The Patient Protection and Affordable Care Act (ACA) 1 laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. 2 During the first openenrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, federal and state funding was used to develop navigator programs in each state. The design of these programs differed by location, 3 and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource.4 This is somewhat surprising, given that LHDs serve as trusted entities in communities, can reach the most-vulnerable populations, and have access to data and resources that might facilitate ACA outreach and enrollment. This is one in a series of reports designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Potential roles include serving as a coordinator for community activities, being a trusted source of health care information for consumers, and leveraging community partners to increase capacity for outreach and enrollment. These reports identify compelling models for how LHDs can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage. Each case study
La falta de gestión y educación ambiental dentro de las centrales de abastos de frutas y verduras en ciudades intermedias de Colombia, está generando volúmenes de residuos innecesarios que terminan dispuestos en rellenos sanitarios, desaprovechando su potencial de recuperación y reciclaje. El propósito de esta investigación fue determinar los factores que ocasionan los problemas en la separación y disposición de residuos, a partir de un estudio de caso dentro del establecimiento comercial de expendio de frutas y verduras más grande de la ciudad de Neiva – Colombia con un área de 80.049 m2. Para su desarrollo se determinó la periodicidad y frecuencia de recolección y transporte de los residuos a diario, se realizó una caracterización de estos y se aplicó una herramienta de recolección a 107 establecimientos. Se encontró un problema cultural, un 72% de la comunidad comerciante envejecida, un 54% de residuos orgánicos desaprovechados, 42% de otros residuos recuperables.
The Patient Protection and Affordable Care Act (ACA) 1 laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. 2 During the first openenrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, federal and state funding was used to develop navigator programs in each state. The design of these programs differed by location, 3 and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource. 4 This is somewhat surprising, given that LHDs serve as trusted entities in communities, can reach the most-vulnerable populations, and have access to data and resources that might facilitate ACA outreach and enrollment. This is one in a series of reports designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Potential roles include serving as a coordinator for community activities, being a trusted source of health care information for consumers, and leveraging community partners to increase capacity for outreach and enrollment. These reports identify compelling models for how LHDs can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage. Each case study • The department established a network of in-person assisters (IPAs) and IPA organizations that were instrumental in outreach and enrollment efforts. It also created a forum for information-sharing around challenges and provided support and technical assistance to the group.• Challenges to outreach and enrollment efforts included the Washington Medicaid renewal policy, the poor relationship between the IPAs and the Washington Health Benefit Exchange, and lack of support to address IPAs' concerns. In addition, some raised concerns about having a public health department serve as a lead agency.• Boosts to those efforts included grant support from the Washington Health Benefit Exchange, formal collaboration with the health sector through a steering committee, the exchange grant, and the collaborative culture among organizations in Tacoma.
A retrospective analysis of data concerned with the regulation of the transport of animals for caged animal feeding operations (feedlots) and the availability and use of antibiotics was accomplished from data available from an aggregation of domestic and global agencies. Agency data sources included are the United States Department of Agriculture‐Animal Plant Health Inspection System (USDA‐APHIS), the Environmental Protection Agency (EPA), the United States Geological Survey (USGS), Center for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Customs and Border Protection‐Eagle Pass Sector (CBP), Drug Enforcement Administration (DEA), Texas Water Development Board‐Laredo, Texas, (TWDB), Texas Commission on Environmental Quality‐Laredo, Texas, (TCEQ), Organization for Economic Cooperation and Development (OECD), Asia Pacific Economic Cooperation (APEC), European Centre for Disease Prevention and Control (ECDC), European Medicines Agency (EMEA), Food and Agriculture Organization (FAO), World Organization for Animal Health (OIE), Transatlantic Taskforce on Antimicrobial Resistance (TATFAR), World Health Organization (WHO), and Central Drugs Standard Control Organization (CDSCO). Based on the analysis, an action plan is proposed for the Global Union for Antibiotics Research and Development[1][2][3](GUARD) to mitigate AR pandemic (ARP). The primary suggestion is the immediate establishment of a centralized database that will serve as an open‐ended system for reporting, monitoring and control, education, and information sharing in the following processes: i. Antibiotics prescription details by name of disease and dosage, ii. Amount of antibiotics produced per country and per capita, including utilization of antibiotics per country and per capita. Implementation of antibiotics time out (ATO), iii. Detection of active pharmaceutical ingredients (API) in soil and water, iv. Streamlining of the disposal of antibiotics by universal and global disposal standards (Best Available Techniques), v. Maintain a global monitoring system for emergence of AR pathogen induced infectious diseases on twenty‐four‐hour and seven day cycles, vi. Mandatory cyclic reporting (quarterly, semiannual, and annual) regarding morbidity and mortality rates due to AR pathogens, vii. Mandatory annual summit to address threats of emergence and spread of AR infectious diseases, viii. Generate global trust fund to create resources for mitigation of the AR, ix. Global implementation‐success rate of Antibiotics Timeout (ATO), x. Creation of a Pharmaco‐Ecotoxicology data sheet for “Bioaccumulation potential of antibiotics, its active pharmaceutical ingredients (API) in the non‐target organisms (aquatic, terrestrial, avian species) and Environmental risk assessment for biological response using multi‐biomarker approach. Taken together, a collective effort addressing the aforesaid suggestions on a global scale would plausibly mitigate ARP. Data analysis and adequate literature sources will be presented at EB 2017.Support or Funding InformationProfessional development funds to Subburaj Kannan
Los Residuos de Aparatos Eléctricos y Electrónicos - RAEEs se han convertido en una nueva fuente de contaminación, al punto que anualmente se están disponiendo en los rellenos sanitarios aproximadamente entre 40 y 50 millones de toneladas en países emergentes. Este tipo de residuos especiales, considerados peligrosos, son un riesgo para el medio ambiente y los seres humanos. Por lo anterior, este artículo presenta el análisis del comportamiento de la generación de residuos peligrosos en el sector industrial, comercial y de servicios en la ciudad de Neiva. Para esto se contó con el apoyo de la autoridad ambiental regional para identificar los generadores de residuos peligrosos de la ciudad y se diseñó una herramienta de recolección de información.El procesamiento de esta información permitió identificar el tipo, la cantidad y el manejo y disposición final de este tipo de residuos en la ciudad. Se encontró que en el año 2013 se generaron 133.396 kg/año de RAEEs, y solo 25% de los generadores consideran a los RAEEs como peligrosos. Este estudio permite sentar las bases para dar un punto de partida a otras investigaciones asociadas con los residuos peligrosos y especiales que permita generar alternativas a mediano plazo relacionadas con la sostenibilidad, la innovación y el emprendimiento a nivel local.
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