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Background: The prevalence of type 2 diabetes is rising quickly in low- and middle-income nations like India. In order to develop preventive strategies and comprehend the effects of diabetes as a contributing factor to other non-communicable diseases (NCDs), it is essential to have robust population-level epidemiological data. It is challenging to generalize findings from regional studies given the diversity of India's population, cultural practices, and dietary patterns. Objective: The primary goal of the national Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study was to produce high-quality data on the prevalence of diabetes and other NCDs, such as dyslipidemia, hypertension, and obesity at the country and state levels. Methods: This is a door-door cross-sectional, multi-stage stratified sampled survey from 2008 to 2020; 31 Indian states and union territories were surveyed for the ICMR-INDIAB study. Findings: National projections for NCDs from this study include 101.3 million with diabetes, 136.0 million with prediabetes, 315.5 million with hypertension, 254.2 million with generalized obesity, 213.3 million with hypercholesterolemia, and 185.7 million with high HDL cholesterol. Knowledge and awareness of diabetes are still largely inadequate. Less than 8% of individuals met the treatment goals for glycemia, blood pressure, and lipid goals. Physical inactivity levels are high in India. Reducing carbohydrate intake and increasing protein intake could help in the prevention of progression of dysglycemia as well as reversal of diabetes. Conclusion: In India, the prevalence of diabetes, prediabetes, and other metabolic risk factors such as obesity, dysglycemia, blood pressure, and physical inactivity is rising. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is the second most common pathogen causing infant mortality. Additionally, RSV is a major cause of morbidity and mortality in older adults (age ≥60 years) similar to influenza. A protein-based maternal vaccine and monoclonal antibody (mAb) are now market-approved to protect infants, while an mRNA and two protein-based vaccines are approved for older adults. First-year experience protecting infants with nirsevimab in high-income countries shows a major public health benefit. It is expected that the RSV vaccine landscape will continue to develop in the coming years to protect all people globally. The vaccine and mAb landscape remain active with 30 candidates in clinical development using four approaches: protein-based, live-attenuated and chimeric vector, mRNA, and mAbs. Candidates in late-phase trials aim to protect young infants using mAbs, older infants and toddlers with live-attenuated vaccines, and children and adults using protein-based and mRNA vaccines. This Review provides an overview of RSV vaccines highlighting different target populations, antigens, and trial results. As RSV vaccines have not yet reached low-income and middle-income countries, we outline urgent next steps to minimise the vaccine delay. [ABSTRACT FROM AUTHOR]

The unmet need for mental health care is a global concern. There is a lack of cross-cultural studies examining adolescent help-seeking behavior from both formal and informal sources, including both high-and lower-income countries. This study investigates mental health help-seeking behavior in eight Asian and European countries. Data from 13,184 adolescents aged 13–15 (51% girls) was analysed using mixed-effects logistic regression with school-wise random intercepts to compare countries and genders. Although a significant proportion of adolescents considered getting or sought informal help, formal help-seeking remained exceptionally low, especially in middle-income countries (< 1%), while it ranged from 2 to 7% in high-income countries. Among adolescents with high emotional and behavioral problems (scoring above the 90th percentile on the Strengths and Difficulties Questionnaire), 1–2% of those in middle-income countries and 6–25% of those in high-income countries sought formal help. Girls generally seek more help than boys. The study shows the most adolescents do not receive formal help for mental health problems. The unmet need gap is enormous, especially in lower-income countries. Informal sources of support, including relatives, peers, and teachers, play a crucial role, especially in lower-income countries. [ABSTRACT FROM AUTHOR]

Auditory statistical learning, or the ability to detect statistical regularities in continuously presented stimuli, is thought to be one element that underlies language acquisition. Prior studies have uncovered behavioral and neural correlates of statistical learning, yet additional work is needed from low- and middle-income countries to explore whether statistical learning varies across cultures or underlies associations often found between socioeconomic status (SES) and language outcomes. In the present study, we explored the feasibility of using functional near-infrared spectroscopy (fNIRS) to explore auditory statistical learning in Bangladesh, a lower-middle-income country. Participants were 102 2-year-old (M = 25.72 months, SD = 2.07 months) and 125 5-year-old children (M = 62.35 months, SD = 2.46 months) living in a low-income urban neighborhood of Dhaka (average family income of 28,145.13 Bangladeshi Takas or 260.06 U.S. dollars per month). We also collected measures of SES and language outcomes. Brain responses during the statistical learning paradigm could be detected with fNIRS in both two- and 5-year-olds, with 2-year-olds exhibiting a higher response to predictable sequences and 5-year-olds exhibiting higher responses to unpredictable sequences. fNIRS correlates of statistical learning were not related to language outcomes but were associated with SES in the 5-year-old cohort. This study demonstrates the utility of employing fNIRS to study the neural correlates of statistical learning in low- and middle-income countries and the feasibility of expanding the representativeness of the existing literature. These findings also highlight potential areas for inquiry into how SES may relate to individual differences in statistical learning responses. Public Significance Statement: Two- and 5-year-old-children living in profound poverty in Dhaka, Bangladesh, showed different brain responses to familiar and novel auditory patterns. These brain responses were not associated with language outcomes in either age group but, for 5-year-olds only, were related to socioeconomic status. These results show the utility of brain imaging techniques in uncovering how children's early environments may relate to auditory processing during different periods of development. [ABSTRACT FROM AUTHOR]

Inducing behavior change is a missing factor in the face of viral threats. We provide evidence from a natural experiment in 2020 on the effects of containment, closure, and economic policy responses to COVID-19 on change in human mobility behavior in the Middle East and North Africa (MENA) region and worldwide. We also examine how social norms, namely risk taking and patience, and institutional trust, could explain the heterogenous effects of policy responses on behavior change. Our results show that the stringency of containment and closure policies decreased human mobility in MENA and worldwide. Risk-averse populations and populations with low-time preference were more likely to pre act and lower their mobility independent of containment and closure policies. The effectiveness of risk communication in promoting positive mobility change increased by the level of institutional trust. Specifically in MENA, populations were less responsive to the actual disease risk and the public perception of that risk. Familiarity with COVID-19 induced negative behavior change among impatient populations. Economic support policies promoted strong positive mobility change among low-risk and high-time preference populations. Income support seems to be the effective economic policy response in low-income countries and debt relief the effective one in higher-income countries. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Obstetric sepsis is a significant contributor to maternal and perinatal morbidity and mortality, especially in low-income countries. Several scoring systems can help in identifying sepsis and its severity; however, their application in the obstetric population is not well-defined because of the altered physiology of pregnancy. The Sepsis in Obstetrics Score (SOS) is designed specifically for the obstetric population to identify the likelihood of the need for critical care admission for the obstetric population presenting with signs of sepsis. Aim: To determine whether the SOS can be used to identify the severity of sepsis. Materials and Methods: This was a prospective observational time-bound study conducted at Gandhi Hospital, Secunderabad, Hyderabad, Telangana, India over six months from February 2023 to July 2023 on 100 subjects that included pregnant women, postpartum women within six weeks, and postabortal women within two weeks of abortion with suspected obstetric sepsis presenting to Gandhi Hospital. SOS score was calculated for all study participants and grouped into scores of <6 and ≥6. Organ failure was assessed. SOS score was associated with culture positivity, organ involvement, need for critical care support, and the severity of sepsis. Data were analysed using Statistical Packages for Social Sciences (SPSS) software, and appropriate statistical tests were applied; the p-value for significance was set at 0.05. Results: The mean age of the study population was 25.48±5.13 years. Out of 100 women with obstetric sepsis, 50% had severe sepsis, graded by the presence of organ failure. When the cutoff score was considered as 6, SOS score had a sensitivity of 64% and specificity of 84%, a Positive Predictive Value (PPV) of 80.0%, a Negative Predictive Value (NPV) of 70.0%, and a diagnostic accuracy of 74.0% to detecting severe sepsis. Conclusion: The findings emphasised the utility of the SOS score as a valuable tool for assessing the severity of illness, predicting outcomes, and guiding clinical management. [ABSTRACT FROM AUTHOR]

• This paper investigates the impact of urban-rural electricity gap on human development index. • Urban-rural electricity gap significantly reduces human development index. • The nexus between urban-rural electricity gap and human development index is closer in low-income countries. • Urban-rural electricity gap directly affects three dimensions of human development index. • Urban-rural electricity inequality gap affects human development index by enlarging income inequality and deteriorating energy poverty. Based on the Instrumental Variables - Generalized Method of Moments (IV-GMM) model, this paper explores the relationship, heterogeneity, and mechanisms between the urban-rural electricity gap and the human development index for 176 countries during 2000–2020. The key findings are as follows: (1) Urban-rural electricity gap is harmful to the improvement of the human development index; an enlarged gap in electricity accessibility between urban and rural is detrimental to sustainable human development. (2) Urban-rural electricity gap is more harmful to the increase of human development index in low-income countries and low governance efficiency countries. Also, the heterogeneity exists in different quantiles, and their nexus is closer in countries with lower levels of human development index. (3) Income inequality and energy poverty act as mechanisms, which means that the urban-rural electricity gap inhibits the human development index by exacerbating income inequality and energy poverty. [ABSTRACT FROM AUTHOR]

Cancer is a major global health threat, with 35 million new cases projected by 2050, predominantly in low-income and middle-income-countries. Within South Asian Association for Regional Cooperation (SAARC) countries, a notable gap in cancer research investment and output compared with high-income countries highlights the need to strengthen research capacity. The rising cancer incidence across SAARC countries is not being matched by local research, particularly in clinical trials in molecular biology, targeted therapy, immunotherapy, and cancer vaccines. This paucity of research is problematic as guidelines and therapies developed in high-income countries might not be directly applicable to low-income and middle-income countries due to distinct regional sociocultural, genetic, and environmental factors and are often impractical in these countries due to cost and implementation challenges. This Series paper examines the cancer research landscape within SAARC countries, focusing on Bangladesh, Nepal, Sri Lanka, India, Pakistan, Afghanistan, Bhutan, and Maldives. We analyse PubMed publication rates and examine available infrastructure, current research (including clinical trials), and limitations and disparities among SAARC countries in terms of cancer research. Key challenges include disparities in health-care access, cultural and economic barriers, and little funding and infrastructure. Strengthening cancer research in SAARC countries requires building collaborative networks, improving research facilities and training, focusing on local epidemiological studies, and developing affordable technologies and treatments. Effective policy and stakeholder engagement could greatly advance cancer care in the region. [ABSTRACT FROM AUTHOR]

Compared with children and older adults, the burden of cancer in adolescents and young adults (ages 15–39) is understudied. We aimed to quantify the global burden of adolescent and young adult cancer in 2022 and 2050, and explore patterns in incidence, mortality, and case fatality. In this population-based study, we used the GLOBOCAN database to quantify the number of new cases and cancer-related deaths, and corresponding age-standardised incidence and mortality rates (ASRs; per 100 000 people aged 15–39 years), in adolescents and young adults. Estimates were quantified for all cancers combined, excluding non-melanoma skin cancer, and 33 specific cancer types. Case fatality was estimated using mortality-to-incidence ratios. Overall and sex-specific estimates were calculated at the world, regional, human development index (HDI), and income level. We estimated the future cancer burden by applying the GLOBOCAN 2022 rates to sex-specific demographic projections for the year 2050 using the UN World Population Prospects 2019 revision. An estimated 1 300 196 cases and 377 621 cancer-related deaths occurred in adolescents and young adults in 2022. Incidence ASRs were 1·9-times higher and mortality ASRs were 1·2-times higher in females than in males (incidence ASR 52·9 vs 28·3; mortality ASR 13·1 vs 10·6). Although the incidence ASR was highest in the high-income countries, the mortality ASR was highest in the low-income countries; as a result, case fatality ranged from 12% in high-income settings to 57% in low-income settings. Of the 33 cancer types included in our analyses, breast or cervical cancer was the most frequently diagnosed cancer and cause of cancer-related death in 163 and 93 countries, respectively; incidence and mortality also varied the most by region for these cancers. Finally, the adolescent and young adult cancer burden globally is projected to increase by about 12% from 2022 to 2050, albeit with declines of 10·7% projected in very high HDI countries. The increase is expected to overwhelmingly impact low HDI settings, where the burden of both cancer cases and deaths is projected to double (a 102·3% increase). Although the adolescent and young adult cancer burden incidence is highest in the most developed settings, transitioning countries have the poorest outcomes and will face the greatest increases in burden by 2050. These findings act as a reference to the global adolescent and young adult cancer community to inform cancer control priorities and decrease global inequities. None. [ABSTRACT FROM AUTHOR]

The application of artificial intelligence methods to electronic patient records paves the way for large-scale analysis of multimodal data. Such population-wide data describing deep phenotypes composed of thousands of features are now being leveraged to create data-driven algorithms, which in turn has led to improved methods for early cancer detection and screening. Remaining challenges include establishment of infrastructures for prospective testing of such methods, ways to assess biases given the data, and gathering of sufficiently large and diverse datasets that reflect disease heterogeneities across populations. This Review provides an overview of artificial intelligence methods designed to detect cancer early, including key aspects of concern (eg, the problem of data drift—when the underlying health-care data change over time), ethical aspects, and discrepancies between access to cancer screening in high-income countries versus low-income and middle-income countries. [ABSTRACT FROM AUTHOR]

The Wash'Em process was developed to improve the design of handwashing behaviour change programmes during outbreaks and humanitarian crises. It aims to rapidly create evidence-based, contextualized handwashing programmes. Wash'Em was widely used during the COVID-19 pandemic. This multi-country secondary data analysis compares data emerging from Wash'Em during the pandemic, to understand whether commonalities in programming constraints or the determinants of handwashing behaviour existed across countries. Wash'Em datasets (n  = 38) were verified prior to inclusion in secondary data analysis; descriptively summarized and then statistical summaries of homogeneity were derived. Wash'Em was implemented as intended during the pandemic, typically taking a small number of humanitarian staff less than a week to complete. Most actors reported using the recommendations suggested by the process but did so within relatively short-term and poorly financed prevention programmes. Homogeneity in the responses to the Wash'Em tools was low indicating that the determinants of handwashing behaviour during the pandemic were predominantly shaped by pre-existing factors rather than the nature of the health threat. Hygiene programmes during outbreaks should avoid 'copying and pasting' interventions from one setting to another and instead make time to holistically understand the behavioural determinants in a specific context and develop programme activities that are designed to address these. Particular attention should be given to factors in the physical and social environment that may enable or constrain handwashing behaviour, pre-existing disease vulnerabilities and the secondary and non-health impacts of outbreaks. Wash'Em provides one feasible way of contextualizing handwashing interventions in outbreak or humanitarian settings. [ABSTRACT FROM AUTHOR]

Children's exposure to outlets selling, and outdoor advertisements marketing, unhealthy foods is an important risk factor for obesity. Yet few policies address the food retail and/or outdoor advertising environment, and research about children's perceptions is limited, especially in low- and middle-income countries. We used a participatory, multimodal visual/verbal approach to explore urban-dwelling South African primary school students' perceptions of unhealthy food outlets and outdoor advertisements they encountered on their journeys to school. Forty-one grade 7 students aged 11–14 years participated in drawing and/or photography activities and elicitation discussions. A mixed-methods, triangulated analysis involving the content analysis and extraction of data from research artefacts (33 journey to school drawings and 10 food advertisement photo collages) and thematic analysis of discussion transcripts was conducted. Drawings depicted 175 food outlets, two-thirds (64%) of which sold only unhealthy foods and 125 advertisements, most of which marketed unhealthy food. Unbranded, deep-fried foods prepared and sold by informal traders and independent shops were prominent. Informal and independent traders also sold unhealthy branded foods. Advertisements were primarily for unhealthy foods, especially branded, sugar-sweetened beverages. Participants thought extensive advertising bans, regulation of the sale of unhealthy food to children and other measures were needed to promote children's health in urban contexts. The results point to the need for food system-wide approaches that address multiple commercial determinants of health, including 'big food' advertising, unhealthy food sales by informal and independent traders and programs to address socio-economic influences such as poverty, unemployment and parents' poor work conditions. [ABSTRACT FROM AUTHOR]

Aim: Many countries risk failing the Sustainable Development Goal to reduce neonatal mortality to 12 in 1000 live births before 2030, necessitating intervention. This scoping review assesses available evidence from studies implementing smartphone application‐based education and clinical decision support in neonatal emergency care in low‐ and middle‐income countries and describes applied assessment tools to highlight gaps in the current literature. Methods: A systematic search on 28 March 2024 of PubMed, Web of Science, and EMBASE identified original research papers published in peer‐reviewed journals after 2014 in English. The evaluation was based on Kirkpatrick's framework. Results: In total, 20 studies assessing eight different smartphone applications were included. Participants found applications acceptable and feasible in 11 of 14 studies. Knowledge and/or skills were improved in 11 of 12 studies. Behaviour was assessed in 10 studies by tracking app usage. Patient outcome was assessed in four studies, focusing on perinatal mortality, Basic Newborn Care outcomes and correct assessment of newborns. Conclusion: Data from included studies further strengthens hope that smartphone applications can improve neonatal mortality rates in low‐ and middle‐income countries. However, further research into the effectiveness of these applications is warranted. This review highlights gaps in the current literature and provides guidance for future trials. [ABSTRACT FROM AUTHOR]

Background: Medication reconciliation is one of the best measures to prevent medication-related errors at the time of admission and discharge of patients. We conducted a quasi-experimental study to evaluate the impact of a Medication reconciliation improvement package (intervention) on adherence to medication reconciliation at the time of admission in Department of Internal Medicine. The study included all adult patients admitted to internal medicine from August 2019 to December 2020. Pre-intervention data on adherence to medication reconciliation was less than 50%. The study involved creation of a quality improvement team to conduct a root-cause analysis which identified the need to target physician related issues and hence drafted a medication reconciliation improvement package which included meetings with physicians on the internal medicine floor, dedicated WhatsApp groups for repeated reminders, and appreciation messages for timely adherence. We used the Chi Square test to check the association between adherence to medication reconciliation and physicians and acuity level. Findings: We included 7914 records of patients, in which 4471 participants (56.4%) were from pre-intervention phase and 3443 (43.5%) were from intervention groups. The overall adherence to medication reconciliation was 54.3% (4297/7914). Adherence of medication reconciliation increased from 44.4% (1983/4471) in the pre-intervention phase to 67.2% (2314/3443) in the intervention phase (P <.001). Improvement was observed in adherence of medication reconciliation done by residents and in low acuity areas (P <.005). Conclusion: The Medical reconciliation improvement package is a simple low-cost intervention that resulted in improvement in adherence to medication reconciliation but needs further studies to assess its sustainability. However, it awaits to be seen if the same improvement can also be replicated to qualitative medication errors and clinical outcomes respectively. [ABSTRACT FROM AUTHOR]

To assess the application value of low-risk human papillomavirus (lrHPV) detection in the prevention and treatment of cervical cancer in low- and middle-resource areas (LMRAs). A retrospective cross-sectional study. Cervical HPV typing results were collected from 2019 to 2023, utilizing fluorescence PCR technology. An adjusted logistic regression model was used to assess the relative risk (OR) and 95 % confidence interval (CI) for co-infection with lrHPV and high-risk HPV (hrHPV). Out of 113,883 women included in the study, the overall lrHPV positivity rate was 1.9 %. In total, 47.7 % (1033/2167) of lrHPV positive women also had hrHPV co-infections. Multivariate analysis identified 12 hrHPV subtypes (T-hrHPV) significantly associated with co-infection risk, including HPV16, 31, 33, 39, 51, 52, 53, 56, 59, 66, 68, and 73. The risk of T-hrHPV infection was 3.77 times higher (95 % CI: 3.44-4.12) for women with a single lrHPV infection and 9.71 times higher (95 % CI: 4.72-19.99) for those with two lrHPV infections. Women screened in the gynecological outpatient clinic faced a T-hrHPV infection risk 2.64 times higher (95 % CI: 2.54-2.74) than those in the general health check department. lrHPV positivity significantly increases the risk of T-hrHPV co-infection, particularly under multiple infections, highlighting the importance of comprehensive HPV screening in LMRAs. The notable differences in T-hrHPV infection risks across various screening settings highlight their critical role in cervical cancer prevention and offer new insights into optimizing vaccination strategies to enhance effective prevention and treatment in LMRAs. [ABSTRACT FROM AUTHOR]

Vaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children. This was a cross-sectional study. This study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI). The prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children. The first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished. [ABSTRACT FROM AUTHOR]

This study aimed to identify the individual- and community-level determinants of mothers' healthcare-seeking behaviour for children under the age of 5 years with acute respiratory infection (ARI) symptoms in low-and middle-income countries (LMICs). Nationally representative Demographic and Health Survey datasets from 29 LMICs were used. The study included 16,893 children aged under 5 years with ARI symptoms in the 2 weeks prior to the survey. A multilevel logistic regression model was used to examine associations between individual- and community-level factors with health-seeking behaviour for ARIs. The adjusted odds ratio (AOR) along with 95% confidence intervals (CIs) were reported as a measure of association. The overall prevalence of healthcare-seeking behaviour for ARIs among children under 5 years in LMICs was 58.83% (95% CI: 58.08, 59.57). Findings showed that mothers with primary or higher education (AOR = 1.20; 95% CI: 1.08, 1.33), and those residing in rich households (AOR = 1.32; 95% CI: 1.18, 1.48), attending antenatal care (ANC) visits (AOR = 1.53; 95% CI: 1.31, 1.79) and delivering at a healthcare facility (AOR = 1.28; 95% CI: 1.16, 1.41) were more likely to seek healthcare for ARIs. A higher level of community maternal education (AOR = 1.44; 95% CI: 1.24, 1.68) was positively associated with seeking healthcare for ARIs, while a higher level of community poverty (AOR = 0.83; 95% CI: 0.72, 0.96) was negatively associated with healthcare seeking for ARIs. This study revealed that mothers' healthcare-seeking behaviour for ARIs was closely linked to modifiable risk factors, including maternal education, household wealth, use of maternal health services (e.g., ANC), as well as community poverty and literacy levels. Future interventions should consider these modifiable risk factors when developing strategies to improve child health outcomes in LMICs. [ABSTRACT FROM AUTHOR]

Background/Aims: Cardiovascular rehabilitation is a secondary preventative care model for outpatients. Despite its benefits, cardiac rehabilitation is greatly underused. Virtual reality‑based therapy could be a complementary treatment for traditional cardiac rehabilitation which promotes physical activity, enhancing motivation and increasing adherence to rehabilitation programmes. This qualitative study examined physiotherapists' perceptions toward using virtual reality‑based therapy based on exergames as part of cardiac rehabilitation programmes. Methods: This qualitative study used focus groups to evaluate the perceptions of nine physiotherapists who have used virtual reality‑based therapy with exergames in cardiac rehabilitation. Results: Participants' attitudes towards virtual reality‑based therapy were overall positive, and found it could improve patients' adherence to a cardiac rehabilitation programme. Barriers to VRBT were also identified, including technical difficulties, patients being insecure about using a new therapeutic modality and managing the level of effort during the session. Suggestions for improvements included training for clinical staff, and having a introductory session for patients to help get used to the therapy and to find out what games they would prefer to play. Conclusions: Virtual reality‑based therapy can provide a change from the traditional treatment routine; however, there are some barriers, including potential safety concerns and technical issues. Feedback on haemodynamic parameters and identification of signs and symptoms of a cardiac event could be incorporated into games made specifically for patients undergoing cardiac rehabilitation. Implications for practice: Finding different ways to engage patients is needed. Based on the perceptions of physiotherapists from this study, VRBT could be one of the solutions to reach these goals for patients receiving cardiac rehabilitation. [ABSTRACT FROM AUTHOR]

In recent years, there has been a surge of interest in violence as a public health issue. Preventing violence before it occurs and developing effective response strategies are key to achieving the United Nations Sustainable Development Goals and improving health and well-being. This systematic scoping review explores the role of public health frameworks in the primary prevention of interpersonal violence. A systematic literature search was undertaken to identify frameworks from both academic and grey literature. Extracted records (n = 17) were thematically analyzed to explore themes, divergences, and theoretical underpinnings. Most frameworks were published in the last decade by national and international public health bodies. The majority were from high-income countries and explored a range of interpersonal violence types. Nine themes were identified, which provide opportunities for violence prevention across the socio-ecological model, including: families, caregivers, and early years; early identification and support; schools, education, and skill development; safe community environments; safe activities and trusted adults; social norms and values; empowerment and equality; policy and legislation; and poverty reduction. These frameworks evidence the leadership role played by public health in the development and implementation of the primary prevention of violence. However, to effectively embed a public health approach, the review identified several areas which warrant further attention. These included redressing disparities in evidence, particularly from low-income countries; building the evidence base for addressing community and structural determinants of violence such as gender, poverty, and inequality; and investing in research which explores the implementation of primary prevention approaches. [ABSTRACT FROM AUTHOR]

In low-income countries, intergenerational processes can culminate in the replication of extreme forms of health disadvantage between mothers and adult daughters, including experiencing a young child's death. The preventable nature of most child deaths raises questions of whether social resources can protect women from enduring this adversity like their mothers. This study examined whether education—widely touted as a vehicle for social mobility in resource-poor countries—disrupts the intergenerational cycle of maternal bereavement. We estimated multilevel discrete-time survival models of women's hazard of child loss using Demographic and Health Survey Program data (N = 195,744 women in 345 subnational regions in 32 African countries). Women's educational attainment minimizes the salience of their mothers' bereavement history for their own probability of child loss; however, mothers' background becomes irrelevant only among women with ≥10 years of schooling. Education's neutralizing influence is most prominent in the highest mortality-burdened communities. [ABSTRACT FROM AUTHOR]

Background: Childhood trauma adversely impacts adolescents, and consequently, they develop behavioural problems. Understanding the distribution of childhood traumas and their association with behavioural problems among adolescents is paramount for the preventive efforts. Aim/Objective: The present research aimed to investigate this association among adolescents. Methods: This association was investigated among adolescents (N = 200) between 12 and 18 years. Childhood Trauma Questionnaire and Strength and Difficulty Questionnaire was used to assess the distribution of trauma and internalizing and externalizing behavioural problems among adolescents through purposive and convenience sampling technique. Results: The findings across trauma distribution indicated higher distribution of childhood abuse and neglect across males as compared to females. Males further significantly scored higher on sexual abuse and emotional neglect. Apparently, a large number of adolescents experienced all five sub types of childhood traumas (sexual abuse, emotional abuse, physical abuse, emotional and physical neglect). Additionally, across the severity continuum of childhood traumas, male scored higher on the severe to extreme continuum for all subtypes except physical abuse, where females scored higher. Lastly, logistic regression analysis indicated higher peer problems among those adolescents who have experienced all types of childhood traumas. Conclusion: These findings could be beneficial for intervention-based programs and policies to help trauma-exposed adolescents cope with their lives. [ABSTRACT FROM AUTHOR]

Global health consensus in recent years has highlighted 'decolonisation' as an important factor in the pursuit of equity. Initiatives such as the United Nations' sustainable development goals for 2030 have come amid talk of 'bottom up' programming, driven by the needs of people living and working in the world's most deprived regions. However, most high-level meetings still take place in wealthy countries where United Nations bodies, major donors and the biggest non-governmental organisations are headquartered. In midwifery, maternity experts from low- and middle-income countries may struggle to take part in discussions because of barriers such as visa restrictions, travel costs and the challenge of breaking into old-school networks. Meanwhile multimillion dollar programmes designed to save mothers' and babies' lives lose out on insights from the very people that they are intended to help. With this in mind, a wave of non-governmental organisations focused on women's health and gender equality are moving their conferences closer to the action. This article explores a dynamic field, where forces for change are responding directly to evidence on 'conference inequity'. Non-governmental organisations including WomenLift Health and the International Confederation of Midwives explain how and why they are shaking things up. [ABSTRACT FROM AUTHOR]

Background: Stigma against persons living with substance use disorders (PLSUD) fosters social and health inequities. Aim: We aimed to map different populations targeted by antistigma interventions, analyze specific characteristics of these interventions, and identify and categorize the theoretical frameworks used in these interventions. Methods: We examined randomized controlled trials and quasi or pre-experimental studies targeting stigma against PLSUD. Using two English databases, our analysis involved mapping study populations, antistigma interventions, and trial characteristics through a narrative synthesis. We adhered to the Workgroup for Intervention Development and Evaluation Research (WIDER) checklist for assessing reporting quality. The Theoretical Domain Framework (TDF) identified intervention domains and constructs of the interventions. Results: Of 698 studies, 29 met eligibility, with three from low-middle-income countries: 12 studies addressed the public, 11 self, and 5 structural stigmas. Reduction in stigma or improvements in knowledge of and attitude toward PLSUD was observed in 23 studies. Eight used social contact-based interventions, and one used direct social contact. Other interventions were psychoeducation, collaborative community care and linkage to social services, acceptance and commitment therapy, and gatekeepers' training. Five focused on injection drug use stigma; others were not substance-specific. Most studies reported the characteristics of the recipients (n = 28), mode of delivery (n = 28), and delivery settings (n = 24). Adherence to delivery protocol was the least reported (n = 5). The number of theoretical domains varied: 18 studies had 1–5 domains, 3 studies had 10, and 8 studies had 6–9 domains. Conclusion: Social contact-based interventions show promise for PLSUD; future research must improve the quality of reporting and design theory-informed interventions. [ABSTRACT FROM AUTHOR]

The global population is predicted to reach 9.3 billion by 2050, increasing food production substantially and posing significant food security risks, particularly for low-income countries. The widening food security gap necessitates innovative, sustainable solutions. In response, promoting edible insects as a viable food source gained momentum, addressing malnutrition and food insecurity. The Kingdom of Saudi Arabia, one of the world's largest countries, has many edible insects. As a result of its unique challenges, Saudi Arabia explores insects as a vital source for enhancing food security, such as Crickets, Mealworms, Black Soldier Flies, Buffalo's, Grasshoppers, Ants, Silkworms, and Cicadas. The Kingdom's commitment to Vision 2030, focusing on sustainable development, underscores the importance of incorporating insects into agricultural processes and food manufacturing. Despite the promising nutritional benefits, challenges such as potential toxicity, pesticide residues, heavy metals, and allergic reactions require careful consideration. Collaborative efforts involving the public and private sectors, universities, and largescale breeding laboratories are essential to realize the full potential of edible insects. This review article delves into the nutritional value of edible insect orders found in the Kingdom, examining protein, lipid, carbohydrate, nucleic acid, mineral, and vitamin content. The review emphasizes the need for extensive research to understand the nutritional composition of diverse insect species in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background and aim: Globally, harmful substance use is among the leading causes of premature deaths in the general population, and most of these behaviours are initiated during pre‐adolescence to young adulthood. Preventing the onset or reducing the prevalence of substance use among young people is thus a global health priority. Diverse school‐based interventions have been implemented in low‐and‐middle‐income countries (LMICs); however, evidence regarding their theoretical underpinnings and core components is lacking. The aim of this scoping review was to identify the underlying (social/behavioural) theories, models or frameworks (TMF) and core (practical) components of school‐based interventions in LMICs aimed at preventing the onset or reducing the prevalence of substance use among young people. Methods: Using the Joanna Briggs Institute (JBI) guidance for conducting scoping reviews, we searched scientific literature databases for articles published from 1995 to 2022. A further search was conducted using the reference lists of included articles. We selected randomized and non‐randomized trials of school‐based interventions in LMICs that aimed at preventing the onset or reducing the prevalence of substance use among young people. We used Covidence software to screen titles and abstracts, as well as full texts. We then extracted the data and analysed it using a descriptive content analysis approach. Two reviewers conducted the screening, extraction and data analysis and discussed discrepancies, and clarified doubts and uncertainties through consultation with the other team members. Findings: A total of 58 articles were included in the review. Most articles (63.8%) used either a single or combination of two or more TMFs to inform their interventions. The most widely used TMF was social learning theory followed by theory of planned behaviour. We identified six core components of substance use prevention interventions: education, school environment, school policy, parental involvement, peer engagement and counselling. Conclusion: This scoping review outlines the core components of school‐based substance use prevention interventions used in low‐and‐middle‐income countries and the common theories, models or frameworks that underpin the design of those interventions. [ABSTRACT FROM AUTHOR]

Background: The recent increase in interest in alternative medicine calls for an investigation into the non-target organ effect. Khaya senegalensis is one of such popular plants used to manage malaria in low-income countries. This study therefore aimed at investigating the effect of stem bark extract of Khaya senegalensis (KSE) on the testes (non-target organ) and its related serum hormones. Methods: Grouped mature male rats (n = 4) were treated with 100–1000 mg/kg KSE or distilled water for twenty-eight days. Serum hormones were taken immediately after cervical dislocation, prepared appropriately, and assayed for Testosterone, Luteinizing, and Follicle Stimulating Hormone. The hormones levels were determined using ELISA kits The right testis and epididymis from treated animals were harvested and prepared for histological studies. Results: The result indicated a significant increase (p = 0.045, 0.038) in the epididymis and serum LH in the 1000 mg/kg KSE, but caused no significant increase in serum FSH and Testosterone (p > 0.05), in any of the treatment groups. Histological sections of the testes showed mild to moderate degeneration of the spermatogonia and hyalinization (1000 mg/kg, 500 mg/kg, 100 mg/kg) of the seminiferous tubules with reduced spermatogenesis in a dose-dependent manner. Conclusion: Khaya senegalensis could have an adverse effect on the morphology of the testis in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Background: Sri Lanka, an island located in South Asia, once experienced a notable prevalence of human intestinal nematode infections (HINIs). With the implementation of control programs, infection prevalence was reduced. Detailed information on prevalence, distribution and temporal trends of HINIs is limited. This review aims to explore Sri Lanka's HINI distribution, trends, diagnostics, control and challenges. Methodology: We reviewed published information on HINIs in Sri Lanka in electronic databases, local journals and grey literature from inception to September 2022. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-Scr), a systematic strategy was used for searching, screening, reviewing and data extraction. The screening was initiated with a review of titles and abstracts using specific keywords, followed by a full-text screening based on predefined eligibility criteria. A total of 105 studies were included in the review, with 28 selected for pooled prevalence analysis. Principal findings: The first nationwide survey in 1924 reported a hookworm infection prevalence of 93.1%. By 2017, soil-transmitted helminth (STH) infection prevalence across the island was 0.97% (ascariasis-0.45%, trichurisis-0.25%, and hookworm infection-0.29%), and the enterobiasis prevalence between 2003 and 2017 ranged from 0% to 42.5%. Strongyloidiasis had been understudied, with a prevalence of 0.1% to 2%. Over the past two decades, the islandwide pooled HINI prevalence was 13.3%. Within specific demographics, it was 6.96% in the general community, 33.4% in plantation sector, and 11.6% in slum communities. During the colonial period, hookworm infection was the commonest HINI, but ascariasis is now more prevalent. The prevailing data relied solely on microscopy, often utilising single stool smears. Mass deworming programs were widely pursued in the first half of the 20th century, initially targeting antenatal women and schoolchildren, and now focusing on specific community groups. National surveys continue monitoring the three main STH infections. Conclusions: The significant reduction in STH prevalence in the country over the past ten decades highlights the effectiveness of public health interventions, particularly mass deworming programs. Despite the success, STH prevalence disparities persist in vulnerable populations like plantation and slum communities, where hygiene and living conditions continue to pose challenges. Reliance on single stool smear microscopy highlights the need for more sensitive diagnostics to better assess infections. Fluctuating enterobiasis prevalence and limited strongyloidiasis data underscore the importance of continued surveillance and targeted interventions for sustained control and eventual elimination. Sri Lanka's experiences and control measures offer valuable insights for low-income countries in South Asia and beyond, particularly in managing HINIs with limited resources. Author summary: HINIs pose a significant public health concern in Sri Lanka, especially among the deprived communities. Most Sri Lankan research information on HINIs over the years has been scattered and inconsistent, and many are not accessible to all. To address this issue, we conducted an extensive review of the literature from inception to September 2022. The review showed the first HINI to be recorded as hookworm infection, while all five HINI species were reported in Sri Lanka. In the early 1900s infection prevalence was over 90%, and a gradual decline in prevalence over the period was noted. Among the many measures taken to reduce the infection rates since the early part of the 20th century are the national deworming guidelines framed and implemented from 2012 onwards. The current islandwide prevalence of STH infection is less than 1%. Prevalence data on enterobiasis and strongyloidiasis are sparse and the current islandwide prevalence of these two species is not known. As all prevalence estimates were made using microscopic techniques, more sensitive diagnostic methods should be employed to understand the true picture of present low prevalence estimates. The burden of disease is highest in the hill country plantation sector and urban slum communities where living conditions and sanitary facilities are poor. The experiences and control measures implemented in Sri Lanka can offer valuable insights to other countries especially when facing limited resources and similar challenges. [ABSTRACT FROM AUTHOR]

Background & Objective: Neurological disorders significantly impact patients' mental, personality, and movement functions, with a rising prevalence globally, especially in low-income and middleincome countries. This study aims to evaluate gene mutations in pediatric neurological disorders patients to contribute to our understanding of these disorders' genetic basis. Methods: In the current survey, all patients with maternal signs of neurological disorders who were referred to the neurology department during 2023 to 2024 were evaluated. DNA samples from patients were enriched using the Agilent SureSelect Human All Exon Kit V6, and subsequent sequencing took place on an Illumina HiSeq 4000 platform based on the manufacturer's procedures. Results: In the current cross-sectional study, 13 patients with maternal neurological disorders including 6 males (46%) and 7 females (54%) were evaluated. Our results identified inherited neurological disorders, including Joubert syndrome, Pelizaeus-Merzbacher disease, and giant axonal neuropathy-1. Our data identified a novel missense mutation in exon 8 of PLP1 gene (NM_001128834.3: c.772A>C; p.Met258Leu) with X-linked recessive inheritance in a patient with Pelizaeus-Merzbacher disease. Gene variants, including CSPP1 frameshift mutation in exon 20 (NM_001382391.1: c.2259_2260delAA; p.Glu755GlyfsTer30), and autosomal recessive homozygous TMEM67 mutation in exon 8 (NM_153704.6: c.725A>G; p.Asn242Ser) were detected in patients with Joubert syndrome. Finally, in a patient with giant axonal neuropathy-1, a homozygous GAN mutation (NM_022041.4: c.1177T>C; p.Cys393Arg) was detected. Conclusion: Our findings can be useful in understanding the pathophysiology of neurological disorders. Also, this study indicated the importance of genetic analysis in utilizing the treatment strategy in patients with neurological disorders. [ABSTRACT FROM AUTHOR]

Background: Perceptions, experiences, facilitators, and inhibitors of disease among patients may be shaped by their lifestyle and cultural background. Despite the significance of understanding their perspectives and experiences about disease for the prevention and management of osteoarthritis (OA) through physiotherapy, this subject has not been explored among patients with knee OA (PKOA) from lower and middle‐income countries (LMICs). Purpose: This study aims to explore the perception, and experiences of knee OA and physiotherapy treatment and identify the facilitators and inhibitors of physiotherapy treatment in PKOA from a lower‐ and middle‐income country, India. Method: 40 PKOA (n = 10 in each Kellgren and Lawrence grade) will be recruited using a purposive sampling technique. Data will be collected through semi‐structured interviews which are composed of pre‐determined open‐ended questions. Based on patients' flexibility and feasibility, the interview will be conducted face‐to‐face or by telephone or videoconference. The interview will be recorded using a digital audio recorder. Recorded data will be transcribed verbatim. Data will be analysed using thematic analysis based on the Braun and Clark approach. Results: The verbatim transcript will be evaluated to identify sub‐themes and themes through thematic analysis. Generated data will be investigated through inductive qualitative analysis to examine the viewpoints of PKOA. Conclusion: This study will explore the patients' perspectives, experiences, and the factors which will facilitate and inhibit the physiotherapy treatment for knee osteoarthritis. The result might reveal a new way to promote insightful decision‐making towards physiotherapy care for PKOA and help to improve their access to physiotherapy care. [ABSTRACT FROM AUTHOR]

All UN member States committed to realizing universal health coverage (UHC) when they included UHC as Target 3.8 in the Sustainable Development Goals in 2015. However, the global commitment to UHC has not been matched with action on the ground. According to the World Health Organization, about half of the world population lacks full coverage for essential health services. To accelerate progress toward UHC, a close understanding of factors that drive adoption of UHC policies at the national and local levels is essential. The purpose of this study was to investigate the impetus for establishing a sub-national health insurance program in Kenya—the Makueni county government health insurance program (MakueniCare)—which led to increasing the percentage of the county population with health insurance, the majority of whom live in poverty, from 8.8% in 2013 to 91% in 2018. This qualitative case study drew on Kenyan law and policy documents as well as semi-structured interviews with 30 key informants in government and NGOs to understand the drivers that led to the establishment of MakueniCare. Findings revealed that several drivers—namely, global norms, decentralization, democratic competition, and the strategic action of social change-minded leaders—coalesced to influence the adoption of MakueniCare. The study offers timely insights into the factors driving UHC in Makueni, Kenya and lessons for other low- and middle-income countries working toward UHC. [ABSTRACT FROM AUTHOR]

In low- and middle-income countries (LMICs), barriers such as low system readiness, contextual mismatches, and resource limitations impede effective implementation of evidence-based interventions. This commentary offers insights into overcoming these challenges with a case study of the PRISM project, designed to reduce behavioral and psychological symptoms of dementia in older adults living in Thailand. The case highlights how combining two evidence-based models - the Reducing Disability in Alzheimer's Disease clinical intervention and the Getting To Outcomes implementation science process enhances program success. Using interviews with stakeholders across various health system levels, we identify factors critical to successful program implementation: (1) integrating interventions into policy frameworks, (2) empowering local implementers, (3) fostering collaborative learning, and (4) adapting interventions to local contexts. The case demonstrates that building system readiness through local engagement and ownership is central to scaling up health programs in LMICs. This commentary's contribution lies in its emphasis on the role of implementation science as a vehicle for translating research into practice. It presents a practical, adaptive model for embedding interventions into routine health systems, thereby offering a pathway for successfully scaling up evidence-based programs in LMICs. Such findings provide lessons for overcoming barriers to implementation in resource-limited environments. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic presents an unprecedented challenge to community wellbeing and mental health. However, quantifiable information on the extent of mental health problems and associated factors due to the pandemic is still lacking in low-income countries. Thus, this study aimed to investigate the levels of depression, anxiety, and stress and their association with risk and resilience factors among residents of Jimma town in Southwestern Ethiopia. A community-based cross-sectional study was conducted between October 2021 and November 2021. Data were collected from 1196 adult Jimma town residents selected through multi-stage sampling. The following scales were used for the cross-sectional assessment of depressions, anxiety and stress and their associations: depression, anxiety, and stress-21(DASS-21), World Health Organization (WHO) wellbeing, University of California, Los Angeles Loneliness Scale (UCLA), Childhood trauma questionnaire, and brief resilience scales. A pre-tested, interviewer-completed questionnaire was used for data collection. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with depression, anxiety, and stress. Odds ratios consistent with 95% CI were used to report the presence of an association between risk and resilience factors and the outcome variable at a P-value < 0.05. Overall, 963 (80.53%) respondents had divergent DASS-21 score findings. Specifically, 27.68%, 31.52% and 21.32% experienced depression, anxiety, and stress respectively. Higher DASS-21 scores were associated with the presence of one or more COVID-19 risk factors for anyone close to the participants (AOR = 1.53, 95% CI 1.03–2.27), feelings of stress/burden (β = 1.09, 95% CI 1.07–1.12), positive coping (β = 1.044, 95% CI 1.01–1.07), loneliness (β = 1.063, 95% CI 1.04–1.08), and childhood trauma (β = 1.03, 95% CI 1.01–1.04). In contrast, lower DASS-21 scores were associated with beliefs about the necessity of solidarity-based behavior (β = 0.94, 95% CI 0.90–0.98), resilience (β = 0.92, 95% CI 0.87–0.97) and wellbeing (β = 0.90, 95% CI 0.87–0.94). In the course of the COVID-19 pandemic in 2021, symptoms of depression, anxiety, and stress in the study community were prevalent, and associated with numerous risk and resilience factors. Although causality cannot be inferred, these findings underscore the importance of strengthening mental health services and may guide COVID-19 prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

This scoping review aimed to examine how self-healing practices had been addressed in the empirical literature on suicide bereavement. Adhering to PRISMA-ScR guidelines, we searched five databases for peer-reviewed studies that reported using self-healing practices, either as a primary or secondary finding and 32 studies were included. The results highlight a substantial research gap in understanding self-healing practices' definition, implementation, and effectiveness in suicide bereavement. Further studies are necessary to clarify the definition, identify facilitators and barriers to implementation, and explore the applicability of these strategies in diverse contexts, particularly in non-Western and Low-and Middle-income countries. [ABSTRACT FROM AUTHOR]

Neonatal diabetes mellitus (NDM) is a disorder characterized by persistent, severe hyperglycemia presenting during the first six months of life. These disorders are rare and the incidence is approximately 1 in 90,000 live births. The aim was to describe the clinical presentation, molecular genetics and outcome of patients with NDM from a single paediatric endocrine center from a low-middle income country, Sri Lanka. A retrospective study was conducted on patients diagnosed with NDM. Medical records were reviewed for demographic data and data on clinical, biochemical and genetic analysis. The majority (96%) who underwent mutation analysis had pathogenic genetic mutations on Sanger sequencing. Permanent NDM (PNDM) was diagnosed in 19 patients with three having a syndromic diagnosis. The most common mutation was in KCNJ11. The majority of patients with PNDM (63%) presented with severe diabetic ketoacidosis. All patients with Transient NDM remitted by six months of age. Nearly half (47%) with PNDM were switched to sulfonylurea therapy with good glycemic control (glycosylated haemoglobin A1c ranged 6-7.5%). Data from the Sri Lankan cohort is comparable with other populations. The majority of cases are due to KCNJ11 mutations resulting in PNDM. [ABSTRACT FROM AUTHOR]

Introduction: In Ethiopia approximately 3,200,000 babies are born annually and 41.09 per 10,000 live births are affected by spina bifida. Hydrocephalus (HCP) is another common pediatric neurosurgical condition with studies in Ethiopia showing the most common etiology is post spina bifida closure. The out-of-pocket expense (OOPE) and indirect expense of patients treated surgically for spina bifida and hydrocephalus during the first year of life were assessed. Methods: A prospective hospital-based study was done on patients treated surgically for spina bifida and HCP in two university-affiliated hospitals, between April 1st, 2022, and April 1st, 2023. Data on direct and indirect expenses were collected during inpatient care and follow-up. Catastrophic health expenditure (CHE) was assessed, defined as total expenditure exceeding 10% of the total annual household expenditure. Result: A total of 245 patients were eligible for analysis. The median annual total expenditure of households for treatment was ETB 11,510.00 with ETB 5700.00 being indirect expenditure. Forty-nine percent of the households suffered CHE. In multivariate analysis, the factors which were found to have a statistically significant association with CHE were the hospital where the patient received the treatment, the household's wealth quintile, the place of residency, and pre-admission duration of stay. Conclusion: Our study revealed a high CHE in households with spina bifida and HCP. We recommend working on primary prevention of spina bifida, expanding surgical services regionally to minimize costs associated with travel for surgical care, and reducing pre-admission duration of stay by improving evaluation and investigations at outpatient clinics. [ABSTRACT FROM AUTHOR]

Purpose: Unresectable pediatric low-grade gliomas (LGG) usually need adjuvant therapy, and carboplatin hypersensitivity reaction (HR) commonly leads to premature treatment cessation of a standard chemotherapy regimen. In the molecular era, advances in understanding tumor genetic characteristics allowed the development of targeted therapies for this group of tumors; however, cost-effectiveness assessment of treatments, especially in low-income countries, is crucial. The aim is to describe the results of carboplatin desensitization protocol in a single center in a middle-income country. Method: Prospective analysis of children with LGG submitted to carboplatin desensitization from December 2017 to June 2020 with follow-up until April 2024. Results: Nine patients were included. The mean age was 11 years. Five patients were male. Seven had optic pathway and two cervicomedullary location. Six had histologic diagnosis and four molecular analyses. The incidence of carboplatin reactions during the study period was 39.1%. Six patients underwent skin prick test, three with positive results. The first HR occurred, on average, around the 9th cycle of treatment. All patients had cutaneous symptoms, and five out of nine had anaphylaxis as the first reaction. 77.7% of the patients completed the protocol, and the clinical benefit rate (stable disease and partial response) was 88.8%. Six patients further required other lines of therapy. Monthly, the total cost for carboplatin was $409.09, and for target therapies (dabrafenib plus trametinib), $4929.28 to $5548.57. Conclusion: Our study presented an interesting and cost-effective option where desensitization allowed children with HR to be treated with first-line therapy, avoiding the discontinuation of an effective treatment. [ABSTRACT FROM AUTHOR]

The advent of advanced molecular diagnostic techniques has revealed plenty of information about signaling pathways and gene regulation in cancer, as well as new inputs for the classification of cancer subtypes, diagnosis, prognosis, and prediction of response to therapy. However, in most cases we do not have single biomarkers yet and, therefore, the final diagnosis is often rendered by the combination of multiple results by means of complex algorithms, eventually leading to an increase in their costs. The problem of the costs of such tests is particularly relevant in the case of thyroid cancer (TC), because of the observed increase in the number of patients affected by thyroid nodules (TN)s, in what is considered a global pandemic. High-income countries can afford the cost of the advanced molecular tests for such a multitude of TNs, since they are covered by private insurances. People living in upper-middle, lower-middle, and especially in low-income countries, where the costs for these advanced molecular tests are supported by general taxation and out-of-pocket payments, are exposed as a personal financial burden. Immunohistochemistry in cancer management represents an extremely cost-effective method in different clinical scenarios. In the preoperative recognition of TC, the use of such method, based on Galectin-3 and others protein markers, such as HMBE1, proved to be effective in diagnosing TC in TNs indeterminate at conventional cytology (Bethesda classification III or IV), with an extremely low cost. Moreover, Galectin-3 fulfills one of the major criteria of an ideal marker, being involved in the thyroid cell transformation. Despite this evidence, Galectin-3 ThyroTest is not considered and not even mentioned in many reviews, focused on the appropriate identification of TC, as well as in studies where the cost-effectiveness of the different approaches is comparatively evaluated. The aim of this review is to emphasize the value of the Galectin-3 based immunohistochemistry as a cheap and "good enough" method in the preoperative diagnosis of TC especially in, but not limited to, low-middle income countries. [ABSTRACT FROM AUTHOR]

Left ventricular non compaction is a genetic cardiomyopathy with a high occurence in individuals of African ancestry and may present in adulthood with diagnostic challenges when there is advanced heart failure. Echocardiography and Magnetic Resonance Imaging have mostly been used in making a diagnosis. However, there is a lack of these diagnostic tools required to aid in early diagnosis in Low and Middle Income Countries. The potential usefulness of echocardiography in this population is the focus of this case presentation. [ABSTRACT FROM AUTHOR]

The Pakistani pharmaceutical industry cannot ignore the contribution of pharmaceutical multinational corporations (MNCs) in terms of innovation and access to advanced treatments. The sale of a pharmaceutical manufacturing plant by an MNC to a Pakistani company has again sparked a debate on why MNCs are closing manufacturing operations in the country. National firms are currently giving MNCs a tough time in Pakistan. Besides competition, MNCs face mergers and acquisitions that hinder the expansion of existing facilities. In the recent past, there has been a noticeable shift in the market shares of multinational corporations (MNCs) and local companies. The market share of national firms has gradually increased, reaching 74.51%, while the market share of MNCs has decreased, falling to 25.49%. These local companies have increasingly partnered with foreign companies through joint ventures, which has had a positive impact on their growth and market share. Nevertheless, the federal government recently deregulated prices for non-essential medicines, so it is expected that MNCs will show their commitment to Pakistan by investing in the country. Investing in new molecules and infrastructure is necessary for MNCs in order to maintain their position in the market. Infrastructure investment is crucial for the smooth operation of pharmaceutical firms. This includes the construction of state-of-the-art manufacturing facilities, the establishment of research and development centres, and the upgrading of technology. [ABSTRACT FROM AUTHOR]

The success of universal coverage depends on ensuring that patients have access to medicine. Encouraging local production of medicines in developing countries can provide better access to medicines. In addition to determining the quality of pharmaceutical goods, Active Pharmaceutical Ingredients (APIs) also determine their cost. According to market forecasts, the active pharmaceutical ingredients market is expected to increase from USD 193.15 billion in 2023 to USD 285.29 billion by 2028. Pakistan largely depends on India and China for its Active Pharmaceutical Ingredient requirements. It was feared that a shortage of medicines would result from Pakistan's government suspending all trade with India on August 9, 2019. To improve health security in Pakistan, the Government of Pakistan has introduced an API promotion Policy in 2022. Financial and non-financial incentives have helped many countries develop their API industries like China, India, and Bangladesh. The current domestic API market of Pakistan is around 150 million $. After the introduction of the policy, the existing units are increasing their capacity while eight new API units are in the process of establishment. Through local production of APIs and intermediates, Pakistan can improve its health security by learning from the experiences of neighbouring countries, especially China. [ABSTRACT FROM AUTHOR]

Objectives: To determine a pooled prevalence of depression and its influencing factors among nursing home residents. Method: PsycINFO, PubMed, Embase, and Web of Science were searched for studies investigating the prevalence and risk factors of late-life depression among nursing home residents between January 2012 and November 2022. Two reviewers independently completed the literature screening, data extraction and quality assessment. A random-effects model was utilized to pool the prevalence of depression and summarize the influencing factors. Results: This meta-analysis included 48 studies involving 28,501 participants. The pooled prevalence of depressive mood and major depressive disorder was 53% and 27%, respectively. The rate of depressive mood is higher in lower-middle-income countries (60.0%), compared with high- (53.0%) and upper-middle-income countries (44.0%). The rate of depressive mood (35.0%) is higher among females than male (19.0%). Depression was influenced by factors, including male (OR = 0.28), insufficient income (OR = 3.53), comorbidities (OR = 2.66), pain (OR = 2.67; r = 0.31), functional disability (r = 0.33), loneliness (r = 0.43), number of chronic health problems (r = 0.18), social support (r = −0.28), activities of daily living (r = −0.43), subjective health (r = −0.28), autonomy (r = −0.41), environment (r = −0.50) and physical (r = −0.57) and psychological health (r = −0.65). Conclusion: The prevalence of depressive mood is high among nursing home residents, especially in lower-middle-income countries. It is influenced by factors including gender, income, social support, daily activities, environment, physical and psychological health and autonomy. Understanding those factors can provide evidence-based recommendations for improved awareness, prevention and better management of late-life depression. [ABSTRACT FROM AUTHOR]

Emerging countries are currently facing an increasing burden of cancer while they do not have adequate prevention, monitoring, and research capabilities to tackle the disease. Cancer outcomes are influenced by several factors, including different cancer patterns, national cancer screening guidelines, current stage of disease, and access to quality care and treatments. Discrepancies in cancer care between emerging and developed countries require actions to achieve global health equity. The process of pioneering a sister relationship in the oncology field can thwart the global burden of cancer. The objective of such cooperation programs should include research and training programs, evidence-based oncology practice, and quality cancer. Building global connections will therefore be the novel approach to addressing the global burden of cancer. [ABSTRACT FROM AUTHOR]

Aim s : Research capacity strengthening (RCS) is crucial in enhancing healthcare outcomes, particularly in low‐ and middle‐income countries (LMICs), which face challenges due to limited resources, unequal access to care and the need for evidence‐based decision‐making. We seek to move beyond a surface‐level understanding of RCS, unearthing the core attributes, the factors that precede its implementation and the transformative outcomes it generates within the LMIC healthcare landscape. Design: This study employs the Walker and Avant approach to concept analysis to comprehensively explore the dimensions and attributes of RCS as it pertains to allied and public health professionals in LMICs, propose empirical referents and suggest an operational definition. Data Sources: Ovid MEDLINE, Embase, CINAHL and Cochrane CENTRAL were searched from inception to 27 July 2023, to identify studies on RCS in LMICs. The Walker and Avant approach to concept analysis was selected because it provides a framework for systematically examining and clarifying the meaning and implications of RCS. This method involves a structured process of defining RCS, identifying its attributes, antecedents, consequences and cases, and ultimately providing a clear understanding of its meaning and implications. Identifying empirical referents offers measurable indicators that researchers and policymakers can use to assess the effectiveness of RCS initiatives in LMICs. Conclusion: RCS for health professionals in LMICs involves a sustainable process that equips them with essential research skills, fostering the ability to conduct high‐quality research and improve healthcare delivery in resource‐constrained settings. Implications: RCS aims to empower health professionals to apply evidence‐based practices, reduce disparities and enhance the well‐being of populations in LMICs. Impact: Ultimately, a concept analysis of RCS empowers us to harness the full potential of research to enhance healthcare delivery, improve patient outcomes and advance the well‐being of populations worldwide. [ABSTRACT FROM AUTHOR]

Aims: To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community‐dwelling older adults aged 55 and above using the protection motivation theory scale. Design: A cross‐sectional study. Methods: The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy‐five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non‐faller', employing IBM SPSS version 26.0 for descriptive, independent t‐test, chi‐square, bivariate correlation and linear regressions. Results: A total of 375 older participants were included in the study. Fallers (n = 82) and non‐fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self‐rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. Conclusion: Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non‐preventive behaviours, leading to a decline in fall protection motivation. Implications for the profession and/or patient care: These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. Patient or Public Contribution: Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty‐five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis. [ABSTRACT FROM AUTHOR]

Aims: Very low‐calorie diet (VLCD) can induce weight loss and diabetes remission (DR) amongst people with obesity and recent‐onset type 2 diabetes (T2D). We aimed to determine the effectiveness and acceptability of VLCD in achieving DR amongst Sri Lankan adults with T2D. Methods: A retrospective analysis was conducted in a diabetes practice where VLCD‐based Diabetes Remission Programme (VDRP) was offered for adults (>18 years) with T2D for <3 years and body mass index over 25 kg/m2. VLCD (~800 kcal/day, provided with/without diet replacement formula) was offered for 8–12 weeks, followed by gradual food reintroduction and exercise. DR was defined as HbA1c <6.5% at least 3 months after stopping glucose‐lowering medications. Results: A total of 170 participants who enrolled in the VDRP (mean age 38.4 years [±11.1], men 68%, mean baseline HbA1c 86.9 [±18.1] mmol/mol (10.1 [±2.1]%), median duration of T2D 2 years [IQR 1–2]) and 87 (51%) of them followed the programme (attended at least one follow‐up visit). Amongst the individuals who followed the VDRP, 40.2% achieved DR (35/87), compared with 2.4% (2/83) amongst those who did not follow the VDRP (aHR 9.3, 95% CI 2.2–16.4, p = 0.002). The proportion achieving normoglycaemia (HbA1c < 6.5%) but continued to take glucose‐lowering medication was 20/87 among VDRP followers and 20/85 amongst VDRP non‐followers. The commonest reasons for not following the VDRP were too restrictive dietary quantity (92%) and difficulties in finding recommended food items (67%). Majority (79%) would recommend VDRP to others. Conclusions: VDRP is effective in achieving T2D remission amongst Sri Lankan adults with recently diagnosed T2D and obesity. Over half of the participants followed the programme and over 75% would recommend it to others, indicating good acceptability. [ABSTRACT FROM AUTHOR]

Primary central nervous system tumors are the second most common cancer among children in high-income countries (HICs). These tumors are also the leading cause of cancer-related deaths in children in this setting. Studies from HICs report gliomas as the most common pediatric cancer. However, there is paucity of data from low- and middle-income countries as not many publications have been made in this field. The objective was to describe the disparities in detection, treatment, and survival of children with central nervous system tumors in low-income countries (LICs) when compared with HICs, using a case series. A retrospective chart review of three children treated for medulloblastoma in Uganda was done. In addition, a review of the literature about management of pediatric central nervous system tumors in both LICs and HICs was conducted. There are no quantifiable results for this case series. There are notable differences in the quality of care for children with pediatric central nervous system tumors in LICs when compared with HICs. In Uganda, the challenges in management of these children include few multidisciplinary specialists, long distance from the neurosurgery centers, and difficulties in making a correct pathologic diagnosis, among others. [ABSTRACT FROM AUTHOR]

Objective This study aimed to assess the viability of implementing a tele-educational training program in neurocritical care for newborns diagnosed with hypoxic–ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH), with the goal of reducing practice variation. Study Design Prospective study including newborns with HIE treated with TH from 12 neonatal intensive care units in Brazil conducted from February 2021 to February 2022. An educational intervention consisting of 12 biweekly, 1-hour, live videoconferences was implemented during a 6-month period in all centers. Half of the centers had the assistance of a remote neuromonitoring team. The primary outcome was the rate of deviations from TH protocol, and it was evaluated during a 3-month period before and after the intervention. Logistic regression via generalized estimating equations was performed to compare the primary and secondary outcomes. Protocol deviations were defined as practices not in compliance with the TH protocol provided. A subanalysis evaluated the differences in protocol deviations and clinical variables between centers with and without neuromonitoring. Results Sixty-six (39.5%) newborns with HIE were treated with TH during the preintervention period, 69 (41.3%) during the intervention period and 32 (19.1%) after intervention. There was not a significant reduction in protocol deviations between the pre- and postintervention periods (37.8 vs. 25%, p = 0.23); however, a decrease in the rates of missing Sarnat examinations within 6 hours after birth was seen between the preintervention (n = 5, 7.6%) and postintervention (n = 2, 6.3%) periods (adjusted odds ratio [aOR]: 0.36 [0.25–0.52], p < 0.001). Centers with remote neuromonitoring support had significantly lower rates of seizures (27.6 vs. 57.5%; aOR: 0.26 [0.12–0.55], p < 0.001) and significant less seizure medication (27.6 vs. 68.7%; aOR: 0.17 [0.07–0.4], p < 0.001). Conclusion This study shows that implementing a tele-educational program in neonatal neurocritical care is feasible and may decrease variability in the delivery of care to patients with HIE treated with TH. Key Points Neurocritical care strategies vary widely in low- and middle-income countries. Heterogeneity of care may lead to suboptimal efficacy of neuroprotective strategies. Tele-education and international collaboration can decrease the variability of neurocritical care provided to infants with HIE. [ABSTRACT FROM AUTHOR]

Background: Preterm birth accounts about 1 million neonatal deaths worldwide and the second causes of both neonatal and under five-child mortality. From this preterm is the second leading cause of death and is steadily increased in low-income countries. In Ethiopia, Preterm neonatal death is the first and fourth cause of newborn and under-5 deaths, respectively. Although the general newborn mortality rate in the research area was 27 per 1000 neonates, but the preterm neonatal mortality rate and determinants were not previously well recognized. This study aimed to identify the Determinants of preterm neonatal mortality admitted to WSUCSH, with some variations from other studies carried out in in terms of the environment, hospital setting and the inclusion of additional factors. Methods: An institution-based, unmatched case-control study was conducted from June 1–15, 2023 on preterm neonates who admitted to Wolaita Sodo University Comprehensive Specialized Hospital from July 1, 2020, to June 30, 2022. A total of 690 with 1:2 ratio (230 cases and 460 controls respectively) preterm neonate medical charts were used for data extraction using a pre-established tool. Data were checked for completeness and consistency, entered using Epi-Data V.4.6, and transported to SPSS version 26 for analysis. Multivariate logistic regression analysis was performed to identify the independent determinants of preterm neonate mortality at a p value of < 0.05 along with a 95% confidence interval (CI). Finally, the model fitness of the study was assessed using the Hosmer and Lemshow model fitness test. Results: The preterm neonatal death rate was 10.9%. Hypothermia (AOR = 1.66, 95% CI:1.03–2.67), Sepsis (AOR = 3.35, 95% CI: 1.25 8.96), hypoglycemia (AOR = 2.85, 95% CI:1.09–7.44), Respiratory distress syndrome(RDS) (AOR = 7.21 95% CI:2.18–23.92), necrotizing enter colitis (AOR = 7.92, 95% CI:2.96–21.12) and neonates who stayed at hospital less than 7 days (AOR = 7.36, 95% CI:2.82,19.22) were predictors of preterm mortality. Conclusion and recommendation: Preterm neonatal mortality in this setting is mainly related to sepsis, respiratory distress syndrome (RDS), necrotizing enter colitis (NEC), hypoglycemia, hypothermia, and brief hospital stay. Thus, it would be preferable to offer appropriate prevention measures and extra care for neonates who have those factors. [ABSTRACT FROM AUTHOR]

Post partum period (1 hour to 42 days after birth) is a crucial phase but often ignored, with the result that many maternal and infant deaths occurring during this period. WHO recommends antenatal care examinations at least three times after giving birth. Low-income countries has challenges in providing inadequate care, leading to high maternal and infant mortality rates. Evaluation of health service quality and strategic location is important to increase patient satisfaction and loyalty in RSUD Majenang as a strategic hospital in Cilacap. This study aims to determine and analyze health quality of service and hospital location (Access, place, infrastructure) on postpartum patient satisfaction which has implications for patient loyalty. This study uses quantitative approach with descriptive verification methods. Research sample obtained was 110 people based on the Slovin formula. Data collection uses a questionnaire and data analysis design with univariate, bivariate and multivariate analysis. Univariate analysis show that service quality, patient satisfaction and patient loyalty are in the good category and the hospital location is in the very good category. Bivariate analysis shows that 2 variables obtained a significance value (p<0.05). Multivariate analysis also showed that more than 2 variables obtained a significance value (p<0.05). Health service quality and hospital location influence patient satisfaction which has implications for patient loyalty. [ABSTRACT FROM AUTHOR]

Postponing the adoption of genome editing (GE) is costly, with lengthy regulatory processes contributing to postponement. Accelerating agricultural research and development (R&D) transfer is important for stimulating sustainable agricultural transitions and enhancing global food security. Using the MAGNET model, we incorporate dynamic R&D accumulation and compare economic projections in scenarios with accelerated R&D transfer. We calculate the cost of delay (COD) from postponing GE adoption. The results show that accelerating R&D transfer in high-income countries impacts economic performance, welfare, and food affordability globally; the annuity of COD ranges from losses of -$1.1 billion (Brazil) to gains of $18.5 billion (Europe). A 3-year acceleration of R&D transfer in all countries benefits middle and low-income countries the most (e.g. China, India, other Asian countries, and Sub-Saharan African countries), with the annuity of COD ranging from -$4.8 billion (Brazil) to $83.9 billion (China). Therefore, streamlining the GE regulatory framework is essential for enhancing food security and global welfare. [ABSTRACT FROM AUTHOR]