The international community can best support countries to implement progressive universal health coverage by financing population, policy, and implementation research, such as on the mechanics of ...designing and implementing evolution of the benefits package as the resource envelope for public finance grows. Antimicrobials based on a new mechanism of action Combined diarrhoea vaccine (rotavirus, enterotoxigenic Escherichia coli, typhoid, and shigella); protein-based universal pneumococcal vaccine; respiratory syncytial virus vaccine; hepatitis C vaccine ..
The problems are systemic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader ...contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health-system performance. Major findings Worldwide, 2420 medical schools, 467 schools or departments of public health, and an indeterminate number of postsecondary nursing educational institutions train about 1 million new doctors, nurses, midwives, and public health professionals every year.
All for universal health coverage Garrett, Laurie, PhD; Chowdhury, A Mushtaque R, PhD; Pablos-Méndez, Ariel, MD
The Lancet (British edition),
10/2009, Letnik:
374, Številka:
9697
Journal Article
Recenzirano
Since the mid-20th century, most nations have signed many accords, establishing that provision of health is a fundamental human right;1-4 health for all should be not only an aspirational target but ...also an essential framework for the United Nations system;5,6 international donor mechanisms should include support for essential health systems and health-workforce development;7,8 poor population health contributes to social and economic instability and undermines development eff orts;9 and specifi c targets for country achievements in health should be set, and funded, through international instruments. Yet, the full bill for health spending in the world may already surpass $6 trillion or 10% of the global gross domestic product (GDP), and the fi nancing challenges in low-income and middle-income countries will increasingly be domestic, just as they are in high-income countries.11 There is increasing appreciation of the links between disease and population health and nations' security, foreign policy, economic, and general social wellbeing.12-14 Amid the unfolding H1N1A infl uenza pandemic, political leaders everywhere are appreciating the strong link between health systems in low-income and middle-income countries, and the ability of the global scientifi c community to acquire real-time assessments of epidemic spread and clinical eff ect. ... new threats to health arising from climate disruption suggest the need for vast infrastructures of adaptation to population-scale health disasters resulting from rising global carbon dioxide concentrations: catastrophic weather events, drought, heatstroke and dehydration, new infectious diseases emergence, food and malnutrition crises, and human migrations.15 On an immediate basis, the global campaign to provide antiretroviral drugs to people with HIV living in low-income countries, coupled with the worldwide increase in cancer, cardiovascular disease, diabetes, and other long-term management ailments, have prompted a shift in thinking about global health.
BACKGROUND: Poor adherence to antituberculosis treatment is the most important obstacle to tuberculosis control.
PURPOSE: To identify and analyze predictors and consequences of nonadherence to ...antituberculosis treatment.
PATIENTS AND METHODS: Retrospective study of a citywide cohort of 184 patients with tuberculosis in New York City, newly diagnosed by culture in April 1991—before the strengthening of its control program—and followed up through 1994. Follow-up information was collected through the New York City tuberculosis registry. Nonadherence was defined as treatment default for at least 2 months.
RESULTS: Eighty-eight of the 184 (48%) patients were nonadherent. Greater nonadherence was noted among blacks (unadjusted relative risk RR 3.0, 95% confidence interval CI 1.1 to 8.6, compared with whites), injection drug users (RR 1.5, 95% CI 1.1 to 2.0), homeless (RR 1.4, 95% CI 1.0 to 1.8), alcoholics (RR 1.4, 95% CI 1.0 to 1.9), and HIV-infected patients (RR 1.4, 95% CI 1.1 to 1.9); also, census-derived estimates of household income were lower among nonadherent patients (
P = 0.018). In multivariate analysis, only injection drug use and homelessness predicted nonadherence, yet 46 (39%) of 117 patients who were neither homeless nor drug users were nonadherent. Nonadherent patients took longer to convert to negative culture (254 versus 64 days,
P <0.001), were more likely to acquire drug resistance (RR 5.6, 95% CI 0.7 to 44.2), required longer treatment regimens (560 versus 324 days,
P <0.0001), and were less likely to complete treatment (RR 0.5, 95% CI 0.4 to 0.7). There was no association between treatment adherence and all-cause mortality.
CONCLUSIONS: In the absence of public health intervention, half the patients defaulted treatment for 2 months or longer. Although common among the homeless and injection drug users, the problem occurred frequently and unpredictably in other patients. Nonadherence may contribute to the spread of tuberculosis and the emergence of drug resistance, and may increase the cost of treatment. These data lend support to directly observed therapy in tuberculosis.
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