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Search Results: 1 - 10 of 297998 matches for " Veronika J. Wirtz "
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Trends in antibiotic utilization in eight Latin American countries, 1997-2007
Wirtz,Veronika J.; Dreser,Anahí; Gonzales,Ralph;
Revista Panamericana de Salud Pública , 2010, DOI: 10.1590/S1020-49892010000300009
Abstract: objective: to describe the trends in antibiotic utilization in eight latin american countries between 1997-2007 methods: we analyzed retail sales data of oral and injectable antibiotics (world health organization (who) anatomic therapeutic chemical (atc) code j01) between 1997 and 2007 for argentina, brazil, chile, colombia, mexico, peru, uruguay, and venezuela. antibiotics were aggregated and utilization was calculated for all antibiotics (j01); for macrolides, lincosamindes, and streptogramins (j01 f); and for quinolones (j01 m). the kilogram sales of each antibiotic were converted into defined daily dose per 1 000 inhabitants per day (did) according to the who atc classification system. we calculated the absolute change in did and relative change expressed in percent of did variation, using 1997 as a reference results: total antibiotic utilization has increased in peru, venezuela, uruguay, and brazil, with the largest relative increases observed in peru (5.58 did, +70.6%) and venezuela (4.81 did, +43.0%). for mexico (-2.43 did; -15.5%) and colombia (-4.10; -33.7%), utilization decreased. argentina and chile showed major reductions in antibiotic utilization during the middle of this period. in all countries, quinolone use increased, particularly sharply in venezuela (1.86 did, +282%). the increase in macrolide, lincosaminde, and streptogramin use was greatest in peru (0.76 did, +82.1%), followed by brazil, argentina, and chile conclusions: analyzing antibiotic utilization in latin america presents a series of challenges. creating policy-relevant evidence based on antimicrobial consumption patterns is needed in order to foster policies aimed at improving appropriate use of antibiotics in the region.
The Market Dynamics of Generic Medicines in the Private Sector of 19 Low and Middle Income Countries between 2001 and 2011: A Descriptive Time Series Analysis
Warren A. Kaplan, Veronika J. Wirtz, Peter Stephens
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074399
Abstract: This observational study investigates the private sector, retail pharmaceutical market of 19 low and middle income countries (LMICs) in Latin America, Asia and the Middle East/South Africa analyzing the relationships between volume market share of generic and originator medicines over a time series from 2001 to 2011. Over 5000 individual pharmaceutical substances were divided into generic (unbranded generic, branded generic medicines) and originator categories for each country, including the United States as a comparator. In 9 selected LMICs, the market share of those originator substances with the largest decrease over time was compared to the market share of their counterpart generic versions. Generic medicines (branded generic plus unbranded generic) represent between 70 and 80% of market share in the private sector of these LMICs which exceeds that of most European countries. Branded generic medicine market share is higher than that of unbranded generics in all three regions and this is in contrast to the U.S. Although switching from an originator to its generic counterpart can save money, this narrative in reality is complex at the level of individual medicines. In some countries, the market behavior of some originator medicines that showed the most temporal decrease, showed switching to their generic counterpart. In other countries such as in the Middle East/South Africa and Asia, the loss of these originators was not accompanied by any change at all in market share of the equivalent generic version. For those countries with a significant increase in generic medicines market share and/or with evidence of comprehensive “switching” to generic versions, notably in Latin America, it would be worthwhile to establish cause-effect relationships between pharmaceutical policies and uptake of generic medicines. The absence of change in the generic medicines market share in other countries suggests that, at a minimum, generic medicines have not been strongly promoted.
Uso de antibióticos en México: revisión de problemas y políticas
Dreser,Anahí; Wirtz,Veronika J; Corbett,Kitty K; Echániz,Gabriela;
Salud Pública de México , 2008, DOI: 10.1590/S0036-36342008001000009
Abstract: the inappropriate use of antibiotics signifies a risk for individual health and a waste of health resources. it triggers the development of antibiotic resistance, which increases expenditures and mortality related to infectious disease, and is hence considered a serious public health problem. the world health organization has thus recommended a series of strategies to be included within national pharmaceutical policies. in mexico, diverse factors related to the inappropriate use of antibiotics have been documented. while the response has been mainly in the form of educational and managerial interventions directed toward physicians in public health services, as well as epidemiological surveillance, there is a paucity of research and interventions focused on consumers, pharmacies, and the private sector. fundamentally, a comprehensive national strategy for antibiotics is not incorporated into health and pharmaceutical policies.
Medicines in Mexico, 1990-2004: systematic review of research on access and use
Wirtz,Veronika J; Reich,Michael R; Leyva Flores,René; Dreser,Anahí;
Salud Pública de México , 2008, DOI: 10.1590/S0036-36342008001000008
Abstract: objective: to review original research studies published between 1990 and 2004 on the access and use of medicines in mexico to assess the knowledge base for reforming mexico's pharmaceutical policy. material and methods: a literature review using electronic databases was conducted of original studies published in the last 15 years about access and use of medicines in mexico. in addition, a manual search of six relevant journals was performed. excluded were publications on herbal, complementary and alternative medicines. results: were identified 108 original articles as being relevant, out of 2289 titles reviewed, highlighting four policy-related problems: irrational prescribing, harmful self-medication, inequitable access, and frequent drug stock shortage in public health centers. conclusions: this review identified two priorities for mexico's pharmaceutical policy and strategies: tackling the irrational use of medicines and the inadequate access of medicines. these are critical priorities for a new national pharmaceutical policy.
Access to medicines by ambulatory health service users in Mexico: an analysis of the national health surveys 1994 to 2006
Wirtz,Veronika J; Russo,Giuliano; Kageyama-Escobar,Ma de la Luz;
Salud Pública de México , 2010, DOI: 10.1590/S0036-36342010000100006
Abstract: objective: to analyse the medicines prescription, prescription filling, payment expenditure for medicines by ambulatory health service users (hsu) in 2006, and to evaluate its evolution in the last 12 years. material and methods: using data from the national health surveys in 2006 three binary logistic regression models were constructed to identify the variables associated with the prescription rate, prescription filling and payment for medicines in 2006. the results of access to medicines were compared to the ones from previous national health services from 1994 and 2000. results: the type of health service provider was found to be the most important predictors of access to medicines. although the proportion of hsu obtaining a prescription and paying for drugs has broadly stayed the same as in 1994, the percentage of hsu paying for their prescribed medicines decreased from 70% in 1994 to 42% at ministry of health institutions in 2006. conclusion: the progress in prescription and population access to medicines has been uneven across health service providers.
Financing HIV Programming: How Much Should Low- And Middle-Income Countries and their Donors Pay?
Omar Galárraga, Veronika J. Wirtz, Yared Santa-Ana-Tellez, Eline L. Korenromp
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0067565
Abstract: Global HIV control funding falls short of need. To maximize health outcomes, it is critical that national governments sustain reasonable commitments, and that international donor assistance be distributed according to country needs and funding gaps. We develop a country classification framework in terms of actual versus expected national domestic funding, considering resource needs and donor financing. With UNAIDS and World Bank data, we examine domestic and donor HIV program funding in relation to need in 84 low- and middle-income countries. We estimate expected domestic contributions per person living with HIV (PLWH) as a function of per capita income, relative size of the health sector, and per capita foreign debt service. Countries are categorized according to levels of actual versus expected domestic contributions, and resource gap. Compared to national resource needs (UNAIDS Investment Framework), we identify imbalances among countries in actual versus expected domestic and donor contributions: 17 countries, with relatively high HIV prevalence and GNI per capita, have domestic funding below expected (median per PLWH $143 and $376, respectively), yet total available funding including from donors would exceed the need ($368 and $305, respectively) if domestic contribution equaled expected. Conversely, 27 countries have actual domestic funding above the expected (medians $294 and $149) but total (domestic+donor) funding does not meet estimated need ($685 and $1,173). Across the 84 countries, in 2009, estimated resource need totaled $10.3 billion, actual domestic contributions $5.1 billion and actual donor contributions $3.7 billion. If domestic contributions would increase to the expected level in countries where the actual was below expected, total domestic contributions would increase to $7.4 billion, turning a funding gap of $1.5 billion into a surplus of $0.8 billion. Even with imperfect funding and resource-need data, the proposed country classification could help improve coherence and efficiency in domestic and international allocations.
Abasto, surtimiento y gasto de bolsillo en medicamentos en hospitales públicos de México en 2009
Sesma-Vázquez,Sergio; Gómez-Dantés,Octavio; Wirtz,Veronika J; Castro-Tinoco,Manuel;
Salud Pública de México , 2011, DOI: 10.1590/S0036-36342011001000010
Abstract: objective. to analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. material and methods. using the national satisfaction and responsiveness survey (ensata) 2009, which includes a representative sample of public hospitals in mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the day of visit, the proportion of prescriptions completely filled for patients when they are discharged and their out-of-pocket expenditure during their hospitalization were analyzed. results. a total of 26 271 patients in 160 public hospitals were interviewed. the mean availability of drugs was 82% for all hospitals, with the lowest availability for the ministry of health (sesa) hospitals (77%, with a range of 30 to 96%). patients discharged at social security hospitals received in 97% of cases a complete prescription filling, while in sesa hospitals the average was only 56.2%, with a large variance among states (13 to 94%). the median inpatient spending was 150 pesos in national currency (1% spent over 10 000 pesos). conclusions. the lack of medicines in public hospitals may increase in-patient morbidity and mortality and has an economic impact on household spending, particularly in those with scarce resources.
Impact of Over-the-Counter Restrictions on Antibiotic Consumption in Brazil and Mexico
Yared Santa-Ana-Tellez, Aukje K. Mantel-Teeuwisse, Anahi Dreser, Hubert G. M. Leufkens, Veronika J. Wirtz
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0075550
Abstract: Background In Latin American countries over-the-counter (OTC) dispensing of antibiotics is common. In 2010, both Mexico and Brazil implemented policies to enforce existing laws of restricting consumption of antibiotics only to patients presenting a prescription. The objective of the present study is therefore to evaluate the impact of OTC restrictions (2010) on antibiotics consumption in Brazil and Mexico. Methods and Findings Retail quarterly sales data in kilograms of oral and injectable antibiotics between January 2007 and June 2012 for Brazil and Mexico were obtained from IMS Health. The unit of analysis for antibiotics consumption was the defined daily dose per 1,000 inhabitants per day (DDD/TID) according to the WHO ATC classification system. Interrupted time series analysis was conducted using antihypertensives as reference group to account for changes occurring independently of the OTC restrictions directed at antibiotics. To reduce the effect of (a) seasonality and (b) autocorrelation, dummy variables and Prais-Winsten regression were used respectively. Between 2007 and 2012 total antibiotic usage increased in Brazil (from 5.7 to 8.5 DDD/TID, +49.3%) and decreased in Mexico (10.5 to 7.5 DDD/TID, ?29.2%). Interrupted time series analysis showed a change in level of consumption of ?1.35 DDD/TID (p<0.01) for Brazil and ?1.17 DDD/TID (p<0.00) for Mexico. In Brazil the penicillins, sulfonamides and macrolides consumption had a decrease in level after the intervention of 0.64 DDD/TID (p = 0.02), 0.41 (p = 0.02) and 0.47 (p = 0.01) respectively. While in Mexico it was found that only penicillins and sulfonamides had significant changes in level of ?0.86 DDD/TID (p<0.00) and ?0.17 DDD/TID (p = 0.07). Conclusions Despite different overall usage patterns of antibiotics in Brazil and Mexico, the effect of the OTC restrictions on antibiotics usage was similar. In Brazil the trend of increased usage of antibiotics was tempered after the OTC restrictions; in Mexico the trend of decreased usage was boosted.
Ambulatory health service users' experience of waiting time and expenditure and factors associated with the perception of low quality of care in Mexico
Alma Sauceda-Valenzuela, Veronika J Wirtz, Yared Santa-Ana-Téllez, Maria de la Luz Kageyama-Escobar
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-178
Abstract: Data from the National Health Survey 2006 were used to compare the experiences of HSUs with their ambulatory care at Ministry of Health and affiliated institutions (MOH), social security institutions (SSI) and private institutions (PrivI). Reference points of quality of care related to waiting time and expenditure were defined for each of the three types of institutions by analyzing HSU experiences rated as 'acceptable'. A multivariable logistic regression model was used to identify the principal factors associated with the general perception of low quality of care.A total of 11,959 HSUs were included in the analysis, of whom 37.6% (n = 4,500) HSUs received care at MOH facilities; 31.2% (n = 3,730) used SSI and 31.2% (n = 3,729) PrivI. An estimated travel and waiting time of 10 minutes respectively was rated as acceptable by HSUs from all institutions. The differences between the waiting time rated as acceptable and the actual waiting time were the largest for SSI (30 min) in comparison to MoH (20 min) and PrivI (5 min) users. The principal factors associated with an overall perception of low quality of care are type of institution (OR 4.36; 95% CI 2.95-6.44), waiting time (OR 3.20; 95% CI 2.35-4.35), improvement of health after consultation (OR 2.93; CI 2.29-3.76) and consultation length of less than 20 minutes (2.03; 95% CI 1.60-2.57).The reference points derived by the HSUs' own ratings are useful in identifying where quality improvements are required. Prioritizing the reduction of waiting times and improving health status improvement after consultation would increase overall quality of care ratings.Health service users (HSUs) have a legitimate interest in the provision of health care with a high level of quality as they are financial contributors, tax paying citizens and recipients of care [1]. However, public health services, particularly in developing countries, struggle to provide not only a high technical quality of care but also responsiveness to non-medica
Organic matter accumulation and degradation in subsurface coastal sediments: a model-based comparison of rapid sedimentation and aquifer transport
J. M. Holstein,K. W. Wirtz
Biogeosciences (BG) & Discussions (BGD) , 2010,
Abstract: The redox succession in shallow marine sediments generally exhibits a predictable pattern. Pore water profiles from a back barrier tidal flat in the German Wadden Sea depart from the expected redox zoning. Instead, a sulfate minimum zone associated with a sulfate-methane-sulfate double interface and a distinct ammonium peak at 1.5 m below sea floor (mbsf) is displayed. Such evidence for significant degradation of organic matter (OM) in subsurface layers is challenging our understanding of tidal flat biogeochemistry as little is known about processes that relocate reactive OM into layers far distant from the sediment-water interface. The objectives of our model study were to identify possible mechanisms for the rapid transport of organic matter to subsurface layers that cause the reversed redox succession and to constrain several important biogeochemical control parameters. We compared two scenarios for OM transfer: rapid sedimentation and burial of OM as well as lateral advection of suspended POM. Using a diagenetic model, uncertain process parameters, in particular those connected to OM degradation and (vertical or lateral) transport, are systematically calibrated using field data. We found that both scenarios, advection and sedimentation, had solutions consistent with the observed pore water profiles. For this specific site, however, advective transport of particulate material had to be rejected since the reconstructed boundary conditions were rather improbable. In the alternative deposition set-up, model simulations suggested the deposition of the source OM about 60 yrs before cores were taken. A mean sedimentation rate of approximately 2 cm yr 1 indicates substantial changes in near coast tidal flat morphology, since sea level rise is at a much lower pace. High sedimentation rates most probably reflect the progradation of flats within the study area. These or similar morphodynamic features also occur in other coastal areas so that inverted redox succession by horizontal or vertical transport may be more common than previously thought. Consequently, regional values for OM remineralization rates may be higher than predicted from surface biogeochemistry.
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