COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.

BACKGROUND: Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million). METHODS AND FINDINGS: We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020. We then projected cases, deaths, and hospitalisation outcomes over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario. We project that 1 year of vaccine distribution, at delivery rates consistent with COVAX projections, using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY averted from the health system perspective. Under a broad range of alternative scenarios, we find that initially prioritising the older (65+) population generally prevents more deaths. However, unprioritised distribution has almost the same cost-effectiveness when considering all outcomes, and both prioritised and unprioritised programmes can be cost-effective for low per-dose costs. High vaccine prices ($10/dose), however, may not be cost-effective, depending on the specifics of vaccine performance, distribution programme, and future pandemic trends. The principal drivers of the health outcomes are the fitted values for the overall transmission scaling parameter and disease natural history parameters from other studies, particularly age-specific probabilities of infection and symptomatic disease, as well as social contact rates. Other parameters are investigated in sensitivity analyses. This study is limited by model approximations, available data, and future uncertainty. Because the model is a single-population compartmental model, detailed impacts of nonpharmaceutical interventions (NPIs) such as household isolation cannot be practically represented or evaluated in combination with vaccine programmes. Similarly, the model cannot consider prioritising groups like healthcare or other essential workers. The model is only fitted to the reported case and death data, which are incomplete and not disaggregated by, e.g., age. Finally, because the future impact and implementation cost of NPIs are uncertain, how these would interact with vaccination remains an open question. CONCLUSIONS: COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact. However, the advantage of prioritising older, high-risk populations is smaller in generally younger populations. This reduction is especially true in populations with more past transmission, and if the vaccine is likely to further impede transmission rather than just disease. Those conditions are typical of many low- and middle-income countries.

Desarrollo histórico de la evaluación del impacto de la formación de especialidades médicas en Cuba / Develop historical of the evaluation of the impact in the formation of the medical specialties in Cuba

RESUMEN La evaluación en la formación surgió en el siglo XVII, buscando dar juicios de valor a las acciones y actitudes de los estudiantes, a la determinación sistemática del mérito, valor y significado del aspecto a evaluar en función de criterios y normas establecidas en aquella época. Su evolución desde lo conceptual y lo procesual tuvo la influencia de los paradigmas investigativos. Muchos han sido los modelos propuestos en el ámbito internacional para perfeccionar el proceso de evaluación de la calidad en la educación. Actualmente, se asocia el término "evaluación" con el término "impacto", usado con frecuencia como expresión del efecto de una acción determinada, con cambios o transformaciones generadas en las personas, organizaciones, procesos o productos. En Cuba, este proceso ha tenido diferentes etapas, pero no es hasta el siglo XXI que comienza a implementarse en el Sistema Universitario de Programas de Acreditación, actual Sistema de Evaluación y Acreditación de la Educación Superior, con el objetivo de lograr una mejora continua en la formación, acorde a los principios y exigencias de la sociedad socialista. Dentro del mismo, el Sistema de Evaluación y Acreditación de Especialidades de Posgrado desempeña un papel fundamental en el desarrollo de dicha figura del posgrado, teniendo una repercusión notable en el desarrollo de las ciencias médicas. Este artículo expone la evolución histórica de la evaluación de la calidad y su impacto en el proceso de formación de especialidades médicas en el país, como referente para futuras investigaciones (AU).

ABSTRACT Training assessment emerged in the 17 century, in search for giving value judgment to the students' actions and behavior, for systematic determining the worth, value and significance of the aspect to assess according to criteria and norms established at that time. Its evolution, from the point of view of the conceptual and process, received the influence of research paradigms. Many models have been proposed around the world to improve the process of quality assessing in the educational field. Currently, the term 'assessment' is associated to the term 'impact', frequently used as an expression of a determinate action's effect on changes or transformations in people, organizations, processes or products. This process has had different stages in Cuba, but only in the 21 century, the University System of Accreditation Programs (SUPRA by its acronym in Spanish) -currently known as Accreditation and Assessment System of High Education (SEAES by its acronym in Spanish)- has begun to be implemented, with the objective of achieving a better continuous training, according to the principles and demands of the socialist society. Among it, the Accreditation and Assessment System of Post-grade Specialties (SEA-EP by its acronym in Spanish), play an important role in the development of the post-grade figure, having a remarkable repercussion in the medical sciences. This article exposes the historical evolution of the quality assessment and its impact in the medical sciences training process in the country as a referent for subsequent researches (AU).

Dimensional Structure of the Early Childhood Oral Health Impact Scale.

Background: Detecting the latent dimensions of quality of life as affected by oral diseases is essential for promoting oral health in children. This study aimed to test the Early Childhood Oral Health Impact Scale (ECOHIS) via an appropriate method to detect its dimensions of quality of life as affected by oral diseases. Methods: An analytical cross-sectional study was carried out in Shiraz, Iran, between 2014 and 2015. A multistage stratified design was used to select 830 parents or the guardians of primary school children aged six years. The Farsi version of the Early Childhood Oral Health Impact Scale (F-ECOHIS) was used to evaluate the children's oral health-related quality of life. The parents were interviewed to collect data on ECOHIS. Mplus, version 7, was employed for descriptive and analytical analyses in the present study. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to extract and verify the latent dimensions of ECOHIS. Results: Out of the 830 invited parents or guardians, 801 participated in this study. The mean ECOHIS score was 21.95±7.45. The mean child impact score and the mean family impact score were 14.25±5.72 and 7.70±3.62, respectively. EFA yielded a 3-factor model: symptom and function, social interaction, and family impact. CFA confirmed the 3-dimensional model (root mean square error of approximation=0.045). The fit indices of the 1- and 2-dimensional models (the child and family domains) were not within the acceptable range. Conclusion: F-ECOHIS is a 3-dimensional model rather than the hypothetical 6-dimensional model. ECOHIS appears to be a useful scale for measuring the multidimensional impact of oral diseases in children.

Recent Advances in Health Impact Assessment and Health in All Policies Implementation: Lessons from an International Convening in Barcelona.

Health Impact Assessment (HIA) and Health in All Policies (HiAP) are policy tools used to include health considerations in decision-making processes across sectors such as transportation, education, and criminal justice that can play a role in improving health and equity. This article summarizes proceedings from an international convening of HIA and HiAP experts held in July 2019 in Barcelona, Spain. The presentations and panel discussions included different models, best practices, and lessons learned, including from government, international banks, think tanks, and academia. Participants discussed ideas from around the world for cross-sector collaboration to advance health. The convening covered the following topics: community engagement, building greater understanding of and support for HiAP, and exploring how mandates for HIA and HiAP approaches may advance health and equity.

Attributable Risk to Assess the Health Impact of Air Pollution: Advances, Controversies, State of the Art and Future Needs.

Despite the increased attention given to the health impact assessment of air pollution and to the strategies to control it in both scientific literature and concrete interventions, the results of the implementations, especially those involving traffic, have not always been satisfactory and there is still disagreement about the most appropriate interventions and the methods to assess their effectiveness. This state-of-the-art article reviews the recent interpretation of the concepts that concern the impact assessment, and compares old and new measurements of attributable risk and attributable fraction. It also summarizes the ongoing discussion about the designs and methods for assessing the air pollution impact with particular attention to improvements due to spatio-temporal analysis and other new approaches, such as studying short term effects in cohorts, and the still discussed methods of predicting the values of attributable risk (AR). Finally, the study presents the more recent analytic perspectives and the methods for directly assessing the effects of not yet implemented interventions on air quality and health, in accordance with the suggestion in the strategic plan 2020-2025 from the Health Effect Institute.

Institutionalization of health impact assessment: a matter of equity in public health / Institucionalización de la evaluación del impacto en salud: una cuestión de equidad en salud pública

No disponible

Salud en todas las políticas en la Comunitat Valenciana: pasos hacia la evaluación del impacto en salud / Health in all policies in the Valencian Community: steps towards the health impact assessment

En este trabajo se describe el inicio del proceso de implementación de la evaluación del impacto en salud en la Comunitat Valenciana como un instrumento para incorporar el marco de los determinantes sociales y las desigualdades en salud en las políticas emanadas de los diferentes departamentos del gobierno valenciano. La propuesta implica: 1) el compromiso político, con acciones legislativas y en la planificación estratégica; 2) la creación de estructuras facilitadoras del trabajo intersectorial, con la constitución de la comisión de evaluación del impacto en salud y del comité técnico intersectorial; y 3) el diseño y la validación de una herramienta para la evaluación simplificada del impacto en salud de las políticas sectoriales adaptada a la Comunitat Valenciana. Se pone en valor la metodología participativa utilizada en todo el proceso y el potencial que representa la evaluación del impacto en salud para el desarrollo de políticas públicas orientadas hacia la ganancia en salud y la equidad

This paper describes the beginning of the implementation process of the health impact assessment in the Valencian Community (Spain), as an instrument to incorporate the framework of social determinants and health inequalities in the policies issued by the different departments of the Valencian government. The proposal involves: 1) political commitment, with legislative and strategic planning actions; 2) the creation of structures to allow intersectoral collaboration, with the establishment of the health impact assessment commission and the intersectoral technical committee; and 3) the design and validation of a tool for the simplified health impact assessment of non-health policies adapted to the Valencian Community. We highlight the importance of the participatory methodology used in the whole process and the potential of the health impact assessment for the development of public policies oriented to improve health and equity

Day-surgery in otology: Impact study of a dedicated organizational model.

AIM: Day surgery (DS) in otology in France is insufficiently implemented compared to other countries of comparable socio-economic level. The aim of the present study was to evaluate changes in surgical practice in "major otology" cases in a hospital center after launching a dedicated ENT DS unit. MATERIAL AND METHODS: This new unit, designed in collaboration with the surgeons, was inaugurated in 2014. Number of procedures, patient demographics, surgery durations, and rates of crossover from DS to conventional management were recorded prospectively for the year before and the year after the launch. All otologic surgery procedures with at least tympanomeatal flap elevation were included; minor surgeries such as grommet insertion were excluded. RESULTS: Between the two time periods, major otology day cases increased from 106 to 153 procedures (+43%). In 2013, the DS rate was 27%, versus 56% in 2015. Otosclerosis surgeries represented 7% in 2013 and 15% in 2015, and type II and III tympanoplasties 3% and 24% respectively. Difference in patient age between DS and conventional surgery was lower in 2015. Crossover rates were 10% in 2013 and 21% in 2015, mainly due to nausea/vertigo (56%) and surgery ending too late in the day (33%). CONCLUSION: Major otologic cases are suitable for DS. Launching this dedicated unit with its specific organization enabled a very significant increase in DS rates, probably due to greater patient satisfaction and surgeons' growing confidence. The main pitfall was in scheduling, with surgery ending too late in the day for discharge home; this has since been corrected.

Community Health Impact Assessment in Ghana: Contemporary Concepts and Practical Methods.

It has long been recognized that health and its determinants are strongly influenced by policies, programs, and projects outside of the health care sector. Few countries have introduced health impact assessments (HIA) to try and ensure that probable impacts on health are considered. An appropriate health impact assessment regime will identify negative and positive impacts of proposed health policies and programs on health, enable the interpretation of health risk and potential health gain, and present the information to assist in decision making. These HIAs are often generic and rapid desk-based appraisals characterized by the use of information and evidence that is already available or easily accessible and generally undertaken by administrators in an organization to gain a snapshot of the health impacts to inform proposal direction. Rapid and generic desk-based assessments require less-intensive effort and resources and draws on existing data sources from scientific peer-reviewed and gray literature to analyze potential health impacts. However, both sources can also be used to determining whether a more detailed review is necessary. The Community HIA model proposed by this work departs from the generic and rapid desk-based appraisals and is intended to provide practical evidence to give higher priority to people's viewpoints, promote participation, understanding and incorporate community voices to help shape future policy, programs, and practice. A comprehensive review of Ghana's National Health Insurance Scheme (NHIS) was carried out using the generic desk-based HIA approach. This was followed by a practical qualitative community field work. In this research, we have demonstrated how community HIA is to be conducted through an actual case study in the Ghanaian West African context. The scope of this work is wide and incorporates the consideration of key concepts and possible methods for carrying out HIA at the community level.

Does clinic-based education have a sustainable impact on asthma patient awareness?

Introduction: Asthma patient education is an essential component of asthma management, just as inhaler treatment adherence and inhaler technique education. These issues face challenges in the developed world communities and the literature demonstrates data of various validity supporting the need for educational activities. However, communities with poor health-care facilities and low socioeconomic status have seen little or no effort to tackle this challenging area of research. Methods: This interventional study aims to impact on sustained asthma awareness with clinic-based asthma patient education. The quasi-experiment recruited asthma patients from achest clinic within apoor healthcare system at desperate economic and political times. The educational intervention consisted of an educational video, posters and leaflets, in addition to the doctor's clinic encounter and inhaler technique education by clinic nurse. Results: 24 patients of the initially recruited 87 patients were re-assessed 4 to 12 weeks later, on the impact of the educational activity on certain asthma awareness parameters. Patients' awareness of their diagnosis of asthma did not improve despite the educational activity with p= 0.141. However, there was asignificant improvement with the awareness of patients for the need of long-term inhalers (p = < 0.0001), adherence to inhaler treatment (p = < 0.0001) and correct use of inhaler (p = < 0.021). Discussion & Conclusion: The study supports the feasibility and efficacy of asthma patient education in poor health-care circumstances at basic levels of asthma knowledge, adherence and inhaler technique. This interventional study is unique in the circumstances it was carried out under. Limitations include the large number of dropouts.

Medicamentos de alto impacto sanitario y económico: el necesario equilibrio entre innovación y sostenibilidad / Medicines of high health and economic impact: The required balance between innovation and sustainability

No disponble

Environmental exposure to cadmium-a risk for health of the general population in industrialized countries and preventive strategies.

Cadmium (Cd) is a heavy metal belonging to the group of the main chemical pollutants of the natural and occupational environment in economically developed countries. The forecasts indicate that contamination of the environment with this toxic metal, and thus the exposure of the general population, will increase. Food (particularly plant products) is the main source of the general population exposure to this element. Moreover, an important, and often the main, source of intoxication with Cd is habitual tobacco smoking. Recent epidemiological studies have provided numerous evidence that even low-level environmental exposure to this toxic metal, nowadays occurring in numerous economically developed countries, creates a risk for health of the general population. The low-level lifetime exposure to this metal may lead to the damage to the kidneys, liver, skeletal system, and cardiovascular system, as well as to the deterioration of the sight and hearing. Moreover, it has been suggested that environmental exposure to this xenobiotic may contribute to the development of cancer of the lung, breast, prostate, pancreas, urinary bladder, and nasopharynx. Taking the above into account, the aim of this review article is to draw more attention to Cd as an environmental risk factor for the health of the general population and the need to undertake preventive actions allowing to reduce the risk of health damage due to a lifetime exposure to this toxic metal.

Health impact assessment (HIA) of political proposals at the local level: successful introduction, but what has happened 15 years later?

Health impact assessments (HIAs) were first introduced in Sweden in the mid-to-late 1990s, with the aim of placing health issues on the political agenda and helping to reduce health inequalities. In the early 2000s, HIAs entered a second phase and the Swedish Parliament adopted a national public health policy. A national survey conducted in 2001 showed that 10/289 municipalities had begun to use HIA and 55/289 had decided to use HIA or had initiated an adoption process. In a 2013 follow-up study based on a strategic sample of municipalities, 9/36 municipalities reported using HIA and/or similar tools. Corresponding figures for the 21 Swedish regions were 10 regions in 2001 and four in 2013. HIA and similar tools (sustainability analyses, child impact assessments, and others) were applied to the same extent as HIA. Fifteen years after implementation began, HIA is still being used. Regions show a clear decrease in the use of HIA. There are several explanations for this development. One is the political context, and other explanations are shifts in which actors are responsible for HIA and for public health at the local/regional levels.

The Impact of Safety Regulations on the Incidence of Upper-Extremity Power Saw Injuries in the United States.

PURPOSE: Over 50,000 power saw-related injuries occur annually in the United States. Numerous safety measures have been implemented to protect the users of these tools. This study was designed to determine which interventions, if any, have had a positive impact on the safety of the consumer or laborer. METHODS: We queried the National Electronic Injury Surveillance System database for hand and upper-extremity injuries attributed to power saws from 1997 to 2014. Demographic information including age, sex, date of injury, device, location, body part involved, diagnosis, and disposition was recorded. We performed statistical analysis using interrupted time series analysis to evaluate the incidence of injury with respect to specific safety guidelines as well as temporal trends including patients' age. RESULTS: An 18% increase in power saw-related injuries was noted from 1997 (44,877) to 2005 (75,037). From 2006 to 2015 an annual decrease of 5.8% was observed. This was correlated with regulations for power saw use by the Consumer Safety Product Commission (CPSC) and Underwriters Laboratories. Mean age of injured patients increased from 48.8 to 52.9 years whereas the proportion of subjects aged less than 50 years decreased from 52.8% to 41.9%. These trends were most pronounced after the 2006 CPSC regulations. CONCLUSIONS: The incidence of power saw injuries increased from 1997 to 2005, with a subsequent decrease from 2006 to 2015. The guidelines for safer operation and improvements in equipment, mandated by the CPSC and Underwriters Laboratories, appeared to have been successful in precipitating a decrease in the incidence of power saw injuries to the upper extremity, particularly in the younger population. CLINICAL RELEVANCE: The publication of safety regulations has been noted to have an association with a decreased incidence in power saw injuries. Based on this, clinicians should take an active role in their practice as well as in their professional societies to educate and counsel patients to prevent further injury.

Impact of value added services on patient waiting time at the ambulatory pharmacy Queen Elizabeth Hospital

Background: Value added services (VAS) are an innovative dispensing system created to provide an alternative means of collecting partial drug supply from our hospital. This in turn was projected to reduce the necessity for patient to visit pharmacy counter and thus reduce the burden of prescription handling. Objective: To evaluate the impact of increased VAS uptake following promotional campaign towards patient waiting time and to explore factors that may affect patient waiting time at the Ambulatory Pharmacy, Queen Elizabeth Hospital. Methods: A quasi experimental study design was conducted from September 2014 till June 2015 at the Ambulatory Pharmacy. During pre-intervention phase, baseline parameters were collected retrospectively. Then, VAS promotional campaign was carried out for six months and whilst this was done, the primary outcome of patient waiting time was measured by percentage of prescription served less than 30 minutes. A linear regression analysis was used to determine the impact of increased VAS uptake towards patient waiting time. Results: An increased in percentage of VAS registration (20.9% vs 35.7%, p<0.001) was observed after the promotional campaign. The mean percentage of prescription served less than 30 minutes increased from 83.2% SD=15.9 to 90.3% SD=11.5, p=0.001. After controlling for covariates, it was found that patient waiting time was affected by number of pharmacy technicians (b=-0.0349, 95%CI-0.0548 : -0.0150, p=0.001), number of pharmacy counters (b=0.1125, 95%CI 0.0631 : 0.1620, p<0.001), number of prescriptions (b=0.0008, 95%CI 0.0004 : 0.0011, p<0.001), and number of refill prescriptions (b=0.0004, 95%CI 0.0002 : 0.0007, p<0.001). The increased in percentage of VAS registration was associated with reduction in number of refill prescription (b=-2.9838, 95%CI -4.2289 : -1.7388, p<0.001). Conclusions: Patient waiting time at the Ambulatory Pharmacy improved with the increased in VAS registration. The impact of increased VAS uptake on patient waiting time resulted from reduction in refill prescriptions. Patient waiting time is influenced by number of pharmacy technicians, number of pharmacy counters, number of prescriptions and number of refill prescriptions (AU)

No disponible

Seasonal forecasting and health impact models: challenges and opportunities.

After several decades of intensive research, steady improvements in understanding and modeling the climate system have led to the development of the first generation of operational health early warning systems in the era of climate services. These schemes are based on collaborations across scientific disciplines, bringing together real-time climate and health data collection, state-of-the-art seasonal climate predictions, epidemiological impact models based on historical data, and an understanding of end user and stakeholder needs. In this review, we discuss the challenges and opportunities of this complex, multidisciplinary collaboration, with a focus on the factors limiting seasonal forecasting as a source of predictability for climate impact models.