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The World Health Organization (WHO) plays an Important role In developing evidence-based and ethically sound guidelines to assist health workers, programme managers and policy-makers, particularly in countries with limited capacities to create their own. While the development of these guidelines follows rigorous methods, contextualizing recommendations is often necessary to ensure their applicability, feasibility and acceptability at the country level. The adaptation and adoption of global guidelines should happen in a transparent, systematic and participatory manner to maintain credibility while ensuring the ownership necessary for implementation. Here, we present an example from Estonia that showcases the process, requirements and outcomes of implementing WHO guidelines through effective contextualization. The work in Estonia showed that contextualization can shorten guideline development time and reduce costs. To support countries in contextualizing guidelines, including those developed by WHO, to local contexts while maintaining trustworthiness and relevance, the WHO Regional Office for Europe has developed a handbook based on the GRADE- Adolopment approach to guide this process. Furthermore, a rapid assessment of 21 of the 53 Member States in the WHO European Region revealed that many countries need guidance and support to build capacity for contextualizing guidelines. To address the capacity gaps, we suggest a way forward that encompasses four areas of further work: standardizing methods; institutionalizing guideline programmes and initiatives; promoting continuous and shared learning; and providing support and identifying resources. Strengthening countries' capacities to contextualize global guidelines is crucial and will become especially relevant during future health threats, such as pandemics, climate change and conflict situations. [phrase omitted] L'Organisation mondiale de la Sante (OMS) joue un role crucial dans l'elaboration de lignes directrices ethiques et fondees sur des donnees factuelles qui viennent soutenir le personnel de sante, les gestionnaires de programmes et les responsables politiques, en particulier dans les pays qui ne disposent pas de capacites suffisantes pour developper les leurs. Bien que la mise au point de ces lignes directrices suive des methodes rigoureuses, il est souvent indispensable de contextualiser les recommandations pour les rendre applicables, faisables et acceptables a l'echelle nationale. Ladaptation et l'adoption de lignes directrices mondiales doivent s'effectuer en toute transparence, de maniere systematique et participative, en vue de preserver leur credibilite tout en assurant le niveau d'implication necessaire a leur deploiement. Ce document s'appuie sur un exemple provenant d'Estonie pour illustrer le processus, les exigences et les resultats lies a la mise en pratique de lignes directrices emises par l'OMS grace a une contextualisation efficace. Le travail realise en Estonie a montre que cette contextualisation pouvait reduire le temps consacre au developpement de la ligne directrice et faire baisser les couts. Afin d'aider les pays a adapter les lignes directrices, notamment celles elaborees par l'OMS, a chaque contexte local tout en conservant leur fiabilite et leur pertinence, le Bureau regional de l'OMS pour l'Europe a redige un manuel qui s'inspire de l'approche GRADEAdolopment pour guider ce processus. En outre, une evaluation rapide de 21 des 53 Etats Membres de la Region europeenne de l'OMS a revele que nombre d'entre eux avaient besoin d'assistance et de conseils pour developper leurs capacites de contextualisation des lignes directrices. Nous suggerons, pour combler les lacunes, une strategie constituee de quatre axes pour la poursuite des travaux: la standardisation des methodes, l'institutionnalisation des initiatives et programmes relatifs aux lignes directrices, la promotion d'un apprentissage commun et continu, ainsi que la mise a disposition d'un soutien et l'identification des ressources. Renforcer les capacites des pays a contextualiser les lignes directrices mondiales est essentiel et revetira une importance particuliere face a de futures menaces sanitaires telles que les pandemies, le changement climatique et les situations de conflit. [phrase omitted] La Organizacion Mundial de la Salud (OMS) desempena una funcion importante en la elaboracion de directrices basadas en evidencias y solidas desde el punto de vista etico para ayudar al personal sanitario, los gestores de programas y los responsables de formular politicas, sobre todo en paises que tienen una capacidad limitada para crear sus propias directrices. Aunque la elaboracion de estas directrices sigue metodos rigurosos, suele ser necesario contextualizar las recomendaciones para asegurar su aplicabilidad, viabilidad y aceptabilidad a nivel nacional. La adaptacion y la adopcion de directrices mundiales deben realizarse de forma transparente, sistematica y participativa para mantener la credibilidad y asegurar al mismo tiempo la apropiacion necesaria para su implementacion. En este documento, se presenta un ejemplo de Estonia que muestra el proceso, los requisitos y los resultados de la aplicacion de las directrices de la OMS mediante una contextualizacion efectiva. El trabajo realizado en Estonia demostro que la contextualizacion puede acortar el tiempo de elaboracion de las directrices y reducir los costes. Para ayudar a los paises a adaptar las directrices, incluidas las elaboradas por la OMS, a los contextos locales, manteniendo al mismo tiempo su fiabilidad y pertinencia, la Oficina Regional para Europa de la OMS ha elaborado un manual basado en el enfoque GRADE-Adolopment para orientar este proceso. Ademas, una evaluacion rapida de 21 de los 53 Estados Miembros de la Region de Europa de la OMS revelo que muchos paises necesitan orientacion y apoyo para crear capacidad a fin de contextualizar las directrices. Para abordar las carencias de capacidad, se sugiere una via de avance que abarca cuatro areas de trabajo ulterior: estandarizar metodos, institucionalizar programas e iniciativas de directrices, promover el aprendizaje continuo y compartido, y proporcionar apoyo e identificar recursos. El refuerzo de las capacidades de los paises para contextualizar las directrices mundiales es crucial y sera de especial relevancia durante futuras amenazas para la salud, como las pandemias, el cambio climatico y las situaciones de conflicto., Introduction The World Health Organization (WHO) has the mandate to develop guidelines and provide recommendations under its normative and global standard-setting function. (1) These guidelines assist health workers, programme managers [...]

Two experiments were conducted to examine the effects of point-loss response cost on the responding under fixed-interval (FI) schedules in humans. Responses by undergraduates produced points exchangeable for money arranged according to an FI 90-s schedule (Experiment 1) or a multiple FI 30-s FI 60-s FI 90-s schedule (Experiment 2). Following this baseline, a contingency of response cost, under which responses lost points, was introduced then withdrawn. Response rates with the response cost were lower than those during the baseline. Following termination of the response cost contingency, the final response rates were again lower than those during the baseline (Experiments 1 and 2). Such low-rate responding was not found for participants who were exposed only to no-cost FI schedules (Experiment 2). These results demonstrate an irreversible effect of response cost. Generality and implications of the findings were discussed in the context of the research in punishment and human schedule performance. Keywords Response cost * Fixed-interval schedules * Screen touch * Key press * Humans, Punishment may be defined as a response-consequence contingency by which a response is weakened (cf. Baron, 1991; Hineline & Rosales-Ruiz, 2013). During the mid-20th century, considerable research analyzed the functions [...]

According to the World Health Organization (WHO), antimicrobial resistance, which occurs when bacteria, viruses, fungi and parasites change and stop responding to medication, is one of the top 10 health [...]

The coronavirus disease 2019 (COVID-19) pandemic, increasingly frequent and severe natural disasters, and geopolitical events have highlighted the need for health systems that are resilient and can be rebuilt efficiently [...]

The present study adds to the existing literature by grouping countries in sub-Saharan Africa into two broad health systems (public and private). A country's health system is classified as predominantly public if the average share of public health expenditure for the period under study is greater than the average share of private health expenditure; it is classified as predominantly private if the reverse is the case. The aim is to derive the income elasticities of health expenditure in other to unravel countries in the sub region where health provision is likely to be a necessary good. To capture the dynamic nature of the relationship, the study's methodology relies on several econometric procedures (pooled mean group, mean group, and common correlated error mean group estimators). Other variables included in the model are official development assistance, the price level, population above 65 and migrant remittances. The unit root test performed showed that most of the variables in the study are not stationary at level; however, they are cointegrated in the long run, justifying the choice of the estimation techniques. The empirical results reveals that the short run income elasticity of health expenditure in sub-Saharan Africa is 0.36 and in the long run, the value becomes 1.18 with a speed of adjustment of 0.41. This suggest that 41% of the short run disequilibrium is dissipated in the current period. Other variables that were included in the model as controls were not statistically significant. In the reduced model that has only income as regressor, the short run and long run income elasticities in the overall sample continues to remain significant, however, the income elasticity in the predominantly public health system is greater than the elasticity in the predominantly private health system. This suggests that health is more of a development issue in a predominantly private health system in sub--Saharan Africa. An implication of the present study is that citizens of sub-Saharan African countries that rely more on private financing of health expenditure are likely to be exposed to catastrophic health financing. Hence, policymakers can avert this by encouraging more public financing of healthcare provision. JEL Classifications: G22; C23 Keywords: Sub Saharan Africa, Panel Data, Health Expenditure, INTRODUCTION The literature is replete with studies that have highlighted the pivotal role health expenditure plays in the population health status of people living in sub-Saharan Africa (1) . This, [...]

Background Since common diagnostic tests for gonorrhea do not provide information about susceptibility to antibiotics, treatment of gonorrhea remains empiric. Antibiotics used for empiric therapy are usually changed once resistance prevalence exceeds a certain threshold (e.g., 5%). A low switch threshold is intended to increase the probability that an infection is successfully treated with the first-line antibiotic, but it could also increase the pace at which recommendations are switched to newer antibiotics. Little is known about the impact of changing the switch threshold on the incidence of gonorrhea, the rate of treatment failure, and the overall cost and quality-adjusted life-years (QALYs) associated with gonorrhea. Methods and findings We developed a transmission model of gonococcal infection with multiple resistant strains to project gonorrhea-associated costs and loss in QALYs under different switch thresholds among men who have sex with men (MSM) in the United States. We accounted for the costs and disutilities associated with symptoms, diagnosis, treatment, and sequelae, and combined costs and QALYs in a measure of net health benefit (NHB). Our results suggest that under a scenario where 3 antibiotics are available over the next 50 years (2 suitable for the first-line therapy of gonorrhea and 1 suitable only for the retreatment of resistant infections), changing the switch threshold between 1% and 10% does not meaningfully impact the annual number of gonorrhea cases, total costs, or total QALY losses associated with gonorrhea. However, if a new antibiotic is to become available in the future, choosing a lower switch threshold could improve the population NHB. If in addition, drug-susceptibility testing (DST) is available to inform retreatment regimens after unsuccessful first-line therapy, setting the switch threshold at 1% to 2% is expected to maximize the population NHB. A limitation of our study is that our analysis only focuses on the MSM population and does not consider the influence of interventions such as vaccine and common use of rapid drugs susceptibility tests to inform first-line therapy. Conclusions Changing the switch threshold for first-line antibiotics may not substantially change the health and financial outcomes associated with gonorrhea. However, the switch threshold could be reduced when newer antibiotics are expected to become available soon or when in addition to future novel antibiotics, DST is also available to inform retreatment regimens., Author(s): Xuecheng Yin 1,2,3,*, Yunfei Li 4, Minttu M. Rönn 4, Song Li 5, Yue Yuan 6, Thomas L. Gift 7, Katherine Hsu 8, Joshua A. Salomon 9, Yonatan H. [...]

The United States does not have enough transplant kidneys to provide one to each person suffering from end-stage kidney disease who would benefit from a transplant. This shortage is costly [...]

The study characterised differences in costs associated with raising a child between four rare disorders and examined the associations between these costs with clinical severity. Caregivers of 108 individuals with Prader-Willi, Angelman (AS), Chromosome 15q Duplication and fragile X (FXS) syndromes completed a modified Client Services Receipt Inventory and participants completed intellectual/developmental functioning and autism assessments. AS incurred the highest yearly costs per individual ($AUD96,994), while FXS had the lowest costs ($AUD33,221). Intellectual functioning negatively predicted total costs, after controlling for diagnosis. The effect of intellectual functioning on total costs for those with AS was significantly different to the other syndromes. The study highlights the significant costs associated with these syndromes, particularly AS, linked with severity of intellectual functioning., Author(s): Emma K. Baker [sup.1] [sup.2] [sup.3] , Sheena Arora [sup.4] , David J. Amor [sup.2] [sup.5] , Perrin Date [sup.1] [sup.11] , Meagan Cross [sup.6] , James O'Brien [sup.7] [...]

Those living in First Nation communities tend to experience a lower quality of life than non-Indigenous Canadians as evidenced by a broad array of indicators such as employment and residential overcrowding. This research focuses on the relationship between household size and wellbeing among First Nation communities in Canada with consideration of the impact of remoteness and population as well. The research objectives are addressed with empirical analysis consisting of three stepwise linear regressions with community level data from the 2016 Census and First Nation government financial statements. Wellbeing, the dependent variable, is assessed with selected wellbeing indices consisting of education, housing quality, and workforce participation. The explanatory variables consist of a set of demographic factors, which includes household size, and a set of financial indicators. Geographic remoteness and community population are each added to the regression models in a stepwise manner. The results reveal that household size has the largest marginal impact on all three measures of wellbeing, suggesting that communities with relatively larger households, often associated with residential overcrowding, are more likely to have lower levels of wellbeing. The stepwise regression results illustrate the significance of including geographical remoteness for all three measures of wellbeing, while the addition of community population is only significant for the workforce index. In regard to geographical remoteness, the empirical results reveal that both educational outcomes and housing quality are lower in more remote communities. Community size, as defined by population, is found to be negatively associated with the workforce index implying that communities with larger populations tend to have lower workforce participation and employment outcomes. Given the ongoing social, health and economic costs associated with residential crowding in First Nation communities, the results will be of interest to policy makers and First Nation leaders in Canada and other countries who seek strategies to raise the level of wellbeing for their Indigenous communities. Policy recommendations include an increase in housing supply coordinated through the creation of an Indigenous-led housing and infrastructure authority. Other recommendations include long-term approaches to supporting education and job training programs with community level initiatives. JEL Classifications: O12, I31, O51, I25 Keywords: Indigenous, wellbeing, community economic development, housing, education, labor force Corresponding Author's Email Address: llamb@tru.ca, INTRODUCTION Indigenous Canadians tend to live a lower quality of life than the rest of Canadians, as evidenced by various measures of wellbeing including physical and psychological health, labor force [...]

To understand the ASD diagnosis and treatment pathways for US families, N = 38 Mexican-heritage mothers were interviewed about how and when they obtained an ASD diagnosis for their children. Most children (84%) were diagnosed between two and three years old. One-third of mothers reported receiving four to seven referrals before diagnosis. Mothers identified multiple diagnosis circumstances including two diagnoses and services offered before diagnosis. A multiple case study design documented the diagnosis and treatment experiences of four representative participants. As compared to previous studies that utilized a deficit lens to rationalize barriers to diagnosis and treatment (e.g., parents not knowledgeable about ASD), these findings revealed a complex understanding of how structural barriers (e.g., immigration status), initial diagnosis rejection among caregivers, and abrupt service cancellation complicated the diagnosis and treatment process. Implications identified suggestions to optimize and streamline ASD diagnosis and treatment pathways for Mexican heritage families., Author(s): Shana R. Cohen [sup.1] , Jessica Miguel [sup.1] , Jessica Trejos [sup.1] Author Affiliations: (1) grid.266100.3, 0000 0001 2107 4242, Department of Education Studies, University of California, , 9500 [...]