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AimTo describe immigrant Latinas' perspectives of a lifestyle behaviour intervention, focusing on their interactions with and perceptions of the promotoras who delivered the program in the USA.BackgroundImmigrant Latinas in the USA have high obesity rates, which contribute to increased risk for cardiovascular disease and other long-term diseases. Interventions using the promotora model appear to be effective in reducing cardiovascular disease risk by improving dietary habits, physical activity and selected clinical variables among Latinas. However, there has been very limited enquiry into what it is about these interventions and promotoras that facilitates behaviour change, from the perspective of participants.DesignGrounded theory methodology guided the data collection and analysis.MethodsThis qualitative study was completed in 2012 in California, after the end of a lifestyle behaviour intervention. Four focus groups and seven one-on-one interviews were conducted with a total of 18 immigrant Latina intervention participants.ResultsWomen described promotoras as helping them change by motivating them through three interconnected elements: tools, support and knowledge. Latinas viewed their ability to make lifestyle changes as connected with their emotional and psychological health and saw promotoras as counsellors who gave emotional and social support. In this respect, the intervention was emotionally therapeutic for this sample of Latinas, although this was not the original intention of the program.ConclusionPromotoras gave the backbone of the intervention and were crucial in motivating Latinas to implement lifestyle changes. Future lifestyle behaviour interventions should include a strong component of mental and emotional well-being.

Abstract Although emergency medical services (EMS) and pre-hospital care have existed in the Kingdom of Saudi Arabia (KSA) since 1934, emergency medicine (EM) is a relatively new medical field in the country that was not formally recognized as a medical specialty until 2001. In 2005, the Saudi Board of Emergency Medicine formed to develop, implement, and evaluate a standardized curriculum for EM residents. Since then, EM and the pre-hospital system in the KSA has evolved and grown. This article provides an overview of emergency medicine in Saudi Arabia and the progress it has made in the pre-hospital system, healthcare delivery system, and emergency medicine training. Finally, we will discuss the challenges and opportunities faced as this specialty continues to develop.

Abstract Background Mortality is a robust indicator of health and offers valuable insight into the health of immigrants. However, mortality estimates can vary significantly depending on the manner in which immigrant status is defined. Here, we assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain. Methods Cross-sectional retrospective study of all adult subjects from the EpiChron Cohort in 2011 (n = 1,102,544), of whom 146,100 were foreign-born (i.e., according to place of birth) and 127,213 were non-nationals (i.e., according to nationality). Directly standardized death proportions between years 2012–2015 were calculated, taking into account the age distribution of the European population in 2013. Binary logistic regression was used to compare the four-year probability of death. Results The age- and sex-standardized number of deaths per 1000 subjects were 45.1 (95%CI 44.7–45.2) for the Spanish-born population, 29.3 (95%CI 26.7–32.1) for the foreign-born population, and 18.4 (95%CI 15.6–21.6) for non-Spanish nationals. Compared with the Spanish-born population, the age- and sex-adjusted likelihood of dying was equally reduced in the foreign-born and non-national populations (OR 0.6; 95%CI 0.5–0.7) when the length of stay was less than 10 years. No significant differences in mortality estimates were detected when the length of stay was over 10 years. Conclusions Mortality estimates in immigrant populations were lower than those of the native Spanish population, regardless of the criteria applied. However, the proportion of deaths was lower when immigrant status was defined using nationality instead of country of birth. Age- and sex-standardized death proportions tended to increase with increased length of stay in the host country.

Abstract Background Benefit Incidence Analysis (BIA) is used to understand the distribution of health care utilization and spending in comparison to income distribution. The results can illustrate how effectively governments allocate limited resources towards meeting the needs of the poor. In analyzing the distribution of public spending on inpatient, outpatient, and deliveries, this paper represents the most recent BIA completed in India. Methods In order to conduct the BIA statistical analysis for this project, 2014 utilization data from the most recently completed Indian National Sample Survey (NSS) was used. Unit costs were estimated for primary care, hospital inpatient, hospital outpatient, and deliveries. Concentration curves and concentration indices were estimated both at the national and state levels. Analyses were reported for overall utilization, as well as for the gross and net benefits for inpatient, outpatient, and deliveries. Results According to the results, utilization of government inpatient and delivery services is pro-poor. When gross and net benefits are included in the analysis, services become more equal and less pro-poor. Gross benefits, which are measured with state-level unit costs, are virtually equal for all services. Although there are some pro-poor gross benefits trends for national outpatient services, the results also show that the equality of national gross benefits trends hides a significant disparity across Indian States. While a number of Indian States have outpatient gross benefits that are pro-poor, few show pro-poor benefits for inpatient and delivery services. Net benefits, which considers both unit costs for each respective service, and out-of-pocket (OOP) expenditures, trend similarly to gross benefits. In addition, those who use public facilities spend considerable OOP to supplement government services. Conclusions This BIA reveals that government spending on public health care has not resulted in significantly pro-poor services. While some progress has been made relative to deliveries and outpatient services, inpatient stays are not pro-poor. In addition, national results mask significant disparities across Indian states.

AimThis study represents an initial effort at examining the association between the construct of self-compassion and human immunodeficiency virus (HIV)-related anxiety in a multinational population with HIV disease.BackgroundPrevious studies have found that self-compassion is a powerful predictor of mental health, demonstrating positive and consistent linkages with various measures of affect, psychopathology and well-being, including anxiety.MethodsCross-sectional data from a multinational study conducted by the members of the International Nursing Network for HIV Research (n = 1986) were used. The diverse sample included participants from Canada, China, Namibia, the United States of America and the territory of Puerto Rico. Study measures included the anxiety subscale of the Symptom Checklist-90 instrument, the Brief Version Self-Compassion Inventory and a single item on anxiety from the Revised Sign and Symptom Checklist.FindingsStudy findings show that anxiety was significantly and inversely related to self-compassion across participants in all countries. We examined gender differences in self-compassion and anxiety, controlling for country. Levels of anxiety remained significantly and inversely related to self-compassion for both males (P = 0.000) and females (P = 0.000). Levels of self-compassion and anxiety varied across countries.ConclusionsSelf-compassion is a robust construct with cross-cultural relevance. A culturally based brief treatment approach aimed at increasing self-compassion may lend itself to the development of a cost effective adjunct treatment in HIV disease, including the management of anxiety symptoms.

Abstract Background Medical student and resident participation in short-term international trips for trainees (STINTTs) has increased in the past few decades. However, there has been no systematic review of trainees’ actual ethical experiences. The authors sought to identify what ethical issues medical trainees encounter during STINTTs, as elicited by and reported in peer-reviewed, quantitative and qualitative research papers. Methods The authors systematically searched five academic databases finding 659 unique titles and abstracts. The authors applied inclusion and exclusion criteria to these titles and abstracts resulting in fourteen papers, which were analyzed using qualitative thematic synthesis. Results The qualitative analysis of the papers generated four themes: (1) Trainees’ Concerns Over Perpetuating Medical Tourism; (2) Struggling to Identify and Balance the Benefits and Harms of STINTTs; (3) The Complicated Trainee Mens (mind); and (4) Ethical Situations Encountered by Trainees. The fourth theme, which was the largest, was further divided into (a) Navigating social and cultural dynamics, (b) Trainees’ experiences related to the learner role, and (c) Ethical situations not qualifying for other catagories. Some of these issues reported in the empirical research papers are well represented in the broader literature on STINTTs, while others were less so—such as mistreatment of trainees. All included papers were published after 2010, and comprised a total of less than 170 medical trainees. Conclusions Medical trainees report experiencing a wide range of ethical challenges during short-term international trips in which they engage in clinical or research activities. The authors call educators’ attention to specific challenges that trainees face. The relevant literature covering US and Canadian STINTTs is relatively young and largely qualitative. The authors briefly sketch a program for expanding the research on this increasingly common educational experience.

Michelle C Chan,1 Angela M Bayer,1 Joseph R Zunt,2 Magaly M Blas,1 Patricia J Garcia1 1School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru; 2Departments of Neurology and Global Health, University of Washington, Seattle, WA, USA Abstract: To solve increasingly complex global health problems, health professionals must collaborate with professionals in non-health-related fields. The Universidad Peruana Cayetano Heredia and University of Washington created the NIH-funded Kuskaya training program in response to the need for transformative global health training for talented graduates from all disciplines. Kuskaya is a 1-year, interdisciplinary training program that teaches Peruvian and US graduates critical skills related to public health research through the design and implementation of a collaborative research project in Peru. Between 2014 and 2018, the program has trained 33 fellows, of which one third were from non-health disciplines. The program is unique because it targets junior trainees from disciplines outside of the health field, the program’s curriculum is adapted to fit the fellows’ backgrounds and professional aspirations, and the structure of the program allows for collaboration within the cohort and encourages fellows to apply for additional funding and pursue advanced degrees. Lessons learned in designing the Kuskaya program include: 1) involving mentors in the fellow selection process, 2) involving fellows in existing lines of research to increase mentor involvement, 3) institutionalizing mentoring through regular works-in-progress meetings and providing mentoring materials, and 4) defining a core curriculum for all fellows while providing additional supplementary materials to meet each cohort’s needs, and evaluating their progress. Kuskaya provides an innovative model for bi-national, global health training to engage and provide a public health career pathway for all professionals. Keywords: public health, international health, program design, education

Abstract Background Integrated Management of Childhood Illness (IMCI) and Emergency Triage, Assessment and Treatment (ETAT) are guidelines developed by the World Health Organization to reach targets for reducing under-5 mortality. They were set out in the Millennium Development Goals. Each guideline was established separately so the purpose of this study was to understand how these systems have been integrated in a primary care setting and identify barriers and facilitators to this integration using a systems approach. Method Interviews were carried out with members of staff of different levels within a primary healthcare clinic in Malawi. Along with observations from the clinic this provided a well-rounded view of the running of the clinic. This data was then analysed using the SEIPS 2.0 work systems framework. The work system elements specified in this model were used to identify and categorise themes that influenced the clinic’s efficiency. Results A process map of the flow of patients through the clinic was created, showing the tasks undertaken and the interactions between staff and patients. In their interviews, staff identified several organisational elements that served as barriers to the implementation of care. They included workload, available resources, ineffective time management, delegation of roles and adaptation of care. In terms of the external environment there was a lack of clarity over the two sets of guidelines and how they were to be integrated which was a key barrier to the process. Under the heading of tools and technology a lack of guideline copies was identified as a barrier. However, the health passport system and other forms of recording were highlighted as being important facilitators. Other issues highlighted were the lack of transport provided, challenges regarding teamwork and attitudes of members of staff, patient factors such as their beliefs and regard for the care and education provided by the clinic. Conclusions This study provides the first information on the challenges and issues involved in combining IMCI and ETAT and identified a number of barriers. These barriers included a lack of resources, staff training and heavy workload. This provided areas to work on in order to improve implementation.

This text analyzes the trajectory of Brazilian doctors from the Oswaldo Cruz Institute who secured Rockefeller Foundation funding to study at Johns Hopkins University between 1919 and 1924. The article is based on material from the Rockefeller Archive Center--such as correspondence between the philanthropic agency's offices in Brazil and United States--a doctoral thesis, a medical report, and oral histories. These sources help illuminate the conflicts, difficulties, and negotiations that occurred during the selection of scholars, their training in North America, and their return to Brazil. Regional and local issues and exchanges of knowledge about public health also characterized the experience of international professional training. [ABSTRACT FROM AUTHOR]

Globally, the highest cervical cancer mortality rates are found in East Africa. Visual inspection with acetic acid (VIA)-based screening in resource-poor settings has been shown to decrease the proportion of women presenting with late-stage cervical cancer, a process known as clinical downstaging. The only cancer treatment center in Tanzania, Ocean Road Cancer Institute (ORCI) in Dar es Salaam, opened a VIA-based cervical cancer screening program in 2002. We reviewed 6,676 medical records of cervical cancer patients at the ORCI from 2002–2011 to 2014–2018 for stage at diagnosis and screening status, among other variables. We investigated whether clinical downstaging occurred in this period among women screened at the ORCI, when compared to unscreened women. Our results indicated that the proportion of women presenting with late-stage cervical cancer among women screened at the ORCI decreased by 27.7% over the 16-year period (χ2 = 16.99; p = 0.0002). Among unscreened women, a non-significant 13.2% decrease in late-stage disease was observed (χ2 = 1.74; p = 0.4179). Our results suggest clinical downstaging occurred among women screened at the ORCI over the 16-year period, and this difference may be attributed to the screening program as the same decrease in stage was not observed among unscreened women during the same time period. At present, less than one percent of Tanzanian women receive yearly cervical cancer screenings. Access to screening through expansion of the ORCI screening clinic and the creation of more clinics should be prioritized. [ABSTRACT FROM AUTHOR]

Background: Human rights violations (HRVs) are common in conflict and displacement contexts. Women are especially vulnerable to HRVs in these contexts, and perinatal health is acutely sensitive to related stressors and health care barriers. However, how HRVs affect immediate and long-term perinatal health in chronic displacement settings has not been closely investigated. Furthermore, it remains unclear whether and how HRVs in these contexts are tied directly to displacement circumstances or other marginalizing factors affecting local migrant and minority populations generally. Methods: We investigated these questions using novel survey data from 577 women at the northern Thai-Myanmar border, where thousands of people have fled conflict in Shan State, Myanmar, for refuge in a range of precarious settings in Thailand, including unofficial refugee camps, villages, and worksites. We compared HRV exposures by ethnicity, country of birth, legal documentation, and residential setting. We then analyzed perinatal outcomes associated with HRV frequency, timing, and type. Results: Birth in Myanmar, and ethnic minority and precarious legal status more broadly, predicted higher HRV prevalence. HRV frequency significantly predicted unmet antenatal care and lower birth weight, along with HRVs related to labor exploitation and violence or conflict. HRVs timed closer to pregnancies were more adversely associated with perinatal outcomes. Resource/property deprivation was the strongest predictor of pregnancy complications. Conclusions: Human rights must be urgently attended to, through expanded HRV screenings and responsive care, and policy changes to further protect migrant workers, displaced persons, and others in precarious legal status situations. [ABSTRACT FROM AUTHOR]

Introduction: Global health agencies and the Vietnam Ministry of Health have identified pediatric emergency care and health information technology as high priority goals. Clinical decision support (CDS) software provides physicians with access to current literature to answer clinical queries, but there is limited impact data in developing countries. We hypothesized that Vietnamese physicians will demonstrate improved test performance on common pediatric emergencies using CDS technologies despite being in English.Methods: This multicenter, prospective, pretest-posttest study was conducted in 11 Vietnamese hospitals enrolled a convenience sample of physicians who attended an 80-minute software training on a pediatric CDS software (PEMSoft). Two multiple-choice exams (A, B) were administered before and after the session. Participants, who received Test A as a pretest, received Test B as a posttest, and vice versa. Participants used the CDS software for the posttest. The primary outcome measure was the mean percentage difference in physician scores between the pretest and posttest, as calculated by a paired, two-tailed t-test.Results: For the 203 participants, the mean pretest, posttest, and improvement scores were 37% (95% CI: 35-38%), 70% (95% CI: 68-72%), and 33% (95% CI: 30-36%), respectively, with p

Although there are concerns regarding children's health in immigration detention, there are little data regarding hospitalizations in this population. Using 2015-2018 Texas inpatient data, we identified 95 hospitalizations of children in detention and found that most (60%) were driven by infectious causes, and that 37% of these children were admitted to an intensive care unit (ICU) or intermediate ICU. [ABSTRACT FROM AUTHOR]

• Patients from endemic areas and on chronic steroids should be screened for Strongyloides stercoralis. • Stool ova and parasite testing may detect Strongyloides when repeated stool samples are obtained. • Strongyloides antibody testing exhibits cross-reactivity with other helminths. • Agar-plate culture and the modified Baermann technique ideally diagnose infections caused by Strongyloides. Strongyloidiasis, a disease caused by the helminth Strongyloides stercoralis , has been identified as a life-threatening parasitic infection among immunocompromised patients. In the most severe cases, which include hyperinfection syndrome and dissemination of larvae throughout multiple organ sites, there is typically a history of immunosuppression among the infected. Herein, we describe a fatal case of S. stercoralis hyperinfection in an immigrant from rural Ecuador presenting with diarrhea along with Clostridium difficile colitis after the use of a prolonged course of steroids. Despite the appropriate administration of ivermectin, living Strongyloides larvae were discovered in a tracheal lavage. The patient ultimately developed a multiorgan failure requiring life-supporting measures in the intensive care unit and later succumbed to his condition. This case of S. stercoralis hyperinfection emphasizes the importance of screening for this parasite in the appropriate clinical scenarios. The diagnosis of S. stercoralis can be made more accessible to practitioners through the use of methods such as the modified Baermann technique, agar-plate culture, and serologic antibody testing. [ABSTRACT FROM AUTHOR]

Background: Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures - the welfare state, political tradition, democracy and globalisation - on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review.Methods: The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories.Results: Out of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to greater child and infant mortality and youth smoking rates in LMECs through greater influence of multinational corporations and neoliberal trade organisations.Conclusion: We present a realist re-analysis of a large systematically identified body of evidence on how four key political exposures - the welfare state, democracy, political tradition and globalisation - relate to child and maternal health outcomes. Three final programme theories were supported. [ABSTRACT FROM AUTHOR]

Chronic diseases are major causes of health inequalities. Community nurses can potentially make large contributions to chronic illness prevention and management in Israel but may be obstructed by professional dominance of physicians. However, insufficient research exists about community nursing in Israel, and how it may differ from other countries. This study aims to document chronic disease‐related community nursing roles in Israel, identify changes and trends in community nursing roles that may increase social justice, and understand how the roles and trends in community health nursing in Israel may differ from developments in other countries. In‐depth interviews were performed with 55 Israeli health system professionals, and 692 nurse care‐givers were asked open‐ended questions. Interview answers were analyzed to find themes and trends. The study found that community nurse roles in Israel have expanded, especially for chronic disease control. Commonalities exist with countries such as the United States and the UK, albeit with important differences. However, continued conflicts with physicians exist, which can limit nurses' contributions to reducing health inequalities. Community nurses' importance is growing. Enabling them to overcome professional dominance and improve chronic disease control can help reduce health inequalities in Israel and elsewhere. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has adversely affected health care systems and dialysis access care in the US and across the globe. Beyond the initial challenges posed by the pandemic and despite the actions taken by health care leaders/organizations/professional societies such as the "Maintaining Lifelines for ESKD Patients" joint statement, there continues to be delays in providing timely care and performing elective and emergent dialysis access procedures worldwide. The aim of this study was to assess the global challenges associated with providing dialysis vascular access care across the international vascular access community during the pandemic., Methods: The American Society of Diagnostic and Interventional Nephrology (ASDIN) conducted an online survey in 2021, that was administered to an expert panel of dialysis vascular access specialists and global leaders spanning across the international community. The respondents who are members of ASDIN, Association of Vascular Access and InTerventionAl Renal physicians (AVATAR), Asia Pacific Society of Dialysis Access (APSDA), Peruvian Vascular Access Society (APDAV), and Australia/New Zealand Society of Interventional Nephrology (ANZSIN) reported their experiences in the care of dialysis vascular access, practice patterns, and challenges faced during the COVID pandemic., Results: Of the 53 individual surveys sent, 16 were opened and 11 (69%) responses were received from across the world and from different practice settings. The survey revealed the continued challenges facing the international community, the stark disparities in care delivery, supply chain disruption and logistical, regulatory, and financial issues that the global community continues to face in the ongoing pandemic., Conclusions: The COVID19 pandemic is far from over, and the challenges and barriers to providing dialysis access care seen on the initial ASDIN survey in the US seem to extend across the globe. We describe those results and discuss options, opportunities, and innovative tools to provide dialysis and access care during these trying times., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Community health projects have played a crucial role in improving health issues. Listening to communities' voices and achieving community ownership are essential for conducting effective health projects. However, there are limited studies on the frameworks for collecting, aggregating, and operationalizing community preferences and values. In this study, we selected two cases of community field surveys from Japan and Cambodia to discuss who may represent a community and propose a practical approach to achieving community ownership. Both cases involved various stakeholders. From the insights of these two cases, we suggested the following three key components in the community project: the community representative, the communicator, and the institute outside the community. Notably, the community representative's role as the community's direct voice should be properly recognized and institutionalised to establish community ownership. We proposed the following key terms of the qualifications of community representatives: they should be able to represent voices from the community, should have extensive experience to decide the project direction and manage the project, and should be independent of outside actors. Our theoretical model of the structure of different stakeholder groups in community-based projects will be helpful to accelerate community capacity strengthening; moreover, it can help build the appropriate community institution and process, including multi-stakeholder groups to promote community ownership in health programs., (© 2023 John Wiley & Sons Ltd.)

Purpose: Breastfeeding behaviours are routinely assessed in worldwide capacities, and the World Health Organization (WHO) European Region has the lowest rates of exclusive breastfeeding. Rates in Italy are not well documented but suggest breastfeeding rates are rising since the early 2000s. Professional recommendations suggest exclusive breastfeeding should persist until the infant is at least six to twelve months of age. However, barriers to adhering to this recommendation exist, often resulting in a lack of initiation or premature cessation of breastfeeding behaviours. This study explored women's perceptions, attitudes, and experiences with breastfeeding living in Florence, Italy. Methods: Participants were 44 reproductive-aged (M = 31.7 ± 6.14; Range = 19 to 45 years) women currently utilizing the Italian healthcare system. All participants completed an in-depth, individual interview between June and August 2017 on topics related to reproductive health, including breastfeeding. Results: Resulting themes relate to breastfeeding trends and influences, the role of identity and empowered choice, as well as perspectives on public breastfeeding. Conclusions: Findings provide practical recommendations for future exploration and social marketing campaign application related to breastfeeding decision-making empowerment. Results can also be used for between-country comparison of breastfeeding behaviours and attitudes. [ABSTRACT FROM AUTHOR]

The ethics of providing health care in resource-poor environments is a complex topic. It implies two related questions: What can we do with the resources on hand? Of all the things we can do, which ones should we do? "Resource-poor" (i.e., resource-challenged, resource-constrained) environments are situations in which clinicians, organizations, or healthcare systems have the knowledge and skills, but not the means, to carry out highly effective and beneficial interventions. Determinants of a population's health often rely less on disease and injury management than on recognizing and meeting their basic needs. Many of the world's people with the greatest health problems live in fragile contexts and remote areas. Their access to food, safe water, personal safety, improved sanitation facilities, and health care remains elusive, with availability often based on socioeconomic status, gender, ethnicity, or geography. Of course, ethical international healthcare work also requires an understanding of the illnesses and injuries that most frequently plague the population. To function ethically and to know both what can and what should be done with available resources, individuals and organizations involved in international healthcare must be experienced, adaptable, culturally sensitive, inspired, situationally aware, beneficent, courageous, honest, and fair. [ABSTRACT FROM AUTHOR]

Depression is common among people living with HIV/AIDS and contributes to a wide range of worsened HIV-related outcomes, including AIDS-related mortality. Targeting modifiable causes of depression, either through primary or secondary prevention, may reduce suffering as well as improve HIV-related outcomes. Food insecurity is a pervasive source of uncertainty for those living in resource-limited settings, and cross-sectional studies have increasingly recognized it as a critical determinant of poor mental health. Using cohort data from 456 men and women living with HIV/AIDS initiating HIV antiretroviral therapy in rural Uganda, we sought to (a) estimate the association between food insecurity and depression symptom severity, (b) assess the extent to which social support may serve as a buffer against the adverse effects of food insecurity, and (c) determine whether the buffering effects are specific to certain types of social support. Quarterly data were collected by structured interviews and blood draws. The primary outcome was depression symptom severity, measured by a modified Hopkins Symptom Checklist for Depression. The primary explanatory variables were food insecurity, measured with the Household Food Insecurity Access Scale, and social support, measured with a modified version of the Functional Social Support Questionnaire. We found that food insecurity was associated with depression symptom severity among women but not men, and that social support buffered the impacts of food insecurity on depression. We also found that instrumental support had a greater buffering influence than emotional social support. Interventions aimed at improving food security and strengthening instrumental social support may have synergistic beneficial effects on both mental health and HIV outcomes among PLWHA in resource-limited settings.

Purpose: Breastfeeding behaviours are routinely assessed in worldwide capacities, and the World Health Organization (WHO) European Region has the lowest rates of exclusive breastfeeding. Rates in Italy are not well documented but suggest breastfeeding rates are rising since the early 2000s. Professional recommendations suggest exclusive breastfeeding should persist until the infant is at least six to twelve months of age. However, barriers to adhering to this recommendation exist, often resulting in a lack of initiation or premature cessation of breastfeeding behaviours. This study explored women’s perceptions, attitudes, and experiences with breastfeeding living in Florence, Italy. Methods: Participants were 44 reproductive-aged (M = 31.7 ± 6.14; Range = 19 to 45 years) women currently utilizing the Italian healthcare system. All participants completed an in-depth, individual interview between June and August 2017 on topics related to reproductive health, including breastfeeding. Results: Resulting themes relate to breastfeeding trends and influences, the role of identity and empowered choice, as well as perspectives on public breastfeeding. Conclusions: Findings provide practical recommendations for future exploration and social marketing campaign application related to breastfeeding decision-making empowerment. Results can also be used for between-country comparison of breastfeeding behaviours and attitudes.

Abstract Globalization is a fairly recent addition to the panoply of concepts describing the internationalization of health concerns. What distinguishes it from ‘international health’ or its newer morphing into ‘global health’ is a specific analytical concern with how globalization processes, past or present, but particularly since the start of our neoliberal era post-1980, is affecting health outcomes. Globalization processes influence health through multiple social pathways: from health systems and financing reforms to migration flows and internal displacement; via trade and investment treaties, labour market ‘flexibilization’, and the spread of unhealthy commodities; or through deploying human rights and environment protection treaties, and strengthening health diplomacy efforts, to create more equitable and sustainable global health outcomes. Globalization and Health was a pioneer in its focus on these critical facets of our health, well-being, and, indeed, planetary survival. In this editorial, the journal announces a re-focusing on this primary aim, announcing a number of new topic Sections and an expanded editorial capacity to ensure that submissions are ‘on target’ and processed rapidly, and that the journal continues to be on the leading edge of some of the most contentious and difficult health challenges confronting us.

Abstract Background To design and implement an emergency medicine (EM) postgraduate training curriculum to support the establishment of the first EM residency program at Addis Ababa University (AAU). Methods In response to the Ethiopian Federal Ministry of Health mandate to develop EM services in Ethiopia, University of Toronto EM faculty were invited to develop and deliver EM content and expertise for the first EM postgraduate residency training program at AAU. The Toronto Addis Ababa Academic Collaboration-EM (TAAAC-EM) used five steps of a six-step approach to guide curriculum development and implementation: 1. Problem identification and general needs assessment, 2. Targeted needs assessment using indirect methods (interviews and site visits of the learners and learning environment), 3. Defining goals and objectives, 4. Choosing educational strategies and curriculum map development and 5. Implementation. Results The needs assessment identified a learning environment with appropriate, though limited, resources for the implementation of an EM residency program. A lack of educational activities geared towards EM practice was identified, specifically of active learning techniques (ALTs) such as bedside teaching, simulation and procedural teaching. A curriculum map was devised to supplement the AAU EM residency program curriculum. The TAAAC-EM curriculum was divided into three distinct streams: clinical, clinical epidemiology and EM administration. The clinical sessions were divided into didactic and ALTs including practical/procedural and simulation sessions, and bedside teaching was given a strong emphasis. Implementation is currently in its seventh year, with continuous monitoring and revisions of the curriculum to meet evolving needs. Conclusion We have outlined the design and implementation of the TAAAC-EM curriculum; an evaluation of this curriculum is currently underway. As EM spreads as a specialty throughout Africa and other resource-limited regions, this model can serve as a working guide for similar bi-institutional educational partnerships seeking to develop novel EM postgraduate training programs.

The article by Monique and Jeffery Wubbenhorst asks the question—Should Evangelical Christian Organizations Support International Family Planning?1 The article’s response to this question shows a lack of understanding of the fundamentals of population dynamics in the modern world as well as of the critical role contraceptives play in preventing unintended pregnancies and abortions and promoting maternal and child health. These errors are compounded by selective citation and misrepresentation of the evidence in the scientific literature. This commentary seeks to provide a balanced view of the evidence and correct several unfounded assertions in order to document why evangelical Christians and Christian organizations are, in fact, providing family planning services around the world. Specific points addressed are as follows: fundamentals of the global demographic transition including how the contraceptive revolution has slowed world population growth; the social, economic, and cultural forces driving couples to choose to control their fertility for the welfare of their families; the critical role of contraceptive practice in preventing unintended pregnancies and abortions as well as directly promoting safe motherhood and child health; the evidence that women and couples in less-developed countries desire to control their fertility as attested by the measurement of unmet need for family planning; and the reason why failing to provide poor women and couples in less-developed countries who want to control their fertility with the information and contraceptive methods of their choice is likely to lead to unintended pregnancies and more abortions. Christian health professionals and organizations need to be in the world, working with people of all belief systems, since that is a powerful way for the world to be reached with the love of Jesus and the gospel of salvation.

Neonatal mortality remains a significant health problem in low-income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990 to 2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact (SSC) and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the 1st day (community-based studies) of life. Implementation strategies and outcomes were categorized according to published frameworks: Expert Recommendations for Implementing Change and Outcomes for Implementation Research. The relationship between implementation strategies and outcomes was evaluated using standardized mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3-31 implementation strategies, though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1-4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality. [ABSTRACT FROM AUTHOR]

Purpose: The importance of assistive technology (AT) as a pillar of universal health coverage was recognized at the 71st World Health Assembly (WHA) through the passing of Resolution 71.8 on improving access to AT (May 2018). A systematic analysis was conducted on the responses made to the Resolution by Member States and non-state actors, in order to provide a snapshot of global intent. Methods: Qualitative content analysis was conducted on over 40 written "Statements" made by Member States and non-state actors in response to Resolution 71.8. Results: The Resolution provides tangible guidance to the World Health Organisation (WHO) and its member states in order for them to meet commitments within the Convention on the Rights of Persons with Disabilities (CRPD). Statements made in response to the Resolution offer a unique plethora of multi-stakeholder views from differing global perspectives. Analysis identified a range of themes within two overarching themes: intersection of health, human rights and sustainable development; and international collaboration and support within an international agenda framework. Conclusion: The content analysis synthesises complex global data and identifies directions to positively influence national and regional AT policy and delivery. The complexity of factors demonstrates the importance of an AT systems-thinking approach; that is, the development and application of organised knowledge, skills, procedures and policies related to assistive products. AT systems thinking will be essential for AT to be effectively deployed as a pillar of universal health coverage. Assistive technology is a key facilitator of health and well-being, playing a critical role in global efforts to improve population health outcomes and strengthening health systems Access to assistive technology is a public health priority and is an essential health product to be covered under Universal Health Coverage Effective action on access to assistive technology must encompass the reality of diverse contexts yet common purposes expressed by global actors This analysis demonstrates the intersection of the health, human rights and sustainable development agendas, and the importance of international collaboration and support in achieving effective access [ABSTRACT FROM AUTHOR]

Background: Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare.Objectives: This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined "availability of patient data" as the ability to access data in and to add data to the patient record in the respective country.Methods: The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators.Results: Availability of patient-related information varies strongly by country. Health care professionals can access patients' most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden.Conclusion: Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future. [ABSTRACT FROM AUTHOR]

Background: Egypt plays a pivotal role in North Africa and the Middle East, and has the largest population of any Arab country and serves as a regional cultural hub. Emergency medicine as a field of study was first initiated at Alexandria University in 1978, but it was only formally recognized as a medical specialty in 2002. Since then, the prehospital system and practice of emergency medicine has evolved and grown.Objectives: This article will outline the development of emergency medicine in Egypt, including infrastructure, education, specialty certification, and future challenges, including those which are common to other specialties in development, and also those which are unique to Egypt.Discussion: Opportunities remain with respect to the development of emergency medicine in Egypt, most notably in a continuing 'brain drain' of physicians who leave the country after receiving training, supervision, and oversight of residency programs, and general public and professional awareness of this new specialty.Conclusion: Egypt has made great strides with respect to the delivery of emergency services, physician education and certification within the specialty of emergency medicine. Learning about these developments in Egypt will provide the reader with a compelling example of how an emergency system is developed in an advancing national setting. [ABSTRACT FROM AUTHOR]

Public health in China has become a global concern as a consequence of the outbreak and worldwide spread of COVID-19. This article examines the historical place of China in international and global health. Contrary to prevalent narratives in the history of medicine, China and Chinese historical actors played key roles in this field throughout the twentieth century. Several episodes illustrate this argument: the Qing organization of the International Plague Conference in 1911; the role of China in the work of the interwar League of Nations Health Organization and postwar establishment of the World Health Organization; Cold War medical diplomacy; and Chinese models of primary health care during the 1970s. These case studies together show that Chinese physicians and administrators helped shape concepts and practices of "global health" even before that term rose to prominence in the 1990s, and current events are best understood in the context of this history. [ABSTRACT FROM AUTHOR]

The global response to the COVID-19 pandemic has laid bare weaknesses and major challenges in the international approach to managing public health emergencies. Populist sentiment is spreading globally as democratic nations are increasing their support for or electing governments that are perceived to represent "traditional" native interests. Measures need to be taken to proactively address populist sentiment when reviewing the IHR (2005) effectiveness in the COVID-19 pandemic. We discuss how populism can impact the IHR (2005) and conversely how the IHR (2005) may be able to address populist concerns if the global community commits to helping states address public health threats that emerge within their borders. [ABSTRACT FROM AUTHOR]

Background: Globally, depression is a leading cause of morbidity and mortality particularly in Low and Middle-Income Countries (LMICs). The burden of non-communicable diseases (NCDs) are also increasing in LMICs, the conditions frequently co-occur and exacerbate NCD outcomes. Depression interventions alone are not effective at improving NCD outcomes, resulting in wide-reaching calls for integrated services. Integrated services are in a nascent phase in LMICs in general and in Malawi in particular. This manuscript serves to clarify Malawian patients' attitudes and perceptions towards depression integration into routine NCD services. Methods: Ten District Hospitals were selected for data collection and 2 participants were interviewed from each site (N = 20). An iterative approach to concept-driven coding was applied to facilitate the formation of similarities, differences, and connections between codes. Results: While patients infrequently described moderate depression as a medical condition, and held various attitudes regarding treatments, they agreed on the appropriateness of integrated services. Patients' respect for their providers led them to support integration. Patients discussed how medical knowledge is highly regarded, revealing a power dynamic with their providers. Patients further acknowledged the importance of a provider's communication in shaping a patient's feelings about depression. Conclusions: Training and interventions that facilitate providers' abilities to transfer their medical knowledge, use strategies to channel their power, and engage patients in a meaningful and collaborative relationship will be key to successfully integrating depression treatment into Malawian NCD clinics. Trial registration: This work served as part of formative data collection for National Institute of Mental Health (NIMH) Trail NCT03711786 registered on 10th October, 2018. [ABSTRACT FROM AUTHOR]

Background: Global Health has increasingly gained international visibility and prominence. First and foremost, the spread of cross-border infectious disease arouses a great deal of media and public interest, just as it drives research priorities of faculty and academic programmes. At the same time, Global Health has become a major area of philanthropic action. Despite the importance it has acquired over the last two decades, the complex collective term "Global Health" still lacks a uniform use today.Objectives: The objective of this paper is to present the existing definitions of Global Health, and analyse their meaning and implications. The paper emphasises that the term "Global Health" goes beyond the territorial meaning of "global", connects local and global, and refers to an explicitly political concept. Global Health regards health as a rights-based, universal good; it takes into account social inequalities, power asymmetries, the uneven distribution of resources and governance challenges. Thus, it represents the necessary continuance of Public Health in the face of diverse and ubiquitous global challenges. A growing number of international players, however, focus on public-private partnerships and privatisation and tend to promote biomedical reductionism through predominantly technological solutions. Moreover, the predominant Global Health concept reflects the inherited hegemony of the Global North. It takes insufficient account of the global burden of disease, which is mainly characterised by non-communicable conditions, and the underlying social determinants of health.Conclusions: Beyond resilience and epidemiological preparedness for preventing cross-border disease threats, Global Health must focus on the social, economic and political determinants of health. Biomedical and technocratic reductionism might be justified in times of acute health crises but entails the risk of selective access to health care. Consistent health-in-all policies are required for ensuring Health for All and sustainably reducing health inequalities within and among countries. Global Health must first and foremost pursue the enforcement of the universal right to health and contribute to overcoming global hegemony. [ABSTRACT FROM AUTHOR]

The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014-15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community-based surveillance teams. To achieve meaningful CE, participants recommended that communities be treated as active participants in-as opposed to passive recipients of-health response efforts and that communication platforms for CE be established ahead of a crisis. Participant responses highlight that meaningful CE led to improved communication with and increased trust in health authorities and programming. This facilitated health system response efforts, leading to a fortuitous cycle of increased trust, improved communication and continued meaningful CE-all necessary conditions for health system resilience. This study refines our understanding of CE and demonstrates the ways in which meaningful CE and trust work together in mutually reinforcing and beneficial ways. These findings provide empirical evidence on which to base policies and programmes aimed at improving health system resilience in low-resource settings to more effectively respond to health system crises. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of nurse-led counselling on the anxiety symptoms and the quality of life following percutaneous coronary intervention for stable coronary artery disease. Design: Randomised control trial. Setting: Rural and remote China. Participants: Rural and remote patients were consecutively recruited from a medical centre located in China between January and December 2014. Interventions: The control group received standard pre-procedure information from a ward nurse on the processes of the hospitalisation and percutaneous coronary intervention, and post-procedural care. The intervention group received a structured 30-minute counselling session the day before and 24 hours after the percutaneous coronary intervention, by nurse consultants with qualifications in psychological therapies and counselling. The health outcomes were assessed by a SF-12 scale and the Seattle Angina Questionnaire at 6 and 12 months after percutaneous coronary intervention. The anxiety and depression symptoms were evaluated by a Zung anxiety and depression questionnaire. Main outcome measures: Cardiac outcomes, quality of life and mental health status. Results: Eighty patients were randomly divided into control (n = 40) and intervention groups (n = 40). There was a significant increase in the scores of the three domains of Seattle Angina Questionnaire 12 months after percutaneous coronary intervention in the intervention group (P < .01). The mental health and physical health scores also increased (P < .01). In the control group, the mean scores of Zung self-rating anxiety scale 12 months following percutaneous coronary intervention were higher than the baseline scores, and higher than in the intervention group (P < .01). Conclusions: Counselling by a clinician qualified in psychological therapies and counselling significantly reduces anxiety symptoms and improves quality of life. [ABSTRACT FROM AUTHOR]

Introduction: The Integrated Telemedicine and e-Health program (ITeHP) of Albania, built by the International Virtual e-Hospital Foundation (IVeH), has improved access to high-quality health care, particularly in high demanding specialty disciplines. We aimed to test the hypothesis that the majority of patients in remote and regional hospitals can be managed using telemedicine and will prevent unnecessary transfers. Methods: A retrospective analysis of prospectively collected data of patients seen between January 2014 and September 2018 was conducted. Patient demographics, type of teleconsultation modality used, and patient disposition were analyzed. The comparison of continuous data was performed with t-test or Mann-Whitney test. The categorical data were tested with chi-squared test and analysis of variance. Results: There were 2,842 patients seen in all the clinical disciplines during the study period. We excluded tele-autism and incomplete data. There were 2,724 records eligible for study. The most frequent consulting clinical programs (82.9%) were teleradiology (39.0%), teleneurotrauma (27.2%), and teletestroke (16.7%). The majority of patients (77.9%) were kept at regional centers and did not require transfer (p < 0.001) to a tertiary center. Of those transferred, 70.3% were male (p < 0.001), of which 81.6% were for transferred due to neurotrauma. Conclusion: The telemedicine program in Albania has improved access to specialized care in a number of specialty clinical disciplines, particularly in potentially life-threatening and time-sensitive conditions such as neurotrauma. Almost 80% of patients did not require transfer to tertiary centers and were kept for further treatment at the regional centers. [ABSTRACT FROM AUTHOR]

Acute bronchiolitis epidemics are known to destabilize healthcare structures and stand as a major public health issue. Our tertiary care regional university hospital designed an organizational infrastructure paediatric plan (OIPP) to adapt to bronchiolitis epidemics. This study aimed to assess the impact of the OIPP on the length of stay and quality of care of children hospitalized for bronchiolitis. This epidemiological study analyzed data from 2 epidemic seasons before and after the OIPP implementation. The OIPP used a standardized algorithm of patient orientation and a 4-level stratification of care. A total of 1636 children were included in the study, with 718 children before and 918 children after the OIPP implementation. The length of stay significantly decreased after the OIPP implementation, from 5.1 ± 6.8 days to 3.9 ± 3 days (P < 0.001). The 30-day readmission for bronchiolitis remained stable (4.6% vs. 3.4%, P = 0.2). The net annual patient service revenue increased from 1,292,532 € to 1,545,720 €. The implementation of the OIPP resulted in a significant decrease in the average hospital length of stay. This plan improved patients' quality of care while maintained a balanced budget. Trial registration number: ClinicalTrials.gov NCT03663660. [ABSTRACT FROM AUTHOR]

Background: People in socially disadvantaged groups face a myriad of challenges to their health. Discrimination, based on group status such as gender, immigration generation, race/ethnicity, or religion, are a well-documented health challenge. However, less is known about experiences of discrimination specifically within healthcare settings, and how it may act as a barrier to healthcare.Methods: Using data from a nationally representative survey of France (N = 21,761) with an oversample of immigrants, we examine rates of reported discrimination in healthcare settings, rates of foregoing healthcare, and whether discrimination could explain disparities in foregoing care across social groups.Results: Rates of both reporting discrimination within healthcare and reporting foregone care in the past 12 months were generally highest among women, immigrants from Africa or Overseas France, and Muslims. For all of these groups, experiences of discrimination potentially explained significant proportions of their disparity in foregone care (Percent disparity in foregone care explained for: women = 17%, second-generation immigrants = 8%, Overseas France = 13%, North Africa = 22%, Sub-Saharan Africa = 32%, Muslims = 26%). Rates of foregone care were also higher for those of mixed origin and people who reported "Other Religion", but foregone healthcare was not associated with discrimination for those groups.Conclusions: Experiences of discrimination within the healthcare setting may present a barrier to healthcare for people that are socially disadvantaged due to gender, immigration, race/ethnicity, or religion. Researchers and policymakers should consider barriers to healthcare that lie within the healthcare experience itself as potential intervention targets. [ABSTRACT FROM AUTHOR]

With the increase in patient and consumer activism through the late twentieth century and into this century, patient roles in research evolved into a new model of research engagement, with patients serving as active advisors and co-leading or leading clinical research. By requiring active engagement of patients and other stakeholders, several government research funders have advanced this model, particularly in Canada, the United States (US), United Kingdom (UK), and Australia. A consortium of individuals from these countries formed a Multi-Stakeholder Engagement (MuSE) consortium to examine critical issues in engaged research, establish consensus on definitions, and provide guidance for the field, beginning with an overview of how to involve stakeholders in health research (Concannon et al. J Gen Intern Med. 2019;34(3):458-463) and continuing here with an examination of definitions of research engagement. The political and advocacy roots of engaged research are reflected in definitions. Engagement is conceptualized with reference to research project goals, from informing specific clinical decisions to informing health-system level decisions. Political and cultural differences across countries are evident. Some of these government funders focus on empirical rather than ethical rationales. In countries with centralized health technology assessment, the link between societal values and engaged research is explicit. Ethical rationales for engagement are explicit in most of the published literature on research engagement. Harmonization of definitions is recommended so that research engagement elements, methods, and outcomes and impacts can be clearly examined and understood, and so that the field of research engagement can proceed from a clear conceptual foundation. Specific recommendations for terminology definitions are provided. Placing engaged research on a continuum from specific clinical decisions to more global public and social justice concerns clarifies the type of engaged research, supports appropriate comparisons, and improves the rigor of engaged research methods. The results help identify knowledge gaps in this growing field. [ABSTRACT FROM AUTHOR]

The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP. [ABSTRACT FROM AUTHOR]

Despite being one of Asia's major economies with a population of over 23 million, Taiwan has been mostly excluded from the World Health Assembly/World Health Organization (WHA/WHO) since 1972, due to China's objection. While this has not stopped Taiwan from developing a comprehensive healthcare system and being an active member of international health community, the lack of membership in the world's leading health authority undermines global health and presents perverse, and yet often neglected, inequality faced by Taiwanese people. This article aims to provide contextual information concerning the impacts of Taiwan's exclusion from WHA/WHO by: (1) enumerating health-related areas where Taiwan has rich knowledge and experiences that would have been cascaded much more widely and efficiently to those in need around the world had it been allowed to participate; and (2) highlighting difficulties faced by Taiwanese people and potential threats to international health arising from the exclusion. [ABSTRACT FROM AUTHOR]

An expansive, worldwide smallpox eradication programme (SEP) was announced by the World Health Assembly in 1958, leading this decision-making body to instruct the World Health Organization Headquarters in Geneva to work with WHO regional offices to engage and draw in national governments to ensure success. Tabled by the Soviet Union's representative and passed by a majority vote by member states, the announcement was subject to intense diplomatic negotiations. This led to the formation, expansion and reshaping of an ambitious and complex campaign that cut across continents and countries. This article examines these inter-twining international, regional and national processes, and challenges long-standing historiographical assumptions about the fight against smallpox only gathering strength from the mid-1960s onwards, after the start of a US-supported programme in western Africa. The evidence presented here suggests a far more complex picture. It shows that although the SEP's structures grew slowly between 1958 and 1967, a worldwide eradication programme resulted from international negotiations made possible through gains during this period. Significant progress in limiting the incidence of smallpox sustained international collaboration, and justified the prolongation and expansion of activities. Indeed, all of this bore diplomatic and legal processes within the World Health Assembly and WHO that acted as the foundation of the so-called intensified phase of the SEP and the multi-faceted activities that led to the certification of smallpox eradication in 1980. [ABSTRACT FROM AUTHOR]