Adopted by the General Assembly of the United Nations in 2015, the Sustainable Development Goals (SDGs) build on the lessons learned from the Millennium Development Goals that had guided development efforts for the preceding 15 years. The World Health Organization (WHO) Western Pacific Region made remarkable progress towards the Millennium Development Goals, but also experienced some challenges and shortcomings. This paper argues that the SDGs incorporate these complexities and aim to capture the many ways in which equitable and robust development is shaped by factors which are linked to each other. The SDGs place greater emphasis on a broader range of determinants of health, including poverty reduction, education, and reducing inequality, thereby reflecting that health influences and is influenced by progress on all goals and targets. Drawing on recent World Health Organization frameworks, the paper suggests options for advancing the SDGs in the Western Pacific. It argues that universal health coverage is core to achieving the SDGs and enacting the principle of leaving no-one behind, and outlines new ways of working within and outside of the health sector as well as appropriate capabilities of the health sector to drive the agenda. The SDGs place renewed demands on Member States and their partners. The strengths of the SDG framework lie in the emphasis on collaboration and joint action to solve shared problems, on collective accountability and the public interest, on tackling the determinants of health, and notably on the primacy of reaching those left furthest behind.
Conservation of Natural Resources* ; Cooperative Behavior ; Education ; Health Equity ; Joints ; Poverty ; Social Responsibility ; Socioeconomic Factors ; United Nations ; World Health Organization

PURPOSE: This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. MATERIALS AND METHODS: The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. RESULTS: The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. CONCLUSION: This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.
Adult ; Aged ; Body Mass Index ; *Case Management ; Diabetes Mellitus/*therapy ; Female ; *Health Behavior ; *Health Knowledge, Attitudes, Practice ; Health Services/*utilization ; Humans ; Male ; Middle Aged ; Republic of Korea ; *Self Care

INTRODUCTION: Drug allergies are often self-reported but of unknown accuracy. We carried out a prospective study to examine the utility and safety of formal allergology evaluation, and to identify factors associated with accurate drug allergy labels. METHOD: All patients who underwent drug allergy evaluation in our clinic during the study period were recruited. Baseline demographics, characteristics of index hypersensitivity reaction and outcomes of evaluation were recorded. RESULTS: A total of 331 patients from March 2019 to June 2021 completed drug allergy evaluation to index drugs of concern. There were 123 (37%) male patients, and the mean age was 49 years (standard deviation 17). There were 170 beta-lactam antibiotics, 53 peri-operative drugs, 43 others, 38 non steroidal anti-inflammatory drugs, and 27 non-beta-lactam antibiotic evaluations. Index reaction occurred within 5 years in 165 (50%) patients, with latency of less than 4 hours in 125 (38%) patients. The most common index reactions were rash, angioedema and urticaria. There were 57 (17%) evaluations stratified as low risk, 222 (67%) moderate risk, and 52 (16%) high risk based on multidisciplinary consensus. Allergy label was found to be false (negative drug evaluation) in 248 (75%) patients, while 16/237 (7%) skin tests, 44/331 (13%) in-clinic graded challenge, and 23/134 (17%) home prolonged challenges were positive (true drug allergy). The most common evaluation reactions were rash and urticaria. No cases of anaphylaxis were elicited. CONCLUSION Seventy-five percent of drug allergy labels are inaccurate. Risk-stratified, protocolised allergy evaluation is safe. Prolonged drug challenge increases the sensitivity of drug allergy evaluation and should therefore be performed when indicated.
Humans ; Male ; Middle Aged ; Female ; Prospective Studies ; Drug Hypersensitivity/epidemiology* ; Exanthema ; Urticaria ; Monobactams

Background The association of long-term bisphosphonate treatment for osteoporosis and related safety problems such as atypical fractures were not clearly defined.This study was to evaluate the structural,densitometric and biomechanical properties of the prolonged bisphosphonate-loaded bones.Methods Bone mineral density (BMD) at hip and femoral midshaft,bone cross-sectional area,moment of inertia of both femurs,bone formation and resorption biochemical markers were compared between 28 elderly with at least 4 years of bisphosphonate treatment from 2002 through 2006 and age-matched group of 37 elderly.Results The total hip BMD and t-score were found not different between two groups.However,bisphosphonate treated patients were found to have significantly lower bone mineral content in the femoral shaft (P ＜0.05); morphological study showed lower cross-sectional area in subtrochanteric and mid-diaphyseal region and thus significantly lower moment of inertia (P ＜0.01).High resolution-peripheral quantitative computed tomography showed significantly decreased trabecular density,bone volume ratio,trabecular number but increased trabecular spacing in tibia and distal radius.Finite element analysis further confirmed significantly lower stiffness and failure load in tibia.Biochemical studies also showed lower bone resorption and severely suppressed bone formation activity (P ＜0.001).Conclusions The unchanged total hip BMD between two groups confirmed the beneficial effects of bisphosphonate on trabecular bone,thus preventing osteoporotic fractures at large in previous studies.However,the inferior structural,densitometric and biomechanical properties at cortical bones,especially femur midshaft,need a special attention to look into the association between long-term bisphosphonate intake and the occurrence of stress fractures.When patients taking bisphosphonate complain of proximal thigh pain or discomfort,plain X-ray film can be the first line screening.All patients prescribed with bisphosphonate should be informed of such a complication though we must stress its rarity.

BACKGROUNDThe association of long-term bisphosphonate treatment for osteoporosis and related safety problems such as atypical fractures were not clearly defined. This study was to evaluate the structural, densitometric and biomechanical properties of the prolonged bisphosphonate-loaded bones.

METHODSBone mineral density (BMD) at hip and femoral midshaft, bone cross-sectional area, moment of inertia of both femurs, bone formation and resorption biochemical markers were compared between 28 elderly with at least 4 years of bisphosphonate treatment from 2002 through 2006 and age-matched group of 37 elderly.

RESULTSThe total hip BMD and t-score were found not different between two groups. However, bisphosphonate treated patients were found to have significantly lower bone mineral content in the femoral shaft (P < 0.05); morphological study showed lower cross-sectional area in subtrochanteric and mid-diaphyseal region and thus significantly lower moment of inertia (P < 0.01). High resolution-peripheral quantitative computed tomography showed significantly decreased trabecular density, bone volume ratio, trabecular number but increased trabecular spacing in tibia and distal radius. Finite element analysis further confirmed significantly lower stiffness and failure load in tibia. Biochemical studies also showed lower bone resorption and severely suppressed bone formation activity (P < 0.001).

CONCLUSIONSThe unchanged total hip BMD between two groups confirmed the beneficial effects of bisphosphonate on trabecular bone, thus preventing osteoporotic fractures at large in previous studies. However, the inferior structural, densitometric and biomechanical properties at cortical bones, especially femur midshaft, need a special attention to look into the association between long-term bisphosphonate intake and the occurrence of stress fractures. When patients taking bisphosphonate complain of proximal thigh pain or discomfort, plain X-ray film can be the first line screening. All patients prescribed with bisphosphonate should be informed of such a complication though we must stress its rarity.

Aged ; Aged, 80 and over ; Biomechanical Phenomena ; Bone Density ; drug effects ; Bone Density Conservation Agents ; adverse effects ; Bone Remodeling ; drug effects ; Densitometry ; Diphosphonates ; adverse effects ; Female ; Finite Element Analysis ; Humans ; Male ; Middle Aged ; RANK Ligand ; blood