scholarly journals Non-Tuberculous Mycobacteria: Molecular and Physiological Bases of Virulence and Adaptation to Ecological Niches

2020 ◽  
Vol 8 (9) ◽  
pp. 1380
Author(s):  
André C. Pereira ◽  
Beatriz Ramos ◽  
Ana C. Reis ◽  
Mónica V. Cunha
Keyword(s):  
Developed Countries ◽  
Decision Makers ◽  
Public Health Issue ◽  
Individual Species ◽  
Ecological Niches ◽  
Research Gaps ◽  
Middle Income ◽  
Middle Income Countries ◽  
Species Specific ◽  
Total Environment

Non-tuberculous mycobacteria (NTM) are paradigmatic colonizers of the total environment, circulating at the interfaces of the atmosphere, lithosphere, hydrosphere, biosphere, and anthroposphere. Their striking adaptive ecology on the interconnection of multiple spheres results from the combination of several biological features related to their exclusive hydrophobic and lipid-rich impermeable cell wall, transcriptional regulation signatures, biofilm phenotype, and symbiosis with protozoa. This unique blend of traits is reviewed in this work, with highlights to the prodigious plasticity and persistence hallmarks of NTM in a wide diversity of environments, from extreme natural milieus to microniches in the human body. Knowledge on the taxonomy, evolution, and functional diversity of NTM is updated, as well as the molecular and physiological bases for environmental adaptation, tolerance to xenobiotics, and infection biology in the human and non-human host. The complex interplay between individual, species-specific and ecological niche traits contributing to NTM resilience across ecosystems are also explored. This work hinges current understandings of NTM, approaching their biology and heterogeneity from several angles and reinforcing the complexity of these microorganisms often associated with a multiplicity of diseases, including pulmonary, soft-tissue, or milliary. In addition to emphasizing the cornerstones of knowledge involving these bacteria, we identify research gaps that need to be addressed, stressing out the need for decision-makers to recognize NTM infection as a public health issue that has to be tackled, especially when considering an increasingly susceptible elderly and immunocompromised population in developed countries, as well as in low- or middle-income countries, where NTM infections are still highly misdiagnosed and neglected.

Opportunities and Challenges for Implementing Neurotrauma Prevention Program: A Practical Perspective for Developing Countries

2019 ◽  
Vol 16 (02/03) ◽  
pp. 077-081
Author(s):  
Amrita Ghosh ◽  
Ranabir Pal ◽  
Luis Rafael Moscote-Salazar ◽  
Huber Said Padilla-Zambrano ◽  
Harsh Deora ◽  
...  
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Developed Countries ◽  
Public Health Issue ◽  
Evidence Based ◽  
Middle Income ◽  
Literature Research ◽  
Middle Income Countries ◽  
Literature Searches ◽  
Low And Middle Income

AbstractNeurotrauma is an underestimated and less understood public health issue in low- and middle-income countries for which we need system-based approach to prevention plans. This study was initiated to find rationale of effective plan with projectile vision of neurotrauma prevention. In search of innovative ideas of neurotrauma prevention evidence was explored from the published literature research on traumatic brain injury. Evidence-based global guidelines on recommended content and scheduling on prevention of neurotrauma literature searches data were also synthesized and summarized from research in developed countries. Our study noted that a considerable number of victims of neurotrauma with death and disabilities put mammoth costs to the already compromised health systems of the low- and middle-income countries. We need systems-based four-pronged approach incorporating neurotrauma registry, neurotrauma surveillance, translational research programs, and current approved process for development of clinical guidelines for prevention.

scholarly journals CHALLENGES FACED IN TRANSFERRING ECONOMIC EVALUATIONS TO MIDDLE INCOME COUNTRIES

2015 ◽  
Vol 31 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Michael Drummond ◽  
Federico Augustovski ◽  
Zoltán Kaló ◽  
Bong-Min Yang ◽  
Andres Pichon-Riviere ◽  
...  
Keyword(s):  
Epidemiological Data ◽  
Developed Countries ◽  
Decision Makers ◽  
Care Practice ◽  
Economic Evaluations ◽  
Health State ◽  
Current Standard ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Developed Countries

Background: Decision makers in middle-income countries are using economic evaluations (EEs) in pricing and reimbursement decisions for pharmaceuticals. However, whilst many of these jurisdictions have local submission guidelines and local expertise, the studies themselves often use economic models developed elsewhere and elements of data from countries other than the jurisdiction concerned. The objectives of this study were to describe the current situation and to assess the challenges faced by decision makers in transferring data and analyses from other jurisdictions.Methods: Experienced health service researchers in each region conducted an interview survey of representatives of decision making bodies from jurisdictions in Asia, Central and Eastern Europe, and Latin America that had at least 1 year's experience of using EEs.Results: Representatives of the relevant organizations in twelve countries were interviewed. All twelve jurisdictions had developed official guidelines for the conduct of EEs. All but one of the organizations evaluated studies submitted to them, but 9 also conducted studies and 7 commissioned them. Nine of the organizations stated that, in evaluating EEs submitted to them, they had consulted a study performed in a different jurisdiction. Data on relevant treatment effect was generally considered more transferable than those on prices/unit costs. Views on the transferability of epidemiological data, data on resource use and health state preference values were more mixed. Eight of the respondents stated that analyses submitted to them had used models developed in other jurisdictions. Four of the organizations had a policy requiring models to be adapted to reflect local circumstances. The main obstacles to transferring EEs were the different patterns of care or wealth of the developed countries from which most economic evaluations originate.Conclusions: In middle-income countries it is commonplace to deal with the issue of transferring analyses or data from other jurisdictions. Decision makers in these countries face several challenges, mainly due to differences in current standard of care, practice patterns, or gross domestic product between the developed countries where the majority of the studies are conducted and their own jurisdiction

scholarly journals COST, CONTEXT, AND DECISIONS IN HEALTH ECONOMICS AND HEALTH TECHNOLOGY ASSESSMENT

2018 ◽  
Vol 34 (5) ◽  
pp. 434-441 ◽  
Author(s):  
Anthony J. Culyer
Keyword(s):  
Health Economics ◽  
Health Technology Assessment ◽  
Decision Maker ◽  
Technology Assessment ◽  
Health Technology ◽  
Decision Makers ◽  
Negative Consequences ◽  
Middle Income ◽  
Middle Income Countries ◽  
Context Dependent

Objectives:This study is an attempt to demystify and clarify the idea of cost in health economics and health technology assessment (HTA).Methods:Its method draws on standard concepts in economics. Cost is a more elusive concept than is commonly thought and can be particularly elusive in multidisciplinary territory like HTA.Results:The article explains that cost is more completely defined as opportunity cost, why cost is necessarily associated with a decision, and that it will always vary according to the context of that decision: whether choice is about inputs or outputs, what the alternatives are, the timing of the consequences of the decision, the nature of the commitment to which a decision maker is committed, who the decision maker is, and the constraints and discretion limiting or liberating the decision maker. Distinctions between short and long runs and between fixed and variable inputs are matters of choice, not technology, and are similarly context-dependent. Harms or negative consequences are, in general, not costs. Whether so-called “clinically unrelated” future costs and benefits should be counted in current decisions again depends on context.Conclusions:The costs of entire health programs are context-dependent, relating to planned rates of activity, volumes, and timings. The implications for the methods of HTA are different in the contexts of low- and middle-income countries compared with high-income countries, and further differ contextually according to the budget constraints (fixed or variable) facing decision makers.

scholarly journals Infectious diseases acquired by international travellers visiting the USA†

2018 ◽  
Vol 25 (1) ◽  
Author(s):  
Rhett J Stoney ◽  
Douglas H Esposito ◽  
Phyllis Kozarsky ◽  
Davidson H Hamer ◽  
Martin P Grobusch ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Descriptive Analysis ◽  
Low Frequency ◽  
Developed Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
International Tourist ◽  
Clinical Diagnoses ◽  
The Usa ◽  
Systemic Infections

Abstract Background Estimates of travel-related illness have focused predominantly on populations from highly developed countries visiting low- or middle-income countries, yet travel to and within high-income countries is very frequent. Despite being a top international tourist destination, few sources describe the spectrum of infectious diseases acquired among travellers to the USA. Methods We performed a descriptive analysis summarizing demographic and travel characteristics, and clinical diagnoses among non-US-resident international travellers seen during or after travel to the USA at a GeoSentinel clinic from 1 January 1997 through 31 December 2016. Results There were 1222 ill non-US-resident travellers with 1393 diagnoses recorded during the 20-year analysis period. Median age was 40 (range 0–86 years); 52% were female. Patients visited from 63 countries and territories, most commonly Canada (31%), Germany (14%), France (9%) and Japan (7%). Travellers presented with a range of illnesses; skin and soft tissue infections of unspecified aetiology were the most frequently reported during travel (29 diagnoses, 14% of during-travel diagnoses); arthropod bite/sting was the most frequently reported after travel (173 diagnoses, 15% after-travel diagnoses). Lyme disease was the most frequently reported arthropod-borne disease after travel (42, 4%). Nonspecific respiratory, gastrointestinal and systemic infections were also among the most frequently reported diagnoses overall. Low-frequency illnesses (<2% of cases) made up over half of diagnoses during travel and 41% of diagnoses after travel, including 13 cases of coccidioidomycosis and mosquito-borne infections like West Nile, dengue and Zika virus diseases. Conclusions International travellers to the USA acquired a diverse array of mostly cosmopolitan infectious diseases, including nonspecific respiratory, gastrointestinal, dermatologic and systemic infections comparable to what has been reported among travellers to low- and middle-income countries. Clinicians should consider the specific health risks when preparing visitors to the USA and when evaluating and treating those who become ill.

scholarly journals Characteristics and circumstances of falls leading to severe fractures in elderly people in Rio de Janeiro, Brazil

2009 ◽  
Vol 25 (2) ◽  
pp. 455-459 ◽  
Author(s):  
Evandro Silva Freire Coutinho ◽  
Kátia Vergetti Bloch ◽  
Laura C. Rodrigues
Keyword(s):  
Risk Factors ◽  
Elderly People ◽  
Rio De Janeiro ◽  
Developed Countries ◽  
Case Control ◽  
Demographic Variables ◽  
Case Control Studies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Gender And Age

The circumstances associated with falls among elderly people have been well described in some developed countries, but little is known about such accidents in middle-income countries. The aim of this paper is to report the circumstances and characteristics associated with falls leading to severe fractures among elderly people living in Rio de Janeiro, Brazil. Cases were obtained from two case-control studies on risk factors for severe fractures due to falls among individuals 60 years or older. Fallers were stratified according to clinical and socio-demographic variables and circumstances of the accident. Women comprised three-fourths of the sample. The femur was the most frequently fractured bone, more common among individuals over 70 years of age. Most falls occurred at home, between 6:00 AM and 6:00 PM, but the rooms where they occurred differed according to gender and age. Most individuals did not attribute their falls to tripping or slipping. This sample's data did not differ substantially from studies in developed countries.

scholarly journals Research and Publication from Developing Countries

2020 ◽  
Vol 42 (3) ◽  
Author(s):  
Mohan R Sharma
Keyword(s):  
Developing Countries ◽  
Burden Of Disease ◽  
Disease Burden ◽  
Developed Countries ◽  
Publishing Research ◽  
Economic Factors ◽  
Middle Income ◽  
High Burden ◽  
Middle Income Countries ◽  
The Developed Countries

In 2002, Richard Smith wrote an editorial, “publishing research from developing countries” in the Journal “Statistics in Medicine” highlighting the importance of research and publication from the developing countries (DCs).1 In that article, he mentioned the disparity in research and publication between the developed and developing countries. Almost two decades on, the problem still largely remains the same. It is estimated that more than 80% of the world’s population lives in more than 100 developing countries.2 In terms of disease burden, the prevalence and mortality from diseases in the low and middle-income countries are disproportionately high compared to developed countries.3 Although there is a high burden of disease, we base our treatment inferring results from research and publication from the developed countries which may not be fully generalizable due to geographical cultural, racial, and economic factors. This is where the problem lies.

Migraine and Stress – An Explorative Cross-Country Study of External Stress Factors

2020 ◽  
Author(s):  
Irene van Staveren
Keyword(s):  
Low Income ◽  
Developed Countries ◽  
Ordinary Least Squares ◽  
External Stress ◽  
Stress Factors ◽  
Middle Income ◽  
Middle Income Countries ◽  
Proxy Variables ◽  
Modifiable Factors ◽  
Cross Country

Abstract BackgroundAccording to the Global Burden of Disease 2016 project, migraine ranks first for 15-49 years and second for all ages. The project has reported no significant relation with socio-economic status of a country. To the contrary, migraine ranks first for all ages in low- and middle-income countries suffering from civic unrest and conflict. This raises the question whether external stress factors may be correlated with migraine years lived with disability (YLD).MethodsIn the absence of cross-country studies on migraine and stress, this is a unique exploratory study. The analysis uses two country groups: developed countries (including some middle-income countries) and developing (middle- and low-income) countries. For the first group, proxy variables for stress are included that relate to flexible and highly competitive labour markets (productivity and unemployment), whereas for the second group, proxy variables are used that relate to conflict and migration. The data were analysed with multiple ordinary least squares cross-section regressions.ResultsThe results show a positive relationship between the stress variables on the one hand and migraine YLD on the other hand for both country groups. Almost all results are statistically significant at p<0.01.ConclusionsThe findings from the exploratory cross-country analysis suggest that societal stress factors may be potential candidates for modifiable factors for the prevalence and severity of migraine at the country level.

The Evolution of the Digital Divide across Developing Countries

2013 ◽  
pp. 1554-1570
Author(s):  
Nicoletta Corrocher ◽  
Anna Raineri
Keyword(s):  
Developing Countries ◽  
Digital Divide ◽  
Low Income ◽  
Competition Policy ◽  
Developed Countries ◽  
Policy Implications ◽  
Effective Strategy ◽  
Middle Income ◽  
Middle Income Countries ◽  
Emerging Patterns

This chapter aims at investigating the evolution of the digital divide within a set of developing countries between the years 2000 and 2005. In doing so, it moves away from the traditional analysis of the digital divide, which compares developed countries and developing countries, and examines the existing gap within a relatively homogeneous group of countries. On the basis of the theoretical and empirical contributions from scholars in different disciplines, we select a series of socioeconomic and technological indicators and provide an empirical assessment of the digitalization patterns in a set of 51 low income and lower-middle income countries. By means of cluster analysis techniques, we identify three emerging patterns of the digital divide and derive a series of policy implications, related to the implementation of an effective strategy to reduce digital backwardness. The characteristics of each pattern of digitalization can be also usefully employed to understand whether past interventions, especially in the area of competition policy, have been successful in addressing country-specific issues.

scholarly journals Exploring Perceived Well-Being from Urban Parks: Insights from a Megacity in Latin America

2020 ◽  
Vol 12 (18) ◽  
pp. 7586
Author(s):  
Andrea Parra-Saldívar ◽  
Sebastián Abades ◽  
Juan L. Celis-Diez ◽  
Stefan Gelcich
Keyword(s):  
Native Species ◽  
Negative Impact ◽  
Urban Parks ◽  
Well Being ◽  
Developed Countries ◽  
Global Scale ◽  
Ecological Knowledge ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Relationship

Urbanization has impacted biodiversity and ecosystems at a global scale. At the same time, it has been recognized as a driver of the physical and emotional gap between humans and nature. The lack of direct contact with nature can have a negative impact on several aspects of human well-being and change knowledge and attitudes of people towards the environment. However, this phenomenon is still poorly understood in megacities outside developed countries. Here, we explore the relationship between ecological knowledge and self-reported well-being in an important urban park in Santiago, Chile. We conducted semi-structured surveys of park users to explore their beliefs, preferences, ecological knowledge of plants and birds, and self-reported well-being. Citizens associated urban parks mainly with “nature,” and particularly with the presence of trees and plants. Trees were recognized as the most relevant elements of urban parks; in turn, birds were ranked as the less relevant. Regarding formal ecological knowledge, respondents correctly identified an average of 2.01 plants and 2.44 birds out of a total of 10 for each taxon, and exotic species were more likely to be recognized. Park users also reported high scores for self-reported well-being. Interestingly, variance of self-reported well-being scores tended to increase at low levels of ecological knowledge of trees, but no significant relationship was detected with knowledge of birds, nor native species. Ecological knowledge of trees was positively related to self-reported well-being. Results suggest that parks can positively contribute to bring people closer to nature in middle-income countries. Improving ecological knowledge can be critical to restore the relationship between humans and nature in megacities.

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