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2.
BMC Public Health ; 21(1): 490, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33706726

RESUMEN

BACKGROUND: It is now 25 years since the adoption of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the same concerns raised during its negotiations such as high prices of medicines, market exclusivity and delayed market entry for generics remain relevant as highlighted recently by the Ebola and COVID-19 pandemics. The World Health Organization's (WHO) mandate to work on the interface between intellectual property, innovation and access to medicine has been continually reinforced and extended to include providing support to countries on the implementation of TRIPS flexibilities in collaboration with stakeholders. This study analyses the role of intellectual property on access to medicines in the African Region. METHODS: We analyze patent data from the African Regional Intellectual Property Organization (ARIPO) and Organisation Africaine de la Propriété Intellectuelle (OAPI) to provide a situational analysis of patenting activity and trends. We also review legislation to assess how TRIPS flexibilities are implemented in countries. RESULTS: Patenting was low for African countries. Only South Africa and Cameroon appeared in the list of top ten originator countries for ARIPO and OAPI respectively. Main diseases covered by African patents were HIV/AIDS, cardiovascular diseases, cancers and tumors. Majority countries have legislation allowing for compulsory licensing and parallel importation of medicines, while the least legislated flexibilities were explicit exemption of pharmaceutical products from patentable subject matter, new or second use of patented pharmaceutical products, imposition of limits to patent term extension and test data protection. Thirty-nine countries have applied TRIPS flexibilities, with the most common being compulsory licensing and least developed country transition provisions. CONCLUSIONS: Opportunities exist for WHO to work with ARIPO and OAPI to support countries in reviewing their legislation to be more responsive to public health needs.


Asunto(s)
/prevención & control , Comercio/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Propiedad Intelectual , Patentes como Asunto , África , Comercio/historia , Países en Desarrollo , Historia del Siglo XX , Humanos , Derecho Internacional , Salud Pública/legislación & jurisprudencia , Organización Mundial de la Salud
5.
JAMA Netw Open ; 4(2): e2036687, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33576816

RESUMEN

Importance: In response to the increase in opioid overdose deaths in the United States, many states recently have implemented supply-controlling and harm-reduction policy measures. To date, an updated policy evaluation that considers the full policy landscape has not been conducted. Objective: To evaluate 6 US state-level drug policies to ascertain whether they are associated with a reduction in indicators of prescription opioid abuse, the prevalence of opioid use disorder and overdose, the prescription of medication-assisted treatment (MAT), and drug overdose deaths. Design, Setting, and Participants: This cross-sectional study used drug overdose mortality data from 50 states obtained from the National Vital Statistics System and claims data from 23 million commercially insured patients in the US between 2007 and 2018. Difference-in-differences analysis using panel matching was conducted to evaluate the prevalence of indicators of prescription opioid abuse, opioid use disorder and overdose diagnosis, the prescription of MAT, and drug overdose deaths before and after implementation of 6 state-level policies targeting the opioid epidemic. A random-effects meta-analysis model was used to summarize associations over time for each policy and outcome pair. The data analysis was conducted July 12, 2020. Exposures: State-level drug policy changes to address the increase of opioid-related overdose deaths included prescription drug monitoring program (PDMP) access, mandatory PDMPs, pain clinic laws, prescription limit laws, naloxone access laws, and Good Samaritan laws. Main Outcomes and Measures: The outcomes of interests were quarterly state-level mortality from drug overdoses, known indicators for prescription opioid abuse and doctor shopping, MAT, and prevalence of drug overdose and opioid use disorder. Results: This cross-sectional study of drug overdose mortality data and insurance claims data from 23 million commercially insured patients (12 582 378 female patients [55.1%]; mean [SD] age, 45.9 [19.9] years) in the US between 2007 and 2018 found that mandatory PDMPs were associated with decreases in the proportion of patients taking opioids (-0.729%; 95% CI, -1.011% to -0.447%), with overlapping opioid claims (-0.027%; 95% CI, -0.038% to -0.017%), with daily morphine milligram equivalent greater than 90 (-0.095%; 95% CI, -0.150% to -0.041%), and who engaged in drug seeking (-0.002%; 95% CI, -0.003% to -0.001%). The proportion of patients receiving MAT increased after the enactment of mandatory PDMPs (0.015%; 95% CI, 0.002% to 0.028%), pain clinic laws (0.013%, 95% CI, 0.005%-0.021%), and prescription limit laws (0.034%, 95% CI, 0.020% to 0.049%). Mandatory PDMPs were associated with a decrease in the number of overdose deaths due to natural opioids (-518.5 [95% CI, -728.5 to -308.5] per 300 million people) and methadone (-122.7 [95% CI, -207.5 to -37.8] per 300 million people). Prescription drug monitoring program access policies showed similar results, although these policies were also associated with increases in overdose deaths due to synthetic opioids (380.3 [95% CI, 149.6-610.8] per 300 million people) and cocaine (103.7 [95% CI, 28.0-179.5] per 300 million people). Except for the negative association between prescription limit laws and synthetic opioid deaths (-723.9 [95% CI, -1419.7 to -28.1] per 300 million people), other policies were associated with increasing overdose deaths, especially those attributed to non-prescription opioids such as synthetic opioids and heroin. This includes a positive association between naloxone access laws and the number of deaths attributed to synthetic opioids (1338.2 [95% CI, 662.5 to 2014.0] per 300 million people). Conclusions and Relevance: Although this study found that existing state policies were associated with reduced misuse of prescription opioids, they may have the unintended consequence of motivating those with opioid use disorders to access the illicit drug market, potentially increasing overdose mortality. This finding suggests that there is no easy policy solution to reverse the epidemic of opioid dependence and mortality in the US.


Asunto(s)
/mortalidad , Tratamiento de Sustitución de Opiáceos/estadística & datos numéricos , Epidemia de Opioides , Trastornos Relacionados con Opioides/epidemiología , Política Pública , Gobierno Estatal , Analgésicos Opioides/uso terapéutico , Control de Medicamentos y Narcóticos , Reducción del Daño , Política de Salud , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Naloxona , Antagonistas de Narcóticos , Clínicas de Dolor/legislación & jurisprudencia , Pautas de la Práctica en Medicina/legislación & jurisprudencia , Programas de Monitoreo de Medicamentos Recetados/legislación & jurisprudencia , Prevalencia , Estados Unidos/epidemiología
11.
Plast Reconstr Surg ; 147(1): 135e-153e, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33370073

RESUMEN

SUMMARY: The Affordable Care Act's provisions have affected and will continue to affect plastic surgeons and their patients, and an understanding of its influence on the current American health care system is essential. The law's impact on pediatric plastic surgery, craniofacial surgery, and breast reconstruction is well documented. In addition, gender-affirmation surgery has seen exponential growth, largely because of expanded insurance coverage through the protections afforded to transgender individuals by the Affordable Care Act. As gender-affirming surgery continues to grow, plastic surgeons have the opportunity to adapt and diversify their practices.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Procedimientos Quirúrgicos Reconstructivos/estadística & datos numéricos , Cirugía de Reasignación de Sexo/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/tendencias , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/tendencias , Masculino , Medicaid/economía , Medicaid/estadística & datos numéricos , Patient Protection and Affordable Care Act/economía , Procedimientos Quirúrgicos Reconstructivos/economía , Procedimientos Quirúrgicos Reconstructivos/tendencias , Cirugía de Reasignación de Sexo/economía , Cirugía de Reasignación de Sexo/tendencias , Factores Socioeconómicos , Estados Unidos , Seguro de Salud Basado en Valor/economía , Seguro de Salud Basado en Valor/estadística & datos numéricos
12.
J Am Med Inform Assoc ; 28(2): 389-392, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33325524

RESUMEN

The widespread use of telehealth resulting from the COVID-19 pandemic has the potential to further exacerbate inequities faced by people with disabilities. Although, for some members of the disability community, the option to engage with telehealth may result in reduced barriers to care, for others, inadequate attention to the design, implementation, and policy dimensions may be detrimental. Addressing such considerations is imperative to mitigate health inequities faced by the disability community.


Asunto(s)
Personas con Discapacidad , Accesibilidad a los Servicios de Salud , Telemedicina , Regulación Gubernamental , Política de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Disparidades en Atención de Salud , Humanos , Telemedicina/legislación & jurisprudencia , Estados Unidos
13.
Radiol Clin North Am ; 59(1): 13-17, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33222995

RESUMEN

In an increasingly competitive and passionate health care environment, radiology advocacy is imperative, now more than ever. Arguably, it is particularly more crucial in the world of breast cancer, as we as a breast cancer community are tirelessly assembling to advocate for our patients on a variety of levels, whether it is including but not limited to, breast cancer screening, diagnosis, and treatment, access-to-care, education, or research funding. As breast radiologists, it is no longer simply enough to clock in our normal work hours; we must ALL make a concerted effort to vociferously advocate for our patients and profession.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Comunicación en Salud/métodos , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Mamografía , Defensa del Paciente/legislación & jurisprudencia , Mama/diagnóstico por imagen , Detección Precoz del Cáncer , Femenino , Humanos
14.
Am J Public Health ; 111(2): 259-264, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33351659

RESUMEN

States have enacted a wave of statutes over the past several years preempting local government law and policies that potentially promote public health in various ways. Among these local preemption measures are statutes in at least 9 states that outlaw municipal policies providing some form of "sanctuary" to immigrants. Such policies, and their preemption, have importance both for direct access to health services and for broader social determinants of health.This article gauges the coverage and potential impact of these state preemption laws based on key informant interviews nationally and a close legal analysis of relevant laws and policy documents. It distinguishes between preemption laws focused on law enforcement cooperation and those that also encompass a wider array of "welcoming" policies and initiatives. It also distinguishes between more passive forms of preemption that prohibit barring cooperation with federal immigration enforcement, and those statutes that more affirmatively require active measures to assist federal enforcement.Drawing these distinctions can help municipalities determine which immigrant-supportive measures are still permitted, and how best to mitigate the adverse public health effects of these preemption laws.


Asunto(s)
Emigración e Inmigración/legislación & jurisprudencia , Gobierno Local , Salud Pública/legislación & jurisprudencia , Gobierno Estatal , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Estados Unidos
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