Challenges and issues in drug utilization research identified from the Latin American and African regions

Background: Despite advancements in drug utilization research (DUR), these have not been universal. Some regions such as the Latin America (LatAm) and African regions are facing challenges that are impeding the development of DUR. Objectives: To identify the main challenges and issues for DUR in the LatAm and African regions Methods: A collaborative initiative by the International Society of Pharmacoepidemiology Global Development Committee in partnership with the Latin America Drug Utilization Group and the Medicines Utilization Research in Africa Group was undertaken. A comprehensive literature review was conducted to identify local and international DUR publications. A core group of investigators and experts in DUR reviewed the publications and identified the main methodological challenges and issues. Subsequently, the group exchanged materials, participated in WebEx discussions, and reviewed the draft document. Results: Main issues: 1) Socioeconomic: high unemployment rate with poor standard of living, socioeconomic inequalities, low literacy levels, urban segregation, high migration rates, high rates of violent crime including drug trafficking and possession. 2) Healthcare-related: Disparities of social determinants of health, differences in the quality of public and private health sectors; and epidemiologic transition from communicable diseases to non-communicable diseases. Most health care systems are fragmented with variable access to medical care and medicines, and substandard record keeping. 3) Drug utilization-related: Inappropriate use of medicines including the elderly; limited infrastructure to reliably collect DU data; over-prescription of antimicrobials; polypharmacy; high rates of self-medication; and poor patient adherence (e.g. HIV/AIDS, diabetes mellitus and hypertension). Planning for DUR is affected by the multiplicity of drug distribution channels; trading in sub-standard, counterfeit medicines and insufficient quality control centers. Some publications are generated by local investigators, often suffering of methodological issues such as lack of representativeness of the population, limited data validity, and small sample sizes. Conclusions: There are common challenges for DUR when working within the LatAm and African regions. Based on our findings, the group is developing Guidance on Good Practices of Drug Utilization Research in those regions to assist researchers with issues pertaining to the planning, conduct, and evaluation of DUR

Challenges facing drug utilization research in the Latin American region

Purpose: The International Society of Pharmacoepidemiology (ISPE) in collaboration with the Latin America Drug Utilization Research Group (LatAm DURG), the Medicines Utilization Research in Africa (MURIA) group, and the Uppsala Monitoring Center, is leading an initiative to understand challenges to drug utilization research (DUR) in the Latin American (LatAm) and African regions with the goal of communicating results and proposing solutions to these challenges in four scientific publications. The purpose of this first manuscript is to identify the main challenges associated with DUR in the LatAm region. Methods: Drug utilization (DU) researchers in the LatAm region voluntarily participated in multiple discussions, contributed with local data and reviewed successive drafts and the final manuscript. Additionally, we carried out a literature review to identify the most relevant publications related to DU studies from the LatAm region. Results: Multiple challenges were identified in the LatAm region for DUR including socioeconomic inequality, access to medical care, complexity of the healthcare system, limited investment in research and development, limited institutional and organization resources, language barriers, limited health education and literacy. Further, there is limited use of local DUR data by decision makers particularly in the identification of emerging health needs coming from social and demographic transitions. Conclusions: The LatAm region faces challenges to DUR which are inherent in the healthcare and political systems, and potential solutions should target changes to the system

Data sources for drug utilization research in Latin American countries - a cross-national study : DASDUR-LATAM study

PURPOSE: Drug utilization research (DUR) contributes to inform policymaking and to strengthen health systems. The availability of data sources is the first step for conducting DUR. However, documents that systematize these data sources in Latin American (LatAm) countries are not known. We compiled the potential data sources for DUR in the LatAm region. METHODS: A network of DUR experts from nine LatAm countries was assembled and experts conducted: (i) a website search of the government, academic, and private health institutions; (ii) screening of eligible data sources, and (iii) liaising with national experts in pharmacoepidemiology (via an online survey). The data sources were characterized by accessibility, geographic granularity, setting, sector of the data, sources and type of the data. Descriptive analyses were performed. RESULTS: We identified 125 data sources for DUR in nine LatAm countries. Thirty-eight (30%) of them were publicly and conveniently available; 89 (71%) were accessible with limitations, and 18 (14%) were not accessible or lacked clear rules for data access. From the 125 data sources, 76 (61%) were from the public sector only; 46 (37%) were from pharmacy records; 43 (34%) came from ambulatory settings and; 85 (68%) gave access to individual patient-level data. CONCLUSIONS: Although multiple sources for DUR are available in LatAm countries, the accessibility is a major challenge. The procedures for accessing DUR data should be transparent, feasible, affordable, and protocol-driven. This inventory could permit a comparison of drug utilization between countries identifying potential medication-related problems that need further exploration

XV International Congress of Control Electronics and Telecommunications: "The role of technology in times of pandemic and post-pandemic: innovation and development for strategic social and productive sectors"

La anterior selección, motivados por la aseveración de Manuel Castells -hace casi 20 años ya- que la innovación y la difusión de la tecnología parecía ser la herramienta apropiada para el desarrollo en la era de la información. Este 2020, sin embargo, ante la situación disruptiva que aquejó y aqueja a la sociedad red como una estructura social emergente de la Era de la Información basada en redes de producción, energizadas por el poder y la experiencia; falló y debe reencontrar su rumbo. Es así que los problemas acuciantes, ahora, fueron: la atención sanitaria y la superación de la epidemia de Sars Cov 2; tomó forma la, hasta entonces, visión irrealista de Castells que … no podemos avanzar con nuestros modelos de desarrollo actual, destruyendo nuestro entorno y excluyendo a la mayor parte de la humanidad de los beneficios de la revolución tecnológica más extraordinaria de la historia, sin sufrir una devastadora reacción por parte de la sociedad y la naturaleza. Fue así que el Cuarto Mundo, específicamente, donde la suficiencia de recurso humano, de capital, trabajo, información y mercado -vinculados todos a través de la tecnología- supuso que atendería eficazmente a través de la población que podía por su capacidad hacer uso racional y profesional del conocimiento, las necesidades de la mayoritaria población vulnerable y vulnerada. Por lo anterior, poner en el centro a las personas, en entornos de tarea y trabajo globales hiperconectados combinando espacios físicos, corrientes de información con canales de conexión expeditos, y formando profesionales del conocimiento que asuman y afronten los retos derivados de la transformación digital de empresas, universidades, y organizaciones, pero en condiciones de equidad y sujetos de prosperidad, será el desafío en los escenarios presentes y futuros inmediatos.The previous selection, motivated by the assertion of Manuel Castells -almost 20 years ago- that innovation and diffusion of technology seemed to be the appropriate tool for development in the information age. This 2020, however, in the face of the disruptive situation that afflicted and continues to afflict the network society as an emerging social structure of the Information Age based on production networks, energized by power and experience; He failed and must find his way again. Thus, the pressing problems now were: health care and overcoming the Sars Cov 2 epidemic; Castells' until then unrealistic vision took shape that... we cannot advance with our current development models, destroying our environment and excluding the majority of humanity from the benefits of the most extraordinary technological revolution in history, without suffering a devastating reaction from society and nature. It was thus that the Fourth World, specifically, where the sufficiency of human resources, capital, work, information and market - all linked through technology - meant that it would serve effectively through the population that could, due to its capacity, make rational use. and knowledge professional, the needs of the majority vulnerable and vulnerable population. Therefore, putting people at the center, in hyperconnected global task and work environments, combining physical spaces, information flows with expedited connection channels, and training knowledge professionals who assume and face the challenges derived from the digital transformation of companies, universities, and organizations, but in conditions of equality and subject to prosperity, will be the challenge in the present and immediate future scenarios.Bogot

Ultrahigh-energy neutrino follow-up of gravitational wave events GW150914 and GW151226 with the Pierre Auger Observatory

International audienceOn September 14, 2015 the Advanced LIGO detectors observed their first gravitational-wave (GW) transient GW150914. This was followed by a second GW event observed on December 26, 2015. Both events were inferred to have arisen from the merger of black holes in binary systems. Such a system may emit neutrinos if there are magnetic fields and disk debris remaining from the formation of the two black holes. With the surface detector array of the Pierre Auger Observatory we can search for neutrinos with energy above 100 PeV from point-like sources across the sky with equatorial declination from about -65 deg. to +60 deg., and in particular from a fraction of the 90% confidence-level (CL) inferred positions in the sky of GW150914 and GW151226. A targeted search for highly-inclined extensive air showers, produced either by interactions of downward-going neutrinos of all flavors in the atmosphere or by the decays of tau leptons originating from tau-neutrino interactions in the Earth's crust (Earth-skimming neutrinos), yielded no candidates in the Auger data collected within $\pm 500$ s around or 1 day after the coordinated universal time (UTC) of GW150914 and GW151226, as well as in the same search periods relative to the UTC time of the GW candidate event LVT151012. From the non-observation we constrain the amount of energy radiated in ultrahigh-energy neutrinos from such remarkable events

Horse Population by Province, 2009-2016

We present a search for ultrarelativistic magnetic monopoles with the Pierre Auger observatory. Such particles, possibly a relic of phase transitions in the early Universe, would deposit a large amount of energy along their path through the atmosphere, comparable to that of ultrahigh-energy cosmic rays (UHECRs). The air-shower profile of a magnetic monopole can be effectively distinguished by the fluorescence detector from that of standard UHECRs. No candidate was found in the data collected between 2004 and 2012, with an expected background of less than 0.1 event from UHECRs. The corresponding 90% confidence level (C.L.) upper limits on the flux of ultrarelativistic magnetic monopoles range from 10$^{-19}$(cm$^2$ sr s)$^{−1}$ for a Lorentz factor γ=10$^9$ to 2.5×10$^{-21}$(cm$^2$ sr s)$^{−1}$ for γ=10$^{12}$. These results—the first obtained with a UHECR detector—improve previously published limits by up to an order of magnitude

Number of Hajj Pilgrims Departured(1) to the Holyland of Mecca by Province, 2012–2015

The azimuthal asymmetry in the risetime of signals in Auger surface detector stations is a source of information on shower development. The azimuthal asymmetry is due to a combination of the longitudinal evolution of the shower and geometrical effects related to the angles of incidence of the particles into the detectors. The magnitude of the effect depends upon the zenith angle and state of development of the shower and thus provides a novel observable, (secθ)max, sensitive to the mass composition of cosmic rays above 3×1018 eV. By comparing measurements with predictions from shower simulations, we find for both of our adopted models of hadronic physics (QGSJETII-04 and EPOS-LHC) an indication that the mean cosmic-ray mass increases slowly with energy, as has been inferred from other studies. However, the mass estimates are dependent on the shower model and on the range of distance from the shower core selected. Thus the method has uncovered further deficiencies in our understanding of shower modeling that must be resolved before the mass composition can be inferred from (secθ)max