findings to global patterns in transdisciplinary transformative change initiatives (TTCIs) and heuristically divide collaboration barriers into two categories: lack of resources and lack of vital functional elements. Two of the major themes that emerged from this research were the continued difficulties with (1) establishing a common ‘language’, understanding, and goals, and (2) meaningful pluralization of knowledge in transdisciplinary collaborations aimed at addressing global change and biodiversity loss. The former is widely cited in the literature as contributing to the failure of TTCIs in the form of incoherent problem-framing, while the latter is often identified as contributing to the lack of structural transformative change (e.g., paradigmatic shifts) in completed initiatives. Another major theme reflected in TTCI literature was limited time. Moreover, based on our own extensive inter- and transdisciplinary experience, we agree with other experts that there is a persistent lack of understanding of the potential contributions of critical social science (CSS) to TTCIs. We thus argue that enhancing resource availability for TTCIs, especially tools for improving CSS literacy, could save time and support both problem-framing alignment and delivery of the structural/paradigmatic changes we aspire to

Variants in the inflammatory IL6 and MPO genes modulate stroke susceptibility through main effects and gene-gene interactions

A complex interplay between genetic background, clinical and life-style factors and the environment is expected to ultimately regulate the onset, acute phase and outcome of stroke. There is substantial evidence that inflammation within the Central Nervous System contributes to stroke risk, and known clinical risk factors for stroke, like atherosclerosis, diabetes, obesity, hypertension, and peripheral infection, are associated with an elevated systemic inflammatory profile. The inflammatory response is equally of major importance in recovery and healing processes after stroke. In this study we tested the genetic association of major inflammatory players IL1B (2q14), IL6 (7p21), TNF (6p21.3) and MPO (17q23.1) with stroke susceptibility and with stroke outcome at three months, in a population sample of 672 patients and 530 controls, adjusting for demographic, clinical and life-style risk factors and/or stroke severity parameters. The apparent complexity of the inflammatory mechanisms in stroke, and the multiplicity of players involved suggest a concerted process, in which implicated molecules interact to tightly regulate each other. We therefore examined both independent gene effects and the occurrence of gene-gene interactions among the tested inflammatory genes in stroke risk and stroke recovery. Two IL6 and one MPO SNP were significantly associated with stroke risk after multiple testing correction (0.022 correctedP 0.042), highlighting gene variants of low to moderate effect in stroke risk. An epistatic interaction between the IL6 and MPO genes was also identified in association with stroke susceptibility (P=0.031 after 1000 permutations). In the subset of 546 patients assessed for stroke outcome at three months using the modified Rankin Scale (mRS), we found one IL6 haplotype associated with stroke outcome (correctedP=0.024). In the present study we present supporting evidence for a role of the IL6 and MPO inflammatory genes in stroke susceptibility, and show that stroke risk is modulated by main gene effects together with clinical and life-style factors as well as by gene-gene interactions. Our findings are compatible and strengthen previous genetic and biological observations, highlighting the need of further functional studies, particularly in view of the possible utility of IL-6 as a diagnostic and/or prognostic biomarker for stroke

Mitochondrial haplogroup H1 is protective for ischemic stroke in Portuguese patients

<p>Abstract</p> <p>Background</p> <p>The genetic contribution to stroke is well established but it has proven difficult to identify the genes and the disease-associated alleles mediating this effect, possibly because only nuclear genes have been intensely investigated so far. Mitochondrial DNA (mtDNA) has been implicated in several disorders having stroke as one of its clinical manifestations. The aim of this case-control study was to assess the contribution of mtDNA polymorphisms and haplogroups to ischemic stroke risk.</p> <p>Methods</p> <p>We genotyped 19 mtDNA single nucleotide polymorphisms (SNPs) defining the major European haplogroups in 534 ischemic stroke patients and 499 controls collected in Portugal, and tested their allelic and haplogroup association with ischemic stroke risk.</p> <p>Results</p> <p>Haplogroup H1 was found to be significantly less frequent in stroke patients than in controls (OR = 0.61, 95% CI = 0.45–0.83, p = 0.001), when comparing each clade against all other haplogroups pooled together. Conversely, the pre-HV/HV and U mtDNA lineages emerge as potential genetic factors conferring risk for stroke (OR = 3.14, 95% CI = 1.41–7.01, p = 0.003, and OR = 2.87, 95% CI = 1.13–7.28, p = 0.021, respectively). SNPs m.3010G>A, m.7028C>T and m.11719G>A strongly influence ischemic stroke risk, their allelic state in haplogroup H1 corroborating its protective effect.</p> <p>Conclusion</p> <p>Our data suggests that mitochondrial haplogroup H1 has an impact on ischemic stroke risk in a Portuguese sample.</p

Characterizing phytoplankton biomass seasonal cycles in two NE Atlantic coastal bays

The seasonal and interannual variability of chlorophyll a was studied between 2008 and 2016 in two coastal bays located in the northeastern limit of the Iberia/Canary upwelling ecosystem. The work aims (i) to understand if small latitudinal distances and/or coastline orientation can promote different chlorophyll a seasonal cycles; and (ii) to investigate if different meteorological and oceanographic variables can explain the differences observed on seasonal cycles. Results indicate three main biological seasons with different patterns in the two studied bays. A uni-modal pattern with a short early summer maximum and relatively low chlorophyll a concentration characterized the westernmost sector of the South coast, while a uni-modal pattern characterized by high biomass over a long period, slightly higher in spring than in summer, and high chlorophyll a concentration characterized the central West coast. Comparisons made between satellite estimates of chlorophyll a and in situ data in one of the bays revealed some important differences, namely the overestimation of concentrations and the anticipation of the beginning and end time of the productive period by satellite. Cross-correlation analyses were performed for phytoplankton biomass and different meteorological and oceanographic variables (SST, PAR, UI, MLD and precipitation) using different time lags to identify the drivers that promote the growth and the high levels of phytoplankton biomass. PAR contributed to the increase of phytoplankton biomass observed during winter/midspring, while upwelling and SST were the main explanatory drivers to the high Chl-a concentrations observed in late-spring/summer. Zonal transport was the variable that contributed most to the phytoplankton biomass during late-spring/summer in Lisbon Bay, while the meridional transport combined with SST was more important in Lagos Bay.FCT: SFRH/BD/52560/2014/ IPMA-BCC-2016-35/ UIDB/04292/2020/ UID/Multi/04326/2020/ UID/MAT/04561/2020 LISBOA-01-0145FEDER-031265 IPMA: MAR2020PO2M01-1490 Pinfo:eu-repo/semantics/publishedVersio

Variants of the Matrix Metalloproteinase-2 but not the Matrix Metalloproteinase-9 genes significantly influence functional outcome after stroke

<p>Abstract</p> <p>Background</p> <p>Multiple lines of evidence suggest that genetic factors contribute to stroke recovery. The matrix metalloproteinases -2 (MMP-2) and -9 (MMP-9) are modulators of extracellular matrix components, with important regulatory functions in the Central Nervous System (CNS). Shortly after stroke, MMP-2 and MMP-9 have mainly damaging effects for brain tissue. However, MMPs also have a beneficial activity in angiogenesis and neurovascular remodelling during the delayed neuroinflammatory response phase, thus possibly contributing to stroke functional recovery.</p> <p>Methods</p> <p>In the present study, the role of <it>MMP-2 </it>and <it>MMP-9 </it>genetic variants in stroke recovery was investigated in 546 stroke patients. Functional outcome was assessed three months after a stroke episode using the modified Rankin Scale (mRS), and patients were classified in two groups: good recovery (mRS ≤ 1) or poor recovery (mRS>1). Haplotype tagging single nucleotide polymorphisms (SNPs) in the <it>MMP-2 </it>(N = 21) and <it>MMP-9 </it>(N = 4) genes were genotyped and tested for association with stroke outcome, adjusting for significant non-genetic clinical variables.</p> <p>Results</p> <p>Six SNPs in the <it>MMP-2 </it>gene were significantly associated with stroke outcome (0.0018<<it>P </it>< 0.0415), two of which survived the Bonferroni correction for multiple testing. In the subset of ischemic stroke patients, association of five of these SNPs remained positive (0.0042<<it>P </it>< 0.0306). No significant associations were found for the <it>MMP-9 </it>gene.</p> <p>Conclusions</p> <p>The results presented strongly indicate that <it>MMP-2 </it>genetic variants are an important mediator of functional outcome after stroke.</p

The Myxobacterial Antibiotic Myxovalargin: Biosynthesis, Structural Revision, Total Synthesis, and Molecular Characterization of Ribosomal Inhibition

Resistance of bacterial pathogens against antibiotics is declared by WHO as a major global health threat. As novel antibacterial agents are urgently needed, we re-assessed the broad-spectrum myxobacterial antibiotic myxovalargin and found it to be extremely potent against Mycobacterium tuberculosis. To ensure compound supply for further development, we studied myxovalargin biosynthesis in detail enabling production via fermentation of a native producer. Feeding experiments as well as functional genomics analysis suggested a structural revision, which was eventually corroborated by the development of a concise total synthesis. The ribosome was identified as the molecular target based on resistant mutant sequencing, and a cryo-EM structure revealed that myxovalargin binds within and completely occludes the exit tunnel, consistent with a mode of action to arrest translation during a late stage of translation initiation. These studies open avenues for structure-based scaffold improvement toward development as an antibacterial agent

Construction and validation of an developmental profile assessment tool for children with autistic spectrum disorder

Nos últimos anos a investigação tem dado particular relevância às alterações do Processamento Sensorial nas crianças com perturbações do espectro do autismo (PEA) e a literatura refere que entre 42% a 88% das crianças com PEA apresentam este tipo de disfunção. Nesta linha foi definido um projeto de investigação centrado na construção de uma escala que avalie a tradicional tríade que caracteriza as crianças com PEA (Interação, Comunicação e Comportamento e interesses repetitivos e estereotipados), enriquecida pela inclusão de um novo domínio: o Processamento Sensorial. Com a construção e validação desta escala pretendemos que pais e profissionais utilizem colaborativamente um instrumento de avaliação da intervenção que lhes permita monitorizar o processo de apoio e adequar as suas práticas. Neste artigo descrevemos os procedimentos e os resultados das sucessivas fases de construção do instrumento, desde as análises iniciais mais qualitativas até aos estudos centrados na análise quantitativa dos itens.During the last few years, research has focused on changes in Sensory Processing in children with Autistic Spectrum Disorder (ASD). As a result, literature has shown that between 42% and 88% of children with ASD present this type of disorder. Based on these findings, a research project was designed centring on the construction of a tool to assess the traditional triad that characterizes children with ASD (Interaction, Communication and Behaviour and Repetitive and Stereotyped Interests), to which was added a new domain: Sensory Processing. By constructing and validating this assessment tool, the intention is for parents and professionals to collaboratively apply this intervention assessment instrument in order to monitor the support process and adapt their practices. In this paper, we describe procedures and results of the successive stages entailed in constructing this instrument, from the first primarily qualitative analyses up to the studies centred on the quantitative item analysis.Fundação para a Ciência e Tecnologia (FCT)ABPEE - Associação Brasileira de Pesquisadores em Educação EspecialConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)CAPESMinistério da Educação - BrasilMinistério da Ciência e da Tecnologia - BrasilGoverno Federal - Brasi