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1.
Hastings Cent Rep ; 51(3): 2, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34028821

RESUMO

In the lead article of the May-June 2021 issue of the Hastings Center Report, Nancy Jecker and Caesar Atuire argue that the Covid-19 crisis is best understood as a syndemic, "a convergence of biosocial forces that interact with one another to produce and exacerbate clinical disease and prognosis." A syndemic framework, the authors advise, will enable bioethicists to recognize the ethical principles that should guide efforts to reduce the unequal effects that Covid-19 has on populations. Drawing on sub-Saharan African conceptions of solidarity, the authors lay out an approach to global vaccine distribution that prioritizes low- and middle-income countries. Like Jecker and Atuire's article, an essay by philosopher Keisha Ray pushes bioethicists to recognize broader justice-oriented responsibilities with the aid of a wide-angle lens. Ray's essay focuses on contemporary examples of environmental injustices that sicken, disable, or kill Black people.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , COVID-19/epidemiologia , COVID-19/prevenção & controle , África ao Sul do Saara/epidemiologia , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , SARS-CoV-2 , Justiça Social , Sindemia
3.
Hastings Cent Rep ; 51(3): 27-36, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33939182

RESUMO

This article sets forth a solidaristic approach to global distribution of vaccines against the SARS-CoV-2 virus. Our approach draws inspiration from African ethics and from the characterization of the Covid-19 crisis as a syndemic, a convergence of biosocial forces that interact with one another to produce and exacerbate clinical disease and prognosis. The first section elaborates the twin ideas of syndemic and solidarity. The second section argues that these ideas lend support to global health alliances to distribute vaccines beyond national borders. The third section introduces ethical criteria to guide global distribution, emphasizing priority to low- and middle-income countries, which have the least ability to obtain vaccines on their own. It also justifies giving priority to people at high risk of infection and high risk of severe disease and death.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , COVID-19/epidemiologia , COVID-19/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/organização & administração , Cooperação Internacional , África , Países em Desenvolvimento , Alocação de Recursos para a Atenção à Saúde/normas , Humanos , SARS-CoV-2 , Justiça Social , Sindemia
4.
Hastings Cent Rep ; 51(3): 3-4, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34028820

RESUMO

The Covid-19 pandemic has exposed four myths in bioethics. First, the flood of bioethics publications on how to allocate scarce resources in crisis conditions has assumed authorities would declare the onset of crisis standards of care, yet few have done so. This leaves guidelines in limbo and patients unprotected. Second, the pandemic's realities have exploded traditional boundaries between clinical, research, and public health ethics, requiring bioethics to face the interdigitation of learning, doing, and allocating. Third, without empirical research, the success or failure of ethics guidelines remains unknown, demonstrating that crafting ethics guidance is only the start. And fourth, the pandemic's glaring health inequities require new commitment to learn from communities facing extraordinary challenges. Without that new learning, bioethics methods cannot succeed. The pandemic is a wake-up call, and bioethics must rise to the challenge.


Assuntos
Temas Bioéticos/normas , COVID-19/epidemiologia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Pesquisa Biomédica/ética , Pesquisa Biomédica/organização & administração , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/normas , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/normas , Humanos , Pandemias , Saúde Pública , SARS-CoV-2
5.
BMJ Glob Health ; 6(5)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33947707

RESUMO

The world continues to battle the ongoing COVID-19 pandemic. Whereas many countries are currently experiencing the second wave of the outbreak; Africa, despite being the last continent to be affected by the virus, has not experienced as much devastation as other continents. For example, West Africa, with a population of 367 million people, had confirmed 412 178 cases of COVID-19 with 5363 deaths as of 14 March 2021; compared with the USA which had recorded almost 30 million cases and 530 000 deaths, despite having a slightly smaller population (328 million). Several postulations have been made in an attempt to explain this phenomenon. One hypothesis is that African countries have leveraged on experiences from past epidemics to build resilience and response strategies which may be contributing to protecting the continent's health systems from being overwhelmed. This practice paper from the West African Health Organization presents experience and data from the field on how countries in the region mobilised support to address the pandemic in the first year, leveraging on systems, infrastructure, capacities developed and experiences from the 2014 Ebola virus disease outbreak.


Assuntos
COVID-19 , Alocação de Recursos para a Atenção à Saúde , Pandemias , África Ocidental/epidemiologia , COVID-19/epidemiologia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos
8.
JAMA Netw Open ; 4(3): e214149, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739434

RESUMO

Importance: Significant concern has been raised that crisis standards of care policies aimed at guiding resource allocation may be biased against people based on race/ethnicity. Objective: To evaluate whether unanticipated disparities by race or ethnicity arise from a single institution's resource allocation policy. Design, Setting, and Participants: This cohort study included adults (aged ≥18 years) who were cared for on a coronavirus disease 2019 (COVID-19) ward or in a monitored unit requiring invasive or noninvasive ventilation or high-flow nasal cannula between May 26 and July 14, 2020, at 2 academic hospitals in Miami, Florida. Exposures: Race (ie, White, Black, Asian, multiracial) and ethnicity (ie, non-Hispanic, Hispanic). Main Outcomes and Measures: The primary outcome was based on a resource allocation priority score (range, 1-8, with 1 indicating highest and 8 indicating lowest priority) that was assigned daily based on both estimated short-term (using Sequential Organ Failure Assessment score) and longer-term (using comorbidities) mortality. There were 2 coprimary outcomes: maximum and minimum score for each patient over all eligible patient-days. Standard summary statistics were used to describe the cohort, and multivariable Poisson regression was used to identify associations of race and ethnicity with each outcome. Results: The cohort consisted of 5613 patient-days of data from 1127 patients (median [interquartile range {IQR}] age, 62.7 [51.7-73.7]; 607 [53.9%] men). Of these, 711 (63.1%) were White patients, 323 (28.7%) were Black patients, 8 (0.7%) were Asian patients, and 31 (2.8%) were multiracial patients; 480 (42.6%) were non-Hispanic patients, and 611 (54.2%) were Hispanic patients. The median (IQR) maximum priority score for the cohort was 3 (1-4); the median (IQR) minimum score was 2 (1-3). After adjustment, there was no association of race with maximum priority score using White patients as the reference group (Black patients: incidence rate ratio [IRR], 1.00; 95% CI, 0.89-1.12; Asian patients: IRR, 0.95; 95% CI. 0.62-1.45; multiracial patients: IRR, 0.93; 95% CI, 0.72-1.19) or of ethnicity using non-Hispanic patients as the reference group (Hispanic patients: IRR, 0.98; 95% CI, 0.88-1.10); similarly, no association was found with minimum score for race, again with White patients as the reference group (Black patients: IRR, 1.01; 95% CI, 0.90-1.14; Asian patients: IRR, 0.96; 95% CI, 0.62-1.49; multiracial patients: IRR, 0.81; 95% CI, 0.61-1.07) or ethnicity, again with non-Hispanic patients as the reference group (Hispanic patients: IRR, 1.00; 95% CI, 0.89-1.13). Conclusions and Relevance: In this cohort study of adult patients admitted to a COVID-19 unit at 2 US hospitals, there was no association of race or ethnicity with the priority score underpinning the resource allocation policy. Despite this finding, any policy to guide altered standards of care during a crisis should be monitored to ensure equitable distribution of resources.


Assuntos
COVID-19 , Alocação de Recursos para a Atenção à Saúde , Disparidades em Assistência à Saúde/etnologia , Hospitalização/estatística & dados numéricos , Alocação de Recursos , Padrão de Cuidado/estatística & dados numéricos , COVID-19/etnologia , COVID-19/terapia , Estudos de Coortes , Grupos Étnicos , Feminino , Florida/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Alocação de Recursos/métodos , Alocação de Recursos/organização & administração
9.
Value Health ; 24(3): 388-396, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33641773

RESUMO

OBJECTIVES: Various strategies to address healthcare spending and medical costs continue to be debated and implemented in the United States. To date, these efforts have failed to adequately contain the growth of healthcare cost. An alternative strategy that has elicited rising interest among policymakers is budget caps. As budget caps become more prevalent, it is important to identify which features are needed to ensure success, both in terms of cost reduction and health improvement. METHODS: We explored the impacts of different features of budget caps by comparing hypothetical service level and global budget caps across 3 annual budget cap growth strategies over a 10-year timeframe in 2005-2015 for 8 of the most commonly occurring conditions in the United States. Health was assessed by a measure of disease burden (disability-adjusted life years). RESULTS: The results indicate that budget caps have the potential for creating savings but can also result in patient harm if not designed well. As a result of these findings, 5 principles were developed for designing budget caps and should guide the use of budget caps to address medical spending. CONCLUSIONS: As public discussion grows about the use of budget caps to constrain health spending, it is critical to recognize that the budget cap design and the resulting healthcare provider behavior will determine whether there is potential harm to public health. Budget cap design should consider variability at the condition level, including patient population, improvements in health, treatment costs, and the innovations available, to both create savings and maximize patient health. In assessing the impact of healthcare spending caps on costs and disease burden, we demonstrate that budget cap design determines potential harm to public health.


Assuntos
Orçamentos/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Medicamentos sob Prescrição/economia , Controle de Custos , Alocação de Recursos para a Atenção à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Estados Unidos
13.
Comunidad (Barc., Internet) ; 22(3): 0-0, nov.-feb. 2021. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-201282

RESUMO

INTRODUCCIÓN: El mapeo de activos en salud es un proceso comunitario para la ubicación territorial de activos para la salud, siendo un activo «cualquier factor (o recurso) que mejora la capacidad de las personas, grupos, comunidades, poblaciones, sistemas sociales e instituciones para mantener y sostener la salud y el bienestar, y que les ayuda a reducir las desigualdades en salud». OBJETIVOS: Visibilizar el trabajo realizado en el Proceso de Activos de Salud del Grupo Motor del Distrito Centro de Madrid y compartir conocimientos entre los diferentes agentes clave que han participado en distintas fases de este proceso. Generar como red comunitaria, estrategias prácticas para la recomendación de activos para la salud en la intervención sociosanitaria. MÉTODOS: Desde el Grupo Motor de Mapeo de Activos para la Salud del Distrito Centro de Madrid (formado por 26 entidades) se ha diseñado y desarrollado una jornada/encuentro para visibilizar los activos para la salud identificados en los últimos 2 años. RESULTADOS: Asistieron 35 profesionales del distrito de vertiente social, sanitaria y sociosanitaria y la evaluación de la jornada que hicieron las personas asistentes fue altamente satisfactoria. DISCUSIÓN: Esta jornada fue el resultado de visibilizar el trabajo realizado desde mayo de 2017, que es cuando se comenzó el Proceso de Mapeo de Activos para la Salud del Distrito Centro. Visibilizar esta tarea se tradujo en un conocimiento en profundidad del proceso de mapeo del distrito y de la metodología de activos, con lo que se consiguió un mayor empoderamiento de las personas asistentes


INTRODUCTION: Mapping of health assets is a community process for locating health assets territorially. Health assets are factors (or resources) that improve the abilities of individuals, groups, communities, populations, social systems and institutions to maintain and sustain health and welfare and help them reduce health inequality. OBJECTIVES: To raise awareness the work performed by the health assets process of the Central District Steering Group of Madrid. Sharing knowledge among different key actors involved in the Central District mapping process at different stages. Creation as a Community Network of practical strategies for recommending health assets for social and health intervention. METHODS: From the Health Asset Mapping Steering Group of the Central District (comprised of 26 entities) a conference/meeting to enhance the visibility of identified health assets has been designed and developed in the last two years. RESULTS: A total of 35 social, health and socio-health professionals from the district attended and the meeting evaluation by attendees was highly satisfactory. DISCUSSION: This meeting has been the result of enhancing visibility of work performed since May 2017, which is when the Central District Health Asset Process began. This visibility led to in-depth knowledge of the District's Health Asset Process and asset methodology, which attained a greater empowerment of attendees


Assuntos
Humanos , Disparidades nos Níveis de Saúde , Gradiente Socioeconômico de Saúde/políticas , Recursos em Saúde/organização & administração , Geografia Médica/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Gestão de Recursos , Promoção da Saúde/organização & administração , Planejamento em Saúde/organização & administração
15.
Eur J Public Health ; 31(2): 253-258, 2021 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-33454782

RESUMO

BACKGROUND: The COVID-19 outbreak has heightened ongoing political debate about the international joint procurement of medicines and medical countermeasures. The European Union (EU) has developed what remains largely contractual and decentralized international procurement cooperation. The corona crisis has broadened and deepened public debate on such cooperation, in particular on the scope of cooperation, solidarity in the allocation of such cooperation, and delegation of cooperative decision-making. Crucial to political debate about these issues are public attitudes that constrain and undergird international cooperation. METHODS: Our survey includes a randomized survey experiment (conjoint analysis) on a representative sample in five European countries in March 2020, informed by legal and policy debate on medical cooperation. Respondents choose and rate policy packages containing randomized mixes of policy attributes with respect to the scope of medicines covered, the solidarity in conferring priority access and the level of delegation. RESULTS: In all country populations surveyed, the experiment reveals considerable popular support for European cooperation. Significant majorities preferred cooperation packages with greater rather than less scope of medicines regulated; with priority given to most in-need countries; and with delegation to EU-level rather than national expertise. CONCLUSION: Joint procurement raises delicate questions with regard to its scope, the inclusion of cross-border solidarity and the delegation of decision-making, that explain reluctance toward joint procurement among political decision-makers. This research shows that there is considerable public support across different countries in favor of centralization, i.e. a large scope and solidarity in the allocation and delegation of decision-making.


Assuntos
COVID-19 , Alocação de Recursos para a Atenção à Saúde , Cooperação Internacional , Preparações Farmacêuticas , Opinião Pública , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , Europa (Continente)/epidemiologia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Inquéritos e Questionários
18.
Lancet Respir Med ; 9(4): 430-434, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33450202

RESUMO

The COVID-19 pandemic strained health-care systems throughout the world. For some, available medical resources could not meet the increased demand and rationing was ultimately required. Hospitals and governments often sought to establish triage committees to assist with allocation decisions. However, for institutions operating under crisis standards of care (during times when standards of care must be substantially lowered in the setting of crisis), relying on these committees for rationing decisions was impractical-circumstances were changing too rapidly, occurring in too many diverse locations within hospitals, and the available information for decision making was notably scarce. Furthermore, a utilitarian approach to decision making based on an analysis of outcomes is problematic due to uncertainty regarding outcomes of different therapeutic options. We propose that triage committees could be involved in providing policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care. An approach guided by egalitarian principles, integrated with utilitarian principles, can support physicians at the bedside when they must ration scarce resources.


Assuntos
COVID-19/terapia , Cuidados Críticos/organização & administração , Alocação de Recursos para a Atenção à Saúde/organização & administração , Pandemias/prevenção & controle , Triagem/organização & administração , Comitês Consultivos/organização & administração , Comitês Consultivos/normas , COVID-19/epidemiologia , Cuidados Críticos/economia , Cuidados Críticos/normas , Cuidados Críticos/estatística & dados numéricos , Tomada de Decisões Gerenciais , Saúde Global/economia , Saúde Global/normas , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/normas , Política de Saúde , Humanos , Colaboração Intersetorial , Pandemias/economia , Guias de Prática Clínica como Assunto , Padrão de Cuidado/economia , Triagem/normas
19.
Eur J Anaesthesiol ; 38(4): 344-347, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33350712

RESUMO

BACKGROUND: In light of the coronavirus disease-2019 (COVID-19) pandemic, how resources are managed and the critically ill are allocated must be reviewed. Although ethical recommendations have been published, strategies for dealing with overcapacity of critical care resources have so far not been addressed. OBJECTIVES: Assess expert opinion for allocation preferences regarding the growing imbalance between supply and demand for medical resources. DESIGN: A 10-item questionnaire was developed and sent to the most prominent members of the European Society of Anaesthesiology and Intensive Care (ESAIC). SETTING: Survey via a web-based platform. PATIENTS: Respondents were members of the National Anaesthesiologists Societies Committee and Council Members of the ESAIC; 74 of 80 (92.5%), responded to the survey. MEASUREMENTS AND MAIN RESULTS: Responses were analysed thematically. The majority of respondents (83.8%), indicated that resources for COVID-19 were available at the time of the survey. Of the representatives of the ESAIC governing bodies, 58.9% favoured an allocation of excess critical care capacity: 69% wished to make them available to supraregional patients, whereas 30.9% preferred to keep the resources available for the local population. Regarding the type of distribution of resources, 35.3% preferred to make critical care available, 32.4% favoured the allocation of medical equipment and 32.4% wished to support both options. The majority (59.5%) supported the implementation of a central European institution to manage such resource allocation. CONCLUSION: Experts in critical care support the allocation of resources from centres with overcapacity. The results indicate the need for centrally administered allocation mechanisms that are not based on ethically disputable triage systems. It seems, therefore, that there is wide acceptance and solidarity among the European anaesthesiological community that local medical and human pressure should be relieved during a pandemic by implementing national and international re-allocation strategies among healthcare providers and healthcare systems.


Assuntos
Anestesiologistas , COVID-19/terapia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Recursos em Saúde/provisão & distribuição , Pandemias , Alocação de Recursos , SARS-CoV-2 , Triagem , COVID-19/epidemiologia , Cuidados Críticos , Atenção à Saúde , Europa (Continente)/epidemiologia , União Europeia , Pessoal de Saúde , Humanos , Inquéritos e Questionários
20.
Cancer Discov ; 11(2): 233-236, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33355178

RESUMO

Published series on COVID-19 support the notion that patients with cancer are a particularly vulnerable population. There is a confluence of risk factors between cancer and COVID-19, and cancer care and treatments increase exposure to the virus and may dampen natural immune responses. The available evidence supports the conclusion that patients with cancer, in particular with hematologic malignancies, should be considered among the very high-risk groups for priority COVID-19 vaccination.


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/organização & administração , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/epidemiologia , Humanos , Imunidade , Programas de Imunização/organização & administração , Razão de Chances , Modelos de Riscos Proporcionais , Saúde Pública/métodos , Risco , Fatores de Risco , Resultado do Tratamento , Vacinação
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