World Health Organization Framework Research Articles

CRITICAL PREPAREDNESS, READINESS AND RESPONSE TO COVID-19 PANDEMIC: A NARRATIVE REVIEW

Background: The COVID-19 was declared as a pandemic by the World Health Organization (WHO). Globally, countries took actions to slow the spread and avoid overwhelming the health system. The WHO issued interim guidelines on critical preparedness, readiness and response actions against COVID-19 to assist level of preparedness and readiness.Aim: This study reviewed the work of Australia, Singapore, Sri Lanka and the United Kingdom on actions and priority areas of work as described in interim guidelines by the WHO in relation to the first two phases of disease transmission scenario.Methods: A non-systematic narrative review was conducted. Relevant documents available in selected websites were searched. The data generated were compiled, and information was synthesised within the WHO framework for critical preparedness, readiness and response actions against COVID-19. Further, scenarios of “no cases” and “sporadic cases” were analysed against the actions and priority areas of work of said framework.Results: Study revealed differences in implementation approach of strategic actions and priority areas of work, such as in terms of activation, timeliness of implementing emergency response plans, variations in case management strategies as seen in contact tracing, management of asymptomatic contacts, isolation, quarantine and selection of cohort for laboratory investigation. Besides, gaps were found in availability and activation of business continuity plans.Conclusion: Global political and health authorities need much robust mechanisms for preparedness, response and coordination of contagious diseases with similar nature. Even the occurrence of one case shall trigger stringent transmission prevention measures and initiate the actions and priority areas of work as stated in the WHO interim guideline.Keywords: pandemics, emergency response, health policy, COVID-19, emergency preparedness.

Emerging evolution trends of studies on age-friendly cities and communities: a scientometric review

AbstractPopulation ageing, together with urbanisation, has become one of the greatest challenges throughout the world in the 21st century. Approximately one million people turn 60 each month worldwide. By 2050, more than 20 per cent of the global population is predicted to be 60 years old or above. Thus, an increasing need is evident for age-friendly communities, services and structures. Numerous studies on age-friendly cities and communities (AFCCs) have been conducted over the past decade. The large volume literature makes it necessary to figure out key areas and the evolution trends of studies on AFCCs. Therefore, this paper aims to provide a comprehensive review of existing literature pertaining to AFCCs. A total of 231 collected publications are analysed and visualised by CiteSpace. According to the keywords and document co-citation networks that are generated, the foundation, hot topics and domains of AFCC research are grouped. Three major themes, namely the characteristics of AFCCs, the application of the World Health Organization's framework in urban and rural areas worldwide, and the measurement of cities’ and communities’ age-friendliness, are identified. In addition, a roadmap of AFCC research is developed. The results of this research will therefore benefit researchers and practitioners.

Cigarette Packs With URLs Leading to Tobacco Company Websites: Content Analysis.

BackgroundTobacco companies include on the packaging of their products URLs directing consumers to websites that contain protobacco messages. Online media tend to be underregulated and provide the industry with an opportunity to present users with protobacco communication.ObjectiveThe objective of our study was to document the content of websites that were advertised on tobacco packs in 14 low- and middle-income countries.MethodsWe purchased tobacco packs from 14 low- and middle-income countries in 2013 and examined them for the presence of URLs. We visited unique URLs on multiple occasions between October 1, 2016 and August 9, 2017. We developed a coding checklist and used it to conduct a content analysis of active corporate websites to identify types of protobacco communication. The coding checklist included the presence of regulatory controls and warnings, engagement strategies, marketing appeals (eg, description of product popularity, luxury/quality, taste), corporate social responsibility programs, and image management. We coded brand websites separately and also described social media and other website types.ResultsWe identified 89 unique URLs, of which 54 were active during the search period. We assessed 26 corporate websites, 21 brand websites, 2 nontobacco websites, and 5 social media pages. We excluded 2 corporate websites and 14 brand websites due to limited accessible content or incomplete content. Corporate social responsibility was discussed on all corporate websites, and marketing appeals were also common. Corporate websites were also more likely to include more nonspecific (12/24, 50%) than specific (7/24, 29%) health warnings. Promotions (6/7, 86%) and sociability appeals (3/7, 43%) were common on brand websites. The small number of social media webpages in our sample used gendered marketing.ConclusionsURLs appearing on tobacco packs direct consumers to websites where users are exposed to marketing that highlights the “positive” contributions of tobacco companies on corporate websites, and extensive promotions and marketing appeals on brand websites and social media pages. It is essential that marketing regulations become more comprehensive and ban all protobacco communication, a policy that is in line with articles 5.3 and 13 of the World Health Organization Framework Convention on Tobacco Control. For countries that already ban internet tobacco advertising, enforcement efforts should be strengthened. Tobacco companies’ use of URLs on packs may also be compelling for plain packaging advocacy, where all branding is removed from the pack and large graphic health warning labels are the only communication on the tobacco packaging. Future research should consider including tobacco websites in marketing surveillance.

Abstract A069: “ ‘She was like, “I'm done. I'm not taking this anymore’ ”: Health care provider perspectives about breast cancer survivors' nonadherence to adjuvant endocrine therapy

Abstract Background: For women diagnosed with hormone-receptor positive breast cancers, adjuvant endocrine therapy (AET) can significantly reduce their risk of recurrence and mortality. Yet, nearly two-thirds of breast cancer survivors do not take AET as prescribed. AET nonadherence rates are even higher among women who are both financially disadvantaged (e.g., Medicaid enrollees) and African American. Health care providers (HCPs) not only prescribe AET but also educate and support women who are taking AET. Thus, it is imperative to elicit HCP perspectives as part of the solution to addressing nonadherence to AET. Purpose: To describe HCPs' perspectives about factors that influence survivors' nonadherence to AET. Methods: We recruited HCPs from oncology sites in South Carolina to participate in semistructured interviews (May 2016 - May 2017). We audio recorded, transcribed, and analyzed the interviews using Assarroudi et al.'s (2018) method of directed qualitative content analysis. Results: Twenty-three HCPs completed interviews. Most HCPs were non-Hispanic White (n=20, 87%) and female (n=19, 83%). Many HCPs had been in their professions for ≥ 15 years (n=11, 48%) and held a variety of positions, such as nurses (n=13, 57%), oncologists (n=4, 19%), and social workers (n=2, 9%). From the interviews, we derived 6 main intervention targets (consisting of 19 specific modifiable factors) informed by the World Health Organization's Multidimensional Adherence Framework and Taplin et al.'s (2012) Multilevel Context of Cancer Care Model. The most frequently discussed intervention targets were individual patients (n=23 HCPs), health care systems/teams (n= 23) and therapy-related concerns, e.g., complexity or duration of treatment regimen (n= 23). The most frequently discussed modifiable factors were AET-related side effects (n= 23, 160 mentions), general patient education about AET (n=20, 114 mentions), and patient-provider communication (n=23, 108 mentions). Conclusions: Our findings suggest that future AET adherence interventions should target multiple levels (e.g., individual patients + HCPs) and aim to improve knowledge, skills, and/or perceptions about patient-provider communication, AET, and AET-related side effects. Future research should explore the extent to which HCP perspectives about AET align with perspectives from breast cancer survivors, particularly among survivors who are African American and financially disadvantaged. Citation Format: Tisha M. Felder, Sue P. Heiney, Rubin L., Daniela B. Friedman, Regina Franco, James R. Hebert, Marvella E. Ford. “ ‘She was like, “I'm done. I'm not taking this anymore’ ”: Health care provider perspectives about breast cancer survivors' nonadherence to adjuvant endocrine therapy [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A069.

Accelerating an end to smoking: a call to action on the eve of the FCTC’s COP9

Purpose The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the WHO. This study aims to describe progress toward the framework’s goals, setbacks and strategies to update its articles to optimize outcomes. Design/methodology/approach A review of relevant literature, including papers in this special issue, forms the basis for identifying steps necessary to amplify the impact of the FCTC. Findings The WHO suggests that there are 1.3 billion users of tobacco globally. The expected deaths associated with tobacco use could be dramatically reduced by hundreds of millions between now and 2060 through measures that improve cessation and harm reduction support among adults. Additional steps needed to achieve the goals of the FCTC include developing new initiatives to address areas of profound neglect (for example, women); investing in global research and innovation; addressing the needs of vulnerable populations; and establishing a mechanism to fund priority actions required by low- and middle-income countries, including support for alternative livelihoods for smallholder farmers. Practical implications In November 2020, the WHO FCTC Parties will host their next Conference of the Parties (COP9) in the Netherlands. This paper aims to contribute to the needed policy decisions related to this meeting. Since acceptance of this article, the WHO FCTC team announced that doe to the COVID-19 pandemic COP9 has been rescheduled till November 2021. Originality/value There exists a need to prioritize the goals of tobacco control and offer clear strategies for its execution. This paper fills this niche via a thorough and up-to-date analysis of how to amend and enforce the FCTC.

Innovative call emerging from a qualitative study for workplace designated stop-smoking area.

INTRODUCTIONDesignated smoking areas (DSAs) have become a common feature of public places in various developed and developing countries that have ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). However, this situation is not in line with the WHO FCTC. In this context, this study was designed to explore the perception of stakeholders on the DSA prevailing in workplaces in Mauritius and to explore the feasibility of smoking cessation interventions in the workplace.METHODSA qualitative study using semi-structured, face-to-face interviews was conducted among the various stakeholders in tobacco control in Mauritius. Data collected were transcribed verbatim for analysis.RESULTSThree main themes emerged from this study: 1) a need for comprehensive smoke-free law, 2) a need for smoking cessation services, and 3) a need for stakeholders’ involvement (local government, employers, and health professionals) in the promotion of tobacco cessation programs.CONCLUSIONSWe make a call for a workplace Designated Stop Smoking Area (DSSA) in order to phase out existing DSAs. DSSAs will be a therapeutic means to divert smokers away from DSAs, in order to change their behaviour with respect to tobacco use. Group therapy, individual counselling, and tobacco treatment will be made accessible in these DSSAs, which with a touch of innovation can become a VIP lounge for stop-smoking services. This innovative call for DSSAs is meant to sensitize policy makers of developing countries on how to proceed for the elimination of DSAs.

Support for smoke-free public places among adults in four countries in sub-Saharan Africa.

There is no known safe level of secondhand smoke exposure; yet, less than 30% of the global population is covered by comprehensive smoke-free policies as of 2016 and there are few smoke-free policies in sub-Saharan Africa (SSA). This study examines the support for smoke-free public places in SSA and delineates their correlates. Data collected through the Global Adult Tobacco Survey (2012-2017) were analyzed using SAS for descriptive and multivariable analyses, with a significance level set at p < .05. No SSA country had comprehensive smoke-free policies, defined as a prohibition of smoking in eight public places. In the four countries whose Global Adult Tobacco Survey data were analyzed (Nigeria, Cameroon, Kenya, and Uganda), support for the prohibition of smoking in public places was over 90% in all eight public places except bars. Support for smoking prohibition in bars was 65.8%, 81.1%, 81.4%, and 91.0% in Nigeria, Cameroon, Kenya, and Uganda, respectively. Factors associated with support for smoke-free bars differed across the four countries, but in all countries, current smokers had decreased odds of support for smoke-free bars. Knowledge of secondhand smoke harm and living in smoke-free homes were associated with increased odds of support for smoke-free bars in all countries except Kenya. The high support for smoke-free public places should inform the efforts of the public health community and policymakers in these four SSA countries toward meeting their obligations of Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Much of the population in SSA is not protected by comprehensive smoke-free policies. It was found that the overwhelming majority of adults in four large countries in SSA support the prohibition of smoking in public places and that knowledge of the health dangers of smoking and exposure to secondhand smoke and home smoking rules increased support for the prohibition. High support for the prohibition of smoking in these four SSA countries suggests tobacco control proponents should advocate for comprehensive smoke-free policies.

Prices and Illicit Trade of Cigarettes in the European Union: A Cross-sectional Analysis.

Within the context of the World Health Organization Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products and the impending revision of the European Union (EU) directive on tobacco excise rules we assessed whether cigarettes price is linked to being offered illicit cigarettes. We combined data being offered illicit cigarettes from the 2015 Special Eurobarometer Survey on Illicit Tobacco (N = 27,672) with area-level data on Gross Domestic Product, unemployment, perceived corruption, and sharing a border with a non-European Economic Area (non-EEA) state. We used the 2015 Weighted Average Price of cigarettes (WAP), which reflects the average price of a cigarette pack in each Member State. We assessed associations between prices and illicit trade using three-level ordered regression models. About 19.6% of respondents reported ever being offered illicit cigarettes, 6.4% repeatedly. In fully adjusted models WAP was not associated with being more likely to have been offered illicit market cigarettes more often (adjusted odds ratio = 1.02, 95% confidence interval: 0.91; 1.15). Sharing a border with a non-EEA Member State was associated with increased likelihood of reporting being offered illicit cigarettes more often (1.73, 1.26; 2.39). This study found no significant association between cigarette prices and reporting being offered illicit cigarettes; sharing a border with a non-EEA Member State was linked to illicit trade. This study adds to evidence that increasing prices of cigarettes are not associated with illicit trade and that the focus should remain on securing supply chains, including through features such as independent traceability systems. After adjusting for individual and regional factors, we did not identify an association between prices of cigarettes and likelihood of reporting being offered illicit cigarettes in the EU. Sharing a border with a non-EEA state, however, was associated with increased likelihood of reporting being offered illicit cigarettes more often. This study adds to evidence that increasing taxes and prices of cigarettes are not a driver of illicit trade and that policies should maintain their focus on securing the supply chain.

Quality of Inpatient Tuberculosis Health Care in High-Burden Resource-Limited Settings: Protocol for a Comprehensive Mixed Methods Assessment Study

BackgroundThe quality of care for tuberculosis (TB) is deficient in high-burden countries and urgently needs improvement. However, comprehensively identifying the required improvements is challenging. Providing high-quality TB care is an important step toward improving patients’ quality of life and decreasing TB morbidity and mortality. Effective tools for assessing the quality of TB services using international standards and guidelines can identify existing gaps in services and inform improvements to ensure high-quality inpatient TB services.ObjectiveThis study aimed to develop evaluation instruments for defining the quality of provision of TB services.MethodsTo assess quality of services in the largest TB hospital in Armenia, we developed instruments based on the Joint Commission International Accreditation Standards for Hospitals, International Standards for TB Care, TB Laboratories Bio-Safety Standards, and the World Health Organization framework for conducting TB program reviews. A mixed methods approach was utilized, triangulating quantitative (checklists) and qualitative (in-depth interviews) results. A scoring system and strengths, weaknesses, opportunities, and treats analysis was applied to detail results for each of the 122 standards assessed. A scaling approach was used to present overall performances of inpatient services for eight patient-centered functions and five organization management functions.ResultsOverall, 40 in-depth interviews and 91 checklists (21 observations, 16 policy papers, 20 staff qualification documents, and 34 medical records) were developed, utilized, and analyzed to explore practices of health care professionals, assess inpatient treatment experience of patients and their family members, evaluate facility environmental conditions, and define the degree of compliance to standards.ConclusionsThe effective comprehensive evaluation instruments and methods developed in this study for quality of inpatient TB services support the implementation of similar effective assessments in other countries. It may also become a platform to develop similar approaches for assessing ambulatory TB services in resource-limited countries.International Registered Report Identifier (IRRID)DERR1-10.2196/13903

What links can be made from narratives of migration and self-perceived health? A qualitative study with Haitian migrants settling in Quebec after the 2010 Haiti earthquake

In January 2010, Haiti was hit by a terrible earthquake that pushed thousands of people to migrate. Many of them chose to settle in Quebec, Canada. Years after the earthquake, many Haitians continue to migrate to the Quebec province. Several studies however have shown that this population's socioeconomic status is lower than the provincial average. Given the potential multiple stressors that affect Haitian migrants in Quebec, there are concerns about their health status.Located at the intersection of international migration studies and global public health, this paper offers an in-depth qualitative investigation of Haitian migrants’ representations of both their situation and self-perceived health in Montreal, Quebec. Our perspective on migrant health was inspired by the World Health Organisation's framework on the social determinants of health and recent studies in the field of migrant health. We collected and analysed qualitative data from 23 key informants (i.e., 12 women and 11 men, aged 21–76 years old) from diverse socioeconomic backgrounds. The analysis of the data from these people's narratives revealed the importance of structural determinants such as social position, and intermediate determinants such as living and working conditions. Our analysis also highlighted several interrelations between those determinants. Specifically, participants reported coping with issues related to migration status, income, occupation, language, challenging living and working conditions, and chronic stress. This study also shows that racism and social support each relate to both the structural and intermediate levels of the social determinants of health. The importance of social support brought by relatives, friends, as well as community-based organisations and religious practice, was underscored.Our findings were coherent with available literature looking at the determinants of health of racialized and migrant minorities in other high-income regions of the world. Our conclusive remarks featured reflections on three cross-cutting issues and their practical implications for policy and practices.

Strengthening public healthcare systems in India; Learning lessons in COVID-19 pandemic.

COVID-19 pandemic has involved nations and incapacitated the health systems globally. The pandemic preparedness has been tested with immense losses. Universal health coverage is needed more than ever to recuperate from the effects of the current pandemic. Post pandemic, many lessons need to be learnt especially for developing economies like India where public healthcare system is grossly inadequate to take care of health needs of citizens. World Health Organization's framework of six health system building blocks was utilized to study the lessons learnt and actionable points in the post pandemic period. Participation in Global Health Security Alliance has to be stepped up with involvement in Joint external evaluation and development of epidemiological core capacities. National Health Security Action Plan needs to drafted and available for health emergences. Ayushman Bharat scheme should incorporate elements to address surge capacity at the time of health emergencies and measures to deliver care at the time of pandemic. Technology through telemedicine, m-health, and digital platforms or apps should contribute to trainings, supervision, and facilitation of healthcare delivery at remote locations. Open data sharing policies should be developed for the practice of evidence-based public health. Public healthcare system and health manpower trained in epidemiology should be given a boost to have system readiness to respond in case of future pandemics.

The status of tobacco control in the Eastern Mediterranean Region: progress in the implementation of the MPOWER measures.

The World Health Organization (WHO) MPOWER measures are a set of highly effective tobacco control measures drawn from the WHO Framework Convention on Tobacco Control (FCTC), designed to help countries reduce the prevalence of tobacco use. The WHO Report on the Global Tobacco Epidemic is published biennially to monitor global implementation of these measures. This review aimed to critically assess the status of MPOWER implementation in the Eastern Mediterranean Region. Data were collected for WHO Reports on the Global Tobacco Epidemic, focusing on the most recent 2019 edition. Regional population coverage figures were calculated using this data and population figures for the countries of the Region. Between 2007 and 2018, for any MPOWER measure, there were 29 cases of countries progressing to the highest level of achievement; 23 cases of countries progressing to the intermediate levels from the lowest level; 12 cases of countries falling from the highest level; and 18 cases of countries falling to the lowest level. 57.7% of people are covered at the highest level for the monitoring measure; 63.7% for the smoke-free policies measure; 6.7% for the cessation measure; 60.7% for the health warnings measure; 37.4% for the mass media measure; 29.4% for the advertising bans measure; and 16.1% for the taxation measure. Countries must work comprehensively to improve tobacco control. Regional priorities should include lifting more people out of lowest level coverage for the health warnings and mass media measures, increasing taxation on tobacco products and improving access to cessation services.

The challenges of Iranian health system preparedness before earthquakes based on the World Health Organization framework.

INTRODUCTION:The state of health-care disaster preparedness in Iran prior to the possible earthquakes is not well documented. This study identified the challenges of the Iranian health system before possible earthquakes in Tehran based on the World Health Organization (WHO) framework.MATERIALS AND METHODS:In this qualitative study, in-depth and semi-structured interviews were conducted for 17 health experts and authorities, who were selected based on purposive sampling method. The questions were designed based on the proposed framework of the WHO in six areas including policies and planning, communication, collaboration and coordination, training, volunteers and the public, and surge capability. The data were analyzed by using framework analysis.RESULTS:The main themes included weak communication infrastructures, inappropriate assessment of specialized training courses and lack of a clear scenario, integrated urban commanding, extra-sectorial coordination, and data banks for public volunteers.CONCLUSION:Iran health-care disaster preparedness was tested by many earthquakes. This research showed that disaster preparedness in Iran faces several challenges.

Nicotine replacement therapy: A friend or foe.

According to the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC), tobacco cessation is a primary health-care service that should be provided not only to the people having adverse habits of consuming tobacco but also to the nonconsumer, as they can also be harmed due to its deleterious effects. Tobacco has been regarded as a potential risk factor for oral diseases such as oral potentially malignant disorders and oral cancers. Various aids of achieving cessation have been studied, including education of the ill effects of tobacco to the patient, behavioral counseling, and pharmacotherapy. Various pharmacological interventions are available nowadays but nicotine replacement therapy (NRT) is most widely used. The various types of NRT products results in general and breakthrough craving relief with immediate release of nicotine. All of these products have different levels of efficacy and variable rates of nicotine absorption. Knowledge of these will be beneficial for the patients, the budding dentist and the nation in the upcoming days ahead.

Psychometric Validation of the Turkish Gaming Disorder Test: A Measure That Evaluates Disordered Gaming According to the World Health Organization Framework

PURPOSE: Previous research on gaming disorder (GD) used psychometric tools, which evaluates according to the American Psychiatric Association (APA) diagnostic framework. The Gaming Disorder Test (GDT), a standardized measure to assess symptoms and prevalence of GD according to the World Health Organization (WHO) diagnostic framework. The main aim of the current study was to adapt GDT to Turkish. METHOD: In the present study participants were assessed with the GDT, the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF), and the CAGE-Problematic Internet Use Questionnaire (CAGE-PIUQ). The factor structure of the scale was tested with Confirmatory Factor Analysis (CFA), and reliability and validity analyses were conducted. The method used in the study, and the scale adaptation, RESULTS: A sample of 932 Turkish gamers (58.3% male, mean age 23.64 years, SD=5.42) was recruited online. Confirmatory factor analyses demonstrated that the unidimensional factor structure of the GDT was satisfactory. The scale was also reliable (i.e., internally consistent with a Cronbach's alpha of 0.879) and showed adequate convergent and criterion-related validity, as indicated by statistically significant positive correlations between average time daily spent playing games (ATDSPG) during last year, IGDS9-SF and CAGE-PIUQ scores. By applying the International Classification of Diseases 11th edition (ICD-11) threshold for diagnosing GD (e.g., meeting all four criteria by answering them either with ‘often’ [4] or ‘very often’ [5]), it was found that the prevalence of GD is 1.9% (n = 18). CONCLUSION: Online gaming preference, ATDSPG and probable ADHD predicted the severity of disordered gaming. These findings support the Turkish version of the GDT as a valid and reliable tool for determining the extent of GD related problems among young adults and for the purposes of early GD diagnosis in clinical settings and similar research.

Smokeless Tobacco dependence and cessation measures in India

India being the largest smokeless tobacco (SLT) producer and consumer in the South East Asia Region (SEAR) entitled with a range of products. SLT consumption is very common because it is associated with socio-economic and cultural perspectives in the India. After the implementation of the first treaty of the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), public health standards were reaffirmed and improvised through successful implementation of articles since 2007 as reported in the global progress factsheet. Many measures have been implemented for achieving the success of WHO-FCTC in India and to control the huge disease burden induced by tobacco use. The objective of the present study was to understand and explore the factors involved in the SLT demand reduction by revealing the dependence and cessation implementation in India in the context of strategies and policies. For this study, we searched for SLT dependence and SLT cessation literature survey in PubMed and obtained 102 literatures consisting of studies and reviews, which were further scrutinized by excluding the reviews, studies conducted abroad and studies conducted within the last 5 years (after 2015). No statistical significance was observed in comparison of National to International SLT dependence and an attempt to quit SLT following the tenure of a year. This is in-line with GATS-2 and international data. We have also discussed a diverse approach in the control of SLT at different levels-such as SLT users, healthcare professional, policy advocates supplier, labeling, legal policies, and educating at various platforms. Effective strategies for the cessation of SLT is mandatory with proper guidance for the manufacturer, users and sellers in controlling SLT products.

Occurrence of green tobacco sickness and associated factors in farmers residing in Dom Feliciano Municipality, Rio Grande do Sul State, Southern Region of Brazil.

This study aimed to evaluate the occurrence of the green tobacco sickness (GTS) and its associated factors in tobacco familiar farmers residing in Dom Feliciano, Rio Grande do Sul State, Brazil. A cross-sectional study was conducted evaluating the sickness in 354 small tobacco farmers, between October 2011 and March 2012. The urinary concentration of cotinine, a biomarker of exposure to nicotine, was determined during the tobacco harvest period. Subjects presenting cotinine urinary levels ≥ 50ng/mL, that had contact with tobacco leaves up to 48 hours before the sample collection and reported at least one disease symptom were deemed as cases. A non-conditional logistic analysis was performed to evaluate the association between GTS and the population characteristics. A total of 122 (34.5%) cases were identified, with 39% of them being smokers and 61% being males. The median cotinine urinary concentrations were 75.6ng/mL (74.1ng/mg of creatinine) for non-cases and 755.8ng/mL (632.1ng/mg of creatinine) for the cases (p-value ≤ 0.01). The multivariate analysis showed a positive association between GTS and sunlight exposure time, exposure to pesticides, worse health status, and inverse association with wood cultivation. This study presented a high GTS prevalence and suggest that the use of urinary cotinine is a significant biomarker to determine GTS cases, influencing in the distribution by sex. Once the tobacco production involves health hazards, is important to implement measures to prevent the harm caused to tobacco farmers, as set in articles 17 and 18 of the World Health Organization Framework Convention on Tobacco Control.

Dilemmas in the implementation of the World Health Organization Framework Convention on Tobacco Control.

The article analyzes some dilemmas related to the implementation of the Framework Convention on Tobacco Control, underscoring the States parties' difficulties in adopting public policies with proven cost-benefit and aimed at reducing tobacco's supply and demand. Specifically, the article examines the recommendation to adopt policies for plain cigarette packaging, as provided in the guidelines for implementation of the Convention's Articles 11 and 13. Based on case analysis, we identified political and legal factors that hinder the Convention's implementation, including the regulatory chill produced by legal claims filed by the tobacco industry, which uses investor-State arbitration clauses from bilateral investment agreements. The article concludes that despite the costs imposed on States and the delays in the adoption of such policies, in the medium and long term the rulings handed down by the arbitration courts and the World Trade Organization's Dispute Settlement Body can consolidate the understanding of the legality and effectiveness of policies that adopt the model.

Challenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment: a qualitative analysis.

To identify barriers to implementing the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 guidelines on tobacco dependence treatment (TDT). Cross-sectional survey conducted from December 2014 to July 2015 to assess implementation of Article 14 recommendations. Survey respondents (n=127 countries) who completed an open-ended question on the 26-item survey. The open-ended question asked the following: 'In your opinion, what are the main barriers or challenges to developing further tobacco dependence treatment in your country?'. We conducted thematic analysis of the responses. The most frequently reported barriers included a lack of health-care system infrastructure (n=86) (e.g. treatment not integrated into primary care, lack of health-care worker training), low political priority (n=66) and lack of funding (n=51). The absence of strategic plans and national guidelines for Article 14 implementation emerged as subthemes of political priority. Also described as barriers were negative provider attitudes towards offering offer TDT (n=11), policymakers' lack of awareness about the effectiveness and affordability of TDT (n=5), public norms supporting tobacco use (n=11), a lack of health-care leadership and expertise in the area of TDT (n=6) and a lack of grassroots and multi-sector networks supporting policy implementation (n=8). The analysis captured patterns of co-occurring themes that linked, for example, low levels of political support with a lack of funding necessary to develop health-care infrastructure and capacity to implement Article 14. Important barriers to implementing the Framework Convention on Tobacco Control Article 14 guidelines include lack of a health-care system infrastructure, low political priority and lack of funding.

Access to cancer medication in public hospitals in a middle-income country: The view of stakeholder.

Access to cancer medicines is a core component of comprehensive cancer care; as such, it is included in Mexico's public health insurance: Seguro Popular de Salud (SPS). Learning about stakeholders' experiences on processes and barriers influencing access to essential cancer medicines within healthcare facilities allows identifying needed policies to improve access to cancer care. The aim of this study was to obtain the insights of health professionals in public hospitals in Mexico on how SPS influences access to cancer medicines regarding medicine selection, financing, and procurement and supply systems. The purpose is to identify policy areas that need strengthening to improve access to cancer medicines. Semi-structured interviews were conducted with 67 health professionals from 21 public hospitals accredited by SPS across Mexico. A framework analysis was used with categories of analysis derived from the World Health Organization's Access framework. Most stakeholders reported that the availability of listed cancer medicines was sufficient. However, cancer specialists reported that medicines coverage by SPS was restrictive covering only basic cancer care. Public hospitals followed SPS treatment protocols in selecting and prescribing cancer medicines but used different procurement procedures. When essential cancer medicines were unavailable (not listed or stocked-out), hospitals reported several strategies such as prescribing alternative therapies, resorting to direct purchases, and assisting patients in obtaining medicines elsewhere. Other reported barriers to access to treatment were: distance to health facilities, poor insurance coverage, and financial restrictions. Health professionals have encountered benefits and challenges from the implementation of SPS influencing access to cancer medicines and care in Mexico, pointing to areas in which action is necessary. Finding the right balance between expanding the range and cost of cancer treatments covered by insurance and making basic cancer care available to all is a challenge faced by Mexico and other middle-income countries.