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Tabll AA, Sohrab SS, Ali AA, Petrovic A, Steiner Srdarevic S, Siber S, Glasnovic M, Smolic R, Smolic M. Future Prospects, Approaches, and the Government's Role in the Development of a Hepatitis C Virus Vaccine. Pathogens 2023; 13:38. [PMID: 38251345 PMCID: PMC10820710 DOI: 10.3390/pathogens13010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Developing a safe and effective vaccine against the hepatitis C virus (HCV) remains a top priority for global health. Despite recent advances in antiviral therapies, the high cost and limited accessibility of these treatments impede their widespread application, particularly in resource-limited settings. Therefore, the development of the HCV vaccine remains a necessity. This review article analyzes the current technologies, future prospects, strategies, HCV genomic targets, and the governmental role in HCV vaccine development. We discuss the current epidemiological landscape of HCV infection and the potential of HCV structural and non-structural protein antigens as vaccine targets. In addition, the involvement of government agencies and policymakers in supporting and facilitating the development of HCV vaccines is emphasized. We explore how vaccine development regulatory channels and frameworks affect research goals, funding, and public health policy. The significance of international and public-private partnerships in accelerating the development of an HCV vaccine is examined. Finally, the future directions for developing an HCV vaccine are discussed. In conclusion, the review highlights the urgent need for a preventive vaccine to fight the global HCV disease and the significance of collaborative efforts between scientists, politicians, and public health organizations to reach this important public health goal.
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Affiliation(s)
- Ashraf A. Tabll
- Microbial Biotechnology Department, Biotechnology Research Institute, National Research Centre, Cairo 12622, Egypt
- Egypt Centre for Research and Regenerative Medicine (ECRRM), Cairo 11517, Egypt
| | - Sayed S. Sohrab
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmed A. Ali
- Molecular Biology Department, Biotechnology Research Institute, National Research Centre, Cairo 12622, Egypt;
| | - Ana Petrovic
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (A.P.); (S.S.S.); (S.S.); (M.G.); (R.S.)
| | - Sabina Steiner Srdarevic
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (A.P.); (S.S.S.); (S.S.); (M.G.); (R.S.)
| | - Stjepan Siber
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (A.P.); (S.S.S.); (S.S.); (M.G.); (R.S.)
| | - Marija Glasnovic
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (A.P.); (S.S.S.); (S.S.); (M.G.); (R.S.)
| | - Robert Smolic
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (A.P.); (S.S.S.); (S.S.); (M.G.); (R.S.)
| | - Martina Smolic
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (A.P.); (S.S.S.); (S.S.); (M.G.); (R.S.)
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Mbachu CO, Ekenna AC, Agbawodikeizu UP, Onwujekwe O. Role and use of evidence in health system response to COVID-19 in Nigeria: a mixed method study. Pan Afr Med J 2023; 44:191. [PMID: 37484579 PMCID: PMC10362686 DOI: 10.11604/pamj.2023.44.191.38990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/18/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction evidence-based decision-making in health is an aspiration needed to effectively respond to current outbreaks and prepare for future occurrences. This paper examines the roles and use of evidence in health systems response to COVID-19 in Nigeria. Methods this was a mixed method study comprising nine key informant interviews and rapid review of 126 official online documents, journal articles and media reports published from December 2019 to December 2020 with a national and sub-national focus. Key informants were drawn from the government agencies that were involved in making or implementing decisions on the health sector response to COVID-19. Data collection was performed by three researchers. Thematic analysis and narrative synthesis of data was done. Results various forms of evidence were used to make decisions on Nigeria´s health system response to COVID-19, and these are broadly classified into three, namely, i) lessons learned from past experiences such as community engagement activities, early recognition of risks and deployment of non-pharmaceutical pandemic control measures, ii) proven interventions with contextual relevance like the emphasis on hand hygiene education for health workers, and iii) risk assessment and situation analysis reports like adopting a multi-sector response to COVID-19 control, expanding COVID-19 diagnostic laboratories to new sites across the country, and relax lockdown restrictions while maintaining key limitations to curb a spike in COVID-19 cases. Conclusion Nigeria´s health system response to COVID-19 upheld the use of evidence in making critical decisions on the prevention and control of the pandemic.
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Affiliation(s)
| | - Adanma Chidinma Ekenna
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Uju Patricia Agbawodikeizu
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Social Work, Faculty of Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Veenstra T, van Schelven PD, Ten Have YM, Swaan CM, van den Akker WMR. Extensive Spread of SARS-CoV-2 Delta Variant among Vaccinated Persons during 7-Day River Cruise, the Netherlands. Emerg Infect Dis 2023; 29:734-741. [PMID: 36848870 PMCID: PMC10045687 DOI: 10.3201/eid2904.221433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
We investigated a large outbreak of SARS-CoV-2 infections among passengers and crew members (60 cases in 132 persons) on a cruise ship sailing for 7 days on rivers in the Netherlands. Whole-genome analyses suggested a single or limited number of viral introductions consistent with the epidemiologic course of infections. Although some precautionary measures were taken, no social distancing was exercised, and air circulation and ventilation were suboptimal. The most plausible explanation for introduction of the virus is by persons (crew members and 2 passengers) infected during a previous cruise, in which a case of COVID-19 had occurred. The crew was insufficiently prepared on how to handle the situation, and efforts to contact public health authorities was inadequate. We recommend installing clear handling protocols, direct contacts with public health organizations, training of crew members to recognize outbreaks, and awareness of air quality on river-cruise ships, as is customary for most seafaring cruises.
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Shannon K, Neville S. Organizational Innovation in Long Term Care Enabled by Collaboration Between Government Agencies: A Critical Realist Case Study. Inquiry 2023; 60:469580221144079. [PMID: 36639919 PMCID: PMC9841830 DOI: 10.1177/00469580221144079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Long term care for older people is a highly regulated sector providing accommodation, health, and social care to vulnerable older adults. Older adults in New Zealand are among the highest users of long term care services globally. Traditionally those requiring specialist care for dementia are housed apart from other residents. In an example of organizational innovation, 1 provider relocated residents to a secure village where residents requiring specialist dementia care would be desegregated. We utilized a critical realist case study to explain the role of intersectoral collaboration among government agencies in supporting the transition while managing risk and ensuring regulatory compliance.
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Affiliation(s)
- Kay Shannon
- Auckland University of Technology, Auckland, New Zealand,Kay Shannon, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 1026, New Zealand.
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Harley JB, Pyarajan S, Partan ES, Epstein L, Wertheim JA, Diwan A, Woods CW, Davey V, Blair S, Clark DH, Kaufman KM, Khan S, Chepelev I, Devine A, Cameron P, McCann MF, Ammons MCB, Bolz DD, Battles JK, Curtis JL, Holodniy M, Marconi VC, Searles CD, Beenhouwer DO, Brown ST, Moorman JP, Yao ZQ, Rodriguez-Barradas MC, Mohapatra S, Molina De Rodriguez OY, Padiernos EB, McIndoo ER, Price E, Burgoyne HM, Robey I, Schwenke DC, Shive CL, Przygodzki RM, Ramoni RB, Krull HK, Bonomo RA. The US Department of Veterans Affairs Science and Health Initiative to Combat Infectious and Emerging Life-Threatening Diseases (VA SHIELD): A Biorepository Addressing National Health Threats. Open Forum Infect Dis 2022; 9:ofac641. [PMID: 36601554 PMCID: PMC9801224 DOI: 10.1093/ofid/ofac641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Indexed: 12/15/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has demonstrated the need to share data and biospecimens broadly to optimize clinical outcomes for US military Veterans. Methods In response, the Veterans Health Administration established VA SHIELD (Science and Health Initiative to Combat Infectious and Emerging Life-threatening Diseases), a comprehensive biorepository of specimens and clinical data from affected Veterans to advance research and public health surveillance and to improve diagnostic and therapeutic capabilities. Results VA SHIELD now comprises 12 sites collecting de-identified biospecimens from US Veterans affected by SARS-CoV-2. In addition, 2 biorepository sites, a data processing center, and a coordinating center have been established under the direction of the Veterans Affairs Office of Research and Development. Phase 1 of VA SHIELD comprises 34 157 samples. Of these, 83.8% had positive tests for SARS-CoV-2, with the remainder serving as contemporaneous controls. The samples include nasopharyngeal swabs (57.9%), plasma (27.9%), and sera (12.5%). The associated clinical and demographic information available permits the evaluation of biological data in the context of patient demographics, clinical experience and management, vaccinations, and comorbidities. Conclusions VA SHIELD is representative of US national diversity with a significant potential to impact national healthcare. VA SHIELD will support future projects designed to better understand SARS-CoV-2 and other emergent healthcare crises. To the extent possible, VA SHIELD will facilitate the discovery of diagnostics and therapeutics intended to diminish COVID-19 morbidity and mortality and to reduce the impact of new emerging threats to the health of US Veterans and populations worldwide.
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Affiliation(s)
- John B Harley
- Correspondence: John B. Harley, Cincinnati VA Medical Center, 3200 Vine St., John B. Harley (151), Cincinnati, OH 45220 ()
| | - Saiju Pyarajan
- Center for Data and Computational Sciences, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Elizabeth S Partan
- Center for Data and Computational Sciences, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Lauren Epstein
- Infectious Diseases, US Department of Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Jason A Wertheim
- Research & Development, Southern Arizona Veterans Affairs Healthcare System, US Department of Veterans Affairs, Tucson, Arizona, USA
| | - Abhinav Diwan
- Cardiology, Veterans Affairs Saint Louis Healthcare System, US Department of Veterans Affairs,Saint Louis, Missouri, USA
| | - Christopher W Woods
- Medicine, US Department of Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Victoria Davey
- Office of Research and Development, US Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Sharlene Blair
- Research Services, US Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Dennis H Clark
- Research Services, US Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Kenneth M Kaufman
- Research Services, US Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Shagufta Khan
- Research Services, US Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Iouri Chepelev
- Research Services, US Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Alexander Devine
- Prometheus Federal Services, Titan Alpha, Washington, District of Columbia, USA
| | - Perry Cameron
- Customer Value Partners, Titan Alpha, Washington, District of Columbia, USA
| | - Monica F McCann
- Office of Research and Development, Chesapeake Medical Communications, Contractor for the US Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Mary Cloud B Ammons
- Research, US Department of Veterans Affairs Medical Center, Boise, Idaho, USA,Idaho Veterans Research and Education Foundation, Boise, Idaho, USA
| | - Devin D Bolz
- Research, US Department of Veterans Affairs Medical Center, Boise, Idaho, USA
| | - Jane K Battles
- Office of Research and Development, US Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Jeffrey L Curtis
- Medicine Service, Veteran Affairs Ann Arbor Healthcare System, US Department of Veterans Affairs, Ann Arbor, Michigan, USA
| | - Mark Holodniy
- Public Health Surveillance, Veterans Affairs Palo Alto Healthcare System, US Department of Veterans Affairs, Palo Alto, California, USA
| | - Vincent C Marconi
- Infectious Diseases, US Department of Veterans Affairs Medical Center, Atlanta, Georgia, USA,Division of Infectious Diseases, Emory School of Medicine and Rollins School of Public Health, Atlanta, Georgia, USA
| | - Charles D Searles
- Infectious Diseases, US Department of Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - David O Beenhouwer
- Medicine, Veterans Affairs Greater Los Angeles Healthcare System, US Department of Veterans Affairs, Los Angeles, California, USA
| | - Sheldon T Brown
- Infectious Diseases, James J. Peters Veterans Affairs Medical Center, US Department of Veterans Affairs, Bronx, New York, USA
| | - Jonathan P Moorman
- Infectious Diseases, James H. Quillen Veterans Affairs Medical Center, US Department of Veterans Affairs, Mountain Home, Tennessee, USA,Center of Excellence in Inflammation, Infectious Diseases, and Immunity, East Tennessee State University, Johnson City, Tennessee, USA
| | - Zhi Q Yao
- Infectious Diseases, James H. Quillen Veterans Affairs Medical Center, US Department of Veterans Affairs, Mountain Home, Tennessee, USA,Center of Excellence in Inflammation, Infectious Diseases, and Immunity, East Tennessee State University, Johnson City, Tennessee, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, US Department of Veterans Affairs, Houston, Texas, USA,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Shyam Mohapatra
- Medicine, James A. Haley Veterans Hospital, US Department of Veterans Affairs, Tampa, Florida, USA
| | - Osmara Y Molina De Rodriguez
- Research & Development, Southern Arizona Veterans Affairs Healthcare System, US Department of Veterans Affairs, Tucson, Arizona, USA
| | - Emerson B Padiernos
- Research, US Department of Veterans Affairs Medical Center, Boise, Idaho, USA
| | - Eric R McIndoo
- Research, US Department of Veterans Affairs Medical Center, Boise, Idaho, USA,Idaho Veterans Research and Education Foundation, Boise, Idaho, USA
| | - Emily Price
- Research, US Department of Veterans Affairs Medical Center, Boise, Idaho, USA,Idaho Veterans Research and Education Foundation, Boise, Idaho, USA
| | - Hailey M Burgoyne
- Research, US Department of Veterans Affairs Medical Center, Boise, Idaho, USA,Idaho Veterans Research and Education Foundation, Boise, Idaho, USA
| | - Ian Robey
- Research & Development, Southern Arizona Veterans Affairs Healthcare System, US Department of Veterans Affairs, Tucson, Arizona, USA
| | - Dawn C Schwenke
- Research & Development, Southern Arizona Veterans Affairs Healthcare System, US Department of Veterans Affairs, Tucson, Arizona, USA
| | - Carey L Shive
- Medicine, Veterans Affairs Northeast Ohio Healthcare System, US Department of Veterans Affairs, Cleveland, Ohio, USA
| | - Ronald M Przygodzki
- Office of Research and Development, US Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Rachel B Ramoni
- Office of Research and Development, US Department of Veterans Affairs, Washington, District of Columbia, USA
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Dow K, Tuler S. Risk Amplification and Attenuation as Communication Strategies in Climate Adaptation in Urban Areas. Risk Anal 2022; 42:1440-1454. [PMID: 34585415 DOI: 10.1111/risa.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 05/21/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
Climate risks are motivating adaptation with local municipal actors becoming key participants in a complex web of climate risk communication. Some cities have created civil service positions focused on climate resilience. We conducted interviews with six such individuals in four U.S. Atlantic coast cities to investigate how they think about and negotiate communication challenges associated with implementation of climate resilience strategies. We grounded our study in the Social Amplification of Risk Framework (SARF), which despite its longevity and wide usage has rarely been used to understand the role of government actors. We found substantial complexity in how these government representatives develop both amplifying and attenuating communication strategies as they often simultaneously reach multiple audiences holding different perspectives. They are familiar with and employ risk communication practices. However, they report needing to modify their efforts as climate adaptation issues and goals evolve over time, and experiment in situations, such as discussions of retreat, where established communication practices provide insufficient guidance. In order to develop a deeper understanding of the governmental risk communication actors, we suggest four potential avenues for taking advantage of the strengths of SARF as a framework for connecting and integrating with other models and theories. We also propose several directions for research based on the challenges these practitioners are finding in their work to facilitate adaptation to climate risks. The activity of government actors is rich in its applied risk communication practice and its challenges offer new questions to expand our thinking about the SARF and risk communication more broadly.
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Affiliation(s)
- Kirstin Dow
- Department of Geography, University of South Carolina, Columbia, SC, USA
| | - Seth Tuler
- Department of Integrative and Global Studies, Worcester Polytechnic Institute, Worcester, MA, USA
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Athreya AP, Lazaridis KN. Discovery and Opportunities With Integrative Analytics Using Multiple-Omics Data. Hepatology 2021; 74:1081-1087. [PMID: 33539039 PMCID: PMC8333231 DOI: 10.1002/hep.31733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/18/2020] [Accepted: 01/15/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Arjun P Athreya
- Department of Molecular Pharmacology and Experimental TherapeuticsMayo ClinicRochesterMN
| | - Konstantinos N Lazaridis
- Center for Individualized MedicineCollege of MedicineMayo ClinicRochesterMN.,Division of Gastroenterology and HepatologyCollege of MedicineMayo ClinicRochesterMN
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Durán CE, Cañás M, Urtasun MA, Elseviers M, Andia T, Vander Stichele R, Christiaens T. Regulatory reliance to approve new medicinal products in Latin American and Caribbean countries. Rev Panam Salud Publica 2021; 45:e10. [PMID: 33859678 PMCID: PMC8040933 DOI: 10.26633/rpsp.2021.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Objective. To describe the current status of regulatory reliance in Latin America and the Caribbean (LAC) by assessing the countries’ regulatory frameworks to approve new medicines, and to ascertain, for each country, which foreign regulators are considered as trusted regulatory authorities to rely on. Methods. Websites from LAC regulators were searched to identify the official regulations to approve new drugs. Data collection was carried out in December 2019 and completed in June 2020 for the Caribbean countries. Two independent teams collected information regarding direct recognition or abbreviated processes to approve new drugs and the reference (trusted) regulators defined as such by the corresponding national legislation. Results. Regulatory documents regarding marketing authorization were found in 20 LAC regulators’ websites, covering 34 countries. Seven countries do not accept reliance on foreign regulators. Thirteen regulatory authorities (Argentina, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Mexico, Panama, Paraguay, Peru, Uruguay, and the unique Caribbean Regulatory System for 15 Caribbean States) explicitly accept relying on marketing authorizations issued by the European Medicines Agency, United States Food and Drug Administration, and Health Canada. Ten countries rely also on marketing authorizations from Australia, Japan, and Switzerland. Argentina, Brazil, Chile, and Mexico are reference authorities for eight LAC regulators. Conclusions. Regulatory reliance has become a common practice in the LAC region. Thirteen out of 20 regulators directly recognize or abbreviate the marketing authorization process in case of earlier approval by a regulator from another jurisdiction. The regulators most relied upon are the European Medicines Agency, United States Food and Drug Administration, and Health Canada.
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Affiliation(s)
- Carlos E Durán
- Ghent University Ghent Belgium Ghent University, Ghent, Belgium
| | - Martín Cañás
- Federación Médica de la Provincia de Buenos Aires (FEMEBA) La Plata Argentina Federación Médica de la Provincia de Buenos Aires (FEMEBA), La Plata, Argentina
| | - Martín A Urtasun
- Federación Médica de la Provincia de Buenos Aires (FEMEBA) La Plata Argentina Federación Médica de la Provincia de Buenos Aires (FEMEBA), La Plata, Argentina
| | | | - Tatiana Andia
- Universidad de los Andes Bogotá Colombia Universidad de los Andes, Bogotá, Colombia
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Arace J, Flores V, Monaghan T, Robins D, Karanikolas N, Winer A, Weiss J. Rates of clinically significant prostate cancer in African Americans increased significantly following the 2012 US Preventative Services Task Force recommendation against prostate specific antigen screening: A Single Institution Retrospective Study. Int J Clin Pract 2020; 74:e13447. [PMID: 31750596 DOI: 10.1111/ijcp.13447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE We determined the impact of the 2012 US Preventative Services Task Force recommendation against prostate specific antigen screening on detection rates and biopsy patterns in African American and Caucasian patients. MATERIALS AND METHODS Demographics, PSA, transrectal ultrasonography volume and pathologic data were collected on patients who underwent their first ultrasound-guided prostate biopsy between January 2007 and June 2018 at a New York City Veteran Affairs Hospital. RESULTS 609 biopsies were analysed preguideline (113 per year), and 487 were analysed postguideline (81 per year). There was no significant difference in the detection rates of low, intermediate or high grade PCa in Caucasians. In contrast, African Americans were significantly more likely to be diagnosed with PCa in the postguideline group (56% pre vs 66% post, P = .016), and significantly more likely to be diagnosed with intermediate-high grade PCa (38% pre vs 47% post, P = .038). Before the 2012 USPSTF recommendation, African American and Caucasian patients undergoing their first biopsy were equally likely to be diagnosed with high-grade PCa (11% AA vs 11% CA). After the 2012 decision, we found that African Americans were 50% more likely than Caucasians to be diagnosed with high-grade PCa on first biopsy (10% AA vs 15% CA, P = .008). CONCLUSIONS In the 6 years following the 2012 USPSTF recommendation, detection rates of intermediate-high risk disease remained unchanged for Caucasian patients but have increased significantly for African Americans. The results of our study strongly support the role of routine PSA screening, particularly in higher risk patients such as African Americans.
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Affiliation(s)
- Jeffrey Arace
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Viktor Flores
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Thomas Monaghan
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Dennis Robins
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Nicholas Karanikolas
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Andrew Winer
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Jeffrey Weiss
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
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Abstract
A large number of civilian agencies have published guides and recommendations on how to assemble personal and family emergency kits. However, the kits resulting from following these guidelines are impractical, particularly in the event evacuation becomes necessary. This report describes an alternative approach to assembling an emergency kit. OstrovskiyG, ShemeshAJ. Contents of a bug-out bag. Prehosp Disaster Med. 2018;33(6):647-649.
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Abstract
The recent environmental tragedy in Flint, Michigan, where lead-contaminated drinking water raised fears of potential health effects for exposed children, revealed the failure of a regulatory system to protect residents from lead exposure. Flint is clearly not alone as a community of color where residents are disproportionately exposed to lead from paint, dust, soil, or water. In southeast Los Angeles County, California, a facility that recycled lead-acid batteries has polluted the air and soil of communities nearby for decades. Termed as "environmental disaster" by the governor, this large-scale pollution of the air and soil in largely Latino communities is emblematic of the continued risk associated with facilities that make or recycle lead-acid batteries. We discuss the influence of industrial lead emissions on public health, the roles of agencies charged with prevention of lead exposure in California, and the fractured system that allowed this large-scale contamination to persist for decades. Finally, we offer recommendations on how public agencies can improve public health surveillance of lead exposures and step out of their individual "silos" to share information and collaborate to better protect vulnerable children, workers, and communities.
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Yang CC, Weinfurt KP, Merion RM, Kirkali Z; LURN Study Group. Symptoms of Lower Urinary Tract Dysfunction Research Network. J Urol 2016; 196:146-52. [PMID: 26784646 DOI: 10.1016/j.juro.2016.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE To address gaps in understanding and treating lower urinary tract symptoms, the NIDDK created the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). The goals of LURN are to work collaboratively to 1) identify and explain the important subtypes of lower urinary tract symptoms; 2) improve the measurement of patient experiences of lower urinary tract symptoms; 3) disseminate novel findings to researchers, clinicians and patients; and 4) generate data, research tools and biological samples for future studies. MATERIALS AND METHODS As a first step in understanding subtypes of lower urinary tract symptoms, LURN will focus on disorders of urinary sensation (eg urgency) and their causes. These are being examined with respect to patient experience, organism or systemic factors, genitourinary organs and tissues, and cellular/molecular factors. This is being achieved via an observational cohort study that is currently enrolling patients with lower urinary tract symptoms (target number 1,000) and that will extensively characterize patients with lower urinary tract symptoms. Future studies embedded within the observational cohort study will focus on neuroimaging and sensory testing, biomarkers and organ based factors. To advance the science of measurement of lower urinary tract symptoms, LURN is also developing and evaluating a comprehensive set of self-report questions to provide more granular assessments of lower urinary tract symptoms. RESULTS LURN has taken its first steps by developing a framework for studying lower urinary tract symptom subtypes. CONCLUSIONS In developing this framework, LURN is choosing an initial domain on which to focus (sensory experiences), and creating and executing protocols designed to improve measurement of self-reported symptoms and identify patient subtypes.
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Hobson RW, Howard VJ, Brott TG, Howard G, Roubin GS, Ferguson RDG. Organizing the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): National Institutes of Health, Health Care Financing Administration, and industry funding. Curr Control Trials Cardiovasc Med 2001; 2:160-164. [PMID: 11806790 PMCID: PMC59640 DOI: 10.1186/cvm-2-4-160] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) is a prospective, randomized, multicenter clinical trial of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) as prevention for stroke in patients with symptomatic stenosis greater than or equal to 50%. CREST is sponsored by the US National Institute of Neurological Disorders and Stroke (NINDS) of the US National Institutes of Health (NIH), with additional support by a device manufacturer, and will provide data to the US Food and Drug Administration (FDA) for evaluation of a stent device. Because of budget constraints for CREST, Health Care Financing Administration (HCFA) reimbursement for hospital costs incurred by CREST patients will be essential. The involvement of academic scientists, industry, and three separate government agencies (NIH, FDA, HCFA) has presented many challenges in conducting the trial. A review of the pathways followed to meet these challenges may be helpful to others seeking to facilitate sharing of the costs and burdens of conducting innovative clinical research.
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Affiliation(s)
- Robert W Hobson
- University of Alabama at Birmingham, Birmingham, Alabama, USA.
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