Private healthcare initiatives in developing countries - Building sustainable neurosurgery in Indonesia and Pakistan.

Introduction: Severe global shortages in neurosurgery, surgery, and healthcare in general have been documented, especially in low- and middle-income countries (LMICs). Research question: In LMICs, how do we expand both neurosurgery and overall healthcare? Material and methods: Two different approaches to improving neurosurgery are presented. Author EW convinced a private hospital chain that neurosurgical resources were important throughout Indonesia. Author TK established a consortium (Alliance Healthcare) to obtain financial support for healthcare in Peshawar, Pakistan. Results: The expansion over 20 years in neurosurgery (throughout Indonesia) and in healthcare (for Peshawar and Khyber Pakhtunkhwa (KP) province, Pakistan) is impressive. In Indonesia, neurosurgery centers have expanded from one in Jakarta to over 40 throughout the islands of Indonesia. In Pakistan, two general hospitals, schools of medicine, nursing, and allied health professions, and an ambulance service have been established. Recently US$11 million has been awarded to Alliance Healthcare by the International Finance Corporation (the private sector arm of the World Bank Group) to further expand healthcare infrastructure in Peshawar and KP. Discussion and conclusion: The enterprising techniques described here can be implemented in other LMIC settings. Three keys to success both programs utilized: (1) educating the community (population at large) of the need for surgery in particular to improve overall healthcare; (2) being entrepreneurial and persistent in seeking the community support and the professional and financial support needed to advance both neurosurgery and overall healthcare through the private sector; (3) creating sustainable training and support institutions and policies for young neurosurgeons.

Hydrocephalus is an independent factor affecting morbidity and mortality of ICH patients: Systematic review and meta-analysis.

Background: Despite advances in our knowledge of the causes, preventions, and treatments of stroke, it continues to be a leading cause of death and disability. The most common type of stroke-related morbidity and mortality is intracerebral haemorrhage (ICH). Many prognostication scores include an intraventricular extension (IVH) after ICH because it affects mortality independently. Although it is a direct result of IVH and results in significant damage, hydrocephalus (HC) has never been taken into account when calculating prognostication scores. This study aimed to evaluate the significance of hydrocephalus on the outcomes of ICH patients by meta-analysis. Methods: Studies that compared the rates of mortality and/or morbidity in patients with ICH, ICH with IVH (ICH â€‹+ â€‹IVH), and ICH with IVH and HC (ICH â€‹+ â€‹IVH â€‹+ â€‹HC) were identified. A meta-analysis was performed by using Mantel-Haezel Risk Ratio at 95% significance. Results: This meta-analysis included thirteen studies. The findings indicate that ICH â€‹+ â€‹IVH â€‹+ â€‹HC has higher long-term (90-day) and short-term (30-day) mortality risks than ICH (4.26 and 2.30 higher risks, respectively) and ICH â€‹+ â€‹IVH (1.96 and 1.54 higher risks). Patients with ICH â€‹+ â€‹IVH â€‹+ â€‹HC have lower rates of short-term (3 months) and long-term (6 months) good functional outcomes than those with ICH (0.66 and 0.38 times) or ICH â€‹+ â€‹IVH (0.76 and 0.54 times). Confounding variables included vascular comorbidities, haemorrhage volume, midline shift, and an initial GCS score below 8. Conclusion: Hydrocephalus causes a poorer prognosis in ICH patients. Thus, it is reasonable to suggest the inclusion of hydrocephalus in ICH prognostication scoring systems.

Potential Correlates of Internet Gaming Disorder Among Indonesian Medical Students: Cross-sectional Study.

BACKGROUND: Internet gaming disorder has been a controversial topic for nearly a decade. Although internet addiction has been studied in medical students, there is a paucity of evidence regarding internet gaming disorder. Previous studies in Indonesia explored only the prevalence rate and characteristics. OBJECTIVE: This study aimed to determine the prevalence rate of internet gaming disorder and correlations between internet gaming disorder, temperament, and psychopathology among Indonesian medical students. METHODS: A cross-sectional study was performed from August 2019 to September 2019 using total and convenience sampling at a private university and a public university, respectively. The study variables were measured using the Indonesian version of the 10-item Internet Gaming Disorder Test, the Temperament and Character Inventory, and the Symptoms Checklist 90. Chi-square and logistic regression analyses were conducted to examine the relationships between demographic factors, temperament, psychopathology, and the presence of internet gaming disorder. RESULTS: Among the 639 respondents, the prevalence rate of internet gaming disorder was 2.03% (n=13), with a mean age of 20.23 (SD 0.13) years and an average gaming duration of 19.0 (SD 0.96) hours/week. Up to 71.2% respondents played using their mobile phones, and respondents with internet gaming disorder reported experiencing all psychopathologies assessed, except phobic anxiety. Bivariate analysis demonstrated that internet gaming disorder was associated with gender, gaming duration, gaming community affiliation, and 9 out of 10 domains of psychopathology. In a logistic regression model, internet gaming disorder was correlated with weekly gaming hours ≥20 hours (odds ratio [OR] 4.21, 95% CI 1.08-16.38, P=.04). CONCLUSIONS: These findings suggest that the prevalence of internet gaming disorder among medical students in Jakarta, Indonesia is similar to that in other populations of Asian countries. The predisposing factor for internet gaming disorder was weekly gaming duration, while other demographic, temperament, and psychopathology variables acted as probable moderators. Strategies should, therefore, be developed and integrated into medical curriculum to screen and aid individuals with these predisposing factors.

Correction: Potential Correlates of Internet Gaming Disorder Among Indonesian Medical Students: Cross-sectional Study.

[This corrects the article DOI: 10.2196/25468.].

Awake Craniotomy in a Low- to Middle-Income Country: A Sustainability Analysis.

OBJECTIVE: This study evaluated the sustainability of teaching awake craniotomy in Indonesia. We explored the factors affecting how awake craniotomy can be taught in a low- to middle-income (LMIC) country and the factors affecting the utilization of awake craniotomy in Indonesia. METHODS: This is a prospective mixed-methods study in Indonesia. A questionnaire was administered to 100 neurosurgeons at a conference on their experience with neuro-oncology, awake craniotomy, and teaching missions. Thirty-three physicians participated in semi-structured interviews elaborating on these topics. Data on tumor caseload and resources were collected. RESULTS: Thirty-three of 88 respondents (41.3%) indicated that they still perform awake craniotomy. Although 87.3% felt that it was beneficial for patients and resource sparing, less than a quarter of them felt they had sufficient exposure/training in awake craniotomy. Almost all of them wanted further training and to maintain a relationship with international mentors. Four themes emerged about the factors that affect how we teach awake craniotomy in an LMIC: 1) the sustainability of a teaching mission is dependent on a culture of information sharing and 2) the support of multiple health care providers; 3) hospital structure affects how changes are implemented; and 4) health care professionals in Indonesia value opportunities for international training. Regarding the uptake of awake craniotomy in Indonesia, there are sociocultural factors that affect patients' receptiveness to surgery and the national insurance plan restricts the provision of neurosurgical care. CONCLUSIONS: Many factors need to be explored when planning a neurosurgical mission in LMICs to ensure its sustainability.