Flows of financial resources for health research and development in Brazil, 2000-2002

OBJECTIVE: To map and measure the flows of financial resources for health research and development in Brazil for the years 2000-2002. METHODS: After adapting the methodology developed for the Center for Economic Policy Research, data were collected on the sources and uses of resources for health research and development. RESULTS: The annual average value of resources apportioned to health research and development was approximately 573 million US dollars. The public sector as a whole invested 417.3 million US dollars and the health department 51.1 million US dollars. Expressed in percentages, the public sector invested 4.15% of the health department's budget although the Ministry of Health assigned only 0.3% of its budget to health research in the country. The universities and the research institutes are the main users of the resources allocated to health research and development, receiving 91.6% of the total public spending, while the private sector receives a small share of around 0.69% of the total. The private sector invested 135.6 million US dollars per year, and the international organizations 20.1 million US dollars per year. CONCLUSION: Besides measuring the financial resources made available for health research and development, the results allowed the filling of gaps in national information; the identification of the flows of applied financial resources; and the testing and adaptation of the proposed methodology, generating information suitable for international comparisons.     

Health benefits of adapting cleaner brick manufacturing technologies in Dhaka,Bangladesh

A total of 1,000 kilns producing 3.5 billion bricks and consuming 0.85 million tons of coal per year resulted in an estimated 2,200 to 4,000 premature deaths and 0.2 to 0.5 million asthma attacks per year in the Greater Dhaka region. In this paper, the emission reductions and health cost savings are presented for moving to cleaner brick manufacturing technologies for the districts of Gazipur, Savar, Dhamrai, Rupganj, Manikganj, Kaliganj, and Narayanganj. A summary of various technologies and feasibility of these technologies based on lessons learnt from the pilots is discussed. We explored three “what-if” scenarios through 2020 for better energy efficiency, lower coal consumption, and lower emission rates, under which the total health cost savings are estimated to range between USD12 million annually for short-term implementation and up to 55 million annually for long-term implementation. Between 2015 and 2020, the cumulative health cost savings could range between USD126 and 234 million, which clearly outweigh any cost of capital investment necessary for the technology change. An improvement in energy efficiency will result in USD1.8 to 3.0 million per year in coal savings, which will accrue to the kiln owners collectively, and these savings will pay back the capital investment within 3–4 years, in addition to the health cost savings for the city inhabitants. Hence, the entrepreneurs have all the social, environmental, and economic incentives to adopt cleaner technologies. A major gap at the regulatory level is in building awareness for the entrepreneurs and setting up an incentive structure to implement this transition, which is being addressed by an advisory committee by the Government of Bangladesh responsible for the revision of the Brick Burning Act of 1989 and related legislations.     

The economic burden of human papillomavirus infection-associated diseases in the Republic of Korea, 2002–2015

BackgroundThis prevalence-based, cost-of-illness study estimated the health care costs of human papillomavirus (HPV) infection-associated diseases in the era before the introduction of organized HPV vaccination for 12-year-old girls in 2016, South Korea.MethodsThe claims data provided by the National Health Insurance Service was used to estimate the prevalence of HPV-associated diseases and their direct medical costs, including costs related to hospitalizations, outpatient visits, and medications.ResultsA total of 1.3 million men and women used medical services for HPV-attributed diseases between 2002 and 2015. Among women, the most common diseases attributable to HPV were cervical dysplasia (64.4%), anogenital warts (12.9%), cervical carcinoma in situ (10.7%) and cervical cancer (2.6%), whereas anogenital warts (80.6%), benign neoplasms of larynx (14.3%), and anal cancers (8.9%) were most common among men. In 2015, the healthcare cost attributable to HPV was 124.9 million US dollars (USD) representing 69.0% of the annual cost of all HPV-associated diseases. At a cost of 75.1 million USD, cervical cancer contributed the largest economic burden in 2015 followed by cervical dysplasia (19.4 million USD) and cervical carcinoma in situ (10.7 million USD). These three conditions represented 58.2% of the total annual cost of all HPV-associated diseases, while 84.2% of the total annual cost was attributable to HPV. Annual health care costs increased from 42.6 million USD in 2002 to 180.9 million USD in 2015.ConclusionThe healthcare costs associated with HPV-related diseases in Korea are substantial and increased between 2002 and 2015 mainly caused by increased number of patients. Expanding the target age for HPV vaccination of girls and introducing HPV vaccination for boys are possible ways of reducing the economic burden of HPV-associated disease and should be considered.     

Current and future avoidable cost of smoking--estimates for Sweden 2007

Objective

To estimate current and future avoidable smoking-attributable costs in Sweden for the year 2007.

Design

Disease specific smoking-attributable proportions were calculated for Swedish smoking patterns and applied to estimate costs for smoking-related diseases based on data from public registers. Avoidable future effects of smoking were calculated employing a Markov simulation model.

Results

The estimated total cost in 2007 was USD 1.6 billion, or USD 181 per capita. Healthcare (direct) cost accounted for 30% of the total cost. The number of deaths was 97 per 100,000 inhabitants (79 in 2001); the number of years of potential life lost 1,227 per 100,000 inhabitants (1012 in 2001); and the number of years of potential productive life lost 226 (185 in 2001) per 100,000 inhabitants. Avoidable future lifetime costs, per 100,000 inhabitants, amounted to USD 19 million (healthcare), 14,000 years of potential life lost, corresponding to a present value of USD 158 million. Total avoidable cost of current smoking amounted to USD 16 billion.

Conclusion

In spite of declining smoking-prevalence rates during the last 30 years, smoking-attributable deaths increased between 2001 and 2007. The number of life years lost per death decreased somewhat, indicating that the age distribution of those dying shifted further towards older age. Simulations indicate that smoking-cessation among young smokers yields considerable more benefits each year than smoking-cessation among older smokers. The health benefits that accrued in 2007, as a result of declining smoking prevalence since 1980, correspond to more than the total cost of smoking in that year.     

Turning the tide: preserving community mental health services

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from the fields of philanthropy, research, government, and health care on September 19, 2002 to examine the status of community-based services for people with mental disorders. This Issue Dialogue, "Turning the Tide: Preserving Community Mental Health Services," explored how health grantmakers can support community programs that provide critical mental health intervention and treatment services to children and adults. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It includes quantitative and qualitative information on mental health, as well as profiles of public sector, private sector, and grantmaker strategies for promoting improvements.     

Allocation of health care resources in the state of Santa Catarina, Brazil: a contribution to a discussion on health financing]

OBJECTIVE: To describe the health situation in municipalities in the state of Santa Catarina, Brazil, in 1996, and to investigate how that correlated with federal health spending in 1997. METHODS: Multiple regression analysis was used to investigate the association between federal health care funding and proportional mortality, supply of health services (hospitals and outpatient clinics), and the municipality's population (number of inhabitants). Also investigated was the association between mortality from broad groups of causes and socioeconomic structure, supply of health services, and the municipality's population. RESULTS: The multiple regression analysis showed an association between proportional mortality due to: 1) infectious diseases and: infant mortality, number of non-doctor medical professionals per 10,000 inhabitants, and number of physicians per 10,000 inhabitants (negative association); 2) chronic degenerative diseases and: percentage of individuals 60 years and older, infant mortality (negative association), and number of non-doctor medical professionals per 10,000 inhabitants (negative association); and 3) external causes of death and: the municipality's population, number of hospitals per 10,000 inhabitants (negative association), and percentage of children younger than 1 year. Health spending per inhabitant in 1997 was mainly associated with the municipality's population, number of outpatient clinics per 10,000 inhabitants, Swaroop and Uemura mortality rate, and deaths due to chronic degenerative diseases in 1996. CONCLUSIONS: Municipalities with a better morbidity and mortality profile and a better health services structure received more federal health care resources. To improve this situation, special strategies should be considered in order to ensure additional resources for municipalities that have poorer health indicators.     

Attitude of medical students towards psychiatry

Findings are presented from a survey of all medical students at the College of Medicine, Abha, Saudi Arabia dealing with students' attitudes towards specialization in psychiatry. The health region of Asir in south-west rural Saudi Arabia, of about one million inhabitants, needs Saudi Nationals to specialize in psychiatry to provide planned future delivery of services. Medical students all over Saudi Arabia, however, have not been choosing psychiatry for their specialization after graduation. The Scientific Committee for Mental Health, convened at the Ministry of Health in Riyadh in February 1986, invited representatives of psychiatry from medical schools in the nation to discuss this priority topic. A year later, a new course called 'Introduction to Psychosomatic Medicine' was introduced as an elective for medical students with its practice at the general hospital. It tries to introduce students to 'voluntary and active as against passive learning ... and problem-solving rather than imposed memorizing' of medicalized forms of psychiatry, an innovation compared with the previous conventional method. A significant difference in attitude was demonstrated between students who had their exposure to psychiatry from this course and those who followed only the conventional methods of learning.     

World health dilemmas: Orphan and rare diseases,orphan drugs and orphan patients

According to global annual estimates hunger/malnutrition is the major cause of death (36 of 62 million). Cardiovascular diseases and cancer (5.44 of 13.43 million) are the major causes of death in developed countries, while lower respiratory tract infections, human immunodeficiency virus infection/acquired immunodeficiency syndrome, diarrhoeal disease, malaria and tuberculosis (10.88 of 27.12 million) are the major causes of death in developing countries with more than 70% of deaths occurring in children. The majority of approximately 800 million people with other rare diseases, including 100000 children born with thalassaemia annually receive no treatment. There are major ethical dilemmas in dealing with global health issues such as poverty and the treatment of orphan and rare diseases. Of approximately 50000 drugs about 10% are orphan drugs, with annual sales of the latter approaching 100 billion USD. In comparison, the annual revenue in 2009 from the top 12 pharmaceutical companies in Western countries was 445 billion USD and the top drug, atorvastatin, reached 100 billion USD. In the same year, the total government expenditure for health in the developing countries was 410 billion USD with only 6%-7% having been received as aid from developed countries. Drugs cost the National Health Service in the United Kingdom more than 20 billion USD or 10% of the annual health budget. Uncontrollable drug prices and marketing policies affect global health budgets, clinical practice, patient safety and survival. Fines of 5.3 billion USD were imposed on two pharmaceutical companies in the United States, the regulatory authority in France was replaced and clinicians were charged with bribery in order to overcome recent illegal practises affecting patient care. High expenditure for drug development is mainly related to marketing costs. However, only 2 million USD was spent developing the drug deferiprone (L1) for thalassaemia up to the stage of multicentre clinical trials. The criteria for drug development, price levels and use needs to be readdressed to improve drug safety and minimise costs. New global health policies based on cheaper drugs can help the treatment of many categories of orphan and rare diseases and millions of orphan patients in developing and developed countries.     

Homicide trends and characteristics--Brazil, 1980-2002

Brazil is the largest and most populous country in South America (2002 population: approximately 175 million) (Brazilian Geography and Statistics Institute [BGSI], unpublished data, 2004). Although life expectancy in Brazil has increased and rates of infant mortality have decreased as a result of reductions in infectious disease mortality, homicide and other forms of injury-related mortality have increased as a proportion of overall mortality. Homicide is now the leading cause of death for persons aged 15-44 years. To describe trends and characteristics of homicides countrywide and in S?o Paulo city (2000 population: approximately 10.4 million) (BGSI, unpublished data, 2004), the State Health Department of S?o Paulo (SHDSP) analyzed vital statistics and census data for 1980-2002. This report summarizes the results of that analysis, which indicated that the homicide rate in Brazil more than doubled during this period. Since 2001, Brazilian authorities have implemented several initiatives to reduce the number of homicides, including a law that controls gun ownership and prohibits anyone other than police and members of the armed forces from carrying guns. However, homicides among adolescents and young adults remain a substantial public health problem in Brazil, and additional prevention strategies that target young persons are needed.     

Academy of Nutrition and Dietetics: Revised 2018 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent,Proficient, and Expert) in Mental Health and Addictions

In 2016, there were 44.7 million adults affected by mental illness, and 20.1 million people aged 12 years or older affected by substance use disorder. More than 8.2 million Americans are afflicted with co-occurring disorders or dual diagnosis, such as both a mental illness and an addiction. Registered dietitian nutritionists (RDNs) have an important role in the treatment of this population, as optimizing nutrition status improves cognitive and emotional functioning. The Behavioral Health Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Mental Health and Addictions for three levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for care of individuals with mental illness and/or addictions. The SOPP describes six domains that focus on professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs caring for individuals with, or specializing in, mental health and addictions and practicing in other mental health and addictions-related areas, including research. The SOP and SOPP are intended to be used by RDNs for self-evaluation to assure competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.     

Financial costs of deworming children in all primary schools in Cambodia

In 2002, Cambodia's Ministry of Health launched a deworming programme to deliver an anthelmintic drug (mebendazole 500 mg) and health education to 75% of its school children twice a year. Cambodia's school population is approximately 2.8 million. The deworming programme was organized into two phases: the first phase (December 2002-March 2003) targeted more than one million school children from 11 provinces; and the second phase (July 2003-January 2004) targeted the entire school population. The cost to treat each child was 12 cents (0.11 USD) during the first phase, 6 cents during the second phase, and 3 cents for re-treatment in areas where the campaign was conducted for the second time. The Cambodian experience demonstrates that, with political commitment, high coverage for deworming is achievable even in a country with minimal resources. Cambodia's deworming programme represents a successful model for other developing countries.     

The forsaken mental health of the Indigenous Peoples - a moral case of outrageous exclusion in Latin America

Background  

Mental health is neglected in most parts of the world. For the Indigenous Peoples of Latin America, the plight is even more severe as there are no specific mental health services designed for them altogether. Given the high importance of mental health for general health, the status quo is unacceptable. Lack of research on the subject of Indigenous Peoples' mental health means that statistics are virtually unavailable. To illustrate their mental health status, one can nonetheless point to the high rates of poverty and extreme poverty in their communities, overcrowded housing, illiteracy, and lack of basic sanitary services such as water, electricity and sewage. At the dawn of the XXI century, they remain poor, powerless, and voiceless. They remain severely excluded from mainstream society despite being the first inhabitants of this continent and being an estimated of 48 million people. This paper comments, specifically, on the limited impact of the Pan American Health Organization's mental health initiative on the Indigenous Peoples of Latin America.     

Evaluation of the impact of the Family Health Program on infant mortality in Brazil, 1990-2002

OBJECTIVE: To use publicly available secondary data to assess the impact of Brazil's Family Health Program on state level infant mortality rates (IMR) during the 1990s. DESIGN: Longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measures of access to clean water and sanitation, average income, women's literacy and fertility, physicians and nurses per 10,000 population, and hospital beds per 1,000 population. Additional analyses controlled for immunisation coverage and tested interactions between Family Health Program and proportionate mortality from diarrhoea and acute respiratory infections. SETTING: 13 years (1990-2002) of data from 27 Brazilian states. MAIN RESULTS: From 1990 to 2002 IMR declined from 49.7 to 28.9 per 1,000 live births. During the same period average Family Health Program coverage increased from 0% to 36%. A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p<0.01). Access to clean water and hospital beds per 1,000 were negatively associated with IMR, while female illiteracy, fertility rates, and mean income were positively associated with IMR. Examination of interactions between Family Health Program coverage and diarrhoea deaths suggests the programme may reduce IMR at least partly through reductions in diarrhoea deaths. Interactions with deaths from acute respiratory infections were ambiguous. CONCLUSIONS: The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil. Existing secondary datasets provide an important tool for evaluation of the effectiveness of health services in Brazil.     

Immunization programme against hepatitis B virus infection in Italy: cost-effectiveness

In Italy in the 1980s the extent of viral hepatitis B infection was on average about 11,000 symptomatic cases of acute viral hepatitis (AVH) per year (19/100,000 inhabitants). The prevalence of HBsAg carriers in the general population was about 3% and in pregnant women 2.4%. 64,000 people were affected by chronic viral hepatitis (CVH) or cirrhosis (prevalence rate 112/100,000) and 3400 by hepatocellular carcinoma (HCC) (prevalence rate 5.9/100,000). To reduce these HBV related pathologies in the Italian population, universal vaccination of newborn babies, 12-year old adolescents and high risk groups was implemented in 1991. The annual cost of this immunization is about 57 million 544 thousand USD: direct costs: 41 million 34 thousand USD; indirect costs: 16 million 510 thousand USD. Concerning the vaccination impact on HBV endemicity in Italy, we found a significant reduction of acute viral hepatitis incidence (4.2/100,000 in 1996 versus 19/100,000 in the '80s) and HBsAg carrier prevalence (0.9% in 1997 versus 3% in the '80s). As for the assistance and social cost of acute viral hepatitis occurring from 1991 to 1996 (17,608 cases) it was 238 million 908 thousand USD, while the cost for the same pathology in the years from 1985 to 1990 (35,614 cases) was 483 million 216 thousand USD. Thus, the saving during the years of the vaccination was evaluated in 244 million 308 thousand USD. At the moment, we have no information about the reduction in chronic sequelae of HBV pathology as an effect of the vaccination, because the incidence of this pathology generally starts to appear after 15 years (in our case in 2006).     

Cost-effectiveness of conjugate pneumococcal vaccination in Singapore: comparing estimates for 7-valent, 10-valent, and 13-valent vaccines

Introduction

Although multiple studies of cost-effectiveness of pneumococcal conjugate vaccines have been conducted, no such study has examined Singapore's situation nor compared the licensed conjugate vaccines in an Asian population. This paper estimates the costs and public health impacts of pneumococcal conjugate vaccine programs, varying estimates of serotype replacement and herd immunity effects as key parameters in the analysis. Based in part on a 2008 analysis also presented here, Singapore has approved the PCV-7, PHiD-10, and PCV-13 pneumococcal conjugate vaccines as part of its National Childhood Immunisation Programme.

Methods

An economic evaluation was performed using a Markov simulation model populated with Singapore-specific population parameters, vaccine costs, treatment costs, and disease incidence data. The vaccinated infant and child cohort of 226,000 was 6% of the Singapore resident population of 3.8 million. Vaccine efficacy estimates were constructed for PCV-7, PHiD-10, and PCV-13 vaccines based on their serotype coverage in Singapore and compared to ‘no vaccination’. The model estimated impacts over a five-year time horizon with 3% per year discounting of costs and health effects. Costs were presented in 2010 U.S. dollars (USD) and Singapore dollars (SGD). Sensitivity analyses included varying herd immunity, serotype replacement rates, vaccine cost, and efficacy against acute otitis media.

Results

Under base case assumptions for the revised analysis (i.e., herd effects in the unvaccinated population equivalent to 20% of direct effects) PCV-13 prevented 834 cases and 7 deaths due to pneumonia, meningitis, and bacteremia in the vaccinated population, and 952 cases and 191 deaths in the unvaccinated population over the 5-year time horizon. Including herd effects, the cost-effectiveness ratio for PCV-13 was USD $37,644 (SGD $51,854) per QALY. Without herd effects, however, the ratio was USD $204,535 (SGD $281,743) per QALY. The PCV-7 cost per QALY including herd effects was USD $43,275 (SGD $59,610) and for PHiD-10 the ratios were USD $45,100 (SGD $62,125). The original 2008 analysis, which had higher estimates of pneumonia prevention due to herd immunity and lower estimates of cost per dose, had found a cost-effectiveness ratio of USD $5562 (SGD $7661) per QALY for PCV-7.

Conclusions

When compared to cost-effectiveness thresholds recommended by the World Health Organization (WHO), our 2008 analysis found that vaccination of infants in Singapore with PCV-7 was very cost-effective if herd immunity effects were present. However, knowledge on herd immunity and serotype replacement that emerged subsequent to this analysis changed our expectations about indirect effects. Given these changed inputs, our current estimates of infant vaccination against pneumococcal disease in Singapore find such programs to be moderately cost-effective compared to WHO thresholds. The different findings from the 2008 and 2011 analyses suggest that the dynamic issue of serotype replacement should be monitored post-licensure and, as changes occur, vaccine effectiveness and cost-effectiveness analyses should be re-evaluated.     

Air pollution and children's health in São Paulo (1986-1998)

Air pollution in the conurbation of S?o Paulo, Brazil, with 17 million inhabitants, has been measured from air quality monitoring stations. In three contrasted sample areas, children's respiratory health parameters were collected to assess the role of air pollution in 1986. Twelve years later, in 1998, a similar study was undertaken to evaluate the impact of pollution control programs on the respiratory symptoms of children living in the same neighborhoods previously studied. Results indicated that pollution control programs were in part neutralized by increased number of cars and that the control of a single pollutant was not enough to protect children's health. In the area where both particulate matter and sulfur dioxide levels decreased, there was a reduction in the prevalence of respiratory symptoms.     

Analysis of nursing dissertations and theses on mental health, Brazil, 1979-2007

This bibliographic study analyzes scientific texts published in the CEPEn database in the mental health field (1979-2007). A total of 280 abstracts were investigated, of which 208 were Master's theses. The individuals investigated in these studies were professionals (57), patients (50), and professors and/or students (18). Among the themes addressed between 2000 and 2007 were the following: Nursing Care in Mental Health (40), Perception in Mental Health (37); and Transversality in Mental Health Care (27). This study provided an overview of the scientific research produced in the mental health field in Brazilian nursing graduate programs. We expect this study to elicit reflections concerning mental health care practice and enable new approaches for nursing promoting health and the prevention of diseases in order to enable patients to recover their citizenship, autonomy and quality of life.     

Population-based linkage of health records in Western Australia: development of a health services research linked database

OBJECTIVES: To introduce the Western Australian Health Services Research Linked Database as infrastructure to support aetiologic, utilisation and outcomes research. To compare the study population, data resources, technical systems and organisational supports with international best practice in record linkage and health research. METHOD AND RESULTS: The WA Linked Database systematically links the available administrative health data within an Australian State of 1.7 million people. It brings together, initially, six core data elements (birth records, midwives' notifications, cancer registrations, in-patient hospital morbidity, in-patient and public out-patient mental health services data and death records). It will be updated regularly and is designed, in future extensions, to include data on primary, residential and domiciliary care and health surveys. Linkage uses probabilistic matching of patient names and other identifiers. Geocodes for spatial analysis are assigned using address linkage and mapping software. By June 1997, the project had taken 2 1/2 years to develop the system and link seven million core data records from 1980 to 1995. CONCLUSIONS: The system is consistent with international benchmarks, from four centres of excellence, for the study population, core datasets, matching and geocoding, and collaborative networks. There are prospects to redress deficiencies in primary medical contact and other data resources, validation studies, tracing systems and a more supportive legal framework. IMPLICATIONS: The WA Linked Database will be used in combination with medical record audits to provide a comprehensive evaluation of health system performance.     

Die Versorgungssituation psychischer Störungen in Deutschland Eine klinisch-epidemiologische Abschätzung anhand des Bundes-Gesundheitssurveys 1998

Data from the German Health Interview and Examination Survey, Mental Health Supplement (N=4181) reveal that 32% (15,6 million people) of the adult population between 18 and 65 years of age suffer from one or more mental disorders. Among those only 36% receive treatment which also varies in type, duration, and adequacy. The proportion of cases receiving “adequate evidence- based treatments” was estimated to be about 10%. Lowest treatment rates were found for somatoform disorders and substance abuses, highest for psychotic disorders, panic disorder, generalised anxiety disorder, and dysthymia. The data reveal substantial regional differences with regard to treatment rates (e.g. lower rates in regions without universities or institutions offering postgraduate mental health education). The paper concludes that, depending on the diagnosis, a considerable degree of unmet medical needs exist for the majority of people affected by mental disorders. No evidence was found for an excessive supply of health care for the patients suffering from mental disorders or for treatments without an existing clinical need.