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Fulltext Is scientific evidence enough? Using expert opinion to fill gaps in data in antimicrobial resistance research

Cousins M, Parmley EJ, Greer AL, Neiterman E, Lambraki IA, Graells T, et al.

PLoS One, 2023;18(8):e0290464.
PMID: 37616319 DOI: 10.1371/journal.pone.0290464

BACKGROUND: Antimicrobial Resistance (AMR) is a global problem with large health and economic consequences. Current gaps in quantitative data are a major limitation for creating models intended to simulate the drivers of AMR. As an intermediate step, expert knowledge and opinion could be utilized to fill gaps in knowledge for areas of the system where quantitative data does not yet exist or are hard to quantify. Therefore, the objective of this study was to identify quantifiable data about the current state of the factors that drive AMR and the strengths and directions of relationships between the factors from statements made by a group of experts from the One Health system that drives AMR development and transmission in a European context.
METHODS: This study builds upon previous work that developed a causal loop diagram of AMR using input from two workshops conducted in 2019 in Sweden with experts within the European food system context. A secondary analysis of the workshop transcripts was conducted to identify semi-quantitative data to parameterize drivers in a model of AMR.
MAIN FINDINGS: Participants spoke about AMR by combining their personal experiences with professional expertise within their fields. The analysis of participants' statements provided semi-quantitative data that can help inform a future of AMR emergence and transmission based on a causal loop diagram of AMR in a Swedish One Health system context.
CONCLUSION: Using transcripts of a workshop including participants with diverse expertise across the system that drives AMR, we gained invaluable insight into the past, current, and potential future states of the major drivers of AMR, particularly where quantitative data are lacking.

Matched MeSH terms: Medical Assistance
A glimpse of public health in China

Low WY, Binns C

Asia Pac J Public Health, 2015 Mar;27(2 Suppl):7S-8S.
PMID: 25712494 DOI: 10.1177/1010539515574405
Matched MeSH terms: Medical Assistance/organization & administration
Fulltext Southeast Asian health system challenges and responses to the 'Andaman Sea refugee crisis': A qualitative study of health-sector perspectives from Indonesia, Malaysia, Myanmar, and Thailand

Legido-Quigley H, Leh Hoon Chuah F, Howard N

PLoS Med, 2020 11;17(11):e1003143.
PMID: 33170834 DOI: 10.1371/journal.pmed.1003143

BACKGROUND: Southeast Asian countries host signficant numbers of forcibly displaced people. This study was conducted to examine how health systems in Southeast Asia have responded to the health system challenges of forced migration and refugee-related health including the health needs of populations affected by forced displacement; the health systems-level barriers and facilitators in addressing these needs; and the implications of existing health policies relating to forcibly displaced and refugee populations. This study aims to fill in the gap in knowledge by analysing how health systems are organised in Southeast Asia to address the health needs of forcibly displaced people.
METHODS AND FINDINGS: We conducted 30 semistructured interviews with health policy-makers, health service providers, and other experts working in the United Nations (n = 6), ministries and public health (n = 5), international (n = 9) and national civil society (n = 7), and academia (n = 3) based in Indonesia (n = 6), Malaysia (n = 10), Myanmar (n = 6), and Thailand (n = 8). Data were analysed thematically using deductive and inductive coding. Interviewees described the cumulative nature of health risks at each migratory phase. Perceived barriers to addressing migrants' cumulative health needs were primarily financial, juridico-political, and sociocultural, whereas key facilitators were many health workers' humanitarian stance and positive national commitment to pursuing universal health coverage (UHC). Across all countries, financial constraints were identified as the main challenges in addressing the comprehensive health needs of refugees and asylum seekers. Participants recommended regional and multisectoral approaches led by national governments, recognising refugee and asylum-seeker contributions, and promoting inclusion and livelihoods. Main study limitations included that we were not able to include migrant voices or those professionals not already interested in migrants.
CONCLUSIONS: To our knowledge, this is one of the first qualitative studies to investigate the health concerns and barriers to access among migrants experiencing forced displacement, particularly refugees and asylum seekers, in Southeast Asia. Findings provide practical new insights with implications for informing policy and practice. Overall, sociopolitical inclusion of forcibly displaced populations remains difficult in these four countries despite their significant contributions to host-country economies.

Matched MeSH terms: Medical Assistance
Budget impact analysis of medicines: estimated values versus real-world evidence and the implications

Faleiros DR, Alvares-Teodoro J, Nunes da Silva E, Godman BB, Gonçalves Pereira R, Gurgel Andrade EI, et al.

Expert Rev Pharmacoecon Outcomes Res, 2021 May 27.
PMID: 33971778 DOI: 10.1080/14737167.2021.1927716

Objectives: Budget Impact Analyses (BIA) of medicines helps managers in promoting health systems' sustainability when assessing the role and value of new medicines. However, it is not clear whether BIAs typically underestimate or overestimate the impact on real-world budgets. This retroactive analysis seeks to compare estimated values obtained by a BIA and Real-World Evidence (RWE) to guide discussions.Methods: The estimated values were obtained through a BIA concerning the incorporation of adalimumab for the treatment of Rheumatoid Arthritis into the Brazilian Unified Health System (SUS) carried out retroactively and per international guidelines. RWE data was extracted from SUS computerized systems. We subsequently compared the number of treatments, costs, and Incremental Budget Impact (IBI).Results - The total number of treatments was underestimated by 10% (6,243) and the total expenditure was overestimated by 463% (US$ 4.7 billion). In five years, the total difference between the estimated values and real IBI reached US$ 1.1 billion. A current expenditure of US$ 1.0 was observed for every US$ 5.60 of estimated expenditure.Conclusion - The higher estimates from the BIA might cause decision makers to be more cautious with the introduction of a new medicine to reduce the opportunity costs for other interventions.

Matched MeSH terms: Medical Assistance
Fulltext Female Community Health Workers and Health System Navigation in a Conflict Zone: The Case of Afghanistan

Parray AA, Dash S, Ullah MIK, Inam ZM, Kaufman S

Front Public Health, 2021;9:704811.
PMID: 34458226 DOI: 10.3389/fpubh.2021.704811

Afghanistan ranked 171st among 188 countries in the Gender Inequality Index of 2011 and has only 16% of its women participating in the labor force. The country has been mired in violence for decades which has resulted in the destruction of the social infrastructure including the health sector. Recently, Afghanistan has deployed community health workers (CHW) who make up majority of the health workforce in the remote areas of this country. This paper aims to bring the plight of the CHWs to the forefront of discussion and shed light on the challenges they face as they attempt to bring basic healthcare to people living in a conflict zone. The paper discusses the motivations of Afghani women to become CHWs, their status in the community and within the health system, the threatening situations under which they operate, and the challenges they face as working women in a deeply patriarchal society within a conflict zone. The paper argues that female CHWs should be provided proper accreditation for their work, should be allowed and encouraged to progress in their careers, and should be instilled at the heart of healthcare program planning because they have the field experience to make the most effective and community oriented programmatic decisions.

Matched MeSH terms: Medical Assistance
Fulltext The Proposed Future Infrastructure Model for Basic Occupational Health Services in Malaysia

Samsuddin N, Razali A, Rahman NAA, Yusof MZ, Mahmood NAKN, Hair AFA

Malays J Med Sci, 2019 Mar;26(2):131-137.
PMID: 31447616 MyJurnal DOI: 10.21315/mjms2019.26.2.14

The objectives of occupational health services (OHS) are to create a healthy and safe working environment, prevent work-related diseases, optimise employees' functional capacity and promote health. According to the literature, global accessibility to OHS has not shown much improvement and even worsened in certain countries. The main challenges come from the small and medium enterprises (SMEs). To respond to these global challenges, the basic occupational health services (BOHS) guideline was published under the purview of the World Health Organization and the International Labour Organization. The guideline describes BOHS as part of the infrastructure called the occupational safety and health system, an essential element that ensures the high service coverage and sustainability of the programme. The BOHS guideline was introduced in Malaysia by the Department of Occupational Safety and Health with a focus on SMEs, but its accessibility is low. A gap analysis was conducted between the current BOHS in Malaysia and the published international guideline. The important challenges identified that contributes to the low BOHS accessibility in Malaysia is the weakness in the BOHS infrastructure and OHS system provision. The proposed BOHS infrastructure model is meant to increase accessibility and to provide fair and equitable health services for Malaysians.

Matched MeSH terms: Medical Assistance
Fulltext Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach

Risso-Gill I, Balabanova D, Majid F, Ng KK, Yusoff K, Mustapha F, et al.

BMC Health Serv Res, 2015;15:254.
PMID: 26135302 DOI: 10.1186/s12913-015-0916-y

The growing burden of non-communicable diseases in middle-income countries demands models of care that are appropriate to local contexts and acceptable to patients in order to be effective. We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve hypertension control in Malaysia.

Matched MeSH terms: Medical Assistance