Concerns about vaccines and vaccination behavior among Japanese budget travelers to India.

BACKGROUND: Low vaccination coverage among travelers poses a critical challenge to global health security. Indeed, public concerns regarding vaccines can lead to vaccine reluctance and refusal, but evidence about the impacts of concerns regarding vaccines on the uptake of travel vaccinations remains sparse. We examined the associations between concerns about vaccines and vaccination behavior among travelers. METHODS: Japanese travelers aged 18 years or older, who stayed at a guesthouse in New Delhi, India, were targeted (n = 153). We conducted cross-sectional surveys from August 23 to September 2, 2019, and from February 19 to March 5, 2020. We examined the associations of three concerns regarding vaccines (5-point scale)-serious side effects from vaccines, vaccine safety, and vaccine effectiveness-with the uptake of travel vaccinations. RESULTS: In total, 60 participants (39.2 %) had been vaccinated for this or a past trip. After adjusting for all potential confounding variables, concerns about serious side effects from vaccines and vaccine safety were negatively associated with the uptake of travel vaccinations. The ORs (95 % CIs) for 1-point increases in concerns about serious side effects from vaccines and vaccine safety were 0.72 (0.52, 0.99) and 0.71 (0.52, 0.96), respectively. Sensitivity analyses did not change the results substantially. CONCLUSIONS: Concerns about vaccine safety issues were negatively associated with the uptake of travel vaccinations among the participants, with no corresponding association observed for vaccine effectiveness. Addressing concerns about vaccine safety issues, rather than vaccine effectiveness may contribute to an increased uptake of travel vaccinations.

Chronic illness experience in the context of resource-limited settings: a concept analysis.

AIM: This review describes the ways in which individuals experience chronic illnesses in resource-limited settings; to define the concept and understand its attributes, antecedents and consequences. METHODS: A comprehensive analysis of the databases CINAHL, PubMed and Google Scholar was conducted. During literature search the following limits were applied: articles published in English with available full-text; articles that focused on living with chronic illness in adults from the patient's perspective. RESULTS: The following three attributes of chronic illness experience were identified: transformational experience, acceptance and self-management. Prominent predisposing factors (antecedents) were: genetic inheritance, malnutrition and poverty, high levels of stress and unhealthy lifestyle. The most dominant consequences were as follows: impact on quality of life; self-management burden; burden to others and economic stressors. CONCLUSIONS: The findings underscore the need for health-care professionals to understand the chronic illness experience in the context of resource-limited settings and its consequences. The greater insights into the concept of chronic illness experience in resource-limited settings will guide nurses to support people in the realities of chronic illness experience in resource-limited settings in developing countries. This knowledge can guide nurses in providing competent care to chronically ill individuals, including meeting their individual needs with such illnesses.

Feasibility of focused parathyroidectomy in developing countries-a scoping review.

Background: The mainstay of treatment of primary hyperparathyroidism involves a parathyroidectomy, which depending on the number of affected parathyroid glands and the availability of resources, may involve a bilateral neck exploration with four gland assessment or a minimally invasive, focused parathyroidectomy (FP) necessitating pre-operative localisation. The feasibility of the latter is yet to be demonstrated in developing countries. Methods: A scoping review was performed with published literature evaluated from the past 15 years (2007 & onwards). Articles were screened and only included if they discussed FP, preoperative localisation, economic impact and they originated from a developing country (upper middle or lower middle-income). Results: A total of 18 articles met the inclusion criteria, comprising seven developing countries (two upper middle-income and five lower middle-income countries). Preoperative localisation was performed in all studies, with overall accuracy rates of 75.5% for ultrasound and 85.7% for 99mTc sestamibi. A total 1,202 patients (70%) had FP. Five hundred and fifty-five patients underwent FP without intraoperative adjuncts and 647 underwent FP with intraoperative adjuncts, with adjusted cure rates of 95.3% and 99.2% respectively. Overall cure rate for FP was 96.4%. Conclusions: With access to accurate preoperative localisation and excellent cure rates with and without intraoperative adjuncts, we conclude that FP is feasible in developing countries.

Hodgkin Lymphoma in Children: A 16-year Experience at the Children's Welfare Teaching Hospital of Baghdad, Iraq.

Background: Childhood Hodgkin lymphoma (HL) is an eminently curable disease. Good outcomes can be achieved even in resource-limited settings, and the focus is increasingly on limiting long-term toxicity. Contemporary treatment incorporates a risk-stratified, response-adapted approach using multiagent chemotherapy with/without low-dose radiotherapy. Many developing countries continue to use ABVD-based regimens due to limited acute toxicity, cost, and ease of delivery. Objective: We herein report the outcomes of childhood HL diagnosed and treated in an Iraqi single centre over 16 years. Methods: Children ≤14 years old with biopsy-proven HL were enrolled. Most patients received ABVD chemotherapy or COPP/ABV when Dacarbazine was unavailable. Radiotherapy was not available. Results: Three hundred-three children were consecutively newly diagnosed with HL; 284 were considered eligible for the retrospective analysis (treatment refusals 9; deaths before therapy 5; initially diagnosed of non-Hodgkin lymphoma 5). ABVD scheme was administered to 184 children (65%), COPP/ABV to 83 (29%), and other schemes to the remaining 17 patients. Complete response (CR) was achieved in 277 (98%); 4 (1.4%) showed disease progression, and 1 had stable disease. Four patients in CR abandoned therapy and were in CR at the time of analysis, 2 died from infection. Relapse occurred in 42 patients (15%). The 15-year OS and EFS are 89.7% and 70.3%, respectively. Conclusion: In this single Centre, over 16 years, almost 90% of children suffering from HL survive, despite the numerous limitations in diagnostic procedures, shortage of chemotherapy, no radiotherapy facilities, absence of effective second-line treatments, and finally, therapy abandonment for social and financial reasons.

Cross-sectional study: mindset towards Coronavirus in developing countries and lessons learned: the case of Sudan.

Introduction: People's mindset towards COVID-19 in developing countries has an impact on how they perceive and react to the preventative measures taken by the governments to contain the virus. Understanding the factors influencing the mindset and identifying lessons learned amidst COVID-19 are critical to inform any future intervention strategy. Methods: This was a cross-sectional, community-based study conducted to assess the mindset changes and lessons learned post-COVID-19 in developing countries, focusing on Sudan. The study adopted a sequential mixed approach (SMA), combining qualitative and quantitative methods. The study used a structured questionnaire with 300 respondents and in-depth interviews with two experts. To identify the factors influencing the mindset of the people towards COVID-19, the study employed logistic regression. The data was analyzed using SPSS software. Results: Of the total (N = 300) respondents, 59.0% are female, 59.3% are between the ages of 20 and 39, 79.7% have a university education, 25.3% have the Coronavirus, and 42.3% has their family or relative contracted the virus. Further, only 22.7% had taken the vaccine. Reasons for vaccine hesitancy include lack of trust (29.5%), fear of side effects (24.1%), and absence of the need to travel outside the country (25.5%). When the virus first appeared, 77.3% thought it posed a health risk, while 22.7% perceived it as a hoax or conspiracy. After 3 years, 73% still regarded it as a health threat, while 27% believed it was a hoax or conspiracy. The mindset was found to be influenced by age, history of the disease, the extent of trust in foreign media coverage, and the belief in the effectiveness of the vaccination. Conclusion: Assessing the mindset towards the virus and identifying the lessons learned from the pandemic could be of vital importance to control the spread of the virus in developing countries. Making use of such lessons and influencing the mindset of the people towards positive attitudes and behaviours are required to enhance the effectiveness of the health precaution measures adopted. Further research is required on the public's mistrust of foreign media coverage and the contribution of local media to educate the public about the virus, particularly among the elderly.

Core recommendations of effective preconception counselling services in low-and-middle-income countries - A scoping review.

BACKGROUND: Extensive guidelines and recommendations are available for preconception counselling service in high-income-countries. However limited comprehensive recommendations are available for preconception care and counselling in low-and-middle-income countries (LMICs), where most of maternal mortality occurs in the settings. AIM/OBJECTIVES: This review aims to identify any design, model or set of recommendations for their potential adoption to develop preconception care and counselling service for LMICs context. METHODS: A systematic literature search was conducted in five major databases to identify articles covering any designs, models or recommendations on preconception care, for or from LMICs settings published between 2013-2023. Articles on any single screening for preconception counselling, those evaluating the service without specific model or sets of recommendations were excluded. Articles satisfied the inclusion criteria were then appraised and were extracted and analysed using inductive approach of thematic analysis. FINDINGS: A total of nine articles were eligible for complete review, mostly were review papers, editorials and commission articles with moderate manuscript quality. Three themes of recommendations emerged from the analysis: Platforms, Core Principles, and Women Empowerment. The Platform contains recommendations on the settings, while Core principles provide essential recommendation of screening and management, while the theme Women Empowerment highlights the importance of empowering women to prepare and decide on their pregnancy. IMPLICATIONS: Actual model of preconception care in LMICs is deficient, results of this review will inform research on the development of appropriate preconception care in LMICs . We also propose for access equity and strategies to promote women empowerment as the key to succeed the preconception care in LMICs.

Inequity in uptake of maternal health care services in developing countries: a systematic review and meta-analysis.

Background: Maternal health service uptake remains an important predictor of maternal outcomes including maternal mortality. This systematic review and meta-analysis aimed to summarize the available evidence on the uptake of maternal health care services in developing countries and to assess the impact of place of residence, education status, and wealth index on the uptake of these services. Methods: We examined the databases MEDLINE, Web of Science, Global Index Medicus, and Scopus until June 14, 2022. Cross-sectional studies done between 2015 and 2022 were considered. Mothers of reproductive age and all states of health were included in the study. Independently, two authors determined the eligibility of studies, extracted data, evaluated the risk of bias, and ranked the evidence's degree of certainty. To combine the data, we performed a random-effects meta-analysis. The PROSPERO registration ID is CRD42022304094. Results: We included 51 studies. Mothers living in urban areas were three times more likely to receive antenatal care (OR 2.95; 95% CI 2.23 to 3.89; 15 studies; 340,390 participants) than rural mothers. Compared with no education, those with primary education were twice as likely to utilize antenatal care (OR 2.36; 95% CI 1.80 to 3.09; 9 studies; 154,398 participants) and those with secondary and higher education were six and fourteen times more likely to utilize antenatal care, respectively. Mothers in the second wealth index were twice as likely as mothers in the lowest wealth index to utilize antenatal care (OR 1.62; 95% CI 1.36 to 1.91; 10 studies; 224,530 participants) and antenatal care utilization increased further among mothers in the higher wealth index. We observed similar relative inequalities in skilled delivery care and postnatal care utilization based on the pace of residence, education, and wealth index. Conclusion: In developing countries, the problem of inequity in utilizing maternal health care services persists and needs considerable attention.

Heavy metals in Ethiopian drinking water and public health risks: Insights from nationwide and regional analysis.

The ambitious sustainable development goal (SDG) 6 of the United Nations, which aims to achieve universal access to safe water and sanitation by 2030, remains elusive for many developing countries like Ethiopia. This is often due to a multitude of intricate factors, including the escalating degradation of water quality. Here, we present a comprehensive nationwide and regional analysis of heavy metal pollution in drinking water sources and the associated human health risks in Ethiopia based on a dataset of 11 heavy metal concentrations (n = 975) collated from available studies. Results indicate significant variations in heavy metal pollution in drinking water sources in Ethiopia, with 44 % of the total concentration exceeding maximum permissible limits. The mean concentrations were ranked as follows: Pb (1.92 mg/L) > Zn (1.25 mg/L) > Fe (0.56 mg/L) > Mn (0.43 mg/L) > Cu (0.40 mg/L) > Co (0.30 mg/L) > As (0.12 mg/L) > Ni (0.12 mg/L) > Cr (0.10 mg/L) > Cd (0.06 mg/L) > Hg (0.04 mg/L). We found that children are more vulnerable to non-carcinogenic health risks than adults, with the highest hazard quotient (HQ) exceedances of up to a factor of 1823 and 762, respectively. Furthermore, a Monte Carlo-based probabilistic risk assessment highlighted significant concerns regarding co-exposure to multiple heavy metals. The measured concentrations, ingestion rates, and exposure frequencies were identified as sensitive parameters. Overall, a higher risk was attributed to Pb and As, with river drinking water sources and the Tigray region requiring immediate mitigation measures. In conclusion, the findings emphasize the urgent need to test and purify water before consumption and to implement effective public health interventions. Furthermore, a multifaceted approach including regular monitoring, source protection, and proper waste management is recommended to expedite the achievement of SDGs and promote water sustainability in resource-limited Ethiopia and sub-Saharan Africa.

Pectoral major myocutaneous flap in our practice: about 25 cases.

The pectoralis major myocutaneous flap (PMMF) was described by Ariyan in 1979 for head and neck reconstructions. It is a safe flap, currently supplanted by free flaps in developed countries, but which remains very useful in developing countries. We report a series of 25 cases of PMMF reconstruction. All patients were treated for advanced stages of oral cavity cancer, where tumor excision left significant tissue loss. The reconstruction used PMMF, taken using the same technique. Supplanted by free flaps in developed countries, PMMF remains useful in developing countries. It is a flap that has numerous advantages (ease of collection, viability, low requirements in terms of instrumentation, etc.). Many variations have been described over the years.

Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies?

Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.

A two-pronged approach to understanding reciprocity and mental health relationship in developing countries: evidence from young informal construction workers in Nigeria.

BACKGROUND: Mental health problems disproportionately affect young people in developing countries. However, there is limited research on help-seeking behaviours and the social support systems that improve mental wellbeing among vulnerable youth populations. OBJECTIVE: This mixed-methods study aimed to examine the relationship between social support reciprocity and mental health among young informal construction workers in Nigeria, a population at high-risk for occupational and socioeconomic stressors. METHODS: A cross-sectional survey was administered to 686 informal workers to measure reciprocity, mental health-related quality of life, and covariates. In-depth interviews with 32 participants provided qualitative context. RESULTS: Quantitative analyses showed 25% of participants reported poor mental health. Reciprocity positively predicted mental health after controlling for covariates. Qualitative findings revealed reciprocity occurs directly between individuals as well as indirectly through trade unions and religious groups. Indirect exchanges through groups helped address limitations of direct support due to limited resources. CONCLUSIONS: This study fills important gaps in understanding how social relationships impact mental health in developing country contexts. Findings emphasize the role of collective action and community-based support systems in promoting mental wellbeing among vulnerable populations. Insights can inform culturally relevant, systems-level mental health interventions.

Pre-eclampsia challenges and care in low and middle-income countries: Understanding diagnosis, management, and health impacts in remote and developing regions.

As an example of a low- and middle-income country (LMIC), India ranks pre-eclampsia among the top three causes of maternal mortality, following haemorrhage and infections. It is one of the primary concerns for maternal and perinatal health in LMICs. Many LMICs lack clear consensus and guidelines for the prevention, diagnosis, and management of hypertensive disorders in pregnancy, including pre-eclampsia. The International Society for the Study of Hypertension in Pregnancy 2021 guidelines address LMIC applications, offering customisable solutions. Atypical presentations of pre-eclampsia contribute to diagnostic delays, resulting in additional adverse maternal and perinatal outcomes. Implementing management strategies faces challenges in both urban and rural settings. Adapting global research involving local populations is imperative, with the potential for cost-effective adoption of international guidelines. Prevention, early diagnosis, and education dissemination are essential, involving healthcare providers and advocacy initiatives. Encouraging government investment in pre-eclampsia management as a public health initiative is important. This article explores socio-economic, cultural, and legislative factors influencing the management of pre-eclampsia in LMICs, addressing emerging challenges and potential partnerships for healthcare provision.

Organochlorine pesticides in Ethiopian waters: Implications for environmental and human health.

Despite the global ban on organochlorine pesticides (OCPs) since the 1970s, their use continues in many developing countries, including Ethiopia, primarily due to the lack of viable alternatives and weak regulations. Nonetheless, the extent of contamination and the resulting environmental and health consequences in these countries remain inadequately understood. To address these knowledge gaps, we conducted a comprehensive analysis of reported concentrations (n=398) of OCPs (n=30) in distinct yet interconnected water matrices: water, sediment, and biota in Ethiopia. Our analysis revealed a notable geographical bias, with higher concentrations found in sediments (0.074-1161.2 µg/kg), followed by biota (0.024-1003 µg/kg) and water (0.001-1.85 µg/L). Moreover, DDTs, endosulfan, and hexachlorohexenes (HCHs) were among the most frequently detected OCPs in higher concentrations in Ethiopian waters. The DDT metabolite p,p'-DDE was commonly observed across all three matrices, with concentrations in water birds reaching levels up to 57 and 143,286 times higher than those found in sediment and water, respectively. The findings showed a substantial potential for DDTs and endosulfan to accumulate and biomagnify in Ethiopian waters. Furthermore, it was revealed that the consumption of fish contaminated with DDTs posed both non-carcinogenic and carcinogenic risks while drinking water did not pose significant risks in this regard. Importantly, the issue of OCPs in Ethiopia assumes even greater significance as their concentrations were found to be eight times higher than those of currently used pesticides (CUPs) in Ethiopian waters. Consequently, given the ongoing concerns about OCPs in Ethiopia, there is a need for ongoing monitoring, implementation of sustainable mitigation measures, and strengthening of OCP management systems in the country, as well as in other developing countries with similar settings and practices.

Home-based care models for patients with terminal illnesses in low and middle-income countries: A systematic review of randomized and quasi-experimental studies.

BACKGROUND: With the increasing lifespan of people and the transition from communicable to non-communicable diseases across the globe, there is an increasing number of people with terminal illnesses requiring home-based care in Low- and Middle-Income Countries (LMICs). AIM: This systematic review evaluated home-based care models for patients with terminal illnesses in LMICs. The primary outcomes measured are quality of life (QoL), adherence to treatment, fatigue, bimanual and related activities. METHODS: This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Four databases; Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE (Ovid), Cochrane Library and Scopus, were systematically searched for potentially relevant studies. Screening of records (titles/abstracts from and full-texts) was done and a total of seven studies (four Randomized Control Trials [RCTs] and three quasi-experimental studies) were included in this review. RESULTS: Even though the included studies reported significant increase in the QoL of the studied patients, the studies have quality concerns. CONCLUSION: Noting the general paucity of existing studies coupled with quality concerns across geographies in LMICs. More studies on home-based care for patients with terminal illness are needed with improved qualities and spread in these regions.

Supporting health systems and environment in the Democratic Republic of Congo: A call for action.

Background: Developing nations have to overcome a number of obstacles to fulfill the Sustainable Development Goals. The Democratic Republic of Congo is one of the five poorest nations in the world and faces several challenges in combating problems related to poverty, health, and sanitation while linking the environment to anthropogenic activities. Methods: This study analyzes anthropogenic activities and their impact on the environment while providing access to the public health of the Congolese population based on the objectives of sustainable development. Thirty-five articles were selected for further analysis as well as relative data. Results: In 2022, 21 million cases of malaria were recorded by the national malaria control program, with 13,000 cases of death. The Democratic Republic of Congo has the highest typhoid incidence, with 315 cases per 100,000 people. A number of 31,342 cases of cholera were reported in 2023, according to multiple reports, with 230 deaths, mainly affecting children. In the same year, a triple epidemic of typhoid, shigellosis, and cholera was identified, with 2389 cases and 52 deaths. These observations cause a health emergency, which can be alleviated and resolved by the establishment of an adequate sanitation system. Waste can be recycled and returned to usable raw materials. Conclusion: Finally, it will be necessary to establish a water safety management plan to combat all diseases linked to the consumption of nonpotable water and improve national coverage on the treatment of recent cases to reduce and at best avoid observed cases of death.

Physical Activity Perceptions and Participation of People With Type II Diabetes Mellitus in the Dominican Republic.

INTRODUCTION: Physical activity (PA) improves health outcomes for people with type II diabetes mellitus (diabetes), but little is known about PA among Dominicans. The purpose was to evaluate PA participation and perceptions among people with diabetes in the Dominican Republic (DR). METHODS: Participants (N=29) were recruited from an urban diabetes clinic in DR. PA was assessed via accelerometry and Godin Leisure Time Exercise Questionnaire (GLTEQ). RESULTS: Eighteen women and 11 men enrolled (age: 55 ± 13 years; BMI: 28.6 ± 4.5 kg·m-2). Twenty-seven participants reached acceptable wear time. Using a one-minute bout minimum, moderate- to vigorous-intensity PA (MVPA) was 152.2 ± 59.7 min·day-1; no vigorous PA was recorded. GLTEQ scores (103 ± 98) classified 25 participants as active. Around 93% reported that PA was "very important" for their health. There was no association between GLTEQ and MVPA (p>0.2). Participants who reported being "very active" (n=17) did more MVPA than those who were "rarely active" or "somewhat active" (n=10; p=0.02). CONCLUSION: Dominicans with diabetes are highly physically active but do very little vigorous PA. The GLTEQ was not an accurate measure of PA. Future research should develop validated questionnaires and evaluate structured exercise and dietary interventions.

Knowledge, attitudes and practices regarding respirable silica exposure and personal protective equipment use among brick kiln workers in Nepal.

OBJECTIVES: Brick kiln workers in Nepal are a neglected population who are exposed to high respirable silica concentrations, and few use interventions to reduce exposure. We aimed to characterise the prevalence of respiratory personal protective equipment (PPE) use, understand knowledge and attitudes towards kiln dust and respiratory PPE and identify factors associated with respiratory PPE use. METHODS: We conducted a cross-sectional study in Bhaktapur, Nepal. We used simple random selection to identify 10 out of 64 total kilns and stratified random sampling of 30 households to enrol workers aged ≥14 years within selected kilns. Field workers surveyed participants using structured questionnaires. Our primary outcome was to characterise the prevalence of current respiratory PPE use and secondary outcomes were summaries of knowledge, attitudes and practice of PPE use. RESULTS: We surveyed 83 workers (mean age 30.8 years, 77.1% male). Of these, 28.9% reported current respiratory PPE use at work, 3.6% heard of silicosis prior to the survey and 24.1% correctly identified the best respiratory PPE (N95, compared with surgical masks and barrier face coverings) for reducing dust exposure. Respiratory PPE users had higher income (mean monthly household income US$206 vs US$145; p=0.04) and education levels (25% vs 5.1% completed more than primary school; p=0.02) compared with non-users. CONCLUSIONS: Respiratory PPE use was low. Workers had poor knowledge of kiln dust health effects and proper respiratory PPE. We highlight important barriers to PPE use, particularly knowledge gaps, which can guide future investigations to reduce the silicosis burden among brick kiln workers.

Barriers faced by primary healthcare providers in addressing emergencies in the Northern region of Palestine before and during the Gaza war.

INTRODUCTION: Physicians working in primary health care (PHC) centers are the first contact for patients and expected to deal with emergencies. Emergency care training in PHC settings has been neglected globally, especially in low to middle income countries. Adequate preparation becomes especially important during periods of conflict. The study objectives are to identify the barriers facing PHC physicians when dealing with emergency cases in the northern region of Palestine during the current conflict. METHODS: A cross-sectional study was conducted with 179 physicians working in the 10 PHC centers distributed among 5 northern governances in Palestine. The study period was from July through December 2023. Data were collected electronically using a self-administered questionnaire, which was adapted from a comprehensive literature review. The questionnaire's internal validity was confirmed by a Cronbach's alpha coefficient of [0.85], indicating high reliability. RESULTS: The ages of the physicians ranged from 25 to 60 years, with a mean ± SD of 35.3 ± 8.15 years. A significant majority (91.6%) were not boarded in any specialty. Most physicians (85.5%) had attended Basic Life Support (BLS) courses, whereas 45.2% and 72% had never attended Advanced Cardiovascular Life Support (ACLS) or Advanced Trauma Life Support (ATLS) courses, respectively. Physicians with emergency department experience (P = 0.002) and those who had attended ACLS courses (P < 0.001) reported significantly higher perceived competence in managing emergency cases. CONCLUSION: Emergency services at PHC centers in northern Palestine are operational but require significant enhancements. There is a critical need for increased availability of essential equipment, supplies, and medications. Additionally, implementing comprehensive training programs in emergency management, particularly ACLS, is essential to improve the competence and performance of PHC physicians in emergency situations.

Use of antibiotic-cement coated plate in the treatment of Gustilo-Anderson type III long bone fractures in low- and middle-income countries vs external fixation: A multicentre randomized control trial study protocol.

BACKGROUND: One of the great challenges in the management of open fractures is postoperative infection with a higher incidence in Gustilo-Anderson type III fractures. Definitive management of such fractures in developing countries is usually with external fixators with its attendant complications such as deep fracture-related infection, non-union, and consequent increased re-operation rates. Recently, there has been a novel method of using antibiotic-cement coated implants such as intramedullary nails and locking plates in the treatment of infected non-unions with reported excellent outcomes. This protocol aims to describe the hypothesis, objectives, design and statistical analysis of a randomized control trial that compares the infection rate between the use of antibiotics-cement coated plate and external fixation in the management of Gustilo-Anderson type III long bone fractures. METHODS: This is a multicentre, open-label, parallel group, superiority, randomized, control trial. All patients with type III long bone fractures who present at the emergency department will be screened for enrolment and only those patients that meet the inclusion criteria will be registered for the study. Patients will be randomized using a centralized 24-hr computerized randomization system into two groups: antibiotic-cement coated plate group and the external fixation group. The primary outcome will be occurrence of infection at any time during the course of one year follow-up which will be counted once for each of the patients. The secondary outcomes are union rate, re-operation rate and change in Health Related Quality of Life (HRQoL) from baseline to end of follow-up. Analysis will be done using R (R Core Team, 2023) and Rstudio (Rstudio Team, 2023). DISCUSSION: Literature has shown that use of antibiotic-coated plate in the management of severe open long bone fractures is effective in reducing infection rate. A significant difference in infection rate with use of antibiotic-cement coated plate compared to use of external fixator for open fractures will be a welcome intervention in developing countries. TRIAL REGISTRATION: The study protocol is registered with ClinicalTrials,gov (NCT06193330).

Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA).

Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programmes that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of 'assisting only'. In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its 'Seal of Approval' for the sustainability of endorsed programmes in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programmes could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.