Notes

Oily lean meats in computed tomography scan on entrance can be a threat element with regard to significant coronavirus illness.
ICER uses a different approach for clinical review but performs cost-effectiveness analysis using methods similar to NICE. The key differences between NICE and ICER arise because of important differences between the United Kingdom's "single payer" health care system and the United States's pluralistic system. ICER's lack of mandatory power translates to substantial differences in terms of its processes and type of recommendations.

No outside funding supported this study. Thokala has received grants from the Institute for Clinical and Economic Review (ICER) for modeling projects. Carlson has received grants from ICER, unrelated to this study. Drummond has nothing to disclose.
No outside funding supported this study. Thokala has received grants from the Institute for Clinical and Economic Review (ICER) for modeling projects. Carlson has received grants from ICER, unrelated to this study. Drummond has nothing to disclose.The movement toward value-based care is occurring in many countries of the world. The increasing population, longer life expectancy, and rising cost for high-tech care necessitates that government and private payers around the world devise new ways to ensure that health care dollars are spent on the most effective interventions. In this Viewpoints article, we present the value-based care transformation that is currently in its infancy in Brazil, which has a mix of private and public payers but still largely reimburses based on a fee-for-service model. We contrast that with recent experience in the United States, where value-based care is slowly but surely becoming the norm. The Brazilian system has many opportunities to learn from the U.S. shift to value-based care-including the development of quality measures, transition to value-based payment, and leveraging data to rank performance across Brazilian health systems. Pharmaceutical manufacturers in Brazil can play a role, as well, with value-based agreements and partnerships with payers. Each country will travel on its own path to value-based health care, but the opportunity to learn from each other presents one of the best chances for success. DISCLOSURES Abicalaffe received funding from Janssen Latin America for the preparation of this manuscript. Schafer is employed by Precision Value, a marketing agency that works with pharmaceutical manufacturers.
Medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires Medicare Part D plans that offer prescription drug coverage to establish MTM programs (MTMPs) for eligible beneficiaries. Even though the term "MTM" was first used in 2003, pharmacists have provided similar services since the term "pharmaceutical care" was introduced in 1990. Degrasyn cell line Fairview Health Services, a large integrated health care system, implemented a standardized pharmaceutical care service system in 1998, naming it a pharmaceutical care-based MTM practice in 2006.

To present the clinical, economic, and humanistic outcomes of 10 years of delivering MTM services to patients in a health care delivery system.

Data from MTM services provided to 9,068 patients and documented in electronic therapeutic records were retrospectively analyzed over the 10-year period from September 1998 to September 2008 in 1 health system with 48 pors shared equally in data interpretation.
No funding supported the writing of this letter. Preblick, Ali, and DasMahapatra are employees and shareholders of Sanofi Genzyme. Gray is a postdoctoral fellow at Sanofi Genzyme and Rutgers University.
No funding supported the writing of this letter. Preblick, Ali, and DasMahapatra are employees and shareholders of Sanofi Genzyme. Gray is a postdoctoral fellow at Sanofi Genzyme and Rutgers University.
Medication adherence is crucial for the successful treatment among elderly patients with diabetes taking oral antidiabetic medications (OAMs). Cost of medications, lack of insurance coverage, and low income are major contributing factors towards medication nonadherence. State pharmaceutical assistance programs (SPAPs) provide medications at little or no cost to income-eligible patients and have potential to improve medication adherence among elderly patients. Despite this, limited research has focused on the association of medication adherence with health care utilization among elderly patients enrolled in SPAPs, and inclusion of health care costs as an outcome is even rarer.

To evaluate the relationship between adherence to OAMs and hospital utilization and costs among elderly patients with diabetes who were enrolled in a SPAP.

This retrospective observational study included elderly patients with diabetes enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) program in 20alization (95% CI = 1.171-1.311) and 12.7% longer for diabetes-related hospitalization (95% CI = 1.036-1.227). Medication nonadherence was associated with significantly greater all-cause ($22,670 vs. $16,383;
< 0.0001) and diabetes-related ($13,518 vs. $12,634;
= 0.0003) hospitalization costs.

Among SPAP-enrolled elderly patients, nonadherence to OAMs was significantly associated with increased risk of hospitalization, longer hospital stays, and greater hospitalization costs. Attention is needed to improve medication adherence among elderly receiving financial assistance to pay their prescriptions to reduce economic burden on the health care system.

No outside funding supported this study. The authors have nothing to disclose.
No outside funding supported this study. The authors have nothing to disclose.
No funding was received for this commentary. The author has nothing to disclose.
No funding was received for this commentary. The author has nothing to disclose.
Traditional adherence measures such as proportion of days covered (PDC) and medication possession ratio (MPR) are limited in their ability to explain patient medication adherence over time. Group-based trajectory modeling (GBTM) is a new methodological approach that visually describes the dynamics of long-term medication adherence and classifies adherence behavior into groups.

To describe and compare trajectories of medication nonadherence reported in the medical literature, including identifying consistent trends in adherence trajectories and disease and patient characteristics that predict trajectory group membership.

A systematic literature review was conducted in April 2020 in PubMed and CINAHL using MeSH terms and key words in appropriate combinations. Citations were screened for relevance using predefined inclusion and exclusion criteria and evaluated according to variables associated with group-based trajectory models.

21 articles met the study criteria and were reviewed. Generally, studies identified 4 to 6 trajectory groups that described longitudinal medication adherence behavior. Most commonly identified trajectories were labeled as (a) consistent, high adherence, (b) declining adherence, (c) early and consistent nonadherence, and (d) initial nonadherence followed by an increase. Several predictors, including socioeconomic status, disease characteristics, and therapy initiation were routinely associated with group membership.

This review suggests that adherence trajectories and predictors of specific group membership may be similar across diverse disease states. GBTM describes longitudinal, dynamic patterns of medication adherence that may facilitate the development of targeted interventions to promote adherence. Implications for value-based payment systems are discussed in this review.

No outside funding supported this study. The authors have no conflicts of interest to declare.
No outside funding supported this study. The authors have no conflicts of interest to declare.
Increasing psychological stressors have posed challenges to the well-being of the people across the globe and greatly affected the functionality and economic output of the individuals and the society. Nigeria has no existing mental health registry. Data on the prevalence of mental disorders are not readily available owing to lack of mental health registry. Hence, this study assessed the prevalence of mental disorders in Abakaliki metropolis, Ebonyi State.

To determine the prevalence of mental disorders and associated factors among the residents of Abakaliki metropolis, Ebonyi State.

This cross-sectional descriptive research study involved 400 participants. Questionnaires adapted from world mental health diagnostic interview and General Health Questionnaire 12 were used for data collection. Data were analyzed using descriptive statistics and hypotheses tested using chi-square test at significance level of .05.

The prevalence of mental disorders among the respondents was 70% depressive disorders and 52.3% substance use disorders-tranquilizers (34.9%) and stimulants (15.8%) were the commonly used, while 85.3% suffered anxiety disorders. These were common among age range of 19 to 28 years-those with higher education and the unemployed. More females had mental disorders except substance use disorders, which was higher in males (53.4%). There was no significant relationship between mental disorders and the demographic variables, but significant relationship was found to exist between individuals' age and anxiety disorder.

Mental disorders, such as depression, anxiety, and substance use disorders, are common among the respondents and, therefore, calls for urgent attention of the government to improve the mental health of the people.
Mental disorders, such as depression, anxiety, and substance use disorders, are common among the respondents and, therefore, calls for urgent attention of the government to improve the mental health of the people.
In many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country.

To determine the relationship between place of birth and early breastfeeding initiation in Indonesia.

This study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey (
= 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders.

The overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90;
= .018) and (0.58; 0.40, 0.85;
= .005), respectively.

Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.
Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.
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