Search Results (347)

Emerging contaminants (ECs) are a diversely mounting group of chemicals and biological compounds found in air, water, and soil, which include pharmaceuticals, personal care products, per- and poly-fluoroalkyl substances (PFASs), microplastics, endocrine-disrupting chemicals, and various other industrial compounds. Unlike conventional pollutants, ECs are usually unregulated, found in very small amounts, and can persist and build up in living organisms, resulting in toxic risks for both ecosystems and human health. These contaminants originate from various anthropogenic activities and enter the environment through wastewater, stormwater, landfill leaching, and atmospheric deposition. This article documents a holistic literature review of ECs available from the last five years, covering classification, sources and pathways of contamination, and environmental behavior, while assessing their ecological, human health, and socioeconomic impacts. Advances in detection, including high-resolution mass spectrometry, non-target screening, real-time sensors, and AI-assisted monitoring, are addressed. Management strategies including advanced oxidation, membrane filtration, electrochemical treatments, and nature-based solutions are explored. It also analyses global and regional policy frameworks, highlighting regulatory gaps and the need for standardized monitoring. The study emphasizes integrated, multidisciplinary approaches combining scientific innovation, sustainable chemical design, predictive modeling, and public engagement. Synergizing technology, governance, and prevention could reduce the risks related to ECs and protect the environment. The novel contribution is an end-to-end, decision-oriented synthesis that links what monitoring can reliably infer to be feasible, integrated control strategies and sustainability outcomes, supporting risk-based prioritization, targeted pollution treatment, and prevention-focused management. Full article

Household medication hoarding is an emerging public and environmental health concern linked to inadequate pharmaceutical waste management and the lack of ecopharmacovigilance programs. This study analyzed the reasons for medication accumulation and associated environmental health risks in urban Mexico using synthetic indicators and risk assessment tools. A cross-sectional survey was conducted in 633 households, and indicators such as the household hoarding index, informal circulation index, and environmental risk index (ERI) were calculated. Multivariate analysis (NMDS) and risk matrices were applied to identify priority therapeutic groups. Results showed that 83.1% of households (95% CI: 79.6–86.0) accumulated medications, with 72.6% engaging in informal circulation practices. Antibiotics, antidiabetics, and antihypertensives accounted for over 70% of the estimated environmental risk, with antibiotics presenting the highest ERI (0.17). Continuous prescriptions and leftover treatments were the main hoarding reasons. It is concluded that pharmaceutical hoarding represents a critical challenge for sustainable waste management and ecopharmacovigilance. The combined use of synthetic indicators and risk matrices enables evidence-based prioritization for public policies, community education, and environmentally sound pharmaceutical disposal programs. Full article

Ensuring uninterrupted access to essential medicines in public healthcare systems is a persistent challenge with clinical, economic, and environmental implications. Oncology services are particularly vulnerable to stockouts, which compromise therapeutic continuity and increase reliance on urgent procurement with high carbon and waste footprints. This study proposes a risk-informed, data-driven framework for pharmaceutical inventory governance in a high-complexity public oncology hospital in Chile, aligning with sustainability goals and green supply chain principles. Using operational data from 2023–2024, we integrate descriptive analytics, ABC–XYZ segmentation, and a continuous-review (s, Q) policy extended through a Logistic Risk Index (LRI) that consolidates demand variability, supply performance, and clinical-economic criticality. Empirical analysis reveals strong expenditure concentration in AX/AY segments and significant misalignment between institutional and analytically derived parameters. A Monte Carlo simulation N = 1000 runs per scenario) compares baseline, adjusted, and fully risk-informed policies under stochastic demand and lead-time conditions. Results show that the risk-informed configuration reduces stockout exposure by up to 46%, improves fill rates (93.1% → 96.4%), and shortens replenishment delays, while maintaining total logistic cost stability. Critically, urgent orders decrease from 27.4 to 14.8 per year, avoiding an estimated 630 kg CO₂ emissions and 25 kg of packaging waste annually. These findings demonstrate that resilience, efficiency, and sustainability are not competing objectives but can be jointly achieved through integrated analytics and governance. The proposed approach offers a scalable blueprint for public health systems seeking to transition from reactive inventory management toward anticipatory, transparent, and sustainability-oriented decision-making, contributing to SDG 3 (health and well-being) and SDG 12 (responsible consumption and production). Full article

National legislative frameworks governing prescribing, pricing, reimbursement, and dispensing play a decisive role in shaping access to medicines. This study examines the financial availability of medicines in Bulgaria and North Macedonia through a comparative review of national pharmaceutical legislation, pricing mechanisms, reimbursement models, and digitalisation policies, assessed in relation to European Union standards. The findings indicate that access to medicines in both countries is shaped by the combined effects of multiple regulatory and financial instruments rather than by individual policy measures. Both systems apply strict control of prescribing and dispensing, external reference pricing, and positive reimbursement lists, reflecting alignment with international recommendations. However, significant differences in policy design lead to divergent access outcomes. Bulgaria’s more advanced digitalisation of prescribing and reimbursement, including mandatory electronic prescribing for selected therapeutic groups, enhances regulatory oversight and expenditure control but is associated with higher patient out-of-pocket expenditure, partly due to the application of the standard value-added tax on medicines. In contrast, North Macedonia combines lower taxation with capped patient co-payments, higher regulated pharmacy margins, and fixed pharmacy remuneration per prescription, contributing to improved financial affordability for patients while supporting pharmacy sustainability. Additional instruments, such as the Generics without Co-Payment List, further strengthen patient financial protection. The study provides comparative evidence relevant to pharmaceutical policy reforms and highlights the importance of balanced regulatory approaches that promote affordability, system sustainability, and equitable access to medicines. Full article

High-cost innovative anticancer drugs pose challenges for health systems in balancing timely patient access with long-term financial sustainability. In Thailand, reliance on Health Technology Assessment for reimbursement decisions may delay access, highlighting the potential role of Managed Entry Agreements (MEAs) as complementary policy instruments to manage uncertainty related to price, effectiveness, and use; however, MEA application remains limited and lacks an analytical framework for technique selection. This study used real-world data from Thammasat University Hospital to examine and compare the cost-saving performance of five MEA techniques—discount, free initiation treatment, utilization cap, conditional treatment continuation, and pay-by-result—across six high-cost anticancer drugs representing dominant uncertainty characteristics. Drug procurement costs were modeled over a 24-month horizon from the payer’s perspective, and one-way sensitivity analyses were conducted using ±10% variation in median progression-free survival. Free initiation treatment generated the highest cost savings across uncertainty types, followed by conditional treatment continuation, while utilization cap and discount produced more moderate savings. Pay-by-result demonstrated the lowest cost-saving potential. Sensitivity analyses confirmed the robustness of comparative rankings. Overall, the findings indicate that MEA performance varies according to dominant sources of drug-related uncertainty and support a more structured, context-appropriate approach to MEA selection to strengthen market access and value-based pricing in Thailand. Full article

Terminalia arjuna (Arjun) is a tropical deciduous tree species significantly valued for its pharmaceutical properties for various heart diseases, as well as its economic role in the sericulture industry. However, the growth performance and physiological responses of T. arjuna under water stress conditions remain largely unexplored, particularly in the context of increasing climate variability and the growing challenges posed by climate change. Therefore, this study aimed to examine the morpho-physio-biochemical alterations, nutrient uptake changes, and adaptive strategies under different degrees of water stress with respect to field capacity ($F_{wc}$), maintained at 100% $F_{wc}$ (control), 75% $F_{wc}$ (mild), 50% $F_{wc}$ (moderate), and 25% $F_{wc}$ (severe). Key growth parameters, including shoot and root length, leaf traits and shoot dry biomass, were significantly (p < 0.05) reduced under the given water stresses. Root dry biomass showed a distinct response, increasing under mild to moderate water stress but failing to sustain its levels under severe stress. Increasing drought severity resulted in a substantial reduction in stomatal density (15–37%), while stomatal size increased (18–49%) under mild to moderate stress but decreased under severe stress. These responses were associated with significant reductions in gas exchange traits (45–75%), whereas water use efficiency increased by 59–99%, reflecting a survival-focused adaptive mechanism. Moderate water stress triggered the stress responses in T. arjuna through high proline accumulation and increased oxidative stress markers. The most critical impact was found under the severe stress with a substantial reduction in leaf relative water content and membrane stability index (MSI), although MSI was sustained above the critical threshold, reflecting cellular protection. Increased stress intensity also altered mineral uptake, decreased major nutrients, and increased potassium and calcium content, indicating an adaptive strategy. These findings suggest a threshold effect, where T. arjuna tolerates mild stress well and activates adaptive morpho-physiological mechanisms under moderate stress but shifts to survival-focused strategies under severe stress. The demonstrated tolerance of Terminalia arjuna to mild–moderate drought suggests that climate-resilient forestry policies and conservation programs should prioritize its cultivation and restoration in drought-prone landscapes while ensuring adequate water management to prevent severe stress and sustain its medicinal and economic benefits. Full article

Background: Limitations in timely and equitable access to essential medicines among older adults not only constitute a clinical barrier to the effective management of chronic conditions, but also represent a violation of the fundamental right to life, health and the principles of dignity, equality and non-discrimination that safeguard this population within the framework of human rights. Objective: To examine access to essential medicines for older adults with high-cost chronic conditions as a constitutive dimension of the fundamental rights to health, life and human dignity, in accordance with international human rights standards. Design: A literature review was conducted of articles published between 2020 and March 2025 in five databases, using the search terms: “pharmacological treatment,” “access to health,” “chronic diseases,” and “barriers to access.” After evaluating the inclusion criteria (language and year) and exclusion criteria (case studies), 12 articles were selected. A narrative synthesis was performed on the following aspects: application of the principles of the right to health, barriers to access, and rights violated or at risk. Results: The expansion of health coverage faces several barriers that violate fundamental principles of the right to health: equity, accessibility to medical advances, and long-term, quality, and specialized services, thus limiting autonomy. In conclusion, guaranteeing access to pharmacological treatments in old age will contribute to building more just and humane societies through public policies on coverage and pharmaceutical education, the simplification of treatment regimens, and the implementation of programs that allow people to age with dignity, considering health a human right based on equality and non-discrimination, participation and transparency. Full article

Objectives: This scoping review aimed to map European and Romanian pharmaceutical legislation and policy-related evidence and to examine how legislative harmonization translates into access outcomes in Romania. Eligibility criteria: Legislative documents, institutional reports, market analyses, and peer-reviewed studies addressing pharmaceutical regulation, pricing, reimbursement, and access to medicines (2000–2024). Sources of evidence: EUR-Lex, the Romanian Legislative Portal, PubMed, Scopus, Google Scholar, and institutional sources (European Commission, OECD, WHO, EFPIA, NAMMDR, CNAS). Charting methods: Data were extracted using a standardized charting form and synthesized narratively across thematic domains (regulatory harmonization, pricing and reimbursement, medicine shortages, comparative EU indicators, and health system implications). Results: Fifty sources were included. The mapped evidence consistently identified three dominant patterns: (1) prolonged time-to-availability for centrally authorized medicines, with mean delays exceeding 800 days in Romania compared with approximately 578 days at EU level; (2) limited availability of innovative therapies, particularly in oncology (approximately 20% availability in Romania versus around 50% EU average); and (3) recurrent medicine shortages associated with low-price regulation and parallel export dynamics. Evidence gaps include limited Romania-specific empirical evaluation of the causal effects of individual policy levers (e.g., external reference pricing, reimbursement timelines, clawback mechanisms). Conclusions: Legislative harmonization alone has not ensured equitable or timely access to medicines in Romania. The evidence suggests that national pricing, reimbursement, and supply governance mechanisms mediate the relationship between EU regulation and real-world patient access, highlighting the need for targeted policy reforms and further empirical investigation. Full article

Background: Medicine shortages present a critical challenge for health systems worldwide, impacting patient care and health outcomes. This study investigated healthcare professionals’ perceptions of the impact of medicine shortages in public health facilities of the Eastern Cape, South Africa. Methods: A quantitative, cross-sectional design was employed, using a self-administered questionnaire distributed to 394 healthcare professionals (professional nurses, pharmacists, and medical officers). Results: The findings revealed a strong consensus that shortages negatively affect all stakeholders, with 96.7% of respondents agreeing that they increase provider stress and reduce patient trust. A significant majority also reported that shortages lead to delayed treatment (70.6%) and compromised health outcomes (67%). However, perceptions varied significantly by profession. Pharmacists were significantly more likely than nurses and medical officers to perceive that shortages result in increased out-of-pocket costs for patients, treatment errors, and compromised health outcomes. Conclusions: The study concludes that medicine shortages severely impact patient safety, clinical outcomes, and healthcare providers’ well-being in this setting. The pronounced concerns among pharmacists highlight their strained role in managing the crisis and underscore the urgent need for strengthened pharmaceutical supply chain governance, interprofessional collaboration, and targeted policies to mitigate the effects of shortages and protect patients from financial hardship. Full article

Microplastic (MP) pollution represents a significant environmental threat, impacting aquatic ecosystems and human health. This review examines critical elements of MP risk assessment, including exposure pathways, properties (polymer type, size, and shape), bioaccumulation, and ecological and health effects. It underscores the challenges of quantifying MP exposure and identifying pollutants, as well as gaps in understanding pollutant adsorption/desorption and biofilm impacts. MPs serve as carriers for organic pollutants, heavy metals, and chemical additives, potentially magnifying toxic effects. Emerging contaminants, such as pharmaceuticals, exacerbate these risks. Laboratory research is crucial to trace MPs through food chains from primary producers to humans and assess bioaccumulation and health impacts. Current assessments, however, are insufficient to provide comprehensive ecological risk evaluations. The review highlights the need for improved methodologies to assess MPs’ fate, trophic transfer, and long-term ecological effects. MPs often release harmful additives like plasticizers and flame retardants, necessitating studies to differentiate the impacts of polymers and additives. It emphasizes integrating MP toxicity data into risk models while fostering collaboration among scientists, policymakers, and communities. The paper advocates for a comprehensive framework combining advanced analytical methods and environmental monitoring to refine risk assessment models. These efforts aim to strengthen public awareness, support informed environmental policies, and promote sustainable practices to mitigate MP pollution impacts. Addressing these research gaps will significantly enhance the scientific understanding of MP risks and guide effective management strategies for environmental and human health protection. Full article

Background: Outpatient drug provision is a critical component of primary healthcare systems and a key determinant of treatment continuity, adherence, and equity, yet the effectiveness of publicly funded outpatient drug programs often depends on how policies are implemented at the point of care. This study examined physician awareness, practical experience, and perceived barriers related to outpatient drug provision and drug cost compensation mechanisms in urban primary care settings in Kazakhstan. Methods: A descriptive cross-sectional survey was conducted between September and December 2024 among 380 physicians working in all 33 state-owned urban polyclinics in Almaty, using a structured author-developed questionnaire. Descriptive statistics and Pearson’s chi-square tests were applied to assess associations between physician characteristics and awareness levels. Results: Only 44.0% of physicians confirmed the existence of outpatient drug cost compensation mechanisms in their polyclinics, while 26.0% believed that no such mechanisms existed and 30.0% were unable to provide a definitive answer, indicating that 56.0% lacked accurate awareness. Limited medicine availability and recurrent shortages were frequently reported, with half of physicians advising patients to purchase medicines out of pocket. Physician awareness was significantly associated with professional experience and specialty (p < 0.001). Conclusions: These findings indicate a substantial physician-level implementation gap in outpatient drug provision, suggesting that organizational and informational barriers—rather than insufficient public financing—are the primary drivers, highlighting the need for strengthened governance. Full article

European citizens made it clear in 2024 that healthcare should be the EU’s top priority for shaping the future of Europe. This sentiment reflects the escalating health challenges facing the region, driven by ageing populations, rising chronic disease burdens, and persistent disparities in access to healthcare. Despite these growing needs, the most recent data on health spending as a share of gross domestic product (GDP) is just slightly above the pre-COVID-19 pandemic level, and spending on pharmaceuticals specifically has remained a stable proportion of healthcare spending over the last 20 years. Austerity measures have profoundly impacted the health sector and pharmaceutical industry, more so than any other sectors, despite the wide range of health and socioeconomic benefits medicines bring to patients, the health system, and society. Such trends are not keeping pace with evolving population demographics and disease prevalence. To secure a healthier, more equitable future, Europe must urgently increase health investments, optimise health systems, and address unmet needs by supporting fast uptake of pharmaceutical innovations. Policymakers must work with all stakeholders to ensure stronger and sustained investments in health innovations by (i) adopting a long-term vision, moving away from short-term thinking and valuing health appropriately to drive economic growth; (ii) implementing transformative policies that eliminate ineffective and wasteful spending; (iii) promoting value-based approaches to improve patient access and system sustainability, and (iv) creating incentives that attract greater investments to strengthen Europe’s competitiveness and safeguard against health threats. Full article

To address collaborative decision-making challenges in the pharmaceutical logistics supply chain amid public health emergencies, this study integrates disappointment aversion, delay effects, and pharmaceutical value attenuation, constructing a three-echelon system. It adopts a “differential game-system dynamics (SD)” two-layer dynamic research method for in-depth synergy. The differential game model focuses on multi-agent dynamic strategic interactions, deriving time-series equilibrium solutions for the optimal effort levels, transportation efficiency, and profits under four decision modes (decentralized, government subsidy, cost-sharing, centralized) to clarify the dynamic impact laws of the core parameters. Compensating for its limitations in complex environmental coupling and practical variable integration, the SD model incorporates the patient consumption rate, inventory fluctuations, weather disturbances and other real factors to build a dynamic feedback system. It not only verifies the practical adaptability of the differential game equilibrium solutions but also reveals the evolutionary laws of supply chain performance and the amplified inter-mode performance differences under multi-factor superposition. This study finds that centralized decision-making performs the best in terms of transportation efficiency peaking, profit stability, and attenuation control. Pharmaceutical stability and enterprise effort levels positively drive benefits, while disappointment aversion and excessive delays exert inhibitory effects. Government subsidies need to be paired with collaborative mechanisms to avoid policy dependence. Management implications suggest that enterprises should prioritize the collaborative centralized-decision-making mode, establish risk-sharing and benefit-sharing mechanisms, precisely regulate key variables, and implement gradient subsidies with exit mechanisms to enhance the supply chain’s dynamic adaptability and achieve the triple optimization of “efficiency–profit–stability”. Full article

Respiratory syncytial virus (RSV) resurged in many regions after the relaxation of stringent non-pharmaceutical interventions (NPIs) implemented during the COVID-19 pandemic. Here, we characterized the epidemiological patterns and molecular evolution of RSV among pediatric inpatients with acute respiratory tract infections (ARTIs) on tropical Hainan Island, China. We retrospectively analyzed 32,329 children (≤18 years) hospitalized at Hainan Women and Children’s Medical Center from January 2021 to December 2024. RSV positivity was determined using targeted next-generation sequencing. In total, 4483/32,329 (13.86%) patients were RSV-positive, with a high positivity in 2021 (20.27%, 957/4721), marked suppression in 2022 (2.03%, 106/5227) during intensive NPIs, and a rebound in 2023–2024 (15.31%, 1490/9732; 15.26%, 1930/12,649). RSV positivity was higher in boys than girls (14.42% vs. 13.00%). Seasonality shifted from a summer–autumn peak in 2021 to a spring–summer predominance in 2023–2024. Among 56 sequenced RSV-positive specimens (29 RSV-A; 27 RSV-B), all RSV-A strains belonged to genotype ON1 (lineages A.D.3 and A.D.5.2), and all RSV-B strains belonged to genotype BA9 (lineages B.D.4.1.1, B.D.E.1, and B.D.E.2). Subtype dominance transitioned from RSV-A (2021–2023; mainly A.D.3) to RSV-B in 2024 (all B.D.E.1). Lineage-specific amino-acid and predicted N-glycosylation changes were observed, including loss of the N179 site in A.D.5.2 and acquisition of N258 in B.D.E.1. These findings indicate that RSV circulation on tropical Hainan was strongly suppressed during intensive NPIs and re-established after policy relaxation, accompanied by earlier seasonal activity and clear lineage replacement, underscoring the need for sustained genomic surveillance to inform locally tailored clinical preparedness and immunization strategies. Full article

Background/Objectives: Safe disposal of unused medicines represents an increasing public health and environmental concern. Until 2024, Romanian community pharmacies collected expired medicines from the public, though implementation was inconsistent. Using a knowledge–attitude–practice (KAP) framework, this study assessed community pharmacists’ self-reported involvement in pharmaceutical waste prevention in Bihor County, Romania, one year after new legislation transferred collection responsibilities to hospital-based centers. Methods: A cross-sectional survey was conducted in May 2025 using a self-administered questionnaire comprising 22 items covering socio-demographics, professional practices, knowledge, and attitudes. Eligible participants were community pharmacists (N = 285). Results: Respondents reported high awareness and favourable attitudes toward pharmaceutical waste management: 98.2% indicated awareness of current legislation, 94.4% reported receiving training on the new regulations, 99.6% acknowledged health and environmental risks, and 98.9% expressed agreement that patient education is important. However, 55.4% reported providing disposal information only when patients requested it, while 89.8% indicated that patients rarely asked about medicine disposal. Self-reported proactive counseling increased with patient request frequency (χ²(3) = 7.914, p = 0.048), with pharmacists in the high-request group reporting substantially higher proactive counseling than those in the low-request group (83.3% vs. 42.9%). In an adjusted logistic regression, low request frequency was associated with lower odds of proactive counseling (aOR = 0.21, 95% CI: 0.05–0.98, p = 0.047). Most respondents (94.6%) perceived waste-related responsibilities, though these perceptions were only weakly related to reported counseling behaviors. Conclusions: Pharmacists reported high awareness and positive attitudes toward pharmaceutical waste management, but counseling remained reactive. Patient demand was a key correlate of counseling proactivity, underscoring the need for structured education within Romania’s hospital-based take-back system. Full article