UK Cancer Healthcare Professionals Collaborating With Colleagues in Low- and Middle-Income Countries: Mapping the Extent and Nature of Partnerships; Future Implications.

AIMS: In 2020 the UK Global Cancer Network (UKGCN) was formed to unite those in the UK interested in Global Oncology and to strengthen collaborative partnerships with stakeholders working across low- and middle-income countries (LMICs) in cancer health systems, governance, and care. The UKGCN undertook a mapping exercise to document collaborations to inform the UK's global oncology strategy. MATERIALS AND METHODS: A semi-structured survey was developed and disseminated using a snowball method over ten weeks from February 2021 across the UK's cancer community, to identify individuals and institutions engaged in clinical practice, research, and/or education with partners in LMICs. The survey was sent to individuals in NHS hospitals, charities, universities, other organisations, UKGCN members, and to contacts identified by a literature and web search. RESULTS: A total of 639 invitations were sent, and 88 responses were received. Results demonstrate a range of collaborative efforts spanning many areas of cancer control: health promotion, prevention, diagnosis and treatment, survivorship, and palliative care. A wide range of countries were represented from Sub-Saharan Africa, South America, the MENA region, China, and South-East Asia. The projects included education and training (146), clinical practice/care (144), and research (226). CONCLUSION: This mapping exercise demonstrated considerable UK collaboration with stakeholders in LMICs across all three domains of education, clinical care, and research. The survey results provide an initial framework from which to promote in-depth strategic intelligence on the broad range of activities undertaken by the UK global oncology community. This information has been used as a catalyst to create new partnerships and connect colleagues working in similar geographical settings, encouraging bidirectional learning. The UKGCN will galvanise endeavours to improve equitable access to cancer services globally.

The Distribution of Dental Health Specialist Locations in Sri Lanka.

AIM: To investigate the distribution of dental health specialist locations staffed by Oral and Maxillo-Facial Surgeons (OMF), Restorative dentists, and Orthodontists in Sri Lanka in relation to population distribution and socio-economic status. METHODS: Specialist dental locations were mapped using GIS (Geographic Information System) and overlayed with census population data and socio-economic quintiles. RESULTS: Overall, there was an uneven geographic distribution of the total 55 specialist dental locations and 74 attributed specialist work force within the country. Access to specialist care is remarkably high in Western and Central provinces, compared to the Northern, Eastern and North Central provinces. When the geographic distribution was compared to population socio-economics, it was found that in Sri Lanka only 22.3%, 44.4%, and 25.4% of the most disadvantaged lived within 20 kms from an Orthodontic, OMF and Restorative clinic respectively, compared to 66.3%, 82.8% and 44.7% of the least disadvantaged. CONCLUSION: The findings of this study can contribute to the decision-making process when determining future locations of dental specialist clinics and identifying subgroups in the population who are geographically and socio-economically isolated from accessing care.

Groundwater fluoride in Sri Lanka: opportunities to mitigate the risk at maximum contaminant level

Introduction: High groundwater fluoride (F) is one of the major environmental hazards in the dry zone of Sri Lanka. The prolonged exposure to F at maximum contaminant levels can give rise to lifelong debility and disability among its inhabitants. Objectives: This study investigated the F contamination in groundwater resources in Sri Lanka above recommended Maximum Contaminant Levels (MCL) and possibilities to mitigate the health risk. Methods: Groundwater samples (6107) were randomly collected from different geographic areas of the country, and categorised as hazardous, if it exceeded the maximum contaminant level of 4 mg/L (the level at which bone health is compromised). The minimum distances from a hazardous to a relatively safe F groundwater source (below 1.0 mg/L and 1.5 mg/L) were determined using geospatial analysis. Results: Only 2.3% (142) of the total sample was found to be hazardous to skeletal health. Optimal F sources were identified in close proximity to highly contaminated sources (>4.0 mg/L), some even within a walking distance of 500 metres. Conclusions: The identification and elimination of maximally contaminated sources, possibly by dilution with widely available low F sources in close proximity, would be a more feasible and cost effective approach to ensure long term public health benefits.

Morphology of the tubercle of Zuckerkandl and its importance in thyroid surgery.

The tubercle of Zuckerkandl (ZT) is an embryological remnant of the thyroid gland. Its close relationship to the recurrent laryngeal nerve (RLN) makes it an important surgical landmark. Presence and size of the ZT was prospectively assessed during thyroidectomies done at a single surgical unit during 2013. Eighty patients were included in the study. Closest distance and relationship of the ZT to the RLN was measured. Median age was 48 years (range 20-75 years). The ZT was present in 72 (90%) patients at least on one side and 55 (69%) patients on both sides. Grade III tubercles were found in 17 (21.25%) patients. Average distance between RLN and the ZT was 1.2 mm posteriorly or posteromedially. In the majority (79%) RLN was lying at a distance of ≤1 mm. Pressure symptoms were present in 19 (23.75%) patients and it was not related to the presence of grade III tubercles (p = 0.207).