Current Information Gaps Research Articles

PSInet: a new global water potential network.

Given the pressing challenges posed by climate change, it is crucial to develop a deeper understanding of the impacts of escalating drought and heat stress on terrestrial ecosystems and the vital services they offer. Soil and plant water potential play a pivotal role in governing the dynamics of water within ecosystems and exert direct control over plant function and mortality risk during periods of ecological stress. However, existing observations of water potential suffer from significant limitations, including their sporadic and discontinuous nature, inconsistent representation of relevant spatio-temporal scales and numerous methodological challenges. These limitations hinder the comprehensive and synthetic research needed to enhance our conceptual understanding and predictive models of plant function and survival under limited moisture availability. In this article, we present PSInet (PSI-for the Greek letter Ψ used to denote water potential), a novel collaborative network of researchers and data, designed to bridge the current critical information gap in water potential data. The primary objectives of PSInet are as follows. (i) Establishing the first openly accessible global database for time series of plant and soil water potential measurements, while providing important linkages with other relevant observation networks. (ii) Fostering an inclusive and diverse collaborative environment for all scientists studying water potential in various stages of their careers. (iii) Standardizing methodologies, processing and interpretation of water potential data through the engagement of a global community of scientists, facilitated by the dissemination of standardized protocols, best practices and early career training opportunities. (iv) Facilitating the use of the PSInet database for synthesizing knowledge and addressing prominent gaps in our understanding of plants' physiological responses to various environmental stressors. The PSInet initiative is integral to meeting the fundamental research challenge of discerning which plant species will thrive and which will be vulnerable in a world undergoing rapid warming and increasing aridification.

Mental health in fishing communities: An overview of current knowledge and information gaps for fisheries

Fishing depends on unstable natural water resources and changing socioeconomic dynamics within and beyond the fishing environment. Changes in the aquatic and socioeconomic environments have effects on the physical and mental health of fishers and sustainability of fisheries. This scoping review aimed to: a) identify the breadth of mental health aspects in fisheries literature, b) establish the geographic focus of fisheries mental health literature, and c) examine the factors responsible for the global disparity in fisheries mental health literature. Eighty three mental health studies dominated by researches from Europe, North America, Africa, Latin America, Australia and Asia were noted from over 7452 fishing community health studies. Literature is lopsided towards the physical rather than mental health in fishers. Paucity of mental health literature for fishers emanates from the complexity of assessing the mental health of a specific group which encompasses confounding, associated and risk factors. With prevailing climate change, economic uncertainty and post COVID-19 effects, mental resilience is important for the recovery and sustainability of fisheries. There is need for development and integration of fisheries specific mental psychometrics into broader schematic health, scientific and social well-being frameworks for fishing communities to enhance mental resilience to environmental, economic and health challenges.

Using social media research in health technology assessment: stakeholder perspectives and scoping review.

The aim of this initiative was to examine collaboratively, in a multi-stakeholder team (health technology assessment (HTA) practitioners with patient involvement expertise, health technology industry, patient advocates, health policy experts, patient engagement experts), whether evidence generated through social media research (SMR) fills current information gaps relating to insights on specific aspects of patient experiences, preferences, or patient needs and delivers additional value to HTA. The framing of the project was done in a co-creative, deliberative multi-stakeholder process. Challenge and refinement happened through discussions with 25 independent stakeholders from HTA bodies, industry, academia, and patient advocacy. For critical themes identified during the framing phase, scoping literature reviews were performed including the state of methods and examples for the use of SMR in HTA. The framing and stakeholder discussions specified a set of expectations and requirements, and the scoping reviews revealed the current state of methods and usage of SMR in health-policy decision making. The project concluded that SMR can contribute new, relevant evidence to HTA. It is however recommended to evolve the science through defining best practices when planning, conducting, and using SMR and to conduct multi-stakeholder pilot SMR projects to address questions relevant to current HTAs and to validate and improve the proposed practices.

Preface to the Second Koala Retrovirus Workshop online 25–27 May 2021. In Proceedings of the Second Koala Retrovirus Workshop, ed. D. E. Alquezar-Planas, D. P. Higgins, C. L. Singleton, and A. D. Greenwood

In 2013, the first Koala Retrovirus Workshop was held in San Diego, bringing together biology and veterinary specialists to assess and discuss the state of knowledge on koala retrovirus (KoRV) and to form professional bridges and networks. Tremendous progress has been made in the years following the San Diego meeting, in large part due to ongoing international collaborations that were fostered to study KoRV. This volume presents peer-reviewed papers from most of the oral presentations and discussions held during the Second Koala Retrovirus Workshop in 2021. Unfortunately, the COVID-19 pandemic forced the workshop into an online only format. Despite this limitation, three days of discussions based on workshop presentations highlighted current knowledge and important information gaps, culminating in suggested ways forward, all summarized in this volume.

Guiding future paediatric drug studies based on existing pharmacokinetic and efficacy data: Cardiovascular drugs as a proof of concept.

Off-label drug use in the paediatric population is common, and the lack of high-quality efficacy studies poses patients at risk for failing pharmacotherapy. Next to efficacy studies, pharmacokinetic (PK) studies are increasingly used to inform paediatric dose selection. As resources for paediatric trials are limited, we aimed to summarize existing PK and efficacy studies to identify knowledge gaps in available evidence supporting paediatric dosing recommendations, thereby taking paediatric cardiovascular drugs as proof of concept. For each cardiovascular drug, paediatric indication and prespecified age group, together comprising one record, the authorized state was assessed. Next, for off-label records, the highest level of evidence was scored. High-quality efficacy studies were defined as meta-analysis or randomized controlled trials. Other comparative research, noncomparative research or consensus-based expert opinions were considered low quality. The level of evidence for PK studies was scored per drug and per age group, but regardless of indication. A total of 58 drugs included 417 records, of which 279 (67%) were off-label. Of all off-label records, the majority (81%) were not supported by high-quality efficacy studies, but for 140 of these records (62%) high-quality PK studies were available. We demonstrated that for the majority of off-label cardiovascular drugs, only low-quality efficacy studies were available. However, high-quality PK studies were frequently available. Combining these PK data with extrapolation of efficacy data from adults may help to close the current information gap and prioritize the drugs for which clinical studies and safety data are urgently needed.

Modulation of Anthocyanin Biosynthesis-Related Genes during the Ripening of Olea europaea L. cvs Carolea and Tondina Drupes in Relation to Environmental Factors.

Anthocyanins protect plants against various biotic and abiotic stresses, and anthocyanin-rich foods exert benefits on human health due to their antioxidant activity. Nevertheless, little information is available on the influence of genetic and environmental factors on the anthocyanin content in olive fruits. Based on this consideration, the total anthocyanin content, the genes involved in anthocyanin biosynthesis, and three putative R2R3-MYB transcription factors were evaluated at different ripening stages in the drupes of the Carolea and Tondina cultivars, sampled at different altitudes in the Calabria region, Italy. During drupe ripening, the total anthocyanin content and the transcript levels of analyzed genes gradually increased. In line with the anthocyanin content, a different level of expression of anthocyanin structural genes was observed in 'Carolea' compared to 'Tondina', and in relation to the cultivation area. Furthermore, we identified Oeu050989.1 as a putative R2R3-MYB involved in the regulation of anthocyanin structural genes correlated with the environmental temperature change response. We conclude that anthocyanin accumulation is strongly regulated by development, genotype, and also by environmental factors such as temperature, associated with the altitude gradient. The obtained results contribute to reducing the current information gap regarding the molecular mechanisms on anthocyanin biosynthesis regulation related to the environmental conditions in Olea europaea.

Estimating complete cancer prevalence in Europe: validity of alternative vs standard completeness indexes.

Comparable indicators on complete cancer prevalence are increasingly needed in Europe to support survivorship care planning. Direct measures can be biased by limited registration time and estimates are needed to recover long term survivors. The completeness index method, based on incidence and survival modelling, is the standard most validated approach. Within this framework, we consider two alternative approaches that do not require any direct modelling activity: i) empirical indices derived from long established European registries; ii) pre-calculated indices derived from US-SEER cancer registries. Relying on the EUROCARE-6 study dataset we compare standard vs alternative complete prevalence estimates using data from 62 registries in 27 countries by sex, cancer type and registration time. For tumours mostly diagnosed in the elderly the empirical estimates differ little from standard estimates (on average less than 5% after 10-15 years of registration), especially for low prognosis cancers. For early-onset cancers (bone, brain, cervix uteri, testis, Hodgkin disease, soft tissues) the empirical method may produce substantial underestimations of complete prevalence (up to 20%) even when based on 35-year observations. SEER estimates are comparable to the standard ones for most cancers, including many early-onset tumours, even when derived from short time series (10-15 years). Longer observations are however needed when cancer-specific incidence and prognosis differ remarkably between US and European populations (endometrium, thyroid or stomach). These results may facilitate the dissemination of complete prevalence estimates across Europe and help bridge the current information gaps.

Dietitians as change agents for promoting healthy and sustainable food systems

Dietitians as change agents for promoting healthy and sustainable food systems

Chemical safety and the exposome

Air pollution and rapid chemical intensification are major threats to the environment and human health. Today, we have produced over 350,000 chemicals, and current testing strategies do not meet the demands. Therefore, it is important to develop new approach methodologies (NAMs) that can help fill current information gaps. Toxicology needs to evolve from hazard and risk assessments based on morphological endpoints in animal tests towards a mechanism-driven integrated approach that better includes computational modelling as well as molecular, human, and in vitro data. The application of new science and technology such as different types of imaging and omics methods can allow faster collection of high-quality toxicological data for hazard identification and better prediction of toxicological potential using advanced in silico approaches including machine learning. A shift toward active prevention of pollution through a safe and sustainable-by-design approach based on cutting-edge science could significantly help safeguard the population and planetary health. Moreover, it is necessary to improve the understanding of how interactions among chemical mixtures, climate change, infectious agents, and other stressors that constitute the exposome, may affect biota and human health. Individual responses to current exposures and susceptibility to disease are influenced by factors such as genetics, epigenetics, physiology, and health status, which involve changes in biological pathways caused by own previous exposures or even ancestral exposures. It is therefore important to better consider individual exposomes and susceptibility in future risk assessments and precision medicine. This review describes the central role of mechanistic toxicology in chemical safety and in the cross-disciplinary efforts needed to characterize the exposome and its complex interactions in detail.

Diagnosing Intramammary Infection: Meta-Analysis and Mapping Review on Frequency and Udder Health Relevance of Microorganism Species Isolated from Bovine Milk Samples

Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry provides accurate species-level identification of many, microorganisms retrieved from bovine milk samples. However, not all those microorganisms are pathogenic. Our study aimed to: (1) determine the species-specific prevalence of microorganisms identified in bovine milk of apparently healthy lactating quarters vs. quarters with clinical mastitis (CM); and (2) map current information and knowledge gaps on udder health relevance of microorganisms retrieved from bovine milk samples. A mixed study design (meta-analysis and mapping review) was chosen. We gathered several large Canadian, US and Brazilian data sets of MALDI-TOF results for organisms cultured from quarter milk samples. For meta-analysis, two datasets (apparently healthy quarters vs. CM samples) were organized. A series of meta-analyses was conducted to determine microorganisms' prevalence. Then, each species reported was searched through PubMed to investigate whether inflammation (increased somatic cell count (SCC) or signs of CM) was associated with microorganism's recovery from milk. A total of 294 different species of microorganisms recovered from milk samples were identified. Among 50,429 quarter-milk samples from apparently healthy quarters, the 5 most frequent species were Staphylococcus chromogenes (6.7%, 95% CI 4.5-9.2%), Aerococcus viridans (1.6%, 95% CI 0.4-3.5%), Staphylococcus aureus (1.5%, 95% CI 0.5-2.8%), Staphylococcus haemolyticus (0.9%, 95% CI 0.4-1.5%), and Staphylococcus epidermidis (0.7%, 95% CI 0.2-1.6%). Among the 43,924 quarter-milk CM samples, the 5 most frequent species were Escherichia coli (11%, 95% CI 8.1-14.3%), Streptococcus uberis (8.5%, 95% CI 5.3-12.2%), Streptococcus dysgalactiae (7.8%, 95% CI 4.9-11.5%), Staphylococcus aureus (7.8%, 95% CI 4.4-11.9%), and Klebsiella pneumoniae (5.6%, 95% CI 3.4-8.2%). When conducting the PubMed literature search, there were 206 species identified by MALDI-TOF for which we were not able to find any information regarding their association with CM or SCC. Some of them, however, were frequently isolated in our multi-country dataset from the milk of quarters with CM (e.g., Citrobacter koseri, Enterococcus saccharolyticus, Streptococcus gallolyticus). Our study provides guidance to veterinarians for interpretation of milk bacteriology results obtained using MALDI-TOF and identifies knowledge gaps for future research.

Structural aspects of hepatitis E virus.

Hepatitis E virus (HEV) is a leading cause of acute hepatitis worldwide. Hepatitis E is an enterically transmitted zoonotic disease that causes large waterborne epidemic outbreaks in developing countries and has become an increasing public-health concern in industrialized countries. In this setting, the infection is usually acute and self-limiting in immunocompetent individuals, although chronic cases in immunocompromised patients have been reported, frequently associated with several extrahepatic manifestations. Moreover, extrahepatic manifestations have also been reported in immunocompetent individuals with acute HEV infection. HEV belongs to the alphavirus-like supergroup III of single-stranded positive-sense RNA viruses, and its genome contains three partially overlapping open reading frames (ORFs). ORF1 encodes a nonstructural protein with eight domains, most of which have not been extensively characterized: methyltransferase, Y domain, papain-like cysteine protease, hypervariable region, proline-rich region, X domain, Hel domain, and RNA-dependent RNA polymerase. ORF2 and ORF3 encode the capsid protein and a multifunctional protein believed to be involved in virion release, respectively. The novel ORF4 is only expressed in HEV genotype 1 under endoplasmic reticulum stress conditions, and its exact function has not yet been elucidated. Despite important advances in recent years, the biological and molecular processes underlying HEV replication remain poorly understood, primarily due to a lack of detailed information about the functions of the viral proteins and the mechanisms involved in host-pathogen interactions. This review summarizes the current knowledge concerning HEV proteins and their biological properties, providing updated detailed data describing their function and focusing in detail on their structural characteristics. Furthermore, we review some unclear aspects of the four proteins encoded by the ORFs, highlighting the current key information gaps and discussing potential novel experimental strategies for shedding light on those issues.

Evaluation of the impact of pre- and post-harvest maize handling practices on mycotoxin contamination on smallholder farms in Guatemala

Mycotoxins are secondary metabolites produced by fungi includingAspergillus andFusarium that commonly contaminate crops, such as maize, resulting in economic losses and food insecurity. Mycotoxins can contaminate crops during pre- and post-harvest stages. Consumption of mycotoxin-contaminated foods has been linked to a variety of negative health outcomes including liver cancer, stunting, and neural tube defects. In countries such as Guatemala where maize constitutes a major portion of the diet, mycotoxins can be a significant contributor to disease burden. This review describes maize pre- and post-harvest practices in Guatemala that can lead to the development of mycotoxins and subsequent exposure to humans and animals, current information gaps, and opportunities for future research. There are specific challenges to minimising fungal growth and subsequent mycotoxin production during storage of maize in Guatemala, including reducing moisture content, minimising pest damage, and controlling temperature. Research on maize-handling practices that are associated with the greatest mycotoxin exposure in Guatemala is needed to prioritise allocation of resources and reduce exposure.

Assessing the Risks to Bats from Plant Protection Products: A Review of the Recent European Food Safety Authority Statement Regarding Toxicity and Exposure Routes

Wild birds and mammals that feed in agricultural habitats are potentially exposed to pesticides through various routes. Until recently, it has been implicitly assumed that the existing European Union risk assessment scheme for birds and mammals also covered bats (Chiroptera). However, recent publications raised concerns and, in 2019, a scientific statement was published by the European Food Safety Authority (EFSA) that concluded that bats were not adequately covered by the current risk assessment scheme. We review the evidence presented and assumptions made in the EFSA bat statement relating to toxicity, bioaccumulation, and exposure pathways (oral, dermal, and inhalation), in terms of their relevance for bats potentially foraging in agricultural areas in the European Union; we highlight where uncertainties remain and how these could be addressed. Based on our review, it is clear that there is still much uncertainty with regard to the appropriateness of the assumptions made in the EFSA bat statement. Significantly more information needs to be gathered to answer fundamental questions regarding bat behavior in agricultural landscapes, together with the relative sensitivity of bats to pesticide exposure. Given the current critical information gaps, it is recommended that quantitative risk assessments for bats not be performed for pesticides until more robust, reliable, and relevant data are available. The risk to bats can then be compared with that for birds and ground‐dwelling mammals, to determine the protectiveness of the existing scheme and thus whether a bat scenario is indeed required and under what circumstances. Environ Toxicol Chem 2021;40:2978–2989. © 2021 Cambridge Environmental Assessments, part of RSK ADAS Ltd. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Is investment in Climate-Smart-agricultural practices the option for the future? Cost and benefit analysis evidence from Ghana

A majority of smallholder farmers in sub-Saharan Africa (SSA) countries depend to a large extent on agriculture for food security and income. Efforts aimed at improving farm-related profitability are therefore important to improving livelihoods among smallholder farmers. In Ghana, for example, smallholder farmers that depend on agriculture face serious risks especially those related to climate change and variability and soil degradation. Notwithstanding these dangers, evidence of the published literature on how best to tackle these challenges is limited. Over the recent decades, however, there has been advancement by programs channelling resources into Climate-Smart Agricultural (CSA) practices to improving smallholder livelihoods and food security. The interest in advancing investment in CSA practices is a key pathway that has the potential to significantly reduce the negative effect of climate change and variability risks on smallholder farmers livelihoods. Investing in CSA practices is also a key pathway to improving farm yield per unit area. Consequently, smallholder farmers are adopting and implementing CSA practices. Despite that, a gap still exists on the profitability of undertaking such an investment, as this is key in determining the sustainability of CSA practices. On this basis, the present study undertook a detailed cost-benefit analysis (CBA) of seven CSA practices identified with smallholder farmers in the coastal savannah agro-ecological zone of Ghana. A total of 48 smallholder farmers that had adopted these practices were studied. Three CBA indicators namely the net present value (NPV), internal rate of return (IRR) and payback period (PP) were assessed for each of the seven CSA practices. The results showed that out of the seven CSA practices examined, six of them were profitably suitable for adoption and scaling up from the perspective of smallholder farmers as well as the public perspective. The finding from this study, therefore, fill the current information gap in the literature on the costs and benefits of adopting CSA practices on household livelihoods in Ghana. Such a finding is critical to the promotion and scaling up the adoption of CSA practices by smallholder farmers and serve as a basis of formulating appropriate guidelines and policies for supporting CSA practices.

Histamine, Metabolic Remodelling and Angiogenesis: A Systems Level Approach.

Histamine is a highly pleiotropic biogenic amine involved in key physiological processes including neurotransmission, immune response, nutrition, and cell growth and differentiation. Its effects, sometimes contradictory, are mediated by at least four different G-protein coupled receptors, which expression and signalling pathways are tissue-specific. Histamine metabolism conforms a very complex network that connect many metabolic processes important for homeostasis, including nitrogen and energy metabolism. This review brings together and analyses the current information on the relationships of the “histamine system” with other important metabolic modules in human physiology, aiming to bridge current information gaps. In this regard, the molecular characterization of the role of histamine in the modulation of angiogenesis-mediated processes, such as cancer, makes a promising research field for future biomedical advances.

Epidemiology of Tuberculosis in Multi-Host Wildlife Systems: Implications for Black (Diceros bicornis) and White (Ceratotherium simum) Rhinoceros.

Cases of tuberculosis (TB) resulting from infection with Mycobacterium tuberculosis complex (MTBC) have been recorded in captive white (Ceratotherium simum) and black (Diceros bicornis) rhinoceros. More recently, cases have been documented in free-ranging populations of both species in bovine tuberculosis (bTB) endemic areas of South Africa. There is limited information on risk factors and transmission patterns for MTBC infections in African rhinoceros, however, extrapolation from literature on MTBC infections in other species and multi-host systems provides a foundation for understanding TB epidemiology in rhinoceros species. Current diagnostic tests include blood-based immunoassays but distinguishing between subclinical and active infections remains challenging due to the lack of diagnostic techniques. In other species, demographic risk factors for MTBC infection include sex and age, where males and adults are generally at higher risk than females and younger individuals. Limited available historical information reflects similar age- and sex-associated patterns for TB in captive black and white rhinoceros, with more reports of MTBC-associated disease in black rhinoceros than in white rhinoceros. The degree of MTBC exposure in susceptible wildlife depends on their level of interaction, either directly with other infected individuals or indirectly through MTBC contaminated environments, which is dependent on the presence and abundance of infected reservoir hosts and the amount of MTBC shed in their excreta. Captive African rhinoceros have shown evidence of MTBC shedding, and although infection levels are low in free-ranging rhinoceros, there is a risk for intraspecies transmission. Free-ranging rhinoceros in bTB endemic areas may be exposed to MTBC from other infected host species, such as the African buffalo (Syncerus caffer) and greater kudu (Tragelaphus strepsiceros), through shared environmental niches, and resource co-utilization. This review describes current knowledge and information gaps regarding the epidemiology of TB in African rhinoceros.

Incorporating home healthcare nurses' admission information needs to inform data standards.

ObjectivePatient transitions into home health care (HHC) often occur without the transfer of information needed for critical clinical decisions and the plan of care. Owing to a lack of universally implemented standards, there is wide variation in information transfer. We sought to characterize missing information at HHC admission.Materials and MethodsWe conducted a mixed methods study with 3 diverse HHC agencies. Focus groups with nurses at each agency identified what information supports patient care decisions at admission. Thirty-six in-home admissions with associated documentation review determined the available information. To inform information standards development for the HHC admission process, we compared the types of information desired and available to an international standard for transitions in care information, the Continuity of Care Document (CCD) enhanced with Office of the National Coordinator for Healthcare Information Technology summary terms (CCD/S).ResultsThree-quarters of the items from the focus groups mapped to the CCD/S. Regarding available information at admission, no observation included all CCD/S data items. While medication information was needed and often available for 4 important decisions, concepts related to patient medication self-management appeared in neither the CCD/S nor the admission documentation.DiscussionThe CCD/S mostly met HHC nurses’ information needs and is recommended to begin to fill the current information gap. Electronic health record recommendations include use of a data standard: the CCD or the proposed, more parsimonious U.S. Core Data for Interoperability.ConclusionsReferral source and HHC agency adoption of data standards is recommended to support structured, consistent data and information sharing.

Feeding ecology and reproduction biology of Glaucostegus cemiculus (Geoffroy Saint-Hilaire, 1817) from the eastern Aegean Sea

Though guitarfish are common bycatch and have an economical value in the Mediterranean Sea, there is still limited knowledge on blackchin guitarfish’s, Glaucostegus cemiculus, their presence or any biological feature, with specific regard to those that inhabit the eastern Mediterranean coasts of Turkey. To explore this information gap, bio-ecological features, which are investigated in terms of stomach contents and reproduction, were examined from individuals obtained from Izmir Bay. A total of 122 individuals caught as by-catch were collected monthly between: July 2015–June 2016. Crustaceans were found to be the main prey item in their diets. Maturity stages were mainly immature, with the exception of two individuals: an immature 2-developing female and mature 3b-active male. Knowledge retrieved from present studies on bio-ecological features contributes to closing the current information gap on endangered blackchin guitarfish in the eastern Aegean Sea. Such studies also provide a platform for essential discussion on the various ways in which effective r monitoring strategies for the species could be implemented and managed; particularly in the Turkish coast of the eastern Mediterranean.

Rising prevalence of diabetes: evidence from the national registry in North Macedonia

Abstract Background Disease reporting and data collection are key tools for the health care systems in order to identify opportunities to address burden of diseases. The country’s diabetes patients register was the first registry to be integrated with the e-health system in North Macedonia in 2017. We aimed to estimate type 2 diabetes mellitus prevalence and effectiveness of diabetes control as one of the proposed national priorities in tackling the non-communicable diseases. Methods Cross-sectional descriptive study was conducted on patients entered in the National Diabetes Register in 2017/2018. Patients’ socio-demographic and anthropometric characteristics in association with diabetes’ complications and outcomes were determined by Pearson correlation coefficient (P < 0.0001, 95% CI). Results This study identified a total of 35541 patients with a diagnosis of diabetes, out of which 32888 with type 2. This corresponds to a prevalence rate of 1583.9 per 100,000 population. The prevalence increased with age (65+) and was higher among females than males (56.8% vs. 43.2%). Over 80% of type 2 patients were overweight out of which 34.5% obese (BMI>30kg/m2). Diabetic retinopathy is reported as first diagnosed complication in diabetic patients, followed by neuropathies and vascular complications. Patient’s low level of education and higher BMI were associated with increased number of early and late-onset complications. Conclusions Evidence accumulating suggests high burden of complications in type 2 diabetic patients, indicating that the patients understanding of diabetes care, treatment adherence and healthy lifestyle are important topics to be address by health professionals in order to avoid complications and premature deaths in people with diabetes. Key messages Integrated reporting of non-communicable diseases and risk factors is needed to complete current information gaps, from completeness of data to quality and comparability. The action plan for chronic diseases should specifically address diabetes control, as most of the patients with diabetes have high prevalence of comorbidities, complications and unfortunate outcomes.

Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review).

Many people travel abroad to access fertility treatments. This growing phenomenon is known as cross border reproductive care (CBRC) or fertility tourism. Due to its complex nature and implications worldwide, CBRC has become an emerging dilemma deserving more attention on the global healthcare agenda. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English during the past 18years to explore CBRC phenomenon in the new millennium. Little is known about the accurate magnitude and scope of CBRC around the globe. In this systematic and critical review, we identify three major dimensions of CBRC: legal, economic, and ethical. We analyze each of these dimensions from clinical and practical perspectives. CBRC is a growing reality worldwide with potential benefits and risks. Therefore, it is very crucial to regulate the global market of CBRC on legal, economic, and ethical bases in order to increase harmonization and reduce any forms of exploitation. Establishment of accurate international statistics and a global registry will help diminish the current information gap surrounding the CBRC phenomenon.