[Implementation of RPNs in psychiatry and mental health]

Advanced practice nursing, a profession created in 2018, is expanding rapidly in France. In order for it to be operational, but also to facilitate its deployment and implementation, changes in the legislative and regulatory texts concerning all the mentions are still necessary. For advanced practice nurses with a diploma in psychiatry and mental health, the challenges in terms of training, implementation and prospects for autonomy are significant in view of the difficulties in this care sector.

[SPECIFIC ASPECTS OF THE LEGISLATIVE CONSOLIDATION OF THE INSTITUTION OF EARLY CARE FOR CHILDREN WITH DISABILITIES]

For the purposes of this work, children with disabilities include disabled children or children aged 0 to 8 years who are not recognized as disabled in the prescribed manner, but who have temporary or permanent deviations in physical and (or) mental development (hereinafter - children with disabilities). The legislative basis for the implementation of the rights and opportunities of children with disabilities and their families is constituted by constitutional provisions that enshrine state guarantees for the protection of childhood, motherhood, paternity, family (part 1 of article 38, paragraph "g.1" of part 1 of article 72 of the Constitution of the Russian Federation). An early start of comprehensive care for children with disabilities contributes to the maximum possible achievements in the development of the child, maintaining his health, as well as successful socialization and inclusion of the child in the educational environment with subsequent integration into society. The research material was the international treaties and regulatory legal acts of the Russian Federation on providing early assistance to children with disabilities. The work used a set of methods of scientific knowledge, including general scientific methods: analysis, synthesis, induction, deduction, special: comparative, formal legal, etc. Legislative consolidation of the institution of providing early assistance to children with disabilities can be carried out by amending the existing legislative acts or by adopting a separate regulatory legal act of the legislative level that establishes the legal basis for providing early assistance. This article outlines the directions for improving legal regulation in terms of legislative consolidation of the institution of providing early assistance to children with disabilities by amending the current legislative acts of the federal level.

Women and babies are dying from inertia: a collaborative framework for obstetrical drug development is urgently needed

Obstetrical complications, often referred to as the "great obstetrical syndromes," are among the most common global causes of mortality and morbidity in young women and their infants. However, treatments for these syndromes are underdeveloped compared with other fields of medicine and are urgently needed. This current paucity of treatments for obstetrical complications is a reflection of the challenges of drug development in pregnancy. The appetite of pharmaceutical companies to invest in research for obstetrical syndromes is generally reduced by concerns for maternal, fetal, and infant safety, poor definition, and high-risk regulatory paths toward product approval. Notably, drug candidates require large investments for development with an unguaranteed return on investment. Furthermore, the discovery of promising drug candidates is hampered by a poor understanding of the pathophysiology of obstetrical syndromes and their uniqueness to human pregnancies. This limits translational extrapolation and de-risking strategies in preclinical studies, as available for other medical areas, compounded with limited fetal safety monitoring to capture early prenatal adverse reactions. In addition, the ethical review committees are reluctant to approve the inclusion of pregnant women in trials, and in the absence of regulatory guidance in obstetrics, clinical development programs are subject to unpredictable regulatory paths. To develop effective and safe drugs for pregnancy complications, substantial commitment, and investment in research for innovative therapies are needed in parallel with the creation of an enabling ethical, legislative, and guidance framework. Solutions are proposed to enable stakeholders to work with a common set of expectations to facilitate progress in this medical discipline. Addressing this significant unmet need to advance maternal and possibly perinatal health requires the involvement of all stakeholders and specifically patients, couples, and clinicians facing pregnancy complications in the dearth of appropriate therapies. This paper focused on the key pharmaceutical research and development challenges to achieve effective and safe treatments for obstetrical syndromes.

[Legislative framework and legal regulation of dental care organization to patients with infectious diseases]

The existing normative legal framework does not fully correspond to modern requirements for the organization and delivering dental care for adult population with various infectious diseases. The authors basing on the analysis of regulatory guidelines consider that in order to provide timely, high-quality and affordable medical care to patients in the infectious diseases departments and clinical hospitals, it is necessary to update the normative legal framework and develop criteria for monitoring the quality of dental care for infectious patients at the stages of its delivering.

State-of-the-Art Review on Diabetes Care in Italy

BACKGROUND

Diabetes is a significant health problem in Italy as in other western countries.

OBJECTIVE

To review available epidemiological data and the legislative framework for diabetes care in Italy.

METHODS

Review of Italian Health Ministry's official documents and analysis of epidemiological data published by Italian Scientific Societies.

FINDINGS

Diabetes affects more than 5% of the Italian population. The expenditures for the care of people with diabetes are about €10 billion ($US 11 billion) a year and are increasing over time. Italian law regulates the clinical care of people with diabetes and creates a clinical framework involving medical organizations, prevention programs, personnel training, and legal protection. The National Health Program is structured in essential levels of assistance that can be defined differently in the various regions. In 2013, the "National Diabetes Plan," defining priority areas for intervention, was approved and represents the main regulatory tool for the management of diabetes within the Italian National Health Service. In Italy, the status of diabetes care is being monitored using the data from 2 permanent observatories: the ARNO Observatory Diabetes and the Associazione Medici Diabetologi Annals.

CONCLUSIONS

A comprehensive approach to diabetes is offered to all citizens, consonant with the constitutionally guaranteed right to health. However, this important effort translates into a relevant financial burden for the National Health Service.