Project description:To establish strategic priorities for the Public Health Agency of Sweden we prioritized pathogens according to their public health relevance in Sweden in order to guide resource allocation. We then compared the outcome to ongoing surveillance. We used a modified prioritization method developed at the Robert Koch Institute in Germany. In a Delphi process experts scored pathogens according to ten variables. We ranked the pathogens according to the total score and divided them into four priority groups. We then compared the priority groups to self-reported time spent on surveillance by epidemiologists and ongoing programmes for surveillance through mandatory and/or voluntary notifications and for surveillance of typing results. 106 pathogens were scored. The result of the prioritization process was similar to the outcome of the prioritization in Germany. Common pathogens such as calicivirus and Influenza virus as well as blood-borne pathogens such as human immunodeficiency virus, hepatitis B and C virus, gastro-intestinal infections such as Campylobacter and Salmonella and vector-borne pathogens such as Borrelia were all in the highest priority group. 63% of time spent by epidemiologists on surveillance was spent on pathogens in the highest priority group and all pathogens in the highest priority group, except for Borrelia and varicella-zoster virus, were under surveillance through notifications. Ten pathogens in the highest priority group (Borrelia, calicivirus, Campylobacter, Echinococcus multilocularis, hepatitis C virus, HIV, respiratory syncytial virus, SARS- and MERS coronavirus, tick-borne encephalitis virus and varicella-zoster virus) did not have any surveillance of typing results. We will evaluate the possibilities of surveillance for the pathogens in the highest priority group where we currently do not have any ongoing surveillance and evaluate the need of surveillance for the pathogens from the low priority group where there is ongoing surveillance in order to focus our work on the pathogens with the highest relevance.

Project description:BackgroundThe exposure of people and infrastructure to flood and storm related disasters across the world is increasing faster than vulnerability is decreasing. For people with non-communicable diseases this presents a significant risk as traditionally the focus of disaster management systems has been on immediate trauma and communicable diseases. This focus must now be expanded to include the management of non-communicable diseases because these conditions are generating the bulk of ill health, disability and premature death around the globe. When public health service infrastructure is destroyed or damaged access to treatment and care is severely jeopardised, resulting in an increased risk of non-communicable disease exacerbation or even death. This research proposes disaster responders, coordinators and government officials are vital assets to mitigate and eventually prevent these problems from being exacerbated during a disaster. This is due to their role in supporting the public health service infrastructure required to maximise treatment and care for people with non-communicable diseases. By focusing on the disaster cycle as a template, and on mitigation and prevention phases in particular, these actions and activities performed by disaster service responders will lead to overall improved preparedness, response, recovery and rehabilitation phases.MethodsData were collected via 32 interviews and one focus group (eight participants) between March 2014 and August 2015 (total of 40 participants). The research was conducted in the State of Queensland, Australia, with disaster service providers. The analysis included the phases of: organizing data; data description; data classification; and interpretation.ResultsThe research found a relationship between the impact of a disaster on public health service infrastructure, and increased health risks for people with non-communicable diseases. Mitigation strategies were described for all phases of the disaster cycle impacting public health service infrastructure. Specific measures include: increasing the use of telemedicine; preplanning with medical suppliers; effective town planning; health professionals visiting evacuation centers; evacuation centers having power for medical equipment; hubs for treatment and care after a disaster; evacuation of high risk people prior to disaster; mapping people at risk by non-communicable disease; and a mechanism for sharing information between agencies. A common theme from the participants was that having accurate and easily accessible data on people with non-communicable diseases would allow disaster service providers to adequately prepare for and respond to a disaster.ConclusionsDisaster service providers can play a vital role in reducing the risk of disaster exacerbated non-communicable diseases through public health service infrastructure resilience. They are often employed in communities where disasters occur and are therefore best-placed to lead implementation of the mitigation strategies identified in this research. To sustainably implement the mitigation strategies they will need to become integrated into effective performance and monitoring of the disaster response and health sector during non-disaster periods. For this to occur, the strategies should be integrated into business and strategic plans. Achieving this will help implement the Sendia Framework for Disaster Risk Reduction 2015-2030 and, most importantly, help protect the health of people with non-communicable diseases before, during and after a disaster.

Project description:BACKGROUND:Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries. Successful management requires consistent access to appropriate medicines. Availability of NCD medicines is generally low, especially in the public sector, however, little is known about other factors affecting access. We explored barriers and facilitators of access to medicines for diabetes and hypertension at public and private health facilities in Uganda. METHODS:We conducted a qualitative descriptive study at six public hospitals and five private health facilities in different regions of Uganda. Data collection included 36 in-depth interviews and 14 focus group discussions (n = 128) among purposively selected adult outpatients with diabetes and/or hypertension and 26 key informant interviews with healthcare workers and patient association leaders. Transcripts were coded and emerging themes identified using the Framework method. RESULTS:Four main themes emerged: Stocking of medicines and supplies, Financial factors, Individual behaviour and attitudes, and Service delivery at health facilities. Stocking of medicines and supplies mainly presented barriers to access at public facilities including frequent stockouts, failure to stock certain medicines and low quality brands often rejected by patients. Financial factors, especially high cost of medicines and limited insurance coverage, were barriers in private facilities. Free service provision was a facilitator at public facilities. Patients' confusion resulting from mixed messages and their preference for herbal treatments were cross-sector barriers. While flexibility in NCD service provision was a facilitator at private facilities, provider burnout and limited operating hours were barriers in public facilities. Patient-driven associations exist at some public facilities and help mitigate inadequate medicine stock. CONCLUSION:Access to NCD medicines in Uganda is influenced by both health system and patient factors. Some factors are sector-specific, while others cross-cutting between public and private sectors. Due to commonalities in barriers, potential strategies for overcoming them may include patient-driven associations, public-private partnerships, and multi-modal health education platforms.

Project description:BACKGROUND:Non-communicable diseases (NCDs) are the leading causes of disease burden and mortality at the European level and in Cyprus. This research was conducted to map the research activities of Cypriot institutions in five NCDs, namely oncology, cardiovascular diseases, diabetes, mental health and respiratory conditions. METHODS:For the period 2002-2013, research in Cyprus was assessed on its biomedical outputs and compared to the rest of Europe relative to their GDP. The research output in the five NCDs was obtained and contrasted to their respective disease burdens. The results from each of the five NCDs showed the amount of cross-country collaboration with other researchers from other European countries and from the rest of the world, and the research level of the papers on a clinical to basic scale. For each NCD field the research application was assessed, whereas for oncology the research type was also assessed. Information was collected on the development of clinical guidelines, on Cypriot newspapers reporting on medical and policy documents and advisory committees' output as well as research and funding organisations available in Cyprus, for potential evaluation of impact in health policy on the five NCDs. RESULTS:Cypriot biomedical research output appeared appropriate in volume compared with its wealth and the expected value from a regression line for other European countries. However, it was focused particularly on the molecular mechanisms of transmittable or hereditary diseases, rather than on the five NCDs. Cyprus performs well in palliative care, which receives funding from several local charities and other non-profit organisations. Cyprus has the highest relative burden from diabetes in Europe, but the subject is largely neglected by researchers. Similarly, it suffers more from mental disorders than most of the rest of Europe, but the amount of research is relatively small. Respiratory conditions research is under-funded and under-researched too. CONCLUSIONS:The biomedical research portfolio in Cyprus is adequate in volume, but not well fitted to its pattern of disease. The means whereby research can be used to improve healthcare in the country are also unsatisfactory, although the Ministry of Health is now developing a comprehensive plan which will include the development of clinical guidelines and proposals for the evaluation of how healthcare is delivered on the island.

Project description:BACKGROUND: Over the past two decades, international health policies focusing on the fight against the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), malaria, and those diseases that address maternal and child health problems, among others, have skewed disease control priorities in China and other Asian countries. Although these are important health problems, an epidemic of chronic, non-communicable diseases (NCDs) in China has accounted for a much greater burden of disease due to the ongoing rapid socioeconomic and demographic transition. DISCUSSION: Although NCDs currently account for more than 80% of the overall disease burden in China, they remain very low on the nation's disease control priorities, attracting marginal investment from central and local governments. This leaves the majority of patients with chronic conditions without effective treatment. International organizations and national governments have recognized the devastating social and economic consequences caused by NCDs in low- and middle-income countries, including China. Yet, few donor-funded projects that address NCDs have been implemented in these countries over the past decade. Due to a lack of strong support from international organizations and national governments for fighting against NCDs, affected persons in China, especially the poor and those who live in rural and less developed regions, continue to have limited access to the needed care. Costs associated with frequent health facility visits and regular treatment have become a major factor in medical impoverishment in China. This article argues that although China's ongoing health system reform would provide a unique opportunity to tackle current public health problems, it may not be sufficient to address the emerging threat of NCDs unless targeted steps are taken to assure that adequate financial and human resources are mapped for effective control and management of NCDs in the country. SUMMARY: The Chinese government needs to develop a domestically-driven and evidence-based disease control policy and funding priorities that respond appropriately to the country's current epidemiological transition, and rapid sociodemographic and lifestyle changes.

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Correction: Communicable Diseases Prioritized According to Their Public Health Relevance, Sweden, 2013.

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Correction: Communicable Diseases Prioritized According to Their Public Health Relevance, Sweden, 2013.

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