Access to essential medicines in Pakistan: policy and health systems research concerns.

NTRODUCTION: Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i) gaps related to access to essential medicine in Pakistan; and ii) prioritization of emerging policy and research concerns. METHODS: An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder\u27s Roundtable. FINDINGS: A synthesis of evidence found major gaps in essential medicine access in Pakistan driven by weaknesses in the health care system as well as weak pharmaceutical regulation. 7 major policy concerns and 11 emerging research concerns were identified through consultative Roundtable. These related to weaknesses in medicine registration and quality assurance systems, unclear and counterproductive pricing policies, irrational prescribing and sub-optimal drug availability. Available research, both locally and globally, fails to target most of the identified policy concerns, tending to concentrate on irrational prescriptions. It overlooks trans-disciplinary areas of policy effectiveness surveillance, consumer behavior, operational pilots and pricing interventions review. CONCLUSION: Experience from Pakistan shows that policy concerns related to essential medicine access need integrated responses across various components of the health systems, are poorly addressed by existing evidence, and require an expanded health systems research agenda

Numerical investigation of the Arctic ice–ocean boundary layer and implications for air–sea gas fluxes

© The Author(s), 2017. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Ocean Science 13 (2017): 61-75, doi:10.5194/os-13-61-2017.In ice-covered regions it is challenging to determine constituent budgets – for heat and momentum, but also for biologically and climatically active gases like carbon dioxide and methane. The harsh environment and relative data scarcity make it difficult to characterize even the physical properties of the ocean surface. Here, we sought to evaluate if numerical model output helps us to better estimate the physical forcing that drives the air–sea gas exchange rate (k) in sea ice zones. We used the budget of radioactive 222Rn in the mixed layer to illustrate the effect that sea ice forcing has on gas budgets and air–sea gas exchange. Appropriate constraint of the 222Rn budget requires estimates of sea ice velocity, concentration, mixed-layer depth, and water velocities, as well as their evolution in time and space along the Lagrangian drift track of a mixed-layer water parcel. We used 36, 9 and 2 km horizontal resolution of regional Massachusetts Institute of Technology general circulation model (MITgcm) configuration with fine vertical spacing to evaluate the capability of the model to reproduce these parameters. We then compared the model results to existing field data including satellite, moorings and ice-tethered profilers. We found that mode sea ice coverage agrees with satellite-derived observation 88 to 98 % of the time when averaged over the Beaufort Gyre, and model sea ice speeds have 82 % correlation with observations. The model demonstrated the capacity to capture the broad trends in the mixed layer, although with a significant bias. Model water velocities showed only 29 % correlation with point-wise in situ data. This correlation remained low in all three model resolution simulations and we argued that is largely due to the quality of the input atmospheric forcing. Overall, we found that even the coarse-resolution model can make a modest contribution to gas exchange parameterization, by resolving the time variation of parameters that drive the 222Rn budget, including rate of mixed-layer change and sea ice forcings.Funding for this research was provided by the NSF Arctic Natural Sciences program through Award # 1203558

Bibliographic review of research publications on access to and use of medicines in low-income and middle-income countries in the Eastern Mediterranean Region: identifying the research gaps.

BJECTIVES: We assessed the situation of academic publications on access to and use of medicines (ATM) in low-income and middle-income countries (LMICs) of the Eastern Mediterranean Region (EMR). We aimed to inform priority setting for research on ATM in the region. DESIGN: Bibliographic review of published studies. SETTING: LMICs in EMR. INCLUSION CRITERIA: Publications on ATM issues originating from or focusing on EMR LMICs covering the period 2000-2011. Publications involving multinational studies were included if at least one eligible country had been included in the study. INFORMATION SOURCES AND DATA EXTRACTION: We conducted comprehensive searches of the PubMed, Social Science Citation Index and Science Citation Index. We used the WHO ATM framework for data extraction and synthesis. We analysed the data according to the ATM issues, health system levels, year of publication and the countries of origin or focus of the studies. RESULTS: 151 articles met the inclusion criteria. Most articles (77%) originated from LMICs in EMR, suggesting that the majority of evidence on ATM in the region is home-grown. Over 60% of articles were from Iran, Pakistan, Jordan and Lebanon (in order of volume), while we found no studies assessing ATM in Somalia, Djibouti and South Sudan, all low-income countries. Most studies focused on the rational use of medicines, while affordability and financing received limited attention. There was a steady growth over time in the number of ATM publications in the region (r=0.87). CONCLUSIONS: There is a growing trend, over the years, of more studies from the region appearing in international journals. There is a need for further research on the financing and affordability aspects of ATM in the region. Cross-border issues and the roles of non-health sectors in access to medicines in the region have not been explored widely

How well does wind speed predict air-sea gas transfer in the sea ice zone? A synthesis of radon deficit profiles in the upper water column of the Arctic Ocean

Author Posting. © American Geophysical Union, 2017. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Oceans 122 (2017): 3696–3714, doi:10.1002/2016JC012460.We present 34 profiles of radon-deficit from the ice-ocean boundary layer of the Beaufort Sea. Including these 34, there are presently 58 published radon-deficit estimates of air-sea gas transfer velocity (k) in the Arctic Ocean; 52 of these estimates were derived from water covered by 10% sea ice or more. The average value of k collected since 2011 is 4.0 ± 1.2 m d−1. This exceeds the quadratic wind speed prediction of weighted kws = 2.85 m d−1 with mean-weighted wind speed of 6.4 m s−1. We show how ice cover changes the mixed-layer radon budget, and yields an “effective gas transfer velocity.” We use these 58 estimates to statistically evaluate the suitability of a wind speed parameterization for k, when the ocean surface is ice covered. Whereas the six profiles taken from the open ocean indicate a statistically good fit to wind speed parameterizations, the same parameterizations could not reproduce k from the sea ice zone. We conclude that techniques for estimating k in the open ocean cannot be similarly applied to determine k in the presence of sea ice. The magnitude of k through gaps in the ice may reach high values as ice cover increases, possibly as a result of focused turbulence dissipation at openings in the free surface. These 58 profiles are presently the most complete set of estimates of k across seasons and variable ice cover; as dissolved tracer budgets they reflect air-sea gas exchange with no impact from air-ice gas exchange.NSF Arctic Natural Sciences program Grant Number: 12035582017-11-0

Evaluation of the Beliefs of Parents in Iran about How to Care for Children During Dental Visits

Parents play an important role in their children’s dental care and in their behavior during dental visits. Separating children from their parents during dental visits has been a challenging subject of debate for many years. Therefore, this study aims to evaluate parents’ attitudes about being present during their children’s visits to the dentist. The subjects for this cross-sectional study included 340 Iranian parents of five-10-year-old children who had been referred to dental clinics in Kerman, Iran. For this study, the parents of these children completed self-administered questionnaires. Results showed that 218 parents (64.1%) agreed with leaving the practice room during their child’s treatment, while 122 (35.9%) did not agree. The main reason expressed by 41.3% of the parents for leaving the practicing room was that the dentist would be better able to control the child if they were alone. Another reason, cited by 16.5% of the parents, was not wanting to see their child suffering, and 42.2% said they believed that their child would be better treated if they were not present. Most parents who were in agreement with leaving the practice room while their child was receiving dental care felt this would lead to a better treatment outcome

Essential medicines for universal health coverage

Основные лекарства удовлетворяют приоритетные потребности населения в области здравоохранения. Политика, основанная на концепции основных лекарств, имеет решающее значение в улучшении здоровья и достижении устойчивого развития. Цель устойчивого развития 3.8 конкретно упоминает важность «доступности безопасных, эффективных, качественных и доступных по цене основных лекарств и вакцин для всех» в качестве центрального компонента всеобщего охвата медицинской помощью (ВОМП), а цель устойчивого развития 3.b подчёркивает необходимость разработки лекарств для устранения постоянно возникающих пробелов в отношении лечения. Признание важности основных лекарств - не новость. В 1985 г. на конференции в Найроби по рациональному использованию лекарств представители правительств и другие заинтересованные стороны предложили всеобъемлющий комплекс мер по разработке политики в области основных лекарств. Через 30 лет была созвана «Комиссия журнала Ланцет (Lancet) по основным лекарствам» (далее Комиссия) для изучения следующих вопросов: Какого прогресса удалось достичь? Какие проблемы ещё остаются для решения? Какие уроки были извлечены для информирования будущих подходов? И как можно использовать политику в области основных лекарств для продвижения ВОМП и внесения вклада в повестку глобального устойчивого развития? В настоящем докладе рассмотрены эти вопросы с намерением репозиционировать политику в области основных лекарств в повестке глобального развития. Комиссия определила пять областей, имеющих решающее значение для политики в области основных лекарств: оплата корзины основных лекарств, обеспечение ценовой доступности основных лекарств, гарантия их качества и безопасности, мероприятия, способствующие их качественному использованию, и разработка недостающих (отсутствующих) основных лекарств. Комиссия позиционировала политику в области основных лекарств в контексте текущих глобальных дебатов о балансировании политики в области торговли и интеллектуальной собственности с правами человека, об обеспечении безопасности здравоохранения, укреплении систем здравоохранения, ориентированных на людей, и улучшении доступности основных технологий. Во всех областях политики особое внимание было уделено совершенствованию принципов равенства и справедливости в доступе, укреплению соответствующих институтов и созданию подотчётности. В каждой из определённых областей Комиссия сформулировала рекомендации к действию, подтвердив тем самым позицию политики в области основных лекарств в качестве центрального компонента глобального здоровья и здравоохранения и повестки развития

A news media analysis of economic sanction effects on access to medicine in Iran

Objective: In the past decades economic sanctions have been used by different countries or international organizations in order to deprive target countries of some transactions. While the sanctions do not target health care systems or public health structures, they may, in fact, affect the availability of health care in target countries. In this study, we used media analysis to assess the impacts of recent sanctions imposed by the Central Bank of Iran in 2012 on access to medicines in Iran. Methods: We searched different sources of written news media including a database of nonspecialized weeklies and magazines, online news sources, web pages of daily newspapers and healthcare oriented weeklies from 2011 to 2013. We searched the sources using the general term "medicine" to reduce the chances of missing relevant items. The identified news media were read, and categorized under three groups of items announcing "shortage of medicines," "medicines related issues" and "no shortage." We conducted trend analyzes to see whether the news media related to access to medicines were affected by the economic sanctions. Findings: A total number of 371 relevant news media were collected. The number of news media related to medicines substantially increased in the study period: 30 (8%), 161 (43%) and 180 (49%) were published in 2011, 2012 and 2013, respectively. While 145 (39%) of media items referred to the shortage of medicines, 97 (26%) reported no shortage or alleviating of concerns. Conclusion: Media analysis suggests a clear increase in the number of news media reporting a shortage in Iran after the sanctions. In 2013, there were accompanying increases in the number of news media reporting alleviation of the shortages of medicines. Our analysis provides evidence of negative effects of the sanctions on access to medicines in Iran