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1.
Value Health ; 24(5): 625-631, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33933230

RESUMO

The potential health and economic value of a vaccine for coronavirus disease (COVID-19) is self-evident given nearly 2 million deaths, "collateral" loss of life as other conditions go untreated, and massive economic damage. Results from the first licensed products are very encouraging; however, there are important reasons why we will likely need second and third generation vaccines. Dedicated incentives and funding focused explicitly on nurturing and advancing competing second and third generation vaccines are essential. This article proposes a collaborative, market-based financing mechanism for the world to incentivize and pay for the development of, and provide equitable access to, second and third generation COVID-19 vaccines. Specifically, we propose consideration of a Benefit-Based Advance Market Commitment (BBAMC). The BBAMC uses health technology assessment to determine value-based prices to guarantee overall market revenues, not revenue for any specific product or company. The poorest countries would not pay a value-based price but a discounted "tail-price." Innovators must agree to supply them at this tail price or to facilitate technology transfer to local licensees at low or zero cost to enable them to supply at this price. We expect these purchases to be paid for in full or large part by global donors. The BBAMC therefore sets prices in relation to value, protects intellectual property rights, encourages competition, and ensures all populations get access to vaccines, subject to agreed priority allocation rules.


Assuntos
/prevenção & controle , Saúde Global/economia , Programas de Imunização/economia , /tratamento farmacológico , /economia , Defesa Civil/métodos , Defesa Civil/tendências , Competição Econômica/normas , Competição Econômica/tendências , Saúde Global/tendências , Humanos , Programas de Imunização/métodos
4.
OMICS ; 25(4): 234-241, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33794117

RESUMO

A key lesson emerging from COVID-19 is that pandemic proofing planetary health against future ecological crises calls for systems science and preventive medicine innovations. With greater proximity of the human and animal natural habitats in the 21st century, it is also noteworthy that zoonotic infections such as COVID-19 that jump from animals to humans are increasingly plausible in the coming decades. In this context, glycomics technologies and the third alphabet of life, the sugar code, offer veritable prospects to move omics systems science from discovery to diverse applications of relevance to global public health and preventive medicine. In this expert review, we discuss the science of glycomics, its importance in vaccine development, and the recent progress toward discoveries on the sugar code that can help prevent future infectious outbreaks that are looming on the horizon in the 21st century. Glycomics offers veritable prospects to boost planetary health, not to mention the global scientific capacity for vaccine innovation against novel and existing infectious agents.


Assuntos
/administração & dosagem , Glicômica/organização & administração , Pandemias/prevenção & controle , Zoonoses/epidemiologia , Animais , /prevenção & controle , /biossíntese , Ecossistema , Saúde Global/economia , Saúde Global/tendências , Humanos , Cooperação Internacional , Vacinação em Massa/métodos , Medicina Preventiva/métodos , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/imunologia , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/biossíntese , Zoonoses/imunologia , Zoonoses/prevenção & controle , Zoonoses/transmissão
8.
South Med J ; 114(3): 161-168, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33655310

RESUMO

The incidence of esophageal cancer (EC) is on the rise. With the distinct subtypes of adenocarcinoma and squamous cell carcinoma comes specific risk factors, and as a result, people of certain regions of the world can be more prone to a subtype. For example, squamous cell carcinoma of the esophagus has the highest incidence in eastern Africa and eastern Asia, with smoking being a major risk factor, whereas adenocarcinoma is more prevalent in North America and western Europe, with gastroesophageal reflux disease being a leading risk factor. With that being said, adenocarcinoma and squamous cell carcinoma have similar and unfortunately poor survival rates, partly because EC is prone to early metastasis given that the esophagus does not have a serosa, as well as the superficial nature of its lymphatics compared with the rest of the gastrointestinal tract. This makes early detection of the utmost importance, and certain patients have been shown to have the benefit of screening/surveillance endoscopies, including those with Barrett's esophagus, lye-induced/caustic strictures, tylosis, and Peutz-Jeghers syndrome. Until treatments significantly improve, identifying EC at the earliest stage will have the best success for patient outcomes, and further elucidation of its pathogenesis and risk factors may lead to identifying other high-risk groups that should be screened.


Assuntos
Adenocarcinoma/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Detecção Precoce de Câncer/tendências , Neoplasias Esofágicas/epidemiologia , Saúde Global/tendências , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/etiologia , Refluxo Gastroesofágico/complicações , Humanos , Incidência , Fatores de Risco , Fumar/efeitos adversos , Taxa de Sobrevida
10.
Nat Med ; 27(3): 396-400, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33723454

RESUMO

Fourteen months into the SARS-CoV-2 pandemic, we identify key lessons in the global and national responses to the pandemic. The World Health Organization has played a pivotal technical, normative and coordinating role, but has been constrained by its lack of authority over sovereign member states. Many governments also mistakenly attempted to manage COVID-19 like influenza, resulting in repeated lockdowns, high excess morbidity and mortality, and poor economic recovery. Despite the incredible speed of the development and approval of effective and safe vaccines, the emergence of new SARS-CoV-2 variants means that all countries will have to rely on a globally coordinated public health effort for several years to defeat this pandemic.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis , Saúde Global , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/tendências , Saúde Global/história , Saúde Global/tendências , Governo , História do Século XXI , Humanos , Pandemias/história , Saúde Pública/história , Saúde Pública/métodos , Saúde Pública/tendências , Administração em Saúde Pública/métodos , Administração em Saúde Pública/normas , Administração em Saúde Pública/tendências , /fisiologia
11.
Int J Stroke ; 16(3): 241-247, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33709834

RESUMO

A year ago the World Stroke Organisation (WSO) highlighted the enormous global impact of the COVID-19 pandemic on stroke care. In this review, we consider a year later where we are now, what the future holds, and what the long-term effects of the pandemic will be on stroke. Stroke occurs in about 1.4% of patients hospitalized with COVID-19 infection, who show an excess of large vessel occlusion and increased mortality. Despite this association, stroke presentations fell dramatically during the pandemic, although emerging data suggest that total stroke mortality may have risen with increased stroke deaths at home and in care homes. Strategies and guidelines have been developed to adapt stroke services worldwide, and protect healthcare workers. Adaptations include increasing use of telemedicine for all aspects of stroke care. The pandemic is exacerbating already marked global inequalities in stroke incidence and mortality. Lastly, the pandemic has had a major impact on stroke research and funding, although it has also emphasized the importance of large scale collaborative research initiatives.


Assuntos
/epidemiologia , Assistência à Saúde/tendências , Saúde Global/tendências , Acidente Vascular Cerebral/epidemiologia , Telemedicina/tendências , /terapia , Assistência à Saúde/métodos , Humanos , Acidente Vascular Cerebral/terapia , Telemedicina/métodos
12.
Lancet Glob Health ; 9(4): e409-e417, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33662320

RESUMO

BACKGROUND: The global health community is devoting considerable attention to adolescents and young people, but risk of death in this population is poorly measured. We aimed to reconstruct global, regional, and national mortality trends for youths aged 15-24 years between 1990 and 2019. METHODS: In this systematic analysis, we used all publicly available data on mortality in the age group 15-24 years for 195 countries, as compiled by the UN Inter-agency Group for Child Mortality Estimation. We used nationally representative vital registration data, estimated the completeness of death registration, and extracted mortality rates from surveys with sibling histories, household deaths reported in censuses, and sample registration systems. We used a Bayesian B-spline bias-reduction model to generate trends in 10q15, the probability that an adolescent aged 15 years would die before reaching age 25 years. This model treats observations of the 10q15 probability as the product of the actual risk of death and an error multiplier that varies depending on the data source. The main outcome that we assessed was the levels of and trends in youth mortality and the global and regional mortality rates from 1990 to 2019. FINDINGS: Globally, the probability of an individual dying between age 15 years and 24 years was 11·2 deaths (90% uncertainty interval [UI] 10·7-12·5) per 1000 youths aged 15 in 2019, which is about 2·5 times less than infant mortality (28·2 deaths [27·2-30·0] by age 1 year per 1000 live births) but is higher than the risk of dying from age 1 to 5 (9·7 deaths [9·1-11·1] per 1000 children aged 1 year). The probability of dying between age 15 years and 24 years declined by 1·4% per year (90% UI 1·1-1·8) between 1990 and 2019, from 17·1 deaths (16·5-18·9) per 1000 in 1990; by contrast with this total decrease of 34% (27-41), under-5 mortality declined by 59% (56-61) in this period. The annual number of deaths declined from 1·7 million (90% UI 1·7-1·9) in 1990 to 1·4 million (1·3-1·5) in 2019. In sub-Saharan Africa, the number of deaths increased by 20·8% from 1990 to 2019. Although 18·3% of the population aged 15-24 years were living in sub-Saharan Africa in 2019, the region accounted for 37·9% (90% UI 34·8-41·9) of all worldwide deaths in youth. INTERPRETATION: It is urgent to accelerate progress in reducing youth mortality. Efforts are particularly needed in sub-Saharan Africa, where the burden of mortality is increasingly concentrated. In the future, a growing number of countries will see youth mortality exceeding under-5 mortality if current trends continue. FUNDING: UN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.


Assuntos
Saúde do Adolescente/tendências , Saúde Global/tendências , Modelos Estatísticos , Mortalidade/tendências , Adolescente , Saúde do Adolescente/estatística & dados numéricos , Teorema de Bayes , Bases de Dados Factuais/estatística & dados numéricos , Geografia , Saúde Global/estatística & dados numéricos , Humanos , Organização Mundial da Saúde , Adulto Jovem
13.
J Manag Care Spec Pharm ; 27(5): 625-637, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33779246

RESUMO

BACKGROUND: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report for the management of chronic obstructive pulmonary disease (COPD) focuses on reducing existing symptoms, decreasing the risk of future exacerbations, and improving health status by recommending specific drug therapy based on exacerbation risk and symptoms. However, disparities exist between evidence-based recommendations and clinical practice. Research that quantifies the real-world effect of COPD regimen alignment with the GOLD recommendations on clinical and economic outcomes is needed. OBJECTIVE: To compare COPD-related health care resource utilization (HRU) and costs, as well as exacerbation rates, among patients with COPD on maintenance therapy based on 2017 GOLD treatment recommendation compliance status per GOLD ABCD risk group classification in a U.S. commercially insured/Medicare Advantage population. METHODS: This retrospective cohort study utilized administrative claims data in the HealthCore Integrated Research Database. The COPD population was identified using a previously validated claims-based predictive model. Among this population, patients with ≥ 1 claim for a COPD maintenance medication (earliest maintenance fill-date = index date) between January 1, 2014, and March 31, 2017, were identified. Patients were required to be aged ≥ 40 years, have ≥ 12 months of pre-index and ≥ 30 days of post-index health plan enrollment, with no diagnosis for asthma, cystic fibrosis, and/or lung cancer at any time from January 1, 2013, to March 31, 2018. Patients were categorized into exacerbation risk/symptomatology groups according to the 2017 GOLD ABCD assessment recommendations and were then classified into treatment-compliance status based on their maintenance therapy. Multivariable analyses were conducted to examine post-index COPD-related HRU, costs, and exacerbations by compliance status. RESULTS: The primary analytical study sample included 38,382 patients in the GOLD A/B group and 6,525 in the GOLD C/D group. Patients were further categorized into GOLD A (n = 19,345), B (n = 19,037), C (n = 1,865), and D (n = 4,670). GOLD-compliant regimens were observed in 32.9% of patients in the GOLD A/B group and in 58.9% of patients in the GOLD C/D group. Inhaled corticosteroid-containing regimens were the most commonly observed noncompliant regimen. Patients on compliant regimens had significantly fewer COPD-related inpatient and emergency department visits and therefore had significantly lower COPD-related medical costs in both the GOLD A/B and C/D cohorts. Similar results were observed for individual GOLD cohorts B, C, and D. These savings were offset by increased pharmacy expenditures. Being on GOLD guideline-compliant regimens significantly reduced the risk of exacerbation by 8% (hazard ratio [HR] = 0.92; P < 0.0001) in the GOLD A/B cohort and by 12% (HR = 0.88; P = 0.0005) in the GOLD C/D cohort, and was also associated with a significantly reduced exacerbation rate in the GOLD A/B (rate ratio [RR] = 0.93; P < 0.0001) and GOLD C/D (RR = 0.93; P = 0.0129) groups. CONCLUSIONS: This study suggests a continuing trend of high prevalence of suboptimal prescriber compliance to GOLD treatment recommendations. Treatment regimens compliant with GOLD recommendations were associated with improvement in exacerbations, reduced COPD-related HRU, and COPD-related medical cost offsets. DISCLOSURES: This study was funded by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI). BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations. Palli and Shaikh are employees of BIPI. Willey is an employee of HealthCore, which was contracted by BIPI to conduct this study. Zhou was an employee of HealthCore at the time of study execution. Data were presented in part during an AMCP webinar (recording not made public) held in lieu of the Spring 2020 AMCP conference, which was canceled due to the COVID-19 pandemic.


Assuntos
Progressão da Doença , Saúde Global/tendências , Custos de Cuidados de Saúde/tendências , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente , Doença Pulmonar Obstrutiva Crônica/terapia , Corticosteroides/economia , Corticosteroides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Saúde Global/economia , Saúde Global/normas , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/economia , Antagonistas Muscarínicos/uso terapêutico , Guias de Prática Clínica como Assunto/normas , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
16.
Adv Ther ; 38(3): 1397-1403, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33590446

RESUMO

The availability of pangenotypic direct-acting antivirals for treatment of hepatitis C (HCV) has provided an opportunity to simplify patient pathways. Recent clinical practice guidelines have recognised the need for simplification to ensure that elimination of HCV as a public health concern remains a priority. Despite the move towards simplified treatment algorithms, there remains some complexity in the recommendations for the management of genotype 3 patients with compensated cirrhosis. In an era where additional clinical trial data are not anticipated, clinical guidance should consider experience gained in real-world settings. Although more experience is required for some pangenotypic therapeutic options, on the basis of published real-world data, there is already sufficient evidence to consider a simplified approach for genotype 3 patients with compensated cirrhosis. The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need to minimise the need for complex patient pathways and clinical practice guidelines need to continue to evolve in order to ensure that patient outcomes remain optimised.


Assuntos
Controle de Doenças Transmissíveis , Procedimentos Clínicos , Erradicação de Doenças , Hepatite C , Antivirais/farmacologia , /prevenção & controle , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Procedimentos Clínicos/normas , Procedimentos Clínicos/tendências , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Saúde Global/tendências , Hepatite C/epidemiologia , Hepatite C/terapia , Humanos , Guias de Prática Clínica como Assunto
17.
Ann Glob Health ; 87(1): 17, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33633928

RESUMO

Member States at this year's World Health Assembly 73 (WHA73), held virtually for the first time due to the COVID-19 pandemic, passed multiple resolutions that must be considered when framing efforts to strengthen surgical systems. Surgery has been a relatively neglected field in the global health landscape due to its nature as a cross-cutting treatment rather than focusing on a specific disease or demographic. However, in recent years, access to essential and emergency surgical, obstetric, and anesthesia care has gained increasing recognition as a vital aspect of global health. The WHA73 Resolutions concern specific conditions, as has been characteristic of global health practice, yet proper care for each highlighted disease is inextricably linked to surgical care. Global surgery advocates must recognize how surgical system strengthening aligns with these strategic priorities in order to ensure that surgical care continues to be integrated into efforts to decrease global health disparities.


Assuntos
Anestesia/normas , Cirurgia Geral , Saúde Global , Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Obstetrícia/normas , /epidemiologia , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Saúde Global/normas , Saúde Global/tendências , Humanos , Melhoria de Qualidade
18.
Elife ; 102021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33588991

RESUMO

Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break down. Over 6 months into the COVID-19 pandemic, the dynamics of AMR remain uncertain. We call for the AMR community to keep a global perspective while designing finely tuned surveillance and research to continue to improve our preparedness and response to these intersecting public health challenges.


Assuntos
Antibacterianos , Procedimentos Clínicos , Farmacorresistência Bacteriana/fisiologia , Saúde Global/tendências , Antibacterianos/provisão & distribução , Antibacterianos/uso terapêutico , /epidemiologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos
19.
Nutrients ; 13(2)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33573027

RESUMO

The associations among early childhood caries (ECC), socioeconomic status, and sugar consumption are of the utmost importance, due to their potential policy implications. The purpose of this study was to identify trends in ECC burden in children under 5 years old among European Union (EU) member states over time and to evaluate the relationship with its risk factors. Global Burden of Disease 2019 data were analyzed to estimate the burden of ECC over time, specifically incidence, prevalence, and years lived with disability (YLDs) for children under 5 years old. Four ecological variables with a potential effect on YLDs for ECC were used to investigate the association between 2014 and 2017. The YLDs rate was consistently higher among Eastern EU countries over time. Univariate models showed a positive significant association between at-risk-of-poverty rate and YLDs rate, while GDP per capita and urbanization were inversely associated with YLDs rate. In the multivariate analysis, sugar consumption, GDP per capita and urbanization showed significant association with YLDs rate. After stratification by region, association remained significant only in the Eastern EU countries between GDP, urbanization, and YLDs rate, while sugar consumption and at-risk-of-poverty rate had no significant impact on YLDs rates. This study found increasing ECC burden in the EU. The complexity of the problem indicates the need for innovative and personalized policy approaches to tackle the disease.


Assuntos
Cárie Dentária/epidemiologia , União Europeia/estatística & dados numéricos , Carga Global da Doença/tendências , Saúde Global/tendências , Saúde Bucal/tendências , Pré-Escolar , Cárie Dentária/etiologia , Suscetibilidade à Cárie Dentária , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Açúcares da Dieta/efeitos adversos , Açúcares da Dieta/análise , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Produto Interno Bruto , Humanos , Incidência , Masculino , Análise Multivariada , Pobreza/estatística & dados numéricos , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Urbanização/tendências
20.
Circ Arrhythm Electrophysiol ; 14(3): e009458, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33554620
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