Tiered Pricing and Alternative Mechanisms for Equitative Access to Vaccines in Latin America: A Narrative Review of the Literature.

OBJECTIVES: To review and describe alternative strategies for the supply of vaccines in Latin America. METHODS: We conducted a narrative review to explore and describe alternatives for equitable vaccine access in Latin America. We searched and considered the main access strategies reported in the literature through PubMed, Science Direct, and Google Scholar. Additionally, we reviewed the web sites of key stakeholders. The search was conducted using the following keywords: ("access" or "availability" or "acquisition" or "affordability" or "tiered pricing") and ("vaccine"). Subsequently, documents that met the inclusion criteria were selected. Finally, findings were grouped by means of a thematic analysis and an interpretative synthesis. RESULTS: Twenty-four publications were included. We identified 5 main topics: current supply strategies, challenges for the acquisition of vaccines, vaccine prices equity, alternative supply strategies, and the advantages and impact of a tiered pricing strategy. CONCLUSIONS: Our review suggests that tiered pricing can be an tool for accelerating the process of introducing vaccines in low-income countries at affordable prices and for countries that do not adhere to the current procurement mechanisms or are not eligible for Vaccine Alliance because giving countries prices for vaccines that reflect their ability to pay can result in better programmatic and financial planning for the purchase of these vaccines, and in return, vaccine manufacturers can gain access to wider markets However, this model has not been z improve access to vaccines that are aimed only at developing countries, mainly because the market in these countries is not profitable for producers.

Capacidad cardiorrespiratoria en pacientes con fibromialgia: revisión sistemática y metaanálisis / Cardiorespiratory fitness in patients with fibromyalgia: a systematic review with meta-analysis

Introducción. La fibromialgia es una enfermedad crónica caracterizada por dolor musculoesquelético generalizado que puede producir deterioro en la capacidad cardiorrespiratoria; sin embargo, hasta la fecha no está claro cuál es el compromiso cardiorrespiratorio en los pacientes con esta condición. Objetivos. Determinar la capacidad cardiorrespiratoria de los pacientes con fibromialgia y analizar las diferencias con controles sanos. Métodos. Se realizó una búsqueda sistemática en las bases de datos PubMed, Web of Science, ScienceDirect, Redalyc, Scopus, Lilacs y Google Scholar. Se incluyeron estudios observacionales publicados en inglés, español y portugués que evaluaran la capacidad cardiorrespiratoria en pacientes con fibromialgia en comparación con sujetos sanos. La calidad metodológica se evaluó mediante la escala Newcastle-Ottawa. Bajo un modelo de efectos aleatorios, el tamaño del efecto combinado se calculó con la diferencia de medias estandarizadas y su intervalo de confianza del 95%; la heterogeneidad se analizó mediante la prueba I-cuadrado (I2). Se realizó análisis de subgrupos para evaluar la influenciadel tipo de prueba de ejercicio clínica utilizada. Resultados. Se incluyeron 14 estudios, con un total de 1.623 participantes (todos de sexo femenino), que cumplieron los criterios de inclusión. Se encontró una diferencia significativa en la distancia recorrida en la prueba de la caminata de seis minutos en mujeres con fibromialgia en comparación con mujeres sanas. Los estudios con ergoespirometría presentaron resultados no concluyentes. Conclusiones. Los pacientes con fibromialgia presentan una menor capacidad cardiorrespiratoria en la prueba de la caminata de seis minutos en comparación con los controles sanos. En este sentido, se necesitan investigaciones que permitan establecer métodos adecuados de medición de la aptitud cardiorrespiratoria que tengan en cuenta las condiciones particulares de los pacientes con esta enfermedad.

Introduction. Fibromyalgia is a chronic disease characterized by widespread musculoskeletal pain that can lead to deterioration in cardiorespiratory capacity; however, to date it is not clear what the cardiorespiratory compromise is in patients with this condition. Objectives. To determine the cardiorespiratory capacity of patients with fibromyalgia and analyze the differences with healthy controls. Methods: A systematic search was performed in PubMed, Web of Science, ScienceDirect, Redalyc, Scopus, Lilacs and Google Scholar databases. Observational studies published in English, Spanish and Portuguese that assessed the car-diorespiratory capacity in patients with fibromyalgia compared with healthy subjects were included. The methodolog-ical quality was assessed using the Newcastle-Ottawa scale. Under a random-effects model, the pooled effect size was calculated with the standardized mean difference and its 95% confidence interval; heterogeneity was analyzed using the I-square (I2) test. Subgroup analyses were performed to assess the influence of the type of clinical exercise testing used. Results. 14 studies, with a total of 1623 participants (all women), that met the inclusion criteria were included. A sig-nificant difference in distance covered on the six-minute walk test was found in women with fibromyalgia compared with healthy women. the studies with ergospirometry showed inconclusive results. Conclusions. Patients with fibromyalgia have lower cardiorespiratory capacity on the six-minute walk test compared to healthy controls. In this sense, research is needed to establish adequate methods of measuring cardiorespiratory fitness that take into account the particular conditions of the patients with this disease.