The impact of the COVID-19 pandemic on children and adolescent mental health in-patient service use in England: interrupted time-series analysis of national patient records

Background During the initial phases of the COVID-19 pandemic, children and young people (CYP) faced significant restrictions. The virus and mitigation approaches significantly impacted how health services could function and be safely delivered. Aims To investigate the impact of COVID-19 lockdowns on CYP psychiatric admission trends during lockdown 1 (started 23 Mar 2020) and lockdown 2 (started 5 Nov 2020) of the COVID-19 pandemic in England. Method Routinely collected, retrospective English administrative data regarding psychiatric hospital admissions, length of stay and patient demographic factors were analysed using an interrupted time series analysis (ITSA) to estimate the impact of COVID-19 lockdowns 1 and 2 on service use trends. We analysed data of 6250 CYP (up to 18 years of age) using ordinary least squares (OLS) regression analysis with Newey–West standard errors to handle autocorrelation and heteroscedasticity. Results Psychiatric hospital admissions for CYP significantly fell during lockdown 1, and then fell even further during lockdown 2. A greater proportion of admissions during lockdown were out of area or to independent sector units. During lockdown, the average age of CYP admitted was higher, and a greater proportion were female. There was also a significant increase in the proportion of looked-after children and CYP from the most socioeconomically deprived areas admitted during lockdown 2. Conclusions During both lockdowns, fewer CYP had psychiatric admissions. The subsequent rise in admissions for more socioeconomically deprived CYP and looked-after children suggests that these CYP may have been disproportionately affected by the pandemic, or overlooked during earlier phases

The impact of protection of the intellectual property rights on the pharmaceutical market in India

India is struggling not only against communicable diseases but also carries a large burden of non-communicable diseases. India is one of the 10 countries hosting 75% of the children who had not received vaccines for vaccine preventable diseases, like diphtheria, pertusis and tetanus. The diseases caused by Haemophilus, Pneumococcus and Rotaviruses, which are causing 2.1 million deaths in all age groups worldwide, have not even nudged the Indian government to provide access to the appropriate vaccines. For the pharmaceutical industry, R&D (research & development) on vaccines is not that profitable as the purchases are made by the government and moreover, the use is only for one time. There is a lack of vaccine coverage in the developing world and there is a growing need for developing new and better vaccines

Health economic aspects in the management of bipolar disorder

Bipolar disorder (BD) is one of the leading causes of disability worldwide and has a detrimental impact on health-related quality of life (HRQoL), and personal and social functioning. Despite this, there is insufficient knowledge of the costs, HRQoL implications relevant to BD, and the cost-effectiveness of current treatments for BD in the UK. This thesis aims to inform decisions about local and national service provision by applying a variety of health economic tools to build an economic case for BD. First, economic evaluations of BD management strategies are systematically reviewed. A cost-of-illness study is then conducted to estimate the societal burden of BD in the UK and explore the factors that drive variations in these costs. The appropriateness of applying the EQ-5D-3L outcome measure in BD is assessed, and the feasibility of mapping disease-specific measures to the EQ-5D-3L is explored. Finally, a cost-utility analysis (CUA) is conducted to bring together evidence on the costs and outcomes associated with alternative psychological interventions in BD management. This thesis makes critical contributions to multiple research domains, informing the allocation of scarce healthcare resources in this context. There is a sheer dearth of evidence on cost-effectiveness strategies for the long-term management of BD in the UK, especially the evidence for psychological therapies is limited. The annual societal costs associated with BD in the UK are estimated to be £5.14 billion, demonstrating the significant economic burden associated with this disease. The EQ-5D-3L instrument is found to be useful in measuring HRQoL in BD patients who predominantly experience depressive symptoms but is not sensitive enough to detect changes in individuals with mania. More psychometric evidence is therefore required before this instrument can be widely applied in economic evaluations of BD-related interventions. Finally, the CUA indicates that a novel structured psychoeducation intervention in individuals on remote mood monitoring in the UK is not cost-effective.</p

Health economic aspects in the management of bipolar disorder

Bipolar disorder (BD) is one of the leading causes of disability worldwide and has a detrimental impact on health-related quality of life (HRQoL), and personal and social functioning. Despite this, there is insufficient knowledge of the costs, HRQoL implications relevant to BD, and the cost-effectiveness of current treatments for BD in the UK. This thesis aims to inform decisions about local and national service provision by applying a variety of health economic tools to build an economic case for BD. First, economic evaluations of BD management strategies are systematically reviewed. A cost-of-illness study is then conducted to estimate the societal burden of BD in the UK and explore the factors that drive variations in these costs. The appropriateness of applying the EQ-5D-3L outcome measure in BD is assessed, and the feasibility of mapping disease-specific measures to the EQ-5D-3L is explored. Finally, a cost-utility analysis (CUA) is conducted to bring together evidence on the costs and outcomes associated with alternative psychological interventions in BD management. This thesis makes critical contributions to multiple research domains, informing the allocation of scarce healthcare resources in this context. There is a sheer dearth of evidence on cost-effectiveness strategies for the long-term management of BD in the UK, especially the evidence for psychological therapies is limited. The annual societal costs associated with BD in the UK are estimated to be £5.14 billion, demonstrating the significant economic burden associated with this disease. The EQ-5D-3L instrument is found to be useful in measuring HRQoL in BD patients who predominantly experience depressive symptoms but is not sensitive enough to detect changes in individuals with mania. More psychometric evidence is therefore required before this instrument can be widely applied in economic evaluations of BD-related interventions. Finally, the CUA indicates that a novel structured psychoeducation intervention in individuals on remote mood monitoring in the UK is not cost-effective.</p

Wpływ ochrony praw własności intelektualnej na rynek leków w Indiach

Artykuł opisuje wpływ, jaki na system opieki zdrowotnej w Indiach wywiera realizacja ochrony praw własności intelektualnej w obszarze leków. Wpływ porozumień TRIPS na innowację farmaceutyczną, dotąd uważany głównie za pozytywny, jest obecnie poddawany analizom i dyskutowany. Porozumienia TRIPS w dużej mierze pomogły rozwinąć przedsiębiorczość w Indiach i wpłynęły na zorientowanie jej na rynki krajów rozwiniętych. Przemysł farmaceutyczny w Indiach przeszedł ewolucję trójfazową, w latach 70. ubiegłego wieku rozwijając się praktycznie od podstaw. Obecnie indyjska produkcja farmaceutyczna zaspokaja prawie 95% potrzeb lekowych całego kraju. Na podstawie schematu SWOT w artykule przeprowadzono analizę wpływu TRIPS na indyjski przemysł farmaceutyczny

The impact of protection of the intellectual property rights on the pharmaceutical market in India

India is struggling not only against communicable diseases but also carries a large burden of non-communicable diseases. India is one of the 10 countries hosting 75% of the children who had not received vaccines for vaccine preventable diseases, like diphtheria, pertusis and tetanus. The diseases caused by Haemophilus, Pneumococcus and Rotaviruses, which are causing 2.1 million deaths in all age groups worldwide, have not even nudged the Indian government to provide access to the appropriate vaccines. For the pharmaceutical industry, R&amp;D (research &amp; development) on vaccines is not that profitable as the purchases are made by the government and moreover, the use is only for one time. There is a lack of vaccine coverage in the developing world and there is a growing need for developing new and better vaccines

When prison is "easier": probationers' perceptions of health and wellbeing

Purpose: there are currently over 300,000 offenders in England and Wales and the majority, around 240,000, are in the community on probation. However, there is a paucity of research on their health and healthcare needs. The purpose of this paper is to explore issues around health and access to health services for those on probation. In particular the paper explores what people on probation consider to be the key health issues currently affecting them, and to identify barriers to accessing healthcare in the community.Design/methodology/approach: the authors ran six focus groups with a total of 41 participants; two were with staff and the others with men and women on probation. In each focus group, the researchers used semi-structured guide and the discussions were recorded electronically and then transcribed. The paper adopted a thematic analytical framework and used NVivo 7 to facilitate analysis.Findings: both probationers and professionals largely agreed about the key issues which included substance use and mental health problems. However, the most important issue for probationers was dealing with the stress of being on probation which was not generally recognised by professionals. All participants recognised the impact of issues such as housing, finances and employment on the wellbeing of probationers and were concerned about the lack of access to health services, in particular mental health and alcohol services.Research limitations/implications: this was a small study conducted in one part of England and therefore it is not clear that the findings are generalisable. However, it raises important issues about the mental health needs of probationers and the lack of appropriate services for them. Effective services may have positive impact on re-offending and further research is needed to evaluate models of care.Practical implications: the challenge remains for local health service commissioners and providers and the probation service to work together to provide appropriate and accessible services for all those on probation.Originality/value: nearly one-quarter of a million people are on probation at any one time in the UK but the existing evidence on their health is patchy and dated. Little is known about effective health interventions or the extent to which their health needs are met. This study shows that probationers see the stress of being on probation as their most important health concern. Both probationers and staff recognise that mental health and substance use are persistent problems and that these important health needs in these areas are not being met by existing services.</p

Funding of health care in India in the context of country development and overall health system goals

India is a pluralistic, multilingual and multi-ethnic country located in Southeast Asia. It is the 2nd largest populated country which has the 7th position in the geographical area. Since 1990 India has emerged as one of the wealthiest economies in the developing world. Recently it is the second fastest growing major economy in the world. Despite the fact that economical development in India has been accompanied by increases in life expectancy, literacy rates and food security, India’s performance in the area of health care has been still far from satisfactory. The system of financing health care as a one of the most privatized in the world faces especially many problems. This paper would therefore attempt to describe and assess the system of financing health care in India. In order to outline to the readers the overall country context the first section will provide a brief description of the demographic, economic and health profile of the Indian population. The second and third sections will present the main methods of funding health care in India as well as and the budget of health care system. The concluding section would attempt to assess the financing system in India and offer a way forward for the better achievement of health care system goals