Negotiating antiretroviral drug prices: the experience of the Andean countries

OBJECTIVES: This study analyses the effect of the Andean countries' June 2003 negotiation of antiretroviral drug (ARV) prices. The objectives were to assess the problems faced during the negotiation process, to evaluate the impact of the negotiation on ARV prices, and to identify factors that could make it difficult for countries to implement the results of the negotiation. METHODS: Price information of ARVs purchased by public programmes during 2004 was collected from the ministries of health. A survey of the ministries of health was conducted using a questionnaire with information related to the countries' health care and drug regulations and policies. Interviews with a convenient sample of key Andean health authorities and other stakeholders were also conducted. RESULTS: Study results show that the negotiation did achieve lower prices and higher quality and bioequivalence standards for ARVs. However, in general, the public health care programmes of the six countries analysed did not purchase ARVs from the companies that participated in the negotiation, nor did they base purchases on the prices or quality and bioequivalence criteria established in the negotiation. Prices paid by the Andean countries' public programmes in 2004 were a weighted average of 65% higher than the negotiated prices; and this difference in negotiated prices vs. actual prices represented 39.5% of the programmes' ARV expenditures in 2004, or US$18 million in ARV expenditures. CONCLUSION: The successful development and implementation of multinational price negotiations requires that participant countries coordinate pharmaceutical regulations and policies, and pool procurement processes.     

Electronic monitoring of variation in drug intakes can reduce bias and improve precision in pharmacokinetic/pharmacodynamic population studies

Population pharmacokinetic (PK) and pharmacodynamic (PD) studies evaluate drug concentration profiles and pharmacological effects over time when standard drug dosage regimens are assigned. They constitute a scientific basis for the determination of the optimal dosage of a new drug. Population PK/PD analyses can be performed on relatively few measures per patient enabling the study of a sizable sample of patients who take the drug over a possibly long period of time. We expose the problem of bias in PK/PD estimators in the presence of partial compliance with assigned treatment as it occurs in practice. We propose to solve this by recording accurate data on a number of previous dose timings and using timing-explicit hierarchical non-linear models for analysis. In practice, we rely on electronic measures of an ambulatory patient's drug dosing histories. Especially for non-linear PD estimation, we found that not only bias can be reduced, but higher precision can also be retrieved from the same number of data points when irregular drug intake times occur in well-controlled studies. We apply methods proposed by Mentré et al. to investigate the information matrix for hierarchical non-linear models. This confirms that a substantial gain in precision can be expected due to irregular drug intakes. Intuitively, this is explained by the fact that regular takers experience a relatively small range of concentrations, which makes it hard to estimate any deviation from linearity in the effect model. We conclude that estimators of PK/PD parameters can benefit greatly from information that enters through greater variation in the drug exposure process.     

Psychosocial working conditions and psychological well-being among employees in 34 European countries

Purpose

The aim of this study was to explore the associations between psychosocial working conditions and psychological well-being among employees in 34 European countries. Another objective was to examine whether these associations varied according to occupation and country.

Methods

The study was based on data from the European Working Conditions Survey 2010 including 33,443 employees, 16,512 men and 16,931 women, from 34 European countries. Well-being was measured by the WHO-5 well-being index. Twenty-five psychosocial work factors were constructed including job demands, role stressors, work hours, job influence and freedom, job promotion, job insecurity, social support, quality of leadership, discrimination and violence at work, and work-life imbalance. The associations between these factors and well-being were examined using multilevel logistic regression analyses. Different models were performed including interaction tests.

Results

When all 25 psychosocial work factors were studied simultaneously in the same model with adjustment variables, 13 showed a significant association with poor well-being among both genders: quantitative demands, demands for hiding emotions, low possibilities for development, low meaning of work, low role conflict, low quality of leadership, low social support, low sense of community, job insecurity, low job promotion, work-life imbalance, discrimination, and bullying. The association with low sense of community on poor well-being was particularly strong.

Conclusions

A large number of psychosocial work factors were associated with poor well-being. Almost no country and occupational differences were found in these associations. This study gave a first European overview and could be useful to inform cross-national policy debate.     

职业女性工作家庭冲突状况及其与社会支持和主观幸福感的关系

目的 了解职业女性工作家庭冲突状况及其与社会支持、主观幸福感的关系,为指导职业女性职业生涯发展、提升家庭生活质量提供依据.方法 采用Carlson(2000)编制的工作家庭冲突量表(the work Family Conflict Inventory,WFCI)的中文修订版、社会支持评定量表、Diener人(1985)编制的主观幸福感问卷,对全国在岗的230名职业女性进行问卷调查.结果 职业女性面临较普遍的工作家庭冲突;工作家庭冲突显著影响职业女性的主观幸福感,基于时间的工作-家庭冲突与基于压力的工作-家庭冲突对其主观幸福感有非常显著的影响(t=-2.61,P ＜0.01;t=-0.129,P ＜0.05):负向作用于主观幸福感;社会支持与主观幸福感显著相关(r =0.223,P＜0.01);社会支持对工作家庭冲突、主观幸福感之间有一定的调节作用,达到显著水平(β=0.753,P＜0.01).结论 职业女性存在较普遍的工作家庭冲突,工作家庭冲突对其主观幸福感有负面影响,社会支持能提升其主观幸福感,社会支持对工作家庭冲突与主观幸福感之间有一定的调节作用.     

延边地区空巢老年人主观幸福感与社会支持相关分析

摘要:目的　了解延边地区空巢老年人的主观幸福感和社会支持情况,为社区空巢老年人的健康服务提供科学依据。方法　对延边地区518名空巢老年人进行主观幸福感和社会支持的调查。结果　空巢老年人主观幸福感得分为（31.26±10.25）分,不同人口学特征人群得分差异具有统计学意义;社会支持得分为（35.43±7.57）分;主观幸福感与社会支持正相关（r＝0.386,P＜0.01）。结论　延边地区空巢老年人主观幸福感水平和全国其他地区相比偏低,社会支持处于中等水平。在社区医疗护理服务中注重空巢老年人的健康管理,除了传统的健康管理外应加大心理支持,提高空巢老年人的生活质量。     

Setting cost-effectiveness thresholds as a means to achieve appropriate drug prices in rich and poor countries

Finding better mechanisms to enable differential pricing that reflects different degrees of willingness to pay across countries with different income levels is an important challenge for drug manufacturers and policy makers. Drug prices must be high enough to meet manufacturers' needs--covering costs and ensuring adequate investment in research and development, as well as producing a profit--but low enough to allow consumers access to medicines that they need. Examining drug pricing, we found that in rich countries, insurance coverage can make consumers insensitive to price, which means that manufacturers' prices are largely unrestrained unless payers intervene. In middle- and low-income countries, where most consumers pay for drugs out of pocket, we found that the poorest countries face the highest prices, relative to their mean per capita income. We recommend that countries and payers set their own cost-effectiveness thresholds to reflect how much they are willing to pay for "health gain"--in other words, for a measured improvement in the health of a person or a population. Adopting this approach broadly should lead to appropriate price differences across and within countries, benefiting consumers and manufacturers alike.     

幼儿教师职业倦怠、社会支持与主观幸福感的关系

摘要:目的　了解幼儿教师职业倦怠、社会支持与主观幸福感的关系,为提升幼儿教师主观幸福感水平提供理论依据。方法　采用Maslach职业倦怠量表、社会支持评定量表与世界卫生组织生活质量测定简表中文版,调查贵州省403名幼儿教师。结果　职业倦怠与社会支持和主观幸福感各因子均呈负相关（r值分别为-0.345～-0.125,P值均＜0.01）;社会支持与主观幸福感各因子均呈正相关（r值分别为0.185～0.282,P值均＜0.01）。职业倦怠与社会支持对主观幸福感都有直接影响（直接效应值分别为-0.46,0.30,P值均＜0.001）;职业倦怠还以社会支持为中介变量对主观幸福感产生间接影响（中介效应值为0.07,P＜0.05）。结论　职业倦怠与社会支持是影响幼儿教师主观幸福感的重要因素,职业倦怠与主观幸福感之间,社会支持起部分中介作用。     

空巢老人人格特征、社会支持与其主观幸福感之间关系研究

目的 调查空巢老人主观幸福感与其人格特征、社会支持之间的关系,为提高空巢老人的主观幸福感水平提供一定理论依据。方法 随机抽取朝阳市三个县615名空巢老人为研究对象,使用一般资料调查表、人格特征评定量表、社会支持量表、主观幸福感量表对615名空巢老人进行问卷调查,使用结构方程模型对社会支持在人格特征对主观幸福感的中介作用进行分析,并应用Bootstrap方法对其中介作用进行验证。结果 空巢老人人格特征得分（51.55±4.86）分,社会支持得分（43.16±3.26）分,主观幸福感得分为（29.83±1.38）分,空巢老人人格特征与社会支持之间呈负相关（r=-0.441,P<0.001）,与主观幸福感之间也呈负相关（r=-0.559,P<0.001）,空巢老人社会支持与主观幸福感之间呈正向相关关系（r=0.487,P<0.001）。结论 空巢老人的人格特征和社会支持是其主观幸福感的两个影响因素,且社会支持在人格特征对主观幸福感之间存在着中介效应。     

Education and audit can improve the identification of excessive drinkers among medical inpatients

This study investigated the effect of education and audit on the identification and management of medical inpatients with excessive alcohol consumptions by use of a cross-sectional survey of medical and nursing notes, compared with historical controls. We report the proportion of medical and nursing notes containing qualitative and quantitative drinking histories, the use of the CAGE questionnaire, and notification of alcohol consumption in discharge summaries. A total of 1,979 out of 2,680 (74%) notes of eligible patients were examined. The number of medical notes containing quantitative alcohol histories rose from 175/792 (22%) among historical controls, to 242/690 (35%) after training of junior medical and nursing staff, and to 241/497 (48%) after feedback of results in a clinical audit meeting. The number of medical notes with no recorded alcohol history changed from 309/792 (39%) to 287/690 (42%) to 152/497 (31%), respectively (chi 2 for trend = 97.2, p < 0.0001). The number of nursing notes containing quantified alcohol histories rose from 31/792 (4%) among historical controls, to 123/690 (18%) after training, and to 237/497 (48%) after feedback of results in a clinical audit meeting. The number of nursing notes with no recorded alcohol history fell from 309/792 (90%), to 512/690 (74%), to 205/497 (41%) respectively (chi 2 for trend = 353.7, p < 0.0001). The proportion of patients found to be drinking excessively rose from 40/792 (5.1%) to 57/690 (8.3%) to 45/497 (9.1%) (chi 2 for trend = 8.25, p = 0.004). There was little worthwhile improvement in use of the CAGE questionnaire and in discharge summaries. Education and audit are effective ways of improving the identification of excessive drinkers by both junior doctors and nurses alike. Other aspects of management are less responsive.     

Exploring household income as a predictor of psychological well-being among long-term colorectal cancer survivors

Purpose  The purpose of this analysis was to determine the unique contribution of household income to the variance explained in psychological well-being (PWB) among a sample of colorectal cancer (CRC) survivors. Methods  This study is a secondary analysis of data collected as part of the Health-Related Quality of Life in Long-Term Colorectal Cancer Survivors Study, which included CRC survivors with (cases) and without (controls) ostomies. The dataset included socio-demographic, health status, and health-related quality of life (HRQOL) information. HRQOL was assessed with the modified City of Hope Quality of Life (mCOH-QOL)-Ostomy questionnaire and SF-36v2. To assess the relationship between income and PWB, a hierarchical linear regression model was constructed combining data from both cases and controls. Results  After accounting for the proportion of variance in PWB explained by the other independent variables in the model, the additional variance explained by income was significant (R ² increased from 0.228 to 0.250; P = 0.006). Conclusions  Although the study design does not allow causal inference, these results demonstrate a significant relationship between income and PWB in CRC survivors. The findings suggest that for non-randomized group comparisons of HRQOL, income should, at the very least, be included as a control variable in the analysis.     

中学生社会适应基本心理需要在领悟社会支持与幸福感间的中介作用

了解中学生社会支持、社会适应、基本心理需要与幸福感的关系,为维护和促进中学生的健康和谐发展提供依据.方法 采用领悟社会支持量表、中学生社会适应量表、基本心理需要量表和中学生多元幸福感问卷,对随机抽取的云南省芒市1 413名中学生进行调查.结果 女生领悟社会支持和社会适应得分分别为(3.67±0.74)(3.85±0.65)分,明显高于男生的(2.73±0.35)(2.82±0.36)分(t值分别为-4.55,-4.37,P值均<0.01);初中生的领悟社会支持和社会适应得分分别为(3.83±0.67)(3.72±0.71)分,明显高于高中生的(2.82±0.39)(2.74±0.31)分(t值分别为2.75,3.91,P值均<0.01).中学生领悟社会支持、社会适应、基本心理需要和幸福感之间均存在正相关(r值分别为0.473 ~0.643,P值均<0.01).领悟社会支持可直接对中学生的幸福感产生正向预测作用(β=0.27,t=11.93,P<0.01),也可通过社会适应、基本心理需要的部分中介对幸福感产生影响,3个变量可累积解释幸福感变异的51.3%.结论 中学生的领悟社会支持、社会适应、基本心理需要与幸福感具有正相关,领悟社会支持、社会适应和基本心理需要对中学生的幸福感具有正向预测效应.     

Vaccination coverage among social and healthcare workers in ten countries of Samu-social international sites

BackgroundWe aim to determine the vaccination coverage of social and healthcare workers in International sites of Samusocial, providing emergency care to homeless people, and to assess factors associated with having received necessary doses at adulthood.MethodsData on immunization coverage of social and healthcare workers were provided by a cross-sectional survey, conducted from February to April 2015 among 252 Samusocial workers in 10 countries. Vaccination status and characteristics of participants were collected through a self-administered questionnaire. Prevalence rate ratio (PRR) of vaccination status was calculated using Poisson regression models.ResultsAmong 252 Samusocial social and health workers who felt a questionnaire, median age was 39 years, 42.1% were female, 88.9% were in contact with homeless beneficiaries (19.1% health workers). Overall, 90.1% of Samusocial staff felt adult vaccinations was useful and 70.2% wished to receive booster doses in future. Vaccination coverage at adulthood was satisfactory for diphtheria and poliomyelitis (96%), but low for influenza (20.8%), meningococcus (50.5%), hepatitis B (56.3%), yellow fever (58.1%), measles (81.3%) and pertussis (90.7%). The main reasons for not having received vaccination booster doses were forgetting the dates of booster doses (38.4%) and not having received the information (13.5%). In adjusted analysis, prevalence of up-to-date for vaccination schedule was 35% higher among health workers than among social workers (aPRR = 1.35, 95%CI: 1.01–1.82, P = 0.05) and was 56% higher among workers who had a documentary evidence of vaccination than in those who did not (aPRR = 1.56, 95%CI: 1.19–2.02, P = 0.001).ConclusionsThe Samusocial International workers vaccine coverage at adulthood was insufficient and disparate by region. It is necessary to strengthen the outreach of this staff and increase immunization policy for hepatitis B, diphtheria, tetanus, and measles, as well as for yellow fever, rabies and meningococcal ACYW135 vaccines in at risk regions.     

知识、态度、社会规范对青少年新型毒品使用的影响研究

目的研究知识、态度和社会规范与青少年新型毒品使用之间的关系并构建影响模式。方法采用分层随机整群抽样的方法进行抽样。来自武汉市初中、高中、职业高中和大学的共3018名学生参加了问卷调查，调查是无记名和自愿的。采用确证性因子分析构建测量模型，采用结构方法模型进行评价、修正以确定最佳模型。结果武汉市青少年新型毒品的滥用率为3．28％，其中男女生分别为4．81％和1．94％，普通初中、高中、职业高中和大学生的毒品滥用率分别为1．80％、2．91％、7．83％和3．25％。模型拟和效果较好。模型结果显示：知识、态度、社会规范影响青少年使用新型毒品，其中态度、社会规范直接影响青少年吸毒或吸毒倾向，而知识通过态度、社会规范的中介作用发挥效应。结论对新型毒品的了解不足、对待毒品的态度不正确以及吸毒社会规范不强增加青少年使用新型毒品的风险。     

Partnerships among community development, public health, and health care could improve the well-being of low-income people

Safe, vibrant neighborhoods are vital to health. The community development "industry"-a network of nonprofit service providers, real estate developers, financial institutions, foundations, and government-draws on public subsidies and other financing to transform impoverished neighborhoods into better-functioning communities. Although such activity positively affects the "upstream" causes of poor health, the community development industry rarely collaborates with the health sector or even considers health effects in its work. Examples of initiatives-such as the creation of affordable housing that avoids nursing home placement-suggest a strong potential for cross-sector collaborations to reduce health disparities and slow the growth of health care spending, while at the same time improving economic and social well-being in America's most disadvantaged communities. We propose a four-point plan to help ensure that these collaborations achieve positive outcomes and sustainable progress for residents and investors alike.     

Alcohol and drug problems among diverse health and social service populations.

OBJECTIVES. This study responds to clinical and research interest in identifying alcohol- and drug-related problems in health and social service agency populations. These problems are associated with a variety of illnesses and social problems, and community agencies serve important screening functions. METHODS. Indicators of problematic alcohol and drug use are compared across representative samples of clients within a county's alcohol, mental health, and drug treatment systems; hospital emergency rooms; primary health clinics; criminal justice and welfare systems; and general population. RESULTS. Agencies followed a consistent rank ordering in the prevalence of substance abuse indicators. Highest prevalences were found in the populations of behavioral health agencies, including alcohol, drug, and mental health treatment facilities and criminal justice, followed by welfare agencies. General medical agencies served populations with the lowest prevalence and problem severity. CONCLUSION. Health and social service agencies provide significant opportunities for the screening and referral of individuals with problematic alcohol and drug use. Although behavioral agencies have higher potential for referral and intervention, general medical services may be more effective in conducting prevention and early case-finding activities.     

应对方式在老年住院患者主观幸福感与社会支持间中介效应分析

目的 探讨老年住院患者主观幸福感与社会支持、应对方式的相关性,对应对方式的中介效应进行分析。方法 从辽宁省锦州市2所三甲医院的住院患者中方便抽取住院老年人600名,使用一般资料调查表,社会支持评定量表（SSRS）、简易应对方式量表（SCSQ）和纽芬兰纪念大学幸福度量表（MUNSH）进行调查,运用SPSS21.0、AMOS22.0软件和PRODCLIN程序对收集的数据进行统计分析。结果 社会支持与积极应对呈正向关联（r = 0.428,P＜0.001）,与消极应对呈负相关联（r = -0.610,P＜0.001）,与主观幸福感呈正相关联（r = 0.532,P ＜0.001）;主观幸福感与积极应对呈正相关联（r = 0.473,P ＜0.001）,与消极应对呈负相关联（r = -0.639,P ＜0.001）;社会支持各维度对主观幸福感预测作用均有统计学意义;积极应对方式对主观幸福感的正向预测作用有统计学意义,消极应对方式对主观幸福感的负向预测作用有统计学意义;应对方式在社会支持与主观幸福感间起部分中介效应,中介效应占总效应的48.6%（0.358/0.736）。结论 应对方式在老年住院患者主观幸福感与社会支持间起部分中介效应。