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In: South African journal of sociology: Suid-Afrikaanse tydskrif vir sosiologie, Band 27, Heft 4, S. 148-149
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In: South African journal of sociology: Suid-Afrikaanse tydskrif vir sosiologie, Band 27, Heft 4, S. 148-149
Background. The introduction of medicine pricing policies in South Africa (SA) in the form of single exit pricing (SEP) provided a mechanism to improve medicine price transparency and reduce the medicine price and inflation. However, regulation of medicine prices may have further unforeseen effects on the availability of medicine. This research presents the impact of SEP on discontinuation of medicine products on the private healthcare market in SA.Objectives. To evaluate the impact of SEP legislation on the availability of medicines in the SA private health sector in terms of withdrawal of medicines from the market.Methods. A descriptive, quantitative analysis of all registered medicines on the SA market by stock-keeping units (SKUs) was done to establish medicine products that were withdrawn from the market by SKUs during a 14-year period (2001 - 2014).Results. A total of 152 manufacturers discontinued 3 691 SKUs between 2001 and 2014. The mean number of discontinuations per generic manufacturer was 22.34 (standard deviation (SD) 58.11), while innovator manufacturers discontinued a mean of 27.61 (41.89). The largest number of SKUs were commercially withdrawn in 2002 (n=603), followed by discontinuations in 2003 (n=463) and 2004 (n=407). There was a negative correlation between number of discontinued SKUs per year and SEP increase (Pearson's correlation coefficient r ‒0.414; p=0.14). The results showed that SEP and a transparent pricing policy may have had an impact on SKU withdrawal from the market prior to SEP implementation.Conclusions. The result of reduced product availability on the market and its impact on the cost and quality of healthcare to the patient need to be regularly monitored and evaluated to ascertain if direct price regulations achieve the intended outcomes. Other intended or unintended effects on pharmaceutical market dynamics should also be evaluated.
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Several calls, from a wide spectrum of sectors for the enactment of hate-crime legislation in South Africa, suggest that there is limited knowledge about the theoretical underpinnings of this area of criminal law and of the practical problems associated with the implementation of hate-crime laws. This submission briefly examines the origins of hate-crime laws and attempts, by using existing American sources, to provide a conceptual framework for hate crimes. The different models of hate-crime laws, definitional issues and the controversies associated with hate-crime laws are considered. These controversies include disagreements about the use of the term 'hate', the inclusion of victim categories, and the consideration of motive as a requirement of hate crimes. The article also considers practical problems associated with the implementation of hate-crime laws. These problems could commence at the complaint stage when evidence of bias has to be established by law-enforcement officers, and extend to the trial stage, when the role of victims must be considered, when plea bargaining is a possibility and when bias has to be proved in court.
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Objective: To obtain information on Refractive Error (RE) services in Kenya in terms of human resources and equipment, their distribution and levels of provision. Methods: All eye health facilities in Kenya were identified (77), through the Division of Ophthalmic Services. The following information was collected by postal questionnaire and telephone calls/visit (two purposively selected provinces) number refracting by cadre, equipment (whether functioning) and refractions performed in the last month. VISION 2020 recommendations were used to benchmark human resources (targets met/not met) and functioning equipment (exceeds/met/not met minimum). Results: Seventy six out of seventy seven facilities responded (98.7%). Sixty eight (88%) were able to provide data. Study facilities were 83% government, 13% NGO/mission and 4% private. Kenya has less than 1/3 of recommended workforce for eye care. Nairobi province was best served (56.8% of target) with rural provinces having greater deficiencies (low as 3.8%). Urban facilities were better equipped than rural (22.9% vs. 9.1% units exceeded targets, p=0.035). Fifty eight point four percent of refractions were performed at NGO/mission/private facilities although they represented only 17%. The number of refractions done per month by each refractionist varied from 12.6 (Nyanza) to 125.3 (Nairobi). Conclusions: There is shortage of eye care workers at all levels of service delivery and lack of essential equipment for refractive services. Most refractions are not performed in the public sector, although more personnel in the sector have been trained on how to refract. The challenge of REs can be addressed with a public health approach. It requires integration at different service levels: diagnosing REs and other ocular conditions, clear referral pathways, health education/awareness and spectacle dispensing.
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Spanish Ministerio de Economia y Competitividad (MINECO) ; Centro de Excelencia Severo Ochoa ; U.S. Department of Energy ; U.S. National Science Foundation ; Ministry of Science and Education of Spain ; Science and Technology Facilities Council of the United Kingdom ; Higher Education Funding Council for England ; National Center for Supercomputing Applications at the University of Illinois at Urbana Champaign ; Kavli Institute of Cosmological Physics at the University of Chicago ; Center for Cosmology and Astro-Particle Physics at the Ohio State University ; Mitchell Institute for Fundamental Physics and Astronomy at Texas AM University ; Financiadora de Estudos e Projetos ; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) ; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) ; Ministerio da Ciencia, Tecnologia e Inovacao ; Deutsche Forschungsgemeinschaft ; Argonne National Laboratory ; University of California at Santa Cruz ; University of Cambridge ; Centro de Investigaciones Energeticas ; Medioambientales y Tecnologicas-Madrid ; University of Chicago ; University College London ; DES-Brazil Consortium ; University of Edinburgh ; Eidgenossische Technische Hochschule (ETH) Zurich ; Fermi National Accelerator Laboratory ; University of Illinois at Urbana-Champaign ; Institut de Ciencies de l'Espai (IEEC/CSIC) ; Institut de Fisica d'Altes Energies ; Lawrence Berkeley National Laboratory ; Ludwig-Maximilians Universitar Munchen ; Excellence Cluster Universe ; University of Michigan ; National Optical Astronomy Observatory ; University of Nottingham ; Ohio State University ; University of Pennsylvania ; University of Portsmouth ; SLAC National Accelerator Laboratory ; Stanford University ; University of Sussex ; Texas AM University ; OzDES Membership Consortium ; National Science Foundation ; MINECO ; European Research Council under the European Union ; NASA ; Science and Technology Facilities Council ; ICREA ; Spanish Ministerio de Economia y Competitividad (MINECO): FPA2012-39684 ; Centro de Excelencia Severo Ochoa: SEV-2012-0234 ; Centro de Excelencia Severo Ochoa: SEV-2012-0249 ; Centro de Investigaciones Energeticas: SEV-2012-0234 ; Centro de Investigaciones Energeticas: SEV-2012-0249 ; National Science Foundation: AST-1138766 ; MINECO: AYA2012-39559 ; MINECO: ESP2013-48274 ; MINECO: FPA2013-47986 ; European Research Council under the European Union: 240672 ; European Research Council under the European Union: 291329 ; European Research Council under the European Union: 306478 ; NASA: PF5-160138 ; Science and Technology Facilities Council: ST/M001334/1 ; Small temperature anisotropies in the cosmic microwave background (CMB) can be sourced by density perturbations via the late-time integrated Sachs-Wolfe (ISW) effect. Large voids and superclusters are excellent environments to make a localized measurement of this tiny imprint. In some cases excess signals have been reported. We probed these claims with an independent data set, using the first year data of the Dark Energy Survey (DES) in a different footprint, and using a different superstructure finding strategy. We identified 52 large voids and 102 superclusters at redshifts 0.2 < z < 0.65. We used the Jubilee simulation to a priori evaluate the optimal ISW measurement configuration for our compensated top-hat filtering technique, and then performed a stacking measurement of the CMB temperature field based on the DES data. For optimal configurations, we detected a cumulative cold imprint of voids with Delta T-f approximate to -5.0 +/- 3.7 mu K and a hot imprint of superclusters Delta T-f approximate to 5.1 +/- 3.2 mu K; this is similar to 1.2 sigma higher than the expected vertical bar Delta T-f vertical bar approximate to 0.6 mu K imprint of such superstructures in Lambda cold dark matter (Lambda CDM). If we instead use an a posteriori selected filter size (R/R-v = 0.6), we can find a temperature decrement as large as Delta T-f approximate to -9.8 +/- 4.7 mu K for voids, which is similar to 2 sigma above Lambda CDM expectations and is comparable to previous measurements made using Sloan Digital Sky Survey superstructure data.
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Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography–year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4–61·9) in 1980 to 71·8 years (71·5–72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7–17·4), to 62·6 years (56·5–70·2). Total deaths increased by 4·1% (2·6–5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8–18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6–16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9–14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1–44·6), malaria (43·1%, 34·7–51·8), neonatal preterm birth complications (29·8%, 24·8–34·9), and maternal disorders (29·1%, 19·3–37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000–183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000–532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Funding Bill & Melinda Gates Foundation. ; We thank the countless individuals who have contributed to the Global Burden of Disease Study 2015 in various capacities. The data reported here have been supplied by the United States Renal Data System (USRDS). Data for this research was provided by MEASURE Evaluation, funded by the United States Agency for International Development (USAID). Collection of these data was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. Views expressed do not necessarily reflect those of USAID, the US Government, or MEASURE Evaluation. Parts of this material are based on data and information provided by the Canadian institute for Health Information. However, the analyses, conclusions, opinions and statements expressed herein are those of the author and not those of the Canadian Institute for Health information. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with licence number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law–2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. The following individuals acknowledge various forms of institutional support. Simon I Hay is funded by a Senior Research Fellowship from the Wellcome Trust (#095066), and grants from the Bill & Melinda Gates Foundation (OPP1119467, OPP1093011, OPP1106023 and OPP1132415). Panniyammakal Jeemon is supported by a Clinical and Public Health Intermediate Fellowship from the Wellcome Trust-DBT India Alliance (2015–20). Luciano A Sposato is partly supported by the Edward and Alma Saraydar Neurosciences Fund, London Health Sciences Foundation, London, ON, Canada. George A Mensah notes that the views expressed in this Article are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, National Institutes of Health, or the United States Department of Health and Human Services. Boris Bikbov acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group supported by the International Society of Nephrology (ISN). Ana Maria Nogales Vasconcelos acknowledges that her team in Brazil received funding from Ministry of Health (process number 25000192049/2014-14). Rodrigo Sarmiento-Suarez receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogotá, Colombia. Ulrich O Mueller and Andrea Werdecker gratefully acknowledge funding by the German National Cohort BMBF (grant number OIER 1301/22). Peter James was supported by the National Cancer Institute of the National Institutes of Health (Award K99CA201542). Brett M Kissela would like to acknowledge NIH/NINDS R-01 30678. Louisa Degenhardt is supported by an Australian National Health and Medical Research Council Principal Research fellowship. Daisy M X Abreu received institutional support from the Brazilian Ministry of Health (Proc number 25000192049/2014-14). Jennifer H MacLachlan receives funding support from the Australian Government Department of Health and Royal Melbourne Hospital Research Funding Program. Miriam Levi acknowledges institutional support received from CeRIMP, Regional Centre for Occupational Diseases and Injuries, Tuscany Region, Florence, Italy. Tea Lallukka reports funding from The Academy of Finland (grant 287488). No individuals acknowledged received additional compensation for their efforts. ; Peer-reviewed ; Publisher Version
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