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1.
Am Soc Clin Oncol Educ Book ; 41: 1-11, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33793315

RESUMEN

The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.


Asunto(s)
Neoplasias de Cabeza y Cuello/terapia , Accesibilidad a los Servicios de Salud , Oncología Médica , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/mortalidad , Prioridades en Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Evaluación de Necesidades , Resultado del Tratamiento
4.
Nat Med ; 27(3): 380-387, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33723458

RESUMEN

All countries worldwide have signed up to the United Nations Sustainable Development Goals and have committed to the objective of achieving 'universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all'. During the COVID-19 pandemic and beyond, advancement toward universal health coverage (UHC) will become more difficult for many countries, demonstrating that locally led priority setting is urgently needed to provide health services with appropriate financial protection to all. Because resources are limited and no national constituency can provide an unlimited number of services to their whole population in a sustainable manner, rationing and setting priorities for the selection of interventions to be included in a defined package of services is critical. In this Perspective, we discuss how packages of essential health services can be developed in resource-constrained settings, and detail how experts and the public can decide on principles and criteria, use a comprehensive array of analytical methods and choose which services to be provided free of charge. We illustrate these main steps while drawing on a recently conducted exercise of revising the national essential health services package in Ethiopia, which we compare with examples from other countries that have defined their essential benefits packages. This Perspective also provides recommendations for other low- and middle-income countries on their pathway to UHC.


Asunto(s)
Asignación de Recursos para la Atención de Salud , Planificación en Salud , Prioridades en Salud , Atención de Salud Universal , Etiopía , Accesibilidad a los Servicios de Salud , Humanos , Desarrollo Sostenible
6.
Document officiel;358
Monografía en Francés | PAHO-IRIS | ID: phr-53365

RESUMEN

Le Budget programme 2020-2021 constitue un « contrat » fondé sur les résultats entre le Bureau sanitaire panaméricain (BSP) et les États Membres de l’OPS, chacun s’engageant à prendre les mesures respectives nécessaires pour obtenir les résultats intermédiaires et les résultats immédiats en matière de santé qu’il contient. L’approbation, la mise en œuvre et l’établissement de rapports sur le présent budget programme sont les principaux moyens de reddition de comptes sur les activités programmatiques du BSP. L’aspect budgétaire du budget programme constitue l’un des deux principaux piliers de la responsabilisation financière (avec le rapport financier annuel du Directeur et le rapport du Commissaire aux comptes). À quelques exceptions notables près, la somme totale des activités du BSP pour les deux prochaines années est représentée dans le présent budget programme.


Asunto(s)
Organización Panamericana de la Salud , Cooperación Técnica , Presupuestos , Agenda de Prioridades en Salud , Prioridades en Salud , Gestión en Salud
7.
Documento Oficial;358
Monografía en Portugués | PAHO-IRIS | ID: phr-53360

RESUMEN

Este Orçamento por Programas 2020-2021 constitui um “contrato” baseado em resultados entre a Repartição Sanitária Pan-Americana (RSPA) e os Estados Membros da OPAS, cada qual realizando os esforços necessários para executar as respectivas ações exigidas para alcançar os resultados imediatos e intermediários relacionados à saúde aqui contidos. A aprovação, implementação e divulgação deste Orçamento por Programas são os principais meios de prestação de contas do trabalho programático da RSPA. O aspecto orçamentário do Orçamento por Programas constitui um dos dois pilares da responsabilidade financeira da Organização, juntamente com o Relatório Financeiro Anual da Diretora e o Relatório do Auditor Externo. Com algumas exceções notáveis, o somatório do trabalho da RSPA para os próximos dois anos está representado neste Orçamento por Programas.


Asunto(s)
Organización Panamericana de la Salud , Cooperación Técnica , Presupuestos , Prioridades en Salud , Gestión en Salud
8.
Documento Oficial;358
Monografía en Español | PAHO-IRIS | ID: phr-53359

RESUMEN

El Presupuesto por Programas 2020-2021 representa un “contrato” basado en resultados entre la Oficina Sanitaria Panamericana (“la OSP”) y los Estados Miembros de la OPS, de acuerdo con el cual cada parte se compromete a tomar las medidas necesarias para alcanzar los resultados intermedios e inmediatos en materia de salud establecidos en este documento. La aprobación, la ejecución y la presentación de informes de este Presupuesto por Programas es el medio principal de rendición de cuentas del trabajo programático de la Oficina. El aspecto presupuestario del Presupuesto por Programas es uno de los dos pilares principales de la rendición de cuentas financiera (junto con el informe financiero anual del Director y el informe del auditor externo). Con unas pocas excepciones notables, en este presupuesto por programas se presenta la totalidad del trabajo de la Oficina para los próximos dos años.


Asunto(s)
Cooperación Técnica , Organización Panamericana de la Salud , Presupuestos , Prioridades en Salud , Gestión de Recursos
9.
Prev Med ; 144: 106294, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33678225

RESUMEN

Cervical cancer remains the fourth most common cancer in women, with 85% of deaths occurring in LMICs. Despite the existence of effective vaccine and screening tools, efforts to reduce the burden of cervical cancer must be considered in the context of the social structures within the health systems of LMICs. Compounding this existing challenge is the global COVID-19 pandemic, declared in March 2020. While it is too soon to tell how health systems priorities will change as a result of COVID-19 and its impact on the cervical cancer elimination agenda, there are opportunities to strengthen cervical screening by leveraging on several trends. Many LMICs maximized the strengths of their long established community-based primary care and public health systems with expansion of surveillance systems which incorporated mobile technologies. LMICs can harness the momentum of the measures taken against COVID-19 to consolidate the efforts against cervical cancer. Self-sampling, molecular human papillomavirus (HPV) testing and digital health will shift health systems towards stronger public health and primary care networks and away from expensive hospital-based care investments. While COVID-19 will change health systems priorities in LMICs in ways that may de-prioritize cervical cancer screening, there are significant opportunities for integration into longer-term trends towards universal health coverage, self-care and digital health.


Asunto(s)
/epidemiología , Países en Desarrollo , Prioridades en Salud , Infecciones por Papillomavirus/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , /prevención & control , Detección Precoz del Cáncer , Femenino , Humanos
11.
Washington; Organización Panamericana de la Salud; mar. 3, 2021.
No convencional en Inglés, Español, Portugués, Francés | LILACS | ID: biblio-1151152

RESUMEN

Há quase um ano desde o início da pandemia de COVID-19, e os cientistas de todo o mundo avançaram rapidamente no desenvolvimento de vacinas seguras e eficazes que ajudarão a reduzir doenças, hospitalizações e mortes associadas à COVID-19. Espera-se que essas vacinas contribuam consideravelmente para a proteção e a promoção equitativas do bem-estar humano e que possibilitem o retorno progressivo às atividades sociais, econômicas, profissionais e familiares. O objetivo deste documento é apoiar os países da Região das Américas no planejamento dos componentes operacionais do programa de imunizações em preparação para a vacina contra a COVID-19. Para tanto, seguem-se os princípios e valores recomendados pelo SAGE e pelo GTA bem como as recomendações técnicas da OPAS e da OMS. Essas recomendações destinam-se ao planejamento da introdução das vacinas contra a COVID-19 no nível operacional, seguindo as recomendações do roteiro do SAGE e da priorização dos grupos populacionais estabelecida pelo país. As recomendações são preliminares e serão atualizadas à medida que novas evidências forem disponibilizadas.


A casi un año del inicio de la pandemia de COVID-19, científicos de todo el mundo han avanzado rápidamente en el desarrollo de vacunas seguras y eficaces que contribuirán a reducir las enfermedades, las hospitalizaciones y las muertes asociadas a la COVID-19. Se espera que dichas vacunas ayuden significativamente a proteger y promocionar de manera equitativa el bienestar humano, y que permitan retomar de forma progresiva las actividades sociales, económicas, laborales y familiares. El propósito de este documento es apoyar a los países de la Región de las Américas a planificar los componentes operacionales del programa de inmunizaciones en preparación para la introducción de la vacuna contra la COVID-19. Para ello se siguen los principios y los valores recomendados por el Grupo de Expertos de la Organización Mundial de la Salud (OMS) en Asesoramiento Estratégico sobre Inmunización y el Grupo Técnico Asesor sobre enfermedades prevenibles por vacunación de la Organización Panamericana de la Salud (OPS), así como las recomendaciones técnicas de la OPS y la OMS. El documento contiene recomendaciones relativas a la microplanificación de la introducción de las vacunas y a la priorización de los grupos poblacionales. Las recomendaciones son preliminares y se actualizarán a medida que se disponga de nueva evidencia.


Almost a year into the COVID-19 pandemic, scientists throughout the world have swiftly moved to develop safe and effective vaccines that will help reduce illness, hospitalizations, and deaths associated with COVID-19. These vaccines are expected to make a significant contribution to equitable protection and promotion of human well-being and a gradual return to social, economic, work, and family life. This manual is designed to assist the countries of the Region of the Americas in planning the operational components of the immunization program to ready them for the COVID-19 vaccine. To accomplish this, it follows the principles and values recommended by SAGE and the TAG, as well as the technical recommendations of PAHO and WHO. The aim of these recommendations is to plan for the introduction of COVID-19 vaccines at the operational level and country prioritization of population groups. The recommendations are preliminary and will be updated as new evidence becomes available.


Près d'un an après le début de la pandémie de COVID-19, les scientifiques du monde entier ont réalisé des avancées rapides dans la mise au point de vaccins sûrs et efficaces qui contribueront à réduire les maladies, les hospitalisations et les décès associés à la COVID­19. Ces vaccins devraient contribuer de manière significative à la protection et à la promotion équitables du bien-être humain, et permettre un retour progressif aux activités sociales, économiques, professionnelles et familiales. Le présent document a pour objet d'aider les pays de la Région des Amériques à planifier les composantes opérationnelles du programme de vaccination en vue des préparatifs concernant le vaccin contre la COVID-19. Il suit les principes et les valeurs recommandés par le SAGE et le GCT, ainsi que les recommandations techniques de l'OPS et de l'OMS. Ces recommandations visent à planifier l'introduction des vaccins contre la COVID-19 au niveau opérationnel et la détermination des groupes de population à vacciner en priorité. Les recommandations sont préliminaires et seront mises à jour à mesure que de nouveaux éléments probants seront disponibles.


Asunto(s)
Humanos , Neumonía Viral/prevención & control , Vacunas Virales/inmunología , Programas de Inmunización/organización & administración , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Betacoronavirus/inmunología , Prioridades en Salud
12.
Recenti Prog Med ; 112(3): 167-170, 2021 03.
Artículo en Italiano | MEDLINE | ID: mdl-33687352

RESUMEN

For covid-19, a disease that has proved fatal in many cases, a specific therapy has not yet been found, but the vaccine. This has triggered a further series of issues. Who to vaccinate first, how to achieve the so-called "herd immunity", especially if it is right, as it is being done, start with the medical staff and immediately after safeguard the elderly which also involve the problem of a clear explanation and acceptance, through informed consent, which it can be particularly difficult to illustrate.


Asunto(s)
/prevención & control , Asignación de Recursos para la Atención de Salud , /inmunología , Anciano , Asignación de Recursos para la Atención de Salud/ética , Asignación de Recursos para la Atención de Salud/normas , Personal de Salud , Prioridades en Salud , Necesidades y Demandas de Servicios de Salud , Derechos Humanos , Humanos , Inmunidad Colectiva , Exposición Profesional , Derecho a la Salud , Justicia Social , Vacunación
14.
Artículo en Inglés | MEDLINE | ID: mdl-33525746

RESUMEN

Identification of health priorities is concerned with equitable distribution of resources and is an important part of strategic planning in the health care system. The aim of this article is to describe health priorities in the Polish health care system from the patients' perspective. The study included 533 patients hospitalized in the Lodz region. The average age of the respondents was 48.5 years and one third (36.6%) had university education. Most of the respondents (64.9%) negatively assessed the functioning of the health care system in Poland. Most of them claimed the following aspects require improvements: financing health services (85.8%), determining priorities in health care (80.3%), the role of health insurance (80.3%), and medical education (70.8%). Over 70% of the respondents agreed the role of politicians in designing and implementing health system reforms should be limited. The fact that the respondents so negatively assessed the Polish health care system implies there is a need for full discussion on redefining health priorities.


Asunto(s)
Prestación de Atención de Salud , Prioridades en Salud , Servicios de Salud , Humanos , Seguro de Salud , Persona de Mediana Edad , Polonia
16.
Clin Trials ; 18(2): 226-233, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33530721

RESUMEN

Given the dearth of established safe and effective interventions to respond to COVID-19, there is an urgent ethical imperative to conduct meaningful clinical research. The good news is that interventions to be tested are not in short supply. Unfortunately, the human and material resources needed to conduct these trials are finite. It is essential that trials be robust and meet enrollment targets and that lower-quality studies not be permitted to displace higher-quality studies, delaying answers to critical questions. Yet, with few exceptions, existing research review bodies and processes are not designed to ensure these conditions are satisfied. To meet this challenge, we offer guidance for research institutions about how to ethically consolidate and prioritize COVID-19 clinical trials, while recognizing that consolidation and prioritization should also take place upstream (among manufacturers and funders) and at a higher level (e.g. nationally). In our proposed three-stage process, trials must first meet threshold criteria. Those that do are evaluated in a second stage to determine whether the institution has sufficient capacity to support all proposed trials. If it does not, the third stage entails evaluating studies against two additional sets of comparative prioritization criteria: those specific to the study and those that aim to advance diversification of an institution's research portfolio. To implement these criteria fairly, we propose that research institutions form COVID-19 research prioritization committees. We briefly discuss some important attributes of these committees, drawing on the authors' experiences at our respective institutions. Although we focus on clinical trials of COVID-19 therapeutics, our guidance should prove useful for other kinds of COVID-19 research, as well as non-pandemic research, which can raise similar challenges due to the scarcity of research resources.


Asunto(s)
/terapia , Ensayos Clínicos como Asunto/ética , Ensayos Clínicos como Asunto/organización & administración , Investigación Biomédica/ética , Investigación Biomédica/organización & administración , Comités de Ética en Investigación , Ética en Investigación , Prioridades en Salud , Recursos en Salud , Humanos , Proyectos de Investigación
18.
Anaesthesia ; 76(5): 608-616, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33572007

RESUMEN

National (and global) vaccination provides an opportunity to control the COVID-19 pandemic, which disease suppression by societal lockdown and individual behavioural changes will not. We modelled how vaccination through the UK's vaccine priority groups impacts deaths, hospital and ICU admissions from COVID-19. We used the UK COVID-19 vaccines delivery plan and publicly available data to estimate UK population by age group and vaccination priority group, including frontline health and social care workers and individuals deemed 'extreme clinical vulnerable' or 'high risk'. Using published data on numbers and distributions of COVID-19-related hospital and ICU admissions and deaths, we modelled the impact of vaccination by age group. We then modified the model to account for hospital and ICU admission, and death among health and social care workers and the population with extreme clinical vulnerability and high risk. Our model closely matches the government's estimates for mortality after vaccination of priority groups 1-4 and groups 1-9. The model shows vaccination will have a much slower impact on hospital and ICU admissions than on deaths. The early prioritisation of healthcare staff and clinically vulnerable patients increases the impact of vaccination on admissions and also protects the healthcare service. An inflection point, when 50% of the adult population has been vaccinated - with deaths reduced by 95% and hospital admissions by 80% - may be a useful point for re-evaluating vaccine prioritisation. Our model suggests substantial reductions in hospital and ICU admissions will not occur until late March and into April 2021.


Asunto(s)
/administración & dosificación , Cuidados Críticos/tendencias , Personal de Salud/tendencias , Admisión del Paciente/tendencias , Vacunación/tendencias , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Prioridades en Salud/tendencias , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Instituciones Residenciales/tendencias , Reino Unido/epidemiología , Adulto Joven
20.
BMC Med ; 19(1): 45, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-33563270

RESUMEN

BACKGROUND: All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China. METHODS: On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic. RESULTS: Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a two-dose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population. CONCLUSIONS: The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries.


Asunto(s)
/uso terapéutico , Personal de Salud , Programas de Inmunización/métodos , Selección de Paciente , Policia , Adolescente , Anciano , /mortalidad , Niño , China/epidemiología , Comorbilidad , Teoría Ética , Femenino , Industria de Alimentos , Prioridades en Salud , Hospitalización , Humanos , Programas de Inmunización/organización & administración , Lactante , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Mortalidad , Casas de Salud , Pandemias/prevención & control , Formulación de Políticas , Embarazo , Transportes , Vacunación , Adulto Joven
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