World Bank Regions Research Articles

Global Representation in Phase 2 and Phase 3 Clinical Trials for Tyrosine Kinase Inhibitors in the Treatment of Chronic Myeloid Leukemia

Objectives Since the introduction of tyrosine kinase inhibitors (TKIs), chronic myeloid leukemia (CML) has evolved from a devastating disease to manageable due to the availability of oral medications. Recent reports indicate an improvement in life expectancy attributed to TKIs. Our objective is to investigate participation in clinical trials from a global perspective to identify regions lacking representation in these pivotal trials. In addition, we inquire into TKI drug approvals and a country's socio-demographic index (SDI). Methods A search was conducted on ClinicalTrials.gov (CT.gov) using the key words "Chronic Myeloid Leukemia". Additional filters were applied to only include phase 2 and phase 3 trials. This query yielded 702 trials, of which 212 had results posted. Fifty-two of these trials used TKIs to treat CML. Trials reporting single-country participation (9; primarily in China, Japan, US, and Turkey) and early termination (13) were excluded. Information on the participating sites for the 30 eligible trials were extracted from CT.gov. CML incidence and disability-adjusted life years (DALYs) from 1999 to 2019 were collected per World Bank regions and individual countries from the Institute of Health Metrics and Evaluation (IHME) database then categorized by SDI. The difference in DALYs over the 10-year period and locations that participated in clinical trials were mapped. Z-statistics were used to assess the difference in proportions of regional DALYs in relation to the proportion of locations that participated in the trials. Global drug approvals for imatinib, nilotinib, bosutinib, ponatinib, and asciminib were collected from their respective pharmaceutical company. Dasatinib data is pending. Results The 30 trials represented 4 imatinib, 11 dasatinib, 8 nilotinib, 3 bosutinib, 3 ponatinib, and 1 asciminib trials. There were 755 locations with investigational sites that participated in these trials. Sub-Saharan African (SSA) had only 11 participating locations (1.5%, all in South Africa). Latin America and Caribbean (LAC) had 46 (6.1%) locations distributed across 10 countries. South Asian (SA) countries were represented by 13 (1.7%) locations, all within India. Europe and Central Asia (ECA) had the 344 locations (45.6%) across 30 countries. The Middle East and North Africa (MENA) had 19 (2.5%) locations in eight countries, while East Asia and Pacific (EAP) had 121 (16.0%) locations with participating sites. In North America (NA, including US and Canada), 201 (26.6%) locations had sites that participated in the trials. Africa, the Middle East, and Latin America had significantly lower representation in the clinical trials than Europe, Asia, or the US and Canada. CML incidence rates reported by IHME from highest to lowest per 100,000 cases were ECA: 3.01, NA: 1.7, SA: 0.62, MENA: 0.57, EAP: 0.45, SSA: 0.43, and LAC: 0.35. DALYs, from highest to lowest were SA: 4.16x105, SSA: 2.10x105, EAP: 1.25x105, ECA: 1.22x105, MENA: 7.58x104, LAC: 6.27x104, and NA: 3.66x104. Calculated Z-scores were SA -56.13 (p<.001), SSA -43.74 (p<.001), EAP 10.24 (<.001), ECA 1.91 (p=.003), MENA -30.93 (p<.001), LAC 2.93 (p= .003), and NA 2.01 (p=.044) Despite ECA and NA having the highest incidence of CML, countries in SA and SSA had significantly more DALYs and the least regional representation in trials (Figure 1). NA and ECA had more locations with investigational sites. Table 1 shows DALYs and incidence overtime for these regions. Of the TKIs collected for drug approvals, there are 142 approvals in 40 High SDI countries, 90 approvals in 30 High-Middle SDI countries, 68 in 31 Middle SDI countries, 21 in Low-Middle SDI countries, and 14 approvals in 9 Low SDI countries. None of the Low-Middle and Low countries yielded >2 approvals. Conclusion The availability of global representative trials is important, especially in regions with underserved populations and greater disease burden. SA, SSA, and MENA had significantly lower representation in 30 trials that investigated TKIs in CML, while experiencing greater burden in DALYs compared to other regions. In addition, findings show that lower SDI countries had fewer approvals for TKIs leading to further disparities. This reveals a disparity that is important to address. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Advanced Nursing Practice and Advanced Practice Nursing roles within low and lower-middle-income countries.

Population health initiatives rely on the availability and skills of an appropriate workforce to meet required goals. One global workforce initiative with demonstrated ability to expand health care services and improve access to care is the development of Advanced Nursing Practice and Advanced Practice Nursing roles. Given the sparse published information about these roles in Low and Lower-Middle-Income countries, this study seeks to describe their development and application in these countries. The researchers developed a descriptive cross-sectional multilingual survey for online distribution to nursing experts within the targeted countries. Survey questions addressed demographic information on the population served, Advanced Nursing Practice and Advanced Practice Nursing titles, the time frame and rationale for creating the title, and how the roles relate to the International Council of Nurses' Advanced Practice Nursing guidelines characteristics of education, practice, and regulation. Of the 167 responses received, only 24 participants met the inclusion criteria. This represented five low-income countries and nineteen lower-middle-income countries from four World Bank regions. Seventy-one roles were identified. Roles emerged predominantly over the last 20 years, focusing on care for underserved populations, with an almost even spread across primary and acute care settings. There were differences in education, practice, and regulation amongst the roles. Roles that required a master's education or higher with practice-related characteristics had a broader scope of practice, which is consistent with international guidelines. This paper describes how Advanced Nursing Practice and Advanced Practice Nursing roles from Low and Lower Middle-Income Countries have been implemented to address gaps in service and highlights disparities in education, practice and regulation compared to international guidelines. Maintaining and increasing support from organizations and universities internationally may be required to assist in developing and expanding educational programs for advanced nursing roles in these countries. Understanding how these advanced nursing roles are operationalized in relation to education, practice, and regulation in Low and Lower-Middle-Income countries can provide baseline information that will inform workforce development policies to address healthcare needs in similar jurisdictions.

RF12 | PSUN117 Sex-Specific Obesity and Cardiometabolic Disease Risks In Low- and Middle-Income Countries: A Meta-Analysis Involving 2,624,289 Individuals

Abstract Background Obesity is a leading cause of preventable deaths from cardiometabolic diseases worldwide. About two-thirds of all individuals with obesity live in low- and middle-income countries (LMICs), facing an epidemiological transition from predominantly infectious to non-communicable diseases burden. The magnitude of sex-related disparities in the risk of obesity and cardiometabolic diseases in LMICs, and if these vary by region, country's income status, setting, and time is unclear. We undertook a systematic review and meta-analysis to assess the magnitude of sex-specific disparities in the prevalence of obesity and cardiometabolic diseases in LMICs, their burden on women, and variations by region, country's income status, setting, and time. Methods We searched MEDLINE and EMBASE (from inception to September 2021). Two independent reviewers selected the studies, assessed their quality, and performed data extraction. We used a random-effects model to obtain pooled estimates of odds ratios and 95% confidence interval (95%CI) for the association between sex and obesity and cardiometabolic diseases and rates of relevant outcomes. Results We included 287 studies (2,624,289 individuals). The risk of obesity was 2.72-fold (OR 2.72, 95% CI 2.54-2.91) higher in women than men, independent of age. The sex-specific disparities varied by World Bank region, with the greatest difference in Sub-Saharan Africa (OR 3.70, 95% CI 2.25-6.08), but it did not vary by the country's income status, setting, or overtime. There were no differences between the sexes in the type 2 diabetes or hypertension rates. Amongst women in LMICs, 22% (95% CI 0.20-0.24) had obesity, 27% (95% CI 0.24-0.30) hypertension, and 7% (95% CI 0.06-0.09) type 2 diabetes. The rates of obesity, hypertension and type 2 diabetes in women varied by region and country's income status, with the highest rates in the Middle East and North-Africa, and in upper-middle-income countries; obesity and type 2 diabetes rates were highest in urban settings. The odds of hypertension (OR 2.43, 95% CI 2.9-2.80) and type 2 diabetes (OR 2.84, 95% CI 2.16-3·74) were doubled in women with vs without obesity. Conclusions Women are disproportionately affected by obesity compared to men in LMICs, with the greatest disparity observed in the Sub-Saharan region. Obesity rates were consistently higher in women than men irrespective of the country's income status (low, low-middle, upper-middle), setting (rural, urban) or overtime. Amongst women, obesity and cardiometabolic diseases prevalence vary by World Bank region and country's income status. Obesity doubles the risk of hypertension and type 2 diabetes in women in LMICs. Our findings call for urgent sex-specific and region-stratified actions targeting obesity awareness, prevention, treatment, and control in women in LMICs. Implementing cost-effective and sustainable programmes specific to women and addressing obesity's burden should be an urgent public health priority in LMICs. Presentation: Saturday, June 11, 2022 1:12 p.m. - 1:17 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

The global, regional and national epidemiology, incidence, mortality, and burden of ovarian cancer.

Ovarian cancer has the highest mortality rate among gynecological malignancies and is associated with poor prognosis. Since the accurate assessment of the global burden along with the trend of cancers contributes to the development of policies, this study aimed to explain the incidence, mortality, and burden of ovarian cancer using the global burden of disease (GBD) 2019 study. Epidemiological data have been collected from the study of the GBD 2019. Data were extracted globally for 204 countries and groups based on a socio-demographic index (SDI), WHO regions, continents, World Bank regions, and 22 GBD regions. In 2019, a total of 294,422 new cases of ovarian cancer were reported. The highest age-standardized incidence rate (ASIR) was reported in areas with higher SDI, World high-income countries, continental Europe, and then America. In GBD regions, the highest age-standardized incidence is in Central Europe. In 2019, a total of 198,412 deaths due to ovarian cancer were reported. The highest ASR death is related to countries with high SDI and the World Bank high-income countries. In 2019, adjusted years of life with disabilities (DALYs) due to ovarian cancer were reported to be 5,359,737, of which 5,205,660 were related to lost years of life (YLLs), and 154,077 were related to years of life with disabilities (YLDs). In 2019, the highest age-standardized incidence of ovarian cancer, ASR death, and DALYs ASR belong to the high SDI countries. Designing interventions based on risk factors as well as providing preventive approaches to reduce the risk of this cancer, improving the treatment of ovarian cancer, and using appropriate and invasive treatments are recommended.

Identifying priority challenges and solutions for COVID-19 vaccine delivery in low- and middle-income countries: A modified Delphi study.

The rapid implementation of global COVID-19 vaccination programs has surfaced many challenges and inequities, particularly in low- and middle-income countries (LMICs). However, there continues to be a lack of consensus on which challenges are global priorities for action, and how to best respond to them. This study uses consensus-based methods to identify and rank the most important challenges and solutions for implementation of COVID-19 vaccination programs in LMICs. We conducted a three-round modified Delphi study with a global panel of vaccine delivery experts. In Round I, panelists identified broad topical challenges and solutions. Responses were collated and coded into distinct items. Through two further rounds of structured, iterative surveys panelists reviewed and ranked the identified items. Responses were analyzed qualitatively and quantitatively to achieve consensus on the most important COVID-19 vaccine delivery challenges and solutions. Of the 426 invited panelists, 96 completed Round I, 56 completed Round II, and 39 completed Round III. Across all three rounds there was equal representation by gender, and panelists reported work experience in all World Bank regions and across a variety of content areas and organizations. Of the 64 initially identified items, the panel achieved consensus on three challenges and 10 solutions. Challenges fell under themes of structural factors and infrastructure and human and material resources, while solutions also included items within themes of communication, community engagement, and access and planning, processes, and operations. COVID-19 vaccine delivery is challenged by long-standing and structural inequities that disadvantage health service delivery in LMICs. These findings can, and should, be used by global health organizations to efficiently and optimally direct resources to respond to these key challenges and solutions.

Authorship Distribution and Under-Representation of Sub-Saharan African Authors in Global Oncology Publications.

PURPOSELocal researchers must be engaged in research conducted in their populations. However, local authors from low- and middle-income countries are often under-represented in global health journals. This report aims to assess and describe the representation of authors in the Journal of Clinical Oncology Global Oncology (JCO GO).METHODSThis retrospective cross-sectional study describes data from JCO GO articles published between October 2015 and March 2020. Data were collected on studied countries, authorship position, classified as first, middle, or last, and country of authors' institutional affiliations. Countries were then categorized on the basis of their World Bank region and income classifications. We describe aggregate authorship distribution and distribution by region and income classification. Additionally, we explore the relationships between author's country and studied country.RESULTSOf the 608 articles identified, 420 (69.1%) studied a single country population. Although articles represented studies from all World Bank regions, the sub-Saharan Africa (SSA) region accounted for the highest number (n = 145; 34.5%). In all other regions except SSA, most of the first (66.7%-100%) and last authors (56.6%-95.2%) had primary institutional affiliations based in the same region as the studied country. However, among articles about SSA countries, SSA first authors (n = 65; 44.8%) and last authors (n = 59; 40.7%) were under-represented. In fact, there were more North American first (n = 74; 51.0%) and last authors (n = 72; 49.6%) than SSA authors. There was higher SSA representation among middle authors (n = 97; 68.8%) in studies from the region. A similar trend was also noted with the under-representation of authors from low-income compared with high-income countries.CONCLUSIONSSA authors are under-represented in global oncology articles. Concerted strategies are needed to build local capacity, promote meaningful engagement, and foster equity.

Delphi Method Consensus on Priority Global Otolaryngology-Head and Neck Surgery Conditions and Procedures.

The objective of this study was to develop an international expert consensus on priority otolaryngology-head and neck surgery conditions and procedures globally for which national health systems should be capable of caring. The Delphi method was employed via a multiround online survey administered to attending otolaryngologists in an international research collaborative of >180 otolaryngologists in >40 countries. International online survey. In round 1, participants listed the top 15 otolaryngologic conditions and top 15 otolaryngology procedures for their World Bank regions. In round 2, participants ranked round 1 responses in order of global importance on a 5-point Likert scale. In round 3, participants reranked conditions and procedures that did not achieve consensus, defined as 50% of the round 2 Likert responses being ranked as "important" or "very important." Descriptive statistics were calculated for each round. The survey was distributed to 53 experts globally, with a response rate of 38% (n = 20). Fifty percent (n = 10) of participants were from low- and middle-income countries, with at least 1 participant from each World Bank region. Ten consensus surgical procedures and 10 consensus conditions were identified. This study identified a list of priority otolaryngology-head and neck surgery conditions and surgical procedures for which all national health systems around the world should be capable of managing. Acute and infectious conditions with preventative and emergent procedures were highlighted. These findings can direct future research and guide international collaborations.

Measuring and comparing World Bank regions’ ‘ease of doing business’ opportunity sets

Measuring and comparing World Bank regions’ ‘ease of doing business’ opportunity sets

197 Emergency Medicine Development Around the World: An Analysis of 2019 American College of Emergency Physicians International Ambassador Country Reports

Emergency medicine (EM) is in different stages of development around the world, with many countries not yet formally recognizing the specialty. The American College of Emergency Physicians (ACEP) International Ambassador Program is composed of emergency physicians who represent ACEP and connect with local EM societies and EM pioneers, practitioners, and educators in 78 countries to promote emergency medicine development. Our objective was to describe the current state of EM around the world by analyzing 63 Country Report survey responses submitted by the ACEP Ambassadors in 2019. The 2019 Country Report survey was developed by ACEP Ambassador Program leadership with input from the ACEP Ambassadors. The survey consisted of 40 questions about EM as a specialty, the history of EM, EM residencies, out-of-hospital care, EM academic activities, and challenges and opportunities for growth in EM. ACEP Ambassadors answered questions based on their experience working in their respective countries with assistance from local partners. Maps of the world were created to display categorical variables. Qualitative data was analyzed for themes. Percentages were calculated and variables were categorized by World Bank regions and income categories. Chi-square was used to look for association between country income and recognition of EM as a specialty. The populations of the 63 countries in this study totaled 5.19 billion or about 67% of the world’s population. The sample included countries in each of the World Health Organization Regions. Of the countries represented, 7.9% are low income, 24% lower middle income, 33.3% upper middle income and 35% high income. Country income was not associated with recognition of EM as a specialty (p = 0.29). The number of residency-trained emergency physicians per 100,000 people was >5 in 6 countries (9.5%), 2 to 5 in 12 countries (19%), and <2 in 37 countries (59%). Nine countries (14.5%) do not recognize EM as a specialty (3 high, 1 high middle and 5 low middle-income). Six countries (9.5%) do not have a out-of-hospital system. Eleven countries (17.5%) do not have an emergency phone number (eg, 911). A majority of countries had fewer than 10 EM residency programs (55%), and 16% had none. Thirty countries (48%) have EM board exams. Eighteen countries (29%) have an EM-specific peer-reviewed journal. Common challenges reported in EM development included: lack of resources and/or funding (53%), lack of EM recognition or resistance to the specialty (47%), the need for more educational and faculty organization (29%), and physician shortages (23% ). Within the constraints of a survey study, the ACEP Ambassador Country Report survey provides unique information about the state of EM development around the world. Most countries in the sample have recognized EM or have EM residencies. However, EM is still in the early stages of development in many countries, with few emergency physicians per 100,000 population and few having board exams or EM peer-reviewed journals. Future research can track the growth of EM over time and help promote collaborations across countries.

1386Ethnic differences in lifestyle interventions for diabetes prevention: a systematic review and meta-analysis

Abstract Background The risk of type 2 diabetes varies by ethnicity, but ethnic differences in response to lifestyle interventions for diabetes prevention remain unclear. This systematic review and meta-analysis aimed to assess differences in the effects of lifestyle interventions on diabetes incidence, glycemic outcomes and anthropometric measures between ethnic groups. Methods MEDLINE, EMBASE, Pubmed, CINAHL, PsycInfo and EBM Reviews were searched (to June 2020) with no language restriction for randomized and non-randomized controlled trials on lifestyle interventions involving diet and/or physical activity in adults at risk of type 2 diabetes. Ethnicity was categorized into European, South Asian, Other Asian, Middle Eastern, Latin American and African groups based on the World Bank regions. Risk ratios for diabetes incidence and mean differences for glycemic outcomes (fasting glucose, 2-h glucose, HbA1c) and anthropometric measures (weight, BMI, waist circumference) were pooled using random-effects meta-analysis. Results Sixty articles representing 43 studies (18,691 participants) were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in diabetes incidence, glycemic outcomes and anthropometric measures compared with controls (all P&amp;lt;0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI and waist circumference (all P&amp;lt;0.05) but not for diabetes incidence, fasting glucose and HbA1c (all P&amp;gt;0.05). Conclusions Lifestyle interventions are similarly effective in reducing diabetes incidence, fasting glucose and HbA1c for all ethnic groups, however, 2-h glucose and anthropometric outcomes should be optimized in certain ethnic groups. Key messages Lifestyle intervention is likely effective in preventing the progression to type 2 diabetes equally across all ethnic groups.

TB risk by time since U.S. entry among non-U.S.-born residents of Washington State, USA.

BACKGROUND: Progress towards TB elimination in the United States will require improved detection and treatment of latent TB infection among non-U.S.-born residents who remain at disproportionate risk of TB disease. To inform targeted testing efforts, we evaluated risk of TB disease among non-U.S.-born residents of Washington State, USA, by region of origin and time from U.S. entry.METHODS: We conducted a retrospective cohort study among non-U.S.-born residents diagnosed with TB disease in Washington State from 2005 to 2014, for which country-specific population estimates were also available. The risk of TB disease among non-U.S.-born residents was estimated by time since U.S. entry, World Bank region of origin, and WHO TB incidence category.RESULTS: Risk of TB disease for non-U.S.-born residents was highest within the first year after U.S. entry. Among persons from countries with high TB incidence who had resided in the United States for more than 20 years, risk for TB remained elevated.CONCLUSION: Elevated risk of developing TB disease among individuals not born in the United States persisted long after U.S. entry, particularly among persons originating from certain regions and from high-burden countries. These findings contribute to evidence supporting a refinement of existing screening guidelines.

Global trends in medical education accreditation

BackgroundAccreditation systems in medical education aim to assure various stakeholders that graduates are ready to further their training or begin practice. The purpose of this paper is to explore the current state of medical education accreditation around the world and describe the incidence and variability of these accreditation agencies worldwide. This paper explores trends in agency age, organization, and scope according to both World Bank region and income group.MethodsTo find information on accreditation agencies, we searched multiple online accreditation and quality assurance databases as well as the University of Michigan Online Library and the Google search engine. All included agencies were recorded on a spreadsheet along with date of formation or first accreditation activity, name changes, scope, level of government independence, accessibility and type of accreditation standards, and status of WFME recognition. Comparisons by country region and income classification were made based on the World Bank’s lists for fiscal year 2021.ResultsAs of August 2020, there were 3,323 operating medical schools located in 186 countries or territories listed in the World Directory of Medical Schools. Ninety-two (49%) of these countries currently have access to undergraduate accreditation that uses medical-specific standards. Sixty-four percent (n = 38) of high-income countries have medical-specific accreditation available to their medical schools, compared to only 20% (n = 6) of low-income countries. The majority of World Bank regions experienced the greatest increase in medical education accreditation agency establishment since the year 2000.ConclusionsMost smaller countries in Europe, South America, and the Pacific only have access to general undergraduate accreditation, and many countries in Africa have no accreditation available. In countries where medical education accreditation exists, the scope and organization of the agencies varies considerably. Regional cooperation and international agencies seem to be a growing trend. The data described in our study can serve as an important resource for further investigations on the effectiveness of accreditation activities worldwide. Our research also highlights regions and countries that may need focused accreditation development support.

Prevalence of the Use of Herbal Medicines among Patients with Cancer: A Systematic Review and Meta-Analysis.

Background Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. The purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories). Methods Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta-regression analyses were performed to explore source of heterogeneity. Results In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). The pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%). Conclusion Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care.

The Relationship Between the Global Burden of Influenza From 2017 to 2019 and COVID-19: Descriptive Epidemiological Assessment.

BackgroundSARS-CoV-2 and influenza are lipid-enveloped viruses with differential morbidity and mortality but shared modes of transmission.ObjectiveWith a descriptive epidemiological framing, we assessed whether recent historical patterns of regional influenza burden are reflected in the observed heterogeneity in COVID-19 cases across regions of the world.MethodsWeekly surveillance data reported by the World Health Organization from January 2017 to December 2019 for influenza and from January 1, 2020 through October 31, 2020, for COVID-19 were used to assess seasonal and temporal trends for influenza and COVID-19 cases across the seven World Bank regions.ResultsIn regions with more pronounced influenza seasonality, COVID-19 epidemics have largely followed trends similar to those seen for influenza from 2017 to 2019. COVID-19 epidemics in countries across Europe, Central Asia, and North America have been marked by a first peak during the spring, followed by significant reductions in COVID-19 cases in the summer months and a second wave in the fall. In Latin America and the Caribbean, COVID-19 epidemics in several countries peaked in the summer, corresponding to months with the highest influenza activity in the region. Countries from regions with less pronounced influenza activity, including South Asia and sub-Saharan Africa, showed more heterogeneity in COVID-19 epidemics seen to date. However, similarities in COVID-19 and influenza trends were evident within select countries irrespective of region.ConclusionsEcological consistency in COVID-19 trends seen to date with influenza trends suggests the potential for shared individual, structural, and environmental determinants of transmission. Using a descriptive epidemiological framework to assess shared regional trends for rapidly emerging respiratory pathogens with better studied respiratory infections may provide further insights into the differential impacts of nonpharmacologic interventions and intersections with environmental conditions. Ultimately, forecasting trends and informing interventions for novel respiratory pathogens like COVID-19 should leverage epidemiologic patterns in the relative burden of past respiratory pathogens as prior information.

Mega-map of systematic reviews and evidence and gap maps on the interventions to improve child well-being in low- and middle-income countries.

Despite a considerable reduction in child mortality, nearly six million children under the age of five die each year. Millions more are poorly nourished and in many parts of the world, the quality of education remains poor. Children are at risk from multiple violations of their rights, including child labour, early marriage, and sexual exploitation. Research plays a crucial role in helping to close the remaining gaps in child well-being, yet the global evidence base for interventions to meet these challenges is mostly weak, scattered and often unusable by policymakers and practitioners. This mega-map encourages the generation and use of rigorous evidence on effective ways to improve child well-being for policy and programming. The aim of this mega-map is to identify, map and provide an overview of the existing evidence synthesis on the interventions aimed at improving child well-being in low- and middle-income countries (LMICs). Campbell evidence and gap maps (EGMs) are based on a review of existing mapping standards (Saran & White, 2018) which drew in particular of the approach developed by 3ie (Snilstveit, Vojtkova, Bhavsar, & Gaarder,2013). As defined in the Campbell EGM guidance paper; "Mega-map is a map of evidence synthesis, that is, systematic reviews, and does not include primary studies" (Campbell Collaboration, 2020). The mega-map on child well-being includes studies with participants aged 0-18 years, conducted in LMICs, and published from year 2000 onwards. The search followed strict inclusion criteria for interventions and outcomes in the domains of health, education, social work and welfare, social protection, environmental health, water supply and sanitation (WASH) and governance. Critical appraisal of included systematic reviews was conducted using "A Measurement Tool to Assess Systematic Reviews"-AMSTAR-2 rating scale (Shea, et al., 2017). We identified 333 systematic reviews and 23 EGMs. The number of studies being published has increased year-on-year since 2000. However, the distribution of studies across World Bank regions, intervention and outcome categories are uneven. Most systematic reviews examine interventions pertaining to traditional areas of health and education. Systematic reviews in these traditional areas are also the most funded. There is limited evidence in social work and social protection. About 69% (231) of the reviews are assessed to be of low and medium quality. There are evidence gaps with respect to key vulnerable populations, including children with disabilities and those who belong to minority groups. Although an increasing number of systematic reviews addressing child well-being topics are being published, some clear gaps in the evidence remain in terms of quality of reviews and some interventions and outcome areas. The clear gap is the small number of reviews focusing explicitly on either equity or programmes for disadvantaged groups and those who are discriminated against.

The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has severely affected ICUs and critical care health-care providers (HCPs) worldwide.Research QuestionHow do regional differences and perceived lack of ICU resources affect critical care resource use and the well-being of HCPs?Study Design and MethodsBetween April 23 and May 7, 2020, we electronically administered a 41-question survey to interdisciplinary HCPs caring for patients critically ill with COVID-19. The survey was distributed via critical care societies, research networks, personal contacts, and social media portals. Responses were tabulated according to World Bank region. We performed multivariate log-binomial regression to assess factors associated with three main outcomes: limiting mechanical ventilation (MV), changes in CPR practices, and emotional distress and burnout.ResultsWe included 2,700 respondents from 77 countries, including physicians (41%), nurses (40%), respiratory therapists (11%), and advanced practice providers (8%). The reported lack of ICU nurses was higher than that of intensivists (32% vs 15%). Limiting MV for patients with COVID-19 was reported by 16% of respondents, was lowest in North America (10%), and was associated with reduced ventilator availability (absolute risk reduction [ARR], 2.10; 95% CI, 1.61-2.74). Overall, 66% of respondents reported changes in CPR practices. Emotional distress or burnout was high across regions (52%, highest in North America) and associated with being female (mechanical ventilation, 1.16; 95% CI, 1.01-1.33), being a nurse (ARR, 1.31; 95% CI, 1.13-1.53), reporting a shortage of ICU nurses (ARR, 1.18; 95% CI, 1.05-1.33), reporting a shortage of powered air-purifying respirators (ARR, 1.30; 95% CI, 1.09-1.55), and experiencing poor communication from supervisors (ARR, 1.30; 95% CI, 1.16-1.46).InterpretationOur findings demonstrate variability in ICU resource availability and use worldwide. The high prevalence of provider burnout and its association with reported insufficient resources and poor communication from supervisors suggest a need for targeted interventions to support HCPs on the front lines.

Mobile applications addressing violence against women: a systematic review

IntroductionViolence against women is a pressing global health problem that is being met with a new intervention strategy—mobile applications. With this systematic review, we provide an initial analysis and functional...

Estimated Worldwide Mortality Attributed to Secondhand Tobacco Smoke Exposure, 1990-2016

The World Health Organization estimates that the 1 billion individuals who smoke worldwide contribute to the 880 000 secondhand smoke (SHS)-related deaths among individuals who do not smoke each year. A better understanding of the scale of harm of SHS to those who do not smoke could increase awareness of the consequences of smoking and help to design measures to protect individuals who do not smoke, especially children. To calculate the number of individuals who smoke associated with the death of 1 individual who died of SHS exposure both on a global scale and in various World Bank regions. In this cross-sectional epidemiologic assessment, data from Our World in Data were used to tabulate the number of individuals who smoke in each country and number of premature deaths related to SHS in that country from 1990 to 2016. The mean number of cigarettes consumed in all countries was also included in analyses. Data were collected for the following World Bank regions: North America, Latin America and the Caribbean, Europe and Central Asia, the Middle East and North Africa, sub-Saharan Africa, South Asia, and East Asia and the Pacific from 1990 and 2016. Statistical analysis was conducted in July 2019. Secondhand smoke. The pack-year index, calculated as the number of pack-years associated with the death of 1 individual who does not smoke but was exposed to SHS, and the SHS index, calculated as the number of individuals who smoked for 24 years (ie, the mean duration of smoking) associated with the death of 1 individual who does not smoke. Globally, the SHS index changed favorably, from 31.3 (95% CI, 30.6-32.0) individuals who smoked associated with the death of 1 individual who did not smoke in 1990 to 52.3 (95% CI, 51.2-53.5) individuals who smoked in 2016. There was a wide regional variation in the 2016 secondhand smoke index, from 42.6 (95% CI, 41.6-43.5) individuals who smoked in the Middle East and North Africa to 85.7 (95% CI, 83.8-87.7) individuals who smoked in North America. Worldwide, the pack-year index also changed favorably from 751.9 (95% CI, 736.3-770.7) pack-years associated with 1 death in 1990 to 1255.9 (95% CI, 1227.2-1284.4) pack-years in 2016. In this study, the substantial disparity among regions in both the SHS index and pack-year index reflected large differences in the scale of the harm of SHS on those who do not smoke. This information may help local policy makers implement measures to better protect those who do not smoke and increase public engagement. Although the number of pack-years and the number of individuals who smoke associated with the death of 1 individual who did not smoke favorably changed over the study period, as of 2016, 52.3 individuals who smoked were associated with the death of 1 individual who did not smoke.

The Global State of Hematopoietic Stem Cell Transplantation for Multiple Myeloma: An Analysis of the Worldwide Network of Blood and Marrow Transplantation (WBMT) Database and the Global Burden of Disease Study

Background: Multiple myeloma (MM), is a clonal plasma cell neoplasm characterized by destructive bony lesions, anemia, and renal impairment. MM is a global disease - worldwide in 2016, there were 138509 incident cases with an age standardized incidence rate (ASIR) of 2.1 per 100 000 persons, with a 126% global increase in incident cases from 1990 to 2016 (Cowan AJ et al JAMA Oncology 2018). Access to effective care, including proteasome inhibitors, immunomodulatory agents, and autologous hematopoietic stem cell transplantation (HSCT) is largely limited to high-income sociodemographic index (SDI) countries. SCT remains the standard of care for eligible patients, and in general is more affordable and accessible worldwide than novel therapies. We sought to evaluate the rates and utilization of ASCT globally from 2006-2015 to better characterize access to SCT for patients with MM. Methods: This was a new analysis of a retrospective survey of WBMT sites, conducted annually between 2006-2015, as described previously (Niederwieser et al BMT 2016). Incidence data estimates were reported from the Global Burden of Disease study (Institute for Health Metrics and Evaluation. 2019 'GBD Results Tool.' Global Health Data Exchange. Seattle WA: University of Washington. Accessed 1 June 2019). South Asia and East Asia regions were combined for this analysis. Outcome measures included total number of autologous and allogeneic stem cell transplants by World Bank (WB) regions, and percentage of newly diagnosed MM patients who underwent ASCT, calculated by the number of transplants per region in calendar year / gross annual incidence of MM per region. Results: From 2006 to 2015, the number of autologous HSCT performed worldwide for MM increased by 107% (Figure 1). Activity increased in each region from 2006 to 2015 from 56% in USA and Canada to 335% in Latin America. Utilization of autologous HSCT was highest amongst the Northern America and European WB regions, with an increase from 13% to 24% in Northern America, and an increase from 15% to 22% in Europe. The activity increased considerably in the Latin American countries (335,46% increase) and the utilization reached &amp;gt;10%. In contrast, the utilization of autologous HSCT was much lower in the Africa/Mediterranean and Asian/Pacific region, with autologous HSCT utilization only changing marginally from 1.8% in 2006 to 4% in 2015 despite increase in activity. The number of first allogeneic HSCT performed globally for MM declined after a peak in 2012 by -3% since 2006 mostly in North America. Allogeneic HSCT remains highest amongst the European WB region (increase 8%). The increase in activity was accompanied by an increase in team numbers from 1327 in 2006 to 1581 in 2015 but also by an increase of activity in the teams. Discussion: Autologous HSCT utilization has increased worldwide in high-income SDI WB region countries for MM yet has not increased proportionally amongst low-middle income WB regions. There is a disparity in autologous HSCT utilization amongst high-income regions, exceeding 20% in North America and Europe, while remaining poorly utilized in Africa and the East Mediterranean. Latin America has increased their utilization and is for the first time above 10%. However, we are limited with respect to use of incidence data in LMIC countries from the GBD, likely due to under reporting. Conflicting clinical trial data likely contributed to the decline in some regions for first allogeneic HSCT in MM. More work is needed to improve access to transplantation services for MM patients, especially in low to middle income countries. Conclusion: Although autologous HSCT numbers and rates have increased globally, there are marked disparities in usage amongst high versus low to middle income countries. More work is needed to improve access to HSCT for MM globally. Figure 1 Disclosures Cowan: Celgene: Consultancy, Research Funding; Cellectar: Consultancy; Juno: Research Funding; Sanofi: Consultancy; Abbvie: Research Funding; Janssen: Consultancy, Research Funding. Atsuta:Janssen Paharmaceutical K.K.: Honoraria; Kyowa Kirin Co., Ltd: Honoraria; Chugai Pharmaceutical Co., Ltd.: Honoraria; Mochida Pharmaceutical Co. Ltd: Honoraria. Worel:Sanofi Genzyme, Malinckrodt Therakos: Research Funding; Jazz, Sanofi, Celgene, Novartis, Malinckrodt Therakos: Honoraria; Sanofi Genzyme, Malinckrodt Therakos: Speakers Bureau. Libby:Alnylam: Consultancy; Abbvie: Consultancy; Pharmacyclics and Janssen: Consultancy; Akcea: Consultancy. Pasquini:Novartis: Research Funding; Kite Pharmaceuticals: Research Funding; BMS: Research Funding; Medigene: Consultancy; Amgen: Consultancy; Pfizer: Consultancy. Galeano:Szabo SA: Other: (Equity interest). Szer:Amgen: Honoraria, Other: Travel, Research Funding; Alexion: Honoraria, Other: Travel, Research Funding; Pfizer: Honoraria, Other: Travel, Research Funding; Sanofi: Honoraria, Other: Travel, Research Funding; Takeda: Honoraria, Other: Travel, Research Funding; Prevail Therapeutics: Honoraria, Other: Travel, Research Funding; Novartis: Honoraria, Other: Travel, Research Funding; MSD: Honoraria, Other: Travel, Research Funding; Celgene: Honoraria, Other: Travel, Research Funding. Kroeger:Neovii: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Riemser: Research Funding; JAZZ: Honoraria; Sanofi-Aventis: Honoraria; Novartis: Honoraria, Research Funding; Medac: Honoraria; DKMS: Research Funding. Weisdorf:Fate Therapeutics: Consultancy; Incyte: Research Funding; Pharmacyclics: Consultancy. Niederwieser:Cellectis: Consultancy; Daichii: Speakers Bureau.

The Relative Caloric Prices of Healthy and Unhealthy Foods Differ Systematically across Income Levels and Continents

ABSTRACTBackgroundRelative prices of healthy/unhealthy foods have been implicated in the obesity epidemic, but never extensively quantified across countries or empirically linked to undernutrition.ObjectivesThis study compared relative caloric prices (RCPs) for different food categories across 176 countries and ascertained their associations with dietary indicators and nutrition outcomes.MethodsWe converted prices for 657 standardized food products from the 2011 International Comparison Program into caloric prices using USDA Food Composition tables. We classified products into 21 specific food groups. We constructed RCPs as the ratio of the 3 cheapest products in each food group, relative to the weighted cost of a basket of starchy staples. We analyzed RCP differences across World Bank income levels and regions and used cross-country regressions to explore associations with Demographic Health Survey dietary indicators for women 15–49 y old and children 12–23 mo old and with WHO indicators of the under-5 stunting prevalence and adult overweight prevalence.ResultsMost noncereal foods were relatively cheap in high-income countries, including sugar- and fat-rich foods. In lower-income countries, healthy foods were generally expensive, especially most animal-sourced foods and fortified infant cereals (FICs). Higher RCPs for a food predict lower consumption among children for 7 of 9 food groups. Higher milk and FIC prices were positively associated with international child stunting patterns: a 1-SD increase in milk prices was associated with a 2.8 percentage point increase in the stunting prevalence. Similarly, a 1-SD increase in soft drink prices was associated with a reduction in the overweight prevalence of ∼3.6 percentage points.ConclusionsRelative food prices vary systematically across countries and partially explain international differences in the prevalences of undernutrition and overweight adults. Future research should focus on how to alter relative prices to achieve better dietary and nutrition outcomes.