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Conclusions and recommendations of health technology assessment (HTA) reports have an impact on all relevant actors involved in the health system (health authorities, administrators, health professionals, patients, citizens and industry). The involvement of all those relevant stakeholders in the HTA process facilitates making valid and informed decisions and an efficient allocation of resources. Improving communication, participation and transparency among all agents will lead to more efficient evaluation and decision-making processes.
To review key aspects of the relations between HTA agencies and health industries, two process were carried out: a narrative review of literature searched in Medline, PubMed, Embase, CINAHL and WOS (2007-2017) and a review of websites of international HTA agencies. References and webs with information on the framework, objectives, methodologies, impact or results of the relationships were included.
A total of 1961 references were located and forty-five were selected. From the synthesis of the selected references the following key aspects of the relationships between HTA and industry were identified: (i) the importance of early dialogues with industry to align HTA objectives with the generation of evidence; (ii) challenges of the bias in the evidence produced by industry; (iii) difficulties in industry engagement in HTA processes; and (iv) industry interest in HTA. The review of six agency websites provided information on industry involvement in strategic activities, early dialogues, provision of documentation, management of industry clarifications, review of the report/allegations and other forms of relationship.
Both the review of the literature and the contents of the web pages of international agencies with experience in relations with industry show that the interest is in the creation of collaborative frameworks between regulatory authorities that decide on authorization and price and reimbursement and HTA agencies, while both try to maintain an early, transparent and systematic interaction with the healthcare industry.
One of the key factors in the process of migration is what the individuals carry with them and what they leave behind. Following the process of migration and then settling down in the new society, the individual may experience cultural bereavement, culture shock or culture conflict. Although grief is often associated with loss, the notion of cultural bereavement arises from an understanding of losses incurred and related to cultural values. This chapter describes in brief various theories related to bereavement. To understand culture shock and culture conflict, the role of acculturation and the processes related to it become very important. Acculturation is seen as the process in which individuals and groups from different cultures come into continuous contact with another culture. Racial and cultural congruity become important in understanding where an individual settles down and what kind of response they and their group generate amongs the larger society.
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