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1.
Cancer J ; 26(4): 323-329, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32732675

RESUMEN

Accessibility to effective cancer treatments is a goal of Universal Health Coverage; yet, achieving this in the context of escalating costs in a diversity of Asian nations with different socioeconomic development is extremely challenging. Value-based assessments within the context of each health care system, financing infrastructure that will facilitate appropriate prioritization of high-cost medications, transparency in international pricing and reducing out-of-pocket costs through national insurance programs are measures that Asian countries should take toward Universal Health Coverage for cancer care. Encouraging sharing data on pricing through the World Health Organization, sharing expertise in health technology assessments and regulatory approvals, and exploring bulk negotiations would also strengthen the process of price control. For each individual country, rational selection of national cancer formulary, aiming at price reduction and sound procurement strategies for each drug, is important toward ensuring affordable access to quality cancer medications.

2.
Washington, D.C.; OPS; 2020-07-17. (OPS/HSS/SF/20-0009).
No convencional en Español | PAHO-IRIS | ID: phr-52486

RESUMEN

En el año 2000, la Organización Panamericana de la Salud (OPS) estableció el Fondo Rotatorio Regional para Suministros Estratégicos de Salud Pública con miras a mejorar el acceso a medicamentos y otros insumos de calidad asegurada, seguros y eficaces para reforzar la eficiencia y la sostenibilidad de los sistemas de salud pública en la Región de las Américas. El Fondo Estratégico es un mecanismo regional de cooperación técnica que facilita la compra mancomunada de medicamentos esenciales e insumos estratégicos de salud. Contribuye a que los países cumplan su compromiso de alcanzar los Objetivos de Desarrollo Sostenible al mejorar el acceso a medicamentos y productos de salud pública asequibles y de calidad asegurada. En el informe anual correspondiente al 2019 del Fondo Estratégico de la OPS se detalla el progreso logrado gracias a una estrecha cooperación técnica con los Estados Miembros. Dada la eficacia del Fondo Estratégico para facilitar una mejor gestión de la cadena de suministro de insumos fundamentales para la salud pública, firmamos acuerdos de participación con 34 países y territorios y establecimos nuevas asociaciones con reconocidos organismos de salud. El volumen de compras realizadas mediante el Fondo Estratégico se incrementó en 81% en comparación con el 2018, lo que pone de manifiesto que el Fondo es un mecanismo de gran importancia para alcanzar la meta de la salud para todos. En respuesta a las necesidades cada vez mayores de los Estados Miembros, el Fondo Estratégico negoció acuerdos a largo plazo para adquirir tratamientos para la infección por el VIH/sida y el cáncer, precalificados por la OMS, a precios muy reducidos; encabezó una iniciativa conjunta para las enfermedades cardiovasculares, y fortaleció la capacidad a nivel de país para proyectar la demanda y gestionar los inventarios. Como resultado de estas iniciativas se han proporcionado directamente tratamientos a más de 7,5 millones de personas en los años 2018 y 2019, y varios millones más de personas tendrán acceso a medicamentos, kits y equipo de diagnóstico, materiales de control de vectores y otros insumos de alta calidad para la salud, así como tecnologías que seguirán siendo asequibles en los próximos años.


Asunto(s)
Fondo Estratégico , Cobertura Universal de Salud , Acceso a Medicamentos Esenciales y Tecnologías Sanitarias , Américas
3.
Washington, D.C.; PAHO; 2020-07-13. (PAHO/NMH/NV/COVID-19/20-0029).
en Inglés | PAHO-IRIS | ID: phr-52477

RESUMEN

Appropriate and adequate management of people with noncommunicable diseases (NCDs) includes access to essential NCD medicines. Disrupted access to chronic medication for hypertension, diabetes, heart disease, mental health disorders, cancer, and asthma could result in severe disease exacerbation and potentially death.


Asunto(s)
Infecciones por Coronavirus , Coronavirus , Hipertensión , Diabetes Mellitus , Cardiopatías , Salud Mental , Asma , Factores de Riesgo , Poblaciones Vulnerables
4.
Washington, D.C.; PAHO; 2020-07-13. (PAHO/HSS/SF/20-0009).
No convencional en Inglés | PAHO-IRIS | ID: phr-52474

RESUMEN

In 2000, the Pan American Health Organization (PAHO) established the Strategic Fund to improve access to safe, efficacious, and high-quality medicines and other health supplies. This increased access would inevitably strengthen the efficiency and sustainability of public health systems in the Americas. The Strategic Fund is a regional technical cooperation mechanism for the pooled procurement of essential medicines and strategic health supplies. The Fund contributes to countries’ commitments to achieving the Sustainable Development Goals (SDGs) by facilitating access to affordable, high-quality medicines, and other health technologies. The 2019 Annual Report of the PAHO Strategic Fund details the progress made possible through close technical cooperation. Because of the Fund’s effectiveness in facilitating enhanced supply chain management of critical public health supplies, we have signed participating agreements with 34 countries and territories and developed new partnerships with pivotal health agencies. Procurement volume through the PAHO Strategic Fund has increased by 81% compared to 2018, proving the Fund is an important mechanism to achieve health for all. Responding to the increasing needs of Member States, the Strategic Fund has negotiated long-term agreements for WHO-prequalified HIV/AIDS and cancer treatments at substantially reduced prices, spearheaded a joint initiative for cardiovascular diseases, and strengthened in-country capacity-building for demand forecasting and inventory management. These initiatives have directly provided treatments for over 7.5 million people in 2018 and 2019 and will enable millions more to access high-quality medicines, diagnostic kits and equipment, vector control materials, and other health supplies and technologies that remain affordable in the coming years.


Asunto(s)
Fondo Estratégico , Acceso a Medicamentos Esenciales y Tecnologías Sanitarias , Cobertura Universal de Salud
5.
Washington, D.C.; OPS; 2020-07-21. (OPS/HSS/MT/COVID-19/20-0026).
No convencional en Español | PAHO-IRIS | ID: phr-52513

RESUMEN

Este documento tiene por objeto proporcionar orientaciones y recomendaciones que sirvan de apoyo para la toma de decisiones regulatorias en materia de farmacovigilancia, tecnovigilancia y hemovigilancia en el marco de la pandemia en la Región de las Américas. Asimismo, y dada la importancia que adquiere en el contexto de la pandemia el fortalecimiento de la detección y la prevención de los productos médicos no registrados, subestándar o falsificados (SF) y la respuesta a ellos, aborda aspectos clave para este fin. El presente documento está dirigido tanto a las autoridades reguladoras nacionales como a otros actores (programas ampliados de inmunizaciones, programas de enfermedades o de salud pública, profesionales de los servicios de salud, etcétera) vinculados a la regulación, selección, indicación y utilización de las tecnologías de salud pertinentes.


Asunto(s)
Infecciones por Coronavirus , Coronavirus , Pandemias , Control de Infecciones , Acceso a Medicamentos Esenciales y Tecnologías Sanitarias , Américas
6.
Artículo en Inglés | MEDLINE | ID: mdl-32712931

RESUMEN

Medical schools worldwide undertake widening access (WA) initiatives (e.g. pipeline, outreach and academic enrichment programmes) to support pupils from high schools which do not traditionally send high numbers of applicants to medicine. UK literature indicates that pupils in these schools feel that their teachers are ill-equipped, cautious or even discouraging towards their aspiration and/or application to medicine. This study aimed to explore teachers' perspectives and practices to include their voice in discussions and consider how medical schools might best engage with them to facilitate WA. Interviews were conducted with high school teachers in three UK regions, working in schools targeted by WA initiatives. Data were analysed thematically using template analysis, using a largely data-driven approach. Findings showed that although medicine was largely seen as a prestigious and worthwhile career, teachers held reservations about advocating this above other choices. Teachers saw it as their role to encourage pupils to educate themselves about medicine, but to ultimately allow pupils to make their own decisions. Their attitudes were influenced by material constraints in their schools, and the perception of daunting, long and emotionally difficult admissions requirements, with low chances of success. Medical schools may wish to work with teachers to understand their hesitations and help them develop the mindset required to advocate a challenging and unfamiliar career, emphasising that this encouragement can further the shared goal of empowering and preparing pupils to feel capable of choosing medicine. Reciprocally, medical schools should ensure pupils have fair opportunities for access, should they choose to apply.

8.
Drug Alcohol Depend ; 214: 108160, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32653721

RESUMEN

BACKGROUND: Immersive video (e.g. virtual reality) poses a promising and engaging alternative to standard in-person trainings and can potentially increase access to evidence-based opioid overdose prevention programs (OOPPs). Therefore, the objective of this equivalence study was to test whether the immersive video OOPP was equivalent to a standard in-person OOPP for changes in opioid overdose knowledge and attitudes. METHODS: A team of nurses and communication researchers developed a 9-minute immersive video OOPP. To test whether this immersive video OOPP (treatment) demonstrated equivalent gains in opioid overdose response knowledge and attitudes as in-person OOPPs (standard of care control), researchers deployed a two-day field experiment in Philadelphia, Pennsylvania, USA. In this equivalence trial, 9 libraries were randomly assigned to offer treatment or control OOPP to community members attending naloxone giveaway events. In this equivalence design, a difference between treatment and control groups pre- to post-training scores within -1.0 to 1.0 supports equivalence between the trainings. RESULTS: Results demonstrate participants (N = 94) exposed to the immersive video OOPP had equivalent improvements on posttest knowledge (ß=-0.18, p = .61) and more favorable attitudes about responding to an opioid overdose (ß=0.26, p = .02) than those exposed to the standard OOPP. However, these minor differences in knowledge and attitudes were within the equivalence interval indicating that the immersive video OOPP remained equivalently effective for community members. CONCLUSIONS: Community partnerships, like those between public health departments and libraries, can provide opportunities for deploying novel immersive video OOPP that, alongside standard offerings, can strengthen community response to the opioid crisis.

9.
Artículo en Inglés | MEDLINE | ID: mdl-32610761

RESUMEN

BACKGROUND: Despite greater attention to the nexus between trade and investment agreements and their potential impacts on public health, less is known regarding the political and governance conditions that enable or constrain attention to health issues on government trade agendas. Drawing on interviews with key stakeholders in the Australian trade domain, this article provides novel insights from policy actors into the range of factors that can enable or constrain attention to health in trade negotiations. METHODS: A qualitative case study was chosen focused on Australia's participation in the Trans-Pacific Partnership (TPP) negotiations and the domestic agenda-setting processes that shaped the government's negotiating mandate. Process tracing via document analysis of media reporting, parliamentary records and government inquiries identified key events during Australia's participation in the TPP negotiations. Semi-structured interviews were undertaken with 25 key government and non-government policy actors including Federal politicians, public servants, representatives from public interest nongovernment organisations and industry associations, and academic experts. RESULTS: Interviews revealed that domestic concerns for protecting regulatory space for access to generic medicines and tobacco control emerged onto the Australian government's trade agenda. This contrasted with other health issues like alcohol control and nutrition and food systems that did not appear to receive attention. The analysis suggests sixteen key factors that shaped attention to these different health issues, including the strength of exporter interests; extent of political will of Trade and Health Ministers; framing of health issues; support within the major political parties; exogenous influencing events; public support; the strength of available evidence and the presence of existing domestic legislation and international treaties, among others. CONCLUSION: These findings aid understanding of the factors that can enable or constrain attention to health issues on government trade agendas, and offer insights for potential pathways to elevate greater attention to health in future. They provide a suite of conditions that appear to shape attention to health outside the biomedical health domain for further research in the commercial determinants of health.

10.
Stud Health Technol Inform ; 272: 421-424, 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32604692

RESUMEN

The aim of this study was to evaluate accessibility of stroke patients to optimal healthcare technology in Greece. Methods: The study population consisted of 313 first ever stroke patients derived from the "Stroke Units Necessity for Patients, SUN4P" registry. Descriptive statistics were used, to present patients' characteristics and resources utilization Results: The vast majority of patients (91.7%) conducted a CT scan during the acute phase (within the first 24hours). Almost, (65%) were admitted to wards of Internal Medicine Departments, whereas only 21% of patients were admitted to a Stroke Unit. Of note, a total of 6.9% of ischemic stroke patients received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA). Conclusions: Preliminary results from SUN4P underline the urgent necessity for the re-organization of acute stroke care in Greece, as rates of admissions to stroke units and rtPA treatment during the acute phase are currently below optimal.

11.
Expert Rev Vaccines ; 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-32605395

RESUMEN

INTRODUCTION: To describe vaccine stock-outs at national, district and health facility levels in the WHO African region. AREAS COVERED: We conducted a systematic review to identify studies reporting on vaccine stock-outs at national, district and health facility levels in 47 African countries. We searched both published and unpublished literature, including the WHO/UNICEF Joint Reporting Form (JRF), for eligible studies. EXPERT OPINION: Countries within the WHO African region continue to face the challenge of vaccine stock-outs at national, district, and health facility levels and this impacts on the delivery of immunisation services. The frequency and the proportion of stock-outs vary between countries and between regions within a country. Countries need to put more efforts towards finding lasting solutions to vaccine shortages. We look forward to having more countries reporting vaccine stock-outs especially at the health facility level. Furthermore, countries are currently exploring different approaches for improving vaccine stock management. It is expected that in half a decade from now, more well-designed studies will be available that will inform decision making.

12.
J Health Econ ; 72: 102347, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32622153

RESUMEN

This paper evaluates the health effects of a large-scale subsidizing program of prescription drugs introduced in Brazil, the Aqui Tem Farmácia Popular program (ATFP). We exploit features of the program to identify its effects on mortality and hospitalization rates by diabetes for individuals aged 40 years or more. We find weak evidence for a decline in mortality, but a robust reduction in hospitalization rates. According to our preferred specification, an additional ATFP pharmacy per 100,000 inhabitants is associated with a decrease in hospitalization rates by diabetes of 8.2, which corresponds to 3.6% of its baseline rate. Effects are larger for Type II diabetes in comparison to Type I, and among patients with relatively lower socioeconomic status. Overall, the results are consistent with insulin-dependent patients being relatively less responsive to subsidies because of higher immediate life-threatening risks; and with lower-SES individuals being more responsive because of liquidity constraints. These results support the view that the optimal design of health systems and cost-sharing mechanisms should take into account equity concerns, heterogeneous impacts by health condition, and their potential offsetting effects on the utilization of downstream health services.

13.
Int J Drug Policy ; 83: 102837, 2020 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-32645585

RESUMEN

Background Monitoring the hepatitis C virus (HCV) cascade of care (CoC) among people who inject drugs (PWID) is an essential component of the response to World Health Organisation's (WHO) hepatitis elimination goals. This study aimed to estimate the Consensus hepatitis C CoC among PWID using data collected in Australia prior to and after the introduction of unrestricted direct-acting antiviral (DAA) therapy in March 2016. Methods The Australian Needle Syringe Program Survey is a cross-sectional bio-behavioural surveillance system that recruits >2000 PWID annually. Using data from 2015 and 2019, HCV antibody and ribonucleic acid (RNA) test results from dried blood spots were combined with self-reported data on HCV diagnostic testing and treatment to project HCV Consensus CoC indicators at a population-level among Australian PWID. Results Among an estimated 75,000 people who inject drugs on a regular basis in Australia, the number with active HCV infection declined from 32,619 (44%) in October 2015 to 12,679 (17%) in October 2019. The majority (78% in 2015 and 2019) of PWID reported HCV diagnosis, while the proportion of those diagnosed who were treated increased from 3% in 2015 to 47% in 2019. Among those treated, the proportion who were HCV RNA negative and assumed to have been successfully treated (cured), increased from 27% in 2015 to 88% in 2019. Conclusion This study demonstrates remarkable HCV CoC progress among PWID in Australia following availability of DAA therapy. There was a substantial increase in the proportion of HCV diagnosed PWID who initiated treatment and were cured, while the number of PWID with active HCV infection more than halved over a 3.5 year period. Estimates of the Consensus hepatitis C CoC among PWID is required to monitor progress toward WHO HCV elimination goals.

14.
J Palliat Med ; 2020 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-32692279

RESUMEN

The World Health Organization recommends that "palliative care should be integrated as a routine element of all Undergraduate Medical Education." However, the provision of training for medical undergraduates is variable; only 18% of 51 European countries have mandatory training in palliative medicine. EDUPALL is an ERASMUS+ funded international collaborative project to develop and pilot an undergraduate program for training in palliative medicine. The objective of this study was to critically review and revise current European Association for Palliative Care (EAPC) Recommendations for the Development of Undergraduate Curricula in Palliative Medicine and translating these into an updated curriculum document. Clinicians, academics, and researchers from Romania, Ireland, Germany, Austria, Spain, and the United Kingdom reviewed the EAPC recommendations using a variant of consensus methodology, Nominal Group Technique. From the updated document, four working-groups translated each recommendation into a specific learning objective, and developed associated learning outcomes, stratified by domain: attitude, cognition, and skills. The outcomes and objectives were organized into discrete teaching units and transferred into a curriculum template, identifying notional hours, teaching, and assessment strategies. To ensure quality control, the draft template was circulated to experts from 17 European countries, together with a brief survey instrument, for peer review purposes. All 17 reviewers returned overwhelmingly positive comments. There was large agreement that: the teaching units were logically organized; learning outcomes covered core training needs; learning objectives provided guidance for teaching sessions; learning modalities were appropriately aligned; and assessment strategies were fit for purpose. An updated and standardized curriculum was developed, which provides a platform for the sequential development of the next phases of the EDUPALL project.

15.
Artículo en Inglés | MEDLINE | ID: mdl-32708060

RESUMEN

BACKGROUND: Developing countries, such as the Philippines, started implementing policies to improve access to medicines, which is a vital step toward universal healthcare coverage. This study aimed to evaluate the prices, availability and affordability of prescribed medicines for diabetes, hypercholesterolemia and hypertension with the exemption of 12% value-added tax in the Philippines. METHODS: The prices and availability of 50 medicines were collected in August 2019 from 36 public and 42 private medicine outlets in six regions of the Philippines, following a modified methodology developed by the World Health Organization and Health Action International. Availability is reported as the percentage of outlets in which the surveyed medicine was found at the time of visit. Medicine prices are expressed as median unit prices (MUPs) in Philippine Peso. Affordability is calculated based on the number of days' wages required for the lowest-paid unskilled government worker to purchase a monthly treatment. RESULTS: The mean availability of surveyed medicines was low in both public and private sectors, with 1.3% for originator brands (OBs) and 25.0% for lowest-priced generics (LPGs) in public outlets, and 34.7% and 35.4% in private outlets, respectively. The MUP of medicines were higher in private outlets, and OBs have higher unit price compared to the generic equivalents. Treatments with OBs were unaffordable, except for gliclazide, but the affordability of most LPGs is generally good. CONCLUSION: Access to medicines in both sectors was affected by low availability. High prices of OBs influenced the affordability of medicines even with tax exemption. A review of policies and regulations should be initiated for a better access to medicines in the Philippines.

16.
Lancet ; 396(10246): 238, 2020 07 25.
Artículo en Inglés | MEDLINE | ID: mdl-32711799
17.
J Nucl Med ; 2020 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-32646881

RESUMEN

The Nuclear Medicine Global Initiative (NMGI) was formed in 2012 by 13 international organizations to promote human health by advancing the field of nuclear medicine and molecular imaging by supporting the practice and application of nuclear medicine. The first project focused on standardization of administered activities in pediatric nuclear medicine and resulted in two manuscripts. For its second project the NMGI chose to explore issues impacting on access and availability of radiopharmaceuticals around the world. Methods: Information was obtained by survey responses from 35 countries on available radioisotopes, radiopharmaceuticals and kits for diagnostic and therapeutic use. Issues impacting on access and availability of radiopharmaceuticals in individual countries were also identified. Results: Detailed information on radiopharmaceuticals utilized in each country, and sources of supply, was evaluated. Responses highlighted problems in access particularly due to the reliance on a sole provider, regulatory issues and reimbursement, as well as issues of facilities and workforce particularly in low- and middle-income countries. Conclusion: Strategies to address access and availability of radiopharmaceuticals are outlined, to enable timely and equitable patient access to nuclear medicine procedures worldwide. In the face of disruptions to global supply chains by the COVID-19 outbreak, renewed focus on ensuring reliable supply of radiopharmaceuticals is a major priority for nuclear medicine practice globally.

18.
JCO Glob Oncol ; 6: 1124-1133, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32692628

RESUMEN

This review will compare and contrast the costs and access to novel drugs for treating chronic lymphocytic leukemia (CLL) and lymphoma in the United States and India during the last 5 years. Clinical outcomes for patients with hematologic malignancies have improved significantly since the approval of immunotherapeutic and targeted therapies. These new treatments have had an impact on overall outcomes and have helped determine the design for translational research and future trials. Although most of these novel drugs called "innovators" are initially approved and marketed in the United States, several have also become available in countries such as India. With the expiration of patents, generic versions of innovator drugs have increased and accessibility has improved for patients. The advent of biosimilars is another route for expanding access to biologic compounds. As a result, the development costs for developing these drugs are lower, and consequently, the costs for the patient are often lower. Although the delivery of cancer care is not the same in India as it is in the United States, the introduction of biosimilars and generics has helped bridge the gap. This has made treatment of CLL and lymphoma similar in both countries and has had the same impact on patient outcomes and quality of life. Compulsory licensing for essential medications, as stipulated by the Doha Declaration, and capping of drug prices could improve global access to treatments for CLL and lymphoma.

19.
Polymers (Basel) ; 12(8)2020 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-32708024

RESUMEN

High potential of emission chemistry has been visualized in many fields, from sensors and imaging to displays. In general, conjugated polymers are the top rankers for such chemistry, despite the fact that they bring solubility problems, high expenses, toxicity and demanding synthesis. Metal-free polymeric semiconductor graphitic carbon nitride (g-CN) has been an attractive candidate for visible light-induced photocatalysis, and its emission properties have been optimized and explored recently. Herein, we present modified g-CN nanoparticles as organodispersible conjugated polymer materials to be utilized in a heterophase emission systems. The injection of a g-CN organic dispersion in aqueous polymer solution not only provides retention of the shape by Pickering stabilization of g-CN, but high intensity emission is also obtained. The heterophase all-liquid emission display can be further modified by the addition of simple conjugated organic molecules to the initial g-CN dispersion, which provides a platform for multicolor emission. We believe that such shape-tailored and stabilized liquid-liquid multicolor emission systems are intriguing for sensing, displays and photonics.

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