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  • Of note gender equity might continue

    2019-04-17

    Of note, gender equity might continue despite the economic development of a society. Studies by Nussbaum and Sen have shown no direct relation between wealth and equity. Hence, some countries with high wealth, such as Saudi Arabia, also a have high degree of gender inequity, whereas others with low wealth, such as Lithuania, have taken substantial steps towards achieving gender equity.
    Because of antimicrobial resistance, the global overuse of fak pathway is now a threat to one of the most effective and mortality-lowering interventions in modern medicine. One of the most important challenges is to substantially lower the use of antibiotics when these drugs are not needed. The fear of missing a severe case of pneumonia can incite health-care providers to ignore the fact that, in many non-severe cases of respiratory tract infections, antibiotic treatment will probably not markedly alter the outcome for the individual patient. Reduction of antibiotic use will require reliable and broadly applicable segregation of non-bacterial infection and trivial bacterial infections from serious bacterial infections. In the , Nga Do and colleagues report the results of a large (more than 2000 participants) randomised controlled trial of a point-of-care antibiotic strategy guided by C-reactive protein concentrations compared with usual best practice in primary care patients with non-severe acute respiratory tract infection in Vietnam. The results demonstrate that a point-of-care C-reactive protein intervention can reduce antibiotic prescribing in this setting, albeit with only a moderate reduction in absolute risk (adjusted 12·5%; intervention 64·4% control 77·9%). Importantly, there were no apparent differences in serious adverse effects or delayed patient recovery.
    In , Victoria Pillay-van Wyk and colleagues report a large-scale analysis of more than 8 million deaths that occurred in South Africa over a 16-year period (1997–2012). The study provides important subnational information on mortality by province and by the different communities in South Africa—a feature that is a major improvement on the previous studies of the burden of disease in South Africa and the Global Burden of Disease study—thus making this report more useful to policy makers and planners at national and provincial levels of the country. HIV/AIDS remains the leading cause of death (accounting for 50% of deaths), although deaths from the disease have decreased substantially across all provinces over the past 10 years. Although deaths related to non-communicable disease and injury have also stabilised, mortality from type 1 conditions that include infectious diseases such as lower respiratory tract infection, septicaemia, or neonatal causes have not. Pillay-van Wyk and colleagues report an increase in age-standardised death rates from diabetes and renal disease from 1997 to 2012, substantial death rates from non-communicable diseases in individuals aged 40–44 years (earlier onset than in high-income settings), and race-related inequity in distribution of causes of death, underlining the persisting effect of the apartheid system. Evidence of disease–disease and drug–disease interactions between HIV, tuberculosis, and non-communicable diseases is increasing. There has also been recent research into the changing epidemiology of population health towards co-existing chronic infections and non-communicable diseases. Pillay-van Wyk and colleagues cite the importance of this epidemiological interaction between communicable and non-communicable diseases in recent studies into the cardiovascular disease risk profile associated with antiretroviral therapy. Known interactions also exist between antiretroviral therapy and diabetes, and evidence of interaction between HIV and the most common non-communicable diseases, including chronic respiratory disease, is increasing. In response to these changing epidemiological patterns, the South African National Strategic Plan for non-communicable diseases seeks to address chronic infectious disease comorbidity through an Integrated Chronic Disease Management tool in order for health-care delivery, and more broadly health systems, to adapt to this population health need. This strategy is essential to prevent a reversal of the positive effects of antiretroviral therapy on HIV outcomes that have been achieved in South Africa. The differential states of epidemiological transition in different population groups shown in this study, and the importance of the differential exposures to the social determinants of health, is highlighted with the association between health outcomes and gross domestic product per head.