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1.
Aust J Gen Pract ; 53(1-2): 57-61, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38316483

RESUMO

METHOD: A retrospective analysis was performed of actual and predicted (Holt-Winters modelling) semaglutide and dulaglutide prescriptions supplied by the Australian PBS and Repatriation PBS in 2021-22. RESULTS: Semaglutide prescriptions decreased by 17% in March - September 2022, whereas dulaglutide prescriptions increased by 53% in April - July 2022 before decreasing by 17% in August - September 2022. There were 119,069 fewer semaglutide and 31,953 more dulaglutide prescriptions supplied than predicted in April - July and June - July 2022, respectively. DISCUSSION: Changes in semaglutide and dulaglutide T2D prescription patterns in 2022 coincided with supply shortages. General practitioners are encouraged to continue to prescribe semaglutide and dulaglutide for their appropriate indication and support patients with alternative treatments during the shortage.


Assuntos
Diabetes Mellitus Tipo 2 , Prescrições de Medicamentos , Hipoglicemiantes , Humanos , Austrália , Diabetes Mellitus Tipo 2/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Peptídeos Semelhantes ao Glucagon/análogos & derivados , Hipoglicemiantes/provisão & distribuição , Hipoglicemiantes/uso terapêutico , Fragmentos Fc das Imunoglobulinas , Proteínas Recombinantes de Fusão , Estudos Retrospectivos
3.
JAMA ; 331(6): 482-490, 2024 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-38349371

RESUMO

Importance: Repeated mass distribution of azithromycin has been shown to reduce childhood mortality by 14% in sub-Saharan Africa. However, the estimated effect varied by location, suggesting that the intervention may not be effective in different geographical areas, time periods, or conditions. Objective: To evaluate the efficacy of twice-yearly azithromycin to reduce mortality in children in the presence of seasonal malaria chemoprevention. Design, Setting, and Participants: This cluster randomized placebo-controlled trial evaluating the efficacy of single-dose azithromycin for prevention of all-cause childhood mortality included 341 communities in the Nouna district in rural northwestern Burkina Faso. Participants were children aged 1 to 59 months living in the study communities. Interventions: Communities were randomized in a 1:1 ratio to receive oral azithromycin or placebo distribution. Children aged 1 to 59 months were offered single-dose treatment twice yearly for 3 years (6 distributions) from August 2019 to February 2023. Main Outcomes and Measures: The primary outcome was all-cause childhood mortality, measured during a twice-yearly enumerative census. Results: A total of 34 399 children (mean [SD] age, 25.2 [18] months) in the azithromycin group and 33 847 children (mean [SD] age, 25.6 [18] months) in the placebo group were included. A mean (SD) of 90.1% (16.0%) of the censused children received the scheduled study drug in the azithromycin group and 89.8% (17.1%) received the scheduled study drug in the placebo group. In the azithromycin group, 498 deaths were recorded over 60 592 person-years (8.2 deaths/1000 person-years). In the placebo group, 588 deaths were recorded over 58 547 person-years (10.0 deaths/1000 person-years). The incidence rate ratio for mortality was 0.82 (95% CI, 0.67-1.02; P = .07) in the azithromycin group compared with the placebo group. The incidence rate ratio was 0.99 (95% CI, 0.72-1.36) in those aged 1 to 11 months, 0.92 (95% CI, 0.67-1.27) in those aged 12 to 23 months, and 0.73 (95% CI, 0.57-0.94) in those aged 24 to 59 months. Conclusions and Relevance: Mortality in children (aged 1-59 months) was lower with biannual mass azithromycin distribution in a setting in which seasonal malaria chemoprevention was also being distributed, but the difference was not statistically significant. The study may have been underpowered to detect a clinically relevant difference. Trial Registration: ClinicalTrials.gov Identifier: NCT03676764.


Assuntos
Antibacterianos , Azitromicina , Mortalidade da Criança , Malária , Humanos , Azitromicina/provisão & distribuição , Azitromicina/uso terapêutico , Burkina Faso/epidemiologia , Quimioprevenção/métodos , Quimioprevenção/estatística & dados numéricos , Mortalidade da Criança/tendências , Malária/epidemiologia , Malária/mortalidade , Malária/prevenção & controle , Antibacterianos/provisão & distribuição , Antibacterianos/uso terapêutico , Estações do Ano , Lactente , Pré-Escolar
5.
Rev. esp. quimioter ; 37(1): 17-28, Feb. 2024.
Artigo em Inglês | IBECS | ID: ibc-230419

RESUMO

Despite having emerged from pandemic status, the incidence of COVID-19 episodes has recently increased in Spain, including pediatric cases and admissions to Intensive Care Units. Several recombinant variants are circulating among us, particularly XBB arising from two Omicron BA.2 sublineages with mutations in the genes encoding the spicule proteins that could increase binding to the ACE2 receptor and be more prone to immune escape. Faced with these, 3 pharmaceutical companies have developed vaccines adapted to the XBB.1.5 sublineage that are already available for administration in our setting with risks that should not be different from those of previous mRNA vaccines and with clearly favorable benefit/risk ratios. They should be applied to patients with potential for poor COVID-19 evolution and to collectives that have a particular relationship of proximity with them. Their application should be understood not only from a perspective of individual convenience but also from that of collective responsibility. The most convenient seems to be a simultaneous immunization of COVID-19 and influenza in our environment. In the therapeutic aspect, there is little to expect right now from antisera, but the already known antiviral drugs are still available and indicated, although their efficacy will have to be reevaluated due to their impact on populations that are mostly immunized and with a better prognosis than in the past. In our opinion, it is necessary to continue to make a reasonable and timely use of masks and other non-pharmacological means of protection. (AU)


Pese a haber salido de la situación de pandemia, la incidencia de episodios de COVID-19 ha aumentado recientemente en España, incluidos los casos pediátricos y los ingresos en Unidades de Cuidados Intensivos. Circulan entre nosotros diversas variantes recombinantes, particularmente la XBB surgidas de dos sublinajes Omicron BA.2 con mutaciones en los genes que codifican las proteínas de la espícula y que pudieran aumentar la unión al receptor ACE2 y ser más propensas al escape inmune. Frente a ellas, 3 empresas farmacéuticas han elaborado vacunas adaptadas al sublinaje XBB.1.5 que ya se encuentran disponibles para su administración en nuestro medio con riesgos que no deben ser diferentes a los de las vacunas mRNA previas y con relaciones beneficio/riesgos claramente favorables. Deben aplicarse a pacientes con potencial de mala evolución de COVID-19 y a los colectivos que tienen una particular relación de proximidad con ellos. Su aplicación debe ser entendida no sólo desde una perspectiva de conveniencia individual sino desde la de la responsabilidad colectiva. Lo más conveniente parece hacer una inmunización simultánea de COVID-19 y gripe en nuestro medio. En el aspecto terapéutico hay poco que esperar ahora mismo de los antisueros pero siguen estando disponibles e indicados los fármacos antivirales ya conocidos aunque su eficacia tendrá que reevaluarse por su impacto en poblaciones mayoritariamente inmunizadas y con pronóstico mejor que las de tiempos pasados. A nuestro juicio, es necesario seguir haciendo un uso razonable y puntual de mascarillas y otros medios no farmacológicos de protección. (AU)


Assuntos
Humanos , /prevenção & controle , /terapia , /instrumentação , /métodos , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Máscaras , Vacinas/administração & dosagem , Vacinas/provisão & distribuição , Vacinas/uso terapêutico , Ritonavir
6.
BMC Health Serv Res ; 24(1): 14, 2024 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-38178088

RESUMO

BACKGROUND: Stock-outs of some life-saving drugs, such as emergency obstetric drugs, are evident in many health facilities and have been reported to be the leading cause of maternal mortality and morbidity for women from low and middle income countries (LMICs). For many cases, this situation is associated with poor inventory management practices. The aim of this study was to investigate the influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: case of the Rwanda Southern Province. Moreover, to gain a better grasp of the problem and to suggest possible areas for improvement. METHODS: An institutional-based cross-sectional study was carried out in all ten district hospitals (DHs) providing maternal health care and dispensing emergency obstetric drugs namely; Kigeme DH, Munini DH, Kabutare DH, Kibilizi DH, Gakoma DH, Nyanza DH, Ruhango DH, Gitwe DH, Kabgayi DH and Remera Rukoma DH. Both quantitative and qualitative data were collected and analyzed. Oxytocin injection, Misoprostol tablet and Magnesium sulphate injection as recommended emergency obstetric drugs by WHO, UNFPA and Rwanda Essential Medicines list were included in the study. RESULTS: The study revealed that keeping logistics management tools up to date is the backbone of inventory management practices in the availability of medicines and medical supplies. The results showed that hospitals with up-to-date logistics tools for their pharmaceutical management were 33.25 times more likely to have their emergency obstetric drugs in stock at all times compared to those that do not regularly update their logistics tools. The proper use of bin cards and electronic software (e-LMIS) contributed greatly to reducing the stock-out rate of emergency obstetric drugs by 89.9% and reduction of unusable to usable stock ratio by appropriate use of simple techniques such as the Min-Max inventory control model by 79%. Over an 18-month period, misoprostol tablet had the highest average days (32) of stock-outs (5.9%), followed by magnesium sulphate injection with an average of 31 days (5.7%), and oxytocin injection with an average of 13 days (2.4%). CONCLUSION: Proper use of pharmaceutical management tools within hospitals premises positively influence the availability of life-saving drugs, such as emergency obstetric drugs. Adequate supply chain staffing in health facilities is the most important key to improving inventory management practices and medicine availability.


Assuntos
Inventários Hospitalares , Sulfato de Magnésio , Misoprostol , Ocitocina , Feminino , Humanos , Gravidez , Estudos Transversais , Hospitais Públicos , Sulfato de Magnésio/provisão & distribuição , Misoprostol/provisão & distribuição , Ocitocina/provisão & distribuição , Ruanda , Comprimidos
9.
JAMA Health Forum ; 5(1): e234819, 2024 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-38214918

RESUMO

This Viewpoint discusses the importance of the Drug Supply Chain Security Act and the need for pharmaceutical supply chain safeguards.


Assuntos
Comércio , Preparações Farmacêuticas , Preparações Farmacêuticas/provisão & distribuição , Controle de Medicamentos e Entorpecentes
14.
J Perinat Neonatal Nurs ; 38(1): 37-45, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38278643

RESUMO

BACKGROUND: Mothers report feeling immense pressure to breastfeed their infants, and not doing so can be associated with stigma, shame, and judgment. Many Latina mothers struggle to meet their breastfeeding goals and substitute formula earlier than planned. During 2022, an infant formula recall caused a shortage and made acquiring formula difficult or impossible in many areas of the United States. This study explores Latina mothers' experiences with infant feeding during the time of the formula shortage. METHODS: In-depth interviews (N = 7) were conducted with Latina mothers who formula-fed during the shortage. Interviews were analyzed using reflexive thematic analysis. Mean maternal age was 29.7 years, and mean infant age was 10.3 months. Three mothers were born in the United States, and 4 were immigrants. RESULTS: Thematic analysis generated 3 themes: (1) Fighting to breastfeed; (2) Breastfeeding is not the only way to be a "good" mother; and (3) No formula on the shelves. Participants described their determination to continue breastfeeding despite challenges before realizing that it limited their ability to care for their children. They discussed the emotional toll of the formula shortage and strategies for finding formula. CONCLUSIONS: The findings emphasize the need for additional structural support for infant feeding in the United States to prevent future formula shortages and for better lactation care and mental health support for mothers who want to breastfeed.


Assuntos
Aleitamento Materno , Mães , Adulto , Feminino , Humanos , Lactente , Aleitamento Materno/psicologia , Hispânico ou Latino , Fórmulas Infantis/provisão & distribuição , Mães/psicologia , Estados Unidos
15.
Nature ; 626(7997): 45-57, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38297170

RESUMO

The linear production and consumption of plastics today is unsustainable. It creates large amounts of unnecessary and mismanaged waste, pollution and carbon dioxide emissions, undermining global climate targets and the Sustainable Development Goals. This Perspective provides an integrated technological, economic and legal view on how to deliver a circular carbon and plastics economy that minimizes carbon dioxide emissions. Different pathways that maximize recirculation of carbon (dioxide) between plastics waste and feedstocks are outlined, including mechanical, chemical and biological recycling, and those involving the use of biomass and carbon dioxide. Four future scenarios are described, only one of which achieves sufficient greenhouse gas savings in line with global climate targets. Such a bold system change requires 50% reduction in future plastic demand, complete phase-out of fossil-derived plastics, 95% recycling rates of retrievable plastics and use of renewable energy. It is hard to overstate the challenge of achieving this goal. We therefore present a roadmap outlining the scale and timing of the economic and legal interventions that could possibly support this. Assessing the service lifespan and recoverability of plastic products, along with considerations of sufficiency and smart design, can moreover provide design principles to guide future manufacturing, use and disposal of plastics.


Assuntos
Poluição Ambiental , Objetivos , Plásticos , Reciclagem , Desenvolvimento Sustentável , Biomassa , Dióxido de Carbono/análise , Dióxido de Carbono/química , Dióxido de Carbono/metabolismo , Poluição Ambiental/economia , Poluição Ambiental/legislação & jurisprudência , Poluição Ambiental/prevenção & controle , Poluição Ambiental/estatística & dados numéricos , Combustíveis Fósseis , Aquecimento Global/prevenção & controle , Gases de Efeito Estufa/análise , Plásticos/síntese química , Plásticos/economia , Plásticos/metabolismo , Plásticos/provisão & distribuição , Reciclagem/economia , Reciclagem/legislação & jurisprudência , Reciclagem/métodos , Reciclagem/tendências , Energia Renovável , Desenvolvimento Sustentável/economia , Desenvolvimento Sustentável/legislação & jurisprudência , Desenvolvimento Sustentável/tendências , Tecnologia/economia , Tecnologia/legislação & jurisprudência , Tecnologia/métodos , Tecnologia/tendências
16.
Stud Health Technol Inform ; 310: 144-148, 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38269782

RESUMO

Waiting time for chemotherapy infusion is a fundamental factor to measure quality of care. It has been shown that a prolonged waiting time is related to a higher incidence of anticipatory nausea and poor patient adherence to scheduled appointments and recommended oncology treatment programs. Some chemotherapy regimens can be prepared hours ahead-of-time, due to long stability. We aimed to study the effect of an informatic-led workflow redesign intervention, facilitating workflow changes in the Oncology Pharmacy, on patient waiting time. This intervention included changes on EHR processes and the chemotherapy CPOE. Their main effect was allowing ahead-of-time preparation of selected chemotherapy regimes. We conducted a cross sectional study, comparing waiting times pre and post intervention periods. A total of 4600 programmed chemotherapy episodes were included. We found a 26.5 % decrease in the mean wait time in the post intervention period (p > 0.02). We were able to show a decrease in waiting time and a measurable impact of the intervention. This evaluation produced valuable and actionable data for Oncology units and adds a valuable, Latin American experience to the literature.


Assuntos
Antineoplásicos , Composição de Medicamentos , Neoplasias , Listas de Espera , Humanos , Estudos Transversais , Neoplasias/tratamento farmacológico , Antineoplásicos/provisão & distribuição
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