Pub Date : 2016-10-18eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.13
P K Garg, D Narayana
Background: The idiopathic variety of chronic pancreatitis (CP) in India particularly in Kerala state was earlier called 'tropical pancreatitis' with peculiar features: early age of onset, severe malnutrition, diabetes and poor prognosis. A change in disease phenotype and behaviour has been observed recently.
Objective: To review the changing profile of CP in India and examine its relationship with environmental influences and socio-economic development.
Methods: Relevant studies on CP in India were reviewed along with social and economic parameters in Kerala over the past 4 decades.
Results: There has been a definite change in the phenotype of CP in India with onset in mid twenties, better nutritional status, and a much better prognosis compared with the reports in 1970s. Genetic susceptibility due to genetic mutations particularly in SPINK1, CFTR, CTRC, and CLDN2/MORC4 genes is the most important factor and not malnutrition or dietary toxins for idiopathic CP suggesting the term 'tropical pancreatitis' is a misnomer. We observed a close relationship between socio-economic development and rising income in Kerala with late onset of disease, nutritional status, and better prognosis of CP.
Conclusion: Changing profile of CP in India and better understanding of risk factors provide evidence for gene-environmental interactions in its pathobiology.
{"title":"Changing phenotype and disease behaviour of chronic pancreatitis in India: evidence for gene-environment interactions.","authors":"P K Garg, D Narayana","doi":"10.1017/gheg.2016.13","DOIUrl":"10.1017/gheg.2016.13","url":null,"abstract":"<p><strong>Background: </strong>The idiopathic variety of chronic pancreatitis (CP) in India particularly in Kerala state was earlier called 'tropical pancreatitis' with peculiar features: early age of onset, severe malnutrition, diabetes and poor prognosis. A change in disease phenotype and behaviour has been observed recently.</p><p><strong>Objective: </strong>To review the changing profile of CP in India and examine its relationship with environmental influences and socio-economic development.</p><p><strong>Methods: </strong>Relevant studies on CP in India were reviewed along with social and economic parameters in Kerala over the past 4 decades.</p><p><strong>Results: </strong>There has been a definite change in the phenotype of CP in India with onset in mid twenties, better nutritional status, and a much better prognosis compared with the reports in 1970s. Genetic susceptibility due to genetic mutations particularly in <i>SPINK1, CFTR, CTRC</i>, and <i>CLDN2/MORC4</i> genes is the most important factor and not malnutrition or dietary toxins for idiopathic CP suggesting the term 'tropical pancreatitis' is a misnomer. We observed a close relationship between socio-economic development and rising income in Kerala with late onset of disease, nutritional status, and better prognosis of CP.</p><p><strong>Conclusion: </strong>Changing profile of CP in India and better understanding of risk factors provide evidence for gene-environmental interactions in its pathobiology.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e17"},"PeriodicalIF":1.9,"publicationDate":"2016-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/gheg.2016.13","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-14eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.14
Hoang Van Minh, Tran Quynh Anh, Nguyen Thi Thuy Nga
The coverage of health insurance as measured by enrollment rates has increased significantly in Vietnam. However, maintaining health insurance to the some groups such as the farmer, the borderline poor and informal workers, etc. has been very challenging. This paper examines the situation of health insurance drop-out among the adult population in sub-rural areas of Northern Vietnam from 2006 to 2013, and analyzes several socio-economic correlates of the health insurance drop-out situation. Data used in this paper were obtained from Health and Demographic Surveillance System located in Chi Linh district, an urbanizing area, in a northern province of Vietnam. Descriptive analyses were used to describe the level and distribution of the health insurance drop-out status. Multiple logistic regressions were used to assess associations between the health insurance drop-out status and the independent variables. A total of 32 561 adults were investigated. We found that the cumulative percentage of health insurance drop-out among the study participants was 21.2%. Health insurance drop-out rates were higher among younger age groups, people with lower education, and those who worked as small trader and other informal jobs, and belonged to the non-poor households. Given the findings, further attention toward health insurance among these special populations is needed.
{"title":"Health insurance drop-out among adult population: findings from a study in a Health and demographic surveillance system in Northern Vietnam 2006-2013.","authors":"Hoang Van Minh, Tran Quynh Anh, Nguyen Thi Thuy Nga","doi":"10.1017/gheg.2016.14","DOIUrl":"https://doi.org/10.1017/gheg.2016.14","url":null,"abstract":"<p><p>The coverage of health insurance as measured by enrollment rates has increased significantly in Vietnam. However, maintaining health insurance to the some groups such as the farmer, the borderline poor and informal workers, etc. has been very challenging. This paper examines the situation of health insurance drop-out among the adult population in sub-rural areas of Northern Vietnam from 2006 to 2013, and analyzes several socio-economic correlates of the health insurance drop-out situation. Data used in this paper were obtained from Health and Demographic Surveillance System located in Chi Linh district, an urbanizing area, in a northern province of Vietnam. Descriptive analyses were used to describe the level and distribution of the health insurance drop-out status. Multiple logistic regressions were used to assess associations between the health insurance drop-out status and the independent variables. A total of 32 561 adults were investigated. We found that the cumulative percentage of health insurance drop-out among the study participants was 21.2%. Health insurance drop-out rates were higher among younger age groups, people with lower education, and those who worked as small trader and other informal jobs, and belonged to the non-poor households. Given the findings, further attention toward health insurance among these special populations is needed.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e16"},"PeriodicalIF":1.9,"publicationDate":"2016-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/gheg.2016.14","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-09eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.10
A Patel, R Webster
Non-communicable diseases (NCDs) have reached pandemic levels globally and pose a major threat to social and economic development worldwide. The discipline of epidemiology has done much to bring this issue to the forefront of global health. Epidemiological approaches have broadened our understanding of the impact of NCDs in widening socioeconomic disparities. Over a number of decades, this discipline has also contributed to the development of many preventive measures and treatments of known efficacy and safety. However, epidemiology also has a critical role to play in better translating these discoveries into practice, through the new science of implementation. As we strive to achieve the "25 by 25" goal of a 25% reduction in premature mortality from common NCDs by 2025, the discipline of epidemiology will need to continuously evolve to remain an essential tool for public health action.
非传染性疾病(NCDs)在全球范围内已达到流行病的程度,对全世界的社会和经济发展构成重大威胁。流行病学学科为将这一问题推向全球卫生的前沿做了大量工作。流行病学方法拓宽了我们对非传染性疾病在扩大社会经济差距方面影响的认识。几十年来,这门学科还促进了许多已知疗效和安全性的预防措施和治疗方法的发展。然而,在通过新的实施科学将这些发现更好地转化为实践方面,流行病学也可以发挥关键作用。在我们努力实现到 2025 年将常见非传染性疾病的过早死亡率降低 25% 的 "25 by 25 "目标时,流行病学学科需要不断发展,以继续成为公共卫生行动的重要工具。
{"title":"The potential and value of epidemiology in curbing non-communicable diseases.","authors":"A Patel, R Webster","doi":"10.1017/gheg.2016.10","DOIUrl":"10.1017/gheg.2016.10","url":null,"abstract":"<p><p>Non-communicable diseases (NCDs) have reached pandemic levels globally and pose a major threat to social and economic development worldwide. The discipline of epidemiology has done much to bring this issue to the forefront of global health. Epidemiological approaches have broadened our understanding of the impact of NCDs in widening socioeconomic disparities. Over a number of decades, this discipline has also contributed to the development of many preventive measures and treatments of known efficacy and safety. However, epidemiology also has a critical role to play in better translating these discoveries into practice, through the new science of implementation. As we strive to achieve the \"25 by 25\" goal of a 25% reduction in premature mortality from common NCDs by 2025, the discipline of epidemiology will need to continuously evolve to remain an essential tool for public health action.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e15"},"PeriodicalIF":1.9,"publicationDate":"2016-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-22eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.12
J G Lavoie, D Kornelsen, L Wylie, J Mignone, J Dwyer, Y Boyer, A Boulton, K O'Donnell
Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations.
{"title":"Responding to health inequities: Indigenous health system innovations.","authors":"J G Lavoie, D Kornelsen, L Wylie, J Mignone, J Dwyer, Y Boyer, A Boulton, K O'Donnell","doi":"10.1017/gheg.2016.12","DOIUrl":"10.1017/gheg.2016.12","url":null,"abstract":"<p><p>Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e14"},"PeriodicalIF":1.9,"publicationDate":"2016-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-25eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.5
J de Vries, K Littler, A Matimba, S McCurdy, O Ouwe Missi Oukem-Boyer, J Seeley, P Tindana
A report on the Second H3Africa Ethics Consultation Meeting, which was held in Livingstone, Zambia on 11 May 2015. The meeting demonstrated considerable evolution by African Research Ethics Committees on thinking about broad consent as a consent option for genomics research and biobanking. The meeting concluded with a call for broader engagement with policy makers across the continent in order to help these recognise the need for guidance and regulation where these do not exist and to explore harmonisation where appropriate and possible.
{"title":"Evolving perspectives on broad consent for genomics research and biobanking in Africa. Report of the Second H3Africa Ethics Consultation Meeting, 11 May 2015.","authors":"J de Vries, K Littler, A Matimba, S McCurdy, O Ouwe Missi Oukem-Boyer, J Seeley, P Tindana","doi":"10.1017/gheg.2016.5","DOIUrl":"https://doi.org/10.1017/gheg.2016.5","url":null,"abstract":"<p><p>A report on the Second H3Africa Ethics Consultation Meeting, which was held in Livingstone, Zambia on 11 May 2015. The meeting demonstrated considerable evolution by African Research Ethics Committees on thinking about broad consent as a consent option for genomics research and biobanking. The meeting concluded with a call for broader engagement with policy makers across the continent in order to help these recognise the need for guidance and regulation where these do not exist and to explore harmonisation where appropriate and possible.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e13"},"PeriodicalIF":1.9,"publicationDate":"2016-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/gheg.2016.5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-11eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.8
Y S Wong, P Allotey, D D Reidpath
Universal health coverage is a key health target in the Sustainable Development Goals (SDGs) that has the means to link equitable social and economic development. As a concept firmly based on equity, it is widely accepted at international and national levels as important for populations to attain 'health for all' especially for marginalised groups. However, implementing universal coverage has been fraught with challenges and the increasing privatisation of health care provision adds to the challenge because it is being implemented in a health system that rests on a property regime that promotes inequality. This paper asks the question, 'What does an equitable health system look like?' rather than the usual 'How do you make the existing health system more equitable?' Using an ethnographic approach, the authors explored via interviews, focus group discussions and participant observation a health system that uses the commons approach such as which exists with indigenous peoples and found features that helped make the system intrinsically equitable. Based on these features, the paper proposes an alternative basis to organise universal health coverage that will better ensure equity in health systems and ultimately contribute to meeting the SDGs.
{"title":"Sustainable development goals, universal health coverage and equity in health systems: the Orang Asli commons approach.","authors":"Y S Wong, P Allotey, D D Reidpath","doi":"10.1017/gheg.2016.8","DOIUrl":"10.1017/gheg.2016.8","url":null,"abstract":"<p><p>Universal health coverage is a key health target in the Sustainable Development Goals (SDGs) that has the means to link equitable social and economic development. As a concept firmly based on equity, it is widely accepted at international and national levels as important for populations to attain 'health for all' especially for marginalised groups. However, implementing universal coverage has been fraught with challenges and the increasing privatisation of health care provision adds to the challenge because it is being implemented in a health system that rests on a property regime that promotes inequality. This paper asks the question, 'What does an equitable health system look like?' rather than the usual 'How do you make the existing health system more equitable?' Using an ethnographic approach, the authors explored via interviews, focus group discussions and participant observation a health system that uses the commons approach such as which exists with indigenous peoples and found features that helped make the system intrinsically equitable. Based on these features, the paper proposes an alternative basis to organise universal health coverage that will better ensure equity in health systems and ultimately contribute to meeting the SDGs.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e12"},"PeriodicalIF":1.9,"publicationDate":"2016-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/gheg.2016.8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-27eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.7
R Ritte, S Panozzo, L Johnston, J Agerholm, S E Kvernmo, K Rowley, K Arabena
Internationally, the 1000 days movement calls for action and investment in improving nutrition for the period from a child's conception to their second birthday, thereby providing an organising framework for early-life interventions. To ensure Australian Indigenous families benefit from this 1000 days framework, an Indigenous-led year-long engagement process was undertaken linking early-life researchers, research institutions, policy-makers, professional associations and human rights activists with Australian Indigenous organisations and families. The resultant model, First 1000 Days Australia, broadened the international concept beyond improving nutrition. The First 1000 Days Australia model was built by adhering to Indigenous methodologies, a recognition of the centrality of culture that reinforces and strengthens families, and uses a holistic view of health and wellbeing. The First 1000 Days Australia was developed under the auspice of Indigenous people's leadership using a collective impact framework. As such, the model emphasises Indigenous leadership, mutual trust and solidarity to achieve early-life equity.
{"title":"An Australian model of the First 1000 Days: an Indigenous-led process to turn an international initiative into an early-life strategy benefiting indigenous families.","authors":"R Ritte, S Panozzo, L Johnston, J Agerholm, S E Kvernmo, K Rowley, K Arabena","doi":"10.1017/gheg.2016.7","DOIUrl":"https://doi.org/10.1017/gheg.2016.7","url":null,"abstract":"<p><p>Internationally, the 1000 days movement calls for action and investment in improving nutrition for the period from a child's conception to their second birthday, thereby providing an organising framework for early-life interventions. To ensure Australian Indigenous families benefit from this 1000 days framework, an Indigenous-led year-long engagement process was undertaken linking early-life researchers, research institutions, policy-makers, professional associations and human rights activists with Australian Indigenous organisations and families. The resultant model, First 1000 Days Australia, broadened the international concept beyond improving nutrition. The First 1000 Days Australia model was built by adhering to Indigenous methodologies, a recognition of the centrality of culture that reinforces and strengthens families, and uses a holistic view of health and wellbeing. The First 1000 Days Australia was developed under the auspice of Indigenous people's leadership using a collective impact framework. As such, the model emphasises Indigenous leadership, mutual trust and solidarity to achieve early-life equity.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e11"},"PeriodicalIF":1.9,"publicationDate":"2016-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/gheg.2016.7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-15eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.6
J A Whitworth
Women have been recognised as playing a central role in global health over millennia. Hygieia in both Greek and Roman mythology was the goddess of good health, cleanliness and sanitation, and her sisters Panacea, Acesco and Laso were goddesses of remedy, healing and recuperation, respectively. Florence Nightingale became a cult figure during the Crimean War and was a key figure in social reforms designed to improve health care across all levels of society. She is credited as the founder of modern nursing. More recently, a few women have made it to the top in global health, e.g. at international level Gro Harlem Bruntland and now Margaret Chan as Directors General of WHO, and at national level Dame Sally Davies as Chief Medical Officer of the UK (I was the Australian equivalent in the late nineties).
{"title":"Women and global health: a personal view.","authors":"J A Whitworth","doi":"10.1017/gheg.2016.6","DOIUrl":"https://doi.org/10.1017/gheg.2016.6","url":null,"abstract":"Women have been recognised as playing a central role in global health over millennia. Hygieia in both Greek and Roman mythology was the goddess of good health, cleanliness and sanitation, and her sisters Panacea, Acesco and Laso were goddesses of remedy, healing and recuperation, respectively. Florence Nightingale became a cult figure during the Crimean War and was a key figure in social reforms designed to improve health care across all levels of society. She is credited as the founder of modern nursing. More recently, a few women have made it to the top in global health, e.g. at international level Gro Harlem Bruntland and now Margaret Chan as Directors General of WHO, and at national level Dame Sally Davies as Chief Medical Officer of the UK (I was the Australian equivalent in the late nineties).","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e10"},"PeriodicalIF":1.9,"publicationDate":"2016-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/gheg.2016.6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-27eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.4
A Matimba, M Dhoro, C Dandara
Pharmacogenomics has the potential of transforming clinical research and improving healthcare in sub-Saharan Africa (SSA). The role of African genome diversity and the opportunities for pharmacogenomics research are highlighted and will enable discovery of novel genetic mechanisms and validation of established markers. African genomics and biobank consortia will play an important role in building capacity for pharmacogenomics in SSA.
{"title":"Is there a role of pharmacogenomics in Africa.","authors":"A Matimba, M Dhoro, C Dandara","doi":"10.1017/gheg.2016.4","DOIUrl":"https://doi.org/10.1017/gheg.2016.4","url":null,"abstract":"<p><p>Pharmacogenomics has the potential of transforming clinical research and improving healthcare in sub-Saharan Africa (SSA). The role of African genome diversity and the opportunities for pharmacogenomics research are highlighted and will enable discovery of novel genetic mechanisms and validation of established markers. African genomics and biobank consortia will play an important role in building capacity for pharmacogenomics in SSA.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e9"},"PeriodicalIF":1.9,"publicationDate":"2016-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/gheg.2016.4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-13eCollection Date: 2016-01-01DOI: 10.1017/gheg.2016.2
K M Sharma, H Ranjani, A Zabetian, M Datta, M Deepa, C R Anand Moses, K M V Narayan, V Mohan, M K Ali
Background: There are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study.
Methods: Persons with diabetes (n = 606) were recruited from government, private, and rural clinics and compared to persons without diabetes matched for age, sex, and socioeconomic status (n = 356). We used interviewer-administered questionnaires to estimate direct costs (outpatient, inpatient, medication, laboratory, and procedures) and indirect costs [absence from (absenteeism) or low productivity at (presenteeism) work]. Excess costs were calculated as the difference between costs reported by persons with and without diabetes and compared across settings. Regression analyses were used to separately identify factors associated with total direct and indirect costs.
Results: Annual excess direct costs were highest amongst private clinic attendees (INR 19 552, US$425) and lowest amongst government clinic attendees (INR 1204, US$26.17). Private clinic attendees had the lowest excess absenteeism (2.36 work days/year) and highest presenteeism (0.06 work days/year) due to diabetes. Government clinic attendees reported the highest absenteeism (7.48 work days/year) and lowest presenteeism (-0.31 work days/year). Ten additional years of diabetes duration was associated with 11% higher direct costs (p < 0.001). Older age (p = 0.02) and longer duration of diabetes (p < 0.001) were associated with higher total lost work days.
Conclusions: Excess health expenditures and lost productivity amongst individuals with diabetes are substantial and different across care settings. Innovative solutions are needed to cope with diabetes and its associated cost burdens in India.
背景:关于印度糖尿病的直接和间接成本的数据很少,关于农村糖尿病成本的数据也很有限。我们的目的是通过一项基于临床的比较疾病成本研究来进一步探讨糖尿病负担的这些方面。方法:从政府、私人和农村诊所招募糖尿病患者(n = 606),并将其与年龄、性别和社会经济地位相匹配的非糖尿病患者(n = 356)进行比较。我们使用访谈者管理的问卷来估计直接成本(门诊、住院、药物、实验室和程序)和间接成本(缺勤或工作效率低下)。超额费用计算为糖尿病患者和非糖尿病患者报告的费用之间的差异,并在不同情况下进行比较。使用回归分析分别确定与总直接和间接成本相关的因素。结果:私人诊所患者的年度超额直接成本最高(19,552印度卢比,425美元),政府诊所患者的年度超额直接成本最低(1204印度卢比,26.17美元)。私人诊所的患者因糖尿病而旷工最少(2.36个工作日/年),出勤最多(0.06个工作日/年)。政府诊所的出勤率最高(7.48个工作日/年),出勤率最低(-0.31个工作日/年)。糖尿病病程增加10年,直接成本增加11% (p p = 0.02),糖尿病病程延长(p结论:糖尿病患者的过度医疗支出和生产力损失是实质性的,并且在不同的护理环境中存在差异。印度需要创新的解决方案来应对糖尿病及其相关的成本负担。
{"title":"Excess cost burden of diabetes in Southern India: a clinic-based, comparative cost-of-illness study.","authors":"K M Sharma, H Ranjani, A Zabetian, M Datta, M Deepa, C R Anand Moses, K M V Narayan, V Mohan, M K Ali","doi":"10.1017/gheg.2016.2","DOIUrl":"https://doi.org/10.1017/gheg.2016.2","url":null,"abstract":"<p><strong>Background: </strong>There are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study.</p><p><strong>Methods: </strong>Persons with diabetes (<i>n</i> = 606) were recruited from government, private, and rural clinics and compared to persons without diabetes matched for age, sex, and socioeconomic status (<i>n</i> = 356). We used interviewer-administered questionnaires to estimate direct costs (outpatient, inpatient, medication, laboratory, and procedures) and indirect costs [absence from (absenteeism) or low productivity at (presenteeism) work]. Excess costs were calculated as the difference between costs reported by persons with and without diabetes and compared across settings. Regression analyses were used to separately identify factors associated with total direct and indirect costs.</p><p><strong>Results: </strong>Annual excess direct costs were highest amongst private clinic attendees (INR 19 552, US$425) and lowest amongst government clinic attendees (INR 1204, US$26.17). Private clinic attendees had the lowest excess absenteeism (2.36 work days/year) and highest presenteeism (0.06 work days/year) due to diabetes. Government clinic attendees reported the highest absenteeism (7.48 work days/year) and lowest presenteeism (-0.31 work days/year). Ten additional years of diabetes duration was associated with 11% higher direct costs (<i>p</i> < 0.001). Older age (<i>p</i> = 0.02) and longer duration of diabetes (<i>p</i> < 0.001) were associated with higher total lost work days.</p><p><strong>Conclusions: </strong>Excess health expenditures and lost productivity amongst individuals with diabetes are substantial and different across care settings. Innovative solutions are needed to cope with diabetes and its associated cost burdens in India.</p>","PeriodicalId":44052,"journal":{"name":"Global Health Epidemiology and Genomics","volume":"1 ","pages":"e8"},"PeriodicalIF":1.9,"publicationDate":"2016-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/gheg.2016.2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}