Affluent Countries Research Articles

The Access to Oncology Medicines Coalition: Enhanced in-Country Coordination for Sustainable Access.

The disparity in access to essential cancer medicines between less and more affluent countries is a major source of inequities in access to cancer care. In May 2022, the Union for International Cancer Control (UICC) launched a new initiative, the Access to Oncology Medicines Coalition (ATOM Coalition), bringing together over 40 organisations from the private and civil society sectors to cooperate and combine resources to address key barriers of access to cancer medicines in low- and lower-middle income countries. While the ATOM Coalition is engaged in global efforts to make cancer medicines more accessible, the initiative also includes a country-level support programme to enhance coordinated locally-led action and accelerate access. This is supported by a transparent governance and organisational structure as well as a working framework with governments and other key stakeholders to assess the current capacity and develop tailored responses that can lift and/or relax some of the identified barriers through joint collaborations with ATOM Coalition partners.

What is Known About the Numbers, Experiences and Outcomes of Young People Transitioning from Out-of-home Care in Indonesia?

Young people transitioning from out-of-home care (OOHC), commonly known as care leavers, are widely recognised internationally as a vulnerable group often subject to disadvantage. Yet, most studies of their pathways and outcomes to date have been completed in affluent Global North countries, and there have been relatively few reports on their experiences in Global South locations where different political, legislative, cultural and religious contexts exist. The particular attention of this article is on the Republic of Indonesia. Previous literature regarding children and young people in OOHC in Indonesia highlighted the poor quality of care within OOHC institutions and their adverse experiences of institutionalisation. In recent years, the Government of Indonesia has encouraged deinstitutionalisation by preventing family separation, promoting family-based alternative care and only utilising residential care as a last resort for child care. Nevertheless, little scholarly attention and studies have been given to researching young people leaving OOHC, who are likely to have poor life outcomes. Utilising existing grey government and non-government literature and reports, this policy briefing critically examines what is known about the numbers, experiences and outcomes of young people transitioning from OOHC in Indonesia.

Pursuing equitable access to vaccines for the next epidemic.

To mitigate the pandemic stemming from COVID-19, numerous nations have initiated extensive vaccination campaigns for their citizens since late 2020. While affluent countries have predominantly received vaccine allocations, fewer doses have been dispatched to nations with lower average incomes. This unequal distribution not only widens the disparity between wealthy and impoverished regions but also prolongs the pandemic, evident in the emergence of new viral variants. Our research delves into the correlation between the duration of the pandemic and the timing of vaccine distribution between two countries with migratory ties. By using a pair of coupled susceptible-infected-recovered-deceased models incorporating vaccination data, we demonstrate that timely sharing of vaccines benefits both nations, regardless of the presence of viral variants. This underscores that in the realm of vaccine distribution, self-interest and altruism are not mutually exclusive.

BARLEY AS A RAW MATERIAL FOR BEER PRODUCTION AND ITS PROCESSING TECHNOLOGY

The study aimed to assess consumer awareness of beer production and its importance in their daily lives. It explored consumption habits, frequency, and locations of beer consumption. Being a less affluent country, the cost of beer posed challenges, affecting sales. The study also examined whether the offered price fulfilled the specified conditions for beer production. It summarized data on consumer interest, consumption habits, and beer-related factors.The Covid-19 pandemic impacted the economy, including the beer industry, emphasizing the need for hygiene in equipment, production processes, and employee practices. The conflict in Ukraine caused price hikes, including beer. Despite this, citizens were already accustomed to ongoing price increases. The pandemic highlighted the importance of controlling, emphasizing, and extensively testing food products, including beer. The study supported these findings, presenting data on gender, age, nationality, and consumer preferences related to beer.Although multiple countries were included, the main focus was on Kosovo, which had the highest representation. The findings showed that 73.9% of respondents enjoy beer consumption, with 26.7% willing to spend an average of 30 to 40 euros. Furthermore, 89.9% of participants were willing to pay a higher, symbolic amount for higher-quality and safer beer meeting necessary standards for adequate consumption.

Evaluation of Comparative Efficacy of Levothyroxine Versus Kshar Basti and Kanchanar Guggul in the Treatment of Hypothyroidism: Protocol for a Randomized Controlled Trial.

The thyroid gland is an endocrine gland that has an impact on the body's general metabolism. Thus, the secretions of the thyroid gland can modify the overall metabolism of the entire body. The prevalence of hypothyroidism is increasing quickly, with rates of 2%-5% in affluent countries and 11% in India. Individuals diagnosed with hypothyroidism need to take medication for the rest of their lives, resulting in significant stress. Therefore, conducting a study in this area is imperative. This study aims to assess the effectiveness of the therapeutic enema (Kshar Basti) and oral Kanchanar Guggul in the treatment of hypothyroidism. The trial group (n=45) will receive a therapeutic enema (Kshar Basti) followed by oral Ayurvedic drugs for 180 days. The control group (n=45) will be given levothyroxine tablets at a dosage of 1.6 µg/kg/day for the same duration. The objective is to examine the alterations in thyroid stimulating hormone (TSH) levels before and after the treatment. Any deviation of the serum TSH by more than 20% from the initial values, while keeping triiodothyronine (T3), and thyroxine (T4) levels within the normal range, will be deemed statistically significant. Consequently, we anticipate a statistically significant variation in serum TSH levels between the therapeutic enema and Kanchanar Guggul treatments. Presently, the drug preparation operations are in progress. We expect to start enrolling patients in June 2024, do data analysis in December 2025, and acquire results by early 2026, marking the end of this trial. This study will evaluate the efficacy of the therapeutic enema, specifically Kshar Basti, in treating hypothyroidism. Furthermore, more research can determine the efficacy of a therapeutic enema (Kshar Basti) in treating overt hypothyroidism and hypothyroidism during pregnancy. Clinical Trials Registry India CTRI/2023/05/052389; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=Nzk1NjY=&Enc=&userName=052389. PRR1-10.2196/57287.

Three Injustices of Adaptation Finance - A Relational Egalitarian Analysis

This primarily diagnostic paper offers, from the perspective of relational egalitarianism, a normative analysis of three major injustices in the context of adaptation finance. Adaptation finance includes payments provided by the affluent countries of the Global North to low-income countries in the Global South, countries particularly exposed to the harms of climate change. Relational egalitarianism is the normative view that interactions between people and between institutions have to respect the equal moral status of every human being. The first injustice, from this perspective, consists in the sheer fact that adaptation measures are required at all to deflect harm from people who did not significantly contribute to the causes of climate change. The second injustice consists in the persisting, even increasing adaptation finance gap, as countries of the Global North do neither provide adequate financial means to reduce climate risks, nor even fulfil their commitments to adaptation finance pledged in the Copenhagen Accord in 2009. The third injustice emerges from current procedures to determine criteria for distributing scarce financial resources that consolidate structural injustice. The paper concludes by providing the contours of a practical response to these injustices that respects the demands of relational egalitarianism.

The Social Implications of Circular Clothing Economies in the Global North

The clothing industry is a hotbed for exploitative working conditions and environmental damage, of which affluent global North countries remain a substantial driver. The circular economy is a potential solution to these issues, but its social implications remain unclear. Using the UK as a case study, this article analyses the global social impacts of a transition to circular clothing economies in the global North, finding these to be (almost) entirely dependent upon the intentions and design of the associated policies and governance, as well as broader socio-economic changes. Some aspects of a transition will be unambiguously good for some people; others will only be beneficial with careful governance. Moreover, entrenched global economic inequalities leave trade-offs borne largely by the global South, highlighting the need for circular economy research—its drive for localization notwithstanding—to look globally to consider how a fair transition can be achieved.

Impacts of early psychological changes on correlates of weight-loss maintenance: Seeking increased precision for sustained behavioural obesity treatment effects.

Obesity is an increasing worldwide health issue. In affluent English-speaking countries, obesity ranges from ~28% (Australia) to ~42% (United States) of the adult population. Enabling weight loss beyond an initial 6 months is an unresolved challenge. Women with obesity participated in community-based obesity treatments incorporating either cognitive-behavioural methods emphasizing self-regulatory skills development (n = 106) or typical information/education processes (n = 47). Psychosocial, behavioural, and weight changes were measured. Significant overall improvements in exercise-related self-regulation and self-efficacy, mood, physical activity/exercise (PA/exercise), diet, and weight were found from baseline-month 6 (weight-loss phase) and baseline-month 12, but not from months 6-12 (weight-loss maintenance phase). Significantly greater improvements were found in the cognitive-behavioural group. Within the weight-loss phase, changes in both PA/exercise and diet significantly contributed to the explained variance in weight loss, whereas within the weight-loss maintenance phase, only change in PA/exercise was a significant predictor. There was no significant relationship of weight loss across phases. Months 6-12 change in PA/exercise significantly mediated relationships of changes in self-regulation→weight, mood→weight, and self-efficacy→weight. Earlier scores and score changes in mood and self-efficacy significantly impacted the subsequent parallel relationships. Cognitive-behavioural methods affect psychosocial changes leading to initial changes in diet, PA/exercise, and weight. Those changes then impact subsequent changes in PA/exercise-a primary malleable correlate of maintained weight loss. SO WHAT?: This research extended previous findings to better-inform behavioural obesity-treatment foci to address the pervasive public health problem of attaining and sustaining weight loss. Findings related to PA/exercise will help impact health-promotion outcomes.

Current and Future Strategies in Insulin Development and Treatment.

Recent advances in insulin research open new avenues for treatment, both, for type 1 and type 2 diabetes. In developed countries, standardized "ultra-rapid-acting insulins" are now also used in addition to rapid-acting insulins. First- and second-generation basal analogs are available. Third-generation basal analogs, which only need to be applied once a week, are in the pipeline. Second-generation "ultra-rapid-acting insulins" insulins with faster onset and offset of action may be particularly useful for multiple daily injections and automated insulin delivery systems. An improved time-action profile of bolus insulin would be able to cover the rapid increase in glucose after meals with a rapid fall thereafter to avoid postprandial hypoglycemia. The third-generation basal insulins allowing once-weekly dosing made major steps toward becoming a clinical reality. However, issues with insulin affordability and availability remain problematic even in more affluent countries. Biosimilar insulins products can provide people with additional safe, high-quality, and potentially cost-effective options for treating diabetes. Particularly in low-middle income countries insulin therapy is facing issues not only of access but also storage, lack of diabetes education, and stigma. With the new bolus insulins, the physiological insulin secretion pattern can be mimicked better and better and hypoglycemia can be avoided. With the ever longer pharmacokinetic action profiles of the basal analogs, the injection frequency is reduced, which leads to better adherence and quality of life, but these insulins are not available for everyone who needs it worldwide.

Molecular Pharmacology of Vitamin C and Relevance to Health and Obesity-A Narrative Review.

The role of food constituents as pharmacological agents is an important consideration in health and obesity. Vitamin C acts as a small molecule antioxidant but is also a co-factor for numerous transition metal-dependent enzymes involved in healthy weight and energy metabolism. Vitamin C cannot be manufactured by humans and is mainly obtained from the dietary intake of fresh fruit and vegetables. There is great variability between different nutritional guidelines in the recommended daily allowance of vitamin C. Vitamin C deficiency results from an inadequate intake of vitamin C-containing foods and also increased utilization by oxidative and carbonyl stress. Risk factors for vitamin C deficiency include cigarette smoking, malnutrition, obesity, type 2 diabetes mellitus, age, race, sex, social isolation, major surgery, and Western-type diets. Despite the common belief that vitamin C deficiency is rare in affluent countries, surveys of large populations and specific patient groups suggest otherwise. Patients with obesity typically consume highly processed, energy-dense foods which contain inadequate micronutrients. As obesity increases, larger amounts of oral vitamin C are required to achieve adequate plasma and tissue concentrations, as compared to persons with a healthy weight. This is important in the control of oxidative stress and the maintenance of homeostasis and organ function. In this narrative review, the dosage, absorption, distribution, excretion, and catabolism of vitamin C are reviewed, together with the latest findings on vitamin C pharmacology in patients with obesity.

The Role of Biomarkers in HPV-Positive Head and Neck Squamous Cell Carcinoma: Towards Precision Medicine.

Head and neck cancer (HNC) represents a significant global health challenge, with squamous cell carcinomas (SCCs) accounting for approximately 90% of all HNC cases. These malignancies, collectively referred to as head and neck squamous cell carcinoma (HNSCC), originate from the mucosal epithelium lining the larynx, pharynx, and oral cavity. The primary risk factors associated with HNSCC in economically disadvantaged nations have been chronic alcohol consumption and tobacco use. However, in more affluent countries, the landscape of HNSCC has shifted with the identification of human papillomavirus (HPV) infection, particularly HPV-16, as a major risk factor, especially among nonsmokers. Understanding the evolving risk factors and the distinct biological behaviors of HPV-positive and HPV-negative HNSCC is critical for developing targeted treatment strategies and improving patient outcomes in this complex and diverse group of cancers. Accurate diagnosis of HPV-positive HNSCC is essential for developing a comprehensive model that integrates the molecular characteristics, immune microenvironment, and clinical outcomes. The aim of this comprehensive review was to summarize the current knowledge and advances in the identification of DNA, RNA, and protein biomarkers in bodily fluids and tissues that have introduced new possibilities for minimally or non-invasive cancer diagnosis, monitoring, and assessment of therapeutic responses.

Minimally Invasive Sacroiliac Joint Fusion: A Systematic Review and a Meta-Analysis

Abstract Background Low back pain (LBP) is a worldwide health problem and one of the top three causes of health deterioration in affluent countries. After the common cold, LBP is the second most prevalent reason for visits to primary care providers. Aside from high levels of disability and lost income, LBP increases the risk of falls in the elderly, which can result in hip and/or spinal fractures, increasing morbidity and mortality in this vulnerable group. Materials and Methods Application of inclusion and exclusion criteria to study Abstracts yielded 9 articles. A total of 390 studies were identified from the database search. After review, a total of 9 studies consisting of 1224 patients with SIJF were selected. Results A total number of 1224 patients with SIJF were selected. The 9 studies ranging from 2012 to 2019. Among the 9 studies were 4 randomized control trials and 2 studies were retrospective studies. Among the patients, 407 males and 817 females. The age ranged from 24 years to 81 years among the 9 studies. The follow-up duration ranged from 6 months to 2 years among our studies. Conclusion The meta-analysis performed in this systematic review demonstrated that patients who fail conservative therapy and have a positive diagnostic SI joint block may clinically benefit from minimally invasive sacroiliac joint fusion using a lateral trans-articular approach. Sacroiliac joint fusion appears to be a satisfactory procedure for alleviating low back pain.

Why do patients with cancer die?

Cancer is a major cause of global mortality, both in affluent countries and increasingly in developing nations. Many patients with cancer experience reduced life expectancy and have metastatic disease at the time of death. However, the more precise causes of mortality and patient deterioration before death remain poorly understood. This scarcity of information, particularly the lack of mechanistic insights, presents a challenge for the development of novel treatment strategies to improve the quality of, and potentially extend, life for patients with late-stage cancer. In addition, earlier deployment of existing strategies to prolong quality of life is highly desirable. In this Roadmap, we review the proximal causes of mortality in patients with cancer and discuss current knowledge about the interconnections between mechanisms that contribute to mortality, before finally proposing new and improved avenues for data collection, research and the development of treatment strategies that may improve quality of life forpatients.

Antenatal toxoplasmosis screening and treatment in Northern Italy: update on the clinical effectiveness.

Antenatal universal screening for toxoplasmosis is recommended in most affluent countries worldwide. Despite evidence is not robust, detected cases are typically treated during pregnancy. Affected newborns are also treated to temper clinical consequences. However, this established mode of management warrants careful and continuous re-evaluation. The epidemiology of the infection is changing and there is the need to monitor the clinical scenario. This is an observational retrospective study conducted at a referral hospital in Northern Italy. Every woman referred from January 2011 to December 2021 for suspected toxoplasmosis in pregnancy was eligible. All women were managed according to a local standardized protocol. Clinical and laboratory findings were obtained from patients' charts. Out of 347 women referred, 191 (55%) were discharged as false positive at initial assessment. We identified 141 women with suspected infection and 15 with confirmed infection. The number of women treated with antibiotics was 136 (96%) and 15 (100%), respectively. A total of 118 amniocenteses were performed, all of which were negative. There were two spontaneous miscarriages and five therapeutic terminations of pregnancy (of whom four were consequent to parental concerns related to the toxoplasmic infection), all among suspected cases. Vertical transmission occurred in a single case, a patient with confirmed infection diagnosed by seroconversion at 28 weeks' gestation. The course of this pregnancy was uneventful, and the infant is healthy at 7 years follow-up. Overall, the incidence of vertical transmission was 7% (95% CI: 1-30%) in confirmed cases and 0% (95% CI: 0-0.2%) in suspected cases. The current policy of universal screening and prompt management of toxoplasmosis infection is efficient. However, undue invasive procedures and terminations of pregnancy could occur. Future studies are warranted to improve clinical management.

How does a poor labour market affect inequalities in access to postsecondary education? Empirical evidence from 31 affluent countries

Abstract This study examines how macroeconomic conditions affect inequality of educational opportunity. Using longitudinal data from 30 European countries and the USA, we study the effect of changing unemployment rates on the extent of social inequality in postsecondary transitions in the period (2004–2016), which includes the Great Recession. The findings from multilevel models with country fixed effects show that rising unemployment rates tend to increase social inequalities in postsecondary transitions, as youth from low-educated families have increased risk for exclusion from both employment and education, while the likelihood of postsecondary enrolment slightly rises for youth from higher-educated families. Yet, economic downturns also incentivize youth whose parents have middle level of education to opt for postsecondary education, especially in contexts where it is more affordable. Our findings suggest that changing opportunity costs and economic insecurity are the relevant factors to explain changing inequalities in access to postsecondary education during a recession.

Interpreting Different Narratives about Land Services and Land Use Economics of Common Agricultural Policy

Since 2023, a new format of the Common Agricultural Policy (CAP) has been implemented in Europe. Market forces alone cannot guarantee land services, which can be described as flows of goods and services from ecosystems to human systems as functions of nature. Market forces also cannot ensure food security everywhere and at all times, so deliberate measures should incentivize farmers to adopt sustainable agricultural practices and maintain necessary skills and resources. This study identifies, quantifies, and interprets four narratives that are typical in the approach to food security and the public debate about the land services in the CAP Strategic Plans: (A) provision of land services within the Pillar 1 economics; (B) small vs. large farms; (C) direct payments in comparison with rural development; and (D) choices by the old and new member states. Participatory processes, descriptive statistics, and partial component analysis were used in terms of the methodology. The key finding is that the importance attached to eco-schemes varies among member states, although a majority dedicate approximately 25% of the Pillar 1 budget to them. We showed that small-scale farming countries move resources from Pillar 2 to strengthen direct payments. In contrast, affluent countries with robust agricultural structures can afford to reinforce Pillar 2 rural development through transfers from direct payments. To support small-scale and medium farms, appropriate support requires a combination of several measures, including the sizable hectare payment in Pillar 1 and farmer-oriented agri-environmental measures.

Assessment of Malondialdehyde and Organochlorine Pesticides in Aplastic Anemia Severity Groups: Insights Into Oxidative Stress and Exposure.

Background There is little evidence that pesticide exposure is the primary cause of acquired aplastic anemia (AAA), even though the prevalence of aplastic anemia (AA) is substantially higher in underdeveloped countries than in affluent countries. AA caused by pesticides has not yet been fully understood. This study aimed to examine the potential link between plasma levels of malondialdehyde (MDA) and organochlorine pesticides (OCPs) as risk factors for developing AAA in the North Indian population. Methods This case-control study was conducted at a tertiary care hospital in North India. A total of 99 participants were chosen for the study, of whom 45 were cases of AA. These cases attended the Clinical Hematology department over a period of 1.5 years (May 2018 to November 2019). Forty-five controls were age and sex-matched, apparently healthy subjects. Written informed consent was obtained from each subject before performing the study. Exclusion criteria included patients unwilling to give consent, those using medication to treat AA, those genetically predisposed to AA, those with characteristics including granuloma and dysplasia of bone marrow, any other systemic illness, and subjects with a history of smoking, drinking, or using tobacco in any form. Gas chromatography-tandem mass spectrometry (GC-MS/MS) was used to evaluate the plasma levels of organochlorines. The estimation of plasma MDA, i.e., the lipid peroxide content, was measured. Results The severity of AA is significantly associated with plasma levels of α-Hexachlorocyclohexane (p = 0.040), Heptachlor (p = 0.006), Aldrin (p < 0.001), p,p'-Dichlorodiphenyldichloroethane (p = 0.004), Endosulfan sulfate (p = 0.010), and Methoxychlor (p = 0.001). There was a statistically non-significant difference in MDA levels between cases and controls (p = 0.145); however, a statistically significant linear increase in MDA levels (p < 0.001) was observed according to the severity of AA. Conclusion Our study suggests that oxidative stress may be linked to the severity of AA. Pesticide exposure (plasma organochlorine levels) could act as a stressor, potentially initiating an alarmin response of oxidative stress in the form of lipid peroxidation (MDA) from damaged tissue, which could then lead to suppression of hematopoiesis and be a possible factor in the development of AA.

A scientometric analysis and visualisation of elderly suicide research from 1951 to 2022.

There are still many gaps in both national and international literature on elderly suicide. This study aimed to identify the most influential journals in elderly suicide, the countries and authors that contribute the most to the field, and the trends in the field. Studies published on elderly suicide between 1951 and 2022 were retrieved utilising the Web of Science Core Collection. Co-authorship analysis of countries and authors, as well as co-occurrence analysis of keywords, were conducted using VOSviewer 1.6.18. There were 2864 articles retrieved, including 95 countries, 889 academic journals, 9162 authors and 4160 keywords. The number of publications in this field has significantly increased after the 2000s, and the United States is the most productive country (996). The most prolific author is Yeates Conwell, while the journal with the highest number of publications in this field is the International Journal of Geriatric Psychiatry. Other than 'suicide' and 'elderly', the most trending keywords are 'depression', 'primary care', 'treatment', 'antidepressant', 'loneliness', 'quality of life' and 'COVID-19'. There has been an increase in both the thematic diversity and quantity of studies on elderly suicide over time. However, these publications predominantly originate from socioeconomically affluent countries with relatively low suicide rates. While the increasing numbers of publications from developing countries in recent years are promising, there is a greater need for publications from countries with lower socioeconomic status for the prevention or intervention of elderly suicides.

Legitimate Transaction? Regulating Commercial International Marriage Brokers in South Korea

Marriages between South Korean men and women from less affluent Asian countries have been popular since the 1990s, and commercial international marriage brokers have played an important role in the trend. This article argues that the laws and regulations governing marriage brokers, such as Marriage Brokers Business Management Act (MBBMA) and consumer protection mechanisms, have reinforced the rights of citizen-husbands and legitimized claims from the men’s movement. As a result, the state’s regulation of commercial matchmaking endorses a form of commodified intimacy and protects the rights of male client-cum-“head of the family,” despite the consequences of commodifying the personhood of migrant women and legitimizing the violence of denying their personal autonomy. Data include public documents and policies from the Ministry of Gender Equality and Family, Korea Institute for Healthy Family, Korea Consumer Agency, Fair Trade Commission, and MBBMA. Analysis of these public texts reveals the legal and policy language that sanitizes and disguises unequal gender roles and discrimination against foreigners.

The Vaccine-Education Paradox in a Cross-Country Analysis: Education Predicts Higher and Lower Vaccination Rates

Research has shown a mixed relationship between education and vaccination rates. In the current analysis, we aimed to determine the relationship between educational level and coronavirus disease 2019 (COVID-19) vaccination rates. We performed a cross-country analysis on data from 133 countries. Correlation analyses showed that higher and better education was associated with higher COVID-19 vaccination rates. When we performed the regression analysis including the education, health system, and economic development variables, education-COVID-19 vaccination relationships were mostly reversed. In particular, in wealthy countries, as the mean years of schooling decreased and the pupil-teacher ratio increased, COVID-19 vaccination rates increased. In less affluent countries, with greater education expenditures, COVID-19 vaccination rates decreased. We explain these contradictions by describing links between vaccination rates, life expectancy, and education-related variables. Our findings may aid in promoting more effective uptake of COVID-19 vaccination.