Accesibilidad, disponibilidad y asequibilidad de medicamentos para Niños con Enfermedad Renal Crónica en Guatemala / Access, availability and affordability of medications for children with Advanced Chronic Kidney Disease in Guatemala

El artículo tiene como objetivo analizar la disponibilidad, acceso y asequibilidad de los medicamentos para niños con Enfermedad Renal Crónica (ERC) en tratamiento con hemodiálisis (HD) en un país de bajos a medianos ingresos. Se llevó a cabo un estudio transversal para determinar los medicamentos más utilizados en una unidad de hemodiálisis pediátrica, incluyendo el nombre del medicamento, dosis, frecuencia, forma farmacéutica y vía de administración. Dos farmacias dentro del perímetro del hospital, una pública y una privada, fueron consultadas para determinar el costoy disponibilidad de medicamentos genéricos y de marca. De un total de 30 pacientes de la unidad de hemodiálisis, 22 expedientes fueron revisados. En general 94% de marca se encontraban disponibles en las farmacias consultadas en comparación a un 52% de los medicamentos genéricos. En farmacias públicas, 41% de medicamentos de marca y 29% de medicamentos genéricos se encontraban disponibles. El costo promedio para un mes de tratamiento con medicamentos de marca adquiridos en una farmacia privada era de $495.00 vs $299.00 en una farmacia pública. Para medicamentos genéricos, el costo promedio correspondía a $414.00 y $239.00 en farmacias privadas y públicas respectivamente. En promedio, los medicamentos de marca adquiridos en una farmacia privada requieren 41 días de trabajo en un mes a comparación de 25 días si se adquieren en una farmacia pública. Los medicamentos genéricos adquiridos en farmacias privadas corresponden a 34 días de trabajo vs 20 días en farmacias públicas. En general existió un acceso limitado a medicamentos genéricos y los medicamentos poseen un costo general más elevado a comparación de otros países lo que implica un posible impacto en la adherencia terapéutica y los padecimientos secundarios de la ERC en los pacientes pediátricos en Guatemala. Esta realidad se puede aplicar a otros países de bajos a medianos ingresos.

This article aims to analyze the availability, access, and affordability of medications for children with advanced Chronic Kidney Disease (CKD) treated with hemodialysis (HD) in a low to middle income country (LMIC). A cross- sectional chart review was carried out to determine the most common medications used in an HD pediatric unit, including medication name, dose, frequency, dosage form, and route of administration. Two pharmacies within the hospital perimeter, one public and one private, were consulted to determine medication cost and availability for generic and brand-name equivalents. From 30 patients attending the HD unit, 22 records were reviewed. Overall, 94 % of brand name medications were available at pharmacies consulted, versus and 52% of generic medications. In public pharmacies, 41% of brand name, and 29% of generic medications were available. The average cost for a full month´s treatment for brand name drugs in the private pharmacy was 495.00 USD versus 299.00 USD in the public pharmacy. For generic drugs, the average cost was 414.00 USD, and 239.00 USD in private and public pharmacies respectively. On average, brand-name drugs in the private pharmacy cost 41 days' wages versus 25 in the public pharmacy. Generic drugs in the private pharmacy cost 34 days' wages versus 20 in the public pharmacy. Overall, there was limited access to generic medications, medications had an overall high cost compared to other countries both of which have the potential to impact treatment adherence and overall outcomes of CKD5 pediatric patients in Guatemala. This reality can be translated to other LMIC.

Availability of resources for paediatric hearing care in a South African province

Background: Unavailability of healthcare resources can lead to poor patient outcomes. The latter is true for infants with hearing loss and require early hearing detection and intervention (EHDI). Aim: To determine the availability and distribution of resources for EHDI in state hospitals in the Eastern Cape (EC) province, South Africa. Setting: Sixteen state hospitals (nine district, four regional and three tertiary hospitals). Methods: Descriptive cross-sectional survey completed between July 2022 and October 2022. Results: Thirteen hospitals had audiologists (n = 4) or speech therapists and audiologists (n = 9). Specific to equipment, 10 hospitals had a screening otoacoustic emissions or automated auditory brainstem response, 8 hospitals had diagnostic middle ear analysers and only 3 hospitals had diagnostic auditory brainstem response and/or auditory steady state response. Twelve hospitals did not have visual response audiometry (VRA) and 94% had no hearing aid verification systems. Budget allocations were uneven, with only 10 hospitals, i.e., 4 districts, all regional and 2 tertiary hospitals being allocated varying amounts. Subsequently, only 50% provided newborn hearing screening, 56% provided diagnostic evaluations and 14 hospitals fitted hearing aids. Conclusion: Results revealed a limited and uneven distribution of resources, which negatively impacted the provision of EHDI. Even distribution of healthcare resources and further research aimed at strengthening hearing health services is recommended as these could potentially improve equitable access to EHDI and the overall quality of healthcare provided. Contribution: This study highlights the need for even distribution of resources and strengthening of health systems, especially in the dawn of the National Health Insurance.

Determinantes externos de la disponibilidad de sangre / External Determinants of Blood Availability

El acceso universal a las transfusiones de sangre depende de diversos factores localizados dentro y fuera de los servicios de salud. Motivados por ser este un tema infrecuente, el trabajo tiene el objetivo de analizar desde una perspectiva multidimensional y holística los determinantes externos de la disponibilidad de sangre para las transfusiones. El desarrollo socioeconómico constituye un importante factor dinamizador porque condiciona, de cierta manera, la infraestructura del sistema sanitario e incide sobre los factores epidemiológicos, sociodemográficos y jurídicos. A su vez, estos influyen en la organización de las actividades y la complejidad de la asistencia sanitaria, factores que otorgan un sentido positivo o negativo a la disponibilidad de sangre. Tomarlos en consideración al diseñar las políticas de salud relacionadas con el uso de la sangre permite una mayor precisión en las intervenciones locales que contribuyan a mejorar la seguridad de las transfusiones(AU)

Universal access to blood transfusions depends on a number of localized factors both inside and outside health services. Motivated by being an infrequent topic, this work aims to analyze from a multidimensional and holistic perspective the external determinants of the availability of blood for transfusions. Socio-economic development is an important dynamic factor because it conditions, in a certain way, the infrastructure of the health system and affects epidemiological, sociodemographic and legal factors. In turn, these influence the organization of activities and the complexity of health care, factors that give a positive or negative meaning to the availability of blood. Taking them into consideration when designing health policies related to the use of blood allows greater precision in local interventions that contribute to improving the safety of transfusions(AU)

Presença de desertos alimentares em um distrito sanitário de uma capital brasileira: um estudo descritivo e exploratório sobre a distribuição espacial de estabelecimentos comerciais de alimentos / Food deserts in a health district of a Brazilian capital: a descriptive and exploratory study on the spatial distribution of commercial food establishments

Introdução: O ambiente alimentar que a comunidade está inserida pode influenciar, positiva ou negativamente no acesso à alimentação de qualidade e consequentemente na sua saúde. Objetivo: Identificar a presença de desertos alimentares em um distrito sanitário de uma capital brasileira. Métodos: Estudo descritivo, transversal e exploratório, utilizando dados secundários de diferentes fontes institucionais para mapear a distribuição espacial de estabelecimentos de comercialização de alimentos: restaurantes, padarias, supermercados, minimercados/mercearias, hortifrutigranjeiros, vendedores ambulantes e lanchonetes/fastfood. Os estabelecimentos foram agrupados nas categorias in natura, ultraprocessados e mistos, de acordo com a predominância do tipo de alimentos comercializados. Para a análise, a densidade de estabelecimentos in natura juntamente com os mistos por mil habitantes (usuários cadastrados nos centros de saúde) foram calculadas.  Resultados: Foram investigados 111 estabelecimentos, sendo 20% que comercializavam alimentos in natura (saudáveis), 27% alimentos ultraprocessados (não saudáveis) e 53% considerados mistos. Conclusões: Foram observadas áreas que podem ser consideradas desertos alimentares, locais onde há pouca (ou ausência) de oferta de alimentos in natura, e por consequência dificultando o acesso a alimentos saudáveis.

Introduction: The communities' food environment can positively or negatively influence access to quality food and consequently, people's health. Objective: Identify the presence of food deserts in a health district of a Brazilian capital. Methods: Descriptive, cross-sectional and exploratory study, using secondary data from different institutional sources to map the spatial distribution of food establishments such as restaurants, bakeries, supermarkets, minimarkets/grocery stores, fruit and vegetable stores, street vendors and cafeterias/fast food. The establishments were grouped into fresh, ultra-processed and mixed food categories, according to the predominance of the type of food offered. For the purpose of analysis, the density of fresh food establishments together with mixed food establishments per thousand inhabitants (as registered in the health centers) was calculated.  Results: A total of 111 establishments were investigated, 20% selling fresh foods (healthy), 27% ultra-processed foods (unhealthy) and 53% considered mixed food sellers. Conclusions: Areas that can be considered food deserts were found, i.e. places where there is little (or absence) of fresh food supply, and consequently making access to healthy foods difficult.

Estrategias de acceso a los alimentos implementadas en Venezuela por un grupo de venezolanos que viven en Cuiabá, Brasil / Food access strategies implemented in Venezuela by a group of Venezuelans living in Cuiabá, Brazil

Resumen La crisis sociopolítica de Venezuela ha generado diversos problemas como la inseguridad alimentaria, la escasez de productos básicos y medicinas, el aumento del desempleo y la migración masiva hacia otros países de la región. Este estudio tuvo por objetivo identificar las estrategias de acceso a los alimentos vividas en Venezuela por los inmigrantes venezolanos que residen en Cuiabá, en Mato Grosso, Brasil. Esta investigación se realizó bajo el enfoque cualitativo para indagar cómo fue el impacto respecto al acceso y consumo de alimentos en Venezuela vivido por los inmigrantes venezolanos desde la documentación, descripción y comprensión de las experiencias que ellos enfrentan. Se incluyeron 13 participantes, la técnica de recolección de datos que se utilizó fueron las entrevistas individuales. Entre los principales hallazgos encontrados se evidenció que la mayoría de los entrevistados no se sentía a gusto con la alimentación que tenía en Venezuela, dadas las pocas condiciones de acceso y disponibilidad de alimentos, muchos de estos manifestaron percepciones de hambre y angustia por la falta de alimentos, y estas situaciones llevaron a buscar mejores condiciones de vida. La crisis en Venezuela que produjo la poca disponibilidad y acceso a los alimentos les generó estrategias para poder garantizar una alimentación permanente dentro de los hogares donde muchas veces estas estrategias no son acordes a una alimentación saludable y adecuada.

Abstract The socio-political crisis in Venezuela has generated various problems, such as food insecurity, shortages of basic products and medicines, increased unemployment and massive migration to other countries in the region. To identify the strategies for access to food experienced by Venezuelan immigrants residing in Cuiabá-MT, Brazil. This research was conducted under the qualitative approach, this approach allowed us to investigate how was the impact regarding the access and consumption of food in Venezuela lived by Venezuelan immigrants residing in Cuiabá - Brazil, from the documentation, description and understanding of the experiences they face; 13 participants were included, the data collection technique used were individual interviews. Among the main findings was that most of the interviewees did not feel comfortable with the food they had in Venezuela, given the poor conditions of access and availability of food, many of them expressed perceptions of hunger and anguish due to the lack of food and these situations led them to seek better living conditions. The socio-political crisis in Venezuela that produced the lack of availability and access to food, generated strategies to ensure a permanent food supply within households where often these strategies are not in line with a healthy and adequate diet.

Assessment of availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia during COVID-19 pandemic

BACKGROUND: The emergence of COVID-19 pandemic has disrupted the supply chain and stock of medicines and drugs across the globe. Tracer drugs are essential medicines that address the population's priority health problems. Thus, this study aimed to assess availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia. METHODS: Facility based cross-sectional study was employed in four regions and one city administration. The primary health care units (PHCUs) were purposively selected in consultation with respective regional health bureaus. Finally, 16 hospitals, 92 health centers and 344 health posts were included. This study adopted WHO's tool that was being used to rapidly assess the capacity of health facilities to maintain the provision of essential health services during the COVID-19. Descriptive analysis was done using frequency and percentage, and results were presented. RESULTS: The overall mean availability of tracer drugs in PHCUs was 77.6%. Only 2.8% of PHCUs have all tracer drugs. The mean availability of basic diagnostic at national level was 86.6% in PHUs except health posts where it was less. Health facilities with all basic diagnostic services was 53.7%. Of the total 344 health posts assessed, 71% were providing diagnostic testing for malaria using either laboratory equipment or rapid diagnostic test (RDT) while 43% provide urine test for the pregnancy. Conclusion: This study shows availability of all tracer drugs in PHCUs in Ethiopia was extremely low. There was regional variation in availability of tracer drugs and basic diagnostics. It is very crucial to increase availability of tracer drugs and diagnostics. Drugs and diagnostic materials should be supplied according to the capacity and location of health facilities.

Availability of maternal, newborn care and child health Services at primary health care unit during COVID-19 outbreak in Ethiopia

Background: The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak. Methods: A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection. Result: During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale. Conclusion: Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.

Utilization of Secondhand Childcare productsand Perceived Health Risks among Mothers of Under-Five Years Children in Ibadan Metropolis, Nigeria

Background: Second-hand economy is a universal phenomenon. In Nigeria, it cut across many decades and all spectrums of life even in childcarepractice. The role of second-hand products in childcare practice and provisioning has been under reported in scholarly discuss in Nigeria. Hence,the prevalence of secondhand childcare products utilization, different categories of secondhand products available for childcare, the perceived health hazards and the reasons why consumers patronize secondhand products for childcareamong mothers of under five years in Ibadan Nigeria.Methods:A cross sectional concurrent mix-methods approach was used in the study. The quantitative and qualitative data weredone simultaneously. While mothers of under-five children were purposively selected for in-depth interviews, a total sampling of all consenting mothers of under-five found at immunization clinic of Primary health care centres were sampled for survey. A total number of 403 mothers of under five children participated in the survey while 50 IDIs were conducted with buyers (mothers) and traders of secondhand children's products. Qualitative data were subjected to thematic analysis, while the quantitative data were analyzed with descriptive statistics and chi-square test.Results:The mean age of mothers is ± SD 28.6 ± 5.4. Majority of respondents 209 (51.9%) had senior secondary education, 140 (34.7%) had tertiary education and only 2 (0.5%) had no formal education. About 339 (84.1%) utilized secondhand childcare products, while 64 (15.9%) never used secondhand childcare products. Mothers with at least senior secondary education 209 (51.9%) were found to be the highest users of secondhand childcare products. Procurement and utilization of secondhand childcare products was based on quality value, availability, affordability attached to constructed superiority of western civilization wrapped around provisioning in childcare. Conclusion: Many mothers of under-five children in Ibadan utilizes secondhand products in childcare. Embedding secondhand products health hazard in health talk during immunization clinics will be beneficial and help in educating mothers on reduced and safe utilization of secondhand products in childcare

The Quality of Logistics Management Information System and the Availability of Tracer Drugs at Health Posts in Rural Ethiopia: A Mixed-Method Study

BACKGROUND: Proper implementation of the logistics management information system (LMIS) would facilitate access to essential pharmaceutical products. It also prevents wastage at health posts. The aim of this study was to assess the implementation of the LMIS and the availability of tracer drugs at health posts in rural Ethiopia. METHODS: We employed a cross-sectional descriptive design with a mixed-method approach. The data used for this paper was collected from March to May 2019 as part of the National HEP assessment. The study involved 343 health posts randomly selected from nine regions of Ethiopia. Women's Development Army members and household heads participated in the qualitative study (i.e. in FGD and KII). The quantitative data were exported from Open Data Kit (ODK) to Stata 15.1 for statistical analysis, and the qualitative data were entered into NVivo 12 and analyzed using thematic content analysis. RESULTS: Of the health posts, 59.4% had a space for storing drugs; less than half (41.9%; 95% confidence interval (CI) [36%, 48%]) had a functioning refrigerator. The mean percentage of the availability of selected tracer drugs at health posts was 59.6%, with a 95% CI (58.9%, 60.3%). Bin cards were available at 43% (95% CI [40%, 46%]) of health posts, and among these, only 27.5% of the health posts adequately used the bin cards. CONCLUSION: The absence and poor use of LMIS tools was observed at health posts. Proper implementation of the LMIS has the potential to improve the availability of essential drugs that, in turn, improve health post level delivery of health services.

Resource components and utilization values of different parts of Panax quinquefolium in Shandong province / 中国中药杂志

To explore the resource components and availability of different parts of Panax quinquefolium in Shandong province, the paper employed the non-targeted metabolomics technology based on ultra-high performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS) to analyze the metabolites and their metabolic pathways in the root, fibril, stem, and leaf of P. quinquefolium. The content of seven ginsenosides and polysaccharides in different parts was determined by high performance liquid chromatography(HPLC) and ultraviolet-visible spectrophotometry(UV-Vis). The results showed that the metabolites were mainly sugars, glycosides, organic acids, amino acids and their derivatives, terpenoids, etc. The total abundance of metabolites followed the trend of leaf > root > fibril > stem. Most of the differential metabolites were concentrated in phenylpropane biosynthesis, flavonoid biosynthesis, citric acid cycle, and amino acid biosynthesis. The leaf contained high levels of sugars, glycosides, amino acids and their derivatives, and flavonoids; the root was rich in terpenoids, volatile oils, vitamins, and lignin; the fibril contained rich organic acids; and the stem had high content of nucleotides and their derivatives. The content of ginsenosides Re and Rb_1 was significantly higher in the root; the content of ginsenosides Rg_1, Rg_2, Rd, F_(11), and polysaccharide was significantly higher in the leaf; and the content of ginsenoside Rb_2 was significantly higher in the stem. We analyzed the resource components and availability of different parts of P. quinquefolium, aiming to provide basic information for the comprehensive development and utilization of P. quinquefolium resources in Shandong province.

A preliminary assessment of availability and pricing of children’s medicines in government hospitals and private retail pharmacies in a district of West Bengal in India

Background: A lack of availability of suitable pediatric formulation and high price are often the major hindrance to the better access of the essential treatment to the children. In the backdrop of paucity of literature addressing this problem in India and in particular West Bengal, the present work was planned. Aim and Objectives: This study has been a maiden approach to generate data regarding this issue in small scale and in an inexpensive way after conducting a survey in different government and private facilities in a district of West Bengal, India. Materials and Methods: This cross-sectional study used “WHO Children’s Medicines Survey Form” to make a rapid assessment of availability and pricing of 20 core children’s medicine formulations among ten government hospitals and nine private retail pharmacies in the district of Burdwan in West Bengal during September-October 2009. In retail pharmacies, the actual price to the patient of the cheapest brand was documented. In public health facilities, procurement prices for medicines were obtained from state government’s Central Medical Stores (CMS) listing. Results: Overall, the availability was sub-optimal in all levels of public health facilities-30% in medical college pharmacy, 33% in the district reserve stores, 33.75% in sub-divisional hospitals, 32.25% in primary health centers, and in retail pharmacies was only 45%. Out of the 20 formulations, only two (ORS, paracetamol) were available in all the public and private retail pharmacies. Availability of anti-infectives was better than other medicines in both types of facilities. The variation of prices among different brands was wide. The cost of even the cheapest brand was much higher than corresponding government procurement price. Conclusion: This maiden effort reveals sub-optimal availability of core essential medicines for children in both public facilities and private retail pharmacies. However, medicines available in private pharmacies were much costlier compared to CMS procurement price. This is a matter of concern. A larger nation-wide study is the need of the hour with a greater focus on affordability and prescribing behavior.

Availability and accessibility of opioids for pain and palliative care in Colombia: a survey study / Disponibilidad y accesibilidad de los opioides para manejo del dolor y cuidado paliativo en Colombia: estudio tipo encuesta

Abstract Introduction: Access to essential medicines, including opioids, is a component of the right to health. Objective: To identify barriers to opioid availability and accessibility for pain and palliative care. Methods: Online survey with Colombian prescribers. Availability barriers were analyzed for each facility (distribution and/or dispensing). Accessibility barriers were analyzed by type. Descriptive analyses were conducted using relative frequencies. Significance within categories and regions was measured using Fisher's exact test. Results: Out of 1,208 prescribers invited, 806 (66.7%) completed the survey. Availability: 76.43% reported barriers. The most cited barrier was "Pharmacies authorized by health insurance companies", where opioids are frequently unavailable. Accessibility: 74.6% reported barriers. Most frequently cited was "Difficulty securing payment authorization for medication from health insurance companies". Significant differences were observed in terms of regions and "Cost" (p=0.02). Lack of coordination among procuring and distributing agencies affects availability. Limited awareness and bureaucratic procedures affect accessibility. Conclusions: There are barriers to opioid availability and access in Colombia, related to the existing structure for guaranteeing equitable supply. From the perspective of healthcare providers, problems related to pharmacy availability, prescription and cost of medicines hinder pain treatment.

Resumen Introducción: El acceso a medicamentos esenciales, incluidos los opioides, es un componente del derecho a la salud. Objetivo: Identificar las barreras de disponibilidad y acceso a los opioides para dolor y cuidados paliativos. Métodos: Encuesta virtual a prescriptores colombianos. Las barreras de disponibilidad se analizaron para cada centro (distribución y/o dispensación) y las barreras de acceso se analizaron por tipo. Los análisis descriptivos se realizaron utilizando frecuencias relativas. La significancia dentro de categorías y regiones se midió utilizando la prueba exacta de Fischer. Resultados: De los 1208 prescriptores invitados, 806 (66.7%) respondieron la encuesta. Disponibilidad: el 76,43% reportó barreras. La barrera más citada fue la relacionada con las "farmacias autorizadas por las aseguradoras de salud", donde los opioides con frecuencia no están disponibles. Acceso: el 74,6% reportó barreras. Se citó con mayor frecuencia la "Dificultad para obtener la autorización de pago de medicamentos por parte de las aseguradoras". Se observaron diferencias significativas entre regiones y "costos" (p=0,02). La falta de coordinación entre las entidades de adquisición y distribución afecta la disponibilidad. La limitada conciencia y los procedimientos burocráticos afectan la accesibilidad. Conclusiones: Existen barreras de disponibilidad y acceso a los opioides en Colombia, las cuales están relacionadas con la estructura disponible para garantizar un suministro equitativo. Desde el punto de vista de los prescriptores, los problemas relacionados con la disponibilidad de las farmacias, la prescripción y el costo de los medicamentos, obstaculizan el tratamiento adecuado del dolor.

Disponibilidad de sangre para transfusiones. Revisión y consideraciones prácticas / Blood availability for transfusions. Review and practical considerations

La disponibilidad de sangre constituye un elemento esencial para el acceso universal a las transfusiones y una prioridad de los sistemas locales de salud. Es un término muy utilizado en la literatura científico-técnica; sin embargo, no muy bien caracterizado. En el presente artículo se ofrece una aproximación teórica a la disponibilidad de sangre, sus componentes y factores determinantes; así como, se ofrecen algunos aspectos prácticos de su gestión dentro de los servicios de salud. La disponibilidad de sangre es una cualidad referida a la cantidad de unidades de sangre que se encuentran listos para ser utilizados en los pacientes que lo requieran en un momento determinado y para un área geográfica definida. Sus componentes principales son la oferta y la demanda de sangre. En la cadena transfusional se planifican, ejecutan y controlan varias actividades estrechamente vinculadas entre ellas y con el medio externo; lo cual le imprime un carácter multidimensional a la disponibilidad de sangre y un dinamismo peculiar a las actividades de donaciones, procesamiento y trasfusiones de sangre. Conocer las relaciones de dependencia que se establecen entre las partes de esta cadena logística, constituye elemento imprescindible para la gestión eficiente de los programas de sangre(AU)

The blood availability (BA) constitutes an essential element for universal access to transfusions and a priority for local health systems. It is a term widely used in the scientific-technical literature, however, not very well characterized. This article offers a theoretical approach to BA, its components and determining factors; as well as, some practical aspects of its management within the health services are offered. BA is a quality referred to the amount of blood units that are ready to be used in patients who require it at a given time and for a defined geographic area, its main components are the supply and demand for blood. In the transfusion chain, various activities closely linked to each other and to the external environment are planned, executed and controlled; which gives a multidimensional character to the BA and a peculiar dynamism to the activities of donations, processing and blood transfusions. Knowing the dependency relationships that are established between the parts of this logistics chain is an essential element for the efficient management of blood programs(AU)

CHINA PHARMACY Volume 33，Number 18，September 30，2022 Semimonthly Table of Contents Study on the availability of essential medicines for children at 18 tertiary children ’s hospitals / 中国药房

OBJECTIVE To provide emp irical evidence for relevant decision makers in China to formulate and improve policies related to children ’s medicine use . METHODS Based on the purchase data （Jul. 2016-Jun. 2019）of 18 tertiary children ’s hospitals，the availability of medicines included in the 7th edition of WHO Model List of Essential Medicines for Children （WHO EMLc）and their influential factors were investigated according to standard medicine investigation method recommended by the WHO and Health Action International . RESULTS A totally 189 active ingredients listed in the 7th edition of WHO EMLc were available at 18 tertiary children ’s hospitals in China ，which referred to 229 medicines. The availability of Budesonide inhalation suspension，oral rehydration salt ，Immunoglobulin for injection and Water for injection was 100%. In each quarter from Jul . 2016 to Jun . 2019，the availability of more than half of the medicines exceeded 50%，and the availability of the medicines remained basically stable in each quarter . The overall availability of cardiovascular system medicines and blood system medicines was the highest，while that of antiparasitic medicines and dermatology medicines was lower . There were 28 medicines（12.2%）that were not approved for use in children in China ，the use of which were off -label. The medicines which had been approved for children and which were included in national essential medicine list had a significantly higher availability （P＜0.05）. CONCLUSIONS The availability of essential medicines for children is generally better at tertiary children ’s hospitals in China . But the use of some essential medicines in children are off -label. In order to ensure the safety and the availability of essential medicines for children ，it is suggested to introduce China ’s essential medicines list for children ，to promote clinical trials in children for commonly used medicines，and to updete the drug manual in time .

Research on Maintenance Management of Equipment of Magnetic Resonance Imaging Based on RAM / 中国医疗器械杂志

OBJECTIVE@#To optimize the maintenance quality management of MRI equipment and ensure the quality and safety of its clinical use.@*METHODS@#The data of failure time and repair time of a MRI equipment in three years were collected by magnetic resonance repair report system, and then the reliability, availability and maintainability(RAM) were studied and analyzed.@*RESULTS@#The results of reliability analysis showed that the communication module was the key subsystem of the MRI equipment. The results of usability analysis showed that RF module was a key subsystem of MRI equipment. Maintainability results showed that the proportion of the MRI equipment not fully utilized due to maintenance-related problems was 2.58%. In order to improve the availability of MRI equipment, the maintenance time of MRI equipment should be shortened.@*CONCLUSIONS@#RAM-based analysis of MRI equipment can help hospital equipment managers to carry out the work of operation optimization, maintenance strategy formulation and safety management of MRI equipment.

Exploration and Application of ESB High-availability Architecture Construction Based on Hospital Information System / 中国医疗器械杂志

OBJECTIVE@#To solve the ESB bus performance and safety problems caused by the explosive growth of the hospital's business, and to ensure the stable interaction of the hospital's business system.@*METHODS@#Taking the construction of our hospital's information system as an example, we used AlwaysOn, load balancing and other technologies to optimize the ESB bus architecture to achieve high availability and scalability of the hospital's ESB bus.@*RESULTS@#The ESB bus high-availability architecture effectively eliminates multiple points of failure. Compared with the traditional dual-machine Cluster solution, the security is significantly improved. The nodes based on load balancing can be scaled horizontally according to the growth of the hospital's business volume.@*CONCLUSIONS@#The construction of the ESB bus high-availability architecture effectively solves the performance and security issues caused by business growth, and provides practical experience for medical information colleagues. It has certain guiding significance for the development of regional medical information.

Relationships between food shortages, endoparasite loads and health status of golden-headed lion tamarins (Leontopithecus chrysomelas) / Relações entre escassez alimentar, carga endoparasitária e estado de saúde do mico-leão-de-cara-dourada (Leontopithecus chrysomelas)

Abstract Both anthropogenic actions and abiotic parameters, such as rainfall, temperature and photoperiod, can affect fruit and flower availability for animals, which consequently affects nutritional status and thus animals' health. Herein, we investigated whether abiotic factors are related to changes in fruit availability that can lead to changes in feeding behavior and, consequently, in endoparasite load and general health status in two groups of golden-headed lion tamarins (Leontopithecus chrysomelas) living in degraded fragments of Atlantic forest in Southern Bahia, Brazil. We detected that there was a high variation in availability of ripe fruits throughout the year, with lower availability occurring at the end of spring and beginning of summer. Despite this, there was no difference in tamarins' general health status, body mass and blood counts between seasons. This is probably because during native fruit scarcity, the tamarins eat cultivated species, such as banana (Musa spp.) and jackfruit (Artocarpus heterophyllus). Temperature and daylength were negatively correlated with golden-headed lion tamarin endoparasite loads. Contrary to our expectations, endoparasite loads are not linked to fruit scarcity and consequent changes in feeding behavior. Nevertheless, we found higher parasite diversity in the group of golden-headed lion tamarins that occupied the smallest home range. The smaller the area available, the greater the contact with parasites the animal will have, as they are forced to travel constantly along the same routes in the forest, increasing infection risk and re-infection rates. Our results highlight how animals' health is associated with environmental health as well as the need for constant monitoring to ensure the effective conservation of endangered species, such as the golden-headed lion tamarin.

Resumo Parâmetros abióticos, como precipitação, temperatura e fotoperíodo, podem afetar a disponibilidade de frutos e flores para os animais, o que consequentemente afeta o estado nutricional e a saúde dos animais. Neste estudo, investigamos se fatores abióticos estão relacionados com alterações na disponibilidade de frutos, o que pode levar a mudanças no comportamento alimentar e, consequentemente, na carga de endoparasitas e estado de saúde geral em dois grupos de mico-leão-de-cara-dourada (Leontopithecus chrysomelas) que vivem em fragmentos degradados de Floresta Atlântica no sul da Bahia, Brasil. Detectamos que houve grande variação na disponibilidade de frutos maduros ao longo do ano, com menor disponibilidade no final da primavera e início do verão. Apesar disto, não houve diferenças no estado geral de saúde, na massa corporal ou nas contagens de células sanguíneas dos animais entre as estações do ano. Isto provavelmente ocorreu porque durante a escassez de frutos nativos, os micos comem espécies cultivadas, tais como a banana (Musa spp.) e jaca (Artocarpus heterophyllus). A temperatura e a duração do dia foram negativamente correlacionadas com a carga de endoparasitas de mico-leão-de-cara-dourada. Contrário ao previsto, a carga de endoparasitas não está ligada à escassez sazonal de frutos e consequentes mudanças no comportamento alimentar. Entretanto, encontramos maior diversidade de endoparasitas no grupo de mico-leão-de-cara-dourada que usou uma área de vida menor. Quanto menor a área disponível, maior o contato com parasitas, porque os micos são forçados a se deslocar constantemente pelas mesmas rotas na floresta, aumentando o risco de infecção e as taxas de reinfecção. Nossos resultados destacam como a saúde dos animais está associada à saúde ambiental, bem como a necessidade de monitoramento constante para a conservação eficaz das espécies ameaçadas de extinção, como o mico-leão-de-cara-dourada.

Métodos de investigación empleados para el análisis del acceso a los servicios de salud en contextos rurales / Research methods used for the analysis of access to health services in rural contexts

Introducción: La ruralidad y los sistemas de salud a nivel global constituyen un campo de fuerzas marcado por la pervivencia de la ruralidad y las condiciones de inequidad y desigualdad en el acceso a los servicios de salud. Objetivo: Identificar los métodos de investigación utilizados en el contexto internacional para analizar los servicios de salud en poblaciones rurales. Métodos: Se realizó un estudio de revisión sistemática que incluyó los reportes de investigación relacionados con el tema, publicados hasta diciembre de 2014. El proceso de selección de los estudios se realizó en cuatro etapas: identificación, cribado, elegibilidad e inclusión. Se recuperaron 253 referencias que muestran la diversidad metodológica de aproximación al acceso a servicios de salud en poblaciones rurales. Conclusiones: Se necesita una mirada diferenciada a la ruralidad para elaborar políticas públicas eficientes, que estén en concordancia con los contextos y necesidades de las comunidades que demandan los servicios de salud(AU)

Introduction: Rurality and health systems represent globally a field of forces marked by the survival of rurality and the inequity and inequality conditions in the access to health services. Objective: Identify the research methods used in the international context to analyze health services in rural populations. Methods: It was carried out an study of systematic review that included research reports related with the topic published until December, 2014. The selection process of the studies was conducted in four stages: identification, sieving, elegibility and inclusion. 253 references were recovered and those show the methodological diversity of approaches in the access to health services in rural populations. Conclusions: It is needed a different view to rurality for creating efficient public policies that are in accordance with the contexts and needs of communities that demand health services(AU)

Emergency Medical Service (EMS) Belt

Background:Emergency medical service has been a well-know n subject of discussion in India where the population is vast and the health care system is inadequate. Essential drugs are a category of drugs that are needed during the golden hour of saving a patient’s life. It becomes necessary that time, when a simple drug can save the life of a patient, a competent health care provider, is needed to administer the drug to the patient. In such a situation, any health care provider in the vicinity of the person who needs medical assistance must get an alert so that the health care provider can reach the site of the emergency and provide assistance. EMS belt is a system in which with the help of a mobile application, any person in case of a medical emergency can get service from a nearby health care provider within a few minutes. The concept is to raise an alarm alerting the nearby health care practitioners about the person in need of medical assistance. This concept is promising with the advantage that it doesn’t need any special manufacturing of the device. Conducting trials on this concept shall yield good observations and produce hopes for a cost-effective EMS system in India.

Jugos de fruta y productos herbáceos como perpetradores de interacciones farmacocinéticas mediadas por enzimas metabolizadoras y transportadores de membrana. Relevancia en clínica / Pharmacokinetic interactions of fruit juices and herbal preparations

Drug disposition in the human body is strongly influenced by transporters and metabolizing enzymes expressed in key organs including intestine, liver and kidney. Since drugs and chemicals present in foods such as fruit juices and herb-based products are substrates of the above-mentioned proteins, there is a high probability of pharmacokinetic interactions. Findings from preclinical and clinical studies helped to characterize the mechanisms by which the components of fruit juices and herbs act as perpetrators of pharmacokinetic interactions. The aim of this review is to provide an overview of pharmacokinetic fruit juice- and herb-drug interactions that could be relevant in the clinical setting.