BackgroundChagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world’s most advanced healthcare systems?Methodology/Principal findingsThis analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma.ConclusionsWe propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.

Background Increased electronic prescribing (eRx) rates have the potential to prevent errors, increase patient safety, and curtail fraud. US Federal meaningful use guidelines require at least a 40% electronic prescribing rate. Objective We evaluated eRx rates among primary care providers in New York City in order to determine trends as well as identify any obstacles to increased eRx rates required by meaningful use guidelines.

ResumoObjetivos: Estimar a prevalência de sintomas depressivos entre idosos internados no Serviço de Emergência do Hospital de Clínicas de Porto Alegre-RS e verificar a associação entre sintomas depressivos e características sociodemográficas e de utilização de serviços de saúde pelos idosos. Métodos: Estudo transversal com 96 idosos internados em um serviço de emergência. A presença de sintomas depressivos foi avaliada por meio da aplicação da Escala de Depressão Geriátrica -versão reduzida (EDG-15), e foi aplicado instrumento sobre variáveis sociodemográficas e de utilização dos serviços de saúde. Foram realizadas análises descritivas e bivariáveis, e o nível de significância estatística adotado foi de 5% ( p≤0,05). Resultados: Encontrou-se a prevalência de 36,5% de sintomas depressivos na amostra, sendo que destes, 6,3% dos idosos apresentavam pontuação sugestiva de depressão grave. Identificou-se associação significativa entre sintomas depressivos e viuvez, observando-se que os sintomas depressivos foram mais frequentes entre as mulheres, os de baixa escolaridade e os que não utilizaram serviços de saúde. Conclusão: O estudo encontrou alta prevalência de sintomas depressivos entre idosos internados no serviço de emergência. Ressalta-se a importância do reconhecimento e realização do diagnóstico de depressão em idosos nesses serviços com objetivo de se trabalhar com uma visão ampliada do processo de saúde-doença, oferecer tratamento e melhores intervenções na rede.Palavras-chave: Sintomas Depressivos. Idoso. Serviço Hospitalar de Emergência.http://dx

EXECUTIVE SUMMARYIn response to issues raised in the report of the World Health Organization (WHO)affiliated Consultative Expert Working Group (CEWG) on research and development (R&D) financing and coordination and the desire of the U.S. government to obtain a wide range of nongovernmental perspectives on the funding and coordination of the global health research enterprise, several members of the IOM Global Health Interest Group and other experts combined efforts to produce an IOM discussion paper to capture their views on approaches to research priority-setting, the leading gaps in global health R&D, R&D planning and costing, the private-sector role in global health R&D, the creation of effective global health research networks, the building of R&D capacity in developing countries, innovations in financing the global health R&D enterprise, and principles of global health R&D management.Overall, we agreed with many fundamental elements of the CEWG report, including its concerns about market failures for many diseases of global health importance and its assessment of the hurdles for advancing global health innovation, especially those required for product development, product licensure, and global patient access. There was agreement on the importance of establishing a well-functioning Global Health R&D Observatory as a first step toward improving global health R&D priority setting and coordination. The co-authors also recognized the complexities around some of the specific CEWG report recommendations, such as those for a binding international treaty or other legal instrument, a common pool of R&D funds, and the call for specific financial targets rather than identified global health R&D deliverables.We wish to emphasize agreement with the need for a "framework" to expand the role of governments in supporting and enabling global health R&D that could incorporate the following elements: 1) financing, 2) priority setting and coordination, 3) other nonfinancial R&D gaps, and 4) key principles and global norms.Our analysis of R&D financing summarized in this paper employed new information just issued from the 2012 Global Funding for Innovation in Neglected Diseases (G-FINDER) report and the Global Burden of Disease 2010 study to confirm that there remains a severe gap in R&D funding for many global health conditions, especially malaria, diarrheal diseases, bacterial pneumonia and meningitis, and almost all of the neglected tropical diseases (NTDs).

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