scholarly journals Proton Therapy in Lower-Middle-Income Countries: From Facts and Reality to Desire, Challenges and Limitations

2021 ◽  
Author(s):  
Sandra Ileana Pérez Álvarez ◽  
Francisco Javier Lozano Ruiz ◽  
Federico Maldonado Magos ◽  
Aida Mota García
Keyword(s):  
Latin America ◽  
Human Resources ◽  
Health Expenditure ◽  
Caribbean Region ◽  
Middle Income ◽  
Proton Beam Radiotherapy ◽  
Middle Income Countries ◽  
Ideal Candidate ◽  
Geographic Coverage ◽  
Latin America And Caribbean

Around 50% of cancer patients will require radiotherapy (RT) and 10–15% of these patients could be eligible for proton beam radiotherapy (PBT). Dosimetric advantages are undeniable, mainly in pediatric and reirradiation scenarios. Though, PBT facilities are scarce worldwide and the IAEA has reported 116 functional particle facilities, of which 98 are PBT, virtually absent in low- and middle-income countries (LMIC). The Latin America and Caribbean region represent a unique opportunity for a PBT center, as there are currently no functional facilities and current RT needs are significant. The challenges can be summarized as high initial investment and maintenance, geographic coverage, required baseline technology and certification, over-optimistic workload, unclear rates and reimbursement, unmet business plan and revenue expectations, and lack of trained human resources. Investment costs for a PBT facility are estimated to be at around 140 million euros; therefore, this seems unsuitable for LMIC. Mexico’s geographical advantage, GDP, baseline technologies and high demand for RT makes it an ideal candidate. Nevertheless, a PBT center would account for a third of Mexico’s annual health expenditure for 2020. Enormous efforts must be made by both the private sector and governmental authorities to provide funding.

scholarly journals The landscape of COVID-19 clinical trials in Latin America and the Caribbean: assessment and challenges

2020 ◽  
Vol 44 ◽  
pp. 1
Author(s):  
Sarah Carracedo ◽  
Ana Palmero ◽  
Marcie Neil ◽  
Anisa Hasan-Granier ◽  
Carla Saenz ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Latin America ◽  
Caribbean Region ◽  
Middle Income ◽  
Middle Income Countries ◽  
Treatment And Prevention ◽  
Latin America And Caribbean ◽  
The Caribbean ◽  
Clinical Trials Registry ◽  
Robust Evidence

A considerable number of clinical trials is being conducted globally in response to the COVID-19 pandemic, including in low- and middle-income countries such as those in the Latin America and Caribbean region (LAC). Yet, an abundance of studies does not necessarily shorten the path to find safe and efficacious interventions for COVID-19. We analyze the trials for COVID-19 treatment and prevention that are registered from LAC countries in the International Clinical Trials Registry Platform, and identify a trend towards small repetitive non-rigorous studies that duplicate efforts and drain limited resources without producing meaningful conclusions on the safety and efficacy of the interventions being tested. We further assess the challenges to conducting scientifically sound and socially valuable research in the LAC region in order to inform recommendations to encourage clinical trials that are most likely to produce robust evidence during the pandemic.

scholarly journals Systematic Review Estimating the Burden of Dementia in the Latin America and Caribbean Region: A Bayesian Approach

2021 ◽  
Vol 12 ◽  
Author(s):  
Yawen Xiang ◽  
Kimberly Vilmenay ◽  
Adrienne N. Poon ◽  
Shant Ayanian ◽  
Christopher F. Aitken ◽  
...  
Keyword(s):  
Systematic Review ◽  
Latin America ◽  
Bayesian Approach ◽  
Epidemiological Studies ◽  
Population Based ◽  
Population Projections ◽  
Caribbean Region ◽  
Age Group ◽  
Middle Income ◽  
Latin America And Caribbean

Background: The global burden of dementia has increasingly shifted to low- and middle-income regions that lack essential data for monitoring epidemiological progression, and policy and planning support. Drawing upon data that have emerged since the last known estimates published in 2015, this study aims to update dementia estimates in the Latin America and Caribbean (LAC) region for the years 2020, 2030, and 2050 through the application of a recently validated Bayesian approach for disease estimates useful when data sources are scarce.Methods: A comprehensive parallel systematic review of PubMed, EMBASE, PsycINFO, Global Health, and LILACS was conducted to identify prospective population-based epidemiological studies on dementia published in English from 2013 to 2018 in LAC. English and non-English data cited by a recent review on dementia estimates in LAC were also examined for additional data. A Bayesian normal-normal hierarchical model (NNHM) was developed to estimate age-specific and age-adjusted dementia prevalence in people aged 60+. Using age-specific population projections from the UN, the total number of people affected by dementia for the years 2020, 2030, and 2050 were estimated.Results: 1,414 studies were identified, of which only 7 met the inclusion criteria. The studies had 7,684 participants and 1,191 dementia cases. The age-standardized prevalence of all forms of dementia in LAC was 8% (95% CI: 5–11.5%) in people aged 60+. The estimated prevalence varied with age, increasing from 2.5% (95% CI: 0.08–4.0%) in the 60-69 age group, to 9.4% (95% CI: 5.4–13.2%) in the 70–79 age group and 28.9% (95% CI: 20.3–37.2%) in the ≥80 age group. The number of people age 60 and older living with dementia in LAC in 2020 was estimated at 6.86 (95% CI: 4.3–9.8) million, 9.94 (95% CI: 6.16–14.15) million in 2030, and 19.33 (95% CI: 12.3–13.6) million in 2050.Conclusion: We project an upward disease trajectory for dementia in LAC countries. The projection is likely an underestimation of the true dementia burden given the underrepresentation of rural and socio-economically deprived populations. More research is urgently needed to improve the accuracy of disease estimates, guide clinicians to improve evaluations for earlier recognition of dementia, and support the development of effective policies for improving dementia prevention, diagnosis and clinical management in LAC's diverse and aging communities.

scholarly journals Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data

2020 ◽  
Vol 5 (11) ◽  
pp. e003423
Author(s):  
Dongqing Wang ◽  
Molin Wang ◽  
Anne Marie Darling ◽  
Nandita Perumal ◽  
Enju Liu ◽  
...  
Keyword(s):  
Weight Gain ◽  
North Africa ◽  
Low Income ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Middle Income Countries ◽  
Gestational Weight ◽  
Latin America And Caribbean ◽  
Nationally Representative ◽  
Sub Saharan

IntroductionGestational weight gain (GWG) has important implications for maternal and child health and is an ideal modifiable factor for preconceptional and antenatal care. However, the average levels of GWG across all low-income and middle-income countries of the world have not been characterised using nationally representative data.MethodsGWG estimates across time were computed using data from the Demographic and Health Surveys Program. A hierarchical model was developed to estimate the mean total GWG in the year 2015 for all countries to facilitate cross-country comparison. Year and country-level covariates were used as predictors, and variable selection was guided by the model fit. The final model included year (restricted cubic splines), geographical super-region (as defined by the Global Burden of Disease Study), mean adult female body mass index, gross domestic product per capita and total fertility rate. Uncertainty ranges (URs) were generated using non-parametric bootstrapping and a multiple imputation approach. Estimates were also computed for each super-region and region.ResultsLatin America and Caribbean (11.80 kg (95% UR: 6.18, 17.41)) and Central Europe, Eastern Europe and Central Asia (11.19 kg (95% UR: 6.16, 16.21)) were the super-regions with the highest GWG estimates in 2015. Sub-Saharan Africa (6.64 kg (95% UR: 3.39, 9.88)) and North Africa and Middle East (6.80 kg (95% UR: 3.17, 10.43)) were the super-regions with the lowest estimates in 2015. With the exception of Latin America and Caribbean, all super-regions were below the minimum GWG recommendation for normal-weight women, with Sub-Saharan Africa and North Africa and Middle East estimated to meet less than 60% of the minimum recommendation.ConclusionThe levels of GWG are inadequate in most low-income and middle-income countries and regions. Longitudinal monitoring systems and population-based interventions are crucial to combat inadequate GWG in low-income and middle-income countries.

Financial Access of Latin America and Caribbean Firms: What Are the Roles of Institutional, Financial, and Economic Development?

2021 ◽  
pp. 097265272110153
Author(s):  
Lan Khanh Chu
Keyword(s):  
Economic Development ◽  
Latin America ◽  
Jel Classification ◽  
Caribbean Region ◽  
Country Level ◽  
Level Data ◽  
Latin America And Caribbean ◽  
The Impact ◽  
Moderating Role

This article examines the impact of institutional, financial, and economic development on firms’ access to finance in Latin America and Caribbean region. Based on firm- and country-level data from the World Bank databases, we employ an ordered logit model to understand the direct and moderating role of institutional, financial, and economic development in determining firms’ financial obstacles. The results show that older, larger, facing less competition and regulation burden, foreign owned, and affiliated firms report lower obstacles to finance. Second, better macro-fundamentals help to lessen the level of obstacles substantially. Third, the role of institutions in promoting firms’ inclusive finance is quite different to the role of financial development and economic growth. JEL classification: E02; G10; O16; P48

The HIV/AIDS epidemic in the Latin America and Caribbean Region

AIDS ◽  
2002 ◽  
Vol 16 ◽  
pp. S1-S2 ◽  
Author(s):  
Bernhard Schwartländer ◽  
Roel Coutinho ◽  
Luiz Loures
Keyword(s):  
Latin America ◽  
Caribbean Region ◽  
Aids Epidemic ◽  
Latin America And Caribbean ◽  
Hiv Aids

scholarly journals Understanding How Incentives Influence Motivation and Retention of Health Workers

2012 ◽  
pp. 1148-1163
Author(s):  
Posy Bidwell ◽  
Stephen Thomas ◽  
Silvia Stringhini
Keyword(s):  
Human Resources ◽  
Financial Incentives ◽  
Health Workers ◽  
Critical Factor ◽  
Research Needs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Professional Ethos ◽  
Human Resources Strategies

A critical factor in addressing the human resources crisis in low and middle income countries (LMIC) is the ability to recruit, motivate, and retain health workers. Failure in this area is one of the main causes of decline in availability of services and quality of care. Various financial and non-financial incentives have been implemented and this chapter will explore available evidence to see whether they have influenced motivation. Additionally, Maslow’s hierarchy of needs is used to determine if there is a hierarchy of how incentives are valued. While Maslow’s model is a useful tool to classify themes of health worker needs, it would appear that workers are motivated without each level having to be fulfilled in turn. While financial incentives may help with retention, they can cause erosion of professional ethos, do not increase job satisfaction, or act as motivators to perform well. More research needs to be done in order to design more effective human resources strategies.

Nature and determinants of out-of-pocket health expenditure among older people in a rural Indian community

2012 ◽  
Vol 24 (10) ◽  
pp. 1664-1673 ◽  
Author(s):  
E. M. Brinda ◽  
A. P. Rajkumar ◽  
U. Enemark ◽  
M. Prince ◽  
K. S. Jacob
Keyword(s):  
Health Services ◽  
Older People ◽  
Health Expenditure ◽  
Health Service Utilization ◽  
Care Delivery ◽  
Health Expenditures ◽  
Gastrointestinal Diseases ◽  
Middle Income ◽  
Middle Income Countries ◽  
Catastrophic Health Expenditures

ABSTRACTBackground: Increasing out-of-pocket health expenditure among older people worsens the inequitable access to essential health services in low and middle-income countries (LMIC). We investigated various socioeconomic and health factors associated with out-of-pocket and catastrophic health expenditures among rural older people in India.Methods: We recruited 1,000 participants aged above 65 years from Kaniyambadi block, Vellore, India. We assessed their out-of-pocket health expenditure, health service utilization, socioeconomic profiles, disability, cognition, and health status by standard instruments. We employed appropriate multivariate statistics evaluating these determinants.Results: Male gender, poor sanitation, diabetes, tuberculosis, malaria, respiratory ailments, gastrointestinal diseases, dementia, depression, and disability were associated with higher out-of-pocket expenditures. Illiteracy, tuberculosis, diabetes, and dementia increased the risk for catastrophic health expenditures, while pension schemes protected against it. Income inequalities were associated with inequities on education, disease prevalence, and access to safe water, sanitation, and nutrition.Conclusions: Interactions between determinants of out-of-pocket health expenditure, economic inequality, and inequities on essential health care delivery to older people are complex. We highlight the need for equitable health services and policies, focusing on both medical and social determinants.

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