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Immunomodulating agents interact with the immune system and alter the outcome of specific immune processes. As our understanding of the immune system continues to evolve, there is a growing effort to identify agents with immunomodulating applications to use therapeutically to treat various diseases. Mycobacterium w (Mw), a heat-killed mycobacterium, is an atypical mycobacterial species that possesses strong immunomodulatory properties. Mw was initially evaluated as an immune-therapeutic against leprosy, but since then Mw has generated a lot of interest and been studied for therapeutic applications across a host of diseases, such as pulmonary tuberculosis, tuberculous pericarditis, sepsis, lung cancer, and more. This article summarizes a large body of work published in the past five decades, describing various aspects of Mw and its potential for further therapeutic development. [ABSTRACT FROM AUTHOR]

Objective To understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines. Methods We conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines--Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality Improvement programmes--were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines' implementation. Findings We identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources, that together described 140 implementation events. Implementation evidence could be found for 51 countries--14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle Income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as Incorporations into policy and 19 (14%) as educational interventions. Conclusion Although WHO's trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed. Objectif Comprendre dans quelle mesure ont ete utilisees les lignes directrices pour les soins en traumatologie, publiees par l'Organisation mondiale de la Sante (OMS) entre 2004 et 2009, et definir des priorites pour la mise en oeuvre et la diffusion futures de ces lignes directrices. Methodes Nous avons procede a une revue systematique de 19 bases de donnees, en utilisant les titres anglais des trois series de lignes directrices--Guidelines for essential trauma care, Prehospital trauma care systems et Guidelines for trauma quality improvement programmes --comme termes de recherche. Les resultats ont ete valides par une analyse de citations et une consultation d'experts. Deux auteurs ont revu de facon independante chaque occurrence d'application des lignes directrices. Resultats Nous avons releve 578 occurrences qui mettaient en evidence la diffusion des lignes directrices de l'OMS concernant les soins en traumatologie et 101 sources d'information qui decrivaient 140 cas de mise en oeuvre de ces lignes directrices. Nous avons trouve des 'elements indiquant leur mise en oeuvre dans 51 pays-14 (40%) des 35 pays a revenu faible, 15 (32%) des 47 pays a revenu intermediaire tranche inferieure, 15 (28%) des 53 pays a revenu intermediaire-tranche superieure et 7 (12%) des 59 pays a revenu eleve. Sur les 140 cas de mise en oeuvre, 63 (45%) relevaient d'evaluations des besoins, 38 (27%) d'approbdtions des parties prenantes, 20 (14%) d'integrations a des politiques et 19 (14%) d'interventions pedagogiques. Conclusion Bien que les lignes directrices de l'OMS concernant les soins en traumatologie aient ete appliquees dans une large mesure, aucun element n'a permis de montrer leur mise en oeuvre dans 143 pays. Il est necessaire de realiser davantage d'evaluations des besoins en serie pour le suivi continu des capacites en matiere de soins en traumatologie dans les systemes de sante et d'integrer davantage ces lignes directrices dans l'education formelle des professionnels de sante ainsi que dans les politiques de sante. Objetivo Comprender hasta que punto se han utilizado las directrices sobre la atencion de traumatismos publicadas por la Organizacion Mundial de la Salud (OMS) entre 2004 y 2009 e identificar las prioridades para la futura implementacion y difusion de dichas directrices. Metodos Se llevo a cabo una revision sistematica, de 19 bases de datos, en la que se utilizaron como terminos de busqueda los titulos de tres conjuntos de directrices: Guidelines for essential trauma care, Prehospital trauma care systems y Guidelines for trauma quality improvement programmes. Se validaron los resultados a traves de un analisis de citas y consultas a expertos. De forma independiente, dos autores revisaron todos los informes de la implementacion de las directrices. Resultados Se identificaron 578 informes que demostraron la difusion de las directrices sobre la atencion de traumatismos de la OMS y 101 fuentes de informacion que describian 140 casos de implementacion. Se pudieron encontrar los casos de implementacion de 51 paises: 14(40%) de los 35 paises de ingresos bajos, 15 (32%) de los 47 paises de ingresos medios, 15 (28%) de los 53 paises de ingresos medios-altos y 7 (12%) de los 59 paises de ingresos altos. De las 140 implementaciones, 63 (45%) podrian categorizarse como evaluaciones de necesidades, 38 (27%) como avales de partes interesadas, 20 (14%) como incorporaciones en la politica y 19 (14%) como intervenciones educativas. Conclusion A pesar de que las directrices sobre la atencion de traumatismos de la OMS se han implementado con cierta amplitud, no se ha demostrado su implementadon en los 143 paises. Es necesario realizar mas evaluaciones de necesidades para evaluacion continuada de la capacidad de la atencion de traumatismos en los sistemas sanitarios, asi como una mayor incorporacion de las directrices tanto en la educacion formal de los profesionales sanitarios como en las politicas sanitarias., Introduction As a result of the unsafe conditions and the relatively poor outcomes once someone is injured in low- and middle-income countries, about 90% of the global burden of injury-related [...]

Musculoskeletal (MSK) health impairments contribute substantially to the pain and disability burden in low- and middle-income countries (LMICs), yet health systems strengthening (HSS) responses are nascent in these settings. We aimed to explore the contemporary context, framed as challenges and opportunities, for improving population-level prevention and management of MSK health in LMICs using secondary qualitative data from a previous study exploring HSS priorities for MSK health globally and (2) to contextualize these findings through a primary analysis of health policies for integrated management of non-communicable diseases (NCDs) in select LMICs. Part 1: 12 transcripts of interviews with LMIC-based key informants (KIs) were inductively analysed. Part 2: systematic content analysis of health policies for integrated care of NCDs where KIs were resident (Argentina, Bangladesh, Brazil, Ethiopia, India, Kenya, Malaysia, Philippines and South Africa). A thematic framework of LMIC-relevant challenges and opportunities was empirically derived and organized around five meta-themes: (1) MSK health is a low priority; (2) social determinants adversely affect MSK health; (3) healthcare system issues de-prioritize MSK health; (4) economic constraints restrict system capacity to direct and mobilize resources to MSK health; and (5) build research capacity. Twelve policy documents were included, describing explicit foci on cardiovascular disease (100%), diabetes (100%), respiratory conditions (100%) and cancer (89%); none explicitly focused on MSK health. Policy strategies were coded into three categories: (1) general principles for people-centred NCD care, (2) service delivery and (3) system strengthening. Four policies described strategies to address MSK health in some way, mostly related to injury care. Priorities and opportunities for HSS for MSK health identified by KIs aligned with broader strategies targeting NCDs identified in the policies. MSK health is not currently prioritized in NCD health policies among selected LMICs. However, opportunities to address the MSK-attributed disability burden exist through integrating MSK-specific HSS initiatives with initiatives targeting NCDs generally and injury and trauma care. [ABSTRACT FROM AUTHOR]

Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global prograrnmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy. Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children. Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. L'une des solutions au probleme grandissant pose par la traumatologie infantile reside dans le renforcement des soins delivres aux enfants victimes de traumatismes. Le present article attire l'attention sur les gains en matiere de sante realisables par un tel renforcement et passe ensuite en revue les progres recemment obtenus par differents etablissements et pays dans les soins aux enfants victimes de traumatismes. II examine comment ces efforts individuels ont ete aides par l'attention internationale grandissante accordee aux soins aux enfatns traumatises. Malgre l'absence de programme mondial de grande envergure et bien finance pour ameliorer ces soins, les recents documents-guides elabores par l'OMS et un large reseau de collaborateurs ont stimule l'interet mondial pour une meilleure planification et un meilleur financement de ces soins. A son tour, cet interet a attire davantage l'attention sur le renforcement des capacites de traitement des traumatismes dans les pays, y compris l'evaluation des besoins et la mise en ceuvre des recommandations de l'OMS dans le cadre des politiques nationales. Neanmoins, la plupart de ces efforts mondiaux ne visaient pas encore specifiquement les enfants. Les besoins particuliers des enfants victimes de traumatismes, comine la mortalite et la charge d'incapacite importantes liees aux traumatismes dans cette classe l'ages, appellent a donner une plus grande priorite aux soins prodigues a ces enfants. Les evaluations de ces soins menees dans un nombre grandissant de pays doivent se concentrer davantage sur les capacites de traitement des enfants. Les politiques de soins aux victimes de traumatismes doivent etre developpees de maniere a mieux integrer les soins aux enfants. Plus largement, le reseau en expansion des individus et des groupes collaborant au renforcement des soins aux victimes de traumatismes doit impliquer une gamme plus etendue de parties prenantes, qui concentreront leurs efforts sur l'amelioration des soins aux enfants aux enfants traumatises et militeront pour cette amelioration. Parte de la solucion al problema creciente de las lesiones infantiles consiste en fortalecer la asistencia que reciben los pacientes. En este articulo se senalan los potenciales beneficios sanitarios que se obtendrian, se examinan los avances recientes que se han realizado en materia de asistencia a los ninos con lesiones en diferentes instituciones y paises, y se analiza como ha contribuido a ello la mayor atencion prestada a nivel internacional a la asistencia a los traumatismos. Aunque no hay grandes programas mundiales bien financiados para mejorar la asistencia a los traumatismos, los documentos de orientacion elaborados recientemente por la OMS y una amplia red de colaboradores han estimulado un aumento de la atencion mundial a la mejora de la planificacion y de los recursos para la asistencia a los traumatismos, lo cual ha generado, a su vez, un aumento de la atencion al fortalecimiento de la capacidad de asistencia a los traumatismos en los paises, y en particular a la evaluacion de las necesidades y a la aplicacion de las recomendaciones de la OMS en las politicas nacionales. Sin embargo, la mayor parte de estos esfuerzos mundiales todavIa no se han ocupado especIficamente de los ninos. Dadas las necesidades especiales de los ninos con lesiones y la elevada mortalidad y discapacidad relacionadas con las lesiones en esta poblacion, hay una necesidad evidente de prestar mayor atencion a la asistencia a los traumatismos en la infancia. La elaboracion de politicas de asistencia a los traumatismos debe prestar mas atencion a los traumatismos infantiles. A un nivel mas general, la creciente red de individuos y grupos que estan colaborando en el fortalecimiento de la asistencia a los traumatismos necesita comprometer a una gama mas amplia de partes interesadas que se centren en la defensa de la mejora de la asistencia a los ninos victimas de lesiones., Introduction Injury has become a leading cause of death and disability globally. The two age groups most affected are older children (aged 5-14 years) and adolescents and younger adults (aged [...]

Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care. Keywords Emergency medical services/organization and administration; Emergency treatment/organization and administration; Triage; Transportation of patients; Allied health personnel/education; Cost-benefit analysis; Evidence-based medicine; Developing countries (source: MeSH, NLM). Mots cles Service medical urgences/organisation et administration; Traitement urgence/organisation et administration; Orientation patients; Transport sanitaire; Personnel sante auxiliaire/enseignement; Analyse cout benefice; Medecine factuelle; Pays en developpement (source: MeSH, INSERM). Palabras clave Servicios medicos de urgencia/organizacion y administracion; Tratamiento de urgencia/organizacion y administracion; Triaje; Transporte de pacientes; Tecnicos medios en salud/educacion; Analisis de costo-beneficio; Medicina basada en evidencia; Paises en desarrollo (fuente: DeCS, BIREME)., Introduction The goal of an effective emergency medical system should be to provide universal emergency care--that is, emergency care should be available to all who need it. However, there are [...]

Background: The completeness of a trauma registry's data is essential for its valid use. This study aimed to evaluate the extent of missing data in a new multicentre trauma registry in India and to assess the association between data completeness and potential predictors of missing data, particularly mortality. Methods: The proportion of missing data for variables among all adults was determined from data collected from 19 April 2016 to 30 April 2017. In-hospital physiological data were defined as missing if any of initial systolic blood pressure, heart rate, respiratory rate, or Glasgow Coma Scale were missing. Univariable logistic regression and multivariable logistic regression, using manual stepwise selection, were used to investigate the association between mortality (and other potential predictors) and missing physiological data. Results: Data on the 4466 trauma patients in the registry were analysed. Out of 59 variables, most (n = 51; 86.4%) were missing less than 20% of observations. There were 808 (18.1%) patients missing at least one of the first in-hospital physiological observations. Hospital death was associated with missing in-hospital physiological data (adjusted OR 1.4; 95% CI 1.02–2.01; p = 0.04). Other significant associations with missing data were: patient arrival time out of hours, hospital of care, 'other' place of injury, and specific injury mechanisms. Assault/homicide injury intent and occurrence of chest X-ray were associated with not missing any of first in-hospital physiological variables. Conclusion: Most variables were well collected. Hospital death, a proxy for more severe injury, was associated with missing first in-hospital physiological observations. This remains an important limitation for trauma registries. [ABSTRACT FROM AUTHOR]

Injury remains a major cause of death and disability worldwide, and places an enormous burden on countries with limited resources. The optimal way to reduce life-threatening injuries is through primary [...]

Road traffic injuries and injuries from other causes have become significant public health problems throughout the world, particularly in low- and middle-income countries (1). Each year, about 20 million people [...]

Injury has become a major cause of death and disability world-wide. Systematic approaches to its prevention and treatment are needed. In terms of treatment, there are many low-cost improvements that could be made particularly in low- and middle-income countries to strengthen their trauma systems. These can be formalised under “Essential Trauma Care” programme, similar to other global programmes for major public health problems.World Health Organisation (WHO), leading the initiative in this direction, convened a meeting at Geneva in June 2002, involving Injuries and Violence Prevention Department of the WHO, the Working Group for Essential Trauma Care of the International Association for Trauma and Surgical Intensive Care (IATSIC), representatives of other organisations and trauma care clinicians representing Africa, Asia, and Latin America.The meeting developed a preliminary list of Essential Trauma Care services and a model template for the skills and equipment needed to assure them. It is intended to be used to assist individual countries in planning their own trauma care services. [Copyright &y& Elsevier]

Background & objectives Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhanced, system-level trauma care to address this challenge. Methods Five working groups conducted separate literature reviews on pre-hospital trauma care, in-hospital trauma resuscitation and training, trauma systems, trauma registries, and India's Towards Improving Trauma Care Outcomes (TITCO) registry. Using a Delphi approach, the TRAIN Trauma India Symposium generated consensus statements and recommendations for interventions to streamline trauma care and reduce preventable trauma mortality in India and LMICs. Experts prioritized interventions based on cost and difficulty. Results An expert panel agreed on four pre-hospital consensus statements, eight hospital resuscitation consensus statements, six system-level consensus statements, and six trauma registry consensus statements. The expert panel recommended six pre-hospital interventions, four hospital resuscitation interventions, nine system-level interventions, and seven trauma registry interventions applicable to the Indian context. Of these, 14 interventions were ranked as low cost/low difficulty, five high cost/low difficulty, five low cost/high difficulty, and three high cost/high difficulty. Interpretation & conclusions This consensus underscores the urgent need for integrated and efficient trauma systems to reduce preventable mortality, emphasizing the importance of comprehensive care that includes community engagement and robust pre-hospital and acute hospital trauma care pathways. It highlights the critical role of inclusive, system-wide approaches, from enhancing pre-hospital care and in-hospital resuscitation to implementing effective trauma registries to improve outcomes and streamline care across contexts.

Background: The burden of injury is greatest in developing countries. Trauma systems have reduced mortality in developed countries and trauma registries are known to be integral to monitoring and improving trauma care. There are relatively few trauma registries in developing countries and no reviews describing the experience of each registry. The aim of this study was to examine the collective published experience of trauma registries in developing countries., Methods: A structured review of the literature was performed. Relevant abstracts were identified by searching databases for all articles regarding a trauma registry in a developing country. A tool was used to abstract trauma registry details, including processes of data collection and analysis., Results: There were 84 articles, 76 of which were sourced from 47 registries. The remaining eight articles were perspectives. Most were from Iran, followed by China, Jamaica, South Africa and Uganda. Only two registries used the Injury Severity Score (ISS) to define inclusion criteria. Most registries collected data on variables from all five variable groups (demographics, injury event, process of care, injury severity and outcome). Several registries collected data for less than a total of 20 variables. Only three registries measured disability using a score. The most commonly used scores of injury severity were the ISS, followed by Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS) and the Kampala Trauma Score (KTS)., Conclusion: Amongst the small number of trauma registries in developing countries, there is a large variation in processes. The implementation of trauma systems with trauma registries is feasible in under-resourced environments where they are desperately needed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: The burden of injury is very high in developing countries. Trauma systems reduce mortality; the trauma registry is a key driver of improvements in trauma care. Developing countries have begun to develop trauma systems but the level of local trauma registry activity is unclear. The aim of this study was to determine a global estimate of trauma registry activity., Methods: A structured review of the literature was performed. All abstracts referring to a trauma registry over a two-year period were included. For the trauma registry described in each abstract, the source country was recorded. An additional search of web pages posted over a one year period was conducted. Those linked to an active trauma registry website were included and the country of the trauma registry was recorded. A selection of trauma registries from countries of different levels of development were identified and compared., Results: 571 abstracts were included in the review. Most articles utilised "general" trauma registries (436(76%)) and were based at a single hospital (279(49%)). Other registries were limited to military or paediatric populations (36(6%) and 35(6%) articles respectively). Most articles sourced registries from the US (288(50%)), followed by Australia (45(8%)), Germany (32(6%)), Canada (27(5%)), UK (13(2%)), China (13(2%)) and Israel (12(2%)). The Americas produced most trauma registry articles and South East Asia the least. The majority of trauma registry articles originated from very highly developed countries 467(82%). Least developed countries had the fewest (5(1%)). The additional search yielded 37 web pages linked to 27 different trauma registry websites. Most of these were based in the US (16(59%)). The basic features of trauma registries, such as inclusion criteria, number and type of variables and injury severity scoring, varied widely depending on the country's level of development., Conclusion: This review, using a combination of the number of trauma registry articles and web pages to locate active trauma registries, demonstrated the disparity in trauma registry activity between the most and least developed countries. The absence of trauma care information systems remains a challenge to trauma system development globally., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

One of the striking deficiencies in the current health delivery structure is lack of focus on emergency care in primary health systems, which are ill-equipped to offer appropriate care in emergency situations resulting in a high burden of preventable deaths and disability. Emergency medical systems (EMS) encompass a much wider spectrum from recognition of the emergency, access to the system, provision of pre-hospital care, through definitive hospital care. The burden of death and disability resulting from lack of appropriate emergency care is very high in low- and middle-income countries. In South Asia, health services in general, and emergency care in particular, have failed to attract priority, investments and efforts for a variety of reasons. It has to be emphasized that integrating EMS with other health system components improves health care for the entire community, including children, the elderly, and other vulnerable groups with special needs. Out-of-facility care is an integral component of the health care system in South Asia. EMS focuses on out-of-facility care and also supports efforts to implement cost-effective community health care. There is a possibility of integration of other health services and programmes with an innovative, cost-effective EMS in the region.