1
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Heller DJ, Hudspeth JC, Kishore SP, Mercer T, Schwartz JI, Rabin TL. Bringing Generalists to Global Health: a Missed Opportunity and Call to Action. J Gen Intern Med 2023:10.1007/s11606-023-08573-x. [PMID: 38135777 DOI: 10.1007/s11606-023-08573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
The credo of the generalist physician has always been the promotion of health for all, in every aspect: not just multiple vulnerable organ systems, but multiple social, cultural, and political factors that contribute to poor health and exacerbate health inequity. In recent years, the field of global health has also adopted this same mission: working across both national and clinical specialty borders to improve health for all and end health disparities worldwide. Yet within the Society for General Internal Medicine, and among American generalists, engagement in global health, both within and outside the USA, remains uncommon. We see this gap as an opportunity, because in fact generalists in America already have the skills and experience that global health badly needs. SGIM could promote generalists to global health's vanguard, with three core steps. First, we generalists must continue to integrate health for the vulnerable into our domestic work, generating care models applicable in low-resource settings around the globe. Conversely, we must also engage with and implement international ideas and solutions for universal access to primary care for vulnerable patients in the USA. And lastly, we must build platforms to connect ourselves with colleagues worldwide to exchange these learnings.
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Affiliation(s)
- David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - James C Hudspeth
- Department of Medicine, Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sandeep P Kishore
- Division of Hospital Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Tim Mercer
- Division of Global Health, Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Jeremy I Schwartz
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tracy L Rabin
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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2
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Garg A, Murphy A, Krishna A, Sahoo SK, Huffman MD, Kishore SP, Shivashankar R. Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level. Natl Med J India 2023; 35:357-363. [PMID: 37167513 DOI: 10.25259/nmji_35_6_357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO's EML, India's national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year's consumption. The approximate time between procurement planning and distribution was 7-8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.
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Affiliation(s)
- Ankur Garg
- Centre for Chronic Disease Control, New Delhi, India
| | - Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago
- Division of Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Roopa Shivashankar
- Centre for Chronic Disease Control, New Delhi, India
- Resolve to Save Lives, Gurugram, Haryana, India
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3
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Agarwal A, Husain MJ, Datta B, Kishore SP, Huffman MD. Access to Heart Failure Medicines in Low- and Middle-Income Countries: An Analysis of Essential Medicines Lists, Availability, Price, and Affordability. Circ Heart Fail 2022; 15:e008971. [PMID: 35249355 PMCID: PMC9872096 DOI: 10.1161/circheartfailure.121.008971] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Anubha Agarwal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Muhammad Jami Husain
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - Biplab Datta
- Department of Population Health Sciences, Medical College of Georgia, Augusta University
| | | | - Mark D. Huffman
- Department of Medicine, Washington University in St. Louis, MO,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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4
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Armstrong-Hough M, Sharma S, Kishore SP, Akiteng AR, Schwartz JI. Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis. PLoS One 2020; 15:e0241555. [PMID: 33362249 PMCID: PMC7757794 DOI: 10.1371/journal.pone.0241555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.
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Affiliation(s)
- Mari Armstrong-Hough
- School of Global Public Health, New York University, New York, NY, United States of America
- * E-mail:
| | - Srish Sharma
- Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Young Professionals Chronic Disease Network, New York, New York, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Salam A, Huffman MD, Kanukula R, Hari Prasad E, Sharma A, Heller DJ, Vedanthan R, Agarwal A, Rodgers A, Jaffe MG, R Frieden T, Kishore SP. Two-drug fixed-dose combinations of blood pressure-lowering drugs as WHO essential medicines: An overview of efficacy, safety, and cost. J Clin Hypertens (Greenwich) 2020; 22:1769-1779. [PMID: 32815663 DOI: 10.1111/jch.14009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
Cardiovascular diseases (CVD) are the world's leading cause of death. High blood pressure (BP) is the leading global risk factor for all-cause preventable morbidity and mortality. Globally, only about 14% of patients achieve BP control to systolic BP <140 mm Hg and diastolic BP <90 mm Hg. Most patients (>60%) require two or more drugs to achieve BP control, yet poor adherence to therapy is a major barrier to achieving this control. Fixed-dose combinations (FDCs) of BP-lowering drugs are one means to improve BP control through greater adherence and efficacy, with favorable safety and cost profiles. The authors present a review of the supporting data from a successful application to the World Health Organization (WHO) for the inclusion of FDCs of two BP-lowering drugs on the 21st WHO Essential Medicines List. The authors discuss the efficacy and safety of FDCs of two BP-lowering drugs for the management of hypertension in adults, relevant hypertension guideline recommendations, and the estimated cost of such therapies.
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Affiliation(s)
- Abdul Salam
- The George Institute for Global Health, University of New South Wales, Hyderabad, India
| | - Mark D Huffman
- Department of Preventive Medicine and Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Raju Kanukula
- The George Institute for Global Health, University of New South Wales, Hyderabad, India
| | - Esam Hari Prasad
- The George Institute for Global Health, University of New South Wales, Hyderabad, India
| | - Abhishek Sharma
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | - David J Heller
- Department of Global Health & Health System Design, Icahn School of Medicine, New York, NY, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Anubha Agarwal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Marc G Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Thomas R Frieden
- Resolve to Save Lives, An Initiative of Vital Strategies, New York, NY, USA
| | - Sandeep P Kishore
- Department of Global Health & Health System Design, Icahn School of Medicine, New York, NY, USA.,Resolve to Save Lives, An Initiative of Vital Strategies, New York, NY, USA.,Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
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6
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Abstract
Background Several states have released Crisis Standards of Care (CSC) guidelines for the allocation of scarce critical care resources. Most guidelines rely on Sequential Organ Failure Assessment (SOFA) scores to maximize lives saved, but states have adopted different stances on whether to maximize long-term outcomes (life-years saved) by accounting for patient comorbidities. Methods We compared 4 representative state guidelines with varying approaches to comorbidities and analyzed how CSC prioritization correlates with clinical outcomes. We included 27 laboratory-confirmed COVID-19 patients admitted to ICUs at Brigham and Women's Hospital from March 12 to April 3, 2020. We compared prioritization algorithms from New York, which assigns priority based on SOFA alone; Maryland, which uses SOFA plus severe comorbidities; Pennsylvania, which uses SOFA plus major and severe comorbidities; and Colorado, which uses SOFA plus a modified Charlson comorbidity index. Results In pairwise comparisons across all possible pairs, we found that state guidelines frequently resulted in tie-breakers based on age or lottery: New York 100% of the time (100% resolved by lottery), Pennsylvania 86% of the time (18% by lottery), Maryland 93% of the time (35% by lottery), and Colorado: 32% of the time (10% by lottery). The prioritization algorithm with the strongest correlation with 14-day outcomes was Colorado (rs = -0.483. p = 0.011) followed by Maryland (rs = -0.394, p =0.042), Pennsylvania (rs = -0.382, p = 0.049), and New York (rs = 0). An alternative model using raw SOFA scores alone was moderately correlated with outcomes (rs = -0.448, p = 0.019). Conclusions State guidelines for scarce resource allocation frequently resulted in identical priority scores, requiring tie-breakers based on age or lottery. These findings suggest that state CSC guidelines should be further assessed empirically to understand whether they meet their goals.
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Affiliation(s)
- Julia L Jezmir
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
| | | | - Sandeep P Kishore
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
| | - Marisa Winkler
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
| | - Bradford Diephuis
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
| | - Edy Y Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
| | - William B Feldman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
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Husain MJ, Datta BK, Kostova D, Joseph KT, Asma S, Richter P, Jaffe MG, Kishore SP. Access to Cardiovascular Disease and Hypertension Medicines in Developing Countries: An Analysis of Essential Medicine Lists, Price, Availability, and Affordability. J Am Heart Assoc 2020; 9:e015302. [PMID: 32338557 PMCID: PMC7428558 DOI: 10.1161/jaha.119.015302] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Access to medicines is important for long-term care of cardiovascular diseases and hypertension. This study provides a cross-country assessment of availability, prices, and affordability of cardiovascular disease and hypertension medicines to identify areas for improvement in access to medication treatment. Methods and Results We used the World Health Organization online repository of national essential medicines lists (EMLs) for 53 countries to transcribe the information on the inclusion of 12 cardiovascular disease/hypertension medications within each country's essential medicines list. Data on availability, price, and affordability were obtained from 84 surveys in 59 countries that used the World Health Organization's Health Action International survey methodology. We summarized and compared the indicators across lowest-price generic and originator brand medicines in the public and private sectors and by country income groups. The average availability of the select medications was 54% in low- and lower-middle-income countries and 60% in high- and upper-middle-income countries, and was higher for generic (61%) than brand medicines (41%). The average patient median price ratio was 80.3 for brand and 16.7 for generic medicines and was higher for patients in low- and lower-middle-income countries compared with high- and upper-middle-income countries across all medicine categories. The costs of 1 month's antihypertensive medications were, on average, 6.0 days' wage for brand medicine and 1.8 days' wage for generics. Affordability was lower in low- and lower-middle-income countries than high- and upper-middle-income countries for both brand and generic medications. Conclusions The availability and accessibility of pharmaceuticals is an ongoing challenge for health systems. Low availability and high costs are major barriers to the use of and adherence to essential cardiovascular disease and antihypertensive medications worldwide, particularly in low- and lower-middle-income countries.
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Affiliation(s)
- Muhammad Jami Husain
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Biplab Kumar Datta
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Deliana Kostova
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Kristy T Joseph
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Samira Asma
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Patricia Richter
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Marc G Jaffe
- Resolve to Save Lives, an Initiative of Vital Strategies New York NY.,Department of Endocrinology The Permanente Medical Group San Francisco CA
| | - Sandeep P Kishore
- Department of Health System Design & Global Health and Department of Medicine Icahn School of Medicine at Mount Sinai Health System New York USA.,Brigham & Women's Hospital Boston MA
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8
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Kishore SP, Majumdar UB. Learning from progress: global NCD policy implementation at national level. The Lancet Global Health 2020; 8:e4-e5. [DOI: 10.1016/s2214-109x(19)30496-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
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Heller DJ, Kumar A, Kishore SP, Horowitz CR, Joshi R, Vedanthan R. Assessment of Barriers and Facilitators to the Delivery of Care for Noncommunicable Diseases by Nonphysician Health Workers in Low- and Middle-Income Countries: A Systematic Review and Qualitative Analysis. JAMA Netw Open 2019; 2:e1916545. [PMID: 31790570 PMCID: PMC6902752 DOI: 10.1001/jamanetworkopen.2019.16545] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Cardiovascular disease, cancer, and other noncommunicable diseases (NCDs) are the leading causes of mortality in low- and middle-income countries. Previous studies show that nonphysician health workers (NPHWs), including nurses and volunteers, can provide effective diagnosis and treatment of NCDs. However, the factors that facilitate and impair these programs are incompletely understood. OBJECTIVE To identify health system barriers to and facilitators of NPHW-led care for NCDs in low- and middle-income countries. DATA SOURCES All systematic reviews in PubMed published by May 1, 2018. STUDY SELECTION The search terms used for this analysis included "task shifting" and "non-physician clinician." Only reviews of NPHW care that occurred entirely or mostly in low- and middle-income countries and focused entirely or mostly on NCDs were included. All studies cited within each systematic review that cited health system barriers to and facilitators of NPHW care were reviewed. DATA EXTRACTION AND SYNTHESIS Assessment of study eligibility was performed by 1 reviewer and rechecked by another. The 2 reviewers extracted all data. Reviews were performed from November 2017 to July 2018. All analyses were descriptive. MAIN OUTCOMES AND MEASURES All barriers and facilitators mentioned in all studies were tallied and sorted according to the World Health Organization's 6 building blocks for health systems. RESULTS This systematic review and qualitative analysis identified 15 review articles, which cited 156 studies, of which 71 referenced barriers to and facilitators of care. The results suggest 6 key lessons: (1) select qualified NPHWs embedded within the community they serve; (2) provide detailed, ongoing training and supervision; (3) authorize NPHWs to prescribe medication and render autonomous care; (4) equip NPHWs with reliable systems to track patient data; (5) furnish NPHWs consistently with medications and supplies; and (6) compensate NPHWs adequately commensurate with their roles. CONCLUSIONS AND RELEVANCE Although the health system barriers to NPHW screening, treatment, and control of NCDs and their risk factors are numerous and complex, a diverse set of care models has demonstrated strategies to address nearly all of these challenges. These facilitating approaches-which relate chiefly to strong, consistent NPHW training, guidance, and logistical support-generate a blueprint for the creation and scale-up of such programs adaptable across multiple chronic diseases, including in high-income countries.
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Affiliation(s)
- David J. Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anirudh Kumar
- Department of Medicine, New York University School of Medicine, New York
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Carol R. Horowitz
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York
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10
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Majumdar UB, Hunt C, Doupe P, Baum AJ, Heller DJ, Levine EL, Kumar R, Futterman R, Hajat C, Kishore SP. Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns. BMJ Open 2019; 9:e029340. [PMID: 31619421 PMCID: PMC6797368 DOI: 10.1136/bmjopen-2019-029340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs. DESIGN Retrospective cross-sectional study. SETTING Mount Sinai Health System, set in all five boroughs of New York City, USA. PARTICIPANTS 192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014. METHODS We classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected. RESULTS 61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%. CONCLUSIONS In this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.
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Affiliation(s)
- Usnish B Majumdar
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Patrick Doupe
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Aaron J Baum
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Erica L Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | | | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Frieden TR, Varghese CV, Kishore SP, Campbell NRC, Moran AE, Padwal R, Jaffe MG. Scaling up effective treatment of hypertension-A pathfinder for universal health coverage. J Clin Hypertens (Greenwich) 2019; 21:1442-1449. [PMID: 31544349 DOI: 10.1111/jch.13655] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 01/21/2023]
Abstract
High blood pressure is the world's leading cause of death, but despite treatment for hypertension being safe, effective, and low cost, most people with hypertension worldwide do not have it controlled. This article summarizes lessons learned in the first 2 years of the Resolve to Save Lives (RTSL) hypertension management program, operated in coordination with the World Health Organization (WHO) and other partners. Better diagnosis, treatment, and continuity of care are all needed to improve control rates, and five necessary components have been recommended by RTSL, WHO and other partners as being essential for a successful hypertension control program. Several hurdles to hypertension control have been identified, with most related to limitations in the health care system rather than to patient behavior. Treatment according to standardized protocols should be started as soon as hypertension is diagnosed, and medical practices and health systems must closely monitor patient progress and system performance. Improvement in hypertension management and control, along with elimination of artificial trans fat and reduction of dietary sodium consumption, will improve many aspects of primary care, contribute to goals for universal health coverage, and could save 100 million lives worldwide over the next 30 years.
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Affiliation(s)
- Thomas R Frieden
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York
| | | | - Sandeep P Kishore
- Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Andrew E Moran
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York.,Columbia University, New York, New York
| | - Raj Padwal
- University of Alberta, Edmonton, Alberta, Canada
| | - Marc G Jaffe
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York
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12
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von Oettingen JE, Ginsburg O, Kishore SP, Pastakia SD, Schroeder LF, Milner DA, Vedanthan R. The AEIOU of essential diagnostics: align, expand, implement, oversee, and update. Lancet Glob Health 2019; 7:e694-e695. [PMID: 31097269 DOI: 10.1016/s2214-109x(19)30039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 01/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Julia E von Oettingen
- Montreal Children's Hospital, Montreal, QC H4A 3J1, Canada; Research Institute, McGill University Health Centre, Montreal, QC, Canada.
| | - Ophira Ginsburg
- Department of Population Health, New York University Langone Health, New York, NY, USA
| | | | | | - Lee F Schroeder
- Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Dan A Milner
- American Society for Clinical Pathology, Chicago, IL, USA
| | - Rajesh Vedanthan
- Department of Population Health, New York University Langone Health, New York, NY, USA
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13
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Abstract
Introduction To design effective policy and interventions, public health officials must have an accurate and granular picture of the state of multiple chronic conditions (MCC) in their region. The objective of this research is to describe the prevalence and distribution of MCC in New York State. Methods We performed a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) from 2011 through 2016 for New York adults (n = 76,186). We analyzed the self-reported prevalence of individuals having 0, 1, 2, or ≥ 3 chronic conditions by sex, race/ethnicity, age, health insurance type, annual household income, and whether respondents lived in New York City. We also examined the most common condition dyads and triads. Finally, we assessed the prevalence of MCC (2 or more chronic conditions) by county across New York State, and neighborhood within New York City. Results During 2011–2016, 25.2% of adults in New York State had zero chronic conditions, 24.1% had 1 condition, 18.4% had 2 conditions, and 32.4% had 3 or more. The most prevalent dyad was hypertension and high cholesterol in 17.0% of individuals. The most prevalent triad was hypertension, high cholesterol, and arthritis in 4.5% of individuals. County prevalence of MCC ranged from 42.6% in Westchester County to 66.1% in Oneida County. The prevalence of MCC in New York City neighborhoods ranged from 33.5% in Gramercy Park—Murray Hill to 60.6% in High Bridge—Morrisania. Conclusion This research contributes to the field’s understanding of multiple chronic conditions and allows policy and public health leaders in New York to better understand the prevalence and distribution of MCC.
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Affiliation(s)
- Daniel Newman
- Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- * E-mail:
| | - Erica Levine
- Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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14
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Heller DJ, Kishore SP. Impacting Global Health Delivery Through Advocacy: The Case of Losartan. Glob Heart 2018; 14:95-96. [PMID: 30584029 DOI: 10.1016/j.gheart.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/07/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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DiPette DJ, Skeete J, Ridley E, Campbell NRC, Lopez-Jaramillo P, Kishore SP, Jaffe MG, Coca A, Townsend RR, Ordunez P. Fixed-dose combination pharmacologic therapy to improve hypertension control worldwide: Clinical perspective and policy implications. J Clin Hypertens (Greenwich) 2018; 21:4-15. [PMID: 30480368 DOI: 10.1111/jch.13426] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/15/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Donald J DiPette
- University of South Carolina School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Jamario Skeete
- University of South Carolina School of Medicine, University of South Carolina, Columbia, South Carolina.,Palmetto Health, Columbia, South Carolina
| | | | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Patricio Lopez-Jaramillo
- FOSCAL, UDES, Bucaramanga, Colombia.,Eugenio Espejo Medical Sciences Faculty, UTE, Quito, Ecuador
| | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Young Professionals Chronic Disease Network, New York, New York
| | - Marc G Jaffe
- Resolve to Save Lives, New York, New York.,Kaiser Permanente South, San Francisco Medical Center South, San Francisco, California
| | | | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, The Pan-American Health Organization, Washington, District of Columbia
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16
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Bennett JE, Stevens GA, Mathers CD, Bonita R, Rehm J, Kruk ME, Riley LM, Dain K, Kengne AP, Chalkidou K, Beagley J, Kishore SP, Chen W, Saxena S, Bettcher DW, Grove JT, Beaglehole R, Ezzati M. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet 2018; 392:1072-1088. [PMID: 30264707 DOI: 10.1016/s0140-6736(18)31992-5] [Citation(s) in RCA: 588] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/14/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022]
Abstract
The third UN High-Level Meeting on Non-Communicable Diseases (NCDs) on Sept 27, 2018, will review national and global progress towards the prevention and control of NCDs, and provide an opportunity to renew, reinforce, and enhance commitments to reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim. In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs. Of these, an estimated 1·7 million (4% of NCD deaths) occurred in people younger than 30 years of age, 15·2 million (38%) in people aged between 30 years and 70 years, and 23·6 million (58%) in people aged 70 years and older. An estimated 32·2 million NCD deaths (80%) were due to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes, and another 8·3 million (20%) were from other NCDs. Women in 164 (88%) and men in 165 (89%) of 186 countries and territories had a higher probability of dying before 70 years of age from an NCD than from communicable, maternal, perinatal, and nutritional conditions combined. Globally, the lowest risks of NCD mortality in 2016 were seen in high-income countries in Asia-Pacific, western Europe, and Australasia, and in Canada. The highest risks of dying from NCDs were observed in low-income and middle-income countries, especially in sub-Saharan Africa, and, for men, in central Asia and eastern Europe. Sustainable Development Goal (SDG) target 3.4-a one-third reduction, relative to 2015 levels, in the probability of dying between 30 years and 70 years of age from cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes by 2030-will be achieved in 35 countries (19%) for women, and 30 (16%) for men, if these countries maintain or surpass their 2010-2016 rate of decline in NCD mortality. Most of these are high-income countries with already-low NCD mortality, and countries in central and eastern Europe. An additional 50 (27%) countries for women and 35 (19%) for men are projected to achieve such a reduction in the subsequent decade, and thus, with slight acceleration of decline, could meet the 2030 target. 86 (46%) countries for women and 97 (52%) for men need implementation of policies that substantially increase the rates of decline. Mortality from the four NCDs included in SDG target 3.4 has stagnated or increased since 2010 among women in 15 (8%) countries and men in 24 (13%) countries. NCDs and age groups other than those included in the SDG target 3.4 are responsible for a higher risk of death in low-income and middle-income countries than in high-income countries. Substantial reduction of NCD mortality requires policies that considerably reduce tobacco and alcohol use and blood pressure, and equitable access to efficacious and high-quality preventive and curative care for acute and chronic NCDs.
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17
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Affiliation(s)
- Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai Health System and Young Professionals Chronic Disease Network, New York.
| | - Abdul Salam
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Marc G Jaffe
- Resolve To Save Lives, New York, NY, USA; Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA
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18
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Hajat C, Kishore SP. The case for a global focus on multiple chronic conditions. BMJ Glob Health 2018; 3:e000874. [PMID: 29989034 PMCID: PMC6035500 DOI: 10.1136/bmjgh-2018-000874] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cother Hajat
- Public Health Institute, UAE University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine, Mount Sinai Health System, New York City, New York, USA
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19
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Affiliation(s)
- Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai Health System, 1216 Fifth Avenue, Room 562, New York, New York 10029, United States of America (USA)
| | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai Health System, 1216 Fifth Avenue, Room 562, New York, New York 10029, United States of America (USA)
| | - Ashwin Vasan
- Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, USA
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20
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Heller DJ, Kishore SP. Closing the blood pressure gap: an affordable proposal to save lives worldwide. BMJ Glob Health 2017; 2:e000429. [PMID: 29018587 PMCID: PMC5623261 DOI: 10.1136/bmjgh-2017-000429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/01/2017] [Accepted: 08/24/2017] [Indexed: 11/03/2022] Open
Affiliation(s)
- David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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21
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22
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Salwan J, Kishore SP. Breaking Silence, Breaking Stigma. NAM Perspect 2017. [DOI: 10.31478/201707a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Marks VA, Latham SR, Kishore SP. On Essentiality and the World Health Organization's Model List of
Essential Medicines. Ann Glob Health 2017; 83:637-640. [DOI: 10.1016/j.aogh.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Coffey DS, Elliot K, Goldblatt E, Grus C, Kishore SP, Mancini ME, Valachovic R, Walker PH. A Multifaceted Systems Approach to Addressing Stress Within Health Professions Education and Beyond. NAM Perspect 2017. [DOI: 10.31478/201701e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Siddharthan T, Ramaiya K, Yonga G, Mutungi GN, Rabin TL, List JM, Kishore SP, Schwartz JI. Noncommunicable Diseases In East Africa: Assessing The Gaps In Care And Identifying Opportunities For Improvement. Health Aff (Millwood) 2017; 34:1506-13. [PMID: 26355052 DOI: 10.1377/hlthaff.2015.0382] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prevalence of noncommunicable diseases in East Africa is rising rapidly. Although the epidemiologic, demographic, and nutritional transitions are well under way in low-income countries, investment and attention in these countries remain focused largely on communicable diseases. We discuss existing infrastructure in communicable disease management as well as linkages between noncommunicable and communicable diseases in East Africa. We describe gaps in noncommunicable disease management within the health systems in this region. We also discuss deficiencies in addressing noncommunicable diseases from basic science research and medical training to health services delivery, public health initiatives, and access to essential medications in East Africa. Finally, we highlight the role of collaboration among East African governments and civil society in addressing noncommunicable diseases, and we advocate for a robust primary health care system that focuses on the social determinants of health.
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Affiliation(s)
- Trishul Siddharthan
- Trishul Siddharthan is a Fogarty Global Health Fellow in Kampala, Uganda, and a fellow in the Department of Pulmonary and Critical Care at the Johns Hopkins University, in Baltimore, Maryland
| | - Kaushik Ramaiya
- Kaushik Ramaiya is a lecturer at Muhimbili University of Health and Allied Sciences, in Dar es Salaam, Tanzania
| | - Gerald Yonga
- Gerald Yonga is head of the NCD Research to Policy Unit in the Department of Internal Medicine at Aga Khan University, in Nairobi, Kenya
| | - Gerald N Mutungi
- Gerald N. Mutungi is the head of the Noncommunicable Diseases Prevention and Control Program at the Ministry of Health, in Kampala, Uganda
| | - Tracy L Rabin
- Tracy L. Rabin is an assistant professor in the Department of Internal Medicine at the Yale School of Medicine, in New Haven, Connecticut
| | - Justin M List
- Justin M. List is a Robert Wood Johnson Foundation/VA Clinical Scholar and clinical lecturer in the Department of Internal Medicine at the University of Michigan, in Ann Arbor
| | - Sandeep P Kishore
- Sandeep P. Kishore is a fellow in the Human Nature Lab at Yale University
| | - Jeremy I Schwartz
- Jeremy I. Schwartz is an assistant professor in the Department of Internal Medicine at the Yale School of Medicine
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26
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Kishore SP, Kolappa K, Jarvis JD, Park PH, Belt R, Balasubramaniam T, Kiddell-Monroe R. Overcoming Obstacles To Enable Access To Medicines For Noncommunicable Diseases In Poor Countries. Health Aff (Millwood) 2017; 34:1569-77. [PMID: 26355060 DOI: 10.1377/hlthaff.2015.0375] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The modern access-to-medicines movement grew largely out of the civil-society reaction to the HIV/AIDS pandemic three decades ago. While the movement was successful with regard to HIV/AIDS medications, the increasingly urgent challenge to address access to medicines for noncommunicable diseases has lagged behind-and, in some cases, has been forgotten. In this article we first ask what causes the access gap with respect to lifesaving essential noncommunicable disease medicines and then what can be done to close the gap. Using the example of the push for access to antiretrovirals for HIV/AIDS patients for comparison, we highlight the problems of inadequate global financing and procurement for noncommunicable disease medications, intellectual property barriers and concerns raised by the pharmaceutical industry, and challenges to building stronger civil-society organizations and a patient and humanitarian response from the bottom up to demand treatment. We provide targeted policy recommendations, specific to the public sector, the private sector, and civil society, with the goal of improving access to noncommunicable disease medications globally.
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Affiliation(s)
- Sandeep P Kishore
- Sandeep P. Kishore is a fellow at Yale University, in New Haven, Connecticut, and president of the Young Professionals Chronic Disease Network, in Boston, Massachusetts
| | - Kavitha Kolappa
- Kavitha Kolappa is a resident in psychiatry at Massachusetts General Hospital, in Boston, a and board member for the Young Professionals Chronic Disease Network
| | - Jordan D Jarvis
- Jordan D. Jarvis is executive director of the Young Professionals Chronic Disease Network and a former postgraduate research fellow at the Harvard Global Equity Initiative, in Boston
| | - Paul H Park
- Paul H. Park is director of noncommunicable diseases for Partners in Health-Rwanda and a member of Universities Allied for Essential Medicines, in Washington, D.C
| | - Rachel Belt
- Rachel Belt is a member of Universities Allied for Essential Medicines
| | | | - Rachel Kiddell-Monroe
- Rachel Kiddell-Monroe is a special adviser for the Universities Allied for Essential Medicines, a board member for the Young Professionals Chronic Disease Network, and a member of the International Board for Médecins sans Frontières, in Geneva
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27
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Jarvis JD, Obscherning E, Siegel K, Kishore SP. A Global Social Network to Catalyze Solutions for Chronic NCD: A Case Study on the Young Professionals Chronic Disease Network. Glob Heart 2016; 11:463-465. [PMID: 27938843 DOI: 10.1016/j.gheart.2016.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jordan D Jarvis
- Young Professionals Chronic Disease Network, Boston, MA, USA.
| | | | - Karen Siegel
- Young Professionals Chronic Disease Network, Boston, MA, USA; Nutrition and Health Sciences Program, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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28
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Ruchman SG, Kishore SP, Singh P. A Platform to Accelerate Global Reductions in Chronic Diseases: Toward Action. Glob Heart 2016; 11:421-423. [PMID: 27938830 DOI: 10.1016/j.gheart.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Samuel G Ruchman
- Office of the UN Secretary-General's Special Envoy for Health in Agenda 2030 and for Malaria, New York, NY, USA
| | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Health System Design and Global Health, Mount Sinai Health System, New York, NY, USA
| | - Prabhjot Singh
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Health System Design and Global Health, Mount Sinai Health System, New York, NY, USA; Peterson Center on Healthcare, New York, NY, USA.
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29
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30
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Jaacks LM, Ali MK, Bartlett J, Bloomfield GS, Checkley W, Gaziano TA, Heimburger DC, Kishore SP, Kohler RE, Lipska KJ, Manders O, Ngaruiya C, Peck R, Pena MB, Watkins DA, Siegel KR, Narayan KV. Global Noncommunicable Disease Research: Opportunities and Challenges. Ann Intern Med 2015; 163:712-4. [PMID: 26301624 PMCID: PMC4850027 DOI: 10.7326/m15-1068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Lindsay M. Jaacks
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Mohammed K. Ali
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - John Bartlett
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Gerald S. Bloomfield
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - William Checkley
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Thomas A. Gaziano
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Douglas C. Heimburger
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Sandeep P. Kishore
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Racquel E. Kohler
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Kasia J. Lipska
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Olivia Manders
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Christine Ngaruiya
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Robert Peck
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Melissa Burroughs Pena
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - David A. Watkins
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - Karen R. Siegel
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
| | - K.M. Venkat Narayan
- From Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina; School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Brigham and Women's Hospital and Young Professionals Chronic Disease Network, Boston, Massachusetts; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Yale School of Medicine, New Haven, Connecticut; University of North Carolina, Chapel Hill, North Carolina; Center for Global Health, Weill Cornell Medical College, New York, New York; and University of Washington, Seattle, Washington
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Kishore SP, Belt R, Park PH. Noncommunicable Diseases: The Authors Reply. Health Aff (Millwood) 2015; 34:2004. [DOI: 10.1377/hlthaff.2015.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Rachel Belt
- Universities Allied for Essential Medicines Port-au-Prince, Haiti
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Carroll L, Ali MK, Cuff P, Huffman MD, Kelly B, Kishore SP, Narayan KV, Siegel KR, Vedanthan R. Envisioning a transdisciplinary university. J Law Med Ethics 2014; 42 Suppl 2:17-25. [PMID: 25564706 PMCID: PMC5536331 DOI: 10.1111/jlme.12183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Achieving social and economic growth requires collaboration, especially in global health. If universities are to improve health globally, they will need to train students and to support faculty who can effectively collaborate with those from other disciplines and cultures.
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Affiliation(s)
| | - Mohammed K. Ali
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | | | - Mark D. Huffman
- Assistant Professor of Preventive Medicine and Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Sandeep P. Kishore
- Young Professionals Chronic Disease Network, YP-CDN, Boston, MA, Yale University, New Haven, CT
| | | | - Karen R Siegel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY
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Affiliation(s)
- Robert Beaglehole
- 42 Albert Rd, Auckland 0624, New Zealand; University of Auckland, Auckland, New Zealand.
| | - Ruth Bonita
- University of Auckland, Auckland, New Zealand
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Affiliation(s)
- Matthew K Wynia
- American Medical Association, Chicago, Illinois2University of Chicago, Chicago, Illinois
| | - Sandeep P Kishore
- Weill Cornell Medical College, Rockefeller University, and Sloan-Kettering Institute and Young Professionals Chronic Disease Network, New York, New York
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Ukaegbu UE, Kishore SP, Kwiatkowski DL, Pandarinath C, Dahan-Pasternak N, Dzikowski R, Deitsch KW. Recruitment of PfSET2 by RNA polymerase II to variant antigen encoding loci contributes to antigenic variation in P. falciparum. PLoS Pathog 2014; 10:e1003854. [PMID: 24391504 PMCID: PMC3879369 DOI: 10.1371/journal.ppat.1003854] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/12/2013] [Indexed: 11/18/2022] Open
Abstract
Histone modifications are important regulators of gene expression in all eukaryotes. In Plasmodium falciparum, these epigenetic marks regulate expression of genes involved in several aspects of host-parasite interactions, including antigenic variation. While the identities and genomic positions of many histone modifications have now been cataloged, how they are targeted to defined genomic regions remains poorly understood. For example, how variant antigen encoding loci (var) are targeted for deposition of unique histone marks is a mystery that continues to perplex the field. Here we describe the recruitment of an ortholog of the histone modifier SET2 to var genes through direct interactions with the C-terminal domain (CTD) of RNA polymerase II. In higher eukaryotes, SET2 is a histone methyltransferase recruited by RNA pol II during mRNA transcription; however, the ortholog in P. falciparum (PfSET2) has an atypical architecture and its role in regulating transcription is unknown. Here we show that PfSET2 binds to the unphosphorylated form of the CTD, a property inconsistent with its recruitment during mRNA synthesis. Further, we show that H3K36me3, the epigenetic mark deposited by PfSET2, is enriched at both active and silent var gene loci, providing additional evidence that its recruitment is not associated with mRNA production. Over-expression of a dominant negative form of PfSET2 designed to disrupt binding to RNA pol II induced rapid var gene expression switching, confirming both the importance of PfSET2 in var gene regulation and a role for RNA pol II in its recruitment. RNA pol II is known to transcribe non-coding RNAs from both active and silent var genes, providing a possible mechanism by which it could recruit PfSET2 to var loci. This work unifies previous reports of histone modifications, the production of ncRNAs, and the promoter activity of var introns into a mechanism that contributes to antigenic variation by malaria parasites. Chemical modifications to histones, the proteins that serve as the primary units of chromatin, often determine whether specific genes are actively transcribed or condensed into transcriptionally silent regions of the genome. In the malaria parasite Plasmodium falciparum, histone modifications have been shown to play a significant role in controlling gene expression involved in many aspects of their lifecycle, including the complex gene expression patterns associated with antigenic variation. The various histone modifications that are found within the parasite's genome have now been extensively cataloged, and the enzymes that are responsible for adding and removing them have been identified. However, how these enzymes are recruited to specific regions of the genome to coordinate gene expression is not understood. In this paper, we provide the first evidence for recruitment of a unique histone methyltransferase to specific regions of the genome through its tethering to RNA polymerase II. We find that disruption of this interaction results in major changes in expression patterns of genes involved in antigenic variation, demonstrating the importance of regulated recruitment of histone modifiers for parasite biology.
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Affiliation(s)
- Uchechi E Ukaegbu
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Sandeep P Kishore
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Dacia L Kwiatkowski
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Chethan Pandarinath
- Program in Computational Biology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Noa Dahan-Pasternak
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research Israel-Canada, The Kuvin Center for the Study of Infectious and Tropical Diseases, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ron Dzikowski
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research Israel-Canada, The Kuvin Center for the Study of Infectious and Tropical Diseases, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Kirk W Deitsch
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
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Matheka DM, Nderitu J, Vedanthan R, Demaio AR, Murgor M, Kajana K, Loyal P, Alkizim FO, Kishore SP. Young professionals for health development: the Kenyan experience in combating non-communicable diseases. Glob Health Action 2013; 6:22461. [PMID: 24262308 PMCID: PMC3837302 DOI: 10.3402/gha.v6i0.22461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 11/14/2022] Open
Abstract
Young individuals (below 35 years) comprise an estimated 60% of the global population. Not only are these individuals currently experiencing chronic, non-communicable diseases (NCDs), either living with or at risk for these conditions, but will also experience the long-term repercussions of the current NCD policy implementations. It is thus imperative that they meaningfully contribute to the global discourse and responses for NCDs at the local level. Here, we profile one example of meaningful engagement: the Young Professionals Chronic Disease Network (YPCDN). The YPCDN is a global online network that provides a platform for young professionals to deliberate new and innovative methods of approaching the NCD challenges facing our societies. We provide a case study of the 2-year experiences of a country chapter (Kenya) of the YPCDN to demonstrate the significance and impact of emerging leaders in addressing the new global health agenda of the 21st century.
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Affiliation(s)
- Duncan M Matheka
- Department of Medical Physiology, School of Medicine, University of Nairobi, Nairobi, Kenya; Young Professionals Chronic Disease Network, Boston, MA, USA;
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Hogerzeil HV, Liberman J, Wirtz VJ, Kishore SP, Selvaraj S, Kiddell-Monroe R, Mwangi-Powell FN, von Schoen-Angerer T. Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration. Lancet 2013; 381:680-9. [PMID: 23410612 DOI: 10.1016/s0140-6736(12)62128-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Access to medicines and vaccines to prevent and treat non-communicable diseases (NCDs) is unacceptably low worldwide. In the 2011 UN political declaration on the prevention and control of NCDs, heads of government made several commitments related to access to essential medicines, technologies, and vaccines for such diseases. 30 years of experience with policies for essential medicines and 10 years of scaling up of HIV treatment have provided the knowledge needed to address barriers to long-term effective treatment and prevention of NCDs. More medicines can be acquired within existing budgets with efficient selection, procurement, and use of generic medicines. Furthermore, low-income and middle-income countries need to increase mobilisation of domestic resources to cater for the many patients with NCDs who do not have access to treatment. Existing initiatives for HIV treatment offer useful lessons that can enhance access to pharmaceutical management of NCDs and improve adherence to long-term treatment of chronic illness; policy makers should also address unacceptable inequities in access to controlled opioid analgesics. In addition to off-patent medicines, governments can promote access to new and future on-patent medicinal products through coherent and equitable health and trade policies, particularly those for intellectual property. Frequent conflicts of interest need to be identified and managed, and indicators and targets for access to NCD medicines should be used to monitor progress. Only with these approaches can a difference be made to the lives of hundreds of millions of current and future patients with NCDs.
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Affiliation(s)
- Hans V Hogerzeil
- Department of Global Health, University of Groningen, University Medical Centre, Groningen, Netherlands.
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Kishore SP, Stiller JW, Deitsch KW. Horizontal gene transfer of epigenetic machinery and evolution of parasitism in the malaria parasite Plasmodium falciparum and other apicomplexans. BMC Evol Biol 2013; 13:37. [PMID: 23398820 PMCID: PMC3598677 DOI: 10.1186/1471-2148-13-37] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 02/05/2013] [Indexed: 12/14/2022] Open
Abstract
Background The acquisition of complex transcriptional regulatory abilities and epigenetic machinery facilitated the transition of the ancestor of apicomplexans from a free-living organism to an obligate parasite. The ability to control sophisticated gene expression patterns enabled these ancient organisms to evolve several differentiated forms, invade multiple hosts and evade host immunity. How these abilities were acquired remains an outstanding question in protistan biology. Results In this work, we study SET domain bearing genes that are implicated in mediating immune evasion, invasion and cytoadhesion pathways of modern apicomplexans, including malaria parasites. We provide the first conclusive evidence of a horizontal gene transfer of a Histone H4 Lysine 20 (H4K20) modifier, Set8, from an animal host to the ancestor of apicomplexans. Set8 is known to contribute to the coordinated expression of genes involved in immune evasion in modern apicomplexans. We also show the likely transfer of a H3K36 methyltransferase (Ashr3 from plants), possibly derived from algal endosymbionts. These transfers appear to date to the transition from free-living organisms to parasitism and coincide with the proposed horizontal acquisition of cytoadhesion domains, the O-glycosyltransferase that modifies these domains, and the primary family of transcription factors found in apicomplexan parasites. Notably, phylogenetic support for these conclusions is robust and the genes clearly are dissimilar to SET sequences found in the closely related parasite Perkinsus marinus, and in ciliates, the nearest free-living organisms with complete genome sequences available. Conclusions Animal and plant sources of epigenetic machinery provide new insights into the evolution of parasitism in apicomplexans. Along with the horizontal transfer of cytoadhesive domains, O-linked glycosylation and key transcription factors, the acquisition of SET domain methyltransferases marks a key transitional event in the evolution to parasitism in this important protozoan lineage.
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Affiliation(s)
- Sandeep P Kishore
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY 10065, USA
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Francis ER, Goodsmith N, Michelow M, Kulkarni A, McKenney AS, Kishore SP, Bertelsen N, Fein O, Balsari S, Lemery J, Fitzgerald D, Johnson W, Finkel ML. The global health curriculum of Weill Cornell Medical College: how one school developed a global health program. Acad Med 2012; 87:1296-302. [PMID: 22929431 PMCID: PMC8052981 DOI: 10.1097/acm.0b013e3182628edb] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Since 2009, a multidisciplinary team at Weill Cornell Medical College (WCMC) has collaborated to create a comprehensive, elective global health curriculum (GHC) for medical students. Increasing student interest sparked the development of this program, which has grown from ad hoc lectures and dispersed international electives into a comprehensive four-year elective pathway with over 100 hours of training, including three courses, two international experiences, a preceptorship with a clinician working with underserved populations in New York City, and regular lectures and seminars by visiting global health leaders. Student and administrative enthusiasm has been strong: In academic years 2009, 2010, and 2011, over half of the first-year students (173 of 311)participated in some aspect of the GHC, and 18% (55 of 311) completed all first-year program requirements.The authors cite the student-driven nature of GHC as a major factor in its success and rapid growth. Also important was the foundation previously established by WCMC global health faculty, the serendipitous timing of the GHC's development in the midst of curricular reform and review, as well as the presence of a full-time, nonclinical Global Health Fellow who served as a program coordinator. Given the enormous expansion of medical student interest in global health training throughout the United States and Canada over the past decade, the authors hope that medical schools developing similar programs will find the experience at Weill Cornell informative and helpful.
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Kishore SP, Siegel KR, Ahmad A, Aitsi-Selmi AA, Ali MK, Baker P, Basu S, Bitton A, Bloomfield GS, Bukhman G, Emery E, Feigl AB, Grepin K, Huffman MD, Kajana K, Khandelwal S, Kolappa K, Liu C, Lokhandwala N, Marwah V, Mwatsama M, Novak N, Nundy S, Park PH, Perez CP, Price MR, Rapkin N, Rice H, Seligman B, Shah S, Silva JD, Sridhar D, Stuckler D, Vedanthan R, Zaman J. Youth manifesto on non-communicable diseases. Glob Heart 2011; 6:201-10. [PMID: 25691046 DOI: 10.1016/j.gheart.2011.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Sanjay Basu
- University of California San Francisco, San Francisco, CA, USA
| | - Asaf Bitton
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Gene Bukhman
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | - Andrea B Feigl
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Chenhui Liu
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | | | - Paul H Park
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | | | - Nikka Rapkin
- International Cardiovascular Health Alliance, San Francisco, CA, USA
| | | | - Ben Seligman
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Joao da Silva
- University of California San Francisco, San Francisco, CA, USA
| | - Devi Sridhar
- Fogarty International Clinical Research Scholar, Lima, Peru
| | - David Stuckler
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | - Justin Zaman
- University College London, London, UK; The George Institute for Global Health, Sydney, Australia
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Huffman MD, Siegel KR, Kishore SP, Bitton A. Regarding the prevention of global chronic disease: academic public health's new frontier. Am J Public Health 2011; 101:2196-7. [PMID: 22021284 DOI: 10.2105/ajph.2011.300400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Finch TH, Chae SR, Shafaee MN, Siegel KR, Ali MK, Tomei R, Panjabi R, Kishore SP. Role of students in global health delivery. ACTA ACUST UNITED AC 2011; 78:373-81. [PMID: 21598264 DOI: 10.1002/msj.20254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
What role do students have in global health activities? On one hand, students have much to offer, including innovative ideas, fresh knowledge and perspective, and inspiring energy. At the same time, students lack technical credentials and may drain resources from host communities. Here, we examine the dynamic, contemporary roles of students in global health activities, including health delivery. We focus on 3 themes that guide engagement: (1) fostering an enabling policy environment (eg, toward greater health equity); (2) understanding and working within the local context and governments' needs; and (3) leading bidirectional partnerships. We next study the implications of short-term exposure and long-term engagement programs. We conclude with 4 recommendations on how to better equip students to engage in the next frontier of global health education and future action.
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Kishore SP, Vedanthan R, Fuster V. Promoting global cardiovascular health ensuring access to essential cardiovascular medicines in low- and middle-income countries. J Am Coll Cardiol 2011; 57:1980-7. [PMID: 21565635 DOI: 10.1016/j.jacc.2010.12.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/08/2010] [Accepted: 12/21/2010] [Indexed: 11/18/2022]
Abstract
On May 13, 2010, a resolution passed at the United Nations for a high-level meeting with heads of state on noncommunicable chronic diseases (NCDs), catapulting NCDs atop the political and health agendas. This meeting on NCDs, slated for September 2011, provides the rare political moment to commit to scaling up international, regional, and national efforts to prevent and treat NCDs, giving the issue the priority it deserves. An analogous high-profile meeting transpired in 2001 on human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), effectively serving as the nucleating event for a vigorous global and political movement towards universal prevention and treatment. As was the case at the HIV/AIDS meeting, a key priority area in the new NCD movement remains ensuring universal access to reliable, affordable essential medicines to prevent and treat NCDs. The upcoming meeting, therefore, provides the perfect opportunity to capitalize on the increased political and social awareness of NCDs and to apply the lessons learned from the HIV/antiretroviral experience in order to improve access to essential medicines for NCDs. Social mobilization and political advocacy, used in tandem with technical solutions, is an important lesson from the HIV experience, and will likely be important to ensure access to essential medicines for NCDs, including cardiovascular disease. Here, we use cardiovascular disease as a specific case study to examine the issue, outlining early solutions while drawing parallels and analogies to the HIV experience.
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Affiliation(s)
- Sandeep P Kishore
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, New York, USA.
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Siegel KR, Feigl AB, Kishore SP, Stuckler D. Misalignment between perceptions and actual global burden of disease: evidence from the US population. Glob Health Action 2011; 4:GHA-4-6339. [PMID: 21562634 PMCID: PMC3092698 DOI: 10.3402/gha.v4i0.6339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/03/2011] [Accepted: 04/06/2011] [Indexed: 11/14/2022] Open
Abstract
Significant funding of health programs in low-income countries comes from external sources, mainly private donors and national development agencies of high-income countries. How these external funds are allocated remains a subject of ongoing debate, as studies have revealed that external funding may misalign with the underlying disease burden. One determinant of the priorities set by both private donors and development agencies is the perceptions of populations living in high-income countries about which diseases are legitimate for global health intervention. While research has been conducted on the priorities expressed by recipient communities, relatively less has been done to assess those of the donating country. To investigate people's beliefs about the disease burden in high-income countries, we compared publicly available data from U.S. surveys of people's perceptions of the leading causes of death in developing countries against measures of the actual disease burden from the World Health Organization. We found little correlation between the U.S. public's perception and the actual disease burden, measured as either mortality or disability-adjusted life years. While there is potential for reverse causality, so that donor programs drive public perceptions, these findings suggest that increasing the general population's awareness of the true global disease burden could help better align global health funding with population health needs.
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Affiliation(s)
- Karen R Siegel
- Laney Graduate School and Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Kishore SP, Bitton A, Cravioto A, Yach D. Enabling access to new WHO essential medicines: the case for nicotine replacement therapies. Global Health 2010; 6:22. [PMID: 21092092 PMCID: PMC2994846 DOI: 10.1186/1744-8603-6-22] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 11/19/2010] [Indexed: 11/30/2022] Open
Abstract
Nicotine replacement therapies (NRT) are powerful tools for the successful treatment of nicotine addiction and tobacco use. The medicines are clinically effective, supported by the Framework Convention on Tobacco Control, and are now World Health Organization-approved essential medicines. Enabling global access to NRT remains a challenge given ongoing confusion and misperceptions about their efficacy, cost-effectiveness, and availability with respect to other tobacco control and public health opportunities. In this commentary, we review existing evidence and guidelines to make the case for global access to NRT highlighting the smoker's right to access treatment to sensibly address nicotine addiction.
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Affiliation(s)
- Sandeep P Kishore
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, New York, USA.
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Chen CE, Gilliland CT, Purcell J, Kishore SP. The silent epidemic of exclusive university licensing policies on compounds for neglected diseases and beyond. PLoS Negl Trop Dis 2010; 4:e570. [PMID: 20361025 PMCID: PMC2846921 DOI: 10.1371/journal.pntd.0000570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Connie E Chen
- School of Medicine, University of California-San Francisco, CA, USA
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Affiliation(s)
- Sandeep P. Kishore
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, United States of America
- * E-mail: (SPK); (PJH)
| | - Gloria Tavera
- Instituto Nacional de Salud Pública, Santa María Ahuacatitlan, Cuernavaca, Morelos, Mexico
| | - Peter J. Hotez
- Sabin Vaccine Institute and Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, D.C., United States of America
- * E-mail: (SPK); (PJH)
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Kishore SP, Perkins SL, Templeton TJ, Deitsch KW. An unusual recent expansion of the C-terminal domain of RNA polymerase II in primate malaria parasites features a motif otherwise found only in mammalian polymerases. J Mol Evol 2009; 68:706-14. [PMID: 19449052 DOI: 10.1007/s00239-009-9245-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 04/22/2009] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
Abstract
The tail of the enzyme RNA polymerase II is responsible for integrating the diverse events of gene expression in eukaryotes and is indispensable for life in yeast, fruit flies, and mice. The tail features a C-terminal domain (CTD), which is comprised of tandemly repeated Y(1)-S(2)-P(3)-T(4)-S(5)-P(6)-S(7) amino acid heptads that are highly conserved across evolutionary lineages, with all mammalian polymerases featuring 52 identical heptad repeats. However, the composition and function of protozoan CTDs remain less well understood. We find that malaria parasites (genus Plasmodium) display an unprecedented plasticity within the length and composition of their CTDs. The CTD in malaria parasites which infect human and nonhuman primates has expanded compared to closely related species that infect rodents or birds. In addition, this variability extends to different isolates within a single species, such as isolates of the human malaria parasite, Plasmodium falciparum. Our results indicate that expanded CTD heptads in malaria parasites correlates with parasitism of primates and provide the first demonstration of polymorphism of the RNA polymerase II CTD within a single species. The expanded set of CTD heptads feature lysine in the seventh position (Y(1)-S(2)-P(3)-T(4)-S(5)-P(6)-K(7)), a sequence only seen otherwise in the distal portion of mammalian polymerases. These observations raise new questions for the radiation of malaria parasites into diverse hosts and for the molecular evolution of RNA polymerase II.
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Affiliation(s)
- Sandeep P Kishore
- Department of Microbiology and Immunology, Weill Cornell Medical College, 1300 York Avenue, Box 62, New York, NY 10021, USA
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Abstract
The authors propose that innovative student-led campaigns to address neglected diseases can and do make a practical difference.
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Affiliation(s)
- Sandeep P Kishore
- Weill Cornell Medical College/Rockefeller University/Memorial Sloan-Kettering Cancer Center Tri-Institutional Medical Scientist Training Program, New York, New York, United States of America.
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