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Background and Objectives: Irritable bowel syndrome (IBS) is an invasive and potentially disabling syndrome characterized by a multitude of symptoms capable of reducing the quality of life of patients. Among the most disabling symptoms of IBS is certainly physical pain, which manifests itself mainly at the abdominal level but can also appear in other areas of the body, particularly in the form of chronic low-back pain (CLBP). Among the non-invasive methods of treating organ-specific pathologies and organ-related musculoskeletal problems, the use of Bioresonance Therapy (BT)—based on the administration of self-modulating Extremely Low-Frequency Electromagnetic Fields, capable of determining a rebalance of bio-electrical and metabolic activity in the presence of various functional alterations—is currently gaining acceptance. Therefore, we decided to monitor results obtained from patients suffering from IBS and CLBP subjected to a cycle of treatments with BT. Materials and Methods: We monitored 20 patients (12 women and 8 men, average age of 51 years) suffering from CLBP and other visceral symptoms related to IBS. Patients were monitored through the use of the Bristol Stool Form Scale (BSFS), the Fecal Calprotectin test and the Short-Form Health Survey 36 (SF-36), collected before (T0) and after (T1) the execution of the cycle of treatments. They undertook a treatment protocol consisting of eight sessions of BT carried out over about a month. Results: At the end of the treatments with BT, it was possible to observe a general and significant improvement in all the parameters observed, as well as a close inversely proportional correlation between the Calprotectin values detected and the quality of life experienced by the patients in relation to their perceived IBS symptoms. Conclusions: Overall, our pilot study would seem to suggest a potential beneficial effect of BT in modulating organic and musculoskeletal symptoms derived from IBS.

The confirmatory comment of Garcia-Teillard et al [...]

The biological history of Chlamydia trachomatis is intertwined with the evolution of the man. Infecting Elemental Bodies (EBs), having penetrated mucosal epithelial cells, wrap themselves in a cloak (ĸλαμις) of glycogen that ensures their obligatory intracellular survival and protects this differentiation into Reticulate Bodies (RBs) that feed on cellular ATP. Multiple chemokines and cytokines are involved under the direction of IL-6 in the florid phase and IL-17A in the scar phase. The WHO has successfully identified the SAFE strategy against trachoma (Surgery, Antibiotics, Facial cleansing, Environment) as the blueprint to eliminate the disease by 2020. Recently, interest has been increasingly focused on changing sexual attitudes in different areas of the world, leaving Musca sorbens, Scatophaga stercoraria, and stepsisters fairly blameless, but extolling the role of Chlamydia trachomatis in apparently “sterile” chronic prostatitis or conjunctivitis or, less frequently, in oropharyngitis and proctitis. The addition of an S (SAFE-S) standing for “sexual behavior” was then proposed to also attract the interest and attention not only of Ophthalmologists and Obstetricians/Gynecologists, Urologists/Andrologists, and the School Authorities for information on the prevention of sexually transmitted diseases, but also of Social Physicians and Pediatricians. This means that sexually transmitted infections should be screened in asymptomatic patients with risky sexual behavior or sexual contact with people diagnosed with a transmitted infection.

Background: Although death in old age is unavoidable, premature death-defined here as death before age 70 years-is not. To assess whether halving premature mortality by 2050 is feasible, we examined the large variation in premature death rates before age 70 years and trends over the past 50 years (1970-2019), covering ten world regions and the 30 most-populous nations. This analysis was undertaken in conjunction with the third report of The Lancet Commission on Investing in Health: Global Health 2050: the path to halving premature death by mid-century., Methods: In this cross-country analysis of past mortality trends and future directions, all analyses on the probability of premature death (PPD) were conducted using life tables from the UN World Population Prospects 2024. For each sex, country, and year, probability of death was calculated from these life tables with 1-year age-specific mortality rates., Findings: Globally, PPD decreased from 56% in 1970 to 31% in 2019, although some countries saw reversals because of conflict, social instability, or HIV and AIDS. Child mortality has decreased faster than adult mortality. Among all countries, 34 halved their PPD over three decades between 1970 and 2019. Among the 30 most-populous countries, seven countries, with varying levels of baseline PPD and income, halved their PPD in the past half century. Seven of the most-populous countries had average annual rates of improvement in the period 2010-19 that, if sustained, could lead to a halving of PPD by 2050, including Korea (3·9%), Bangladesh (2·8%), Russia (2·7%), Ethiopia (2·4%), Iran (2·4%), South Africa (2·4%), and Türkiye (2·3%)., Interpretation: Halving premature death by 2050 is feasible, although substantial investments in child and adult health are needed to sustain or accelerate the rate of improvement for high-performing and medium-performing countries. Particular attention must be paid to countries with very low or a worsening rate of improvement in PPD. By reducing premature mortality, more people will live longer and more healthy lives. However, as people live longer, the absolute number of years lived with chronic disease will increase and investments in services reducing chronic disease morbidity are needed., Funding: The Norwegian Agency for Development Cooperation, the Bill & Melinda Gates Foundation, and a Norwegian Research Council Centre of Excellence grant., Competing Interests: Declaration of interests SB declares support from the University of Bergen, Bergen, Norway. AYC declares support for this work from the Norwegian Agency for Development Cooperation. DTJ declares support for the Commission from the Bill & Melinda Gates Foundation. WM declares support for this work from the Gates Foundation. OFN declares support for this work from the Norwegian Agency for Development Cooperation (Oslo, Norway) and a Norwegian Research Council Centre of Excellence grant (Oslo, Norway). OO declares support for this work from the Gates Foundation. DW declares salary support for participation in The Lancet Commission on Investing in Health (322282–SFF). GY declares research funding to his institution to support this work from the Gates Foundation. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY CC 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: The World Health Organization provides 10 specific guidelines for managing the prices of pharmaceutical products. Many of those are widely known and used such as reference pricing, value-based pricing, price transparency, and tendering. Less attention and knowledge is concentrated in markup regulation across the pharmaceutical supply chain and distribution and in tax exemptions or reductions. This article quantifies the impact of these price components in the Latin American (LatAm) region and places the findings in the context of economic theory and international policy experiences., Methods: 2020 retail pharmaceutical sales data from 8 major LatAm markets covered in the IQVIA database were decomposed into ex-factory, distributor markups, and taxes using price build up information and the Price Decipher Methodology developed by the Novartis Global Pricing Governance and Negotiation team. The findings were reviewed by an international panel representing academia, health policy, health economics, patient, and industry., Results: The ex-factory market value of the analyzed markets was $49 billion. Distribution markups added $20 billion and taxes a further $10.5 billion. This represented a 63% increase over ex-factory prices, considered high if compared with 24% for an international benchmark of 35 ex-LatAm countries. Reducing markups for these LatAm countries to 24% would represent up to $19 billion in savings for payers and patients., Conclusions: There is potential for significant cost reductions associated with tax and distribution markup refinements in the LatAm retail pharmaceutical market. National policies should be informed by additional context-specific research for effective implementation., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2024 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of interests OA declares consulting fees from the Asian Development Bank, WHO, the World Bank, and Pharos Global Health Advisors and speaker's fees from Pfizer. SA declares research grants from the US National Institutes of Health (NIH R01 R01DK127138, NIH R21MD019394, and NIH U01AI169477); consulting fees from Travere Therapeutics, Vera Therapeutics, and Mendara; support for travel or attending meetings from Travere Therapeutics; unpaid leadership or fiduciary roles with the International Society of Nephrology, the Kidney Health Initiative, and American Nephrologists of Indian Origin; and receipt of assay materials for work conducted under U01AI169477 from Abbott Laboratory and Ascend Laboratory. SFB declares consulting fees from the Serum Institute of India, Micron Biomedical, VAXCO, Global Health Investment Corporation, Brown University, Gavi, the Vaccine Alliance, and SICPA; payment or honoraria from University of California Press; support for attending meetings or travel from UN Office for Project Services and STOP TB, Gavi, SICPA, and Serum Life Sciences; participation on data safety monitoring or advisory boards for CEPI, COVAX, and Gavi; membership of the board of PHARE BIO and of the strategic oversight board of Apriori Bio; and stock or stock options in VAXCO and Apriori Bio. SMB declares that two graduate students reporting to him received support from the University of Bergen for work on pandemic preparedness as part of the 4th edition of the Disease Control Priorities Project; received support for travel from the University of Bergen, the Japan International Cooperation Agency, and the AIDS Healthcare Foundation; and is a board member for HopeLab and the Bay Area Global Health Alliance. SB declares research support from the University of Bergen and consulting fees from the World Bank. FB declares travel support from the Partnership for Maternal, Newborn and Child Health and Fondation Botnar and is chair of the Governance and Ethics Committee for the Partnership for Maternal, Newborn and Child Health, international advisory board chair of the UN University International Institute for Global Health, co-chair of the Lancet Commission on Gender-Based Violence and the Maltreatment of Young People, interim board chair of Fondation Botnar, a member of the Lancet Future of Neonatology Commission, and a member of the Lancet and Chatham House Commission on Universal Health. EG-P declares consulting fees from the International Monetary Fund and the World Bank, is board chair of Aceso Global, and has participated in advisory committees for Roche and Medtronic. WM declares research support to her institution from WHO, the Bill & Melinda Gates Foundation, the Pfizer Foundation, the Open Society Foundation, the Hilton Foundation, and the Rockefeller Foundation, and an unpaid role as a member of the Research Committee of the Consortium of Universities for Global Health. OO is a member of the Africa Centres for Disease Control and Prevention Health Economics and Financing Programme Advisory Board and a member of the Partnership for Maternal, Newborn and Child Health Economics and Financing Working Group. AP-M is a member of the board of the Global Alliance for TB Drug Development and Iliad Biotechnologies and a member of the Cabrini Global Health Commission, and has stock or stock options in Iliad Biotechnologies. DW declares a grant from the Research Council of Norway Centre of Excellence. GY declares research funding from WHO, the Gates Foundation, the Carnegie Corporation of New York, the UN Economic and Social Commission for Asia and the Pacific, and the Economic and Social Research Council, is co-chair of the Economics and Finance Working Group of the Partnership for Maternal, Newborn and Child Health, and has served as a paid adviser to the evaluation of Partners for a Malaria-Free Zambia Program of Scale (conducted by Metrics 4 Management). All other authors declare no competing interests.

Although the importance of access to, and utilization of, home and community-based services (HCBS) is a well-documented aspect of informal care and the ability to age in place among people living with dementia, these resources are underutilized, especially in the initial stages of the disease. In 2017, the Georgia Memory Net was established as a novel private-public partnership to extend dementia screening, diagnosis, care planning, and direct HCBS connections for people with memory concerns throughout the State of Georgia. We aimed to identify barriers and facilitators to HCBS utilization following a dementia diagnosis and subsequent referral for services. Data were collected through in-depth interviews with 7 Georgia Memory Net patients and 19 care partners (unconnected dyads) and analyzed using thematic analysis. We found that even with a direct handoff, many people do not use HCBS and face barriers to accessing services. We offer several recommendations based on these findings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Family planning (FP) programmes in low and lower-middle income countries are confronting the dual impact of reduced external donor commitments and stagnant or reduced domestic financing, worsened by economic consequences of the COVID-19 pandemic. Co-financing-a donor-government agreement to jointly fund aspects of a programme, with transition towards the government assuming increasing responsibility for total cost-can be a powerful tool to help build national ownership, fiscal sustainability and programme visibility. Using Gavi's successful co-financing model as reference, the current paper draws out a set of key considerations for developing policies on co-financing of FP commodities in resource-poor settings. Macroeconomic and contextual sensitivities must be incorporated while classifying countries and determining co-financing obligations-using the actual GNI per capita on a scale or sovereign credit ratings, in conjunction with programmatic indicators, may be preferred. It is also important for policies to allow sufficiently long time for countries to transition-dependent on the country context, may be up to 10 years as allowed under the US Agency for International Development FP graduation policy and flexibility to revisit the terms following externalities that can influence the fiscal space for health. Incentivizing new domestic financing to pay for co-financing dues is critical, so as not to displace government funding from related health or social sector programs. Pragmatic ways to ensure country compliance can include engaging both the ministries of health and finance as co-signatories to identify and address known administrative and fiscal challenges; establishing dedicated co-financing account with the finance ministry; and instituting a mutual monitoring mechanism. Lastly, the overall process of policymaking can benefit from an alignment of goals and interests of the key development partners., (© The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Despite abundant evidence demonstrating that improvements to health and education are positively correlated, and the importance of school-based platforms to achieve shared impacts, collaboration between ministries of health and education remains limited across low- and middle-income countries. Enhancing this collaboration is essential to realize mutually beneficial results, especially following the COVID-19 pandemic, which severely impacted health and education outcomes globally and highlighted the importance of resilient, domestically funded systems for delivering key social services including primary health care and education. We argue that the lack of an effective joint financing mechanism has hindered adoption of collaborative multisectoral approaches such as the WHO/UNESCO's Health Promoting Schools (HPS) model. HPS is well-positioned to organize, finance, and deliver primary health care and education services through a school-based platform and strategy. Case studies from several low- and middle-income countries highlight the need to expand limited inter-ministerial collaborations to achieve cross-sectoral benefits and ensure sustainability of HPS beyond the lifecycle of external partners' support. It is important to identify ways to widen the resource envelope for sector-specific activities and create efficiencies through mutually beneficial outcomes. This paper offers two pragmatic solutions: an inter-ministerial joint financing mechanism that starts with alignment of budgets but matures into a formal system for pooling funds, or a fixed-term co-financing mechanism that uses donor contributions to catalyze inter-ministerial collaborations. Achieving sustainability in these initiatives would require engaging the ministries of health, education, and finance; developing a common administrative, financial, and monitoring mechanism; and securing long-term commitment from all concerned stakeholders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Schiff, Jha, Walker and Gonzalez-Pier.)

Fair process is instrumental to implementing and sustaining health financing reforms. Ensuring a fair process during the design and adoption phases can garner political capital and secure a sense of citizens' ownership. This will prove useful when reforms are contested before benefits are yet to be fully materialized. Since many well devised health financing reforms are vulnerable to being dismantled after a few years of being launched, fair process should play a more strategic role in the implementation and evaluation phases when policies get challenged and reformulated to reflect the changing political and socioeconomic landscapes and to better manage early evidence on performance., (© The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: Induced abortion in Costa Rica is illegal in all cases except to save the life of the pregnant person. Despite severe restrictions to legal abortion, individuals in Costa Rica still induce abortions outside of the formal healthcare system. These individuals and those with spontaneous abortions, also known as miscarriages, occasionally need medical care for complications. In Costa Rica, an estimated 41% of unintended pregnancies end in abortion, yet there is very little published literature exploring the perspectives of healthcare providers on abortion in Costa Rica., Methods: We interviewed ten obstetrician-gynecologist clinicians and five obstetrician-gynecologist medical residents in San José, Costa Rica about their beliefs and practices related to extra-legal abortion and post-abortion care (PAC) using a Spanish language in-depth semi-structured interview guide. After transcription and translation into English, analysis team pairs used a combination of deductive and inductive coding to identify themes and sub-themes within the data., Results: Obstetrician-gynecologist clinicians and medical residents were aware of the presence of extra-legal abortion, and particularly, medication abortion, in their communities, but less familiar with dosing for induction. They expressed the desire to provide non-judgmental care and support their patients through extra-legal abortion and PAC journeys. Study participants were most familiar with providing care to individuals with spontaneous abortions. When discussing PAC, they often spoke about a policy of reporting individuals who seek PAC following an extra-legal abortion, without commenting on whether or not they followed the guidance., Conclusions: This study contributes to a gap in research about the knowledge, attitudes, and practices of Costa Rican obstetrician-gynecologist clinicians and medical residents around extra-legal abortion and PAC. The results reveal an opportunity to train these healthcare providers as harm reduction experts, who are able to accurately counsel individuals who are seeking abortion services outside of the healthcare system, and to provide training to improve care for individuals needing PAC., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Essential packages of health services (EPHS) potentially contribute to universal health coverage (UHC) financing through several pathways. Generally, expectations on what an EPHS can achieve for health financing are high, yet stakeholders rarely spell out mechanisms to reach desired outcomes. This paper analyses how EPHS relate to the three health financing functions (revenue raising, risk pooling and purchasing) and to public financial management (PFM). Our review of country experiences found that using EPHS to directly leverage funds for health has rarely been effective. Indirectly, EPHS can translate into increased revenue through fiscal measures, including health taxes. Through improved dialogue with public finance authorities, health policy-makers can use EPHS or health benefit packages to communicate the value of additional public spending connected with UHC indicators. Overall, however, empirical evidence on EPHS contribution to resource mobilisation is still pending. EPHS development exercises have been more successful in advancing resource pooling across different schemes: EPHS can help comparing performance of coverage schemes, occasionally leading to harmonisation of UHC interventions and identifying gaps between health financing and service delivery. EPHS development and iterative revisions play an essential role in core strategic purchasing activities as countries develop their health technology assessment capacity. Ultimately, packages need to translate into adequate public financing appropriations through country health programme design, ensuring funding flows directly address obstacles to increased coverage., Competing Interests: Competing interests: This paper is part of a series of seven papers to be published as a supplement coordinated by the DCP3 Country Translation project at the LSHTM, which is funded by the Bill & Melinda Gates Foundation., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The number of people living with dementia is growing and most patients go years without receiving a specific diagnosis or support services, leading to suboptimal care, negative impacts on the quality of life, and increased costs of care. To address these gaps, the State of Georgia Department of Human Services collaborated with academic and community partners to create the Georgia Memory Net (GMN)., Design: GMN is a hub and spoke model partnered with Emory University's Cognitive Neurology Clinic and Emory Goizueta Alzheimer's Disease Research Center to provide training and support for best practices in diagnosis and management to Memory Assessment Clinics (MACs) throughout the state., Setting: Communities across the State of Georgia., Participants: GMN is a mix of academic and community providers, hospital systems, state and community agencies. Patients and families are evaluated at the MACs and connected to community services., Intervention: A dedicated clinic workflow: primary care providers (PCPs) identify a memory problem and refer to the MACs for diagnostic evaluation; meeting with a community services educator, and development of a care plan. The patient is reconnected with the PCP for continuity of care., Measurements: Initial metrics include numbers of unique patients, total patient visits, and referrals to state agency partners for community services., Results: GMN established five MACs across Georgia with annual state funding. Partners at Emory University provided initial training; refined patient workflows for best practices; and provide ongoing support, guidance, and continuing education for MAC teams. Local PCPs and community services partners demonstrated strong engagement with the new model., Conclusions: GMN is an innovative care model to improve access to accurate and timely diagnosis in patients with memory loss. GMN may help improve the quality of life for patients and families through preventive and early care., (© 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: Hepatitis C is a preventable and treatable disease that has been declared a public health problem. In 2012, the prevalence of HCV serum anti-bodies in the Mexican adult population aged 20 to 49 years was 0·30%., Methods: We randomly selected a probabilistic sub-sample of 12,389 adults (20+ years) from adults participating in the National Health and Nutrition Survey (ENSANUT) 2018 who provided a venous blood sample. Anti-HCV antibodies and HCV RNA were determined for this sub-sample. We estimated the national prevalence of anti-HCV antibodies and the proportion with viral RNA detection and evaluated their association with sociodemographic characteristics for all adults and with sexual behaviours in those aged 20 to 49 years using logistic regression., Findings: The national prevalence of anti-HCV antibodies in serum was 0·38% (95%CI 0·24, 0·59) in the population aged 20 years and older; 14·9% of them had viral RNA. In the population aged 20 to 49 years antibody prevalence was 0·23% (95%CI 0·11, 0·48), being higher for males and people living in urban areas. In the population aged 50 years and older, the prevalence was 0·59% (95%CI 0·34, 1·06)., Interpretation: The prevalence of antibodies anti-HCV in people aged 20 to 49 years was similar in 2018 than in 2012, suggesting that the prevalence of HCV has remained stable. ENSANUT is a household study and could underestimate the prevalence of HCV. Further efforts must be made to identify cases in non-household populations., Funding: National Institute of Statistics and Geography and National Institute of Public Health of Mexico [CIEE/1807]., Competing Interests: None declared, (© 2021 The Authors.)