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1.
Ann Glob Health ; 86(1): 123, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-33024709

RESUMO

Background: To reduce the non-communicable diseases (NCDs) burden, the World Health Organization has set a target to reach 80% availability of the affordable essential medicines required to treat NCDs by 2025. Objectives: This study described the availability, costs, and stock-outs of essential NCD drugs in three rural Rwandan districts. Methods: We retrospectively assessed 54 NCD drugs listed for district hospitals or health centers in the Rwanda national essential medicines list. Data were collected from three district hospitals and 17 health centers that host NCD clinics. We extracted data on drug availability, quantity dispensed, costs, stock-outs, and the replenishing supplier for these drugs between January 1 and December 31, 2017. Results: Overall, 71% of essential medicines for health centers and 78% of essential medicines for district hospitals were available at facilities. Only 15% of health centers experienced a stock-out of beclomethasone, while 77% experienced at least one stock-out of amlodipine and metformin. The median length of stock-out ranged from nine to 72 days, and 78% of the stock-outs across all health centers were replenished by a Non-Governmental Organization (NGO) partner. Except for enoxaparin and metformin, all district hospitals experienced at least one stock-out of each drug. The median length of stock-out ranged from 3.5 to 228 days, and 82% of the stock-outs across all district hospitals were replenished by the Rwandan Ministry of Health (RMOH). The least expensive drug was digoxin ($0.02, Interquartile range (IQR): 0.01, 0.10), while the most expensive was beclomethasone ($9.35, IQR: 3.00, 13.20). Conclusions: This study shows the viability of drug-supported NCD care in rural settings of sub-Saharan Africa. Stock-outs are a challenge; our study emphasizes the importance of the MOH/NGO partnerships in this context. Medicine costs are also challenging, though, in these districts, drugs are more affordable through community-based health insurance, government, and NGO partner subsidies.

2.
BMJ Open ; 10(10): e034720, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33033079

RESUMO

OBJECTIVE: To evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability. DESIGN: Two cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology. SETTING: Four districts of Lahore division, Pakistan. PARTICIPANTS: 16 public sector hospitals and 16 private sector retail pharmacies. MEASURES: The pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days' wages required to get a standard treatment by the lowest paid unskilled government worker. RESULTS: The overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%-58.3% and 20.3%-32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019. CONCLUSIONS: The availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, the drug pricing policy must be reviewed to ensure access to essential medicines.

3.
Virulence ; 11(1): 1310-1328, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33017224

RESUMO

Nasopharyngeal colonization by Streptococcus pneumoniae is a prerequisite for pneumococcal transmission and disease. Current vaccines protect only against disease and colonization caused by a limited number of serotypes, consequently allowing serotype replacement and transmission. Therefore, the development of a broadly protective vaccine against colonization, transmission and disease is desired but requires a better understanding of pneumococcal adaptation to its natural niche. Hence, we measured the levels of free and protein-bound transition metals in human nasal fluid, to determine the effect of metal concentrations on the growth and proteome of S. pneumoniae. Pneumococci cultured in medium containing metal levels comparable to nasal fluid showed a highly distinct proteomic profile compared to standard culture conditions, including the increased abundance of nine conserved, putative surface-exposed proteins. AliA, an oligopeptide binding protein, was identified as the strongest protective antigen, demonstrated by the significantly reduced bacterial load in a murine colonization and a lethal mouse pneumonia model, highlighting its potential as vaccine antigen.

7.
Disaster Med Public Health Prep ; : 1-21, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33040768

RESUMO

Our purpose was to determine the intensive care units' (ICUs) medical staff surge capacity during the Covid-19 outbreak in spring 2020 in Spain. Methods: a multicenter retrospective survey addressing the medical specialties present in the ICUs and the increase in bed capacity during this period. Results: Sixty-seven centers (62.04%) answered the questionnaire. The ICU bed capacity during the pandemic outbreak increased by 160% (95%CI 128.97-191.03%). The average number of beds per intensive care medicine (ICM) specialist was 1.5 ± 0.60 and 3.71 ± 2.44 beds/specialist before and during the Covid-19 outbreak, respectively. Non-ICM specialists and residents were present in 50 (74.63%) and 23 (34.3%) ICUs during the outbreak, respectively. The number of physicians (ICM and non-ICM residents and specialists) in the ICU increased by 89.40% (95%CI 64.26 -114.53%). The increase in ICM specialists was, however, of 4.94% (95%CI -1.35 - 11.23%) Most non-ICM physicians were anesthetists, followed by pediatricians and cardiologists. Conclusion: The majority of ICUs in our study were able to rapidly expand critical care capacity by adapting areas outside of the normal ICU to manage critically ill patients, and by extending the critical care staff with noncritical care physicians working as force multipliers.

8.
J Addict Med ; 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33009167

RESUMO

: Globally, there are concerns about access to healthcare and harm reduction services for people who use drugs (PWUD) during the coronavirus disease 2019 (COVID-19) pandemic. Members from the Network of Early Career Professionals working in Addiction Medicine shared their experiences of providing treatment to PWUD during the COVID-19 pandemic. Drawing on these qualitative reports, we highlight the similarities and discrepancies in access to services for PWUD in 16 countries under COVID-10 restrictions. In most countries reported here, efforts have been made to ensure continued access to services, such as mobilising opioid agonist maintenance treatment and other essential medicines to patients. However, due to travel restrictions and limited telemedicine services, several Network of Early Career Professionals working in Addiction Medicine members from lower-resourced countries experienced challenges with providing care to their patients during periods of COVID-19 lock-down. The insights provided in this commentary illustrate how the COVID-19 lock-down restrictions have impacted access to services for PWUD.

9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1783-1786, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018344

RESUMO

Children with cerebral palsy and complex communication needs face limitations in their access technology (AT) usage. Speech recognition software and conventional ATs (e.g., mechanical switches) can be insufficient for those with speech impairment and limited control of voluntary motion. Automatic recognition of head movements represents a promising pathway. Previous studies have shown the robustness of head pose estimation algorithms on adult participants, but further research is needed to use these methods with children. An algorithm for head movement recognition was implemented and evaluated on videos recorded in a naturalistic environment when children were playing a videogame. A face-tracking algorithm was used to detect the main facial landmarks. Head poses were then estimated using the Pose from Orthography and Scaling with Iterations (POSIT) algorithm and three head movements were classified through Hidden Markov Models (HMMs). Preliminary classification results obtained from the analysis of videos of five typically developing children showed an accuracy of up to 95.6% in predicting head movements.

11.
12.
J Exp Med ; 217(11)2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33064151

RESUMO

Over the past 9 mo, with 34 million infections and 1 million deaths, the COVID-19 pandemic has levied a grisly toll. Some countries, through political will and social organization, have successfully reduced the number of infections and deaths, but the global scale of loss reflects the difficulty of translating these approaches in other countries. An effective SARS-CoV-2 vaccine presents a technological solution to the failure of social and political ones. Vaccines are, however, not a silver bullet, but a safe, cost-effective, and globally applicable tool that will require a substantial effort-cooperation, commitment, time, and funding-to be effective.

13.
N Z Med J ; 133(1523): 76-86, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33032305

RESUMO

AIMS: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are classes of medications shown to reduce cardiovascular events and slow decline in renal function in people with type 2 diabetes (T2DM). They are recommended for many people as second-line agents after metformin by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). PHARMAC have proposed criteria for funding in New Zealand. This clinical audit compares which patients would be eligible for treatment under each criterion. METHODS: This retrospective audit was conducted in December 2019 of all registered patients with T2DM at three general practices within the Wellington/Porirua region. Relevant data were extracted from the electronic health records to enable assessment of eligibility under PHARMAC and ADA/EASD criteria. RESULTS: Of the 23,517 patients enrolled, 1,160 had T2DM. Under PHARMAC criteria 399 (34.4%) patients would be eligible for funded access compared with 339 (27.2%) by the 2018 ADA/EASD criteria and 559 (48.2%) by the revised 2020 ADA/EASD criteria. Differences in eligibility relate to threshold of HbA1c and inclusion of microalbuminuria for treatment. CONCLUSION: The proposed PHARMAC criteria will give access to these important drugs to those people with T2DM who will likely benefit the most.

14.
Global Health ; 16(1): 98, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054820

RESUMO

BACKGROUND: Health systems are struggling with unprecedented drug spending and governments have devised various policy options to manage high-priced medicines. Meanwhile, some pricing and reimbursement processes are currently moving under the jurisdiction of international agreements. This study aims to understand trends in international agreements from the perspectives of pricing and reimbursement policies for newly marketed medicines. METHODS: We proposed the framework to interpret the international agreements as code and applied computational text analysis to understand international agreements as data. In particular, we selected the AUSFTA, KORUS, and TPP to assess the progress and evolution in international agreements and investigate the existing relevant content on the pricing and reimbursement of newly marketed medicines. RESULTS: Similar to the provisions for intellectual property, the scope of international agreements regarding pricing and reimbursement decisions are broadened and strengthened. Over time, the domain of transparency, re-naming procedural fairness, has changed significantly more than the remaining domains. Pharmaceutical companies will have more opportunities to advocate for their positions, to protect their interests in decision processes, to investigate the decisions on listings and setting the amounts of reimbursement, and to challenge these decisions. CONCLUSIONS: Recently signed international agreements favor companies over governments with underscoring procedural fairness and timely access. However, access to affordable medicines is the goal towards which international agreements should aim. In a similar vein, substantial fairness and the accountability of companies should be discussed when negotiating agreements or adopting international agreements through domestic legislation.

16.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47844

RESUMO

A diretora da Organização Pan-Americana da Saúde (OPAS), Carissa F. Etienne, pediu nesta quinta-feira (27) ao bloco PROSUL de presidentes sul-americanos para trabalharem juntos no acesso às vacinas contra a COVID-19.


Assuntos
Infecções por Coronavirus , Vacinas , América do Sul
17.
J Infect Dis ; 222(Supplement_5): S420-S428, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32877551

RESUMO

BACKGROUND: Medicaid expansion under the Affordable Care Act increased insurance coverage, access to healthcare, and substance use disorder treatment, for many Americans. We assessed differences in healthcare access and utilization among persons who inject drugs (PWID) by state Medicaid expansion status. METHODS: In 2018, PWID were interviewed in 22 US cities for National HIV Behavioral Surveillance. We analyzed data from PWID aged 18-64 years who reported illicit use of opioids (n = 9957) in the past 12 months. Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were used to examine differences by Medicaid expansion status in indicators of healthcare access and utilization. RESULTS: Persons who inject drugs in Medicaid expansion states were more likely to have insurance (87% vs 36%; aPR, 2.3; 95% CI, 2.0-2.6), a usual source of healthcare (53% vs 34%; aPR, 1.5; 95% CI, 1.3-1.9), and have used medication-assisted treatment (61% vs 36%; aPR, 1.4; 95% CI, 1.1-1.7), and they were less likely to have an unmet need for care (21% vs 39%; aPR, 0.6; 95% CI, 0.4-0.7) than those in nonexpansion states. CONCLUSIONS: Low insurance coverage, healthcare access, and medication-assisted treatment utilization among PWID in some areas could hinder efforts to end the intertwined human immunodeficiency virus and opioid overdose epidemics.

18.
Cad Saude Publica ; 36 Suppl 2: e00154519, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32876097

RESUMO

This study analyzed the main economic trends, market structure, production, and innovation in vaccines against infectious diseases at the global and national levels, observing the effects on access to vaccination in Brazil and on the sustainability of the Brazilian Unified National Health System. In order to update a global overview of R&D and the market, the authors conducted a literature search and drew on a competitive intelligence database. In order to understand Brazil's role in this context, with the Health Economic-Industrial Complex as the structural focus, the authors accessed information from the Brazilian Health Regulatory Agency, the National Immunization Program, and the Questel Orbit Intelligence database on patent protection in Brazil; identified the technologies transferred to public institutions in Brazil; and analyzed the trend in the trade balance deficit in health. The analysis revealed a global trend of concentration of vaccine production in a few leading pharmaceutical companies and the exacerbation of economic and technological asymmetries in the vaccine sector. In Brazil, the study identified technological weaknesses, risks, and manufacturing bottlenecks that impact the guarantee of immunizations in the country and showed that despite the installed industrial base, public policies and actions by domestic manufacturers have not been sufficient to confront and overcome the global context of structural dependence. In conclusion, the study indicates the need for progress in the Brazilian national strategy to link domestic production, technological capacity-building, and innovation in the vaccine sector to help guarantee universal access to health in Brazil.

20.
BMC Med Inform Decis Mak ; 20(1): 221, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917201

RESUMO

BACKGROUND: Access to health care is a fundamental human right, and the provision of affordable, high-quality, and appropriate medicines for maternal and child health is a vital component of a well-functioning health system. The study assessed the availability, price, and affordability of WHO priority maternal and child medicines in public health facilities, Dessie, North-East Ethiopia. METHODS: A retrospective cross-sectional study design was conducted in Dessie town from November 2018 to February 2019. A standard checklist adapted from the Logistics Indicator Assessment Tool and WHO/HAI was used to collecting data on the availability, affordability, and price of 45 priority life-saving medicines from eight public health centers and two public hospitals. Descriptive statistics (percent and median) were computed for availability and prices. Affordability was reported in terms of the daily wage of the lowest-paid unskilled government worker. RESULTS: Twenty-two medicines were not found at all in public health facilities. The overall availability of WHO priority maternal and child medicines was 34.02%. The mean number of stock-outs was 3.9, and the mean number was 128.9 days. The mean average point availability was 33.5%, and 7 medicines stock out on the days of assessment. From WHO priority maternal and child medicines, 4 (40%) of the products were unaffordable and 5 (55.5%) had higher prices than international prices. Ceftriaxone 1 g, ceftriaxone 500 mg, and hydralazine 20 mg injection required wages of 6.58, 8.01, and 5.02 to cover specific maternal health problems respectively. The median price ratio of priority lifesaving maternal and child medicines in public health facilities ranged from 0.65 to 3.19. CONCLUSIONS: The average mean period and point mean availability was very low. The available products were encountered with a high number of stock-outs and unaffordable. The strict control of inventory is recommended to have a steady supply of these essential medicines and improve the quality of health services.

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