Leadership development training for brazilian orthopedic surgeons / Treinamento de desenvolvimento de liderança para cirurgiões ortopédicos brasileiros

ABSTRACT Objective: To report on the experience and impressions of the Brazilian orthopedic trauma surgeons attending the Leadership Development Program (LDP) hosted by the Sociedade Brasileira do Trauma Ortopédico (SBTO) in Sao Paulo, Brazil on November 4, 2022. Methods: Forty-eight orthopedic trauma surgeons from five different regions throughout Brazil were provided a link to complete The Big Five Test, a validated online personality assessment. The questionnaire was available in Portuguese and was intended to provide a background on individual personality traits and their influence on interpersonal interactions. The LDP integrated content from literature reviews specific to Latin America, established leadership programs from leading business schools, and various subject matter experts. Prior to the start of the LDP, participants received a pre-course survey evaluating demographic information, a needs assessment, and the prioritization of leadership topics utilizing a 5-point Likert-scale. Attendees participated in the one-day, interactive LDP focusing on the fundamental principles of leadership development, communication, personal development, emotional intelligence and negotiation. Following the LDP, a post-course evaluation was administered to determine the participants' overall experience, and suggestions for LDP improvement. Results: Forty-one of the forty-eight course participants completed the pre-course evaluation, whereas forty-six of the forty-eight participants completed the post-course evaluations. Overwhelmingly, the lack of opportunity was most prevalently reported as the main obstacle to attending a leadership course, as cited by 56% of respondents. Conclusion: Expanding the accessibility, diversity, and customizability of leadership programs can facilitate the development of personal tools needed to move healthcare forward. Critical topics include emotional intelligence and other differentiating leadership qualities that distinguish true transformational and servant leaders. Advancing leadership skills can stimulate networking, expose learners to experiential learning styles, inspire others to create positive change, and engender creative solutions for systematic improvements and health outcomes. Level of Evidence III; Individual Case-Control Studies.

RESUMO Objetivo: Relatar a experiência e as impressões de cirurgiões de trauma ortopédico brasileiros participantes do Programa de Desenvolvimento de Liderança (PDL), organizado pela Sociedade Brasileira do Trauma Ortopédico (SBTO), em São Paulo, Brasil, em 4 de novembro de 2022. Métodos: Quarenta e oito cirurgiões de trauma ortopédico de cinco regiões diferentes do Brasil receberam um link para preencher o The Big Five Test, uma avaliação de personalidade on-line validada. O questionário estava disponível em português e pretendia fornecer informações básicas sobre traços de personalidade individuais e sua influência nas interações interpessoais. O PDL integrou conteúdo de análises de literatura específicas da América Latina, e programas de liderança estabelecidos pelas principais escolas de negócios e por vários especialistas no assunto. Antes do início do PDL, os participantes receberam uma pesquisa pré-curso solicitando informações demográficas, uma avaliação de necessidades e a priorização de tópicos de liderança utilizando uma escala Likert de 5 pontos. Os participantes participaram do PDL interativo de um dia com foco nos princípios fundamentais de desenvolvimento de liderança, comunicação, desenvolvimento pessoal, inteligência emocional e negociação. Após o PDL, foi realizada uma avaliação pós-curso para determinar a experiência geral dos participantes e sugestões para melhoria do PDL. Resultados: Quarenta e um dos quarenta e oito participantes do curso concluíram a avaliação pré-curso, enquanto quarenta e seis dos quarenta e oito participantes concluíram a avaliação pós-curso. A falta de oportunidade foi relatada com maior prevalência como o principal obstáculo para frequentar um curso de liderança, conforme citado por 56% dos entrevistados. Conclusão: Expandir a acessibilidade, a diversidade e a personalização dos programas de liderança podem facilitar o desenvolvimento de ferramentas pessoais necessárias para fazer avançar os cuidados de saúde. Os tópicos críticos incluem inteligência emocional e outras qualidades de liderança diferenciadas, que distinguem verdadeiros líderes transformacionais e servidores O avanço das competências de liderança pode estimular o networking, expor os alunos a estilos de aprendizagem experiencial, inspirar outros a criar mudanças positivas e gerar soluções criativas para melhorias sistemáticas dos resultados na saúde. Nível de Evidência III; Estudos de caso-controle individuais.

Impact of COVID-19 containment measures on children with cancer in Indonesia

Introduction: Containment measures to limit COVID-19 spreading profoundly impact children around the globe, especially in low- and middle-income countries such as Indonesia. The aim of this case series study is to uncover the impact that COVID-19 measures have on Indonesian children with cancer and their families. Materials and Methods: A case series study was conducted in July 2021. Investigators identified three children diagnosed with cancer at an Indonesian referral hospital and studied their medical records. Caretakers were interviewed inside the hospital by an independent interviewer using a semi-structured questionnaire. Results: This study presents three children with cancer and their families. Access to proper healthcare was hindered during the COVID-19 pandemic due to mobility restrictions, medical staff shortage, limited chemotherapy and blood products availability, postponed medical procedures, and delayed or modified treatment administration. Financial hardships resulted because caretakers lost their jobs due to lockdowns and medication costs were no longer fully covered by health-insurance. Children and their relatives suffered from mental health issues. Anxiety, depression, stress, and loneliness were caused by the fear of receiving suboptimal cancer treatment, serious concerns about financial difficulties, and restricted social interactions. All families believed that COVID-19 measures worsened their children’s survival chances. Conclusion: COVID-19 measures adversely impact children with cancer and their families in Indonesia, and most likely in other low- and middle-income countries as well. Disruptions in timely and adequate childhood cancer treatment administration may importantly deteriorate survival chances. Governments and policymakers should take these indirect effects into account to protect vulnerable children and their families.

Early Identification of Autism Spectrum Disorder (ASD): Strategies for Use in Local Communities

Early diagnosis of autism spectrum disorder (ASD) is essential for improved outcomes. There is a paucity of data on the prevalence of ASD in low- and middle-income countries (LMIC), but early identifcation may be further delayed in those communities. In this paper, recent studies on strategies for the early detection of ASD, and the prevalence of ASD in LMIC are reviewed. The limitations that can arise in the early identifcation of ASD in LMIC communities are discussed, and screening tools and strategies that can be helpful are identifed. The goal is to recommend models that are culturally appropriate and scientifcally valid, easily integrated within community settings while strengthening community systems and reducing disparities in the early identifcation of ASD. Starting locally by simplifying and demystifying the ASD identifcation process and building community connections will inform global researchers and policymakers while making a diference in the lives of the children and families afected by ASD.

Barriers and Facilitators Factors to Uptake of Cervical Cancer Screening Among Women in Low- and Middle-income Countries: A Narrative Review

@#Cervical cancer is a worldwide health issue. Each year, it kills hundreds of thousands of women worldwide. Despite the availability of screening tests, the incidence of cervical cancer remains high in low and middle-income countries. In this review, we survey the current literature on factors affecting cervical cancer screening uptake among women in low and middle-income countries. It also highlights potential strategies for improving screening uptake and suggests directions for future research. Knowledge about cervical cancer and its screening, socio-demographic factors, personal and behavioural factors, cultural factors and beliefs, and health service factors are considered the main barriers and facilitators to cervical cancer screening uptake among women in low and middle-income countries. Understanding the facilitators and barriers to cervical cancer screening encountered by women in low and middle-income countries can improve screening uptake by overcoming inequalities in resource and information access. Culturally sensitive screening programs, improvement of the health system, and health education interventions to raise awareness of screening and its benefits can be effective strategies to improve screening uptake among women in low and middle-income countries.

A Neonatal Early Warning System (NEWS) in Port Moresby General Hospital, Special Care

@#The neonatal mortality rate in Papua New Guinea is high, estimated at 24 per 1000 live births. The neonatal case fatality rate in newborns in provincial and referral hospitals was 5.9% in 2021. Deteriorating newborns can be difficult to identify. This observational study investigated the feasibility of using a neonatal colour coded observation and response chart to identify neonates at risk of deterioration and to promptly escalate care in the Special Care Nursery of Port Moresby General Hospital. The chart was adapted from the Plymouth Hospital Neonatal Early Warning System chart, and was used to collect data over 8 weeks between 1st May and 30th June 2022. One hundred and fifty seven (157) neonates were observed over the 72 hours following admission to the Special Care Nursery. Neonates were grouped into those that had triggers (vital signs that fell in the red zone) and a stable group (who had no observations in the red zone). Of the 157 patients recruited 72 (45.9%) were stable, and 85 (54.1%) had triggers that should prompt a response. Forty seven (55.3%) of the neonates in the trigger group had appropriate interventions. Neonates with observations in the red zone (triggers) were more likely to die in the first 72 hours compared with those with no triggers. Most of the nurse responded positively to the introduction of the chart. Whilst the Neonatal Early warning System is a tool that can be used to identify neonates at risk of clinical deterioration, proper training of its use and knowledge of and appropriate escalation of care are necessary to ensure its benefit

Expected Benefits and Challenges of Using Economic Evaluations to Make Decisions About the Content of Newborn Screening Programs in Vietnam: A Scoping Review of the Literature

Abstract Screening newborns for genetic and other diseases is one of the most effective ways to improve health and reduce disease in a population. In developed countries, newborn screening has been a cornerstone of public health for decades. In many developing countries, however, newborn screening is still in its infancy. Many countries still lack screening programs. When a program is available, it generally lacks well-defined criteria on which decision-makers can justify the choice of diseases screened for and the methods used. One of the reasons put forward to understand this observation is the fact that little consideration is given by decision-makers to economic evaluations as a pillar of decision-making, as is the case in industrialized countries. This article provides a brief description of the challenges of using economic evaluation of newborn screening in developing countries. This will be illustrated by the example of the national newborn screening program in Vietnam.

Access to HER2?targeted therapy at a tertiary care center in India: An evolution

Background:In a previous retrospective audit from our institution we reported that patients had limited access to HER2-targeted therapy due to financial constraints. Subsequently, the advent of biosimilar versions of trastuzumab and philanthropic support has potentially changed this situation. Herein, we reanalyzed and reported access to HER2-targeted therapy in a more recent cohort of patients. Methods: Medical records of new breast cancer patients registered in one calendar year were retrospectively reviewed, supplemented by online pharmacy data to extract information on receptor status, use of HER2-targeted therapy, and other relevant variables. Since not all HER2 immunohistochemistry (IHC) 2+ tumors underwent fluorescent in-situ hybridization (FISH) testing, we estimated the probable HER2 amplified from this group based on a FISH amplified fraction in those HER2 2+ tumors who did undergo FISH. Results: Between January 2016 and December 2016, 4717 new BC patients were registered at our institution, of whom 729 (20.04%) had HER2 IHC 3+ tumors while 641 (17.62%) had HER2 IHC 2+ tumors. The final number of HER2 overexpressing/amplified tumors was estimated to be 928 (729 HER2 IHC 3+, 105 known FISH amplified, and 94 estimated FISH amplified), of whom 831 received treatment at our institution. Overall 474 (57.03%, 95% confidence interval [CI] 53.6–60.4) of these 831 patients received trastuzumab for durations ranging from 12 weeks to 12 months in the (neo)adjuvant setting or other durations in metastatic setting compared to 8.61% (95% CI 6.2–11.6) usage of HER2-targeted therapy in the 2008 cohort. Conclusion: Access to HER2-targeted therapy has substantially increased among patients treated at a public hospital in the past decade, likely due to the advent of biosimilars, the use of shorter duration adjuvant regimens, and philanthropic support. However, further efforts are required to achieve universal access to this potentially life-saving treatment.

Validity of the computerized version of the pediatric triage system CLARIPED for emergency care

Abstract Objective: To evaluate the validity of the computerized version of the pediatric triage system CLARIPED. Methods: Prospective, observational study in a tertiary emergency department (ED) from Jan-2018 to Jan-2019. A convenience sample of patients aged 0-18 years who had computerized triage and outcome variables registered. Construct validity was assessed through the association between urgency levels and patient outcomes. Sensitivity, specificity, positive and negative predictive values (PPVand NPV), undertriage, and overtriage rates were assessed. Results: 19,122 of 38,321 visits were analyzed. The urgency levels were: RED (emergency) 0.02%, ORANGE (high urgency) 3.21%, YELLOW (urgency) 35.69%, GREEN (low urgency) 58.46%, and BLUE (no urgency) 2.62%. The following outcomes increased according to the increase in the level of urgency: hospital admission (0.4%, 0.6%, 3.1%, 11.9% and 25%), stay in the ED observation room (2.8%, 4.7%, 15.9%, 40.4%, 50%), ≥ 2 diagnostic or therapeutic resources (7.8%, 16.5%, 33.7%, 60.6%, 75%), and ED length of stay in minutes (18, 24, 67,120, 260). The odds of using ≥ 2 resources or being hospitalized were significantly greater in the most urgent patients (Red, Orange, and Yellow) compared to the least urgent (Green and Blue): OR 7.88 (95%CI: 5.35-11.6) and OR 2.85 (95%CI: 2.63-3.09), respectively. The sensitivity to identify urgency was 0.82 (95%CI: 0.77-0.85); specificity, 0.62 (95%CI: 0.61-0.6; NPV, 0.99 (95%CI: 0.99-1.00); overtriage rate, 4.28% and undertriage, 18.41%. Conclusion: The computerized version of CLARIPED is a valid and safe pediatric triage system, with a significant correlation with clinical outcomes, good sensitivity, and low undertriage rate.

Neonatal Seizures—Perspective in Low-and Middle-Income Countries

Neonatal seizures are the commonest neurological emergency and are associated with poor neurodevelopmental outcome. While they are generally difcult to diagnose and treat, they pose a signifcant clinical challenge for physicians in low- and middle-income countries (LMIC). They are mostly provoked seizures caused by an acute brain insult such as hypoxic– ischemic encephalopathy (HIE), ischemic stroke, intracranial hemorrhage, infections of the central nervous system, or acute metabolic disturbances. Early onset epilepsy syndromes are less common. Clinical diagnosis of seizures in the neonatal period are frequently inaccurate, as clinical manifestations are difcult to distinguish from nonseizure behavior. Additionally, a high proportion of seizures are electrographic-only without any clinical manifestations, making diagnosis with EEG or aEEG a necessity. Only focal clonic and focal tonic seizures can be diagnosed clinically with adequate diagnostic certainty. Prompt diagnosis and timely treatment are important, with evidence suggesting that early treatment improves the response to antiseizure medication. The vast majority of published studies are from high-income countries, making extrapolation to LMIC impossible, thus highlighting the urgent need for a better understanding of the etiologies, comorbidities, and drug trials evaluating safety and efcacy in LMIC. In this review paper, the authors present the latest data on etiology, diagnosis, classifcation, and guidelines for the management of neonates with the emphasis on low-resource settings.

O desafio de envelhecer na América Latina: cuidados prolongados na Costa Rica / The challenge of ageing in Latin America: long-term care in Costa Rica

Resumo Embora políticas públicas de cuidados prolongados estejam começando a ser implementadas na América Latina, poucos estudos analisam a situação dos países que compõem a região. Este estudo tem por objetivo examinar programas públicos de cuidados prolongados na Costa Rica e estimar a demanda do país por cuidados formais. Os dados foram obtidos por meio de revisão das Contas Nacionais de Saúde, cinco entrevistas com representantes de instituições governamentais, revisão da literatura científica e relatórios oficiais, e análise dos dados extraídos de uma pesquisa nacional de cuidados. Os resultados indicam a existência de programas fragmentados e focados no enfrentamento à pobreza que não foram projetados para atender às necessidades de cuidados prolongados. Estima-se que, atualmente, 13,4% dos idosos da região necessitam de ajuda na execução de atividades básicas da vida diária, e que o trabalho informal de cuidados é intensivo, oferecido principalmente por um membro da família, e não remunerado.

Abstract Latin America is beginning to implement long-term care public policies. But only a few studies look at the situation of the countries in the region. This study aims to examine long-term care public programs in Costa Rica and to estimate the country's demand for formal care. For this purpose, we have revised its National Health Accounts, conducted five interviews with representatives of governmental institutions, reviewed the scientific literature and official reports, and analyzed the data drawn from a national care survey. The results show the existence of fragmented, poverty-focused programs that were not designed for long-term care needs. The estimated percentage of older adults in the region that currently require help to perform activities of daily living is 13.4%. The informal care work is intensive, mostly provided by a family member, and unpaid.

Association between physical education classes and physical activity among 187, 386 adolescents aged 13-17 years from 50 lowand middle-income countries

Abstract Objective: This study aimed to examine the association between physical education classes and PA among adolescents from 50 lowand middle-income countries (LMICs). Methods: A self-reported questionnaire from the Global School-based Student Survey (GSHS) was used to collect information on participation frequency of physical education classes and being physically active over the last week, as well as other control variables (e.g., sex, age, country, sedentary behavior). Multivariable logistic regression and a pooled meta-analysis were performed to explore the association and compared country-wise differences. Results: Included adolescents aged from 13 to 17 years (n = 187,386, %boys = 51.7; mean age = 14.6 years), the prevalence of sufficient PA (meeting the PA guidelines) was 14.9%. The prevalence of 5 days or more to engage in physical education classes was 16.5%. Compared with adolescents who had 0 days for physical education classes, higher participation frequency was more likely related to sufficient PA (OR: 1 day = 1.34, 2 days = 1.66, 3 days = 1.67, 4 days = 1.79, 5 days or more = 2.46), these findings were also observed in both sexes. A moderate inconsistency on the association across the included countries was found (I2 = 53%, p < 0.01), although the pooled OR was 1.50 (95% CI: 1.36-1.65). Conclusions: Participating in more physical education classes may be an effective approach to increase physical activity levels among adolescents in LMICs. However, promoting physical activity levels among adolescents in LMICs through physical education classes should consider more country-specific factors.

Longitudinal measurement invariance of neuropsychological tests in a diverse sample from the ELSA-Brasil study

Objective: Longitudinal measurement invariance analyses are an important way to assess a test's ability to estimate the underlying construct over time, ensuring that cognitive scores across visits represent a similar underlying construct, and that changes in test performance are attributable to individual change in cognitive abilities. We aimed to evaluate longitudinal measurement invariance in a large, social and culturally diverse sample over time. Methods: A total of 5,949 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were included, whose cognition was reassessed after four years. Longitudinal measurement invariance analysis was performed by comparing a nested series of multiple-group confirmatory factor analysis models (for memory and executive function factors). Results: Configural, metric, scalar and strict invariance were tested and supported over time. Conclusion: Cognitive temporal changes in this sample are more likely to be due to normal and/or pathological aging. Testing longitudinal measurement invariance is essential for diverse samples at high risk of dementia, such as in low- and middle-income countries.

Living well with kidney disease by patient and care-partner empowerment: kidney health for everyone everywhere / Cómovivirbien con unaenfermedad renal a través del empoderamiento del paciente y de sucuidador: salud renal para todosentodaspartes

Abstrac Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize burden and consequences of CKD related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including emphasis on patients being in control. The World Kidney Day (WKD)Joint Steering Committee has declared 2021 the year of "Living Well with Kidney Disease" to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics.In the overall wellness program for kidney disease patients, the need for prevention should be reiterated. Early detection with prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries.

Resumen Vivir con unaenfermedad renal crónica (ERC) se asocia con dificultadestanto para lospacientescomo para suscuidadores. Empoderar a lospacientes y a suscuidadores, incluidoslosfamiliares y amigos que losasisten, minimiza la carga y las consecuencias de lossíntomas de la ERC y posibilitaparticiparenactividadescotidianas. Esnecesarioampliar el enfoque para lograrunabuenacalidad de vida para lospacientes con nefropatías y que puedanretomarsuvidadiaria, y hacerhincapiéen que estostengan el control. El ComitéDirectivo del Día Mundial del Riñón (DMR) ha declarado el 2021 el año de "Vivirbien con unaenfermedad renal" para aumentarlosconocimientos y generarconcienciaacerca de la importancia de empoderar al paciente y de que participenen las actividadescotidianas. Estoexige el desarrollo y la implementación de criterios de valoración de losresultadoscomunicadosporlospacientes para evaluar y enfocarseenáreas de la vidacotidianaen el cuidado. Podríacontarse con el aval de organismosregulatorioscomomedida de la calidad de cuidado o para darrespuesta a losreclamosacerca del etiquetado de medicamentos y dispositivos. Las agencias de financiamientopodríanlanzarconvocatorias para investigaciones que se centrenen las prioridades de lospacientes. Los pacientes con enfermedad renal y suscuidadoresdebenrecibirapoyo para llevarunabuenavida a través del esfuerzocoordinado de las sociedades de investigación renal, incluso, duranteunapandemia. Esprecisoreiterar la importancia de la prevenciónenlosprogramasintegrales de bienestar para pacientesrenales. Deben promoverse la deteccióntemprana con evoluciónprolongada del bienestar a pesar de la enfermedad renal luego de programas de prevenciónsecundarios y terciarios. El DMR 2021 siguefomentandouna mayor concienciaacerca de la importancia de las medidaspreventivasen la población, profesionales y legisladores, que se apliquenenpaísesdesarrollados y envías de desarrollo.

Active surveillance of carbapenem-resistant Gram-negative healthcare-associated infections in a low-middle-income country city

ABSTRACT Background: Carbapenem-resistance in healthcare-associated infections (HCAIs) is of great concern, and it is urgent to improve surveillance. We aimed to describe and analyze HCAIs trends on Gram-negative antimicrobial susceptibility in a city from a developing country, following the implementation of an active surveillance program. Methods: This is an aggregated study describing data from 24 hospitals with intensive care units, including a trend analysis by Joinpoint regression between January 2012 and December 2017. Results: There were 23,578 pathogens in 39,832 HCAIs, from which 16,225 were Gram-negatives (68.8%). Carbapenem susceptibility was lowest in A. baumannii (15.4-25.9%), K. pneumoniae (51.0-55.9%), and P. aeruginosa (64.9-84.1%) and highest in E. coli (96.5-99.2%). Only K. pneumoniae showed a significant Joinpoint at 95% confidence interval: −10.71% (−18.02; −2.75) from 2012 to 2014, p = 0.02, and 6.54% (−2.00; 15.83) from 2015 to 2017, p = 0.12, which was most influenced by urinary tract infections: −9.98% (−16.02; −3.48) from 2012 to 2014, p = 0.01, and 9.66% (−1.75; 22.39) from 2015 to 2017, p = 0.09. Conclusion: Although we found a significant change toward an improvement in carbapenem susceptibility in K. pneumoniae, resistance is high for most pathogens. These data should encourage health institutions to improve their prevention and control strategies.

Patient needs four years after first psychiatric hospitalization in a Brazilian cohort

Knowledge about the needs of psychiatric patients is essential for mental health care planning. However, research on met and unmet needs is still scarce, particularly in low- and middle-income countries. This study aimed to describe the patients' needs (met and unmet) at least four years after their first psychiatric hospitalization and to verify the role of demographic and clinical features as possible predictors of these needs. Patients who had their first psychiatric admission between January 1, 2006 and December 31, 2007 at an inpatient unit in the city of Ribeirão Preto, Brazil, were eligible to participate in the study. Patients were contacted and face-to-face interviews were conducted by psychologists using the Camberwell Assessment of Need. Data were analyzed using zero-inflated negative binomial regression model. Of 933 eligible patients, 333 were interviewed. The highest level of needs was related to welfare benefits (32.4%, unmet=25.5%), followed by household skills (30.3%, unmet=3.0%), psychotic symptoms (29.4%, unmet=9.0%), psychological distress (27.6%, unmet=8.4%), physical health (24.3%, unmet=5.4%), daytime activities (19.5%, unmet=16.5%), and money (16.8%, unmet=9.0%). Fewer years of schooling, living with relatives, and unemployment at the moment of the first admission were significantly associated with a higher number of both met and unmet needs in the follow-up. Unmet needs were also more often reported by patients living alone. In conclusion, socioeconomic indicators were the best predictors of needs. The unmet needs related to welfare benefits point to the need for specific social and health policies.

Living well with kidney disease by patient and care-partner empowerment: kidney health for everyone everywhere

Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize burden and consequences of CKD-related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of "Living Well with Kidney Disease" in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness program for kidney disease patients, the need for prevention should be reiterated. Early detection with prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries.

Population neuroscience: challenges and opportunities for psychiatric research in low- and middle-income countries

Objective: Population neuroscience is an emerging field that combines epidemiology and neuroscience to study how genes and the environment shape typical and atypical brain functioning. The objective of this study was to review key studies on population neuroscience from low- and middle-income countries (LMICs) and to identify potential gaps vis-à-vis studies conducted in high-income countries. Methods: We conducted a systematic review to search for longitudinal cohort studies investigating the development of psychiatric disorders in children and adolescents in LMICs. We performed an electronic search in the EMBASE and MEDLINE databases from inception to July 5th, 2019. Results: We found six cohorts from four countries that met our search criteria: three cohorts from Brazil, one from China, one from South Africa, and one from Mauritius. Relevant examples of findings from these studies are reported. Conclusion: Our results demonstrate the impact of the valuable science output these cohort designs promote, allowing LMICs to have a share in frontline global psychiatry research. National and international funding agencies should invest in LMIC population neuroscience in order to promote replication and generalization of research from high-income countries.

A scoping review on barriers to implementation of health education programs in low to middle income countries

We aimed to map literature on the barriers to effective implementation of health education programs (HEPs) in low to middle income countries (LMICs) to guide future implementation research. We employed a rigorous scoping review design. Our review was guided by the Arksey and O’Malley framework, 2005, further enhanced by Levac et al. The keyword search was comprehensive for relevant studies presenting evidence on barriers to implementation of HEPs in LMICs from Google Scholar, PubMed, EBSCOHost (CINAHL and Academic Search Complete) databases and grey literature. The first search identified 3,092 articles, of which 1,412 duplicates were eliminated. An additional 1,632, 34 and 7 articles did not meet the inclusion criteria based on sequential title screen, abstract review and full text review respectively. Seven studies met the inclusion criteria for the actual scoping review. Findings of the review revealed three categories of barriers to effective implementation of HEPs in LMICs grouped as individual or patient level, community level and population level barriers. A key barrier to effective implementation of HEPs in LMICs revealed from the review was socio-economic challenges, which result from resource constraints. This calls for adequate allocation of the limited resources toward health education to ensure effective implementation of HEPs in LMICs and improve health outcomes.

Tobacco control in Mexico: a decade of progress and challenges / El control de tabaco en México: una década de avances y desafíos

Abstract: Mexico was the first country in the Americas to sign and ratify the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. More than a decade later, it is appropriate to evaluate legislative and regulatory progress and the associated challenges; and also, to propose a roadmap to prioritize the problems to be addressed to achieve long-term sustainable solutions. Mexico has made substantial progress in tobacco control. However, regulations have been only weakly enforced. The tobacco industry continues to interfere with full implementation of the WHO-FCTC. As a result, tobacco consumption remains stable at about 17.6%, with a trend upwards among vulnerable groups: adolescents, women and low-income groups. The growing popularity of new tobacco products (electronic cigarettes or e-cigs) among young Mexicans is an increasing challenge. Our review reveals the need to implement all provisions of the WHO-FCTC in its full extent, and that laws and regulations will not be effective in decreasing the tobacco epidemic unless they are strictly enforced.

Resumen: México fue el primer país de América en firmar y ratificar el Convenio Marco de la OMS para el Control del Tabaco (CMCT-OMS) en 2004. Un poco más de una década después, es relevante evaluar aspectos legislativos, regulatorios, avances y desafíos, además de proponer una ruta crítica con soluciones sustentables a largo plazo. México ha avanzado en el control del tabaco; sin embargo, las medidas se han implementado parcialmente y la industria del tabaco continúa interfiriendo con la implementación completa del CMCT-OMS. Como resultado, el consumo de tabaco se mantiene estable alrededor de 17.6%, con una tendencia ascendente entre los más vulnerables: adolescentes, mujeres y grupos de bajos ingresos. La creciente popularidad de uso de los e-cig entre los jóvenes mexicanos trae nuevos y complejos desafíos. Es perentorio implementar al más alto nivel todas las disposiciones del CMCT-OMS: las leyes y los reglamentos no serán eficaces para abatir la epidemia de tabaquismo si no se aplican adecuadamente.

Assisted reproductive technology: prevalence and associated factors in Southern Brazil

ABSTRACT OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.