A framework for the implementation of new radiation therapy technologies and treatment techniques in low-income countries

We present a practical, generic, easy-to-use framework for the implementation of new radiation therapy technologies and treatment techniques in low-income countries. The framework is intended to standardize the implementation process, reduce the effort involved in generating an implementation strategy, and provide improved patient safety by reducing the likelihood that steps are missed during the implementation process. The 10 steps in the framework provide a practical approach to implementation. The steps are, 1) Site and resource assessment, 2) Evaluation of equipment and funding, 3) Establishing timelines, 4) Defining the treatment process, 5) Equipment commissioning, 6) Training and competency assessment, 7) Prospective risk analysis, 8) System testing, 9) External dosimetric audit and incident learning, and 10) Support and follow-up. For each step, practical advice for completing the step is provided, as well as links to helpful supplementary material. An associated checklist is provided that can be used to track progress through the steps in the framework. While the emphasis of this paper is on addressing the needs of low-income countries, the concepts also apply in high-income countries.     

Ecoepidemiology,short history and control of Chagas disease in the endemic countries and the new challenge for non-endemic countries

Chagas disease is maintained in nature through the interchange of three cycles: the wild, peridomestic and domestic cycles. The wild cycle, which is enzootic, has existed for millions of years maintained between triatomines and wild mammals. Human infection was only detected in mummies from 4,000-9,000 years ago, before the discovery of the disease by Carlos Chagas in 1909. With the beginning of deforestation in the Americas, two-three centuries ago for the expansion of agriculture and livestock rearing, wild mammals, which had been the food source for triatomines, were removed and new food sources started to appear in peridomestic areas: chicken coops, corrals and pigsties. Some accidental human cases could also have occurred prior to the triatomines in peridomestic areas. Thus, triatomines progressively penetrated households and formed the domestic cycle of Chagas disease. A new epidemiological, economic and social problem has been created through the globalisation of Chagas disease, due to legal and illegal migration of individuals infected by Trypanosoma cruzi or presenting Chagas disease in its varied clinical forms, from endemic countries in Latin America to non-endemic countries in North America, Europe, Asia and Oceania, particularly to the United States of America and Spain. The main objective of the present paper was to present a general view of the interchanges between the wild, peridomestic and domestic cycles of the disease, the development of T. cruzi among triatomine, their domiciliation and control initiatives, the characteristics of the disease in countries in the Americas and the problem of migration to non-endemic countries.     

Bladder preservation by concurrent chemoradiation for muscle-invasive bladder cancer: Applicability in low-income countries

Background

Radical cystectomy is the standard treatment for patients with muscle-invasive urinary bladder cancer; however, is associated with major treatment – related morbidity. Furthermore, a significant proportion of patients are deemed unsuitable for surgery due to inoperability, advanced age, and/or comorbid conditions. As such, several groups have explored effectiveness of less radical therapeutic strategies that aim at bladder preservation. Nonetheless, there is scarcity of reports assessing the applicability of urinary bladder-sparing outside developed countries.

Aim

Determine the achievable outcomes for patients with muscle-invasive urinary bladder cancer treated via bladder-sparing techniques in a low income country.

Materials and methods

Fourteen consecutive patients with a diagnosis of muscle-invasive urinary bladder cancer (clinical stage; T2-3N0M0) were treated via a bladder-sparing approach at King Hussein Cancer Center (Amman, Jordan) between 2005 and 2009. Records were electronically retrieved and retrospectively analyzed and included 11 males and 3 females from 41 to 74 years of age (median age, 61). Initial therapy consisted of trans-urethral resection of bladder tumor (TURBT) followed by induction chemotherapy then irradiation (4500cGy) with concurrent platinum-based chemotherapy. Urological evaluation directed additional therapy in a proportion of patients with irradiation (up to 6400 cGy) in patients who achieved CR.

Results

Eleven patients were evaluable for pathological response at time of re-staging; of whom 8 (73%) achieved CR and 3 (27%) achieved partial response (PR). In all but one patient; combined-modality treatment was well tolerated. After a median follow-up of 18.5 months (range, 3–48 months); 5 of 8 (62.5%) patients with CR were alive.

Conclusions

Bladder-sparing strategies via concurrent chemoradiation for muscle-invasive bladder cancer results in an acceptable rate of complete pathological response with adequate short-term outcomes. This approach appears applicable in low-income countries.     

On new challenge for the Bioinformatics

The living organisms may be studied as a whole complex system. The “omics sciences” tend at understanding and describing the global information of genes, mRNA, proteins, and metabolites. The aim of the Bioinformatics should be that of developing methods not only able to study the individual components of a system, but also to represent and simulate the relationships between all these components.     

Development of a social impact assessment methodology for recycling systems in low-income countries

Purpose

Informal recycling is one of the most significant activities within waste management systems in low-income countries. The main aspect of a number of recently implemented waste management systems has been to organise the informal recycling sector. The implementation of formalisation is expected to eliminate social problems related to the informal sector, but this has not been precisely measured and evaluated. A lack of methodology to assess social impacts persists, as does the comparison of different formalisation approaches. The goal of this work is to develop a methodological procedure for assessing the contribution of formalised recycling systems in low-income countries in terms of social impacts, in comparison with informal systems.

Methods

Some existing social assessment approaches were evaluated by a review of literature. This investigation focuses on the development of the social life cycle assessment approach, the analysed social aspects, proposed indicators and characterisation models within this framework.

Results and discussion

This study proposes an approach for the social assessment of recycling systems based on formalisation approaches in low-income countries oriented towards the social life cycle assessment methodology (sLCA). The approach developed considers 3 social impact categories, 9 social subcategories and 26 semi-quantitative indicators for the assessment of the social impacts on formalised recyclers. It includes a characterisation procedure that takes into consideration the application of a score system and the calculation of average scores at both the indicator and subcategory levels.

Conclusions

This research shows that it would be feasible to apply a sLCA-based methodology to evaluate recycling systems based on formalisation of the informal sector. The impact categories and subcategories identified represent the social problems of informal recyclers. The 26 semi-quantitative indicators and the proposed characterisation approach attempt to measure the social impacts that currently are only qualitatively assumed. The applicability and validation of the indicators and characterisation procedure will be determined by further research. The methodology developed will be tested using data from three recycling systems in Peruvian cities.     

Infertility in African countries: challenges created by the HIV epidemic

¹ Correspondence address. E-mail: silke.dyer{at}uct.ac.za HIV infection and infertility are two common reproductive healthdisorders in Africa. From the perspective of infertility-relatedreproductive health care, the HIV epidemic has created severalchallenges which include reduction of fecundity, depletion ofscarce health resources, creation of barriers to infertilitytreatment and increased suffering. Infertility in turn is arisk factor for HIV acquisition and a possible force in thespread of the HIV epidemic. Recognition of the reproductivehealth needs and desires of HIV-infected infertile men and womenis a prerequisite for addressing these challenges. Subsequentstrategies comprise the development of treatment guidelinesfor low-resource environments and a greater integration of HIVand sexual and reproductive health services. Where resourcesfor infertility treatment are not available, the consequencesmust be critically assessed.     

New drugs for the treatment of human African trypanosomiasis: research and development

Chemotherapy of human African trypanosomiasis is problematic because of the high frequency of severe adverse events, the long duration and high cost of treatment, and an increasing number of treatment-refractory cases. New cost-efficient, easy-to-use drugs are urgently needed. Whereas basic research on potential drug targets is anchored in academia, the complex, highly regulated and very expensive process of preclinical and clinical drug development is almost exclusively in the hands of pharmaceutical companies. Jennifer Keiser, August Stich and Christian Burri here review, from the angle of industrial drug research and development, the past ten years of research activities at different stages of the development of trypanocidal drugs, and assess future prospects. The absence of compounds in clinical development Phases I-III indicates no new drugs will become available in the next few years.     

Human Cytokinome: a new challenge for systems biology

Cytokines play an important role in the evolution of inflammatory processes. Therefore, they are also key components of the cancer evolution, a disease recognized to depend on chronic inflammation. On the whole, we define cytokinome as the totality of these proteins and their interactions in and around biological cells. Understanding the complex interaction network of cytokines in patients affected from cancers should be very useful both to follow the cancer evolution from its early steps and to define innovative therapeutic strategies by using systems biology approaches.     

Socioeconomic inequality in smoking in low-income and middle-income countries: results from the world health survey

Objectives

To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries.

Methods

We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied.

Results

In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups.

Conclusion

Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population.