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5.
Lancet Oncol ; 22(2): 173-181, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33485459

RESUMO

BACKGROUND: Estimating a population-level benchmark rate for use of surgery in the management of cancer helps to identify treatment gaps, estimate the survival impact of such gaps, and benchmark the workforce and other resources, including budgets, required to meet service needs. A population-based benchmark for use of surgery in high-income settings to inform policy makers and service provision has not been developed but was recommended by the Lancet Oncology Commission on Global Cancer Surgery. We aimed to develop and validate a cancer surgery benchmarking model. METHODS: We examined the latest clinical guidelines from high-income countries (Australia, the UK, the EU, the USA, and Canada) and mapped surgical treatment pathways for 30 malignant cancer sites (19 individual sites and 11 grouped as other cancers) that were notifiable in Australia in 2014, broadly reflecting contemporary high-income models of care. The optimal use of surgery was considered as an indication for surgery where surgery is the treatment of choice for a given clinical scenario. Population-based epidemiological data, such as cancer stage, tumour characteristics, and fitness for surgery, were derived from Australia and other similar high-income settings for 2017. The probabilities across the clinical pathways of each cancer were multiplied and added together to estimate the population-level benchmark rates of cancer surgery, and further validated with the comparisons of observed rates of cancer surgery in the South Western Sydney Local Health District in 2006-12. Univariable and multivariable sensitivity analyses were done to explore uncertainty around model inputs, with mean (95% CI) benchmark surgery rates estimated on the basis of 10 000 Monte Carlo simulations. FINDINGS: Surgical treatment was indicated in 58% (95% CI 57-59) of newly diagnosed patients with cancer in Australia in 2014 at least once during the course of their treatment, but varied by site from 23% (17-27) for prostate cancer to 99% (96-99) for testicular cancer. Observed cancer surgery rates in South Western Sydney were comparable to the benchmarks for most cancers, but were higher for some cancers, such as prostate (absolute increase of 29%) and lower for others, such as lung (-14%). INTERPRETATION: The model provides a new template for high-income and emerging economies to rationally plan and assess their cancer surgery provision. There are differences in modelled versus observed surgery rates for some cancers, requiring more in-depth analysis of the observed differences. FUNDING: University of New South Wales Scientia Scholarship, UK Research and Innovation-Global Challenges Research Fund.


Assuntos
Países Desenvolvidos/economia , Neoplasias Embrionárias de Células Germinativas/economia , Neoplasias/economia , Neoplasias Testiculares/economia , Austrália/epidemiologia , Benchmarking/economia , Canadá/epidemiologia , Gerenciamento de Dados , Guias como Assunto/normas , Humanos , Neoplasias/epidemiologia , Neoplasias/cirurgia , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Neoplasias Testiculares/epidemiologia , Reino Unido/epidemiologia
7.
BMJ ; 371: m4750, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323376

RESUMO

OBJECTIVE: To analyze the premarket purchase commitments for coronavirus disease 2019 (covid-19) vaccines from leading manufacturers to recipient countries. DESIGN: Cross sectional analysis. DATA SOURCES: World Health Organization's draft landscape of covid-19 candidate vaccines, along with company disclosures to the US Securities and Exchange Commission, company and foundation press releases, government press releases, and media reports. ELIGIBILITY CRITERIA AND DATA ANALYSIS: Premarket purchase commitments for covid-19 vaccines, publicly announced by 15 November 2020. MAIN OUTCOME MEASURES: Premarket purchase commitments for covid-19 vaccine candidates and price per course, vaccine platform, and stage of research and development, as well as procurement agent and recipient country. RESULTS: As of 15 November 2020, several countries have made premarket purchase commitments totaling 7.48 billion doses, or 3.76 billion courses, of covid-19 vaccines from 13 vaccine manufacturers. Just over half (51%) of these doses will go to high income countries, which represent 14% of the world's population. The US has reserved 800 million doses but accounts for a fifth of all covid-19 cases globally (11.02 million cases), whereas Japan, Australia, and Canada have collectively reserved more than one billion doses but do not account for even 1% of current global covid-19 cases globally (0.45 million cases). If these vaccine candidates were all successfully scaled, the total projected manufacturing capacity would be 5.96 billion courses by the end of 2021. Up to 40% (or 2.34 billion) of vaccine courses from these manufacturers might potentially remain for low and middle income countries-less if high income countries exercise scale-up options and more if high income countries share what they have procured. Prices for these vaccines vary by more than 10-fold, from $6.00 (£4.50; €4.90) per course to as high as $74 per course. With broad country participation apart from the US and Russia, the COVAX Facility-the vaccines pillar of the World Health Organization's Access to COVID-19 Tools (ACT) Accelerator-has secured at least 500 million doses, or 250 million courses, and financing for half of the targeted two billion doses by the end of 2021 in efforts to support globally coordinated access to covid-19 vaccines. CONCLUSIONS: This study provides an overview of how high income countries have secured future supplies of covid-19 vaccines but that access for the rest of the world is uncertain. Governments and manufacturers might provide much needed assurances for equitable allocation of covid-19 vaccines through greater transparency and accountability over these arrangements.


Assuntos
/economia , Saúde Global/economia , Acesso aos Serviços de Saúde/economia , Financiamento da Assistência à Saúde , /imunologia , Estudos Transversais , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Acesso aos Serviços de Saúde/organização & administração , Humanos
9.
Surgery ; 168(3): 550-557, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620304

RESUMO

BACKGROUND: The lack of access to essential surgical care in low-income countries is aggravated by emigration of locally-trained surgical specialists to more affluent regions. Yet, the global diaspora of surgeons, obstetricians, and anesthesiologists from low-income and middle-income countries has never been fully described and compared with those who have remained in their country of origin. It is also unclear whether the surgical workforce is more affected by international migration than other medical specialists. In this study, we aimed to quantify the proportion of surgical specialists originating from low-income and middle-income countries that currently work in high-income countries. METHODS: We retrieved surgical workforce data from 48 high-income countries and 102 low-income and middle-income countries using the database of the World Health Organization Global Surgical Workforce. We then compared this domestic workforce with more granular data on the country of initial medical qualification of all surgeons, anesthesiologists, and obstetricians made available for 14 selected high-income countries to calculate the proportion of surgical specialists working abroad. RESULTS: We identified 1,118,804 specialist surgeons, anesthesiologists, or obstetricians from 102 low-income and middle-income countries, of whom 33,021 (3.0%) worked in the 14 included high-income countries. The proportion of surgical specialists abroad was greatest for the African and South East Asian regions (12.8% and 12.1%). The proportion of specialists abroad was not greater for surgeons, anesthesiologists, or obstetricians than for physicians and other medical specialists (P = .465). Overall, the countries with the lowest remaining density of surgical specialists were also the countries from which the largest proportion of graduates were now working in high-income countries (P = .011). CONCLUSION: A substantial proportion of all surgeons, anesthesiologists, and obstetricians from low-income and middle-income countries currently work in high-income countries. In addition to decreasing migration from areas of surgical need, innovative strategies to retain and strengthen the surgical workforce could involve engaging this large international pool of surgical specialists and instructors.


Assuntos
Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Emigração e Imigração/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Especialidades Cirúrgicas/estatística & dados numéricos , Anestesiologistas/economia , Anestesiologistas/estatística & dados numéricos , Estudos Transversais , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Mão de Obra em Saúde/economia , Humanos , Renda/estatística & dados numéricos , Especialidades Cirúrgicas/economia , Cirurgiões/economia , Cirurgiões/estatística & dados numéricos
10.
Microbes Infect ; 22(9): 400-402, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32653475

RESUMO

In this commentary we argue that the hygiene hypothesis may apply to COVID-19 susceptibility and also that residence in low hygienic conditions acts to train innate immune defenses to minimize the severity of infection. We advocate that approaches, which elevate innate immune functions, should be used to minimize the consequences of COVID-19 infection at least until effective vaccines and antiviral therapies are developed.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Hipótese da Higiene , Higiene/economia , Estilo de Vida/etnologia , Pandemias , Pneumonia Viral/epidemiologia , Fatores Etários , Idoso , Alérgenos/imunologia , Betacoronavirus/imunologia , Criança , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Suscetibilidade a Doenças , Exposição Ambiental/análise , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/etnologia , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Índice de Gravidade de Doença , Vacinas Virais/biossíntese
11.
PLoS One ; 15(6): e0232960, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497086

RESUMO

BACKGROUND: Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences. The incidence rate of SSI is high in Low- and Middle-Income countries (LMICs) compared to high income countries, and the costly surgical complication can raise the potential risk of financial catastrophe. OBJECTIVE: The aim of the study is to critically appraise studies on the cost of SSI in a range of LMIC studies and compare these estimates with a reference standard of high income European studies who have explored similar SSI costs. METHODS: A systematic review was undertaken using searches of two electronic databases, EMBASE and MEDLINE In-Process & Other Non-Indexed Citations, up to February 2019. Study characteristics, comparator group, methods and results were extracted by using a standard template. RESULTS: Studies from 15 LMIC and 16 European countries were identified and reviewed in full. The additional cost of SSI range (presented in 2017 international dollars) was similar in the LMIC ($174-$29,610) and European countries ($21-$34,000). Huge study design heterogeneity was encountered across the two settings. DISCUSSION: SSIs were revealed to have a significant cost burden in both LMICs and High Income Countries in Europe. The magnitude of the costs depends on the SSI definition used, severity of SSI, patient population, choice of comparator, hospital setting, and cost items included. Differences in study design affected the comparability across studies. There is need for multicentre studies with standardized data collection methods to capture relevant costs and consequences of the infection across income settings.


Assuntos
Efeitos Psicossociais da Doença , Países em Desenvolvimento/economia , Infecção da Ferida Cirúrgica/epidemiologia , Países Desenvolvidos/economia , Saúde Global , Gastos em Saúde , Recursos em Saúde/economia , Humanos , Incidência , Renda , Tempo de Internação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/economia
13.
PLoS One ; 15(5): e0232458, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401823

RESUMO

INTRODUCTION: Research productivity has been linked to a country's intellectual and economic wealth. Further analysis is needed to assess the association between the distribution of research across disciplines and the economic status of countries. METHODS: By using 55 years of data, spanning 1962 to 2017, of Elsevier publications across a large set of research disciplines and countries globally, this manuscript explores the relationship and evolution of relative research productivity across different disciplines through a network analysis. It also explores the associations of those with economic productivity categories, as measured by the World Bank economic classification. Additional analysis of discipline similarities is possible by exploring the cross-country evolution of those disciplines. RESULTS: Results show similarities in the relative importance of research disciplines among most high-income countries, with larger idiosyncrasies appearing among the remaining countries. This group of high-income countries shows similarities in the dynamics of the relative distribution of research productivity over time, forming a stable research productivity cluster. Lower income countries form smaller, more independent and evolving clusters, and differ significantly from each other and from higher income countries in the relative importance of their research emphases. Country-based similarities in research productivity profiles also appear to be influenced by geographical proximity. CONCLUSIONS: This new form of analyses of research productivity, and its relation to economic status, reveals novel insights to the dynamics of the economic and research structure of countries. This allows for a deeper understanding of the role a country's research structure may play in shaping its economy, and also identification of benchmark resource allocations across disciplines for developing countries.


Assuntos
Eficiência , Pesquisa , Países Desenvolvidos/economia , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Status Econômico , Geografia/estatística & dados numéricos , Humanos , Publicações/economia , Publicações/estatística & dados numéricos , Publicações/tendências , Pesquisa/economia , Pesquisa/estatística & dados numéricos , Pesquisa/tendências , Comunicação Acadêmica/economia , Comunicação Acadêmica/estatística & dados numéricos , Comunicação Acadêmica/tendências
15.
Am J Trop Med Hyg ; 102(6): 1175-1177, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32314697

RESUMO

Two decades of growing resource availability from agencies and foundations in wealthy countries has transformed approaches to health in poorly resourced nations. This progress looks increasingly unstable as climate change, social unrest, and, now, disruptive pandemics present threats not only to health but also to the mechanisms that manage it, and to funding itself. The growth in "global health" schools, technology development laboratories, nongovernmental organizations and multilateral institutions in donor countries has delivered not only successes but also disappointment, and reflect a paradigm that is in many ways contrary to the principles of population-based ownership that they espouse. Although the COVID-19 crisis has underlined the importance of health access and health service capacity, we may have a limited window of opportunity in which to rethink the current model and improve both efficiency and effectiveness. With a dose of humility, we may all benefit from studying our own rhetoric on human-centered design and applying these principles across global health to ensure that our approach is effective, efficient, and defensible.


Assuntos
Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/economia , Infecções por Coronavirus/epidemiologia , Saúde Global/economia , Acesso aos Serviços de Saúde/economia , Pandemias , Pneumonia Viral/epidemiologia , Distúrbios Civis/economia , Técnicas de Laboratório Clínico/tendências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Saúde Global/tendências , Humanos , Cooperação Internacional , Propriedade/economia , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Pobreza/economia , Fatores de Tempo
17.
Proc Natl Acad Sci U S A ; 117(17): 9277-9283, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32284412

RESUMO

It is well documented that earnings inequalities have risen in many high-income countries. Less clear are the linkages between rising income inequality and workplace dynamics, how within- and between-workplace inequality varies across countries, and to what extent these inequalities are moderated by national labor market institutions. In order to describe changes in the initial between- and within-firm market income distribution we analyze administrative records for 2,000,000,000+ job years nested within 50,000,000+ workplace years for 14 high-income countries in North America, Scandinavia, Continental and Eastern Europe, the Middle East, and East Asia. We find that countries vary a great deal in their levels and trends in earnings inequality but that the between-workplace share of wage inequality is growing in almost all countries examined and is in no country declining. We also find that earnings inequalities and the share of between-workplace inequalities are lower and grew less strongly in countries with stronger institutional employment protections and rose faster when these labor market protections weakened. Our findings suggest that firm-level restructuring and increasing wage inequalities between workplaces are more central contributors to rising income inequality than previously recognized.


Assuntos
Países Desenvolvidos/economia , Fatores Socioeconômicos , Emprego/economia , Emprego/tendências , Europa (Continente) , Extremo Oriente , Humanos , Renda/tendências , Oriente Médio , América do Norte , Ocupações/economia , Salários e Benefícios/tendências , Países Escandinavos e Nórdicos , Local de Trabalho/psicologia
18.
PLoS One ; 15(3): e0230512, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32208435

RESUMO

Chronic kidney disease (CKD) affects over 10% of the global population and poses significant challenges for societies and health care systems worldwide. To illustrate these challenges and inform cost-effectiveness analyses, we undertook a comprehensive systematic scoping review that explored costs, health-related quality of life (HRQoL) and life expectancy (LE) amongst individuals with CKD. Costs were examined from a health system and societal perspective, and HRQoL was assessed from a societal and patient perspective. Papers published in English from 2015 onward found through a systematic search strategy formed the basis of the review. All costs were adjusted for inflation and expressed in US$ after correcting for purchasing power parity. From the health system perspective, progression from CKD stages 1-2 to CKD stages 3a-3b was associated with a 1.1-1.7 fold increase in per patient mean annual health care cost. The progression from CKD stage 3 to CKD stages 4-5 was associated with a 1.3-4.2 fold increase in costs, with the highest costs associated with end-stage renal disease at $20,110 to $100,593 per patient. Mean EuroQol-5D index scores ranged from 0.80 to 0.86 for CKD stages 1-3, and decreased to 0.73-0.79 for CKD stages 4-5. For treatment with renal replacement therapy, transplant recipients incurred lower costs and demonstrated higher HRQoL scores with longer LE compared to dialysis patients. The study has provided a comprehensive updated overview of the burden associated with different CKD stages and renal replacement therapy modalities across developed countries. These data will be useful for the assessment of new renal services/therapies in terms of cost-effectiveness.


Assuntos
Insuficiência Renal Crônica/economia , Efeitos Psicossociais da Doença , Países Desenvolvidos/economia , Economia Médica , Custos de Cuidados de Saúde , Humanos , Falência Renal Crônica/economia , Falência Renal Crônica/terapia , Transplante de Rim/economia , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal/economia
20.
PLoS One ; 15(2): e0228387, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049989

RESUMO

Capital flows is an important aspect of the international monetary system because they provide great direct and indirect benefits, and at the same time, they carry risks of vulnerability for countries with an open economy. Numerous works have studied the behavior of these flows and have developed models to predict sudden stop events. However, the existing models have limitations and the literature demands more research on the subject given that the accuracy of the models is still poor, and they have only been developed for emerging countries. This paper presents a new prediction model of sudden stop events of capital flows for both emerging countries and developed countries with the ability to estimate accurately future sudden stop scenarios globally. A sample of 103 countries was used, including 73 emerging countries and 30 developed countries, which has allowed the use of sample combinations that consider the regional heterogeneity of the warning indicators. To the sample under study, a method of decision trees has been applied, which has provided excellent prediction results given its ability to learn characteristics and create long-term dependencies from sequential data and time series. Our model has a great potential impact on the adequacy of macroeconomic policy against the risks derived from sudden stops of capital flows, providing tools that help to achieve financial stability at the global level.


Assuntos
Algoritmos , Árvores de Decisões , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Administração Financeira/estatística & dados numéricos , Modelos Teóricos , Humanos
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