Should China Expand Its Medical Education Scale? Evidence From Comparative Research

Purpose This study compares doctor staffing level and the scale of medical education in China with those of other countries and proposes policy recommendations for future adjustments to the scale of China's medical education. Design/Approach/Methods This study employs a literature review and descriptive analysis. Findings China had 1.98 medical doctors per 1,000 people in 2018, ranking 85th out of the 193 member-states of the World Health Organization (WHO). In 2017, China had 1.99 practicing doctors per 1,000 people, only ranking above Turkey (1.88) in Organisation for Economic Co-operation and Development (OECD) countries. China had only 10.28 medical graduates per 100,000 people—placing in the bottom third of OECD countries. China's provision of 1.4 medical schools per 10 million people was also significantly lower than the global average (3.9). However, the average number of students enrolled in medical schools (509) in China was significantly higher than the global average (160). Originality/Value Although the scale of admission in undergraduate medical education must be expanded in China, this needs to be achieved while controlling the average number of medical students per school and reducing enrollment in low-quality medical schools. Furthermore, it is necessary to establish new medical schools while improving the operating level of existing ones.

The Future of COVID-19: What Is Next in the Drug Pipeline

Objectives: Development of new and repurposed medicines in response to the COVID-19 pandemic has occurred at an unprecedented rate, resulting in a dynamic pipeline marked by significant challenges and successes. This analysis provides an overview of the vaccines and therapies undergoing clinical evaluation or with recent approval for the treatment and prevention of COVID-19 in global markets. Method(s): For this analysis, COVID-19 pipeline medicines are defined in three categories: vaccines, new treatments and repurposed medicines. GlobalData is the primary data source for this study, in addition to online databases from Health Canada, the US FDA, and the EMA. International markets examined include the US and geographic Europe (excluding Russia and Turkey). Result(s): As of November 2022, the global pipeline contained over 600 therapies and vaccines undergoing Phase I, II, III clinical trials or pre-registration for the prevention and treatment of COVID-19. Preventive and repurposed medicines include antivirals, immunoglobulins, monoclonal antibodies, cellular therapies, and convalescent plasma. In Canada, twelve medicines, including six vaccines, have been approved for COVID-19. The number of global approvals is greater, with approximately 9 vaccines on the market in OECD countries. In addition to pre-exposure preventative therapies, manufacturers are also developing COVID-19 drugs to be used as prophylactic therapy. The analysis identifies new oral antiviral treatments and preventative therapies in the pipeline and under review in various jurisdictions globally. Conclusion(s): This research provides a clearer picture of the characteristics and evolution of the market for new and emerging COVID-19 medicines, which will help policy-makers and other stakeholders understand and anticipate the unique pressures of the COVID-19 pandemic.Copyright © 2023

EPH118 Healthcare Systems Sustainability and Resilience: Creating an Index

Objectives: The COVID-19 pandemic has highlighted the need for sustainable and resilient healthcare systems to protect population health. This requires measuring the relative progress of health systems towards becoming more sustainable and resilient. In this research, we design, construct and estimate a country-level healthcare system sustainability and resilience index (HSSRI) that reflects and combines the two dimensions. Method(s): The HSSRI aims to summarise the performance of a health system in the different domains contributing to its sustainability and resilience. These domains are: i) health system governance, ii) health system financing, iii) health system workforce, iv) medicines and technologies, v) health service delivery, vi) population health and social determinants, and vii) environmental sustainability. As part of our analyses, we conduct a rapid evidence assessment to identify indicators reflecting the domains included in the sustainability and resilience dimensions. We assess the domain indicators' suitability by the quantity and quality of the literature supporting their inclusion. The variables in each indicator are extracted from publicly available data sources, such as the OECD, World Bank, and others. The period covered is from 2000 to 2020. Weighted means of the indicators are used to construct the domains' indices in each dimension. We apply a geometric mean to combine the domain indices into one final index. Result(s): The HSSRI is piloted using data from five high-income countries, providing a credible instrument for measuring and reporting healthcare system sustainability and resilience. The results enable policy-makers and stakeholders to observe how different domains of sustainability and resilience have evolved across countries and time. Conclusion(s): The HSSRI will facilitate better understanding and monitoring of the healthcare system's relative weaknesses and strengths, and empower policy-makers to design interventions that improve its resilience and sustainability.Copyright © 2022

Do South Africa's e-commerce VAT rules measure up to international trends and OECD guidelines?

Orientation: The taxability of e-commerce transactions have been the subject of many studies to protect governments from Value-Added Tax (VAT) erosion, illegal recovery and fraud. Research purpose: This study critically analyses the challenges posed by e-commerce transactions in South Africa's VAT Act . Recommendations are made for amendments to the VAT Act to improve rules to effectively tax e-commerce transactions occurring in South Africa. Motivation for the study: Globally, including in South Africa, enforcing relevant VAT legislation to target output tax collections and input tax credits from e-commerce transactions aptly remains a challenge. Research approach/design and method: By integrating qualitative literature reviews and comparative synthesis, this study employed a comparative legal methodology. VAT levied on e-commerce transactions in South Africa is compared to the Organisation for Economic Co-operation and Development's guidelines as well as New Zealand's and Australia's Goods and Services Tax legislations. Main Findings: While the South African VAT Act aligns with international best practices on the use of intermediaries, there are some differences as detailed in the study. Practical/managerial implications: To align with international trade counterparts, the South African VAT Act should differentiate between business-to-business and business-to-consumer sales. A provision concerning the place of consumption for bundled goods should be included in the VAT Act . The VAT Act should contain a provision that allows bad debts to be claimed on cash sales made instead of total sales made. Contribution/value-add: This study harmonises South African VAT legislation with international best practices within the context of continual advancement of e-commerce transactions.

Disparities in access to cancer diagnostics in ASEAN member countries.

Diagnostics, including laboratory tests, medical and nuclear imaging, and molecular testing, are essential in the diagnosis and management of cancer to optimize clinical outcomes. With the continuous rise in cancer mortality and morbidity in the Association of Southeast Asian Nations (ASEAN), there exists a critical need to evaluate the accessibility of cancer diagnostics in the region so as to direct multifaceted interventions that will address regional inequities and inadequacies in cancer care. This paper identifies existing gaps in service delivery, health workforce, health information systems, leadership and governance, and financing and how these contribute to disparities in access to cancer diagnostics in ASEAN member countries. Intersectoral health policies that will strengthen coordinated laboratory services, upscale infrastructure development, encourage health workforce production, and enable proper appropriation of funding are necessary to effectively reduce the regional cancer burden.

Cost-containment long-term care policies for older people across the Organisation for Economic Co-operation and Development (OECD): a scoping review

In most Organisation for Economic Co-operation and Development (OECD) countries, the government has to manage tension between growth in the need for long-term care (LTC) services for older people and significant public budget constraints. Not surprisingly, therefore, cost-containment policies are of increasing relevance. Nevertheless, despite the flourishing interest in the comparative literature in reforms and the sustainability of LTC policies, a scoping review of these measures has so far not been produced. This article aims to contribute to filling this gap. We present a typology of LTC cost-containment policies across the OECD. Cost-containment policies cluster in two areas according to their focus: demand-side policies, which reduce the actual chances of receiving LTC services and/or make them more expensive for users;and supply-side ones, which modify the provision of services. Furthermore, an indirect outcome of the review is that it allows an overview of potential negative implications of these policies. These negative implications can be grouped in two macro spheres relating to a worsening of the care arrangements for beneficiaries and to increased demand for individual/family resources, in both economic and time and effort terms. In the light of the expected profound impacts of the COVID-19 outbreak on all social security sectors in the medium and long term, this article provides a valuable tool for both academic and policy-making debate. It allows an analytical comprehension of cost-containment strategies adopted in LTC sectors linking them with the related impacts on beneficiaries and their families.

Multisectoral Factors Associated with Global National Trends in Neonatal Mortality Rates: A Call for Targeted Public Health Intervention, Particularly in Countries Impacted Most by COVID-19

Background: The United Nations' 2030 Sustainable Development Goals (SDGs) target an end to preventable newborn deaths and a reduction in neonatal mortality rate (< 28 d, NMR) to 12/1,000 live births for all countries. Understanding concurrent trends in country-level, multisectoral factors associated with NMR trends may illuminate opportunities for intervention strategies. Our objective was to explore country-specific trends in NMR from 1990-2019 and identify those countries which contribute to the largest percentage of neonatal deaths in order to focus efforts on reducing NMRs in those specific countries. Unfortunately, due to the COVID-19 pandemic, the 2030 SDGs have been severely impacted. Methods: We created a comprehensive global database of NMR and associated variables that were selected based on literature review and categorized into Population Health, Health Systems, Maternal, Neonatal, and Social factors from 1990 to 2019. Data were compiled from publicly available sources including UNICEF, World Bank, WHO, and OECD. Data were collected and analyzed for 195 countries. NMR trends were analyzed from 1990 to 2019 with more targeted analysis of trends in the last 2 decades from 2000 to 2019. We then performed statistical analyses using the selected variables to compare variable means using t-tests, identify bivariate associations, and generate multivariable regression models. Results: In terms of total deaths, 20 countries contributed 75% of the total 2.5 million neonatal deaths. All of these 20 countries showed decreases in NMR since 1990 (Figure 1). However, only China and Egypt accomplished the UN goal of reducing NMR to 12/1,000 live births. We compared variables associated with NMR in our 20 target countries to the remaining countries and found significant differences between the means for most variables (Table 1). Bivariate regression analyses showed statistically significant associations between NMR trends and changes over time in median income, health care spending, literacy level, maternal mortality ratio, and low birthweight rate. Ultimately the variables maternal mortality ratio change and median income change were selected for multivariable analysis based on collinearity. The multivariate regression model generated using NMR, maternal mortality ratio change, median income change resulted in an r-squared value of 0.54, explaining 54% of the variance in NMR trends. Conclusion: Since 20 countries contribute 75% of the neonatal deaths worldwide, we propose that targeting these 20 countries would have the greatest impact on global neonatal deaths. Future research will focus on identification of country specific barriers and evaluating the countries with greatest NMR improvements to propose effective focused strategies for reducing NMRs in high burden countries. The disparate impact that COVID-19 has had on countries with the highest neonatal mortality burden should be a primary focus of continued public health invention efforts, and is a specific focus of our ongoing research.

Evaluation of Antiviral Effects and Toxicity of Herbal Medicine Vipdervir Capsules

Background: Antiviral vaccine is not effective, synthetic antiviral drugs are highly toxic, leading to increased interest in herbal medicines as promising antiviral drugs. Recently, Vipdervir has been developed from medicinal herbs with the aim to support and treat diseases caused by viruses such as H5N1 and SARSCoV- 2. In the present study, we assessed Vipdervir's antiviral activity against H5N1 and SARS-CoV-2. In addition, we also evaluated the acute toxicity and repeated dose toxicity of Vipdervir in mice and rabbits, respectively. Methods: H5N1 inhibitory effect of Vipdervir was assessed using hemagglutination inhibition assay. Vipdervir's SARS-CoV-2 inhibitory effect was evaluated by Plaque Reduction Neutralization assay. Acute and repeated dose oral toxicities of Vipdervir were determined according to OECD 423 and OECD 407 guidelines, respectively. Results: Data show that Vipdervir is effective against both H5N1 and SARSCoV- 2. At concentrations of 3 mg/mL and 5 mg/mL Vipdervir completely inhibits H5N1. At a concentration of 50 μg/mL Vipdervir showed an inhibitory effect on SARS-CoV-2. Acute toxicity data revealed that the LD50 of Vipdervir is greater than 35200 mg/kg, b.wt. in mice. Repeated toxicity data indicated that Vipdervir did not induce significant differences in body weight gain, hematology and clinical biochemistry in compared to the control group. The No Observed Adverse Effect Level of Vipdervir is greater than 613.8 mg/kg b.wt./day in rabbits. No delayed toxicity effects of Vipdervir were observed. Conclusion: Vipdervir capsules were found to be antiviral effective and relatively safe in the tested doses and experimental conditions.

ACCESS TO AND EXPERIENCES OF REMOTE HIV CLINICAL SERVICES IN HIGH-INCOME SETTINGS: A SCOPING REVIEW

Background Remote delivery of HIV services (often facilitated by digital technology) has increased over recent years, especially in response to the COVID-19 pandemic. Using scoping methods, we synthesise current knowledge about remote HIV healthcare services. Methods We systematically searched literature using multiple databases, supplementing this with searches of grey literature. We included papers reporting on empirical studies in high income countries (OECD) of remote HIV healthcare delivery by digital technology including mobile apps, video, SMS and telephone. We extracted data using a standardised tool and analysed data thematically. Results A large proportion of studies focus on interventions supporting antiretroviral therapy adherence, often via mobile apps or SMS. There has been a recent uptick in work describing remote routine HIV clinical appointments in the context of COVID-19. There was a dearth of evidence on the impact of remote HIV healthcare services on clinical and patientreported outcomes, as well as factors shaping access to remote HIV healthcare services. Discussion There is an increasingly large body of work investigating remote HIV healthcare services, much of it focusing on adherence support. Less is known on barriers to and facilitators of remote HIV healthcare service provision and access, and how these services impact patient experience and outcomes. Given the enduring change to models of HIV healthcare as a result of COVID-19, we urgently require a robust evidence-base to inform inclusive, equitable and effective service design.

Trends in utilization of antidepressants in twenty European Countries

Introduction: The use of antidepressants seems to be increasing in most countries worldwide, probably due to the increasing burden of stressful life (1). Apart from their therapeutic application, antidepressants are sometimes used as lifestyle drugs. Monitoring antidepressant usage is crucial to prevent unnecessary consumption and avoid adverse effects and additional costs (2). Objectives: The aim of this work was to study trends in antidepressants utilization in various European countries, and to note changes in their usage between the years 2013 and 2019, before the outbreak of COVID 19 pandemic. Methods: Data on antidepressants consumption in 20 European countries were collected from the Organization for Economic Cooperation and Development (OECD) data bases. Antidepressants consumption was expressed in Defined Daily Doses (DDDs) per 1,000 inhabitants per day, and calculations referred to years 2013 and 2019. Changes in antidepressants use during this six-year period in each European country were assessed. The statistical package SPSS (Chicago, IL, USA) was used for calculations. Results: There was a huge variation in antidepressants usage among the 20 countries of our study. The mean consumption of antidepressants was 52.67 DDDs per 1,000 inhabitants per day in 2013 (range 10.2-113.7 DDDs) and 62.51 DDDs per 1,000 inhabitants per day in 2019 (range 17.6-146.0 DDDs), with a mean increase of 9.84 DDDs per 1,000 inhabitants per day (18.68%) in just six years. The countries with the highest consumption of antidepressants in 2013 were Iceland (113.7 DDDs), Portugal (87.5 DDDs), Sweden (84.3 DDDs), Belgium (72.1 DDDs), Finland (69.4 DDDs) and Spain (65.2 DDDs). The countries with the highest consumption of antidepressants in 2019 were Iceland (146.0 DDDs), Portugal (123.7 DDDs), Sweden (102.7 DDDs), Spain (83.6 DDDs) and Belgium (81.9 DDDs). The countries with the lowest consumption of antidepressants in 2013 were Latvia (10.2 DDDs), Estonia (21.4 DDDs), Lithuania (24.7 DDDs), and Hungary (27,5 DDDs). The countries with the lowest consumption of antidepressants in 2019 were Latvia (17.6 DDDs), Hungary (29.5 DDDs), Estonia (34,8 DDDs) and Lithuania (35,4 DDDs). The use of antidepressants was increased in all European countries in the study period. There was only one exception: Finland, being one the countries with the highest consumption of antidepressants, reduced their use by 13%. In the countries with the lowest consumption of antidepressants (Latvia, Estonia and Lithuania), the increase in antidepressants usage was higher than 40%. A similarly high increase (41.37%) was also observed in Portugal, which was second in antidepressant use in both years studied (2013 and 2019). The Countries with the lowest increase (less than 5%) were Austria, Norway and Luxemburg, which displayed an average consumption of antidepressants in the study period. Conclusion: There was a huge variation in antidepressants use among the 20 European countries of our study. A trend for increase in antidepressants use was observed in almost all countries during the six-year study period.

Canada National and Provincial Cataract Surgery Wait Times (2017-2021): A Targeted Literature Review

Objectives: Pan-Canadian benchmark for cataract surgery wait times is 16 weeks, with aim for 90% of patients to meet this target timeframe. A targeted literature review was conducted to assess recent trends of Canada’s cataract surgery wait times, including impact of COVID-19. Methods: PubMed was searched January 1, 2017–December 10, 2021, and supplemented by grey literature search. Search terms included cataract surgery, wait times, epidemiology, Canada, and COVID-19. Inclusion criteria comprised of literature reporting national and provincial (Ontario, Quebec, British Columbia, Alberta) data with outcomes of interest: percentage of patients treated within 16-week benchmark, 90th percentile wait time (10% waited >x weeks), and 50th percentile/median wait time (half waited >x weeks). Results: Published data from 8 unique sources were included (n=3 white papers, n=5 government data). Canadian Institute for Health Information (CIHI) reported percentage of patients treated within 16 weeks nationally (2017=71%, 2018=70%, 2019=71%, 2020=45%) and by province (Ontario: 2017=69%, 2020=40%;Quebec: 2017=85%, 2020=53%;British Columbia: 2017=63%, 2020=53%;Alberta: 2017=56%, 2020=34%). Five sources reported 90th percentile: CIHI national data showed 10% waited >30.0-31.0 weeks from 2017–2019, and >44.0 weeks in 2020;for Ontario in 2018, 10% waited >28.9 weeks, according to the Eye Physicians and Surgeons of Ontario;provincial government data showed similar results for Alberta (2017–2018=>38.6, 2020–2021=>41.0-63.0) and British Columbia (2021=>27.9). Median wait times (weeks) were reported by 5 sources, with similar national results by CIHI and OECD (2017–2019=9.3-9.6, 2020=18.9);Fraser Institute also reported 2020 national (20.6 [12.0-64.0]) and provincial (Ontario=17.0, Quebec=12.0, British Columbia=28.0, Alberta=24.0) data. Conclusions: Approximately 30% of patients experienced a wait longer than the 16-week pan-Canadian benchmark from 2017–2019, growing to 55% in 2020 amidst COVID-19. To mitigate the impact of COVID-19 and bring wait times to the recommended threshold, collaboration among provincial health authorities and clinicians may be necessary with prioritization of stable funding and reimbursement for cataract surgery.

Development policy from a systemic perspective: changes, trends and its future role within a broader framework for transnational co-operation

Over the past decade a number of changes can be observed within the development policy system. This paper presents and discusses these changes along three dimensions: narratives, strategies and operational approaches. Changes are manifold, ranging from the application of new narratives, such as the migration narrative, to alternations in strategic objectives (e.g. developing countries’ graduation issues), new instruments (in the form of development finance at the interface with the private sector), and the application of new concepts for project implementation (e.g. through frontier technologies). We discuss the implications and effects of these changes for the current and potential future role of the development policy system, as well as preliminary ideas for a concept of global co-operation for sustainable development (GCSD), spanning beyond the development policy system.

POSB178 Geographical Inequalities in Coronavirus (SARS-COV-2) Mortality in Europe

Objectives: Morbidity and mortality rates show different patterns in European countries. The aim of the study was to map geographical inequalities in mortality caused by coronavirus (Sars-COV-2) infection in Europe in 2020. Methods: In our research the ’COVID deaths by week, 2020 and 2021’ indicator from ’OECD Health Statistics’ online database was analysed. Mortality data reported for weeks were aggregated, and calculated for 1,000,000 population using the Eurostat database on the population number for 2020. European countries were classified and compared according to their geographical location: Western-European, Eastern-European, Mediterranean and Nordic countries. After a preliminary normality test (Shapiro-Wilk test) single factor analysis of variance (ANOVA) was performed for comparison. Our analysis was carried out at a 95% probability level (p<0.05). SPSS 25.0 software was used for calculations. Results: In Western Europe, an overall 886, Eastern Europe 826, in Mediterranean region 1,083 and in Northern Europe 463 COVID deaths per 1,000,000 population were reported in 2020. In Europe, Belgium (1,725 deaths/1,000,000 population), Slovenia (1,379 deaths/1,000,000 population) and the United Kingdom (1,331 deaths/1,000,000 population) had the highest registered number of death cases, whereas the lowest numbers recorded were in Norway (84/1,000,000), Finland (102/1,000,000) and Estonia (189/1,000,000). Single factor analysis of variance (ANOVA) did not show significant differences among country groups (p=0.119). Conclusions: Our study revealed that overall, the lowest death rates resulting from the coronavirus infection were reported in Northern Europe in proportion to the population. There were no significant differences between the mortality rates of the geographical areas examined.

Structure features of peptide-type SARS-CoV main protease inhibitors: Quantitative structure activity relationship study.

In the present work, an extensive QSAR (Quantitative Structure Activity Relationships) analysis of a series of peptide-type SARS-CoV main protease (MPro) inhibitors following the OECD guidelines has been accomplished. The analysis was aimed to identify salient and concealed structural features that govern the MPro inhibitory activity of peptide-type compounds. The QSAR analysis is based on a dataset of sixty-two peptide-type compounds which resulted in the generation of statistically robust and highly predictive multiple models. All the developed models were validated extensively and satisfy the threshold values for many statistical parameters (for e.g. R2 â€‹= â€‹0.80-0.82, Q2 loo â€‹= â€‹0.74-0.77, Q 2 LMO  â€‹= â€‹0.66-0.67). The developed QSAR models identified number of sp2 hybridized Oxygen atoms within seven bonds from aromatic Carbon atoms, the presence of Carbon and Nitrogen atoms at a topological distance of 3 and other interrelations of atom pairs as important pharmacophoric features. Hence, the present QSAR models have a good balance of Qualitative (Descriptive QSARs) and Quantitative (Predictive QSARs) approaches, therefore useful for future modifications of peptide-type compounds for anti- SARS-CoV activity.