Research In High-income Countries Research Articles

Abstract PO3-10-09: The allocation of US $2.6 billion in global funding for breast cancer research between 2016 – 2020: are we investing wisely for breast cancer patients?

Abstract Background: Breast cancer is a global health challenge and the highest incident cancer globally, with over 2 million new cases and 685,000 deaths in 2020, making it the highest incident cancer globally. Furthermore, it is the most prevalent cancer, resulting in the loss of more disability-adjusted life years than any other malignancy. Research is thus crucial to improving outcomes and reducing suffering for breast cancer patients worldwide. This study aimed to analyse global patterns of funding for breast cancer research. Methods: We have previously created a comprehensive database of awards for human cancer research in this period using publicly available data on research funding awards. From this database we extracted all awards relating to breast cancer research, and categorised these by cancer type, cross-cutting research theme and phase of research. Findings: We identified 7051 awards with a total investment of $2.6 billion in 2016-2020, representing 11.2% of all global public and philanthropic cancer research funding during this period. Breast cancer research funding fell year on year, from $773.4 million in 2016 to $243.8 million in 2020. The majority of the investment was in pre-clinical research ($1.9 billion, 73.9%), with clinical trials ($276 million, 10.7%) and public health ($269.2 million, 10.5%) receiving roughly equivalent amounts of funding. The USA accounted for 66.9% of all global breast cancer research investment, with China ($110.4 million, 4.3%) and the UK ($96.6 million, 3.8%) the next largest funders. By research theme, cancer biology research received most funding ($926.2 million, 37.5% of investment), with drug treatment the next best funded research area ($600.5 million, 23.4%), and diagnosis, screening and monitoring third ($396 million, 15.4%). Surgery ($65.2 million, 2.5%) and radiotherapy ($35.3 million, 1.4%) accounted for only a small proportion of research investment. There was minimal investment into breast cancer as a global health issue ($8.1 million, 0.3%). Research into metastatic disease received a greater proportion of investment in breast cancer than in the overall cancer portfolio (23.2% in breast cancer, $597.4 million, compared with 11.7% across all cancers). Conclusions: Breast cancer public and philanthropic research funding is largely invested in pre-clinical research in high-income countries, with the main areas of investment being cancer biology research and drug treatment. The direct benefit to patients from such research is likely to be low and only apparent after a substantial time lag (if at all). Despite their pivotal role in the treatment of the majority of breast cancer patients, surgery and radiotherapy research received a tiny proportion of the overall research investment. Furthermore, relatively little investment is directed towards cancer prevention and early detection, despite their acknowledged key role in cancer control globally. Finally, more equitable research funding is required to align with the global burden of breast cancer, with increased funding for low- and middle-income countries, which account for an increasing proportion of this burden. These data should be considered by funders and policymakers in the allocation of finite resources, which must be invested wisely. Citation Format: Stuart McIntosh, Ellen Copson, Ramsey Cutress, Michael Head. The allocation of US $2.6 billion in global funding for breast cancer research between 2016 – 2020: are we investing wisely for breast cancer patients? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-09.

The prevalence and pattern of comorbid long-term conditions with low back pain and osteoarthritis in low- and middle-income countries: a systematic review and meta-analysis

ABSTRACT Chronic musculoskeletal (MSK) pain, specifically low back pain (LBP) and osteoarthritis (OA), are a major cause of global disability, reduced quality of life and high socioeconomic burden. Research in high income countries suggests MSK pain is often comorbid with other long-term conditions / non-communicable diseases (NCDs) including diabetes, hypertension, and cardiovascular disease. However, the epidemiology of comorbid NCDs and MSK pain in low- and middle-income countries (LMICs) is unclear. This systematic review aims to describe the prevalence and pattern of comorbid NCDs in adults with MSK pain in LMICs. Nine databases were searched for epidemiological studies in LMICs (World Bank categories). Paired researchers independently identified studies, extracted data, and completed critical appraisal using Hoy risk of bias tool. Random-effect meta-analysis was used to estimate prevalence of NCDs comorbid with MSK pain. From 2112 citations; 14 studies (n=6093 adults with MSK pain, mean age=46.9years) were included. Overall prevalence of MSK pain with comorbid NCDs was 46.1% (95%CI 32.3 - 59.9). Systemic hypertension had the highest comorbid prevalence with MSK pain (42.6%, 95%CI 25.6-59.6), followed by diabetes (26.7%, 95%CI 16.1-37.3) and mental health conditions (anxiety/depression; 24.9% 95%CI 11.5-38.4). A high proportion of patients with MSK pain in LMICs experience comorbid NCDs. Variable data/population samples, and under-reporting limit accurate capture of prevalence estimates. Understanding the true burden of MSK pain (specifically lower back pain and hip/knee osteoarthritis) and comorbid NCDs is critical to informing effective treatment strategies. The health systems implications of these findings are imperative towards person-centred care, organisation of care and efficient resource utilisation in LMICs.

Systematic review of character development in low- and middle-income countries

ABSTRACT Character strengths and development is one of the most important and influential areas of positive psychology. Yet most of this research involves – as per the field generally – research in high income countries, with relatively little awareness of its dynamics in low- and middle-income countries (LMICs). However, there is a burgeoning research base in such countries, but this has hitherto been neither consolidated nor widely disseminated. To remedy this lacuna, this paper reports on a systematic review of the peer-reviewed journal articles on character development in LMICs, analysing 164 articles selected from 1,507 initial abstracts. Our analysis shows that research into character in LMICs is developing rapidly, noting various significant trends with respect to countries, populations, outcomes, and interventions. We also point where further efforts are needed, showing how research on this important topic can continue to prosper in regions that have been relatively neglected in the literature.

Home learning environments and children's language and literacy skills: A meta-analytic review of studies conducted in low- and middle-income countries.

A robust finding from research in high-income countries is that children living in resource-poor homes are vulnerable to difficulties with language and literacy but less is known about this association in low- and middle-income (LMI) countries. We present a meta-analysis of 6,678 correlations from studies in 43 LMI countries. Overall, the results indicate a small but significant association (r = .08) between home language and literacy environment and children's language and literacy skills. After examining a range of moderators, adult literacy practices and books-at-home had a significantly larger association with children's language and literacy skills than did home tutoring. Studies using customized measures demonstrated a more marked association between home attributes and children's outcomes (r = .14) than studies using a common measure across multiple sites (r = .06). Published studies showed significantly larger associations than unpublished studies, and countries with greater income inequality showed a larger association than relatively egalitarian societies. We conclude that the small overall association should not be taken as support for the absence of, or a vanishingly small relationship between the home learning environment and children's language and literacy skills in LMI countries. Rather, an important factor in detecting this relationship is that assessments must better reflect the nature of homes in different cultures to capture true variation in the population. Such contextually situated measurement would lead to an inclusive conceptualization of home learning environments and can better inform intervention programs to enhance children's educational success, a critical target for many LMI countries. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Healthcare workers’ attitudes toward children getting Covid-19 vaccinations in Gaza Strip

Healthcare workers’ attitudes toward children getting Covid-19 vaccinations in Gaza Strip

To adopt or adapt an existing neonatal core outcome set in Kenya: a study protocol

BackgroundDevelopment and use of core outcome set(s) (COS) in research can reduce research wastage by ensuring that a minimum set of outcomes are always reported on. Neonatal morbidity and mortality are a big burden in low- and middle-income countries (LMICs). Research is continuously being undertaken to reduce this burden. Currently, there is no COS for neonatal research in LMICs but there exists one for neonatal research in high-income countries (HICs).ObjectivesTo determine outcomes that are useful for neonatal care in Kenya to inform whether an existing COS should be adopted or adapted. To assess the feasibility of a routine data collection system to collect data of the agreed-on COS.MethodsA review of existing literature on neonatal research in LMICs followed by a qualitative study of key stakeholders in neonatal care. To explore whether to adapt or adopt, in two hospitals, two focus group discussions with 6–8 parents/caregivers will be undertaken (one each in two hospitals). Key informant interviews will also be conducted with 6 health care providers in each of the hospitals. At the policy-making level, we will conduct 10 key informant interviews. Qualitative data will be analyzed thematically. A consensus meeting will be undertaken with key stakeholders, who will be presented with an overview of the COS developed for HICs, key findings from the literature, and the qualitative study to determine context-appropriate COS. The agreed-on outcomes will be counterchecked against the case records in the two hospitals. The feasibility of collecting the outcomes on a routine electronic research database, the Clinical Information Network that collects standardized data at admission and discharge, will be explored. The congruence (or not) of the outcomes will be documented and be used to enrich the discussion and provide a snapshot of the feasibility of the health information system to collect routine data on the COS.ConclusionsA COS for use in neonatal care in Kenya will help enhance outcome measurements and reporting not just in research but also in routine practice. This will enhance the comparability of interventions in trials and routine settings leading to reduced research wastage and likely improved quality of care. Additionally, the methodology used for this work can be adopted in other settings as a means of adopting or adapting an existing COS.

Quantifying quality: The impact of measures of school quality on children's academic achievement across diverse societies.

Recent decades have seen a rapid acceleration in global participation in formal education, due to worldwide initiatives aimed to provide school access to all children. Research in high income countries has shown that school quality indicators have a significant, positive impact on numeracy and literacy-skills required to participate in the increasingly globalized economy. Schools vary enormously in kind, resources, and teacher training around the world, however, and the validity of using diverse school quality measures in populations with diverse educational profiles remains unclear. First, we assessed whether children's numeracy and literacy performance across populations improves with age, as evidence of general school-related learning effects. Next, we examined whether several school quality measures related to classroom experience and composition, and to educational resources, were correlated with one another. Finally, we examined whether they were associated with children's (4-12-year-olds, N=889) numeracy and literacy performance in 10 culturally and geographically diverse populations which vary in historical engagement with formal schooling. Across populations, age was a strong positive predictor of academic achievement. Measures related to classroom experience and composition were correlated with one another, as were measures of access to educational resources and classroom experience and composition. The number of teachers per class and access to writing materials were key predictors of numeracy and literacy, while the number of students per classroom, often linked to academic achievement, was not. We discuss these results in the context of maximising children's learning environments and highlight study limitations to motivate future research. RESEARCH HIGHLIGHTS: We examined the extent to which four measures of school quality were associated with one another, and whether they predicted children's academic achievement in 10 culturally and geographically diverse societies. Across populations, measures related to classroom experience and composition were correlated with one another as were measures of access to educational resources to classroom experience and composition. Age, the number of teachers per class, and access to writing materials were key predictors of academic achievement across populations. Our data have implications for designing efficacious educational initiatives to improve school quality globally.

Use of Intersectionality Theory in Interventional Health Research in High-Income Countries: A Scoping Review.

Intersectionality theory posits that considering a single axis of inequality is limited and that considering (dis)advantage on multiple axes simultaneously is needed. The extent to which intersectionality has been used within interventional health research has not been systematically examined. This scoping review aimed to map out the use of intersectionality. It explores the use of intersectionality when designing and implementing public health interventions, or when analysing the impact of these interventions. We undertook systematic searches of Medline and Scopus from inception through June 2021, with key search terms including "intersectionality", "interventions" and "public health". References were screened and those using intersectionality and primary data from high-income countries were included and relevant data synthesised. After screening 2108 studies, we included 12 studies. Six studies were qualitative and focused on alcohol and substance abuse (two studies), mental health (two studies), general health promotion (one study) and housing interventions (one study). The three quantitative studies examined mental health (two studies) and smoking cessation (one study), while the three mixed-method studies examined mental health (two studies) and sexual exploitation (one study). Intersectionality was used primarily to analyse intervention effects (eight studies), but also for intervention design (three studies), and one study used it for both design and analysis. Ethnicity and gender were the most commonly included axes of inequality (11 studies), followed by socio-economic position (10 studies). Four studies included consideration of LGBTQ+ and only one considered physical disability. Intersectional frameworks were used by studies to formulate specific questions and assess differences in outcomes by intersectional markers of identity. Analytical studies also recommended intersectionality approaches to improve future treatments and to structure interventions to focus on power and structural dynamics. Intersectionality theory is not yet commonly used in interventional health research, in either design or analysis. Conditions such as mental health have more studies using intersectionality, while studies considering LGBTQ+ and physical disability as axes of inequality are particularly sparse. The lack of studies in our review suggests that theoretical and methodological advancements need to be made in order to increase engagement with intersectionality in interventional health.

Who does what? Reproductive responsibilities between heterosexual partners

Managing fertility and sexual and reproductive health across the life course is associated with numerous responsibilities disproportionately experienced by women. This extends beyond dealing with the physical side effects of contraception and can include the emotional burden of planning conception and the financial cost of accessing health services. This scoping review aimed to map how reproductive responsibilities were defined and negotiated (if at all) between heterosexual casual and long-term partners during any reproductive life event. Original research in high-income countries published from 2015 onwards was sourced from Medline (Ovid), CINAHL and Scopus. In studies that focused on pregnancy prevention and abortion decision making, men felt conflict in their desire to be actively engaged while not wanting to impede their partner’s agency and bodily autonomy. Studies identified multiple barriers to engaging in reproductive work including the lack of acceptable male-controlled contraception, poor sexual health knowledge, financial constraints, and the feminisation of family planning services. Traditional gender roles further shaped men’s involvement in both pregnancy prevention and conception work. Despite this, studies reveal nuanced ways of sharing responsibilities – such as companionship during birth and abortion, ensuring contraception is used correctly during intercourse, and sharing the costs of reproductive health care.

Review article: Parenting leaves, workplace characteristics, male health, and the pandemic: Currents in policy-related fatherhood research in higher income countries

Objective: This review article provides an overview on the state of policy-related fatherhood research in high income countries. Background: The review article focuses on four main currents of multi-disciplinary policy-related fatherhood research. The first considers the research on national level parenting leaves. The second explores research on organisation and workplace policies. The third presents research on policies around male health and fatherhood practices. The fourth looks at the impact of COVID-19 related policies on fathers. Method: This is a review article and so presents a review of the literature. It is not a systematic literature review but rather aims to show the benefit of multi-disciplinary conversation within fatherhood research. Results: Commonalities are found across the four policy-related areas in terms of key questions, but also in terms of research gaps. Conclusion: There is consensus around what works for engaging fathers across policy contexts. There is perhaps a paradox in that 'de-gendered' policies are usually most effective, but that fathers need to recognise that these degendered policies are for them.

DESIGNING INTERVENTIONS FOR OLDER ADULTS WITH LOW- AND MIDDLE-INCOME COUNTRIES SETTINGS IN MIND

Abstract Most people living with dementia (PLWD) live in low- and middle-income countries (LMIC) and the proportion in LMICs is poised to continue growing. But 99.9% of dementia funding is awarded to researchers in high-income countries (HIC). Our team of scientists from India, Cameroon, the Philippines, the USA, Ukraine, and Germany draw on our involvement in interventions in 12 countries to suggest one way to help meet the needs of PLWD living in LMICs. We suggest that researchers in HICs who are developing new interventions might consider the needs of LMICs during intervention development. By thinking through implementation scenarios in different settings or countries where barriers and facilitators to implementation vary in type, or in importance, it might speed future adaptation of those interventions to LMICs. We outline anticipated challenges, case studies from our own work, benefits for individual researchers, benefits for public health, and recommendations for employing this strategy.

Use of intersectionality theories in interventional health research in high-income countries: a systematic scoping review

BackgroundIntersectionality theory suggests that multiple forms of inequality need to be considered simultaneously. The extent to which intersectionality has been used within interventional health research has not been systematically examined. This scoping review explores the use of intersectionality when designing and implementing interventions to reduce health inequalities, or when analysing the impact of these interventions. MethodsWe did a systematic search of MEDLINE and Scopus for articles published from inception up to June 30, 2021, with the key search terms “intersectionality”, “interventions”, and “public health”. References were screened and those including use of intersectionality and primary data from high-income countries were included and relevant data synthesised. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines extension for scoping reviews. Findings2108 studies were screened, of which 12 met inclusion criteria Six (50%) of the 12 studies were qualitative and focused on alcohol and substance abuse (two studies), mental health (two studies), general health promotion (one study), and housing interventions (one study). The three quantitative studies (25%) examined mental health (two studies) and smoking cessation (one study), whereas the three mixed-methods studies (25%) examined mental health (two studies) and sexual exploitation (one study). Nine studies (75%) used intersectionality to analyse intervention effects, two studies (25%) used intersectionality for intervention design, and one study (8%) used intersectionality for both design and analysis of an intervention. Ethnicity and gender were the most commonly included axes of inequality (11 studies [92%]), followed by socioeconomic status (ten studies [83%]). Only four studies (33%) included consideration of LGBTQ+ individuals and only one (8%) considered physical disabilities. InterpretationIntersectionality theories are not yet commonly used in either the design or the evaluation of interventional health research, and evidence on the implementation of some key elements of intersectionality is still scarce. Studies on some conditions, such as mental health, have more often used intersectionality, whereas studies considering the LGBTQ+ community and individuals with physical disabilities as axes of inequality are particularly scarce. FundingNational Institute for Health and Care Research School for Public Health Research.

Smoking-related psychosocial beliefs and justifications among smokers in India: Findings from Tobacco Control Policy (TCP) India Surveys

BackgroundPrevious research in high-income countries (HICs) has shown that smokers reduce their cognitive dissonance through two types of justifications over time: risk minimizing and functional beliefs. To date, however, the relationship between these justifications and smoking behaviors over time has limited evidence from low- and middle-income countries. This study examines these of justifications and their relation to quitting behavior and intentions among smoking tobacco users in India.MethodsThe data are from the Tobacco Control Policy (TCP) India Survey, a prospective cohort of nationally representative sample of tobacco users. The respondents include smoked tobacco (cigarettes and bidi) users (n = 1112) who participated in both Wave 1 (W1; 2010–2011) and Wave 2 (W2; 2012–2013) surveys. Key measures include questions about psychosocial beliefs such as functional beliefs (e.g., smoking calms you down when you are stressed or upset) and risk-minimizing beliefs (e.g., the medical evidence that smoking is harmful is exaggerated) and quitting behavior and intentions at Wave 2.FindingsOf the 1112 smokers at W1, 78 (7.0%) had quit and 86 (7.8%) had intentions to quit at W2. Compared to W1, there was a significant increase in functional beliefs at W2 among smokers who transitioned to mixed use (using both smoking and smokeless tobacco) and a significant decrease among those who quit. At W2, smokers who quit held significantly lower levels of functional beliefs, than continuing smokers, and mixed users ((M = 2.96, 3.30, and 3.93, respectively, p < .05). In contrast, risk-minimizing beliefs did not change significantly between the two waves. Additionally, higher income and lower functional beliefs were significant predictors of quitting behavior at W2.ConclusionThese results suggest that smokers in India exhibit similar patterns of dissonance reduction as reported in studies from HICs: smokers who quit reduced their smoking justifications in the form of functional beliefs, not risk-minimizing beliefs. Smokers’ beliefs change in concordance with their smoking behavior and functional beliefs tend to play a significant role as compared to risk-minimizing beliefs. Tobacco control messaging and interventions can be framed to target these functional beliefs to facilitate quitting.

Active Transportation, the Ultimate Low Carbon Way to Travel—A Review of International Research and Education

Active transport1 is a relatively new term but one that has been gaining support over the past decade as an alternative to “non-motorized transport” (NMT). Walking and cycling are the main transport modes within the active transport cluster. This paper summarizes the current state of international research and knowledge on active transport in urban and peri-urban areas in high-, middle- and low-income countries. It also explores current research gaps and potential “future looking” research areas. The information was collected in early 2020 and is based on a rapid literature review, a 15-question Internet survey, semi-structured interviews, and a peer-review process with key actors and experts in active transport. Respondents were professionally active in a broad range of areas directly or indirectly connected to the topic. A total of 112 cleaned responses2 were obtained from high, middle- and low-income countries. The main findings show that there is a high level of scholarship in the subject, with a greater breadth of research in high income countries. There has been an increase in research attention since 1990. Both are widely covered by work on road safety aspects. A key difference can be seen between cycling and walking and their positioning as transport modes. More papers on cycling are published in transport-related journals, while walking is better covered in health-related journals. Based on the identified research gaps found in this review, suggestions are put forward for further possible research areas of interest on active transport in the post COVID recovery.

Simultaneously Developing Interventions for Low-/Middle-Income and High-Income Settings: Considerations and Opportunities.

Most older adults reside in low- and middle-income countries (LMICs) but most research dollars spent on interventions to improve the lives of older adults are awarded to researchers in high-income countries (HICs). One approach to improve the implementation of evidence-based innovations for older adults in LMICs is designing interventions that are relevant to LMICs and HICs simultaneously. We propose that researchers in HICs could partner with stakeholders in an LMIC throughout the intervention design process to better position their intervention for the implementation in that LMIC. We provide an example study from an adaptation of the Resources for Enhancing Caregiver Health II in Vietnam, which did not use this strategy but may have benefited from this strategy. We then turn to several considerations that are important for researchers to contemplate when incorporating this strategy. Finally, we explore incentives for creating interventions that are relevant to both HICs and LMICs for funders, intervention designers, and intervention receivers. Although this is not the only strategy to bring interventions to LMICs, it may represent another tool in researchers' toolboxes to help expedite the implementation of efficacious interventions in LMICs.

The formation of youth entrepreneurial intention in an emerging economy: the interaction between psychological traits and socioeconomic factors

PurposeYouth entrepreneurship has been identified as a key driver in overcoming the economic crisis spurred by youth unemployment. However, the understanding of youth entrepreneurship is largely based on research in high-income countries. Furthermore, entrepreneurship studies to date are largely limited to the independent effects of individual traits on entrepreneurial intention (EI). Hence, this study aims to model the cognitive and social conditions, mediating processes and interactions to understand how youth EI can be formed and strengthened in an emerging economy.Design/methodology/approachA cross-sectional sample of 295 Malaysian youths participating in an online entrepreneurship program were included to assess their family socioeconomic background, individual personality traits and EI using regression, mediation and moderation models. Within the sample, 29 youths who completed the program were examined for pre- and post-training intervention differences to identify whether entrepreneurial traits can be developed.FindingsResults showed that a proactive personality or proactiveness was a key mediator in how an internal locus of control (ILOC) and self-esteem influence EI. Furthermore, ILOC and proactiveness were found to compensate for the lack of parental financial support in the formation of EI among low-income youth. Finally, there was a significant increase in proactive personality scores post-intervention, indicating that this trait can be strengthened through entrepreneurship programs.Research limitations/implicationsThis study focused on parental income as an indicator of family socioeconomic background, which may not accurately represent the diversity of the socio-ecological environment of an individual. Therefore, future research should assess the multi-dimensional indicators of socioeconomic status and their relations with psychological attributes in shaping EI. Furthermore, this study observed a small sample size for the pre- and post-intervention analysis. Hence, more studies with large sample sizes are needed to examine the impact of entrepreneurship education.Practical implicationsConsidering that entrepreneurship is envisioned as an instrument to lift youths out of poverty, this study has important implications for entrepreneurship programs that target low-income youths. The findings suggest that such programs need to first emphasize developing ILOC and proactiveness among these youths, thus enabling them to overcome various structural barriers toward entrepreneurship, as opposed to a purely knowledge-based learning approach.Social implicationsTo effectively lift youths out of poverty through entrepreneurship, policymakers and educational institutions need to first recognize that the EI of youth from varying socioeconomic backgrounds are formed differently. Hence, the approach of entrepreneurship programs catered toward youth from lower socioeconomic backgrounds will differ from programs catered to youths who are financially secure. Instead of a one-size-fits-all approach, entrepreneurship programs targeted at low-income youths must first emphasize building their mindsets of ILOC and proactivity to overcome financial challenges as opposed to focusing solely on building entrepreneurial skills and knowledge.Originality/valueThe findings offer a more holistic and nuanced view of the contingencies where the efforts of policymakers, educational institutions and practitioners are more likely to succeed in stimulating EI among youths in emerging economies. In addition, the study also bridges the gap between the theoretical understanding of EI and the practical implications of developing effective entrepreneurship programs by combining the cross-sectional analysis and pre- and post-intervention test in the same study. Importantly, the study highlighted the importance of considering youth’s socioeconomic background in the design and implementation of entrepreneurship programs.

Use of RWE to Inform Regulatory, Public Health Policy, and Intervention Priorities for the Developing World.

For low‐ and middle‐income countries (LMICs) to benefit from real‐world evidence (RWE)/real‐world data (RWD) in both product registration (“regulatory”) decision making and in product utilization policy (“policy”) decision making, they need to overcome several challenges. They need to deploy more electronic health records systems (EHRs), adjust for confounder variables, build trust between stakeholders, and create laws and regulations for local generation of data that are assented for secondary use. The role of procurers and their use of RWE/RWD in the LMIC context likewise is in a state of ongoing development. Procurers of health products are strong players currently in the “access” chain as LMICs continue to work on strengthening governmental health technology assessment (HTA) bodies. Procurers’ use of RWE is presently at an early stage and is mostly indirect, leveraging RWE results that are produced by researchers in high‐income countries (HICs), often under considerably different regulatory and policy objectives and constraints compared to LMICs’ epidemiology and priorities. Pending wider deployment of EHRs and other RWE sources, stakeholders must realize that populations from HIC RWE (i) can be devised to closely resemble phenotypic patterns in LMIC populations and (ii) can be analyzed to align with LMICs’ unmet needs.

A scoping review on the measurement of transnationalism in migrant health research in high-income countries

BackgroundMigrants commonly maintain transnational ties as they relocate and settle in a new country. There is a growing body of research examining transnationalism and health. We sought to identify how transnationalism has been defined and operationalized in migrant health research in high income countries and to document which populations and health and well-being outcomes have been studied in relation to this concept.MethodsWe conducted a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI). We searched nine electronic databases; no time restrictions were applied. Studies published in English or French in peer-reviewed journals were considered. Studies were eligible if they included a measure of transnationalism (or one of its dimensions; social, cultural, economic, political and identity ties and/or healthcare use) and examined health or well-being.ResultsForty-seven studies, mainly cross-sectional designs (81%), were included; almost half were conducted in the United States. The majority studied immigrants, broadly defined; 23% included refugees and/or asylum-seekers while 36% included undocumented migrants. Definitions of transnationalism varied according to the focus of the study and just over half provided explicit definitions. Most often, transnationalism was defined in terms of social connections to the home country. Studies and measures mainly focused on contacts and visits with family and remittance sending, and only about one third of studies examined and measured more than two dimensions of transnationalism. The operationalization of transnationalism was not consistent and reliability and validity data, and details on language translation, were limited. Almost half of the studies examined mental health outcomes, such as emotional well-being, or symptoms of depression. Other commonly studied outcomes included self-rated health, life satisfaction and perceived discrimination.ConclusionTo enhance comparability in this field, researchers should provide a clear, explicit definition of transnationalism based on the scope of their study, and for its measurement, they should draw from validated items/questions and be consistent in its operationalization across studies. To enhance the quality of findings, more complex approaches for operationalizing transnationalism (e.g., latent variable modelling) and longitudinal designs should be used. Further research examining a range of transnationalism dimensions and health and well-being outcomes, and with a diversity of migrant populations, is also warranted.

Physical Activity Levels of Adolescents and Adults With Cerebral Palsy in Urban South Africa.

Background: Research in high income countries shows that people with cerebral palsy (CP) are less physically active than typically developing (TD) peers, but less is known regarding physical activity (PA) in those with CP in low-to-middle income countries. The aim of this study was to determine daily step count and levels of PA in adolescents and adults with CP living in urban South Africa, compared to TD peers, and to determine associations with sex, Gross Motor Function Classification System (GMFCS) level, body mass index and socio-economic status.Materials and Methods: This case–control study included 26 adolescents and 22 adults with CP (GMFCS Level I-V) and matched TD peers (25 and 30, respectively). Participants wore an ActiGraph GT3X for 7 consecutive days to determine step count and time (minutes per hour) spent in PA levels, including sedentary (SED), low physical activity (LPA) and moderate to vigorous physical activity (MVPA).Results: The daily step count and PA levels for ambulant adolescents with CP (GMFCS level I-III) were similar to TD peers, while this was less for adolescents classified in GMFCS level IV-V. Daily step count, SED and MVPA were similar for adults classified in GMFCS level I-II compared to TD adults, while all parameters were lower for adults using assistive devices (GMFCS level III) and non-ambulant adults (GMFCS level IV-V) compared to TD peers. Daily step count and PA levels were inversely associated with GMFCS, while no other associations were found.Conclusion: People with CP who were more mobile dependent (higher GMFCS level) were less active. However, adolescents and adults with CP classified as GMFCS levels I-II living in urban South Africa recorded similar step count and PA levels as their TD peers. This was also the case for adolescents using assistive devices, though not for those in the adult group (GMFCS level III). Furthermore, it was apparent that even the ambulant individuals with CP and TD cohorts were relatively inactive. Intervention programs for CP and TD adolescents should be aimed at finding strategies to keep adolescents physically active well into adulthood, in order to promote physical health, social and emotional well-being and independence.

Family socioeconomic status and child telomere length among the Samburu of Kenya

Previous research in high-income countries suggests that children from families with lower socioeconomic status (SES) tend to have shorter telomere length – a biomarker of stress and cell aging – than children from families with greater social and economic resources. However, little is known about predictors of child telomere length in low-income settings. Data for the current study are from a sample of 214 Samburu children aged 1–9 years. The Samburu are semi-nomadic pastoralists who live in the Rift Valley of north-central Kenya. Samburu livelihood is based primarily on livestock, and polygynous marriage is common. Drawing on prior ethnographic research, we measured 14 culturally relevant indicators of family SES, including mother's education, head of household's education, whether the child is currently attending school, household spending, mother's employment history, head of household's employment history, mother's perceived wealth, whether the child lives in a modern house, livestock holdings (total, cows, sheep/goats, and camels), mother's wife number, and whether the child lives in a polygynous household. Telomere length was measured in salivary DNA by the quantitative polymerase chain reaction (qPCR) method. Using latent class analysis, we identified four groups of children that are similar based on the 14 indicators of family SES: Lower SES; Middle SES, Traditional; Middle SES, Modern; and Higher SES. SES classes were not significantly associated with child telomere length. In models examining individual indicators of SES, we found that telomere length was 0.57 standard deviations greater for children who lived in families in the lowest quartile of total livestock holdings compared to those in the highest quartile (b = 0.57, p = 0.03). While additional research is needed to identify the mechanisms underlying this counterintuitive finding, the current study highlights the importance of cultural context in shaping the social gradient in health.