Primary care, cancer and AMR: from prevention and diagnosis to survivorship and advocacy

The speaker will discuss how cancer patients experience the system, with emphasis on primary care settings and survivorship. Highlighting differences across developed and developing settings, and the implications overuse may further represent for sustainable development, elaborating on the role interprofessional approaches and advocacy can play for changing practice and cross-border collaboration.

Can camp get you into a better secondary school? A field experiment of targeted instruction in Kenya

Access to quality secondary schooling can be life-changing for students in developing contexts. In Kenya, entrance to such schools was historically determined by performance on a high-stakes exam. Understandably then, preparation for this exam is a high priority for Kenyan families and educators. To increase the share of students entering these schools, some educational providers offer targeted instruction for students they believe have a chance of securing a spot. We use a randomized control trial to evaluate the impact of these “symposia” programs—week-long, sleep-away camps where eighth grade students receive a burst of academic instruction from teachers selected based on merit. While similar models have been tested in the U.S., less is known about this type of intervention in developing settings. We find these programs were not particularly effective for the average nominated student relative to a typical week of school. However, we find large, positive effects among students attending schools from which few students are nominated for symposia. We provide suggestive evidence that this was because students from lowrepresentation schools had less pre-camp practice test resources outside of school. The results have implications for program design and the growing literature on the effectiveness of appropriately targeted individualized instruction.

Implementing a quick Sequential (Sepsis-Related) Organ Failure Assessment sepsis screening tool: an interrupted times series study

Objective The aim of this study was to evaluate the outcomes of implementing a sepsis screening (SS) tool based on the quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and the presence of confirmed/suspected infection. The implementation of the 6-h bundle was also evaluated. Design Interrupted times series with prospective data collection. Setting Five hospital wards in a developing nation, Argentina. Participants A total of 1151 patients (≥18 years) recruited within 24–48 h of hospital admission. Intervention The qSOFA-based SS tool and the 6-h bundle. Main outcome measures The primary outcome was the timing of implementation of the first 6-h bundle element. Secondary outcomes were related to the adherence to the screening procedures. Results Of 1151 patients, 145 (12.6%) met the qSOFA-based SS tool criteria, among them intervention (39/64) patients received the first 6-h bundle element earlier (median 8 h; 95% confidence interval (CI): 0.1–16) than baseline (48/81) patients (median 22 h; 95% CI: 3–41); these times, however, did not differ significantly (P = 0.525). Overall, 47 (4.1%) patients had sepsis; intervention patients (18/25) received the first 6-h bundle element sooner (median 5 h; 95% CI: 4–6) than baseline patients (15/22) did (median 12 h; 95% CI: 0–33); however, times were not significantly different (P = 0.470). While intervention patients were screened regularly, only one-third of patients who required sepsis alerts had them activated. Conclusion The implementation of the qSOFA-based SS tool resulted in early, but not significantly improved, provision of 6-h bundle care. Screening procedures were regularly conducted, but sepsis alerts rarely activated. Further research is needed to better understand the implementation of sepsis care in developing settings.

Assessing trends of breast cancer and carcinoma in situ to monitor screening policies in developing settings

There have been arguments about the role of breast cancer screening at the population level, and some points of controversy have arisen, such the establishment of organized screening policies and the age at which to begin screening. The real benefit of screening has been questioned because the results of this practice may increase the diagnosis of indolent lesions without decreasing mortality due to breast cancer. The authors have proposed a study of incidence and mortality trends for breast cancer in a developing setting in Brazil to monitor the effectiveness of the official recommendations that prioritize the age group from 50 to 69 years. The database of the Cancer Registry and the Mortality Information System was used to calculate age-standardized and age-specific rates, which were then used to calculate incidence and mortality trends using the Joinpoint Regression Program. The results showed stability in trends across all ages and age-specific groups in both incidence and mortality. In conclusion, we found that incidence and mortality rates are compatible with those in regions with similar human development indexes, and trends have demonstrated stabilization. Thus, we do not endorse changes in the official recommendations to conduct screening for ages other than 50 to 69 years, nor should policy makers implement organized screening strategies.

Strengthening district healthcare in rural Africa: a cross-sectional survey assessing difficulties in pulse oximetry use and handoff practices

Background: Rural hospitals in sub-Saharan Africa suffer from numerous disparities in resources and practices, and subsequently patient care is affected.Methods: In order to assess current practices and opportunities for improvement in pulse oximetry use and patient-care handoffs, a cross-sectional survey was administered to clinicians at a referral level hospital serving a large rural area in Shinyanga, Tanzania.Results: Respondents (n=46) included nurses (50%), medical doctors (48%), and clinical officers (2%). A response rate of 92% was achieved, and 81% of clinicians acknowledged routine difficulties in the use of current devices when obtaining pulse oximetry. Although 83% of respondents reported using a written handoff at shift change, information reporting was inconsistent and rarely included specific management guidance.Conclusions: Further research is needed to elucidate handoff practices in developing settings, but there is a large opportunity for novel point-of-care devices and tools to improve both pulse oximetry use and patient care handoffs in rural Africa.

Innovation in a globalized world

PurposePrevious IMP research has shown that innovation benefits tend to gravitate across organisational, company and legal borders. However, OECD and EU policy assume that innovation investments will create benefits in close spatial relation to where these were made. The overall purpose of this paper is to consider how opportunities and obstacles of innovation appear from the perspective of: a national policy actor, its regional mediators and a policy supported and research-based firm engaged in innovation. A specific interest is directed to what interactive aspects that are considered by these actors; in the using, producing and developing settings.Design/methodology/approachInfluenced by the research question and theoretical point of departure the authors investigate what type of interfaces our focal actors recognise in the using, producing and developing settings. A total of 41 face-to-face and phone interviews focusing on each actor’s approach were conducted; 23 interviews in order to investigate the “policy side” of innovation attempts, while 18 interviews have been performed in order to understand a single business actor’s innovation approach.FindingsThe study shows that both the national policy agency and the regional policy mediators primarily operate within a developing setting, and furthermore, applies a rather peculiar interpretation of proximity. As long as the developing setting of the innovation journey is in focus, with the task to transfer academic knowledge advances to commercial actors, the proximity aspect is rather easy to fulfil. However, as soon as the producing and using settings of the innovation is taken into consideration, the innovation, if it survives, will gravitate to a producing setting where it can contribute to investments in place.Originality/valueThe study investigates the opportunities and obstacles of innovation; the spatial aspects included, and how these are considered by: a national policy agency, a regional mediator and a policy-supported innovating firm, in order to juxtapose the policy doctrine with the experience of the business actors such policy wishes to support.

Jungle beef: consumption, production and destruction, and the development process in the Brazilian Amazon

The environmental impacts of the global livestock industry are expected to continue increasing due to high meat consumption among affluent consumers in developed nations, and "new" consumers in emerging countries, such as Brazil. There is substantial research on the connections between international meat consumption and the destruction of Latin American environments, but less is known about the links between production/destruction and consumption in developing settings. In the western Amazon state of Acre, Brazil, increasing beef consumption is directly linked with local cattle production and environmental destruction, providing an opportunity to examine the relationships between these processes in a developing context. Interviews, participant-observation, and a standardized survey provide data on perceptions of beef and meat preferences, and how these relate to practices and patterns of consumption among a range of groups, from urban environmentalists to beef-loving cowboys. The results reveal how the hierarchical ordering of foods, with beef at the top, maps onto similar hierarchies of status and class, as well as notions of strength and nutrition. The analysis of beef consumption in a developing setting illustrates how beef is both a signifier of development and the symbolic and material fuel for a development process in which individuals, society, and the environment are transformed and improved. This study of local connections complements macro- and regional-level research on destruction and consumption linkages by offering insights on why consumers in a developing setting choose beef, and how the rubble and destruction of expanding Latin American agricultural frontiers is hidden, ignored, or written off in a discourse emphasizing the social and economic benefits of development. Keywords: Amazonia, beef, Brazil, cattle ranching, consumption, deforestation, development, food, meat

Cinco Pilares da Oncologia Moderna Bem Ilustrados neste Número da Gazeta Médica Dedicado a Cancro

A oncologia é hoje uma das áreas mais relevantes da saúde. Anualmente são diagnosticados 10 milhões de novos casos de cancro e morrem 8,7 milhões de doentes por ano com cancro, o que representa mais do que a soma das mortes devidas a malária, tuberculose e vírus da imunodeficiência humana (VIH).1 A incidência de cancro aumenta devido ao envelhecimento da população, aos nossos estilos de vida e ao rastreio e diagnóstico precoce. A mortalidade não tem acompanhado o aumento de incidência, felizmente, e, assistimos, por isto, a um aumento de prevalência de doentes com cancro e de sobreviventes. Assim, neste número da Gazeta Médica podemos ler exemplos ilustrativos das principais tendências da oncologia moderna. O diagnóstico precoce, seguimento apertado e abordagem multidisciplinar, o que leva a maior sobrevivência por intervenções terapêuticas racionais e atempadas, ilustradas no caso do adenocarcinoma do pulmão na mulher jovem não fumadora. Avanços tecnológicos cirúrgicos bem patentes no artigo sobre abordagem da doença metastática vertebral. Terapêutica sistémica dirigida a alvos moleculares com toxicidades diversas das toxicidades clássicas das terapêuticas sistémicas citotóxicas, como exemplificado no caso da pneumonite devido ao rituximab. O acompanhamento centrado no doente com avaliação de sintomas, nomeadamente, dos níveis de bem-estar psíquico, aqui avaliados no artigo do distress. E, finalmente, a necessidade urgente de criarmos programas de sobreviventes de cancro, abordando problemas como a fertilidade pós-terapêutica, discutidos no caso da jovem com adenocarcinoma do endométrio.Boas leituras deste número da Gazeta exclusivamente dedicado a cancro!Sofia Azambuja BragaCoordenadora Científica do Instituto CUF Oncologia 1. Moten A, Schafer D, Farmer P, Kim J, Ferrari M. Redefining global health priorities: Improving cancer care in developing settings. J Glob Health. 2014;4:010304.

Rainer Gross Award Lecture 2016

The need for improving methods of nutritional assessment and delivering primary health care globally cannot be overemphasized. While advances in medical technology typically create more disparities because of access being limited to resource-rich settings, a transition of health care to a mobile platform is increasingly leveling the field. Technological advances offer opportunities to scale laboratory procedures down to mobile devices, such as smartphones and tablets. Globalization also provides the required infrastructure and network capacity to support the use of mobile health devices in developing settings where nutritional deficiencies are most prevalent. Here, we discuss some of the applications and advantages provided by expanding markets of biomarker measurement coupled with primary health care and public health systems and how this is enhancing access and delivery of health services with significant global impact.