Country Report Research Articles

Comparison of Production Indexes and GDP Levels of Russia and Turkey over the Years

This research aimed to compare the production indexes and GDP levels of Russia and Turkey over the years. The study uses manufacturing and GDP statistics for Turkey and Russia from the World Bank's Country Reports for the years 2002–2023. The data was analyzed using relational and descriptive scanning techniques. The mean MVA value of Türkiye was 128.033.708.560,22±45.970.873.474,95 with 60.042.508.306,24-210.698.007.198,77 range. For Russia, the MVA mean was 164.593.974.821,70±25.737.507.037,58 with 114.335.877.575,54-210.748.733.491,24 range. The mean MVA was significantly higher in Russia (p<0.05). GDP differences between Türkiye and Russia were statistically insignificant (p>0.05). Manufacturing value added in Türkiye had a higher range and lower mean compared to Russia. Pearson correlation analysis results between MVA and GDP showed that in Türkiye, MVA was significantly and positively correlated with GDP (r=0.599; p<0.01). Similarly, MVA was positively correlated with GDP in Russia (r=0.729; p<0.01). Although Turkey and Russia significantly convert their value added production into economic value as GDP, Russia is more successful than Turkey in terms of correlation coefficient. In other words, Russia's value added production is more convertible to the economy than Turkey's.

Comparative Analysis of Employment and Foreign Trade Data of Russia and Turkey by Year

This research aimed to compare the relationships between unemployment rates and foreign trade data of Türkiye and Russia. In the research, unemployment and foreign trade data from the Country Reports provided by the World Bank for Turkey and Russia were used for the years 2002-2023. Descriptive scanning and relational scanning analyses of the data were performed. The unemployment rate in Turkey had a 10.91±1.30 mean with a 9.21-14.03 range. In Russia, the unemployment rate mean was 5.99±1.41 with a 3.08-8.30 range. The export rate in Russia was significantly higher than Türkiye (p<0.05). Unemployment and import mean values were significantly higher in Türkiye (p<0.05). The correlation between unemployment and foreign trade was insignificant in Türkiye (p>0.05). The correlation between unemployment with export (r=0.554; p<0.01) and import (r=0.609; p<0.01) was significant for Russia. Although foreign trade is not directly associated with employment due to its relationship with finance and other sectors, foreign trade positively affects unemployment in Russia. In Turkey, unemployment is not significantly related to foreign trade.

Firework aversion in cats and dogs as reported by Dutch animal owners

Firework (noise) aversion is seen in cats and dogs relatively often and comes with a risk of animal welfare impairment. Affected animals may show behaviours like freezing, hiding, fleeing, but also inappropriate elimination, loss of appetite and (social) withdrawal. In The Netherlands, firework regulation has been a much-debated topic and we aimed to provide insight into how owners in this country report on their cat's or dog's firework aversion. We gathered reports on 3,009 dogs’ and 622 cats’ firework-related behaviours, exposure, animal (early life) characteristics and owner (dis)agreement with statements relating to firework aversion and animal guidance. We hypothesized that 1) suboptimal early life factors come with higher prevalence of firework aversion and 2) owners that report less firework aversion for their animal, agree more to the statement that owner behaviour affects an animal's future reactions to firework. Our findings confirm the first hypothesis for dogs and the second hypothesis for both species. Firework affects Dutch cats, dogs and their owners not just on New Year's Eve, but for multiple months a year: 64% of the owners heard firework noise from September onwards. Suboptimal early life factors, of for instance not being noise habituated as a young animal came with higher prevalence of firework fear for dogs, but not cats and habituating particularly kittens seemed uncommon (4% of kittens). Advice seeking was more common for dogs (54%) than cats (23%) with firework aversion. For both species reporting of lasting effects of therapeutic interventions was uncommon. Less than 30% of the most often applied interventions were reported to have a lasting mitigating effect on firework aversion. This may indicate a high importance of hereditary and early life preventive measures, but our respondents were not in high agreement with statements reflecting such importance. Although our study presents associative evidence only and was based on owner report, not on direct animal observations, we present attention points for future studies. One such attention point is a seemingly low awareness of the lifelong influence of an animal's early life factors. Studying how such awareness affects people that opt for a puppy or kitten as to facilitate acquisition decisions that may or may not come with firework resilient animals, may ultimately benefit animals that were in this study seen to experience firework aversion for multiple months a year, with limited long-term effectiveness of therapeutic interventions.

External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TB.

Chest X-ray (CXR) misinterpretation negatively affects the accuracy of childhood TB diagnosis. External quality assurance (EQA) could strengthen CXR reading skills. We assessed the uptake, performance and challenges of an EQA of CXR interpretation within the childhood TB-Speed decentralisation study in six resource-limited countries. Every quarter, TB suggestive or unreadable CXRs and 10% of remaining CXRs from children with presumptive TB were selected for blind re-reading by national re-readers. The proportion of CXRs selected for EQA and re-read assessed the uptake. The performance was assessed by the proportion of discordant interpretations and the sensitivity and specificity of clinicians' vs re-readers' interpretations. Challenges were retrieved from country reports. Of 513 eligible CXRs, 309 (60.8%) were selected for EQA and 278/309 (90.0%) re-read. The proportion of discordant interpretation was between 13/48 (27%) in Sierra Leone and 7/13 (53.8%) in Cote d'Ivoire during the first EQA and decreased after the EQAs periods in 3/5 countries. Clinician sensitivity reached 100% in all countries over EQA. Specificity ranged between 13% in Sierra Leone and 65% in Cambodia (first EQA) and increased in 4/5 countries after the EQA periods. CXR transfer and re-readers' workload were the main challenges. EQA can enhance CXR interpretation for childhood TB diagnosis, provided operational challenges are overcome.

350 Emergency Medicine Around the World: Analysis of the 2023 American College of Emergency Physicians International Ambassador Country Reports

350 Emergency Medicine Around the World: Analysis of the 2023 American College of Emergency Physicians International Ambassador Country Reports

Longitudinal analysis of social and community factors effective in increasing the number of liver donors in the United States.

In this research, it was aimed to evaluate of social and community factors effective in increasing the number of liver donors. Descriptive and relational scanning models were used to conduct the research. Data on liver donors was gathered from the USA Health Resources & Services Administration's Organ Procurement and Transplantation Network between 1988 and 2023. The United States (USA) World Bank Country Reports provided the mortality rates. The data was analyzed using Spearman rho correlation, year-controlled partial correlation, and Generalized Linear Model-Logit analysis. Deceased donor numbers were significantly and negatively correlated with government health expenditure (r = -0.816; P < .01), current health expenditure (r = -0.768; P < .01), female education attainment (r = -0.804; P < .01) and Gini index (r = 0.434; P < .05). Living donor numbers were significantly and negatively correlated with government health expenditure (r = -0.731; P < .01), current health expenditure (r = -0.781; P < .01), male percentage (r = -0.786; P < .01), female education attainment (r = -0.640; P < .05), employment (r = 0.751; P < .01), GDP (r = -0.792; P < .01) and Gini index (r = -0.486; P < .01). Living donor numbers were significantly and positively correlated with age dependency (r = 0.815; P < .01). Generalized Linear Model-Logit (GLM-L) results showed that effect of female education attainment had significant contribution on deceased liver donor (B = -3290.605; P < .01). Effects of significantly correlated community factors on living liver donor numbers were found to be statistically insignificant (P > .05). Research findings reveal that among community factors, especially women's participation in education has a statistically significant effect on liver donors. These results show that the health expenditures made over the years do not provide any added value for liver donors, and role of women on liver donor is significantly dominant.

Evaluation of the review models and approval timelines of authorities participating in the East African Medicine Regulatory Harmonisation initiative: alignment and strategies for moving forward.

Medicines regulatory harmonisation has been embraced by many national regulatory authorities (NRAs) to improve public health through faster availability of safe, high-quality, and effective medical products to patients and enhanced standardisation of technical guidelines and work sharing, leading to reduced cost to pharmaceutical companies. After ten years of implementing regulatory harmonisation by the East African Community Medicines Registration Harmonization (EAC-MRH) initiative, it is now imperative for participating NRAs to rely on each other to minimise duplication of use of limited resources. Major challenges in implementing reliance are the lack of clear registration processes and delays in the approval. The aim of this study was to compare review models, target timelines and data requirements used in assessing applications by EAC-MRH NRAs so as to align and propose strategies for improvement. A validated questionnaire that standardises and captures review processes was completed by the head of the medicine's registration division in each of the seven EAC-MRH NRAs. A country report based on the completed questionnaire was developed for each NRA and validated by the heads of the respective authorities. Most applications received by all countries were for generics except Kenya, which received a significant number of new active substance applications (55 and 53 in 2020 and 2021). Mean approval times for generics using full review varied, with Tanzania's time declining for the three years. Target timelines for full review for the five countries ranged between 180 calendar days (Tanzania) to the highest 330 days (Zanzibar). The three countries (Kenya, Rwanda and Uganda) utilising the verification review model had a target timeline of 90 days. All six authorities conducted abridged reviews and fast-track assessments through a priority review track. The common technical document format was mandatory for applications in all authorities. The target timeline for key milestones in the review process varied for each country with a few similarities. The study has provided a baseline for review models, target timelines and data requirements utilised in assessing applications for registration by EAC-MRH NRAs. Implementing the recommendations from this study will enable the NRAs to align and improve their registration processes.

Implementing the WHO Indicators for Assessing Palliative Care Development in Three Countries: A Do-It-Yourself Approach

ContextPalliative care is an essential health service, with over 56.8 million people needing it yearly, particularly in low- and middle-income countries. The World Health Assembly has recognized palliative care as an ethical responsibility and called for comprehensive primary health care. The World Health Organization has published a technical report titled "Assessing the Development of Palliative Care Worldwide," as a crucial first step in addressing palliative care. The report includes 14 indicators to help decision-makers identify service provision gaps and inform health priorities, piloted by WHO's ATLANTES in Benin, Morocco, and Uruguay as part of a global assessment. ObjectivesTo describe, for the three countries, the primary outcomes and lessons learned to enable replication in further countries. MethodsA step-by-step description of the assessment project, a summary of the main results obtained through evaluations, and a description of how the selected countries effectively implemented the WHO indicators through a six-step process, including a phase of action plan design. We advocated a 'Do-it-yourself' approach. ResultsThe summary data from three country reports reveals national development at a national level. A SWOT analysis involving consultants and program managers was conducted. A stakeholder guide was developed, providing trigger questions and practical recommendations for assessing development using specific indicators. Full information can be found in the specific published reports. ConclusionThe WHO approach has proven effective in identifying health system deficiencies and disseminating information about palliative care evaluation processes. The report provides a 'Do-it-yourself' approach, encouraging self-management without expert guidance.

Transparency, institutions, and investment: The case of the extractive industries transparency initiative (EITI)

Since the establishment of the Extractive Industries Transparency Initiative (EITI), many resource-rich countries have joined international transparency initiatives. Considering that resource-rich countries have historically preferred opacity, this trend is surprising. Once a country joins the EITI, the country reports on its revenues, contracts, and licenses related to natural resources. The disclosure of information on resource revenues could threaten the survival of the leadership in less transparent democratic and autocratic regimes. In the face of the threats posed by enhanced transparency, these countries maintain their EITI membership, but for what reason? Using newly released data, this study argues that countries participate in international transparency initiatives to signal a favorable economic environment to international investors. This study demonstrates that under the self-reporting mechanism, investors reward or punish a country according to the level of its EITI membership. Based on an empirical analysis of 128 countries using two-stage least squares regression and the instrumental variable estimation in order to deal with selection bias and endogeneity (2002–2015), this study finds that joining in the EITI has a stronger positive effect on the inflow of foreign direct in-vestment (FDI) in less transparent countries, than in more transparent ones.

Country Report

As a result of the acts of devolution in Scotland, Wales, and Northern Ireland, the education systems of each nation (plus England)tea are different. Differences may pertain to the age students start following the national curriculum, what the national curriculum includes, public exam bodies, and ages of compulsory school attendance. As such, this country report will focus on philosophy in schools in England. Isolating data solely to England, however, will not always be possible, for example concerning the numbers of students taking A Level Philosophy which is taken in all nations.

Poverty Alleviation in Nigeria: A Decadal Examination of Political Economic Forces and Implications for Future Initiatives, Spotlighting Microfinance Banks

This research investigates the impact of political-economic dynamics on the effectiveness of Poverty Reduction Strategy Papers (PRSPs) in Nigeria from 2004 to 2014, with a specific emphasis on the role played by Microfinance Banks (MFBs). Employing a phenomenological approach within the social constructionist tradition, the study utilizes both individual and focus group interviews, complemented by the analysis of official documents from Nigerian Federal Ministries and the Central Bank. The case selection centers on microcredit, an important component of the IMF country report for the specified period. The findings reveal that while the National Economic Empowerment and Development Strategy (NEEDS) exhibits positive macroeconomic indicators, its alignment with the empowerment framework is nuanced. The study highlights the challenges faced by microcredit users, emphasizing the high interest rates, lack of government support, and inadequacies in the regulatory framework. Microfinance policy, as outlined by the Central Bank of Nigeria, is critiqued for its failure to provide safety nets and welfare benefits for microcredit users, exacerbating their economic vulnerabilities. This research contributes a comprehensive understanding of the socio-economic impact of PRSPs in Nigeria, shedding light on the complex interplay between macroeconomic policies and micro-level dynamics. The policy recommendations provided aim to address these challenges, advocating for regulatory enhancements, targeted interventions, and inclusive economic growth to foster a more effective and equitable poverty reduction strategy.

An Analysis of Anti-Tax Avoidance Approaches in Nine European Countries: An Update to the Conclusions of the First Meeting of the European Association of Tax Law Professors in 1999

In this General Report, as well as the accompanying country reports, the authors revisit a 1999 European Taxation article discussing tax avoidance, which stemmed from the first European Association of Tax Law Professors meeting. The authors explore shifts in tax avoidance perception due to the introduction of the treaty general anti-avoidance rule (GAAR) (principal purpose test), EU GAAR and specific anti-avoidance rules post-BEPS and the two OECD Pillars. Using eight 1999 cases for comparison, it provides a fresh empirical perspective on tax avoidance in Austria, Belgium, Finland, France, Germany, Spain, Sweden, the Netherlands and the United Kingdom.

Building Quality Control for Molecular Assays in the Global Measles and Rubella Laboratory Network.

More than 100 laboratories in the World Health Organization Global Measles and Rubella Laboratory Network (GMRLN) perform nucleic acid-based methods for case confirmation of measles or rubella infections and/or strain surveillance (genotyping). The quality of laboratory data is critical to ensure that diagnostic results and country reports to regional verification committees are based on accurate data. A molecular External Quality Assurance (mEQA) program was initiated by the US-CDC in 2014 to evaluate the performance of laboratories in the network. The inclusion of testing for measles and rubella viruses, with a focus on detection and genotyping, plus the diversity of assays and platforms employed required a flexible and comprehensive proficiency testing program. A stepwise introduction of new evaluation criteria gradually increased the stringency of the proficiency testing program, while giving laboratories time to implement the required changes. The mEQA program plays an important role in many processes in the GMRLN, including informing plans for the training of laboratory staff, access to reagents, and the submission of sequence data to global databases. The EQA program for Local Public Health Institutes in Japan is described as an example for national mEQA programs. As more laboratories initiate molecular testing, the mEQA will need to continue to expand and to adapt to the changing landscape for molecular testing.

Driving Forces of Impunity in South Asia: A Human Rights Framework

This paper is the outcome of a research on impunity in South Asia. Undertaken by Forum Asia in 2021, the research collected cases from Afghanistan, Bangladesh, India, Maldives, Nepal, Pakistan and Sri Lanka. The cases related to impunity were collected by the country researchers deputed in these countries. The lead author and co-author of this paper were the main contributors in compiling the country reports, processing the data, editing them and publishing them as country reports and South Asia regional report. Out of the huge compilation, this paper mainly sketches the debates over the constructs on impunity prevailing in these countries. The paper highlights how these countries are combating impunity with respect to the drivers and to what extent this effort is compatible in the realm of global human rights framework. Impunity is found deeply rooted in South Asia both in the cognitive, productive, economic, and political lives of the victims as well as on the psychosocial mindset of society. Individual victims of gross violations of human rights have been denied access to justice at large. This develops post-traumatic stress disorder (PTSD) along with loss of memory, nightmares, excessive fear, loss of attention, loss of self-esteem, self-isolation, distrust, withdrawal from normal life events as well as a refusal to participate in civil, cultural and social interactions. The paper concludes that most South Asian states follow democratic norms and values as they hold periodic elections and form governments. These states, however, severely lack concrete plans and tools to combat impunity. The paper suggests the vibrant role of the legislation penal codes in these countries to make accountable to the stakeholders involved in impunity matters both as perpetrators and those acting against the perpetrators.

Global biomass maps can increase the precision of (sub)national aboveground biomass estimates: A comparison across tropical countries

Countries within the tropics face ongoing challenges in completing or updating their national forest inventories (NFIs), critical for estimating aboveground biomass (AGB) and for forest-related greenhouse gas (GHG) accounting. While previous studies have explored the integration of map information with local reference data to fill in data gaps, limited attention has been given to the specific challenges presented by the clustered plot designs frequently employed by NFIs when combined with remote sensing-based biomass map units. This research addresses these complexities by conducting four country case-studies, encompassing a variety of NFI characteristics within a range of AGB densities. Examining four country case-studies (Peru, Guyana, Tanzania, Mozambique), we assess the potential of European Space Agency's Climate Change Initiative (CCI) global biomass maps to increase precision in (sub)national AGB estimates. We compare a baseline approach using NFI field-based data with a model-assisted scenario incorporating a locally calibrated CCI biomass map as auxiliary information.The original CCI biomass maps systematically underestimate AGB in three of the four countries at both the country and stratum level, with particularly weak agreement at finer map resolution. However, after calibration with country-specific NFI data, stratum and country-level AGB estimates from the model-assisted scenario align well with those obtained solely from field-based data and official country reports. Introducing maps as a source of auxiliary information fairly increased the precision of stratum and country-wise AGB estimates, offering greater confidence in estimating AGB for GHG reporting purposes.Considering the challenges tropical countries face with implementing their NFIs, it is sensible to explore the potential benefits of biomass maps for climate change reporting mechanisms across biomes. While country-specific NFI design assumptions guided our model-assisted inference strategies, this study also uncovers transferable insights from the application of global biomass maps with NFI data, providing valuable lessons for climate research and policy communities.

Contraceptive use, unmet need, and demand satisfied for family planning across Cameroon: a subnational study including indirect effects of COVID-19 and armed conflict on projections

BackgroundCameroon is among countries that have made notable investments nationwide in line with the Family Planning 2030 initiative. This study examines the progress made across the 10 regions and 58 divisions of the country, including potential impairments following COVID-19 and armed conflict.MethodsIn this time-series analysis, parameters were sourced from 5 Demographic and Health Surveys and 3 Multiple Indicator Cluster Surveys conducted between 1991 and 2018. The Family Planning Estimation Tool (FPET) was used to estimate key family planning indicators among married women of reproductive age. Data from official country reports and FPET results were incorporated into Bayesian models to assess how projections (from 2020 to 2030) would vary given varying contractions (i.e., 0%, 5%, 10%, and 25% annually) to services coverage.ResultsNationally, modern contraceptive prevalence rate (mCPR) and demand satisfied with modern (contraceptive) methods reached 16.8% (95% credible interval 12.0 to 23.0) and 37.6% (28.7 to 47.0), respectively; and unmet need for modern methods decreased to 27.9% (22.9 to 33.7) in 2022. Notable improvements were observed in the East region and Boumba et Ngoko division, with annual mCPR trends of 2.1 percentage points (%p) (− 0.2 to 4.2) and 7.0%p (4.5 to 9.3) from 2015–2020; and 2030 projections of 58.7% (41.3 to 74.0) and 79.1% (65.0 to 89.0), respectively. The least performing in terms of demand satisfied with modern methods include Adamawa at the regional and Boyo at the divisional level, with 2030 projections of 45.5% (26.5 to 65.1) and 0.4% (0.2 to 0.8), respectively. The northern regions (Adamawa, Far North, and North) recorded the lowest levels of unmet need for modern methods. To achieve ≥ 75% demand satisfied with modern methods in 2030, an additional 1.4 (0.6 to 2.2) million modern contraceptive users are required. Given large reductions (− 25% annually) in services coverage post-COVID-19/armed conflict (2020 to 2030), the South region could experience the most significant contraction in projected mCPR, with a decrease of − 9.2%.ConclusionsFamily planning outcomes vary significantly across subnational territories of Cameroon. While the East region shows notable success, greater attention is needed in the northern regions. Strategies must be adaptive to address unprecedented emergencies that may disrupt access to services.

PACTA SUNT SERVANDA: EVALUATING PAKISTAN’S REPORTING ON CHILD SEXUAL ABUSE WITHIN THE CONVENTION ON THE RIGHTS OF THE CHILD FRAMEWORK

This article critically assesses the extent to which Pakistan has complied with the Convention on the Rights of the Child (CRC) and focuses on the principle of pacta sunt servanda, which advocates thorough and faithful performance of the covenants entered by a party. The article’s focus is on the measures that have been established under the provision of the CRC by Pakistan to protect children from sexual abuse. However, the contention remains whether Pakistan as a member of CRC effectively utilizes the legislature in the course of protecting a child from sexual abuse under CRC. The recommendations of this article entail a firm comparison between the provisions of the legislation of Pakistan and those of CRC regarding the protection of children from sexual abuse. This article assesses the reports prepared by Pakistan on CRC requirements and submitted periodically to the CRC Committee. This article seeks to establish to what extent these reports show Pakistan in abidance with Pacta sunt servanda as well as the principles of the CRC encompassing the protection of children from sexual abuse. The concluding observations of the CRC Committee in case of consideration of the country reports of Pakistan are explained in detail to decipher the legal nakedness and the lack of enforcement approach to child sexual abuse in the country. The conclusions of this article draw this realization that it is high time that the country enhances its laws that would align with the international obligations of Pakistan under the CRC.

The Impact of Mental Models on the Transition from Communism to Capitalism. The Comparative Case Study of Azerbaijan and Poland

The purpose of the article. The breakdown of the so-called Eastern Bloc, the disintegration of the Soviet Union, and the demise of communism fueled transition processes in Central and Eastern Europe, Western Asia, and Central Asia. The great majority of transformation difficulties across different areas demonstrate that when pursuing the process of a structural change, it is important to take into account diverse sets of formal and informal institutions preserved in each country. Each country has a unique set of formal and informal institutions. These differences are easily observed between Poland and Azerbaijan. The aim of this paper is to compare and contrast the outcomes of Poland and Azerbaijan's transitions from communism to capitalism and to identify the primary factors driving these two different transformations. Methodology. The paper presents two complementary methods to compare the transitions from communism to capitalism in Poland and Azerbaijan. The first method involves secondary analysis, where existing data from reputable sources such as the European Bank for Reconstruction and Development (EBRD) database, the Bertelsmann Transformation Index (BTI), and country reports are compiled to provide insights into economic, political, and social indicators. Additionally, a comparative case study approach is employed, using Geert Hofstede's six cultural dimensions framework to explore the cultural influences on transition outcomes. By integrating these methods, the study aims to offer a comprehensive analysis of the transformation processes in Poland and Azerbaijan. Results of the research. The results of the analysis presented in the paper support the hypothesis that the historically-shaped differences in mental models and strong ties to international protectors determined the paths of transformations in Poland and Azerbaijan. The primary similarities and contrasts in the mindset are justified by the colonial or imperial history of the nations.

Treatment trends for metastatic urothelial carcinoma across eight Mexican centers: A global oncology perspective.

11171 Background: Urothelial carcinoma represents 3% of new cancer cases globally. Metastatic urothelial carcinoma (mUC) poses a notable challenge to healthcare systems, given its treatment complexity and high mortality. These challenges are magnified in resource-constrained settings. We aim to describe treatment trends for mUC across public and private Mexican centers. Methods: Retrospective study across 8 referral centers. Adults with mUC from 01/2001-12/2021 were included. We assessed clinical records, demographics and comorbidities. We recorded subject eligibility for first line platinum therapy, treatment lines received, and access to novel drugs. Descriptive statistics were used for demographics, treatment details and outcomes. Survival analysis was performed, including Kaplan Meier curves and Cox proportional hazards model. Results: We found 342 cases of mUC, 76% were male, with a median age of 67 years. Median follow-up was 8.4 months. Among those that received a first line (n=223, 65%), regimens used were cisplatin-based chemotherapy (n=100, 45%), carboplatin-based chemotherapy (n=87, 39%), gemcitabine (n=5, 2.2%), immunotherapy (n=4, 1.8%) or unspecified (n=27, 12%). Most causes of cisplatin ineligibility were ECOG ≥2 (41%) and glomerular filtration rate &lt;60 ml/min (33%). Of those who received upfront platinum therapy (n=187), 65% received &gt;3 cycles (n=121), 20% received 2 or 3 cycles (n=38) and 15% received 1 cycle (n=28). Progression as best response was found in 47% (n=88). Avelumab maintenance was only used in 14/99 eligible patients (14.1%). The proportion of individuals receiving a second, third or more lines was 24.6%, 8.8% and 3.5%, respectively. The most common second line treatment was chemotherapy (64.4%) followed by immunotherapy (28.6%). Median overall survival (mOS) was 11.8 months. Treatment notably impacted mOS, favoring those who received a first line(16.7 vs. 4.6 months, p&lt;0.0001). Stratified analysis showed worse mOS for those with visceral disease (17.1 vs 10.3 months, p=0.0065) and ECOG ≥2 (17.6 vs 5.8 months, p&lt;0.001).These features correlated with higher mortality, while first line treatment was associated with lower mortality. Conclusions: These data represent the first effort to delineate treatment trends of mUC in Mexico. First line treatment rates were higher than those described worldwide (35-60%1). Further, cisplatin-eligibility was higher compared to reports of high-income countries. Considerable rates of progression to platinum therapy were found, likely due to aggressive disease. This study highlights the limited access to novel treatments, showed by the infrequent use of avelumab maintenance, immunotherapy or targeted agents. [Table: see text]

Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East.

Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems. A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided to address these issues. All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.