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Background: The work of the WHO Commission on the Social Determinants of Health has been fundamental to provide a conceptual framework of the social determinants of health. Based on this framework, this study assesses the relationship of income inequality as a determinant of neonatal mortality in the Americas and relates it to the achievement of the Sustainable Development Goal target 3.2 (reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births). The rationale is to evaluate if income inequality may be considered a social factor that influences neonatal mortality in the Americas. Methods: Yearly data from 35 countries in the Americas during 2000–2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques. Results: A positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country's Gini index during 2000–2019 is associated with a 0.27 (95% CI [− 0.04, 0.57], P =.09) increase in the neonatal mortality rate. Conclusion: The analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000–2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance. [ABSTRACT FROM AUTHOR]

The merits and effectiveness of advance care planning (ACP) continue to be debated a full 30 years after the passage of the Patient Self‐Determination Act. This act gave patients the right to create advance directives, with the objective of ensuring that the care they received at the end of life was consistent with their preferences and goals. ACP has definitively moved beyond the completion of advance directives to encompass the identification of a healthcare agent and the facilitation of communication among patients, surrogates, and clinicians. Nonetheless, the provision of goal‐concordant care remains a primary objective for ACP. This article argues that this cannot and should not be the objective for ACP. Patients' goals change, and the provision of goal‐concordant care is sometimes incompatible with other critical determinants of appropriate care. Instead, ACP should focus on the objective of improving caregiver outcomes. Surrogate decision‐making by caregivers is associated with an elevated risk of post‐traumatic stress disorder and other adverse outcomes, and these outcomes can be improved with ACP. ACP focused on caregivers involves helping caregivers to understand how they can help to shape the final chapter in a patient's life story, preventing caregivers from making promises they cannot keep, and preparing them to use all relevant information at the time decisions need to be made. [ABSTRACT FROM AUTHOR]

America has spent nearly two decades fighting costly wars in the Middle East while its regional and near peer competitors significantly gained strength and now pose major threats to the United States and its allies. To focus on these threats, America is seeking a way to extract itself from the post 9/11 "endless wars" in the Middle East. These wars have failed because America ties its ability to achieve its strategic goals to ineffective local governments. The U.S. must cease its cumbersome nation building efforts to address the terror threat from the region while refocusing on major threats posed by Russia and Iran. The U.S. can accomplish this by exploiting existing local conflicts to fulfill counter-terror objectives while bogging Iran and Russia down in conflicts they cannot sustain. To achieve this the U.S. must move its operations out of the limelight of military action and diplomacy into the shadows of covert action. [ABSTRACT FROM AUTHOR]

A new version of the Japanese clinical guidelines for myasthenia gravis is under development. The current version was published in 2014, in which the top priority in treatment was to maintain patients' health‐related quality of life. The treatment goal was to achieve a post‐intervention status of minimal manifestations or better (according to the Myasthenia Gravis Foundation of America classification), with an oral prednisolone dose of 5 mg/day or less. The guidelines recommend minimizing the oral prednisolone dose, starting calcineurin inhibitors early in the course of treatment, and effectively treating patients with an early fast‐acting treatment regimen. Since the release of the 2014 version, the therapeutic tendencies in myasthenia gravis have been gradually changing in Japan, with an observed increase in the number of patients that achieved the treatment goal. Therefore, it is conceivable that the rationale of the 2014 guidelines was appropriate to treat patients with myasthenia gravis and that it should be taken over by the new guidelines. Meanwhile, the anti‐complement antibody (eculizumab) has been approved, and although off‐label in Japan, the effect of the anti‐CD20 antibody rituximab has been reported repeatedly. Many other agents are currently undergoing clinical trials. In the new guidelines, the treatment strategy should be demonstrated clearly, including these most recent developments. [ABSTRACT FROM AUTHOR]

Over two‐thirds of American adults have obesity or overweight, increasing the risk of comorbidities, mortality, and healthcare costs. Despite this growing issue, screening and counseling for an unhealthy weight are not common in primary care and clinical practice guidelines (CPGs) for prevention and management of obesity are underutilized. Following the stepwise approach outlined in the Registered Nurses' Association of Ontario Toolkit: Implementation of Best Practice Guidelines, the Institute for Clinical Systems Improvement: Prevention and Management of Obesity for Adults were implemented in a primary care office in Lexington, KY. Education was implemented with providers and staff. An assessment of readiness for change was completed at check‐in and customizable phrases were built into the electronic health record. After a 12‐week implementation, providers were consistently assessing for comorbidities, setting goals, and managing weight in those with obesity using evidence‐based strategies. Readiness for change was being documented in less than 40% of those patients. For those with overweight providers were assessing readiness for change in only 30% of patients and were setting goals in just over 40% of patients. After the implementation, care more closely followed the CPG but additional steps are necessary to improve the prevention and management of obesity in this population. [ABSTRACT FROM AUTHOR]

Although numerous factors have been demonstrated in laboratory settings to lead to more successful health goal attainment, their actual use in daily goal pursuit is unknown. This study examines spontaneously reported health goals and their characteristics in a sample of 557 American adults. Participants responded to questions about health and health goals, with items assessing motivation, social support, and implementation intentions. In all, 66 percent of respondents had a health goal, 26 percent of participants had implementation intentions, and 47 percent received support from close others. Results suggest that interventions should focus on encouraging goal setting, teaching implementation intentions, and educating close others in providing support. [ABSTRACT FROM AUTHOR]

The approaches and tools of health promotion can be useful for civil society groups, local and national governments and multilateral organizations that are working to operationalize the 2030 agenda for sustainable development. Health promotion and sustainable development share several core priorities, such as equity, intersectoral approaches and sustainability, that help maximize their impact across traditional sectoral boundaries. In the Region of the Americas, each of these priorities has strong resonance because of prominent and long-standing health inequities that are proving resistant to interventions driven solely by the health sector. We describe several cases from the World Health Organization's (WHO) Region of the Americas in which the approaches and tools of health promotion, with a focus on cities, healthy settings and multisectoral collaboration, have been used to put the agenda into practice. We highlight areas where such approaches and tools can be applied effectively and provide evidence of the transformative potential of health promotion in efforts to achieve the sustainable development goals. [ABSTRACT FROM AUTHOR]

During recent centuries, cultivated olive has evolved to one of the major tree crops in the Mediterranean Basin and lately expanded to America, Australia, and Asia producing an estimated global average value of over USD 18 billion. A long-term research effort has been established with the long-term goal to preserve biodiversity, characterize agronomic behavior, and ultimately utilize genotypes suitable for cultivation in areas of unfavorable environmental conditions. In the present study, a combination of 10 simple sequence repeat (SSR) markers with the classification binary tree (CBT) analysis was evaluated as a method for discriminating genotypes within cultivated olive trees, while Olea europaea subsp. cuspidata was also used as an outgroup. The 10 SSR loci employed in this study, were highly polymorphic and gave reproducible amplification patterns for all accessions analyzed. Genetic analysis indicated that the group of SSR loci employed was highly informative. A further analysis revealed that two sub populations and pairwise relatedness gave insight about synonymies. In conclusion, the CBT method which employed SSR allelic sizes proved to be a valuable tool in order to distinguish olive cultivars over the traditional unweighted pair group method with the arithmetic mean (UPGMA) algorithm. Further research which will combine phenotyping characterization of olive germplasm will have the potential to enable the utilization of existing, and breeding of new, superior cultivars. [ABSTRACT FROM AUTHOR]