World Health Organization Model Research Articles

Pleiotropic Effects of Heparin and its Monitoring in the Clinical Practice.

Unfractionated heparin (UFH) was uncovered in 1916, has been used as an anticoagulant since 1935, and has been listed in the World Health Organization's Model List of Essential Medicines. Despite the availability of many other anticoagulants, the use of heparin (either low molecular weight heparin [LMWH] or UFH) is still substantial. Heparin has pleotropic effects including anticoagulant and several nonanticoagulant properties such as antiproliferative, anti-inflammatory activity, and anticomplement effects. Although UFH has been widely replaced by LMWH, UFH is still the preferred anticoagulant of choice for patients undergoing cardiopulmonary bypass surgery, extracorporeal membrane oxygenation, and patients with high-risk mechanical cardiac valves requiring temporary bridging with a parenteral anticoagulant. UFH is a highly negatively charged molecule and binds many positively charged molecules, hence has unpredictable pharmacokinetics, and variable anticoagulant effect on an individual patient basis. Therefore, anticoagulant effects of UFH may not be proportional to the dose of UFH given to any individual patient. In this review, we discuss the anticoagulant and nonanticoagulant activities of UFH, differences between UFH and LMWH, when to use UFH, different methods of monitoring the anticoagulant effects of UFH (including activated partial thromboplastin time, heparin anti-Xa activity level, and activated clotting time), while discussing pros and cons related to each method and comparison of clinical outcomes in patients treated with UFH monitored with different methods based on available evidence.

Implementation and evaluation of the WHO maternity care model: a convergent parallel mixed-methods study protocol.

According to the World Health Organization (WHO), intrapartum care is considered a platform for providing respectful, personalized, and women-centered services to women. This study aims to investigate the intrapartum care model proposed by WHO. This convergent parallel mixed-methods study will be carried out in qualitative and quantitative phases. In the quantitative phase (a quasi-experimental study), 108 pregnant women admitted to the maternity ward will be randomized to intervention (receiving intrapartum care based on the WHO model) and control group (receiving routine hospital care) before the beginning of the active stage of labor (cervix dilatation equal to 5 cm) and Wijma's delivery fear scale (DFS) will be completed for them and again at 7-8 cm dilatation. The participants of both groups will be followed up for 6 weeks after labor and then they will be invited to a relatively quiet place to complete the Childbirth Experience Questionnaire (CEQ 2.0), the Edinburgh Postpartum Depression Scale (EPDS), the Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS-I), the Pregnancy and Childbirth Questionnaire (PCQ), exclusive breastfeeding and a checklist on willingness to give birth to another child. The qualitative phase will employ content analysis to explain mothers' views about the effects of this model especially subjective components of this model on their labor process after 4-6 weeks. The two phase's results will be discussed in combination. The implementation of such care models is expected to prevent mental disorders caused by negative experiences of childbirth, and also, prevent uncontrolled increases in cesarean sections. https://fa.irct.ir/user/trial/68313/view, identifier (IRCT20120718010324N69).

Concordance between essential medicines lists and diabetes guidelines in Latin America and the CaribbeanConcordância entre as listas de medicamentos essenciais e diretrizes para diabetes na América Latina e no Caribe

Conduct an analysis to determine the existence and updating of national essential medicines lists (EMLs) and clinical practice guidelines (CPGs) for the treatment of diabetes in Latin America and the Caribbean (LAC); and compare the medicines included in each country's list and guidelines both with each other and with those of the World Health Organization (WHO). Cross-sectional study. EMLs and CPGs for diabetes were found on the websites of the Pan American Health Organization and national health authorities. Medicines were noted and analyzed according to pharmacological group, based on the fourth level of nomenclature of the Anatomical Therapeutic Chemical (ATC) classification system. F1 scoring was used to assess the proximity of EMLs to the WHO Model List of Essential Medicines (MLEM). Of the total number of countries, 87.2% have EMLs, and 91% have CPGs (78% and 45% updated in the last five years, respectively). Compared to the six hypoglycemic groups of the MLEM, the EMLs had a median (range) of 6 (4-13) and an F1 score of 0.80; This indicates proper alignment. CPGs had a median (range) of 12 (1-12) hypoglycemic drugs compared to eight in the WHO guidelines. CPGs had a median of 15 more drugs than their respective EMLs. While most LAC countries have EMLs and CPGs for diabetes, the lack of concordance among them limits their effectiveness. It is necessary to align the processes and criteria for the development of these two tools for policymaking on medicines.

Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study

BackgroundInappropriate antibiotic use contributes to the global rise of antibiotic resistance, prominently in low- and middle-income countries, including India. Despite the considerable risk of surgical site infections, there is a lack of antibiotic prescribing guidelines and long-term studies about antibiotic prescribing in surgery departments in India. Therefore, this study aimed to analyse 10 years’ antibiotic prescribing trends at surgery departments in two tertiary-care hospitals in Central India.MethodsData was prospectively collected from 2008 to 2017 for surgery inpatients in the teaching (TH-15,016) and the non-teaching hospital (NTH-14,499). Antibiotics were classified based on the World Health Organization (WHO) Access Watch Reserve system and analysed against the diagnoses and adherence to the National List of Essential Medicines India (NLEMI) and the WHO Model List of Essential Medicines (WHOMLEM). Total antibiotic use was calculated by DDD/1000 patient days. Time trends of antibiotic prescribing were analysed by polynomial and linear regressions.ResultsThe most common indications for surgery were inguinal hernia (TH-12%) and calculus of the kidney and ureter (NTH-13%). The most prescribed antibiotics were fluoroquinolones (TH-20%) and 3rd generation cephalosporins (NTH-41%), and as antibiotic prophylaxis, norfloxacin (TH-19%) and ceftriaxone (NTH-24%). Access antibiotics were mostly prescribed (57%) in the TH and Watch antibiotics (66%) in the NTH. Culture and susceptibility tests were seldom done (TH-2%; NTH-1%). Adherence to the NLEMI (TH-80%; NTH-69%) was higher than adherence to the WHOMLEM (TH-77%; NTH-66%). Mean DDD/1000 patient days was two times higher in the NTH than in the TH (185 vs 90). Overall antibiotic prescribing significantly increased in the TH (β1 =13.7) until 2012, and in the NTH (β2 =0.96) until 2014, and after that decreased (TH, β2= -0.01; NTH, β3= -0.0005). The proportion of Watch antibiotic use significantly increased in both hospitals (TH, β=0.16; NTH, β=0.96).ConclusionTotal antibiotic use decreased in the last three (NTH) and five years (TH), whereas consumption of Watch antibiotics increased over 10 years in both hospitals. The choice of perioperative antibiotic prophylaxis was often inappropriate and antibiotic prescribing was mostly empirical. The results of this study confirmed the need for antibiotic prescribing guidelines and implementation of antimicrobial stewardship programs.

Validity of the models predicting 10-year risk of cardiovascular diseases in Asia: A systematic review and prediction model meta-analysis.

We aimed to review the validity of existing prediction models for cardiovascular diseases (CVDs) in Asia. In this systematic review and meta-analysis, we included studies that validated prediction models for CVD risk in the general population in Asia. Various databases, including PubMed, Web of Science conference proceedings citation index, Scopus, Global Index Medicus of the World Health Organization (WHO), and Open Access Thesis and Dissertations (OATD), were searched up to November 2022. Additional studies were identified through reference lists and related reviews. The risk of bias was assessed using the PROBAST prediction model risk of bias assessment tool. Meta-analyses were performed using the random effects model, focusing on the C-statistic as a discrimination index and the observed-to-expected ratio (OE) as a calibration index. Out of 1315 initial records, 16 studies were included, with 21 external validations of six models in Asia. The validated models consisted of Framingham models, pooled cohort equations (PCEs), SCORE, Globorisk, and WHO models, combined with the results of the first four models. The pooled C-statistic for men ranged from 0.72 (95% CI 0.70 to 0.75; PCEs) to 0.76 (95% CI 0.74 to 0.78; Framingham general CVD). In women, it varied from 0.74 (95% CI 0.22 to 0.97; SCORE) to 0.79 (95% CI 0.74 to 0.83; Framingham general CVD). The pooled OE ratio for men ranged from 0.21 (95% CI 0.018 to 2.49; Framingham CHD) to 1.11 (95%CI 0.65 to 1.89; PCEs). In women, it varied from 0.28 (95%CI 0.33 to 2.33; Framingham CHD) to 1.81 (95% CI 0.90 to 3.64; PCEs). The Framingham, PCEs, and SCORE models exhibited acceptable discrimination but poor calibration in predicting the 10-year risk of CVDs in Asia. Recalibration and updates are necessary before implementing these models in the region.

Facilitators and barriers to adherence to medical recommendations among adolescents with cancer: A systematic review.

We aimed to systematically review barriers/facilitators of adherence among adolescents with cancer (aged 10-24years), following a comprehensive approach to adherence that goes beyond medication-taking. Empirical studies published in English exploring determinants of adherence to medical recommendations among adolescents with cancer were identified in MEDLINE, PsycInfo, and Web of Science, up to October 2021. Records and full-text articles were reviewed by two independent reviewers, and results were classified according to the World Health Organization's (WHO) multidimensional adherence model. Eighteen studies were included. Despite heterogeneity in the definition and measurement of adherence, literature supported barriers/facilitators at patient, treatment, condition, healthcare team/system, and social/economic levels. Specifically, patient-related factors (i.e., psychological functioning and beliefs about disease and treatment) and social-related factors (i.e., family functioning) were major determinants of adolescent adherence. Few studies were conducted, and inconsistent findings were displayed for other dimensions (i.e., healthcare team/system, treatment, and condition-related factors). Adherence is a complex and multidetermined phenomenon. More research is needed to provide critical insights for policymakers and healthcare professionals in planning practices and interventions that effectively address meaningful barriers/facilitators of adolescents' adherence.

Baby, children, and adult biscuits. Differences in nutritional quality and naturalness.

This study examined and compared the nutritional quality and degree of naturalness between baby biscuits (<3 years), children biscuits (>3 years), and adult biscuits. Mintel's Global New Products Database was searched for "Baby Biscuits & Rusks" and "Sweet Biscuits/Cookies" (re)launched between July 2019 and July 2022 in four European countries (Germany, the Netherlands, Spain, and the United Kingdom), which resulted in 1280 products to be analyzed. Nutritional quality was measured by means of nutrient values per 100 g, and baby biscuits were assessed for compliance with the World Health Organization's latest Nutrient and Promotion Profile Model (NPPM). Degree of naturalness was measured using the food naturalness index (FNI). Baby biscuits had the best nutritional quality and were the most natural as compared to children and adult biscuits, but their energy density and sugar content require further attention. Nutritional quality was comparably poor in children and adult biscuits, and children biscuits were the least natural of the three groups. The NPPM requirements of not adding any free sugar at all to baby biscuits may drive parents to purchase alternative sweeter biscuits originally formulated and meant for children and adults. Reasonable regulations are needed to support product (re)formulations and to improve the current market food offer for babies and children.

Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience.

Communication changes following acquired brain injury (ABI) may necessitate use of augmentative and alternative communication (AAC). Speech pathologists regularly assist people with ABI and their families with AAC assessment and recommendations, as well as education and training on AAC use. To date, there has been no Australian research investigating the perspectives of speech pathologists working in the field of ABI and AAC. This research aimed to 1) Explore speech pathologists' insights regarding enablers and barriers to considerations and uptake, and ongoing use, of AAC by people with ABI and 2) Understand their perspectives on AAC acceptance, abandonment and rejection. A qualitative research design, with semi-structured interviews, was used with seven speech pathologists working across three Australian states. Interviews were transcribed verbatim, and thematically analysed. To triangulate results, the lived experience reflections of one co-author, who has an ABI and uses AAC, were drawn on. Seven themes were identified, relating to four of the five domains of the World Health Organization's assistive technology model. These included that AAC should be person-centred, with consideration of both products and personnel required, and with effective policy aiding AAC trial, uptake and use. This research has highlighted considerations for AAC use by people with ABI, from the perspective of speech pathologists and aided by lived experience reflections. Speech pathologists need to understand the breadth of products, and good practice service steps, to ensure successful AAC use and skill development. Listening to the perspectives of people with ABI is central to that understanding.

Assessing the Isfahan Hospitals based on the World Health Organization's Age-Friendly Hospital Model: A Mixed Method Study

Objectives The rapid growth of the elderly population requires the design of age-friendly healthcare systems to respond to the complex needs of the elderly. This study aims to assess the hospitals in Isfahan, Iran based on the age-friendly primary health care centers criteria and identify challenges. Methods &amp; Materials This cross-sequential study was conducted in two phases in 2020-2021. First, using the checklist of Ahmadi et al.’ study, the teaching hospitals in Isfahan were assessed based on the age-friendly primary health care centers criteria. The checklists were completed by observation and based on the opinions of the experts. Data analysis was done in SPSS software, version 26 using descriptive statistics and Pearson correlation test. Qualitative data were collected through a semi-structured interview and were analyzed using Conventional content analysis method. Results Most of the hospitals were in good conditions in terms of physical environment, sanitary facilities, and signboards. The lowest scores were related to the areas of admission and payment, appointments, accessibility, and inpatient services. The mean age-friendly score of hospitals was 51.7 out of 100. There was no significant relationship between the characteristics of hospitals (type of ownership, type of activity, specialty, number of beds, bed occupancy rate, degree of accreditation, and manager’s study field) and their age-friendly scores. We identified 9 themes and 27 sub-themes related to challenges of being age-friendly in the hospitals. Conclusion The hospitals in Isfahan have many shortcomings in being age-friendly. Promoting the expertise of geriatric medicine and geriatric nursing, designing a special queuing system for the elderly, considering a special administrator for the elderly in different departments, reducing the costs of treatment for the elderly, promoting consultation/examination/treatment/follow-up programs for the elderly with an emphasis on upstream documents and cooperation between different departments, empowering employees, upgrading physical infrastructure can help solve existing challenges.

H15 A treatment for leprosy developed on the edge of Europe: Vincent Barry (1908–1975)

Abstract Leprosy is the prototype of a biblical disease. Without an effective cure, it was deemed a ‘curse’ for millennia. It is an infection caused by Mycobacterium leprae and Mycobacterium lepromatosis. With an affinity for peripheral skin (due to lower temperatures), a rash is a common presenting feature. A tropism to infiltrate neural tissue causes a reduction in sensation leading to repeated injury, infection and disfigurement. Affected individuals were often shunned from society and sent to leper colonies. Treatment for leprosy only became effective in the mid-20th century. Initial treatment for leprosy was with promin and dapsone. Clofazimine and rifampicin were later added in the 1960s–70s. Treatment for leprosy consists of a multidrug therapy regime of rifampicin, dapsone and clofazimine for 6–12 months. This was first recommended by the World Health Organization (WHO) in 1981 and remains the recommended treatment. Clofazimine was developed in a laboratory in Trinity College Dublin by Vincent Barry and his scientific team. Vincent Barry was born in Cork, Ireland, and later graduated in chemistry from University College Dublin. He became associate professor of chemistry in Galway where he lectured bilingually in Irish and English and co-authored the first Irish-language textbook for chemistry (Ceimic). Barry spent time working in and observing leper colonies in both Zimbabwe and India. In 1943, he was given a fellowship by the Medical Research Council of Ireland to carry out research on the chemotherapy of tuberculosis (TB). However, as TB became more curable, he focused his attention on leprosy. His team were given laboratory space in Trinity College Dublin, and in 1957, they developed compound B663, clofazimine. Intended as an anti-TB medication, clofazimine showed more effectiveness against leprosy. The product was launched in 1969 after several clinical trials in Nigeria. In 1974, they devoted the patents of the drug to India to allow it to be produced in a more cost-effective manner. The team was not interested in fame or fortune; their goal was simply to make the drug available in the developing world. They received the Boyle Award from the Royal Dublin Society in 1969, and the UNESCO Science prize in 1980 ‘for their work on the synthesis of an anti-leprosy agent, B-633’. The achievements of Mr Barry and his team, seldom discussed, have led to millions of lives being saved. Clofazimine is part of the WHO Model list of Essential Medicines.

Epidemiology of skin cancer based on Japan's National Cancer Registry 2016-2017.

Skin cancer is most frequently diagnosed in the White population. However, its subtypes and epidemiology in Japan are understudied. We aimed to elucidate skin cancer incidence in Japan based on the National Cancer Registry, a new nationwide integrated population-based registry. Data from patients diagnosed with skin cancer in 2016 and 2017 were extracted and classified by cancer subtypes. Data were analyzed using the World Health Organization and General Rules tumor classifications. Tumor incidence was calculated as the number of new cases divided by the corresponding total person-years. Overall, 67,867 patients with skin cancer were included. The percentage of each subtype was as follows: basal cell carcinoma, 37.2%; squamous cell carcinoma, 43.9% (18.3% of which, in situ); malignant melanoma, 7.2% (22.1% of which, in situ); extramammary Paget's disease, 3.1% (24.9% of which, in situ); adnexal carcinoma, 2.9%; dermatofibrosarcoma protuberans, 0.9%; Merkel cell carcinoma, 0.6%; angiosarcoma, 0.5%; and hematologic malignancies, 3.8%. The overall age-adjusted incidence of skin cancer was 27.89 for the Japanese population model and 9.28 for the World Health Organization (WHO) model. The incidences of basal cell carcinoma and squamous cell carcinoma were the highest (3.63 and 3.40 per 100,000 persons, respectively, in the WHO model) among skin cancers, whereas the incidences of angiosarcoma and Merkel cell carcinoma were the lowest (0.026 and 0.038 per 100,000 persons, respectively, in the WHO model). This is the first report to provide comprehensive information on the epidemiological status of skin cancers in Japan using population-based NCR data.

WHO cardiovascular disease risk prediction model performance in 10 regions, China

To validate the World Health Organization (WHO) non-laboratory-based cardiovascular disease risk prediction model in regions of China. We performed an external validation of the WHO model for East Asia using the data set of China Kadoorie Biobank, an ongoing cohort study with 512 725 participants recruited from 10 regions of China from 2004-2008. We also recalculated the recalibration parameters for the WHO model in each region and evaluated the predictive performance of the model before and after recalibration. We assessed discrimination performance by Harrell's C index. We included 412 225 participants aged 40-79 years. During a median follow-up of 11 years, 58 035 and 41 262 incident cardiovascular disease cases were recorded in women and men, respectively. Harrell's C of the WHO model was 0.682 in women and 0.700 in men but varied among regions. The WHO model underestimated the 10-year cardiovascular disease risk in most regions. After recalibration in each region, discrimination and calibration were both improved in the overall population. Harrell's C increased from 0.674 to 0.749 in women and from 0.698 to 0.753 in men. The ratios of predicted to observed cases before and after recalibration were 0.189 and 1.027 in women and 0.543 and 1.089 in men. The WHO model for East Asia yielded moderate discrimination for cardiovascular disease in the Chinese population and had limited prediction for cardiovascular disease risk in different regions in China. Recalibration for diverse regions greatly improved discrimination and calibration in the overall population.

The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance.

Guidance on the appropriate use of antibiotics for common infections is lacking in many settings. The World Health Organization (WHO) has recently released The WHO AWaRe (Access, Watch, Reserve) antibiotic book which complements the WHO Model list of essential medicines and WHO Model list of essential medicines for children. The book gives specific guidance on the empiric use of antibiotics in the model lists with a strong emphasis on the AWaRe framework, which is centred around the risk of antimicrobial resistance development associated with the use of different antibiotics. Recommendations in the book cover 34 common infections in primary and hospital care both for children and adults. The book also includes a section on the use of the last-resort Reserve antibiotics, whose use should be restricted to very selected cases when an infection is confirmed or suspected to be caused by multidrug-resistant pathogens. The book highlights the use of first-line Access antibiotics or no antibiotic care if this is the safest approach for the patient. Here we present the background behind the development of the AWaRe book and the evidence behind its recommendations. We also outline how the book could be used in different settings to help reach the WHO target of increasing the proportion of global consumption of Access antibiotics to at least 60% of total consumption. The guidance in the book will also more broadly contribute to improving universal health coverage.

Healthy work environments in the perception of nursing professors and students

Introduction: Healthy work environments are positive for the construction and realization of professional identities. From the beginning of their vocational training, nursing students experience work environments in the area of health, accompanied by teaching nurses. Therefore, the object, the work environment, is important in the analysis of the work and teaching-learning process.Methods: Qualitative, descriptive and exploratory research. Developed in two Universities in Santa Catarina State, Brazil, with fourteen professors and fourteen students. Data were collected in a semi-structured interview with professors and focus groups with students, through a digital platform with previously scheduled times. The data were analyzed according to content analysis. The study was approved by a research ethics committee.Results: The findings were organized in the four dimensions that make up the World Health Organization's model of healthy work environments: the physical, psychosocial environment, resources for personal health and the institution's involvement in the community.Conclusions: Perceptions about healthy work environments are closely related to the conditions and requirements imposed to perform the work. Healthy work environments are the result of the infrastructure of institutions, work management and characteristics specially implicated in the teaching-learning process.

Enhancing the Capacity of Providers in Mental Health Integration (ECaP-MHI) in Rural Uganda: The Adaptation Process.

Uganda adopted the World Health Organization (WHO) model of creating district health management teams (DHMT) comprised of public health officials and administrators to supervise health service delivery at the community level. The purpose of this study was to characterize the perspectives of the DMHT in providing support supervision to primary health-care providers implementing mental health integration using the pre-recorded material. Our aim was to identify barriers to individual uptake and contextual fit, and to solicit solutions for co-designed improvements. We conducted a qualitative exploratory study using one-on-one interviews informed by the Practical Robust Implementation and Sustainability Model. Members of the DHMT identified a systemic gap in supporting mental health integration into primary care, and reported limited knowledge in how to supervise mental health integration and lacked data on mental health delivery and outcomes. They recommended training of the DHMT in supervising mental health integration supported by standard outcome reports, pre-recorded instructional material by psychiatrists, checklists to help guide and standardize the process, and use of visual aids illustrating mental disorders and treatments for low-health literacy populations. Implementing integrated mental health care using the WHO model of DHMTs as external facilitators and supervisors of primary health-care providers is potentially feasible and scalable, provided that substantial reforms occur such as training in how to provide supervision, standard collection of outcome reports, and practical tools to help guide and facilitate the process.

Essential medicines for mental disorders: comparison of 121 national lists with WHO recommendations

BackgroundTo compare the medicines for mental disorders included in national essential medicines lists with the World Health Organization (WHO) essential medicines list and assess the extent to which economic status and WHO Region account for the differences.MethodsWe searched WHO repository and government sites for national essential medicines lists and we abstracted medicines for mental disorders. We calculated the proportion of WHO essential medicines included, the total number of differences (counting both additions and deletions) between national and WHO model list and the proportion of lists including one second-generation oral antipsychotic plus one new-generation antidepressant. Non-parametric statistics was used to investigate whether these indicators were dependent on economic status and WHO Region.ResultsAmongst the 121 identified national lists, the total number of medicines for mental disorders ranged from 2 to 63 (median: 18; IQR: 14 to 25). The median proportion of WHO essential medicines for mental disorders included was 86% (IQR: 71–93%), with 16 countries (13%, 95% CI 7.75–20.5%) including all WHO essential medicines, while the median number of differences with the WHO EML was 11 (IQR: 7 to 15). Country economic level was positively associated with both the proportion of WHO essential medicines included (Spearman's rho = 0.417, p < 0.001) and the number of differences (Spearman's rho = 0.345, p < 0.001), implying that countries with higher income level included more WHO essential medicines, but also more additional medicines. Significant differences were observed in relation to WHO Region, with the African and Western Pacific Region showing the lowest proportions of WHO essential medicines, and the European Region showing the highest median number of differences. Overall, 88 national lists (73%, 95% CI 63–80%) included at least one second-generation oral antipsychotic and new-generation antidepressant, with differences by income level and WHO Region.ConclusionsThe degree of alignment of national lists with the WHO model list is substantial, but there are considerable differences in relation to economic status and WHO Region. These findings may help decision-makers to identify opportunities to improve national lists, aiming to increase access to essential medicines for mental disorders.

PS-P07-6: ACCESS TO ESSENTIAL MEDICINES AND DIAGNOSTIC TESTS FOR HYPERTENSION AND HEART FAILURE IN MAPUTO CITY, MOZAMBIQUE

Objective: To evaluate access (availability, price, affordability) to essential medicines (EMs) and diagnostic tests and technologies for management of hypertension and heart failure (HF) in Maputo City, Mozambique. Design and method: In a cross sectional survey, using a modified version of World Health Organization (WHO)/Health Action International methodology, data from a representative sample comprising 6 public and 6 private sector hospitals and 30 private sector retail pharmacies was collected. Upon reviewing WHO Model EM List (EML), Priority Medicines for Children and Women list, Mozambique National EML and guidelines, 50 EMs, including 14 WHO Core and 36 cardiovascular diseases (CVD) EMs were selected. Of those, data for 19 EMs (including different formulations and dosages) for management of hypertension and HF are presented here. Data on 19 diagnostic tests and 17 devices was collected from hospitals. Availability was calculated as percentage of surveyed facilities where a medicine or diagnostic tool was found on the day of survey. Median price ratio (MPR) refers to median consumer price of a medicine compared to respective international reference price (IRP). Medicines were considered unaffordable if to purchase a monthly supply, the lowest paid government worker had to spend more than one day wage. Results: Mean availability of anti hypertensive and HF medicines combined was far below WHO target (80%), both in private (retail: 35.0%, hospital pharmacies: 30.6%) and public sectors (hospital pharmacies: 27.8%). Only two surveyed medicines were available in over 80% of public-sector hospital pharmacies. Most (11/19) medicines were available in less than 50% of retail pharmacies. Median MPR (range) of medicines was high [Lowest Priced Generic (LPG): 3.2 (0.98;19.84); Most Sold Generic (MSG): 4.8 (1.67;19.98)] compared to WHO recommendation (no one should pay greater than 4 times the IRP). LPG versions above that recommendation included amlodipine, enalapril, spironolactone. The lowest paid worker, on average, would spend more than one day wage to purchase a monthly supply of most EMs. Mean availability of CVD diagnostic tests and devices was lower in public (54.6% and 61.1%, respectively) compared to private (89.5% and 91.7%, respectively) sector. Conclusion: Access to EMs for management of hypertension and HF is very limited in Maputo City, characterized by high prices, low availability and affordability. Access to CVD diagnostic tests and devices is particularly low in public-sector. These data raise important concerns and may guide policies and interventions for improving access to cardiovascular care and serve as benchmark for future comparations.

A laboratory assessment of how biomass pellets could reduce indoor air pollution, mitigate climate change and benefit health compared to other solid fuels used in Ghana

To reduce indoor air pollution, the government of Ghana in 2019 formulated the renewable energy master plan to help disseminate biomass pellets and stoves to 2,000,000 households by 2030. But pellets have neither been included in Ghana's energy mix nor have their surmised climate and health benefits been empirically assessed. This laboratory study tested emissions by burning wood, charcoal and pellets in improved cookstoves. It further modelled their associated indoor air pollution reduction, personal exposure, health benefits and climate impact for comparison. The emission factors based on useful energy delivered of CO, CO2 and PM2.5 were 3.506 ± 0.704, 306.6 ± 43.35, and 0.229 ± 0.039 g/MJdelivered, respectively, for wood rocket 1 stove; 2.115 ± 0.695, 272.8 ± 16.70, and 0.256 ± 0.166 g/MJdelivered for wood rocket 2 stove; 4.820 ± 1.098, 205.3 ± 60.49, and 0.051 ± 0.044 g/MJdelivered for charcoal 1 stove; 4.474 ± 1.525, 221.8 ± 65.71, 0.043 ± 0.040 g/MJdelivered for charcoal 2 stove; and 0.511 ± 0.325, 338.1 ± 45.41, and 0.041 ± 0.023 g/MJdelivered for pellet stove. The forced air supplied by the gasifier stove reduced pollutant emissions from pellet combustion. The 100-year global warming contribution of the pellet stove was lower than that of charcoal stoves, and was influenced by upstream emissions of fuel processing. The WHO (World Health Organization) models showed that a complete transition from wood to pellets in one million households could significantly improve health with most benefits for children below five years. However, the reported benefits can only be achieved if pellets are added to Ghana's energy mix. The government of Ghana can ensure a sustained adoption of pellets by fostering market enablers for supply and demand of pellets and gasifier stoves, and mitigating the factors that impact pellet production and use. Field evaluation of the economic, health and climate co-benefits of using pellets in Ghana is recommended for future study.

Inclusion of essential components of the World Health Organization palliative care development model in national palliative care plans: A documentary analysis in 31 countries

ContextThe World Health Organization has proposed a new model for the development of palliative care. Whether the current national palliative care plans of Member States are aligned or need to be reformed to meet the new model is unknown. MethodsWe conducted a documentary analysis of national palliative care plans based on an analytic framework structured with the elements recommended by the World Health Organization: (a) building a plan, (b) plan components, and (c) plan implementation. We conducted a categorical analysis of national plans by subgroups according to income and development level of palliative care. FindingsWe identified 112 countries with a palliative care plan, of which 31 were included in the analysis. Of these 31 plans, only 8 had the six components proposed by the World Health Organization, 29 reported an implementation strategy, 23 were aligned with the country's national public health plan, and 15 allocated financial resources for plan implementation. All the national plans assessed included the component provision of palliative care in integrated health services; 93%, education and training; 83%, research; 80%, empowered people and communities; 54%, health policies related to palliative care, and 48% use of essential medicines. ConclusionsNational palliative care plans include the two new development components, but few are fully aligned with the 2021 World Health Organization's model.

Accuracy of the China-PAR and WHO risk models in predicting the ten-year risks of cardiovascular disease in the Chinese population

Objective: To externally validate and compare the accuracy of the China-PAR (Prediction for ASCVD Risk in China) model and the 2019 World Health Organization (WHO) cardiovascular disease risk charts for East Asian in predicting a 10-year cardiovascular disease in a general Chinese population. Methods: Participants aged 40-79 years without prior cardiovascular disease at baseline in the CHinese Electronic health Records Research in Yinzhou (CHERRY) were analyzed. The Kaplan-Meier analysis estimated the observed cardiovascular events (including non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) rate within ten years. The expected risks were calculated using the WHO risk charts for East Asia (including the laboratory-based and non-laboratory-based models) and the China-PAR model. The expected-observed ratios were calculated to evaluate the overestimation or underestimation of the models in the cohort. Model accuracy was assessed by discrimination C-index, calibration χ2 value, and calibration plots. Results: During a median of 7.26 years of follow-up, 13 301 cardiovascular events were identified among 225 811 participants. The C-index for the China-PAR model, WHO laboratory-based model and WHO non-laboratory-based model were 0.741 (0.735-0.747), 0.747 (0.740-0.753), and 0.739 (0.733-0.746) for men, and 0.782 (0.776-0.788), 0.789 (0.783-0.795), and 0.782 (0.776-0.787) for women, respectively. The WHO laboratory-based model and non-laboratory-based model underestimated the 10-year ASCVD risk by around 15% in women and underestimated by 0.8% and 4.4% in men, respectively. The China-PAR model underestimated the risks by 19.5% and 42.3% for men and women. Conclusions: The China-PAR and WHO models all have pretty good discriminations for 10-year cardiovascular risk assessment in this general Chinese population. However, the accuracy should be improved in the highest-risk groups, suggesting further specific models are still needed for those with the highest risk, such as patients with diabetes or older persons.