Pub Date : 2024-03-28DOI: 10.1101/2024.03.27.24304987
Daihun Kang
Background: The intersection of cryptocurrency, especially Bitcoin, with public health issues, particularly synthetic opioid-related deaths, presents an emerging field of study. This research explores the statistical relationship between Bitcoin market fluctuations and synthetic opioid mortalities, against the backdrop of Drug Enforcement Administration (DEA) enforcement actions. Methods: Utilizing data from 2009 to 2022, this study employs Pearson correlation and linear regression models to investigate the relationship between annual Bitcoin price fluctuations and synthetic opioid-related death rates, alongside DEA domestic arrest trends. Results: A pronounced positive correlation (r = 0.92) was found between Bitcoin price changes and synthetic opioid mortality rates, with the Bitcoin price accounting for approximately 84.78% of the variance in opioid-related deaths (R² = 0.8478). The analysis also notes a disparity between increasing synthetic opioid fatalities and decreasing DEA domestic arrests. Conclusions: The findings reveal significant correlations between Bitcoin price fluctuations and synthetic opioid-related fatalities, highlighting potential gaps in current drug enforcement strategies. This study underscores the need for an interdisciplinary approach to address the complexities introduced by cryptocurrency in the opioid crisis and suggests the necessity of integrating financial and public health strategies to combat emerging drug abuse trends.
{"title":"Statistical Relationship Between Bitcoin and Synthetic Opioid Mortalities: Are DEA Enforcement Actions Aligning with Trends in Drug Related Deaths?","authors":"Daihun Kang","doi":"10.1101/2024.03.27.24304987","DOIUrl":"https://doi.org/10.1101/2024.03.27.24304987","url":null,"abstract":"Background: The intersection of cryptocurrency, especially Bitcoin, with public health issues, particularly synthetic opioid-related deaths, presents an emerging field of study. This research explores the statistical relationship between Bitcoin market fluctuations and synthetic opioid mortalities, against the backdrop of Drug Enforcement Administration (DEA) enforcement actions. Methods: Utilizing data from 2009 to 2022, this study employs Pearson correlation and linear regression models to investigate the relationship between annual Bitcoin price fluctuations and synthetic opioid-related death rates, alongside DEA domestic arrest trends. Results: A pronounced positive correlation (r = 0.92) was found between Bitcoin price changes and synthetic opioid mortality rates, with the Bitcoin price accounting for approximately 84.78% of the variance in opioid-related deaths (R² = 0.8478). The analysis also notes a disparity between increasing synthetic opioid fatalities and decreasing DEA domestic arrests. Conclusions: The findings reveal significant correlations between Bitcoin price fluctuations and synthetic opioid-related fatalities, highlighting potential gaps in current drug enforcement strategies. This study underscores the need for an interdisciplinary approach to address the complexities introduced by cryptocurrency in the opioid crisis and suggests the necessity of integrating financial and public health strategies to combat emerging drug abuse trends.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140322811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infection is a public health problem affecting 2.7 million worldwide. In Mozambique, the prevalence of this co-infection is 9,1%, calling for specific policies on prevention, diagnosis and adequate management in health facilities caring for HIV patients. This study aimed to review the existing policies and to assess the knowledge and practices of health professionals about HIV/HBV co-infection. Methods A document and literature review to describe the existing policies and guidelines on HIV/HBV co-infection in Mozambique was performed. Key informants were contacted to clarify or add information. Health professionals who care for HIV-positive patients in four health centers in Maputo City, the capital of Mozambique responded to a questionnaire on knowledge and practices about this co-infection. Qualitative analysis was done to identify main themes using content analysis. Descriptive statistics of sociodemographic, knowledge, practices variables was presented using the SPSS Program version 20 and bivariate analysis was applied to describe the association between variables. Results Twenty-one policy documents were found and five key informants were interviewed. Fifty-two participants answered the questionnaire. Only one policy document explicitly referred to HIV/HBV co-infection treatment. Most health professionals (96%) were aware of HIV/HBV co-infection. Although the only existing policy is on the treatment, few (33%) referenced antiretrovirals formulations containing Tenofovir and Lamivudine. Only 29% of health professionals reported screening HIV patients for HBV and 21% practiced HIV/HBV co-infection counseling. No statistically significant differences were found when relating the sociodemographic variables with knowledge and practices. Conclusion Policy documents relating to prevention, diagnosis and clinical management of HIV/HBV co-infection were rare or absent. Health professionals had little knowledge about HIV/HBV co-infection. Defining adequate policies and training of health professionals may help increase awareness, increase counselling of patients for disease prevention, diagnosis and proper management of HIV/HBV co-infected patients.
{"title":"HIV and Hepatitis B virus co-infection in Mozambique: Policy review and Health Professionals knowledge and practices","authors":"Vanda Suzel Viana Dos Muchangos, Charlotta Nilsson, Esperanca Sevene, Lucia Chambal","doi":"10.1101/2024.03.23.24304747","DOIUrl":"https://doi.org/10.1101/2024.03.23.24304747","url":null,"abstract":"Background\u0000Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infection is a public health problem affecting 2.7 million worldwide. In Mozambique, the prevalence of this co-infection is 9,1%, calling for specific policies on prevention, diagnosis and adequate management in health facilities caring for HIV patients. This study aimed to review the existing policies and to assess the knowledge and practices of health professionals about HIV/HBV co-infection.\u0000Methods\u0000A document and literature review to describe the existing policies and guidelines on HIV/HBV co-infection in Mozambique was performed. Key informants were contacted to clarify or add information. Health professionals who care for HIV-positive patients in four health centers in Maputo City, the capital of Mozambique responded to a questionnaire on knowledge and practices about this co-infection. Qualitative analysis was done to identify main themes using content analysis. Descriptive statistics of sociodemographic, knowledge, practices variables was presented using the SPSS Program version 20 and bivariate analysis was applied to describe the association between variables.\u0000Results\u0000Twenty-one policy documents were found and five key informants were interviewed. Fifty-two participants answered the questionnaire. Only one policy document explicitly referred to HIV/HBV co-infection treatment. Most health professionals (96%) were aware of HIV/HBV co-infection. Although the only existing policy is on the treatment, few (33%) referenced antiretrovirals formulations containing Tenofovir and Lamivudine. Only 29% of health professionals reported screening HIV patients for HBV and 21% practiced HIV/HBV co-infection counseling. No statistically significant differences were found when relating the sociodemographic variables with knowledge and practices.\u0000Conclusion\u0000Policy documents relating to prevention, diagnosis and clinical management of HIV/HBV co-infection were rare or absent. Health professionals had little knowledge about HIV/HBV co-infection. Defining adequate policies and training of health professionals may help increase awareness, increase counselling of patients for disease prevention, diagnosis and proper management of HIV/HBV co-infected patients.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140298837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1101/2024.03.21.24304670
Alesha Wale, Jordan Everitt, Toby Ayres, Chukwudi Okolie, Helen Morgan, Hannah Shaw, Rhiannon Tudor Edwards, Jacob Davies, Ruth Lewis, Alison Cooper, Adrian Edwards
Older adults constitute the largest proportion of non-users of the internet. With the increasing digitalisation of services, in particular those provided by Social Care Wales, it is important to understand how best to support older adults to overcome the challenges they face with accessing or engaging with the digital world (for personal use). This rapid review aimed to assess the effectiveness of interventions to address digital exclusion in older adults (aged 60 years and above). Digital exclusion can occur due to issues with motivation (if people do not see why the internet might be beneficial), accessibility (unable to physically access to the internet), ability (lack of skills to use the internet) or affordability (unable to afford access to the internet) of digital technology. Research Implications and Evidence Gaps The majority of studies included in this review were of low quality. It is unclear whether study findings would be generalisable to the UK. Outcome measures were heterogeneous across studies making it difficult to compare findings directly. Only one study assessed the cost-effectiveness of a digital education intervention. No study reported on interventions to address language barriers, for example, that may be experienced by people whose first language is not English. No study focused specifically on interventions to improve access to, or affordability of the internet and digital technologies to overcome digital exclusion. Further high-quality UK-based research is needed to better understand the effectiveness and cost-effectiveness of interventions for addressing digital exclusion in older adults. Policy and Practice Implications This rapid review highlighted the potential benefits of a range of complex multi-component educational interventions, particularly with regards to improving digital literacy, and suggests that older adults are accepting of these interventions. To reduce digital exclusion in older adults, evidence suggests it may be important to ensure structural barriers, such as access to the internet and affordability of devices are removed. However, the cost of provision should be considered and assessed. Educational interventions may help to reduce perceptual barriers regarding digital technologies that contribute to digital exclusion including lack of confidence, fear and anxiety, or perceived lack of abilities. It is important to consider that older adults should be equipped with the skills to make an informed choice to interact with essential services physically (offline) or digitally. With the increasing digitalisation of services, it is important that older members of the community who do not wish to use digital technologies, are not left behind or disadvantaged.
{"title":"A rapid review of the effectiveness of interventions for addressing digital exclusion in older adults","authors":"Alesha Wale, Jordan Everitt, Toby Ayres, Chukwudi Okolie, Helen Morgan, Hannah Shaw, Rhiannon Tudor Edwards, Jacob Davies, Ruth Lewis, Alison Cooper, Adrian Edwards","doi":"10.1101/2024.03.21.24304670","DOIUrl":"https://doi.org/10.1101/2024.03.21.24304670","url":null,"abstract":"Older adults constitute the largest proportion of non-users of the internet. With the increasing digitalisation of services, in particular those provided by Social Care Wales, it is important to understand how best to support older adults to overcome the challenges they face with accessing or engaging with the digital world (for personal use). This rapid review aimed to assess the effectiveness of interventions to address digital exclusion in older adults (aged 60 years and above). Digital exclusion can occur due to issues with motivation (if people do not see why the internet might be beneficial), accessibility (unable to physically access to the internet), ability (lack of skills to use the internet) or affordability (unable to afford access to the internet) of digital technology. Research Implications and Evidence Gaps\u0000The majority of studies included in this review were of low quality. It is unclear whether study findings would be generalisable to the UK. Outcome measures were heterogeneous across studies making it difficult to compare findings directly. Only one study assessed the cost-effectiveness of a digital education intervention. No study reported on interventions to address language barriers, for example, that may be experienced by people whose first language is not English. No study focused specifically on interventions to improve access to, or affordability of the internet and digital technologies to overcome digital exclusion. Further high-quality UK-based research is needed to better understand the effectiveness and cost-effectiveness of interventions for addressing digital exclusion in older adults. Policy and Practice Implications\u0000This rapid review highlighted the potential benefits of a range of complex multi-component educational interventions, particularly with regards to improving digital literacy, and suggests that older adults are accepting of these interventions. To reduce digital exclusion in older adults, evidence suggests it may be important to ensure structural barriers, such as access to the internet and affordability of devices are removed. However, the cost of provision should be considered and assessed. Educational interventions may help to reduce perceptual barriers regarding digital technologies that contribute to digital exclusion including lack of confidence, fear and anxiety, or perceived lack of abilities. It is important to consider that older adults should be equipped with the skills to make an informed choice to interact with essential services physically (offline) or digitally. With the increasing digitalisation of services, it is important that older members of the community who do not wish to use digital technologies, are not left behind or disadvantaged.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"2015 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140196401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.1101/2024.03.20.24304569
Oscar Bruck, Enni Sanmark, Ville Ponkilainen, Alexander Butzow, Aleksi Reito, Joonas Kauppila, Ilari Kuitunen
The European Health Data Space regulation (EHDS) has been proposed to harmonize health data processing. Given its parallels with the Act on Secondary Use of Health and Social Data (Secondary Use Act) implemented in Finland in 2020, this study examines the consequences of heightened privacy constraints on registry-based medical research. Between 2020 and 2023, a median of 5.5% fewer data permits were approved annually in by Finnish university hospitals. Based on linear regression modelling, we estimated a reduction of 46.9% in new data permits nationally in 2023 compared to the expected count. Similar changes were not observed in other medical research types highlighting the consequences of excessive data privacy laws on registry-based medical research.
{"title":"European Health Regulations Reduce Registry-Based Research","authors":"Oscar Bruck, Enni Sanmark, Ville Ponkilainen, Alexander Butzow, Aleksi Reito, Joonas Kauppila, Ilari Kuitunen","doi":"10.1101/2024.03.20.24304569","DOIUrl":"https://doi.org/10.1101/2024.03.20.24304569","url":null,"abstract":"The European Health Data Space regulation (EHDS) has been proposed to harmonize health data processing. Given its parallels with the Act on Secondary Use of Health and Social Data (Secondary Use Act) implemented in Finland in 2020, this study examines the consequences of heightened privacy constraints on registry-based medical research. Between 2020 and 2023, a median of 5.5% fewer data permits were approved annually in by Finnish university hospitals. Based on linear regression modelling, we estimated a reduction of 46.9% in new data permits nationally in 2023 compared to the expected count. Similar changes were not observed in other medical research types highlighting the consequences of excessive data privacy laws on registry-based medical research.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140196330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1101/2024.03.17.24304386
Till Bruckner, Yixuan Chen, Carolina Cruz, Christie Ebube Dike, Belen Chavarria, Shiyu Chen, Ernest Dela Dzidzornu
Transparency shortcomings can undermine confidence in the safety and efficacy of vaccines. This study assesses the publication status of 95 clinical trials of 3 COVID-19 vaccines developed by Chinese companies that received a World Health Organization Emergency Use Listing (EUL) and have been marketed globally. We searched trial registries and the scientific literature to assess current trial status and the public availability of results. After excluding 2 withdrawn trials, we found that at least 62/93 trials (67%) involving 307,933 patients had verifiably been completed or terminated. Only 44 of those 62 trials (71%) had published results in a peer-reviewed journal; none had tabular summary results available on a trial registry. The results of 18/62 (29%) verifiably completed or terminated trials remained unpublished. The trial status information stated in trial registries was often incorrect. Our findings reveal a substantial gap between the disclosure practices of the 3 Chinese companies and global best practice benchmarks. Transparency and global public trust in Chinese biopharmaceutical products could be improved by aligning Chinese legal disclosure requirements with those prevalent in more mature markets, or by the voluntary adoption of stronger transparency practices by Chinese companies.
{"title":"Publication status of 95 clinical trials of 3 COVID-19 vaccines developed by Chinese companies: An observational cohort study","authors":"Till Bruckner, Yixuan Chen, Carolina Cruz, Christie Ebube Dike, Belen Chavarria, Shiyu Chen, Ernest Dela Dzidzornu","doi":"10.1101/2024.03.17.24304386","DOIUrl":"https://doi.org/10.1101/2024.03.17.24304386","url":null,"abstract":"Transparency shortcomings can undermine confidence in the safety and efficacy of vaccines. This study assesses the publication status of 95 clinical trials of 3 COVID-19 vaccines developed by Chinese companies that received a World Health Organization Emergency Use Listing (EUL) and have been marketed globally. We searched trial registries and the scientific literature to assess current trial status and the public availability of results. After excluding 2 withdrawn trials, we found that at least 62/93 trials (67%) involving 307,933 patients had verifiably been completed or terminated. Only 44 of those 62 trials (71%) had published results in a peer-reviewed journal; none had tabular summary results available on a trial registry. The results of 18/62 (29%) verifiably completed or terminated trials remained unpublished. The trial status information stated in trial registries was often incorrect. Our findings reveal a substantial gap between the disclosure practices of the 3 Chinese companies and global best practice benchmarks. Transparency and global public trust in Chinese biopharmaceutical products could be improved by aligning Chinese legal disclosure requirements with those prevalent in more mature markets, or by the voluntary adoption of stronger transparency practices by Chinese companies.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140171189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The aim of this paper is to assess the impact of the measures and procedures imposed by the National Medicines and Poisons Board (NMPB) on the availability of safe, effective and quality medicines of affordable price on the Sudanese market. Methods: This is a descriptive study in which pharmacists, who were responsible for the regulatory affairs within their importing and locally manufacturing medicine companies, were asked to complete a 45-question online survey using the Google application, covering relevance and challenges of medicines quality and pricing system. A link to the data collection tool website was sent to all members of the Sudanese Society of Regulatory Affairs Pharmacists through WhatsApp. The survey was available on 6th May 2020 through 6th June 2020. Descriptive statistics were used to report results. Results: Survey respondents were 70 regulatory affairs’ pharmacists. 38% of participants believe that the technical procedures adopted by the NMPB do not achieve the goal of establishing Medicine Regulatory Authorities as described by World Health Organization. Almost all respondents believe that Sudan current economic situation, including the scarcity of foreign currency, has greatly impacted the availability of quality-assured medicines in pharmacies. Participants said that the situation is exacerbated by the intervention of NMPB in determining the exchange rate and controlling the medicine prices. Conclusion: The NMPB should consider options for balancing patient access to quality medicines, and reasonable pricing policies that encourage the local pharmaceutical manufacturing to flourish and a steady flow of quality-assured medicines from abroad to the Sudan market.
{"title":"The impact of measures set by national regulatory authority to enhance affordability of medicines in Sudan: when good intention leads to worse outcomes","authors":"Gamal Khalafalla Ali, Yasir Abubaker Abuelrish, Abubakr Abdelraouf Alfadl, Mohamed Abdelrahman Shigidi","doi":"10.1101/2024.03.13.24304248","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304248","url":null,"abstract":"Introduction: The aim of this paper is to assess the impact of the measures and procedures imposed by the National Medicines and Poisons Board (NMPB) on the availability of safe, effective and quality medicines of affordable price on the Sudanese market.\u0000Methods: This is a descriptive study in which pharmacists, who were responsible for the regulatory affairs within their importing and locally manufacturing medicine companies, were asked to complete a 45-question online survey using the Google application, covering relevance and challenges of medicines quality and pricing system. A link to the data collection tool website was sent to all members of the Sudanese Society of Regulatory Affairs Pharmacists through WhatsApp. The survey was available on 6th May 2020 through 6th June 2020. Descriptive statistics were used to report results.\u0000Results: Survey respondents were 70 regulatory affairs’ pharmacists. 38% of participants believe that the technical procedures adopted by the NMPB do not achieve the goal of establishing Medicine Regulatory Authorities as described by World Health Organization. Almost all respondents believe that Sudan current economic situation, including the scarcity of foreign currency, has greatly impacted the availability of quality-assured medicines in pharmacies. Participants said that the situation is exacerbated by the intervention of NMPB in determining the exchange rate and controlling the medicine prices.\u0000Conclusion: The NMPB should consider options for balancing patient access to quality medicines, and reasonable pricing policies that encourage the local pharmaceutical manufacturing to flourish and a steady flow of quality-assured medicines from abroad to the Sudan market.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140150679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-13DOI: 10.1101/2024.03.11.24304111
Kéfilath Bello, Bart Criel, Jean-Paul Dossou, Djimon Marcel Zannou, Jan De Lepeleire
Introduction In Benin, policies for guiding the practices of primary care physicians (PCPs) are sparse and incomplete. This leads to sub-optimal use of these relatively rare human resources and reduces their potential contribution to people’s health and well-being. In this study, a policy framework guiding PCPs’ practice in Benin is developed in cooperation with key stakeholders. Methods The cocreation was a long-term process spread over several years, culminating in a two-day workshop in Cotonou (Benin’s capital city) in October 2022. The core principles of a successful cocreation process were respected: a clear definition of goals, the participation of all relevant stakeholders, including community members, and evidence-informed discussions. Results The resulting policy framework includes four overarching dimensions: first, the objectives assigned to PCPs in Benin; second, their roles and related activities; third, their professional identity; and fourth, the governance arrangements guiding their practices. The policy framework provided concrete recommendations for these dimensions based on the Benin context and international evidence. Conclusion The cocreation process was instrumental in developing an evidence-informed and consensual policy framework guiding PCPs' practices in Benin. The framework may be relevant for other West African countries but must be customised to each country’s context.
{"title":"Primary health care improvement in Benin: Cocreating an evidence-informed policy framework to guide the practices of primary care physicians","authors":"Kéfilath Bello, Bart Criel, Jean-Paul Dossou, Djimon Marcel Zannou, Jan De Lepeleire","doi":"10.1101/2024.03.11.24304111","DOIUrl":"https://doi.org/10.1101/2024.03.11.24304111","url":null,"abstract":"Introduction\u0000In Benin, policies for guiding the practices of primary care physicians (PCPs) are sparse and incomplete. This leads to sub-optimal use of these relatively rare human resources and reduces their potential contribution to people’s health and well-being. In this study, a policy framework guiding PCPs’ practice in Benin is developed in cooperation with key stakeholders.\u0000Methods\u0000The cocreation was a long-term process spread over several years, culminating in a two-day workshop in Cotonou (Benin’s capital city) in October 2022. The core principles of a successful cocreation process were respected: a clear definition of goals, the participation of all relevant stakeholders, including community members, and evidence-informed discussions.\u0000Results\u0000The resulting policy framework includes four overarching dimensions: first, the objectives assigned to PCPs in Benin; second, their roles and related activities; third, their professional identity; and fourth, the governance arrangements guiding their practices. The policy framework provided concrete recommendations for these dimensions based on the Benin context and international evidence.\u0000Conclusion\u0000The cocreation process was instrumental in developing an evidence-informed and consensual policy framework guiding PCPs' practices in Benin. The framework may be relevant for other West African countries but must be customised to each country’s context.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"366 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140128816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-13DOI: 10.1101/2024.03.10.24304058
Jonathan Herington, Jessica Shand, Jeanne Holden-Wiltse, Anthony Corbett, Richard Dees, Chin-Lin Ching, Marjorie H Shaw, Xueya Cai, Martin Zand
Introduction: Arguments over the appropriate Crisis Standards of Care (CSC) for public health emergencies often assume that there is a tradeoff between saving the most lives, saving the most life-years, and preventing racial disparities. However, these assumptions have rarely been explored empirically. To quantitatively characterize possible ethical tradeoffs, we aimed to simulate the implementation of five proposed CSC protocols for rationing ventilators in the context of the COVID-19 pandemic. Methods: A Monte Carlo simulation was used to estimate the number of lives saved and life-years saved by implementing clinical acuity-, comorbidity- and age-based CSC protocols under different shortage conditions. This model was populated with patient data from 3707 adult admissions requiring ventilator support in a New York hospital system between April 2020 and May 2021. To estimate lives and life-years saved by each protocol, we determined survival to discharge and estimated remaining life expectancy for each admission. Results: The simulation demonstrated stronger performance for age- and comorbidity-sensitive protocols. For a capacity of 1 bed per 2 patients, ranking by age bands saves approximately 28.7 lives and 3408 life-years per thousand patients, while ranking by Sequential Organ Failure Assessment (SOFA) bands saved the fewest lives (13.2) and life-years (416). For all protocols, we observed a positive correlation between lives saved and life-years saved. For all protocols except lottery and the banded SOFA, significant disparities in lives saved and life-years saved were noted between White non-Hispanic, Black non-Hispanic, and Hispanic sub-populations. Conclusion: While there is significant variance in the number of lives saved and life-years saved, we did not find a tradeoff between saving the most lives and saving the most life-years. Moreover, concerns about racial discrimination in triage protocols require thinking carefully about the tradeoff between enforcing equality of survival rates and maximizing the lives saved in each sub-population.
{"title":"Investigating Ethical Tradeoffs in Crisis Standards of Care through Simulation of Ventilator Allocation Protocols","authors":"Jonathan Herington, Jessica Shand, Jeanne Holden-Wiltse, Anthony Corbett, Richard Dees, Chin-Lin Ching, Marjorie H Shaw, Xueya Cai, Martin Zand","doi":"10.1101/2024.03.10.24304058","DOIUrl":"https://doi.org/10.1101/2024.03.10.24304058","url":null,"abstract":"Introduction: Arguments over the appropriate Crisis Standards of Care (CSC) for public health emergencies often assume that there is a tradeoff between saving the most lives, saving the most life-years, and preventing racial disparities. However, these assumptions have rarely been explored empirically. To quantitatively characterize possible ethical tradeoffs, we aimed to simulate the implementation of five proposed CSC protocols for rationing ventilators in the context of the COVID-19 pandemic.\u0000Methods: A Monte Carlo simulation was used to estimate the number of lives saved and life-years saved by implementing clinical acuity-, comorbidity- and age-based CSC protocols under different shortage conditions. This model was populated with patient data from 3707 adult admissions requiring ventilator support in a New York hospital system between April 2020 and May 2021. To estimate lives and life-years saved by each protocol, we determined survival to discharge and estimated remaining life expectancy for each admission.\u0000Results: The simulation demonstrated stronger performance for age- and comorbidity-sensitive protocols. For a capacity of 1 bed per 2 patients, ranking by age bands saves approximately 28.7 lives and 3408 life-years per thousand patients, while ranking by Sequential Organ Failure Assessment (SOFA) bands saved the fewest lives (13.2) and life-years (416). For all protocols, we observed a positive correlation between lives saved and life-years saved. For all protocols except lottery and the banded SOFA, significant disparities in lives saved and life-years saved were noted between White non-Hispanic, Black non-Hispanic, and Hispanic sub-populations.\u0000Conclusion: While there is significant variance in the number of lives saved and life-years saved, we did not find a tradeoff between saving the most lives and saving the most life-years. Moreover, concerns about racial discrimination in triage protocols require thinking carefully about the tradeoff between enforcing equality of survival rates and maximizing the lives saved in each sub-population.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140128750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-09DOI: 10.1101/2024.03.08.24303972
Wingston Felix Ng'ambi, Cosmas Zyambo, Alice Ngoma Hazemba, Adamson Sinjani Muula, Dominic Nkhoma, Twaambo Hamonga, Angel Mwiche
OBJECTIVE To describe the adoption of at least four early ANC (ANC4+) visits among women of reproductive age in Zambia between 2007 and 2019. METHODS We used Zambia Demographic and Health Survey data gathered between 2007 and 2019. Early ANC4+ was the desired result and was defined as having at least four ANC visits with the first ANC visit occurring during the first four months of pregnancy. Weighted univariate, bivariate, and multivariate logistic regression analyses were performed. RESULTS A total of 11633 (56%) of the 20661 women enrolled in our study had received early initiation of ANC4+. We saw an increase in the proportion of women who started ANC4+ early, from 55% in 2007 to 63% in 2018/19. There was a decreasing trend in the odds of early ANC4+ initiation with parity, but an increasing trend in the odds of early ANC4+ initiation with a higher level of education. Being a member of a wealthier household was associated with a lower risk of ANC4+ (OR= 0.81, 95%CI: 0.66-0.99, P=0.03). 27% of the 12,333 women who had at least four ANC visits, regardless of the timing of their first visit, reported being late for ANC. CONCLUSION Early ANC4+ uptake increased in Zambia between 2007 and 2019. We found that 27% of women who were misclassified as having at least ANC4+ using conventional analysis were actually late for ANC. We provide some key considerations for ensuring that Zambia and other similar settings achieve universal antenatal care coverage by 2030.
{"title":"Factors associated with the uptake of early antenatal care visits among pregnant women in Zambia: 2007-2019","authors":"Wingston Felix Ng'ambi, Cosmas Zyambo, Alice Ngoma Hazemba, Adamson Sinjani Muula, Dominic Nkhoma, Twaambo Hamonga, Angel Mwiche","doi":"10.1101/2024.03.08.24303972","DOIUrl":"https://doi.org/10.1101/2024.03.08.24303972","url":null,"abstract":"OBJECTIVE To describe the adoption of at least four early ANC (ANC4+) visits among women of reproductive age in Zambia between 2007 and 2019. METHODS We used Zambia Demographic and Health Survey data gathered between 2007 and 2019. Early ANC4+ was the desired result and was defined as having at least four ANC visits with the first ANC visit occurring during the first four months of pregnancy. Weighted univariate, bivariate, and multivariate logistic regression analyses were performed. RESULTS A total of 11633 (56%) of the 20661 women enrolled in our study had received early initiation of ANC4+. We saw an increase in the proportion of women who started ANC4+ early, from 55% in 2007 to 63% in 2018/19. There was a decreasing trend in the odds of early ANC4+ initiation with parity, but an increasing trend in the odds of early ANC4+ initiation with a higher level of education. Being a member of a wealthier household was associated with a lower risk of ANC4+ (OR= 0.81, 95%CI: 0.66-0.99, P=0.03). 27% of the 12,333 women who had at least four ANC visits, regardless of the timing of their first visit, reported being late for ANC. CONCLUSION Early ANC4+ uptake increased in Zambia between 2007 and 2019. We found that 27% of women who were misclassified as having at least ANC4+ using conventional analysis were actually late for ANC. We provide some key considerations for ensuring that Zambia and other similar settings achieve universal antenatal care coverage by 2030.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140075347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.06.24303850
Llinos Haf Spencer, Bethany Fern Anthony, Jacob Davies, Kalpa Pisavadia, Elizabeth Gillen, Jane Noyes, Deborah Fitzsimmons, Ruth Lewis, Alison Cooper, Dyfrig Hughes, Rhiannon Tudor Edwards, Adrian Edwards
Some people receive palliative or end of life care at home, others in hospitals or hospices, or a combination of home and hospice/home and hospital models. This rapid review aims to determine the costs and cost-effectiveness of different service models of palliative care or end of life care. These studies are mostly conducted from the perspective of the healthcare system, disregarding costs related to patients/caregivers economic burden (Perea-Bello et al., 2023). Research Implications and Evidence Gaps: More UK research is needed on cost impacts of new services such as Enhanced Supported Care (ESC). Future research should consider which methods are most appropriate to evaluate palliative care models. Standard methodology, such as the calculation of quality-adjusted life years (QALYs), may not be most appropriate for this end of life population. Improving QALYs may not be the intended aim of palliative care or end of life interventions, and prolonging death may be inconsistent with patient preferences and wishes. The quality and applicability of the evidence we found in our rapid review were variable, and therefore, uncertainty remains, especially when the perspective of analysis was not stated clearly. Therefore, it was difficult to ascertain whether all relevant costs were considered. Assumptions on costs were not varied in many studies, and most studies had different time horizons. Policy and Practice Implications: This rapid review has shown that hospital-based palliative care costs are higher than hospice or home-based palliative care. This suggests that home-based palliative care should be available to all patients in a recognisable end of life phase who desire to remain and die at home. Healthcare planners should aim to reduce hospitalisation at the end of life but only if access to quality home care at the end of life is guaranteed. Patients should have a choice about where they prefer to die without moving the costs from the healthcare system to the home caregivers, rendering the costs invisible.
{"title":"The costs and cost-effectiveness of different service models of palliative care, focusing on end of life care: A rapid review","authors":"Llinos Haf Spencer, Bethany Fern Anthony, Jacob Davies, Kalpa Pisavadia, Elizabeth Gillen, Jane Noyes, Deborah Fitzsimmons, Ruth Lewis, Alison Cooper, Dyfrig Hughes, Rhiannon Tudor Edwards, Adrian Edwards","doi":"10.1101/2024.03.06.24303850","DOIUrl":"https://doi.org/10.1101/2024.03.06.24303850","url":null,"abstract":"Some people receive palliative or end of life care at home, others in hospitals or hospices, or a combination of home and hospice/home and hospital models. This rapid review aims to determine the costs and cost-effectiveness of different service models of palliative care or end of life care. These studies are mostly conducted from the perspective of the healthcare system, disregarding costs related to patients/caregivers economic burden (Perea-Bello et al., 2023). Research Implications and Evidence Gaps: More UK research is needed on cost impacts of new services such as Enhanced Supported Care (ESC). Future research should consider which methods are most appropriate to evaluate palliative care models. Standard methodology, such as the calculation of quality-adjusted life years (QALYs), may not be most appropriate for this end of life population. Improving QALYs may not be the intended aim of palliative care or end of life interventions, and prolonging death may be inconsistent with patient preferences and wishes. The quality and applicability of the evidence we found in our rapid review were variable, and therefore, uncertainty remains, especially when the perspective of analysis was not stated clearly. Therefore, it was difficult to ascertain whether all relevant costs were considered. Assumptions on costs were not varied in many studies, and most studies had different time horizons. Policy and Practice Implications: This rapid review has shown that hospital-based palliative care costs are higher than hospice or home-based palliative care. This suggests that home-based palliative care should be available to all patients in a recognisable end of life phase who desire to remain and die at home. Healthcare planners should aim to reduce hospitalisation at the end of life but only if access to quality home care at the end of life is guaranteed. Patients should have a choice about where they prefer to die without moving the costs from the healthcare system to the home caregivers, rendering the costs invisible.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140054384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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