Neoadjuvant therapy for pancreas cancer: Global perspective and optimal care pathways in low to middle‐income countries

2021 ◽  
Vol 123 (6) ◽  
pp. 1441-1448
Author(s):  
Senthil J. Rajappa ◽  
Rakesh Pinninti ◽  
Chandrakanth Are
Keyword(s):  
Neoadjuvant Therapy ◽  
Pancreas Cancer ◽  
Global Perspective ◽  
Care Pathways ◽  
Optimal Care ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals A global perspective on the issue of access to insulin

Diabetologia ◽  
2021 ◽  
Author(s):  
David Beran ◽  
Maria Lazo-Porras ◽  
Camille M. Mba ◽  
Jean Claude Mbanya
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Multinational Companies ◽  
Global Perspective ◽  
Patient Access ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wide Range ◽  
Pricing And Reimbursement

AbstractThe discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO’s framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients’ abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO’s Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes. Graphical abstract

DETERMINANTS OF GREENHOUSE GAS EMISSIONS REVISITED: A GLOBAL PERSPECTIVE

2020 ◽  
pp. 1-27
Author(s):  
THAI-HA LE ◽  
CANH PHUC NGUYEN
Keyword(s):  
Co2 Emissions ◽  
Panel Data Analysis ◽  
Generalized Method Of Moments ◽  
Global Perspective ◽  
Stirpat Model ◽  
Middle Income ◽  
Ch4 Emissions ◽  
Middle Income Countries ◽  
Global Environmental ◽  
Global Environmental Policy

This study examines the determinants of emissions for a global sample of 120 countries during the 1995–2012 period using panel data analysis. Specifically, an extended version of the STIRPAT model combined with the EKC was employed to examine the determinants of emissions for the full sample and three subsamples of countries at different income levels. Three proxies for emissions are used, including CO2, N2O and CH4 emissions. The two-step generalized method of moments (GMM) is employed as the estimation technique. The empirical results indicate the evidence of EKC for the global sample and all subgroups of countries for CO2 emissions. On the other hand, U-shaped relationships between income and emissions are found for all three subsamples in the cases of N2O and CH4 emissions. Energy intensity appears to be the major driver of CO2 emissions for all groups of countries as well as for N2O and CH4 emissions for high-income and upper-middle-income countries. The effects of industrialization and urbanization vary across different types of emissions and different income country groups. The global environmental policy should focus on encouraging energy efficiency, enhancing the use of eco-friendly energy resources, as well as incorporating the impacts of industrialization and urbanization on emissions.

scholarly journals Improving the global diagnosis and management of asthma in children

Thorax ◽  
2018 ◽  
Vol 73 (7) ◽  
pp. 662-669 ◽  
Author(s):  
Warren Lenney ◽  
Andrew Bush ◽  
Dominic A Fitzgerald ◽  
Monica Fletcher ◽  
Anders Ostrem ◽  
...  
Keyword(s):  
School Attendance ◽  
Substantial Improvement ◽  
Optimal Care ◽  
Middle Income ◽  
Diagnosis And Management ◽  
Middle Income Countries ◽  
New Thinking ◽  
Specific Barriers ◽  
Selection Of

Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. Guidelines are increasingly evidence based, but their impact on improving outcomes has been negligible in many parts of the world, often due to lack of implementation. New thinking is needed to enable substantial improvements in outcomes. The disease varies globally and plans will need to differ for individual countries or places where region-specific barriers prevent optimal care. A wide selection of educational activities is needed, including community-targeted initiatives, to engage with families. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.

scholarly journals Association between depression and smoking: A global perspective from 48 low- and middle-income countries

2018 ◽  
Vol 103 ◽  
pp. 142-149 ◽  
Author(s):  
Brendon Stubbs ◽  
Davy Vancampfort ◽  
Joseph Firth ◽  
Marco Solmi ◽  
Najma Siddiqi ◽  
...  
Keyword(s):  
Global Perspective ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Theatres without borders: a systematic review of the use of intraoperative telemedicine in low- and middle-income countries (LMICs)

2021 ◽  
pp. bmjinnov-2021-000837
Author(s):  
Hariharan Subbiah Ponniah ◽  
Viraj Shah ◽  
Arian Arjomandi Rad ◽  
Robert Vardanyan ◽  
George Miller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Case Reports ◽  
Surgical Care ◽  
Cochrane Collaboration ◽  
Optimal Care ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

ObjectiveThis systematic review aims to provide a summary of the use of real-time telementoring, telesurgical consultation and telesurgery in surgical procedures in patients in low/middle-income countries (LMICs).DesignA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration published guidelines.Data sourcesEMBASE, MEDLINE, Cochrane, PubMed and Google Scholar were searched for original articles and case reports that discussed telementoring, telesurgery or telesurgical consultation in countries defined as low-income or middle-income (as per the World Banks’s 2021–2022 classifications) from inception to August 2021.Eligibility criteria for selecting studiesAll original articles and case reports were included if they reported the use of telemedicine, telesurgery or telesurgical consultation in procedures conducted on patients in LMICs.ResultsThere were 12 studies which discussed the use of telementoring in 55 patients in LMICs and included a variety of surgical specialities. There was one study that discussed the use of telesurgical consultation in 15 patients in LMICs and one study that discussed the use of telesurgery in one patient.ConclusionThe presence of intraoperative telemedicine in LMICs represents a principal move towards improving access to specialist surgical care for patients in resource-poor settings. Not only do several studies demonstrate that it facilitates training and educational opportunities, but it remains a relatively frugal and efficient method of doing so, through empowering local surgeons in LMICs towards offering optimal care while remaining in their respective communities.

scholarly journals Clubfoot treatment in 2015: a global perspective

2018 ◽  
Vol 3 (4) ◽  
pp. e000852 ◽  
Author(s):  
Rosalind M Owen ◽  
Beth Capper ◽  
Christopher Lavy
Keyword(s):  
Low Income ◽  
Income Group ◽  
Cross Sectional Study ◽  
Global Perspective ◽  
Access To Treatment ◽  
Cross Sectional ◽  
Permanent Disability ◽  
Middle Income ◽  
Middle Income Countries ◽  
Treatment Services

IntroductionClubfoot affects around 174 000 children born annually, with approximately 90% of these in low-income and middle-income countries (LMIC). Untreated clubfoot causes life-long impairment, affecting individuals’ ability to walk and participate in society. The minimally invasive Ponseti treatment is highly effective and has grown in acceptance globally. The objective of this cross-sectional study is to quantify the numbers of countries providing services for clubfoot and children accessing these.MethodIn 2015–2016, expected cases of clubfoot were calculated for all countries, using an incidence rate of 1.24/1000 births. Informants were sought from all LMIC, and participants completed a standardised survey about services for clubfoot in their countries in 2015. Data collected were analysed using simple numerical analysis, country coverage levels, trends over time and by income group. Qualitative data were analysed thematically.ResultsResponses were received from 55 countries, in which 79% of all expected cases of clubfoot were born. More than 24 000 children with clubfoot were enrolled for Ponseti treatment in 2015. Coverage was less than 25% in the majority of countries. There were higher levels of response and coverage within the lowest income country group. 31 countries reported a national programme for clubfoot, with the majority provided through public–private partnerships.ConclusionThis is the first study to describe global provision of, and access to, treatment services for children with clubfoot. The numbers of children accessing Ponseti treatment for clubfoot in LMIC has risen steadily since 2005. However, coverage remains low, and we estimate that less than 15% of children born with clubfoot in LMIC start treatment. More action to promote the rollout of national clubfoot programmes, build capacity for treatment and enable access and adherence to treatment in order to radically increase coverage and effectiveness is essential and urgent in order to prevent permanent disability caused by clubfoot.

scholarly journals The hazards of conducting induction of labour in high-risk pregnancies at district hospitals in low- and middle-income countries: lessons to learn from a case report

2020 ◽  
Vol 20 (3) ◽  
pp. 1237-1240
Author(s):  
Nnabuike Chibuoke Ngene ◽  
Jagidesa Moodley
Keyword(s):  
High Risk ◽  
Healthcare Facility ◽  
Induction Of Labour ◽  
Optimal Care ◽  
Fetal Demise ◽  
Middle Income ◽  
Middle Income Countries ◽  
Risk Pregnancy ◽  
District Hospitals ◽  
Emergency Hysterectomy

Background: Induction of labour (IOL) is an obstetric procedure that should be conducted in a healthcare facility with the capacity to provide optimal care based on the patient risk status. Inadequate monitoring, untimely procedure and lack of readily available and experienced medical staff to participate in the care of the patient undergoing induction are hazardous with snowball effects. Methods: A 38-year-old G4P2+1 had IOL because of oligohydramnios at term in a district hospital. The procedure was inadequately monitored and fetal demise occurred. The duration of second stage was prolonged and sequential use of vac- uum and forceps deliveries were unsuccessfully performed. Results: At the ensuing caesarean delivery, uterine rupture/tear was diagnosed, and the patient died due to haemorrhage during an emergency hysterectomy. Conclusion: This report highlights important clinical lessons on IOL in a high-risk pregnancy. The timelines for monitoring during IOL, particularly when there is fetal demise in labour, are proposed. Keywords: Assisted vaginal delivery; induction of labour; prolonged labour; oligohydramnios; uterine tear.

scholarly journals A systematic review of care pathways for psychosis in low-and middle-income countries

2020 ◽  
Vol 54 ◽  
pp. 102237
Author(s):  
Philippa Lilford ◽  
Onali Bimalka Wickramaseckara Rajapakshe ◽  
Swaran Preet Singh
Keyword(s):  
Systematic Review ◽  
Care Pathways ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Pay for Performance: A Reflection on How a Global Perspective Could Enhance Policy and Research

2020 ◽  
Author(s):  
Laura Anselmi ◽  
Josephine Borghi ◽  
Garrett Wallace Brown ◽  
Eleonora Fichera ◽  
Kara Hanson ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Pay For Performance ◽  
Knowledge Exchange ◽  
Healthcare Providers ◽  
Global Perspective ◽  
Healthcare Provision ◽  
Middle Income ◽  
Performance Targets ◽  
Middle Income Countries ◽  
Policy Tool

Pay-for-performance (P4P) is the provision of financial incentives to healthcare providers based on pre-specified performance targets. P4P has been used as a policy tool to improve healthcare provision globally. However, researchers tend to cluster into those working on high or low- and middle-income countries (LMICs), with still limited knowledge exchange, potentially constraining opportunities for learning from across income settings. We reflect here on some commonalities and differences in the design of P4P schemes, research questions, methods and data across income settings. We highlight how a global perspective on knowledge synthesis could lead to innovations and further knowledge advancement.

scholarly journals Implementation of breast cancer continuum of care in low- and middle-income countries during the COVID-19 pandemic

2020 ◽  
Vol 16 (31) ◽  
pp. 2551-2567 ◽  
Author(s):  
Hagar Elghazawy ◽  
Joaira Bakkach ◽  
Mohamed S Zaghloul ◽  
Atlal Abusanad ◽  
Mariam Mohamed Hussein ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Continuum Of Care ◽  
Global Perspective ◽  
Breast Cancer Patients ◽  
Middle Income ◽  
Middle Income Countries ◽  
Clinical Scenarios ◽  
Team Setting ◽  
Common Malignancy ◽  
Low And Middle Income

Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.

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