Breast cancer as a global health concern

Public health data indicate that the global burden of breast cancer in women, measured by incidence, mortality, and economic costs, is substantial and on the increase. Worldwide, it is estimated that more than one million women are diagnosed with breast cancer every year, and more than 410,000 will die from the disease. In low- and middle-income countries (LMCs), the infrastructure and resources for routine screening mammography are often unavailable. In such lower resource settings, breast cancers are commonly diagnosed at late stages, and women may receive inadequate treatment, pain relief, or palliative care. There have been an increasing number of global health initiatives to address breast cancer including efforts by Susan G. Komen for the Cure^©, the Breast Health Global Initiative (BHGI), the U.S. Centers for Disease Control and Prevention (CDC), the American Cancer Society, the National Cancer Institute (NCI), and ongoing work by leading oncology societies in different parts of the world. To support such initiatives, and to provide a scientific evidence base for health policy and public health decision making, there is a need for further health services research and program evaluations. Cancer registries can be invaluable in ascertaining the magnitude of cancer disease burden and its distribution in these countries. Additional data are needed for various geographic areas to assess resources required, cost-effectiveness, and humane approaches for preventing or controlling breast cancer in low resource settings in developing countries.     

Artisanal Fisheries Research: A Need for Globalization?

Given limited funds for research and widespread degradation of ecosystems, environmental scientists should geographically target their studies where they will be most effective. However, in academic areas such as conservation and natural resource management there is often a mismatch between the geographic foci of research effort/funding and research needs. The former frequently being focused in the developed world while the latter is greater in the biodiverse countries of the Global South. Here, we adopt a bibliometric approach to test this hypothesis using research on artisanal fisheries. Such fisheries occur throughout the world, but are especially prominent in developing countries where they are important for supporting local livelihoods, food security and poverty alleviation. Moreover, most artisanal fisheries in the Global South are unregulated and unmonitored and are in urgent need of science-based management to ensure future sustainability. Our results indicate that, as predicted, global research networks and centres of knowledge production are predominantly located in developed countries, indicating a global mismatch between research needs and capacity.     

Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes

Background

Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities.

Methodology and Principal Findings

A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants'' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants.

Conclusion

The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening national health research systems, particularly in the least developing countries. The engagement of stakeholders at country level would facilitate the design of more specific and comprehensive strategies based on local needs.     

The science,art and business of successful bioherbicides

In this article, the critical issues in the production of successful bioherbicides have been defined in an effort to stimulate discussion on the underlying science, art of formulation and fermentation and the business of producing and marketing of bioherbicides. To a large extent the science of bioherbicides has focussed on epidemiology, although the enormous potential of molecular technology to improve the efficacy of these agents is being investigated. Some of this potential is coming to fruition in terms of development of tools for the identification and tracking of biological controls, although the genetic modification of biological control agents is still in its infancy. On the other hand, knowledge in the areas of formulation and fermentation is often proprietary in nature. This makes it critical for researchers to work in collaboration with other researchers or industry in these areas. The importance of the appropriate involvement of industry and commercialization partners early in the development process should not be underestimated. Although ad hoc research into biological control should not be discouraged, researchers should be encouraged to think carefully before they postulate on the potential of a bioherbicide based purely on preliminary isolation and pathogenicity testing. As much of the research is specific to a single pathogen/host system, the way ahead in bioherbicide research would appear to be the development of consortia or research nodes in which scientists and business people with backgrounds in the discovery, development and commercialization of biopesticides work collaboratively on a number of projects. There has been movement towards this type of model in countries such as Canada, USA and New Zealand although other countries lag behind. Interestingly, all five of the recently registered bioherbicides in the U.S. and Canada were developed and registered by small-business enterprises or a subsidiary of enterprises with no prior record in pesticide development.The constraints to bioherbicides are not in the science, art or business: it is in bringing all of these aspects together in an accessible way and the sharing of intellectual property in an equitable fashion. A new model for the commercialization of bioherbicides should build on currently established research networks, but need to have a stronger link to industry (especially small–medium enterprises) and requires funding for infrastructure and personnel. This funding needs to come from the public sector. Industry is interested in engaging this type of research, but they need to be reassured that the approach is feasible, economic and realistic and that the resources required are available.     

Epidemiological profile of India: Historical and contemporary perspectives

Knowledge and understanding of the epidemiological profile is an essential pre-requisite to assess and address public health needs in the country and to enable efficient programme planning and management. The need for adequate and accurate health information and data to undertake such an exercise cannot be over-emphasized. The present effort is a modest attempt to critically analyse the epidemiological profile of India from the historical and contemporary perspective. In order to assess the successes achieved as well caution against the daunting challenges awaiting the country, parameters such as disease burden and health status indicators, are increasingly being used. Changes in the population age structure, improvements in the nation’s economic status, altered life-styles of people and duality of disease burden testify to the demographic, development and health transition occurring in the country. Population stabilization, poverty alleviation, life-style modification, surveillance and control of communicable and non-communicable diseases constitute the major challenges demanding urgent attention in the future.     

Disease Risk Assessment in African Great Apes Using Geographic Information Systems

This unique study illustrates the potential application of Geographic Information Systems (GIS) to generate hypotheses regarding which African great ape populations, including bonobos (Pan paniscus), chimpanzees (Pan troglodytes), and gorillas (Gorilla gorilla and Gorilla beringei), are at increased risk from human diseases. Human demographic data and core human health indicator data for the African great ape range countries were obtained. Human population density and percent annual human population growth rate were used as combined indicators of environmental stress/vulnerability (as a proxy measure of human–great ape contact), and infant mortality rate (IMR) and healthy life expectancy (HALE) were used as separate indicators of disease burden among the human populations living in the great ape range countries. Cut-off values were determined and, using GIS, these indicators were analyzed to create maps of critical areas (countries) with both environmental stress and high burden of human diseases. When using IMR as the indicator of disease burden, the great ape range countries identified as critical areas included Benin, Guinea-Bissau, Ivory Coast, Liberia, Nigeria, and Tanzania. Cameroon and Uganda were also identified as critical areas when using HALE as the indicator of disease burden; however, Benin was excluded. Validation of these results would allow for targeted interventions thereby maximizing the use of limited resources. Improvements in public health infrastructure in these critical areas would benefit the human populations that have unmet health needs as well as these endangered species.     

Reflections on the development of health economics in low- and middle-income countries

Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623–1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost–benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country''s economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding.     

Evaluation of existing sustainable infrastructure rating systems for their application in developing countries

Several sustainable building rating systems were created worldwide during the last decades due to economic growth and the significance of environmental impact associated with the building industry. Similar infrastructure rating tools have started to be developed and implemented, being highly necessary to promote its development. Even though the existing sustainable infrastructure rating systems are focused on advanced economies, growing environmental concerns are increasing the need for new systems in the Developing World. This research analyses some of the mainstream infrastructure rating frameworks such as Envision (USA), Civil Engineering Environmental Quality (CEEQUAL) assessment (UK) and Infrastructure Sustainability (IS) Rating Tool (Australia) from the perspective of the Triple Bottom Line (economy, environment and society), in order to determine the effectiveness of their application in the context of the least developed countries. The analysis revealed that the three tools are biased towards the environmental dimension and are mainly oriented to developed countries. Consequently, the foundations on which these systems are based need to be further developed and enhanced to be of real relevance in poorer nations by balancing the weight of sustainable pillars, incorporating effective management guidelines and development goals set by United Nations declarations, and considering impacts beyond the single project framework.     

Phytotechnologies – Preventing Exposures,Improving Public Health

Phytotechnologies have potential to reduce the amount or toxicity of deleterious chemicals and agents, and thereby, can reduce human exposures to hazardous substances. As such, phytotechnologies are tools for primary prevention in public health. Recent research demonstrates phytotechnologies can be uniquely tailored for effective exposure prevention in a variety of applications. In addition to exposure prevention, plants can be used as sensors to identify environmental contamination and potential exposures. In this paper, we have presented applications and research developments in a framework to illustrate how phytotechnologies can meet basic public health needs for access to clean water, air, and food. Because communities can often integrate plant-based technologies at minimal cost and with low infrastructure needs, the use of these technologies can be applied broadly to minimize potential contaminant exposure and improve environmental quality. These natural treatment systems also provide valuable ecosystem services to communities and society. In the future, integrating and coordinating phytotechnology activities with public health research will allow technology development focused on prevention of environmental exposures to toxic compounds. Hence, phytotechnologies may provide sustainable solutions to environmental exposure challenges, improving public health and potentially reducing the burden of disease.     

Attention to Local Health Burden and the Global Disparity of Health Research

Most studies on global health inequality consider unequal health care and socio-economic conditions but neglect inequality in the production of health knowledge relevant to addressing disease burden. We demonstrate this inequality and identify likely causes. Using disability-adjusted life years (DALYs) for 111 prominent medical conditions, assessed globally and nationally by the World Health Organization, we linked DALYs with MEDLINE articles for each condition to assess the influence of DALY-based global disease burden, compared to the global market for treatment, on the production of relevant MEDLINE articles, systematic reviews, clinical trials and research using animal models vs. humans. We then explored how DALYs, wealth, and the production of research within countries correlate with this global pattern. We show that global DALYs for each condition had a small, significant negative relationship with the production of each type of MEDLINE articles for that condition. Local processes of health research appear to be behind this. Clinical trials and animal studies but not systematic reviews produced within countries were strongly guided by local DALYs. More and less developed countries had very different disease profiles and rich countries publish much more than poor countries. Accordingly, conditions common to developed countries garnered more clinical research than those common to less developed countries. Many of the health needs in less developed countries do not attract attention among developed country researchers who produce the vast majority of global health knowledge—including clinical trials—in response to their own local needs. This raises concern about the amount of knowledge relevant to poor populations deficient in their own research infrastructure. We recommend measures to address this critical dimension of global health inequality.     

The distribution of biomedical research resources and international justice

According to some estimates, less than 10% of the world's biomedical research funds are dedicated to addressing problems that are responsible for 90% of the world's burden of disease. This paper explains why this disparity exists and what should be done about it. It argues that the disparity exists because: 1) multinational pharmaceutical and biotechnology companies do not regard research and development investments on the health problems of developing nations to be economically lucrative; and 2) governmental agencies that sponsor biomedical research face little political pressure to allocate funds for the problems of developing nations. This paper argues that developed nations have an obligation to address disparities related to biomedical research funding. To facilitate this effort, developed countries should establish a trust fund dedicated to research on the health problems of developing nations similar to the Global AIDS Fund.     

On the development of plasma protein biomarkers

The development of plasma biomarkers has proven to be more challenging than initially anticipated. Many studies have reported lists of candidate proteins rather than validated candidate markers with an assigned performance to a specific clinical objective. Biomarker research necessitates a clear rational framework with requirements on a multitude of levels. On the technological front, the platform needs to be effective to detect low abundant plasma proteins and be able to measure them in a high throughput manner over a large amount of samples reproducibly. At a conceptual level, the choice of the technological platform and available samples should be part of an overall clinical study design that depends on a joint effort between basic and clinical research. Solutions to these needs are likely to facilitate more feasible studies. Targeted proteomic workflows based on SRM mass spectrometry show the potential of fast verification of biomarker candidates in plasma and thereby closing the gap between discovery and validation in the biomarker development pipeline. Biological samples need to be carefully chosen based on well-established guidelines either for candidate discovery in the form of disease models with optimal fidelity to human disease or for candidate evaluation as well-designed and annotated clinical cohort groups. Most importantly, they should be representative of the target population and directly address the investigated clinical question. A conceptual structure of a biomarker study can be provided in the form of several sequential phases, each having clear objectives and predefined goals. Furthermore, guidelines for reporting the outcome of biomarker studies are critical to adequately assess the quality of the research, interpretation and generalization of the results. By being attentive to and applying these considerations, biomarker research should become more efficient and lead to directly translatable biomarker candidates into clinical evaluation.     

Constraints to implementing the Essential Health Package in Malawi

Increasingly seen as a useful tool of health policy, Essential or Minimal Health Packages direct resources to interventions that aim to address the local burden of disease and be cost-effective. Less attention has been paid to the delivery mechanisms for such interventions. This study aimed to assess the degree to which the Essential Health Package (EHP) in Malawi was available to its population and what health system constraints impeded its full implementation. The first phase of this study comprised a survey of all facilities in three districts including interviews with all managers and clinical staff. In the second and third phase, results were discussed with District Health Management Teams and national level stakeholders, respectively, including representatives of the Ministry of Health, Central Medical Stores, donors and NGOs. The EHP in Malawi is focussing on the local burden of disease; however, key constraints to its successful implementation included a widespread shortage of staff due to vacancies but also caused by frequent trainings and meetings (only 48% of expected man days of clinical staff were available; training and meetings represented 57% of all absences in health centres). Despite the training, the percentage of health workers aware of vital diagnostic and therapeutic approaches to EHP conditions was weak. Another major constraint was shortages of vital drugs at all levels of facilities (e.g. Cotrimoxazole was sufficiently available to treat the average number of patients in only 27% of health centres). Although a few health workers noted some improvement in infrastructure and working conditions, they still considered them to be widely inadequate. In Malawi, as in similar resource poor countries, greater attention needs to be given to the health system constraints to delivering health care. Removal of these constraints should receive priority over the considerable focus on the development and implementation of essential packages of interventions.     

Process and operations strategies to enable global access to antibody therapies

Few monoclonal antibodies are currently approved for treating infectious diseases, but multiple products are in development against a broad range of infectious diseases, including Ebola, influenza, hepatitis B, HIV, dengue, and COVID-19. The maturity of mAb technologies now allow us to identify and advance neutralizing mAb products to the clinic at “pandemic pace”, as the pipeline of mAbs targeting SARS-CoV-2 has demonstrated. Ensuring global access to these products for passive immunization, however, will require both low manufacturing cost and multi-ton production capacity—particularly for those infectious diseases where the geographic burden falls mostly in low- and middle-income countries or those with pandemic potential. Analysis of process economics and manufacturing technologies for antibody and other parenteral protein therapeutics demonstrates the importance of economies of scale to reducing the cost of goods for drug substance manufacturing. There are major benefits to convergence on a standardized platform process for antibody production that is portable to most existing very large-scale facilities, carries low risk for complications during process transfer and scale-up, and has a predictable timeline and probability of technical and regulatory success. In the case of an infectious disease with pandemic potential which could be treated with an antibody, such as COVID-19 or influenza, these advantages are paramount.     

Geographical representativeness of published and ongoing randomized controlled trials. The example of: Tobacco consumption and HIV infection

Background

The challenge for evidence-based healthcare is to reduce mortality and the burden of diseases. This study aimed to compare where research is conducted to where research is needed for 2 public health priorities: tobacco consumption and HIV infection.

Methods

We identified randomized controlled trials (RCTs) included in Cochrane systematic reviews published between 1997 and 2007 and registered ongoing RCTs identified in January 2009 through the World Health Organization''s International Clinical Trials Registry Platform (WHO-ICTRP) evaluating interventions aimed at reducing or stopping tobacco use and treating or preventing HIV infection. We used the WHO and World Bank reports to classify the countries by income level, as well as map the global burden of disease and mortality attributable to tobacco use and HIV infection to the countries where the trials performed.

Results

We evaluated 740 RCTs included in systematic reviews and 346 ongoing RCTs. For tobacco use, 4% of RCTs included in systematic reviews and 2% of ongoing trials were performed in low- and middle-income countries, even though these countries represented 70% of the mortality related to tobacco use. For HIV infection, 31% of RCTs included in systematic reviews and 33% of ongoing trials were performed in low- and middle-income countries, even though these countries represented 99% of the mortality related to HIV infection.

Conclusions

Our results highlight an important underrepresentation of low- and middle-income countries in currently available evidence (RCTs included in systematic reviews) and awaiting evidence (registered ongoing RCTs) for reducing or stopping tobacco use and treating or preventing HIV infection.     

Barriers in the mind: promoting an economic case for mental health in low- and middle-income countries

In recent years, policy makers in high-income countries have placed an increasing emphasis on the value of maintaining good mental health, recognizing the contribution that this makes to quality of life, whilst ever more mindful of the socio-economic consequences of poor mental health. The picture in many other parts of the world is much less encouraging; policy attention and resources are still directed largely at communicable diseases. We reflect on some of the challenges faced in these countries and outline the role that economic evidence could play in strengthening the policy case for investment in mental health. Clearly this should include assessment of the economic impact of strategies implemented outside, as well as within the health sector. The ways in which mental health services are delivered is also of critical importance. Non-governmental organizations (NGOs) have long been shown to be key stakeholders in the funding, coordination and delivery of these services in high-income countries. Their role in low- and middle-income countries, where infrastructure and policy focus on mental health are more limited, can be even more vital in overcoming some of the barriers to the development of mental health policy and practice.     

新世纪的中国昆虫系统学

对未来我国昆虫系统学在能力建设、物种编目、理论研究、技术创新和国际合作等方面提出一系列建议。在昆虫系统学能力建设方面,政府和科学家应该在生物分类学能力评估、基础硬件建设、各级生物标本馆中建立伙伴关系（包括标本采集、标本馆管理、 科学研究、 知识共享和标本与资料交换）等方面重点开展工作。在物种编目方面,我国的昆虫物种编目有赖于各级政府和机构继续关注标本的收集和保藏,继续启动一些考察项目,以满足发现和认识昆虫物种的实际需求。在物种水平上研究以往昆虫系统学家的工作,进行地区性和世界性的昆虫类群的订正更是非常必要的。在理论研究方面,我国昆虫系统应该在下列方面积极探索：物种概念、进化理论、比较生物学理论和高级分类系统研究。在技术创新方面,我国的昆虫系统学家应该在数据库与网络技术应用、图形图像处理技术、专家鉴定系统技术、分类性状分析技术、分子生物学技术、系统发育推断程序、信息统一管理技术和知识传播技术等方面进行深入研究,以满足昆虫系统学的发展需求。在国际合作方面,要进一步推动我国昆虫系统学研究机构加入生物分类学全球战略联盟、加入各种相关国际相关组织,要促进物种信息管理系统的建立与共享,要推动研究项目国际化。     

How Can the Operating Environment for Nutrition Research Be Improved in Sub-Saharan Africa? The Views of African Researchers

Optimal nutrition is critical for human development and economic growth. Sub-Saharan Africa is facing high levels of food insecurity and only few sub-Saharan African countries are on track to eradicate extreme poverty and hunger by 2015. Effective research capacity is crucial for addressing emerging challenges and designing appropriate mitigation strategies in sub-Saharan Africa. A clear understanding of the operating environment for nutrition research in sub-Saharan Africa is a much needed prerequisite. We collected data on the barriers and requirements for conducting nutrition research in sub-Saharan Africa through semi-structured interviews with 144 participants involved in nutrition research in 35 countries in sub-Saharan Africa. A total of 133 interviews were retained for coding. The main barriers identified for effective nutrition research were the lack of funding due to poor recognition by policymakers of the importance of nutrition research and under-utilisation of research findings for developing policy, as well as an absence of research priority setting from within Africa. Current research topics were perceived to be mainly determined by funding bodies from outside Africa. Nutrition researchers argued for more commitment from policymakers at national level. The low capacity for nutrition research was mainly seen as a consequence of insufficient numbers of nutrition researchers, limited skills and a poor research infrastructure. In conclusion, African nutrition researchers argued how research priorities need to be identified by African stakeholders, accompanied by consensus building to enable creating a problem-driven national research agenda. In addition, it was considered necessary to promote interactions among researchers, and between researchers and policymakers. Multidisciplinary research and international and cross-African collaboration were seen as crucial to build capacity in sub-Saharan nutrition research.