Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use. Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known. Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals. Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored

Temporal patterns of den use suggest polygamous mating patterns in an obligate monogamous mammal

Mating systems in animal societies contain both social and genetic components. Deviations between these components may have important ramifications for our understanding of the evolution of animal reproductive strategies and their ecological correlates. However, although there is ample evidence for discrepancies between genetically assigned paternities and social associations in birds, relatively few studies have documented such differences in mammals. Moreover, few studies have addressed how deviations between social mating associations and actual mating activities influence patterns of resource utilisation in males and females. The aardwolf is a socially monogamous hyaenid that exhibits polygamous mating behaviour. Suitable den sites for resting and rearing offspring is an important resource for terrestrial mammals, and dens are vital to aardwolves as thermal refugia for protection of offspring. We show that temporal patterns in aardwolf den use relates to predictions from polygamous mating rather than social monogamy. Male aardwolves used more dens, changed dens more frequently and stayed in dens for shorter periods of time than females during both wet and dry seasons. We suggest that lower male den fidelity is either caused by males trying to maximize female encounters and to monitor female activity, or that it had evolved as a non-adaptive behaviour related to elevated androgen levels. Our data did not point to territorial defence or space use optimization as cause for the observed sex differences, since we did not find any sex or seasonal differences in the spatial patterns of utilized dens. We suggest that aardwolves may have been ecologically constrained to exhibit social monogamy but that polymagous mating is maintained through extra pair copulations. We recommend that the evolutionary stability of these two conflicting strategies of male fitness maximization must be further investigated.An NRF focal area grant (EZC), NRF incentive funds (CWWP, FD), an NRF SARCHi chair in mammal behavioural ecology and physiology (NCB) and a research fellowship from University of Pretoria (FD).http://www.elsevier.com/locate/anbehavhb2016Centre for Wildlife ManagementMammal Research InstituteZoology and Entomolog

Barriers for access to new medicines: Searching for the balance between rising costs and limited budgets

Introduction: There is continued unmet medical need for new medicines across countries especially for cancer, immunological diseases, and orphan diseases. However, there are growing challenges with funding new medicines at ever increasing prices along with funding increased medicine volumes with the growth in both infectious diseases and non-communicable diseases across countries. This has resulted in the development of new models to better manage the entry of new medicines, new financial models being postulated to finance new medicines as well as strategies to improve prescribing efficiency. However, more needs to be done. Consequently, the primary aim of this paper is to consider potential ways to optimize the use of new medicines balancing rising costs with increasing budgetary pressures to stimulate debate especially from a payer perspective. Methods: A narrative review of pharmaceutical policies and implications, as well as possible developments, based on key publications and initiatives known to the co-authors principally from a health authority perspective. Results: A number of initiatives and approaches have been identified including new models to better manage the entry of new medicines based on three pillars (pre-, peri-, and post-launch activities). Within this, we see the growing role of horizon scanning activities starting up to 36 months before launch, managed entry agreements and post launch follow-up. It is also likely there will be greater scrutiny over the effectiveness and value of new cancer medicines given ever increasing prices. This could include establishing minimum effectiveness targets for premium pricing along with re-evaluating prices as more medicines for cancer lose their patent. There will also be a greater involvement of patients especially with orphan diseases. New initiatives could include a greater role of multicriteria decision analysis, as well as looking at the potential for de-linking research and development from commercial activities to enhance affordability. Conclusion: There are a number of ongoing activities across countries to try and fund new valued medicines whilst attaining or maintaining universal healthcare. Such activities will grow with increasing resource pressures and continued unmet need. © 2018 Godman, Bucsics, Vella Bonanno, Oortwijn, Rothe, Ferrario, Bosselli, Hill, Martin, Simoens, Kurdi, Gad, Gulbinovič, Timoney, Bochenek, Salem, Hoxha, Sauermann, Massele, Guerra, Petrova, Mitkova, Achniotou, Laius, Sermet, Selke, Kourafalos, Yfantopoulos, Magnusson, Joppi, Oluka, Kwon, Jakupi, Kalemeera, Fadare, Melien, Pomorski, Wladysiuk, Markovic-Pekovic, Mardare, Meshkov, Novakovic, Fürst, Tomek, Zara, Diogene, Meyer, Malmström, Wettermark, Matsebula, Campbell and Haycox