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1.
Medicine (Baltimore) ; 99(45): e23015, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157948

RESUMO

INTRODUCTION: The World Health Organization announce that novel coronavirus (COVID-19) is pandemic worldwide on March 11, 2020. In this pandemic, cancer patients are prone to become critically ill after being infected with COVID-19 due to special immune conditions, and cannot effectively benefit from the treatment plan designed for normal people. However, only a few literatures report the differences between cancer patients and normal people after being infected with COVID-19. There is no systematic review to evaluate the clinical, inflammatory, and immune differences between COVID-19 patients with and without cancer. The systematic review aims to summarize and analyze the clinical, inflammatory, and immune differences between them. METHODS AND ANALYSIS: We plan to conduct a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidelines. Several databases (PubMed/MEDLINE, Embase, Web of Science, The Cochrane Library, CNKI, CBM, VIP, WanFang) were searched for relevant eligible observational studies on COVID-19 patients with cancer published from December 2019 to September 2020. Two researchers (Y.ZY and W.PP) will independently complete search strategy formulation, literature selecting, Information extraction, data collation, and quality assessment. The primary outcome will be the clinical characteristics differences between COVID-19 patients with and without cancer. Secondary outcomes will include immune function regulation characteristics such as T cell subset status, inflammation and other factors for COVID-19 patients with cancer. We intend to perform a meta-analysis of studies calculating odds ratio differences (Hedge g) for comparison in Forest plots and subgroup analysis after assessment of heterogeneity using I statistics based on compatibility on the basis of population and outcomes. ETHICS AND DISSEMINATION: We will use the information from published researches with no need for ethical assessment. Our findings will be published in a peer-reviewed journal according to the PRISMA guidelines. PROSPERO REGISTRATION NUMBER: CRD42020204417.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Neoplasias/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Betacoronavirus , Humanos , Metanálise como Assunto , Estudos Observacionais como Assunto , Pandemias , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
2.
Bull World Health Organ ; 98(11): 754-765B, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33177772

RESUMO

Objective: To explore how primary care organizations assess and subsequently act upon the social determinants of noncommunicable diseases in their local populations. Methods: For this systematic review we searched the online databases of PubMed®, MEDLINE®, Embase® and the Health Management Information Consortium from inception to 28 June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of noncommunicable diseases were included. For quality assessment we used Cochrane's tool for assessing risk of bias in non-randomized studies of interventions. We used narrative data synthesis to appraise the extent to which the assessments gathered data on the domains of the World Health Organization social determinants of health framework. Findings: We identified 666 studies of which 17 were included in the review. All studies used descriptive study designs. Clinic-based and household surveys and interviews were more commonly used to assess local social determinants than population-level data. We found no examples of organizations that assessed sociopolitical drivers of noncommunicable diseases; all focused on sociodemographic factors or circumstances of daily living. Nevertheless, the resulting actions to address social determinants ranged from individual-level interventions to population-wide measures and introducing representation of primary care organizations on system-level policy and planning committees. Conclusion: Our findings may help policy-makers to consider suitable approaches for assessing and addressing social determinants of health in their domestic context. More rigorous observational and experimental evidence is needed to ascertain whether measuring social determinants leads to interventions which mitigate unmet social needs and reduce health disparities.

3.
PLoS One ; 15(11): e0241907, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33196679

RESUMO

Due to unavailability of consistent income data at the sub-state or district level in developing countries, it is difficult to generate consistent and reliable economic inequality estimates at the disaggregated level. To address this issue, this paper employs the association between night time lights and economic activities for India at the sub-state or district-level, and calculates regional income inequality using Gini coefficients. Additionally, we estimate the relationship between night time lights and socio-economic development for regions in India. We employ a newly available data on regional socio-economic development (Social Progress Index), as well as an index that represents institutional quality or governance. Robust to the choice of socio-economic development indicators, our findings indicate that regional inequality measured by night time lights follow the Kuznets curve pattern. This implies that starting from low levels of socio-economic development or quality of institutions, inequality rises as regional socio-economic factors or quality of institutions improve, and with subsequent progress in socio-economic factors or quality of institutions, regional inequality declines.

4.
BMC Med ; 18(1): 315, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33138813

RESUMO

BACKGROUND: Epidemics of infectious disease occur frequently in low-income and humanitarian settings and pose a serious threat to populations. However, relatively little is known about responses to these epidemics. Robust evaluations can generate evidence on response efforts and inform future improvements. This systematic review aimed to (i) identify epidemics reported in low-income and crisis settings, (ii) determine the frequency with which evaluations of responses to these epidemics were conducted, (iii) describe the main typologies of evaluations undertaken and (iv) identify key gaps and strengths of recent evaluation practice. METHODS: Reported epidemics were extracted from the following sources: World Health Organization Disease Outbreak News (WHO DON), UNICEF Cholera platform, Reliefweb, PROMED and Global Incidence Map. A systematic review for evaluation reports was conducted using the MEDLINE, EMBASE, Global Health, Web of Science, WPRIM, Reliefweb, PDQ Evidence and CINAHL Plus databases, complemented by grey literature searches using Google and Google Scholar. Evaluation records were quality-scored and linked to epidemics based on time and place. The time period for the review was 2010-2019. RESULTS: A total of 429 epidemics were identified, primarily in sub-Saharan Africa, the Middle East and Central Asia. A total of 15,424 potential evaluations records were screened, 699 assessed for eligibility and 132 included for narrative synthesis. Only one tenth of epidemics had a corresponding response evaluation. Overall, there was wide variability in the quality, content as well as in the disease coverage of evaluation reports. CONCLUSION: The current state of evaluations of responses to these epidemics reveals large gaps in coverage and quality and bears important implications for health equity and accountability to affected populations. The limited availability of epidemic response evaluations prevents improvements to future public health response. The diversity of emphasis and methods of available evaluations limits comparison across responses and time. In order to improve future response and save lives, there is a pressing need to develop a standardized and practical approach as well as governance arrangements to ensure the systematic conduct of epidemic response evaluations in low-income and crisis settings.

5.
Diagnostics (Basel) ; 10(10)2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33081114

RESUMO

Medical diagnosis in low-resource settings is confronted by the lack of suitable guidelines, protocols and checklists. Online-accessible procedural documents are difficult to find, might be mistranslated or interpreted and usually do not address the needs of developing countries. Urinalysis, one of the most frequently performed diagnostic examinations worldwide, involves a series of tests aiming to detect particular disorders, such as urinary tract infections, kidney disease and diabetes. In this guideline, we present an alternative approach for clinical laboratories with limited resources to identify common bacterial uropathogens. We propose dividing the identification plan into two levels. The implicated pathogen will first be assigned into a bacterial group, basic identification, against which a suitable panel of antimicrobial agents shall be selected for the antimicrobial susceptibility testing (AST). Characterization of the pathogen to the genus or species level, advanced identification, will then be performed to ensure correct reading of the AST results and determine the epidemiology of clinically significant pathogens. Most of the proposed steps in our guideline are tailored to meet the needs of clinical laboratories in low-resource settings. Such guidelines are needed to strengthen the capacity of regional pathology laboratories and to enhance international initiatives on antimicrobial resistance and health equity.

6.
Res Soc Stratif Mobil ; : 100555, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33041426

RESUMO

The effect of labor market inequalities during economic crises is a well-established topic. Yet, little is known about this in the contexts of developing countries. We use recently collected phone survey data by Young Lives from four countries-Ethiopia, India (Andhra Pradesh and Telangana State), Peru and Vietnam-to examine whether men and women suffer from coronavirus-triggered economic hardship differently. We find that men are more likely to lose jobs and income in Ethiopia and India-countries with a very high male-dominated formal sector. Conversely, gender effect is not significant in Peru and Vietnam with comparatively higher integration of women in formal employment. We further investigate whether gender effect varies by 'wealth' level. Findings suggests that only in India, in the wealthier group, men are more likely to face job and income loss than women, possibly indicating greater male concentration in higher-class occupations. However, gender differences in facing hardship by wealth group is not significant for other countries.

7.
Artigo em Inglês | MEDLINE | ID: mdl-32942663

RESUMO

(1) Background: Childhood obesity has become a main global health problem and active video games (AVG) could be used to increase energy expenditure. The aim of this study was to investigate the energy expenditure during an AVG intervention combined with exercise, differentiating by gender. (2) Methods: A total of 45 children with overweight or obesity (19 girls) performed an AVG intervention combined with exercise. The AVG used were the Xbox Kinect, Nintendo Wii, dance mats, BKOOL cycling simulator, and Nintendo Switch. The energy expenditure was estimated from the heart rate recorded during the sessions and the data from the individual maximal tests. (3) Results: The mean energy expenditure was 315.1 kilocalories in a one-hour session. Participants spent the most energy on BKOOL, followed by Ring Fit Adventures, Dance Mats, Xbox Kinect, and the Nintendo Wii, with significant differences between BKOOL and the Nintendo Wii. Significant differences between boys and girls were found, but were partially due to the difference in weight, VO2max, and fat-free mass. (4) Conclusions: The energy expenditure with AVG combined with multi-component exercise was 5.68 kcal/min in boys and 4.66 kcal/min in girls with overweight and obesity. AVG could be an effective strategy to increase energy expenditure in children and adolescents with overweight and obesity.

8.
Public Health ; 186: 271-282, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32871449

RESUMO

OBJECTIVE: The aim of the present study is two-fold. First, it attempts to identify the barriers and enablers of implementing clinical commissioning policy. Second, it synthesises how these barriers and enablers affect the success of National Health Service (NHS) efforts to reduce health inequalities in the UK. METHODS: A systematic review was conducted. We searched large biomedical bibliographic databases, namely MEDLINE, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies, conducted in the UK, that assessed the factors - barriers and enablers related to health inequalities, published from 2010 onwards and in English, and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We used Joanna Briggs Institute (JBI) Critical Appraisal and Mixed Methods Appraisal tools to assess the methodological qualities, and synthesised by performing thematic analysis. Two reviewers independently screened the articles and extracted data. RESULTS: We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: (1) the agenda of health inequalities has not been given priority; (2) there was very little evidence for reducing health inequalities through the clinical commissioning (CC) process; (3) CC was positively associated with the restructuring of NHS; and (4) CC brings better collaboration and engagement, which led to some improvements in health services access, utilisation and delivery at the local level. CONCLUSION: This study provides useful factors - barriers and enablers - to implement and deliver clinical commissioning policy in improving health and well-being. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities.

9.
Glob Health Action ; 13(1): 1806527, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867605

RESUMO

Background Hypertension requires life-long medical care, which may cause economic burden and even lead to catastrophic health expenditure. Objective To estimate the extent of out-of-pocket expenditure for hypertension care at a population level and its impact on households' budgets in a low-income urban setting in Colombia. Methods We conducted a cross-sectional survey in Santa Cruz, a commune in the city of Medellin. In 410 randomly selected households with a hypertensive adult, we estimated annual basic household expenditure and hypertension-attributable out-of-pocket expenditure. For socioeconomic stratification, we categorised households according to basic expenditure quintiles. Catastrophic hypertension-attributable expenditure was defined as out-of-pocket expenditure above 10% of total household expenditure. Results The average annual basic household expenditure was US dollars at purchasing power parity (USD-PPP) $12,255.59. The average annual hypertension-attributable out-of-pocket expenditure was USD-PPP $147.75 (95% CI 120.93-174.52). It was incurred by 73.9% (95% CI 69.4%-78.1%) of patients, and consisted mainly of direct non-medical expenses (76.7%), predominantly for dietary requirements prescribed as non-pharmacological treatment and for transport to attend health care consultations. Medical out-of-pocket expenditure (23.3%) was for the most part incurred for pharmacological treatment. Hypertension-attributable out-of-pocket expenditure represented on average 1.6% (95% CI 1.3%-1.9%) of the total annual basic household expenditure. Eight households (2.0%; 95% CI 1.0%-3.8%) had catastrophic health expenditure; six of them belonged to the two lowest expenditure quintiles. Payments related to dietary requirements and transport to consultations were critical determinants of their catastrophic expenditure. Conclusions Out-of-pocket expenditure for hypertension care is moderate on average, but frequent, and mainly made up of direct non-medical expenses. Catastrophic health expenditure is uncommon and affects primarily households in the bottom socioeconomic quintiles. Financial protection should be strengthened by covering the costs of chronic diseases-related dietary requirements and transport to health services in the most deprived households. Abbreviations NCDs: Non-communicable diseases; LMICs: Low and middle-income countries; WHO: World Health Organization; HTN: hypertension; CVDs: Cardiovascular diseases; OOPE: out-of-pocket expenditure; USD-PPP: US dollars at purchasing power parity; CI: Confidence interval.

10.
J Environ Manage ; 271: 111035, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32778315

RESUMO

Human-made material stocks promote the economic prosperity, while the consumption, maintenance, and operation of them have led to adverse environmental impacts. Decoupling materials stocks from economic growth is a key strategy for relieving environmental pressures and achieving sustainable development. China's unprecedented development offers a unique opportunity for uncovering the relationship between in-use stocks and economic growth. In this study, we analyzed the regional disparity of in-use steel stocks estimated by bottom-up accounting method during 1978-2018 in 31 provinces in mainland China, explored the stocks productivity on provincial and regional scale, and conducted a decoupling analysis of in-use steel stocks with economic growth. The results showed that there was a huge disparity among the provincial total steel stocks, per-capita steel stocks, and stocks density. Some provinces, e.g. Beijing, Tianjin, and Shanghai, that had the highest stocks density had comparatively lower per-capita steel stocks and total steel stocks, indicating higher share of in-use steel stocks and lower material intensive economic structure. In-use steel stocks in China showed no clear signs of saturation or flatten off pattern although their growth rate declined recently. An increase in steel stocks productivity was found during 1978-2018, which means relative decoupling of in-use steel stocks from economic growth, but still far away from absolute decoupling. The dematerialization pattern revealed in this study deepens our understanding of material-economy interactions. Policy implications for dematerialization transition should focus on developing compact cities, prolonging the lifespan of products, and advancing technological development.


Assuntos
Desenvolvimento Econômico , Aço , Pequim , China , Cidades , Humanos
11.
Occup Environ Med ; 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32839184

RESUMO

OBJECTIVES: To evaluate socio-economic disparity in the global burden of occupational noise-induced hearing loss (ONIHL) using disability-adjusted life-years (DALYs). METHODS: The numbers of DALYs due to ONIHL, age-standardised DALY rates and national human development index (HDI) data from 1990 to 2017 were collected. The relationship between the age-standardised DALY rates and the 2017 HDI was analysed. A concentration index (CI) and a relative index of inequality (RII) were calculated to evaluate the trend in socio-economic disparity in the burden of ONIHL for the period 1990-2017. RESULTS: From 1990 to 2017, the global DALYs due to ONIHL increased from 3.3 to 6.0 million, with the highest growth occurring in low-income countries (110.7%). Age-standardised DALY rates due to ONIHL were negatively associated with the HDI (ß = -0.733, p<0.001), and these rates were significantly higher in countries with a lower HDI. From 1990 to 2017, the trend in between-country inequality was flat with little fluctuation, the CIs stayed near -0.17, and the RIIs remained near 0.35. CONCLUSIONS: Over the past few decades, low-income countries have experienced the most rapid growth in DALYs worldwide. A widening socio-economic disparity has persisted in the global burden of ONIHL, with a higher burden in lower socio-economic countries. These data suggest that more prevention programmes and healthcare services should be provided for developing countries.

12.
Glob Health Promot ; : 1757975920941435, 2020 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-32748728

RESUMO

Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critical role of policy in understanding population health, we conducted a systematic review of original primary research which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persisted among subgroups of women. Neither the reviewed studies nor the policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research, including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.

13.
J Clin Epidemiol ; 127: 125-133, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32717312

RESUMO

OBJECTIVE: To evaluate how and to what extent health equity considerations are assessed in World Health Organization (WHO) guidelines. STUDY DESIGN AND SETTING: We evaluated WHO guidelines published between January 2014 and May 2019. Health equity considerations were assessed in relation to differences in baseline risk, importance of outcomes for socially disadvantaged populations, inclusion of health inequity as an outcome, equity-related subgroup analysis, and indirectness in each recommendation. RESULTS: We identified 111 WHO guidelines, and 54% (60 of 111) of these used the Evidence to Decision (EtD) framework. For the 60 guidelines using an EtD framework, the likely impact on health equity was supported by research evidence in 28% of the recommendations (94 of 332). Research evidence was mostly provided as differences in baseline risk (23%, 78/332). Research evidence less frequently addressed the importance of outcomes for socially disadvantaged populations (11%, 36/332), considered indirectness of the evidence for socially disadvantaged populations (2%, 5/332), considered health inequities as an outcome (2%, 5/332) and considered differences in the magnitude of effect in relative terms between disadvantaged and more advantaged populations (1%, 3/332). CONCLUSION: The provision of research evidence to support equity judgements in WHO guidelines is still suboptimal, suggesting the need for better guidance and more training.

14.
Soc Psychiatry Psychiatr Epidemiol ; 55(10): 1241-1259, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32666210

RESUMO

PURPOSE: To identify, review and synthesize evidence on whether social disadvantage moderates antidepressant treatment outcomes, even when access to treatment is not a consideration. METHODS: The systematic review was done in accordance with PRIMSA guidelines. An a priori systematic search strategy was used to search databases (MEDLINE, PsychINFO, EMBASE, Global Health and Cochrane Trials Library) from their earliest entries through December 31, 2018. A two-step screening procedure was followed, and all experimental studies of antidepressant treatment in ICD/DSM diagnosed cases of depression were included. Studies with subjects < 18 years or investigating other modalities of treatment were excluded. RESULTS: Thirteen papers reporting analyses from nine studies met inclusion criteria. There was heterogeneity in sample sizes, target populations, treatment settings, clinical outcomes and definition of SES indices. The primary outcome was the relative effect of socioeconomic status (SES) (as measured by income, employment status and level of education)-on antidepressant treatment outcomes. CONCLUSIONS: The evidence from this review suggests that lower SES may lead to social inequalities in antidepressant treatment outcomes even in the context of clinical trials in which all participants have equal access to the same high-quality, standardized care. The review calls for more careful consideration of the choice and operationalization of SES indicators, and the need to "employ sampling methods that ensure ample representation of individuals from a wide range of social worlds". The review concludes with tentative suggestions about how to reduce social inequalities in antidepressant treatment outcomes at the level of individuals and populations.


Assuntos
Antidepressivos , Emprego , Antidepressivos/uso terapêutico , Necessidades e Demandas de Serviços de Saúde , Humanos , Resultado do Tratamento
15.
BMC Public Health ; 20(1): 1040, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32605608

RESUMO

BACKGROUND: The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. Two secondary aims assessed the impact of health literacy interventions on health behaviours and whether health literacy interventions have been conducted in cardiovascular patients. METHODS: A systematic review (Prospero registration: CRD42018110772) with no start date running through until April 2020. Eligible studies were conducted in adults and included a pre/post measure of health literacy. Medline, Embase, Eric, PsychINFO, CINAHL, Psychology and Behavioural Science, HMIC, Web of Science, Scopus, Social Care Online, NHS Scotland Journals, Social Policy and Practice, and Global Health were searched. Two thousand one hundred twenty-seven papers were assessed, and 57 full text papers screened to give 22 unique datasets from 23 papers. Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases. Intervention reporting quality was assessed using the TIDieR checklist. RESULTS: Twenty-two studies were included reporting on 10,997 participants in nine countries. The majority of studies (14/22) were published in 2018 or later. Eight studies (n = 1268 participants) also reported on behavioural outcomes. Health literacy interventions resulted in improvements in at least some aspect of health literacy in 15/22 studies (n = 10,180 participants) and improved behavioural outcomes in 7/8 studies (n = 1209 participants). Only two studies were conducted with cardiovascular patients. All studies were at risk of bias with 18 judged as high risk. In addition, there was poor reporting of intervention content with little explication of the theoretical basis for the interventions. CONCLUSIONS: Health literacy interventions can improve health literacy and can also lead to changes in health behaviours. Health literacy interventions offer a way to improve outcomes for populations most at risk of health inequalities. Health literacy is a developing field with very few interventions using clear theoretical frameworks. Closer links between health literacy and behaviour change theories and frameworks could result in higher quality and more effective interventions. PROSPERO REGISTRATION: Prospero registration: CRD42018110772.


Assuntos
Comportamentos Relacionados com a Saúde , Letramento em Saúde/estatística & dados numéricos , Promoção da Saúde , Humanos , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Escócia
16.
Health Place ; 63: 102329, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32543420

RESUMO

Understanding what contributes to cross-national differences in public health spending among low- and middle-income countries (LMICs) can help identify how policy-makers can reduce global disparities. Yet, research on this topic has so far overlooked the potential influence of one of the most strongly recommended economic reforms during the post-war era: reducing international trade taxes, 'tariffs'. Tariffs are an important source of tax revenue for some LMICs. Tariff declines can impact on government finances, and these changes may constrain public health expenditure where states lack the capacity to tax non-trade activities. We examined the association between tariff changes and public health spending in 65 LMICs, 1996-2015. We identify substantial variation in this association according to one indicator of state capacity, a country's score on the World Governance Indicators government effectiveness (GE) index. For example, tariff declines corresponded to reduced public health expenditures in countries with low GE scores. Our results suggest that tariff changes and domestic taxation capacities have an under-recognised impact on public health expenditure and may contribute to global health spending disparities.

17.
Reprod Health ; 17(1): 82, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487182

RESUMO

BACKGROUND: Contraception is a key component of sustainable development, empowering women, reducing the risk of maternal and child mortality and promoting economic growth. It is part of the Sustainable Development Goals agenda, where the aim is to achieve universal access to sexual and reproductive health. Our objective was to evaluate trends and inequalities in modern contraceptive prevalence, and according to the type of modern contraceptive, in 11 low- and middle-income countries that are partners of the Family Planning 2020 initiative. METHODS: Analyses were performed using 62 Performance Monitoring and Accountability 2020 (PMA2020) surveys from 11 countries. Forty surveys were nationally representative, while 22 had regional coverage. Regional surveys were analyzed separately, totalizing 15 geographies from 11 countries. We described trends on modern contraceptive prevalence, and its subtypes (short- and long-acting reversible contraceptives, and permanent methods), by calculating absolute average annual changes. Absolute inequalities on the prevalence of modern contraceptives were assessed for the most recent survey of each geography using the slope index of inequality, and according to wealth, education and age. RESULTS: The overall prevalence of modern contraception increased in most geographies analyzed, reaching a 7.2 percentage points increase per year in Lagos, Nigeria. This increase was mostly influenced by the long-acting reversible contraceptives, which increased in 73% of the geographies. Although the largest share of modern contraception is represented by short-acting reversible contraceptives, these are reducing and giving space for the long-acting methods. The exception was Rajasthan, India, where the permanent methods accounted for 70% of the modern contraception share, and their prevalence was almost 40%. Inequalities were identified in favor of richer, older and better educated women. CONCLUSIONS: Out of the 15 geographies analyzed, 11 demonstrated an increase in overall modern contraceptive use - mainly driven by the uptake of long-acting reversible contraception. However, even in the groups with the highest prevalence, modern contraceptive use was at most 60% in most geographies. So, we are far from reaching the desired universal coverage proposed by the Sustainable Development Goals.

18.
Artigo em Inglês | MEDLINE | ID: mdl-32567036

RESUMO

Equity in health care financing has gained increased attention in low- and middle-income countries (LMICs) following the renewed global interest in universal health coverage (UHC), a key component of the sustainable development goals (SDGs). UHC requires that people have access to the health services they need without risking financial hardship. Health financing is central to UHC and many LMICs have initiated reforms to align their health financing systems with the goals of UHC. Evaluation of the equity impact of these reforms has become a growing area of research, especially in countries with large health inequalities where the pressure to move towards UHC is most intense and the need for evidence to inform policy most critical. However, current analytical tools for evaluating equity in health financing conspicuously exclude indicators of quality, an important dimension of UHC. The aim of this paper was to address this critical methodological gap by introducing quality scores into benefit incidence analysis (BIA), one of the key techniques for assessing equity in health financing. BIA measures the extent to which different socioeconomic groups benefit from public spending on health care through their use of health services. The benefit (public subsidy) is captured in monetary terms by multiplying the quantity of a particular health service consumed by the unit cost of that service and subtracting any out-of-pocket costs incurred while using the service. It does not account for variations in the quality of health services in the computation of the public subsidy.

19.
J Med Ethics ; 46(8): 514-525, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32561660

RESUMO

BACKGROUND: Humanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care-a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, the WHO released a guide on 'Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises'-the first guidance on the topic by an international body. AIMS: This paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances. IMPLICATIONS: In parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance.


Assuntos
Temas Bioéticos , Assistência à Saúde/ética , Planejamento em Desastres , Cuidados Paliativos/ética , Pandemias/ética , Assistência Terminal/ética , Altruísmo , Betacoronavirus , Bioética , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Cuidados Críticos , Tomada de Decisões/ética , Emergências , Ética Clínica , Saúde Global , Alocação de Recursos para a Atenção à Saúde , Equidade em Saúde , Recursos em Saúde , Humanos , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Fatores Socioeconômicos , Estresse Psicológico
20.
Environ Sci Pollut Res Int ; 27(26): 32707-32718, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32519100

RESUMO

There is a glaring concern of income inequality in the light of the post-2015 global development agenda of Sustainable Development Goals (SDGs), especially for countries that are in the south of the Sahara. There are also concerns over the present and future consequences of ecological degradation on development outcomes in Sub-Saharan Africa (SSA). This study provides carbon dioxide (CO2) emissions thresholds that should be avoided in the nexus between financial development and income inequality in a panel of 39 countries in SSA over the period 2004-2014. Quantile regressions are used as an empirical strategy. The following findings are established. Financial development unconditionally decreases income inequality with an increasing negative magnitude, while the interactions between financial development and CO2 emissions have the opposite effect with an increasing positive magnitude. The underlying nexuses are significant exclusively in the median and top quantiles of the income inequality distribution. CO2 emission thresholds that should not be exceeded for financial development to reduce income inequality continuously are 0.222, 0.200, and 0.166 (metric tons per capita) for the median, the 75th quantile, and the 90th quantile of the income inequality distribution, respectively. Policy implications are discussed with particular relevance to Sustainable Development Goals (SDGs).


Assuntos
Dióxido de Carbono/análise , Renda , África ao Sul do Saara , África do Norte , Desenvolvimento Econômico , Fatores Socioeconômicos
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