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Objective: There is an increasing need to understand how differential levels of resource inequality between spouses are associated with women's experience of intimate partner violence (IPV) in lower- and middle-income countries across four regions. This study aims to focus on four areas of relative power and resources between couples in a partnership: employment, job skills, earnings, and household making-decision across four lower- and middle-income regions., Method: Data on 150,623 women was drawn from the most recent, harmonized Demographic and Health Survey (DHS) for 24 countries in West-Central Africa (WCA), East-Southern Africa (ESA), Middle East and North Africa (MENA), and South Asia (SA). Leveraging an event history framework, we fitted mixture cure models to illuminate both the likelihood of never experiencing IPV and the onset of IPV among women in their first union across the four regions., Results: We found that women who are not in the labor market are less likely to experience violence compared to those who are in all places except MENA. Among couples in which both partners are in the labor market, women with lower job skills than their partner are less likely to experience violence. Inequality in earnings is associated with the onset of intimate partner violence in ESA and SA. Similarly, inequality in household decision-making is associated with the onset of the first spousal violence but only in ESA, MENA, and SA., Conclusion: This study found vast heterogeneity in the different measures of spousal resource inequality and women's experience of IPV across LMIC settings. This underscores the imperative for interventions focused on enhancing women's economic outcomes to consider and confront the contextual norms associated with women's economic empowerment, in order to mitigate unintended adverse consequences., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Health policy frameworks for the prevention and control of non-communicable diseases have largely been developed for application in high-income countries. Limited attention has been given to the policy exigencies in lower- and middle-income countries where the impacts of these conditions have been most severe, and further clarification of the policy requirements for effective prevention is needed. This paper presents a policy approach to prevention that, although relevant to high-income countries, recognizes the peculiar situation of low-and middle-income countries. Rather than a narrow emphasis on the implementation of piecemeal interventions, this paper encourages policymakers to utilize a framework of four embedded policy levels, namely health services, risk factors, environmental, and global policies. For a better understanding of the non-communicable disease challenge from a policy standpoint, it is proposed that a policy framework that recognizes responsible health services, addresses key risk factors, tackles underlying health determinants, and implements global non-communicable disease conventions, offers the best leverage for prevention., Competing Interests: The authors declare no competing interests., (Copyright: Mark Fordjour Owusu et al.)

Introduction: In 2020, the Orthopaedic Trauma Association (OTA) adopted an updated strategic plan emphasizing global outreach. A task force was appointed to better understand the current global orthopaedic trauma educational demand and how the organization may better partner with our global colleagues. This article provides a description of the process and the results of the findings., Methods: First, the current international demographics of the OTA membership were reviewed. Then, 2 surveys were distributed. The first was sent to all current members of the OTA to determine how important the members believe that global orthopaedics should be to the organization's mission. The second survey was sent out to our international orthopaedic trauma colleagues. The results of both surveys were reviewed, analyzed, and summarized in an executive summary report which was presented to the OTA Board of Directors earlier this year., Results: The responses from the membership survey indicated a keen interest in the development of global outreach within our organization. The global outreach survey received 72 responses from 28 different countries, mostly lower and lower-middle income countries. This included many countries in Asia and Africa who had no prior relationship with the OTA. Most respondents were already using online educational materials and expressed a desire for more high-quality online offerings as well as regional resource-specific orthopaedic trauma courses., Conclusion: The overwhelming majority of member respondents believe that global orthopaedics is highly important and central to our mission. Similarly, a majority of the international respondents believed that global orthopaedics is necessary and worthwhile. They expressed a need for more educational opportunities and collaboration, particularly in the areas of online offerings as well as regional, resource-specific courses., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

The demand for palliative care (PC) is ever-increasing globally. The emergence of COVID-19 pandemic has further accelerated the need for PC. In the lower-income countries (LICs), where PC need is highest, PC, the most humane, appropriate and realistic approach to care for patients and families affected by life-limiting illness, is minimal or non-existent. Recognising the disparity between high, middle and LICs, the World Health Organization (WHO) has recommended public health strategies for PC within the socioeconomic, cultural and spiritual contexts of individual countries. This review aimed to: (i) identify PC models in the LICs utilising public health strategies and (ii) characterise how social, cultural and spiritual components were integrated into these models. This is an integrative literature review. Thirty-seven articles were included from a search of four electronic databases - Medline, Embase, Global Health and CINAHL. Literature, both empirical and theoretical literature, published in English from January 2000 to May 2021 that mentioned PC models/services/programmes integrating public health strategies in the LICs were included in the study. A number of LICs utilised public health strategies to deliver PC. One-third of the selected articles highlighted the importance of integrating sociocultural and spiritual components into PC. Two main themes - WHO-recommended public health framework and sociocultural and spiritual support in PC and five subthemes - (i) suitable policies; (ii) availability and accessibility of essential drugs; (iii) PC education for health professionals, policymakers and the public; (iv) implementation of PC at all levels of healthcare and (v) sociocultural and spiritual components, were derived. Despite embracing the public health approach, many LICs encountered several challenges in integrating all four strategies successfully., Competing Interests: There are no conflicts of interest., (© 2023 Published by Scientific Scholar on behalf of Indian Journal of Palliative Care.)

In recent years, a proportion of older Germans has been sent to relatively high-end care homes within lower-income countries where the care tends to be cheaper and more extensive than that in German care homes. Destination countries are found predominantly within Eastern Europe (e.g. Poland, Hungary, Czech Republic), but to a lesser extent also within South-East Asia (e.g. Thailand). At the same time, these expatriations have caused much controversy, with some German commentators calling them 'inhumane' and 'shameful'. In this article, I argue that such criticisms are overdrawn. Although sending an older individual to a care home within a lower-income country can be morally impermissible, I find that there are at least three sets of conditions under which it is not., (© 2021 The Authors. Bioethics published by John Wiley & Sons Ltd.)

Many higher-income countries are struggling to make decent and affordable care available to their older populations. In response, some Germans are sending their ageing relatives to relatively high-end care homes within Eastern Europe and South-East Asia where the care tends to be more comprehensive and a lot cheaper. At the same time, this practice has caused much controversy within Germany, with some commentators calling it "inhumane" and "shameful." The aim of this article is to show that such criticisms are exaggerated. Whereas sending people to care homes in lower-income countries can be immoral, I argue that the most promising objections against it do not always apply and, to the extent that they do, do not always provide decisive reasons against sending people abroad. These objections maintain that such expatriations harm three different groups of individuals, namely the emigrants themselves; their friends and relatives; and vulnerable members of the receiving societies., (© 2021. The Author(s).)

Background: Low level viremia (LLV) often occurs during antiretroviral therapy (ART) against HIV-1. However, whether LLV increases the risk of virologic failure (VF) is controversial because of the non-uniform definitions of LLV and VF., Methods: A long-term first line regimen ART cohort from 2002 to 2018 from Shenyang, northeast China, was retrospectively studied. All participants were followed up every 3 to 6 months to evaluate the treatment effect. The high-risk LLV subgroups leading to VF (with strict standards) were explored with Cox proportional hazards model and linear mixed-effect model. The association factors of high-risk LLV were further explored using multivariate logistic regression analyses., Results: A total of 2155 HIV-1 infected participants were included; of these, 38.7% showed LLV. Both high level LLV (HLLV) and any other level LLV coupled with high level blip (HLB) showed higher risk of VF (hazards ratios, HR HLLV  = 5.93, and HR HLB  = 2.84, p <  0.05 respectively). Moreover, HR increased with prolonged duration of LLV. Independent factors associated with high-risk LLV included the zenith baseline viral load (VL) above 6 log copies/ml (aOR = 3.49, p = 0.002), nadir baseline CD4 + T cell counts below 200 cells/mm 3 (aOR = 1.78, p = 0.011), Manchu (aOR = 2.03, p = 0.003), ART over 60 months (aOR = 1.81, p = 0.004), AZT + 3TC + NVP (aOR = 2.26, p <  0.001) or DDI-based regimen (aOR = 9.96, p = 0.002), and subtype B' infection (aOR = 8.22, p = 0.001)., Conclusions: In case of VF with strict standards, high-risk LLV leading to VF includes VL above 400 copies/ml, occurring at least once. Serious laboratory indicators or advanced stage of infection, long term ART and subtype B' infection might also predict the occurrence of high-risk LLV.

Research shows a positive relationship between women's empowerment and reproductive health. Yet we know little about the quantitative relationship between women's agency and contraceptive use. We conducted a systematic review of peer-reviewed literature assessing the link between women's decision-making and freedom of movement with their contraceptive use in lower- and middle-income countries. Of 102 articles that met the initial screening criteria, 12 met all inclusion and exclusion criteria. Of the 12 included studies, consistently positive associations with contraceptive use were found in those that measured decision-making and freedom of movement as separate constructs. Composite measures had a less clear relationship with contraceptive use. In conclusion, women's agency is associated with women's contraceptive use in lower- and middle-income countries. However, the relationship is sensitive to how agency and its components are measured. Our review suggests the need for consistent validation of scales for women's agency as well as more rigorous research using standardised and validated scales, when possible. Longitudinal and intervention studies in lower- and middle-income countries will be useful for understanding the causal impact of women's agency on contraceptive use, and will help to inform policies and programmes to increase contraceptive use in these settings.

Purpose: Grand Bahama (pop. 51,000) is an island within the Bahamas archipelago. A local chapter of International Us TOO Prostate Cancer Support Group (UTGB) has led an annual community-based prostate cancer screening clinic in Grand Bahama each September since 2009. Features of this initiative, characteristics of attendees, and a description of found cancers were summarized to determine the clinic's value and to guide improvements., Method: We analyzed the established clinic from 2012 to 2015, wherein UTGB attracted corporate funding, volunteers managed clinics, and health professionals provided healthcare services. An explicit algorithm was used to sort clients by age, comorbidities, and findings from digital rectal examinations, and prostate-specific antigen (PSA) values, to determine which clients would undergo secondary assessment and prostate biopsy., Results: Overall, 1,844 males were registered (mean age 57.6 years), and only 149 men attended on more than one occasion for a total of 1,993 clinic visit. The urologist reviewed 315 men in secondary follow-up, for elevated PSA and/or an abnormal digital rectal examination. Of these, 45 men fulfilled criteria for trans-rectal ultrasound biopsy, and there were 40 found cases of prostate cancer, for a positive-predictive value of 89%. By D'Amico risk-stratification, these 40 cases were low (10%), intermediate (40%), and high risk (50%). The urologist counseled all 40 cases and facilitated access to standard care., Conclusion: This study suggests that low-resource countries can advance cost-effective screening clinics, apply policy guidelines, and provide services within acceptable standards of care. It is the expectation, with a sustained effort and community participation over the ensuing years, that earlier disease presentation will occur and, consequently, a concomitant decrease in the disease-specific mortality.

Introduction: Schizophrenia (SCZ) is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia., Methods: A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL). The medical charts were identified electronically by matching the unique patient's identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted., Results: The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million (M) which was equivalent to 0.04% of the national gross domestic product. On average, the mean cost per patient was USD 6,594. Of the total economic burden of SCZ, 72% was attributed to indirect cost, costing at USD 72M, followed by direct medical cost (26%), costing at USD 26M, and direct non-medical cost (2%), costing at USD 1.7M., Conclusion: This study highlights the magnitude of economic burden of SCZ and informs the policy-makers that there is an inadequate support for SCZ patients. More resources should be allocated to improve the condition of SCZ patients and to reduce the economic burden., Competing Interests: Disclosure The authors report no conflicts of interest in this work.