Are developing countries prepared to face Ebola-like outbreaks?

<正>Ebola virus disease has caused havoc in West Africa,with 11,162deaths and more than 27,181 cases(as of May 31,2015)being reported since the virus emerged in early2014 in Guinea.The maximum number of cases has been reported in Sierra Leone(12,827),while most of the reported deaths have occurred in Liberia(4,806),according to the Center for Disease Control and     

How can we adapt education for children across different countries?

The development of educational material as part of major changes in the service of the diabetic clinic in Glostrup University Hospital turned out to be a very rewarding process for the multidisciplinary team. This material includes age-appropriate goals and guidelines for teaching and learning about diabetes, and advice on coping with diabetes in hand-outs designed for diabetic educators, parents/adults and teenagers. The paper briefly describes the developmental process, the concepts and designs of the material, and makes recommendations on how it can be applied. Part of the material was later translated into Polish and Russian in connection with educational projects in these countries, and the material as a whole was recently incorporated into the Novo Care website at www.d4pro.com - Childhood Diabetes. Growing Internet access by diabetes patients, their relatives and health care professionals creates almost overwhelming possibilities, but also brings up many new questions. The development of diabetes educational material of the more 'traditional' type is discussed with regard to content, ideas and design, and focuses on how these concepts and projects can be influenced and adapted across different countries by Internet communication.     

Beech forest communities in the Nordic countries – a multivariate analysis

In this study we present the first comprehensive multivariate analysis of beech (Fagus sylvatica) forest communities in the Nordic countries. The history of beech and beech forests in Scandinavia are described. In the north, the species is climatically restrained and, at present, restricted to Denmark and the southern parts of Sweden and Norway.More than 2000 sample plots were compiled, partly from literature, partly from new and unpublished data. The material included more than 20 studies of beech forests, often recorded by different non-standardised sampling designs. Therefore, prior to data analysis, a large number of plots had to be excluded to reduce the heterogeneity of the data. Only such sample plots were considered that showed a predominance of Fagus sylvatica in the canopy, that had a size within the interval of 16–100 m2, and that could be located by geographical coordinates. All species abundance values were transformed into simple species presences, and data from different vegetation layers were merged into one.A TWINSPAN cluster analysis resulted in 15 types. Three main communities with several sub-communities and varieties can be distinguished: (1) the Fagus sylvatica-Fraxinus excelsior-Stachys sylvatica community on the most basic and fertile soils, (2) the Fagus sylvatica-Corylus avellana-Galium odoratum community on moderately fertile and acid soils, and (3) the Fagus sylvatica-Sorbus aucuparia-Deschampsia flexuosa community on very acid and oligotrophic soils. Synonyms in the recent literature on Nordic beech forests to these communities are given. An ordination with the program DECORANA confirmed the primary significance of soil acidity and nutrient status for community differentiation.p>     

What is the best approach to treating schizophrenia in developing countries?

BACKGROUND TO THE DEBATE: Schizophrenia affects an estimated 25 million people in low- and middle-income countries, with an average lifetime risk of about 1%. The illness is associated with excess mortality from a variety of causes. A 2001 Institute of Medicine report on mental illness in developing countries found that in 1990, over two-thirds of people with schizophrenia in these countries were not receiving any treatment (http://www.nap.edu/catalog/10111.html). The report found no evidence that the proportion of treated people in the developing world had increased since 1990. There is now a debate among mental health professionals in low-income countries over how best to improve patient care. In this article, three psychiatrists give their different viewpoints on the current status of treatment efforts for schizophrenia in the developing world and the measures that can be taken to increase the proportion of patients receiving treatment.     

Biological invasions in developing and developed countries: does one model fit all?

There is a strong bias concerning the regions of the globe where research on biological invasions is conducted, with notably lower representation of developing countries. However, in developing countries, effective management strategies to control invasions could be more beneficial in conserving global biodiversity since these countries tend to have larger, highly diverse natural habitats. Lower levels of development are seen as an obstacle to tackling biological invasions, but little thought is given to the advantages of developing countries in dealing with invasive species. We analyzed differences between developed and developing countries regarding the problem of invasive species and their historical and current patterns of international trade, disturbance levels and land use, research and monitoring, control and mitigation, and social awareness. Developed nations have some advantages, especially in levels of social awareness and means for controlling and studying exotics, but developing nations also enjoy important advantages given their lower levels of international trade and the availability of low-cost labor. Also, there is evidence that the process of economic development, which results in more efficient ways to transform landscapes and increases international trade, is strongly associated with increasing rates of biological invasion. Differences in data quality and availability between developed and developing countries make comparative analyses of biological invasions a difficult task. Thus, these differences creates a challenge in forming global strategies to deal with invasions. There have been calls for creating international plans to deal with invasive species, but we believe that it is important first to acknowledge the challenges and understand both the advantages and disadvantages of developing countries.     

Do clinicians understand the size of treatment effects? A randomized survey across 8 countries

Background:

Meta-analyses of continuous outcomes typically provide enough information for decision-makers to evaluate the extent to which chance can explain apparent differences between interventions. The interpretation of the magnitude of these differences — from trivial to large — can, however, be challenging. We investigated clinicians’ understanding and perceptions of usefulness of 6 statistical formats for presenting continuous outcomes from meta-analyses (standardized mean difference, minimal important difference units, mean difference in natural units, ratio of means, relative risk and risk difference).

Methods:

We invited 610 staff and trainees in internal medicine and family medicine programs in 8 countries to participate. Paper-based, self-administered questionnaires presented summary estimates of hypothetical interventions versus placebo for chronic pain. The estimates showed either a small or a large effect for each of the 6 statistical formats for presenting continuous outcomes. Questions addressed participants’ understanding of the magnitude of treatment effects and their perception of the usefulness of the presentation format. We randomly assigned participants 1 of 4 versions of the questionnaire, each with a different effect size (large or small) and presentation order for the 6 formats (1 to 6, or 6 to 1).

Results:

Overall, 531 (87.0%) of the clinicians responded. Respondents best understood risk difference, followed by relative risk and ratio of means. Similarly, they perceived the dichotomous presentation of continuous outcomes (relative risk and risk difference) to be most useful. Presenting results as a standardized mean difference, the longest standing and most widely used approach, was poorly understood and perceived as least useful.

Interpretation:

None of the presentation formats were well understood or perceived as extremely useful. Clinicians best understood the dichotomous presentations of continuous outcomes and perceived them to be the most useful. Further initiatives to help clinicians better grasp the magnitude of the treatment effect are needed.Health professionals increasingly rely on summary estimates from systematic reviews and meta-analyses to guide their clinical decisions and to provide information for shared decision-making. Meta-analyses of clinical trials typically provide the information necessary for decision-makers to evaluate the extent to which chance can explain apparent intervention effects (i.e., statistical significance). However, interpreting the magnitude of the treatment effect — from trivial to large — particularly for continuous outcome measures, can be challenging.Such challenges include decision-makers’ unfamiliarity with the instruments used to measure the outcome. For instance, without further information, clinicians may have difficulty grasping the importance of a 5-point difference on the Short-Form Health Survey-36 (SF-36) or a 1-point difference on a visual analogue scale for pain.¹ Second, trials often use different instruments to measure the same construct. For instance, investigators may measure physical function among patients with arthritis using 1 of 5 instruments (the Western Ontario and McMaster Universities Arthritis Index using either a visual analogue or Likert scale; the Arthritis Impact Measurement Scale; the SF-36 Physical Function; or the Lequesne index).^2,3Authors have several options for pooling results of continuous outcomes. When all trials have used the same instrument to measure outcomes such as physical function or pain, the most straightforward method is to present the mean difference in natural units between the intervention and control groups. When trialists have used different instruments to measure the same construct, authors of systematic reviews typically report differences between intervention and control groups in standard deviation units, an approach known as the standardized mean difference (SMD). This approach involves dividing the mean difference in each trial by the pooled standard deviation for that trial’s outcome.⁴For meta-analyses of outcomes measured using different instruments, presenting results as an SMD is the longest standing and most widely used approach and is recommended in the Cochrane handbook for systematic reviews of interventions.⁴ Limitations of this approach include, however, statistical bias toward decreased treatment effects,^5,6 the possibility that decision-makers will find the measure difficult to interpret^7,8 and the possibility that the same treatment effect will appear different depending on whether the study population had similar results in the measure of interest (i.e., if homogeneous, a small standard deviation) or varied greatly in the measure of interest (i.e., if heterogeneous, a large standard deviation).^9,10Several research groups have proposed alternative statistical formats for presenting continuous outcomes from meta-analyses that they postulate clinicians will more easily interpret.^{6–8,11–16} The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group recently provided an overview of methods for presenting pooled continuous data.^9,10 These alternatives (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150430/-/DC1), although intuitively compelling, have seen limited use.We conducted a survey to determine clinicians’ understanding of the magnitude of treatment effect for 6 approaches to the presentation of continuous outcomes from meta-analyses, as well as their perceptions of the usefulness of each approach for clinical decision-making. We also evaluated whether their understanding and perceptions of usefulness were influenced by country, medical specialty, clinical experience or training in health research methodology.     

Does searching online for vaccination information affect vaccination coverage? Evidence from Sub-Saharan African countries

The Internet is reshaping the way people access health information. Over the past decades, an increasing number of people have been using the Internet to access vaccine-related information. Many studies suggest that the Internet can help improve people’s understanding of health issues but at the same time facilitate the rapid spread of misinformation. This study explores the impact that searching the Internet for immunization information has on vaccination coverage. Using Google trends data, we found that access to online vaccination information has impacted vaccine uptake from 2004 to 2017, in Sub-Saharan African countries. The results indicate an overall positive impact on vaccine uptake. We also found that the effects are heterogeneous among vaccines. The effect is statistically significant for the vaccine related to high-risk disease, but not significant for the controversial vaccine and the vaccine related to low-risk disease.     

Do Turkish women in the diaspora build social capital? Evidence from the Low countries

Abstract

Ever since Putnam (2000) made social capital a concept that should be mourned for its decline in the USA, researchers and policy makers in some western countries have adopted it as a solution to what they believe to be the failed practices of multiculturalism. Instead of preserving their individual cultures and traditions, critics would have them build social capital by bridging to people and institutions in their new countries and adopt the ‘shared values’ of the host countries and become ‘integrated’. This study, based on a study conducted in the Netherlands in 2006, and supplemented with survey findings from Flanders at the same time, examines whether this perspective is accurate, focusing on women migrants who live in the Low Countries (Netherlands and Flanders in Belgium), of the networks they have built or not and the reasons for that, and of the role of media and the internet in that process.     

Assisted reproductive technologies: how to minimize the risks and complications in developing countries?

¹ Correspondence address. E-mail: petra.desutter{at}ugent.be In 2% of assisted reproductive techniques (ART) cycles complicationsoccur. Some are preventable, some are not. In this paper, wewill discuss risks and complications of the standard ‘Western’approach in ART today and point to some measures to be takenwhen implementing ART in developing countries, where resourcesand access to medical care may be limited. Ovarian hyperstimulationsyndrome (OHSS, and its thrombo-embolic complications) is responsiblefor the majority of cycle-related complications, followed bybleeding and infection at oocyte retrieval. ART pregnanciesare complicated by first-trimester bleeding more often thanspontaneous pregnancies, they are more often ectopic, but themajor complication is the very high incidence of multiple pregnancies,when more than one embryo is transferred. OHSS can be preventedby screening patients at risk and by using mild or no stimulation.Simple measures can minimize the risks of bleeding or infection.Obviously single embryo transfer is the only way to avoid multiplepregnancies, which have a highly increased risk for severe maternaland neonatal morbidity and mortality (mainly due to prematurity).Special attention should be given to pre-existing pathologies.Risk minimization of ART in developing countries is not onlymandatory from an economical but also an ethical point of view.     

What can the residents of malaria endemic countries do to protect themselves against malaria?

The incidence of malaria may vary substantially between adjacent communities and within an individual community, even in areas of high malaria transmission. Analysis of the factors responsible for these local variations in the incidence of malaria may identify potential control measures. Factors shown to be associated with local protection against malaria in some situations include house position, house design, the use of insect repellents and mechanical barriers such as bednets and curtains. The efficacy of insecticide treated nets and curtains in preventing mortality and morbidity from malaria, at least in the short-term, has been demonstrated convincingly. However, other measures of personal protection have not been evaluated in large trials which have clinical malaria as their endpoint. Such trials are needed to see if new malaria control tools can be identified that will assist current international efforts to improve malaria control, especially in Africa. The millions of non-immune travellers who visit malaria endemic areas each year need to protect themselves against malaria and the ways in which they can do this most effectively have been studied extensively. However, less attention has been paid to the local population of malaria endemic areas. What steps can they adopt to provide personal protection against malaria and how effective are these measures? Clues to which measures might be effective can come from study of the reasons for local variations in the incidence of malaria.     

Review: Sustainability of crossbreeding in developing countries; definitely not like crossing a meadow…

Crossbreeding, considering either terminal or rotational crossing, synthetic breed creation or breed replacement, is often promoted as an efficient strategy to increase farmers’ income through the improvement of productivity of local livestock in developing countries. Sustainability of crossbreeding is however frequently challenged by constraints such as poor adaptation to the local environment or lack of logistic support. In this review, we investigate factors that may influence the long-term success or the failure of crossbreeding programs, based on the scientific literature and country reports submitted for The Second Report on the State of the World’s Animal Genetic Resources for Food and Agriculture. Crossbreeding activities vary widely across species and countries. Its sustainability is dependent on different prerequisites such as continual access to adequate breeding stock (especially after the end of externally funded crossbreeding projects), the opportunity of improved livestock to express their genetic potential (e.g. through providing proper inputs) and integration within a reliable market chain. As formal crossbreeding programs are often associated with adoption of other technologies, they can be a catalyst for innovation and development for smallholders. Given the increasing global demand for animal products, as well as the potential environmental consequences of climate change, there is a need for practical research to improve the implementation of long-term crossbreeding programs in developing countries.     

Development of health biotechnology in developing countries: Can private-sector players be the prime movers?

Health biotechnology has rapidly become vital in helping healthcare systems meet the needs of the poor in developing countries. This key industry also generates revenue and creates employment opportunities in these countries. To successfully develop biotechnology industries in developing nations, it is critical to understand and improve the system of health innovation, as well as the role of each innovative sector and the linkages between the sectors. Countries' science and technology capacities can be strengthened only if there are non-linear linkages and strong interrelations among players throughout the innovation process; these relationships generate and transfer knowledge related to commercialization of the innovative health products. The private sector is one of the main actors in healthcare innovation, contributing significantly to the development of health biotechnology via knowledge, expertise, resources and relationships to translate basic research and development into new commercial products and innovative processes. The role of the private sector has been increasingly recognized and emphasized by governments, agencies and international organizations. Many partnerships between the public and private sector have been established to leverage the potential of the private sector to produce more affordable healthcare products. Several developing countries that have been actively involved in health biotechnology are becoming the main players in this industry. The aim of this paper is to discuss the role of the private sector in health biotechnology development and to study its impact on health and economic growth through case studies in South Korea, India and Brazil. The paper also discussed the approaches by which the private sector can improve the health and economic status of the poor.     

Does energy intensity contribute to CO2 emissions? A trivariate analysis in selected African countries

The present study investigates the dynamic relationship between energy intensity and CO₂ emissions by incorporating economic growth in environment CO₂ emissions function using data of Sub Saharan African countries. For this purpose, we applied panel cointegration to examine the long run relationship between the series. We employed the VECM Granger causality to test the direction of causality amid the variables.At panel level, our results validate the existence of cointegration among the series. The long run panel results show that energy intensity has positive and statistically significant impact on CO₂ emissions. There is also positive and negative link of non-linear and linear terms of real GDP per capita with CO₂ emissions supporting the presence of environmental Kuznets curve (EKC). The causality analysis reveals the bidirectional causality between economic growth and CO₂ emissions while energy intensity Granger causes economic growth and hence CO₂ emissions, while across the individual countries, the results differ. This paper opens up new insights for policy makers to design comprehensive economic, energy and environmental policy for sustainable long run economic growth.