Reducing health care costs - potential and limitations of local authority health services

Local authorities (LAs) currently provide preventive and promotive services. It is argued that, by extending the role of the LA to the provision of comprehensive services, including ambulatory and hospital curative care, both the quality and the cost-effectiveness of health care would be improved.Making health care the responsibility of the LA would minimise fragmentation, allow for the provision of a number of services that currently are neglected because they fall through the gap that exists between preventive and curative services, and result in the more effective use of personnel currently restricted to providing preventive care only.LAs offer an appropriate structure for effective community control over the health services, and are more likely to be sensitive to local needs and demands. In addition, their administrative proximity to other LA departments responsible for housing, town planning and parks and recreation allows for an effective multisectoral approach to health.The positive aspects of LA care can only be achieved in the context of racially integrated services provided by an LA elected by universal adult franchise. Smaller LAs may need to be grouped together in larger units for the purpose of achieving satisfactory economies of scale in the provision of health care

Africa’s neglected area of human resources for health research – the way forward

Building the skills for doing, managing and delivering healthresearch is essential for every country’s development. Yet humanresources for health research (HRHR) are seldom considered inAfrica and elsewhere. Africa’s health research capacity has grownconsiderably, with potential to increase this growth. However, asystemic way of defining, co-ordinating and growing the HRHRneeded to support health systems development is missing.Reviewing the status of HRHR in Africa, we assert that it consistsof unco-ordinated, small-scale activities, primarily driven fromoutside Africa. We present examples of ongoing HRHR capacitybuilding initiatives in Africa. There is no overarching framework, strategy or body for African countries to optimise research support and capacity in HRHR. A simple model is presented to help countries plan and strategisefor a comprehensive approach to research capacity strengthening.Everyone engaged with global, regional and national researchfor health enterprises must proactively address human resourceplanning for health research in Africa. Unless this is made explicitin global and national agendas, Africa will remain only an interestedspectator in the decisions, prioritisation, funding allocations,conduct and interpretation, and in the institutional, economic andsocial benefits of health research, rather than owning and drivingits own health research agendas

The reliability of mortality data in Johannesburg

Infonnation on deaths in Johannesburg is collected on a voluntary basis by the Johannesburg City Health Department from the Department of Home Affairs regional offices as well as state mortuaries in the area. The reliability of these routinely collected data was assessed. Records of deaths of Asians, coloureds and whites from 1 July 1989 to 31 December 1989 were included in the study. Burial orders obtained from the different cemeteries and crematoria in the area were compared with the routinely collected mortality data. Two thousand eight hundred and thirty-seven deaths were included in the study. One hundred and ninety (6%) deaths in the department's records could not be found among the corresponding burial orders while 1 019 (36%) burial order records were not found among the department's routinely collected mortality data. Underreporting of deaths was greatest among the aged (43%) and infants (39%). When this underreporting was taken into account, the corrected infant mortality rate was 19,111 000 live births as opposed to 14,1. Recommendations are made for the improvement ofthe quality of routinely collected mortality data

Africa's neglected area of human resources for health research - the way forward

Building the skills for doing, managing and delivering health research is essential for every country's development. Yet, human resources for health research (HRHR) are seldom considered in Africa and elsewhere. Africa’s health research capacity has grown considerably, with potential to increase this growth. However, a systemic way of defining, co-ordinating and growing the HRHR needed to support health systems development is missing. Reviewing the status of HRHR in Africa, we assert that it consists of unco-ordinated, small-scale activities, primarily driven from outside Africa. We present examples of ongoing HRHR capacity building initiatives in Africa. There is no overarching framework, strategy or body for African countries to optimise research support and capacity in HRHR. A simple model is presented to help countries plan and strategise for a comprehensive approach to research capacity strengthening. Everyone engaged with global, regional and national research for health enterprises must proactively address human resource planning for health research in Africa. Unless this is made explicit in global and national agendas, Africa will remain only an interested spectator in the decisions, prioritisation, funding allocations, conduct and interpretation, and in the institutional, economic and social benefits of health research, rather than owning and driving its own health research agendas

Comparison between the STENTYS self-apposing bare metal and paclitaxel-eluting coronary stents for the treatment of saphenous vein grafts (ADEPT trial)

Aims To describe the safety and performance of STENTYS self-expandable bare metal stents (BMS) versus paclitaxel-eluting stents (PES) in saphenous vein grafts (SVGs). Methods and Results A randomised controlled trial was performed in four hospitals in three European countries between December 2011 and December 2013. Patients with de novo lesions (>50% stenosis) in an SVG with a diameter between 2.5–6 mm were included. Primary endpoint was late lumen loss at 6 months. Secondary endpoints included procedural success and the occurrence of major adverse cardiac events (MACE) at 12 months. A total of 57 patients were randomised to STENTYS self-apposing BMS (n = 27) or PES (n = 30). Procedural success was obtained in 89.5%. No significant differences in late lumen loss were found between BMS and PES at 6 months (0.53 mm vs 0.47; p = 0.86). MACE rates at 12 months were comparable in both groups (BMS 22.2% vs. PES 26.7%; p = 0.70). Conclusions Treatment of SVGs with STENTYS self-expandable stents is safe and effective. No significant differences were found in late lumen loss and MACE between BMS and PES

Post COVID-19 implications on genetic diversity and genomics research & innovation: A call for governance and research capacity. White paper.

This is the final version. Available from the Food and Agriculture Organisation via the DOI in this record. At a time of significant technological change and digitization in the biological sciences, the COVID19 pandemic has highlighted again the inequities in the research and innovation ecosystem. Based on a consultation with an internationally diverse group of stakeholders from multiple fields and professions, and on a broadly representative set of case studies, this report offers a new approach to the global governance of genetic diversity and genomic research and innovation. We recommend that in addition to the many valuable efforts at the macro-policy level and at the micro-level of projects, teams and organizations, the global community concerned with genetic diversity and genomic research and innovation should devise and implement a meso-level initiative that includes three main components: 1. First, it should establish a new professional capacity to govern research and innovation at the meso-level. Governance capacity, built through a networked community of practice, has the benefit of connecting and integrating macrolevel policy intentions with micro-level actions. It facilitates a consistent professional basis from which local and regional level flexibilities can generate new norms of reflection that better integrate multiple synergies, reconcile tensions, recognize inequities, and redress persistent inequalities. 2. Second, the global community should redouble efforts to build research capacity in genomic research and innovation in the Global South and for Indigenous Peoples. Such an effort should be focused on broader programmatic objectives that facilitate cross-national and cross-regional collaboration, as well as enhancing research communities in the Global South and in Indigenous communities. Together, the twin capacities of governance and research can reduce power differentials among diverse actors and support crisisbased imperatives for data openness. 3. Third, we recommend that existing global policy frameworks interface with research governance and capacity investment. This meso-level approach should gain the commitment and support from national and international policy bodies, embedded within existing specific issue-areas (health, agriculture, environment). A new approach, one that can better respond to global crises though more open, inclusive and equitable participation in research and innovation, is necessary to resolve the tensions among openness, innovation and equity that the current discourse on genetic diversity reiterates. Failure to systematically address the social and technical governance challenges will result in further fragmentation, inequity and vulnerability for decades to come. Conversely, investing in the current historical moment of the pandemic to build twin capacities for meso-level governance and research is poised to prevent and/or reduce the impact of future ecological crises, while contributing to planetary sustainability and prosperity in the 21st century for current and future generations.European CommissionAlan Turing Institut