Background: Asthma and COPD cause a high burden of morbidity and mortality in low- and middle-income countries (LMICs). Access to quality-assured, affordable essential medicines is variable. Methods: We performed a systematic literature review, searching 7 databases to identify articles published between 01.01.2010–22.11.2021 (PROSPERO: CRD42021281069). Original studies of named World Health Organization (WHO) Essential Medicines for asthma and COPD in LMICs were included. 2 authors screened, extracted data and assessed bias independently. The outcomes were availability (WHO target of 80%), cost (compared to median price ratio (MPR)) and affordability (number days of work of the lowest paid government worker). Results: Of 4,096 identified studies 29 were included, providing data from 60 LMICs. All had a low risk of bias. 6/58 countries met the availability target for short-acting beta-agonist agonists (SABA), 3/48 countries for inhaled corticosteroids (ICS) and 0/4 for inhaled corticosteroid-long-acting beta-agonist combination (ICS-LABA). Costs were reported by 12 studies: the MPR range was 1.1-351 for SABA, 2.6-340 for ICS and 24 for ICS-LABA (1 study). Affordability was shown in 10 studies: SABA inhalers cost around 1-4, ICS 2-7 and ICS-LABA at least 6 days' wages. Interpretation Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was especially true for inhalers containing corticosteroids. Funding The work was commissioned by the WHO, after an open request for proposals. MS was funded by a Wellcome Trust PhD fellowship. The expressed views do not represent those of the WHO/funders.
Background: Asthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost and affordability of World Health Organization (WHO) Essential Medicines for asthma and COPD in LMICs. Methods: A systematic review of the literature was conducted by searching seven databases to identify research articles published between 01 January 2010–22 November 2021 (PROSPERO: CRD42021281069). Studies on named essential medicines for asthma and COPD in LMICs were included, review articles excluded. Two authors screened and extracted data independently and assessed bias using Joanna Briggs Institute appraisal tools. The main outcome measures were availability (WHO target of 80%), cost (compared to median price ratio (MPR)) and affordability (number days of work of the lowest paid government worker). Findings: Of 4,096 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias. Six (out of 58) countries met the 80% availability target for short-acting beta-agonist agonists (SABA), 3/48 countries for inhaled corticosteroids (ICS) and 0/4 for corticosteroid-long-acting beta-agonist combination (ICS-LABA). Costs were reported by twelve studies: the range of MPRs was 1.1-351 for SABA, 2.6-340 for ICS and 24 for ICS-LABA in the single study reporting this. Affordability was calculated in ten studies: SABA inhalers typically cost around 1-4 days’ wages, ICS 2-7 and ICS-LABA at least six. Interpretation: Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids. Registration Details: PROSPERO: CRD42021281069Funding Information: The systematic review was commissioned by the WHO, following an open request for proposals. MS was funded by a Wellcome Trust PhD fellowship (203919/Z/16/Z). Declaration of Interests: KM is an advisory board member for AstraZeneca. DMGH reports honoraria for lecturing, attending advisory boards and preparing educational materials from Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, Glaxo-Smith Kline (GSK), Novartis, Pfizer & Sanofi. RH has received funding from the Global Initiative for Chronic Obstructive Lung Disease to assist with literature searches. BA reports grants from the National Institutes of Health Research, honoraria from GSK, Novartis, Boehringer Ingelheim, Cipla Medpro and participation on advisory board for Cipla Medpro, Boehringer Ingelheim &Janssen Pharmaceuticals. SS reports honoraria for lectures from Cipla, Glenmark and GSK. MMO reports speaker fees from AstraZeneca. No other conflicting interests reported.
Background Administrative or population health datasets (PHDS) are increasingly being used for research related to maternal and infant health. However, the accuracy and completeness of the information in the PHDS is important to ensure validity of the results of this research. Objective To compile and review studies that validate the reporting of conditions and procedures related to pregnancy, childbirth, and newborns and provide a tool of reference for researchers. Methods A systematic search was conducted of Medline and EMBASE databases to find studies that validated routinely collected datasets containing diagnoses and procedures related to pregnancy, childbirth, and newborns. To be included datasets had to be validated against a gold standard, such as review of medical records, maternal interview or survey, specialized register, or laboratory data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and/or κ statistic for each diagnosis or procedure code were calculated. Results Forty-three validation studies were included. Under-enumeration was common, with the level of ascertainment increasing as time from diagnosis/procedure to birth decreased. Most conditions and procedures had high specificities indicating few false positives, and procedures were more accurately reported than diagnoses. Hospital discharge data were generally more accurate than birth data, however identifying cases from more than 1 dataset further increased ascertainment. Conclusions This comprehensive collection of validation studies summarizing the quality of perinatal population data will be an invaluable resource to all researchers working with PHDS.
Routinely collected datasets are frequently used for population-based research but their accuracy needs to be assured.This study aims to assess the accuracy of hospital discharge data in identifying obstetric haemorrhage diagnoses and procedures, and estimate their population incidence.The medical records of 1200 randomly selected women were reviewed and compared with obstetric haemorrhage diagnoses and procedures in the hospital discharge data. Sensitivity, specificity, and positive and negative predictive values were calculated using the medical records as the 'gold standard'. Estimates of population incidence were calculated and weighted by the sampling probabilities.Estimated population incidence for any antepartum haemorrhage was 1.8 per 100, and post partum haemorrhage was 7.2 per 100 women. Obstetric haemorrhage diagnosis and procedure codes tended to be underreported, with sensitivities ranging from 28.3% to 100%. All codes had specificities of 98.9% or greater. The identification of obstetric haemorrhage differed between levels of severity.The results indicate that population health datasets can be a reliable information source; however, these datasets could be improved with more complete documentation in medical records.
An association between the N314D polymorphism of galactose-1-phosphate uridyl transferase and endometriosis has recently been reported in a North American population. To determine whether such an association exists in the UK population, we genotyped 148 women with sporadic (n = 91) or familial (n = 57) endometriosis, a control population of 95 male blood donors and a control group of 53 women with a normal pelvis at hysterectomy. Heterozygosity for the polymorphism was found in 14.9% (22/148) of affected women, 13.7% (13/95) of male blood donors and 11.3% (6/53) of women with a normal pelvis. There was no statistically significant difference in the frequency of the polymorphism between cases and controls in the UK population, even when the cases were divided into groups of moderate–severe disease, sporadic cases or familial cases. We conclude that the galactose-1-phosphate uridyl transferase N314D polymorphism is unlikely to be associated with endometriosis in the UK population.
There is now considerable evidence that endometriosis is likely to be a complex multifactorial trait, such as diabetes or asthma, in which a number of susceptibility loci interact with each other, and the environment, to produce the disease phenotype. This thesis presents studies on the genetic and environmental basis of endometriosis in both a non-human primate model and in women. The study of the autopsy records of 399 female rhesus monkeys identified 81 (20%) with spontaneous endometriosis. Age, exposure to ≥ 3 oestradiol implants (relative risk 9.7, P P = 0.006) were significant risk factors as determined by conditional logistic regression. Living descendants of the affected animals had MRI scans which suggested that 8/113 (7%) had at least one endometriotic lesion >1 cm in diameter. Segregation analysis was conducted on the resulting 12 pedigrees, which contained 64 half sib-pairs, 2 full sibpairs and 11 mother-daughter pairs. Human, affected sib-pairs and families were recruited for the OXEGENE study to conduct sib-pair analysis using microsatellite markers at 10cM resolution across the entire genome. MRI studies of the first-degree relatives of women with rAFS stage III-IV disease estimated that the relative risk (λ R ) may be as high as 14 (95% Cl 4.8 - 30.3). Candidate gene studies, comparing the frequency of the GALT N314D polymorphism, the CYP1A1 MspI polymorphism and the GSTM1 and T1 null mutations in two case groups, with either sporadic disease or a family history of endometriosis, and two control groups, did not show evidence of association. Linkage analysis using three microsatellite markers and 50 affected sib-pairs in the region to which GSTM1 maps (1p13) did not show evidence of linkage to this region. However, there was an apparent relationship between the presence of both the GSTM1 null mutation and the CYP1A1 MspI polymorphism and an increased risk of endometriosis. The initial findings of a sib-pair analysis, using 29 microsatellite markers across chromosome one in 128 affected sib-pairs, did not reveal evidence of linkage. These findings provide some insight into the aetiology of endometriosis in women.
BackgroundAsthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and affordability of WHO's essential medicines for asthma and COPD in LMICs.MethodsA systematic review of the literature was done by searching seven databases to identify research articles published between Jan 1, 2010, and June 30, 2022. Studies on named essential medicines for asthma and COPD in LMICs were included and review articles were excluded. Two authors (MS and HT) screened and extracted data independently, and assessed bias using Joanna Briggs Institute appraisal tools. The main outcome measures were availability (WHO target of 80%), cost (compared with median price ratio [MPR]), and affordability (number of days of work of the lowest paid government worker). The study was registered with PROSPERO, CRD42021281069.FindingsOf 4742 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias. Six of 58 countries met the 80% availability target for short-acting beta-agonists (SABAs), three of 48 countries for inhaled corticosteroids (ICSs), and zero of four for inhaled corticosteroid–long-acting beta-agonist (ICS–LABA) combination inhalers. Costs were reported by 12 studies: the range of MPRs was 1·1–351 for SABAs, 2·6–340 for ICSs, and 24 for ICS–LABAs in the single study reporting this. Affordability was calculated in ten studies: SABA inhalers typically cost around 1–4 days' wages, ICSs 2–7 days, and ICS–LABAs at least 6 days. The included studies showed heterogeneity.InterpretationEssential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids.FundingWHO and Wellcome Trust.
Objective: To determine whether the proportion of babies born large for gestational age (LGA) in New South Wales has increased, and to identify possible reasons for any increase. Design and setting: Population-based study using data obtained from the NSW Midwives Data Collection, a legislated surveillance system of all births in NSW. Participants: All 1 273 924 live-born singletons delivered at term (≥ 37 complete weeks’ gestation) in NSW from 1990 to 2005. Main outcome measures: LGA, defined as > 90th centile for sex and gestational age using 1991–1994 Australian centile charts; maternal factors associated with LGA were assessed using logistic regression. Results: The proportion of babies born LGA increased from 9.2% to 10.8% (18% increase) for male infants and from 9.1% to 11.0% (21% increase) for female infants. The mean birthweight increased by 23 g for boys and 25 g for girls over the study period. Increasing maternal age, higher rates of gestational diabetes and a decline in smoking contributed significantly to these increases, but did not fully explain them. Conclusions: There is an increasing trend in the proportion of babies born LGA, which is only partly attributable to decreasing maternal smoking, increasing maternal age and increasing gestational diabetes.
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