The association between hope and mortality in homebound elders.

OBJECTIVE: Despite high rates of mortality and depression, there is limited knowledge of how depressive symptoms, especially feeling of hopefulness, affect mortality in the homebound elderly. METHODS: We conducted a secondary analysis of data from a community sample of 1034 adults, age 60 years and older. The Center for Epidemiologic Studies Depression Scale was used to evaluate the mood symptoms and feeling of hopefulness at baseline. The death data were collected within an 8-year follow-up period. Analysis of variance and Chi-square were used to compare the clinical conditions among the groups of individuals who feel hopeful always, sometimes, and rarely. Logistic regression was used to explore the association between the hopefulness about the future and mortality as an outcome. RESULTS: In the 8-year follow-up period, frequency of feeling hopeful, but not other individual depressive symptoms, was associated with mortality rate. The mortality rate among those who always, sometimes, and rarely felt hopeful were 21.6%, 26.4%, and 35.7%, respectively (P = 0.002). Logistic regression also confirmed that individuals who rarely feel hopeful had higher odds of decease within the 8-year follow-up period than those who always felt hopeful (OR = 1.74, CI = 1.14-2.65) after adjusting for age and medical conditions. CONCLUSIONS: Baseline hopefulness predicts mortality outcome among the homebound elderly in the community. Identifying individuals who are depressed with hopelessness in the elderly and providing early intervention may improve the mortality rate. Copyright © 2017 John Wiley & Sons, Ltd.

Approaches to improving access to essential cancer medicines in the WHO South-East Asia Region.

The high cancer burden in the World Health Organization (WHO) South-East Asia Region represents not only a significant cause of death, disability and suffering but also a major threat to development. In 2015, the need for equitable access to cancer treatments was underscored by the addition of 16 cancer drugs to the 19th WHO model list of essential medicines, including three high-cost medicines. This paper explores strategies to improve access, including - but not limited to - managing costs through regional cooperation; coordinated procurement mechanisms; price controls; differential pricing; and licensing agreements. The composition of the region, with small and large pharmaceutical markets with a range of manufacturing capacities and supply-chain issues, offers a unique frame of comparison and consideration for access issues. Different approaches are needed that are tailored to specific country situations. However, in the absence of global collaborative funding mechanisms, the region can advocate now, with one voice, for regional action to improve the affordability and availability of essential cancer medicines and align national cancer-control strategies to leverage regional strengths. Delays will lead to more premature cancer deaths and more households in the WHO South-East Asia Region being impoverished through out-of-pocket payments for cancer medicines.

Essential cancer medicines in the national lists of countries of the WHO South-East Asia Region: a descriptive assessment.

Background: In 2015, the need for equitable access to cancer treatments in low- and middle income countries was underscored by the addition of 16 essential cancer medicines to the 19th World Health Organization (WHO) model list of essential medicines (WHO EML). This study assessed the degree to which this expanded WHO EML from 2015 has influenced inclusion of cancer medicines in the most recent national essential medicines lists of the countries of the WHO South-East Asia Region. Methods: The inclusion of a selected list of 38 essential cancer medicines in the 2015 WHO EML was assessed in the most recent national lists of essential medicines from the 11 countries of the WHO South-East Asia Region. Additionally, the availability of six essential cancer medicines common to the national lists of essential medicines from six countries of the WHO South-East Asia Region was explored. Results: Of the 38 selected essential cancer medicines included in the 19th WHO EML, a mean of 18.0 (range 2-33) were included in the national lists of countries of the WHO South-East Asia Region. Of the 25 essential cancer medicines included in the WHO EML prior to the 19th revision, a mean of 14.6 (range 2-21) were included in national lists; notably fewer of the 13 cancer medicines added in the 2015 revision were included: mean 3.4 (range 0-12). Conclusion: Compared with the WHO EML, there is a lag in the inclusion of essential cancer medicines in national lists of essential medicines in the WHO South-East Asia Region. Alignment of essential cancer medicines in national lists of essential medicines among the 11 countries in the region varies significantly. These differences may hinder regional strategies to improve access to essential cancer medicines, such as pooled procurement of selected high-cost medicines. The link between the availability and affordability of essential cancer medicines warrants further investigation, in the context of access to medicines for universal health coverage.

An amylin analog used as a challenge test for Alzheimer's disease.

INTRODUCTION: Preclinical studies demonstrate the potential of amylin in the diagnosis of Alzheimer's disease (AD). We aimed to lay the foundation for repurposing the amylin analog and a diabetes drug, pramlintide, for AD in humans. METHODS: We administered a single subcutaneous injection of 60 µg of pramlintide to nondiabetic subjects under fasting conditions. RESULTS: None of the participants developed hypoglycemia after the injection of pramlintide. The pramlintide challenge induced a significant surge of amyloid-ß peptide and a decrease in total tau in the plasma of AD subjects but not in control participants. The pramlintide injection provoked an increase in interleukin 1 receptor antagonist and a decrease in retinol-binding protein 4, which separates AD subjects from control subjects. DISCUSSION: Pramlintide use appeared to be safe in the absence of diabetes. The biomarker changes as a result of the pramlintide challenge, which distinguished AD from control subjects and mild cognitive impairment.