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BACKGROUND: Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. CASE PRESENTATION: In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally. CONCLUSIONS: Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing certification with CHWs representing different populations, and in particular Tribal Nations, it is essential to assure that the CHW definition is in alignment with all groups and that the scope of practice reflects CHW roles in both clinic and community-based settings. The Arizona experience underscores the benefits of a flexible approach that leverages existing strengths in organizations and the population served.

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The presence of performance-enhancing drugs in dietary supplements poses serious anti-doping and health risks to athletes and military service members. A positive drug test, suboptimal health, or adverse event can ruin a career in either setting. These populations need to be certain in advance that a product is of high quality and free from performance-enhancing drugs and other banned substances. However, no regulatory authority conducts or mandates a quality review before dietary supplements are sold. Under the Food Drug and Cosmetic Act, the Food and Drug Administration does not have a role in the premarket safety review of dietary supplements. Due to the increasing demand for high-quality, properly labeled dietary supplements, multiple companies have stepped into this void by offering testing and quality review programs for dietary supplements. Each of these third-party programs has its own quality assurance program with varying testing components. It is difficult for consumers in the sport and military settings to assess whether a particular certification program reduces the risks enough so that they can use a product with confidence. This article puts forward the consensus of the authors on current best practices for third-party certification programs for dietary supplements consumed by athletes and military service members. Also discussed are important ways that third-party programs can develop in the future to improve access to safe, high-quality dietary supplements for these populations.

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BACKGROUND: Title revalidation of foreign medical graduates to practice medicine in Chile is a complex and expensive process. According to the legislation they are required to approve the Unique National Exam of Medical Knowledge (EUNACOM), which has a theoretical and a practical section. AIM: To demonstrate that a collaborative and standardized examination of the practical section of EUNACOM is more effective and efficient than traditional practical examinations. MATERIAL AND METHODS: The faculties of Medicine of the Catholic University of Chile, University of Chile and University of Concepción were associated to implement an examination proposal, framed in the legislation. The EUNACOM board supported and funded the initiative which consisted in the implementation of Objective Structured Clinical Examination (OSCE) for each basic specialty of medicine, applied to 40 designated candidates. This format was selected because of the wide experience and evidence at the international level in the certification of medical professionals. RESULTS: A collaborative and standardized OSCE reduces to less than half the time spent by examiners, providing more evidence of validity, reliability and objectivity. It also allows to visualize the real costs per applicant, which proved to be higher than those currently charged by EUNACOM, but comparatively lower than the examination used in the United States. CONCLUSIONS: A collaborative OSCE responds to the ethical principle of justice by being more valid, reliable, objective and cost efficient.

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Background: Title revalidation of foreign medical graduates to practice medicine in Chile is a complex and expensive process. According to the legislation they are required to approve the Unique National Exam of Medical Knowledge (EUNACOM), which has a theoretical and a practical section. Aim: To demonstrate that a collaborative and standardized examination of the practical section of EUNACOM is more effective and efficient than traditional practical examinations. Material and Methods: The faculties of Medicine of the Catholic University of Chile, University of Chile and University of Concepción were associated to implement an examination proposal, framed in the legislation. The EUNACOM board supported and funded the initiative which consisted in the implementation of Objective Structured Clinical Examination (OSCE) for each basic specialty of medicine, applied to 40 designated candidates. This format was selected because of the wide experience and evidence at the international level in the certification of medical professionals. Results: A collaborative and standardized OSCE reduces to less than half the time spent by examiners, providing more evidence of validity, reliability and objectivity. It also allows to visualize the real costs per applicant, which proved to be higher than those currently charged by EUNACOM, but comparatively lower than the examination used in the United States. Conclusions: A collaborative OSCE responds to the ethical principle of justice by being more valid, reliable, objective and cost efficient.

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Global markets for agricultural products, timber, and minerals are critically important drivers of deforestation. The supply chains driving land use change may also provide opportunities to halt deforestation. Market campaigns, moratoria, and certification schemes have been promoted as powerful tools to achieve conservation goals. Despite their promise, there have been few opportunities to rigorously quantify the ability of these nonstate, market-driven (NSMD) governance regimes to deliver conservation outcomes. This study analyzes the impacts of three NSMD governance systems that sought to end the conversion of natural forests to plantations in Chile at the start of the 21st century. Using a multilevel, panel dataset of land use changes in Chile, we identify the impact of participation within each of the governance regimes by implementing a series of matched difference-in-differences analyses. Taking advantage of the mosaic of different NSMD regimes adopted in Chile, we explore the relative effectiveness of different policies. NSMD governance regimes reduced deforestation on participating properties by 2-23%. The NSMD governance regimes we studied included collaborative and confrontational strategies between environmental and industry stakeholders. We find that the more collaborative governance systems studied achieved better environmental performance than more confrontational approaches. Whereas many government conservation programs have targeted regions with little likelihood of conversion, we demonstrate that NSMD governance has the potential to alter behavior on high-deforestation properties.

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Desde 1984 la Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM) ha certificado 12.294 especialistas médicos en Chile. La disciplina de Anestesiología inició su certificación en 1985, habiendo reconocido hasta diciembre de 2012 a 716 especialistas. Para la certificación existen tres vías posibles: a) haber aprobado un Programa de Formación Universitario Acreditado, lo que hizo el 53 por ciento de los postulantes; b) cumplir los requisitos de Adiestramiento en Práctica durante 5 años, lo que hizo un 41 por ciento de los postulantes. c) haber sido formado en el extranjero de acuerdo a programas convalidados. Existen 7 programas universitarios acreditados, de 3 años de duración, con un cupo total anual de 39 alumnos que se desarrollan en Santiago y provincias. Salvo los médicos aprobados en los Programas Universitarios acreditados, el resto de los postulantes requieren dar un examen práctico; desde 2002 se ha agregado un examen escrito, cuya aprobación es requisito para dar el práctico, y que ha resultado tener buena discriminación (49 por ciento de rechazo promedio en el período de 11 años de existencia). Las certificaciones dadas hoy, tienen una duración de 10 años al inicio y serán de 7 años en la recertificación. La caducidad de las certificaciones está aparejada al proceso de recertificación, de lo cual se discuten las razones que lo avalan; se presentan los requisitos y tabla de créditos a cumplir, elaborada por CONACEM. La legislación vigente y en proceso, requiere la actuación de al menos una entidad certificadora, condición que ha sido otorgada legalmente en forma única por el Ministerio de Salud a CONACEM a partir del 11/02/2014...

Since 1984, 12.294 different medical specialists have been certified in Chile by the Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM). The certification in Anestesiology specialty was initiated in 1985 reaching 716 candidates approved until December 2012. Three ways are available to achieve certification: a) to be approved by a reputable university program in the specialization; this way has been used by 53 percent of postulants; b) to fulfill the requirements of a 5 years practical training program, as 41 percent of postulants did; c) to have passed a training program abroad, similar to those in force in Chile (< 5 percent). There are 7, three-year-long reputable university programs with a total annual capacity of 39 students; half of it is for programs developed in provinces. With the exception of doctors completing reputable university programs, others postulants are require to pass a five days practical examination. Since 2002 a written test has been added, which must be taken and approved as a condition of the practical examination. Written examinations have demonstrated good discriminative capacity (52 percent average approval in 11 years). Extended certifications currently have a 10 years duration for the first time and 7 years for subsequent recertification. Revocation of certification involves installing a recertification mechanism. The reasons that support the recertification are analyzed, and also present the requirements to obtaining it. Current legislation requires that certification and recertification are done by accrediting entities. CONACEM has been legally recognized by de Ministery of Health since February 2014 as the unique entity to perform that labor...

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Introdução: buscando aliar a utilização de recursos tecnológicos digitais com a segurança jurídica, o objetivo do presente trabalho é viabilizar, por meio de conceitos da Ciência do Direito, uma proposta para validação jurídica do “Prontuário Odontológico Eletrônico”. Métodos: como no Ordenamento Jurídico brasileiro não há legislação específica sobre esse assunto, a questão foi analisada conforme a analogia, os costumes e os princípios gerais de direito. Resultados e Conclusões: é possível obter “Prontuário Odontológico Eletrônico” com a mesma validade jurídica do “Prontuário Odontológico Convencional”. Para tanto, o cirurgião-dentista, o laboratório de radiologia e o paciente devem assinar digitalmente os arquivos da documentação digital que tenham responsabilidade de assinar na documentação convencional não-digital.

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We analyzed the Mexican legal framework, identifying the vectors that characterize quality and control in gastrointestinal surgery. Quality is contemplated in the health protection rights determined according to the Mexican Constitution, established in the general health law and included as a specific goal in the actual National Development Plan and Health Sector Plan. Quality control implies planning, verification and application of corrective measures. Mexico has implemented several quality strategies such as certification of hospitals and regulatory agreements by the General Salubrity Council, creation of the National Health Quality Committee, generation of Clinical Practice Guidelines and the Certification of Medical Specialties, among others. Quality control in gastrointestinal surgery must begin at the time of medical education and continue during professional activities of surgeons, encouraging multidisciplinary teamwork, knowledge, abilities, attitudes, values and skills that promote homogeneous, safe and quality health services for the Mexican population.

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This article is about the psychiatric educational components in the field of psychiatry. Currently the training and educational objectives focus on five major areas: undergraduate education (medical students); graduate education (psychiatric residents); psychiatric education for primary care physicians, as well as physicians in other medical specializations (psychosomatic training); public health and public education at large, and patient and family education, and the promotion of 'mental health' at a community level. Given the strong globalization process observed in all regions of the world in the past two or three decades, it is very important for Latin America to constantly review and update its psychiatric and behavioural sciences curriculum across all medical institutions and universities of the continent. New methods of teaching and novel approaches to education in the field of psychiatry are currently based on models that are also in use in other parts of the world, especially in the USA. Boards of certification for psychiatrists are being implemented all over the continent. Sound certification guarantees that the professional has followed and passed an educational training plan to make him/her qualified to start practising the profession. The future of psychiatric training will be closely bound to the future of the practice of psychiatry, and will have to get ahead of the challenges the specialism will face during the next decades.

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