scholarly journals Distance Management of Spinal Disorders in the COVID-19 pandemic and beyond: Evidence-based Patient and Clinician Guides from the Global Spine Care Initiative. (Preprint)

2020 ◽  
Author(s):  
Scott Haldeman ◽  
Michael Schneider ◽  
Ralph Gay ◽  
Jean Moss ◽  
Joan Haldeman ◽  
...  
Keyword(s):  
Low Income ◽  
Clinical Symptoms ◽  
Spinal Pain ◽  
Low Income Countries ◽  
Evidence Based ◽  
Spinal Disorders ◽  
Step Process ◽  
Record Keeping ◽  
Symptom Pattern ◽  
Spine Care

BACKGROUND The COVID-19 pandemic has greatly limited the access of patients to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic lockdown. In most low- and middle-income countries, as well as many underserved marginalized communities in high income countries there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. OBJECTIVE To describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. METHODS One set of guides for patients and one for clinicians were developed by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on four continents participated. They included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga as well as epidemiologists, research methodologists, and lay stakeholders. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. RESULTS The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care; when to contact a clinician, or when to seek emergency care. The Clinician Guide is a 5-step process. 1. Obtain and document patient demographics, location of primary clinical symptoms and psychosocial information. 2. Review the symptoms noted in the patient guide. 3. Determine of the GSCI classification of the patient’s spine related complaints. 4. Ask additional questions to determine the GSCI subclassification of the symptom pattern. 5. Consider appropriate treatment interventions. CONCLUSIONS The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine related symptoms or disorders including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government mandated physical or social distancing due to infections such as the COVID pandemic. They should also be of value in underserved communities in high, middle, and low-income countries where there is a dearth of accessible trained spine care clinicians, These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

scholarly journals Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative

10.2196/25484 ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e25484
Author(s):  
Scott Haldeman ◽  
Margareta Nordin ◽  
Patricia Tavares ◽  
Rajani Mullerpatan ◽  
Deborah Kopansky-Giles ◽  
...  
Keyword(s):  
Low Income ◽  
Clinical Symptoms ◽  
Spinal Pain ◽  
Low Income Countries ◽  
Evidence Based ◽  
Spinal Disorders ◽  
Step Process ◽  
Record Keeping ◽  
Symptom Pattern ◽  
Spine Care

Background The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient’s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

Environmental Hazards and Global Child Health: The Need for Evidence-Based Advocacy

2018 ◽  
pp. 255-276
Author(s):  
Philip J. Landrigan
Keyword(s):  
Air Pollution ◽  
Drinking Water ◽  
Environmental Health ◽  
Low Income ◽  
Environmental Hazards ◽  
Low Income Countries ◽  
Evidence Based ◽  
Environmental Threats ◽  
The World ◽  
Health Organization

Children in today’s ever-smaller, more densely populated, tightly interconnected world are surrounded by a complex array of environmental threats to health.1 Because of their unique patterns of exposure and exquisite biological sensitivities, especially during windows of vulnerability in prenatal and early postnatal development, children are extremely vulnerable to environmental hazards.2,3 Even brief, low-level exposures during critical early periods can cause permanent alterations in organ function and result in acute and chronic disease and dysfunction in childhood and across the life span.4 The World Health Organization estimates that 24% of all deaths and 36% of deaths in children are attributable to environmental exposures,5 more deaths than are caused by HIV/AIDS, malaria, and tuberculosis combined.6–8 In the Americas, the Pan American Health Organization estimates that nearly 100,000 children younger than 5 years die annually from physical, chemical, and biological hazards in the environment.9 Children in all countries are exposed to environmental health threats, but the nature and severity of these hazards vary greatly across countries, depending on national income, income distribution, level of development, and national governance.10 More than 90% of the deaths caused by environmental exposures occur in the world’s poorest countries6–8—environmental injustice on a global scale.11 In low-income countries, the predominant environmental threats are household air pollution from burning biomass and contaminated drinking water. These hazards are strongly linked to pneumonia, diarrhea, and a wide range of parasitic infestations in children.9,10 In high-income countries that have switched to cleaner fuels and developed safe drinking water supplies, the major environmental threats are ambient air pollution from motor vehicles and factories, toxic chemicals, and pesticides.10,12,13 These exposures are linked to noncommunicable diseases—asthma, birth defects, cancer, and neurodevelopmental disorders.9,10 Toxic chemicals are increasingly important environmental health threats, especially in previously low-income countries now experiencing rapid economic growth and industrialization.10 A major driver is the relocation of chemical manufacturing, recycling, shipbreaking, and other heavy industries to so-called “pollution havens” in low-income countries that largely lack environmental controls and public health infrastructure. Environmental degradation and disease result. The 1984 Bhopal, India, disaster was an early example.14 Other examples include the export to low-income countries of 2 million tons per year of newly mined asbestos15; lead exposure from backyard battery recycling16; mercury contamination from artisanal gold mining17; the global trade in banned pesticides18; and shipment to the world’s lowest-income countries of vast quantities of hazardous and electronic waste (e-waste).19 Climate change is yet another global environmental threat.20 Its effects will magnify in the years ahead as the world becomes warmer, sea levels rise, insect vector ranges expand, and changing weather patterns cause increasingly severe storms, droughts, and malnutrition. Children are the most vulnerable. Diseases of environmental origin in children can be prevented. Pediatricians are trusted advisors, uniquely well qualified to address environmental threats to children’s health. Prevention requires a combination of research to discover the environmental causes of disease coupled with evidence-based advocacy that translates research findings to policies and programs of prevention. Past successful prevention efforts, many of them led by pediatricians, include the removal of lead from paint and gasoline, the banning of highly hazardous pesticides, and reductions in urban air pollution. Future, more effective prevention will require mandatory safety testing of all chemicals in children’s environments, continuing education of pediatricians and health professionals, and enhanced programs for chemical tracking and disease prevention.

Utilization of Evidence-Based Therapy for Acute Coronary Syndrome in High Income and Middle/Low Income Countries

2013 ◽  
Vol 29 (10) ◽  
pp. S297-S298
Author(s):  
A. Shimony ◽  
S.M. Grandi ◽  
L. Pilote ◽  
L. Joseph ◽  
J. O'Loughlin ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Low Income ◽  
High Income ◽  
Low Income Countries ◽  
Evidence Based ◽  
Coronary Syndrome ◽  
Evidence Based Therapy

Challenges for Evidence-Based Care for Children With Developmental Delays in Nicaragua

2014 ◽  
Vol 28 (3) ◽  
pp. 226-237 ◽  
Author(s):  
Abraham A. Salinas-Miranda ◽  
Eric A. Storch ◽  
Robert Nelson ◽  
Claudia Evans-Baltodano
Keyword(s):  
Early Childhood ◽  
Low Income ◽  
Developmental Delays ◽  
Early Childhood Development ◽  
Economic Consequences ◽  
Childhood Development ◽  
Low Income Countries ◽  
Evidence Based ◽  
Low Income Country ◽  
Evidence Based Care

Evidence of successful models for promoting early childhood development and for effectively addressing developmental delays is available, yet the adoption of evidence-based strategies is limited in low-income countries. Nicaragua, a low-income country on the Central American isthmus, faces policy-, organizational-, and community-level obstacles which prevent families from receiving the benefits of early child development programs as well as other necessary services for children at risk of or with developmental delays. Failing to address developmental delays in a timely manner leads to detrimental social and economic consequences for families and society at large. In this article, we examine existing information on early childhood development in Nicaragua and discuss some programmatic implications for the recognition and early intervention of developmental delays in Nicaragua.

Global Health Perspective in Sarcomas and Other Rare Cancers

2018 ◽  
pp. 916-924 ◽  
Author(s):  
Vaia Florou ◽  
Antonio G. Nascimento ◽  
Ashish Gulia ◽  
Gilberto de Lima Lopes
Keyword(s):  
Radiation Therapy ◽  
Global Health ◽  
Low Income ◽  
Multidisciplinary Approach ◽  
Low Income Countries ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Management Guidelines ◽  
Systemic Treatments ◽  
Poor Outcomes

Sarcomas, rare and heterogenous malignancies that comprise less than 1% of all cancers, have poor outcomes in the metastatic and refractory setting. Their management requires a multidisciplinary approach that consists of medical and surgical oncologists, radiation oncologists, and pathologists as well as ancillary support. In addition to systemic treatments, most patients will require surgical resection and radiation therapy, which mandates the use of the latest technologies and specialized expertise. Management guidelines have been developed in high-income countries, but their applicability in low-income countries, where resources may be limited, remains a challenge. In this article, we propose the best possible evidence-based practices specifically for income-constrained settings to overcome this challenge. In addition, we review the different methods that can be used in low-income countries to access new and expensive treatments, which often times carry prohibitive costs for these areas.

scholarly journals How Poor Are People With Disabilities? Evidence Based on the Global Multidimensional Poverty Index

2020 ◽  
pp. 104420732091994 ◽  
Author(s):  
Monica Pinilla-Roncancio ◽  
Sabina Alkire
Keyword(s):  
Low Income ◽  
People With Disabilities ◽  
Multidimensional Poverty ◽  
Low Income Countries ◽  
High Risk Population ◽  
Evidence Based ◽  
Poverty Index ◽  
Middle Income ◽  
Multidimensional Poverty Index ◽  
Middle Income Countries

People with disabilities and their families have been recognized as a high-risk population for poverty. Although the number of studies analyzing the levels of poverty of this group has increased, there is still a lack of empirical evidence that establishes whether and how people with disabilities are significantly poorer than families with no disabled members. This study analyses the levels of multidimensional poverty of people living in households with members with disabilities in 11 low- and middle-income countries in different regions of the world, using the global Multidimensional Poverty Index (MPI). The results reveal that in five of the 11 countries people living in households with disabled members face higher levels of multidimensional poverty compared with people without disabilities. In addition, we found that differences between the levels of poverty were larger in middle-income countries than in low-income countries, revealing the existence of a development disability gap.

Case study: Reducing preventable maternal mortality in Rwandan healthcare facilities through improvements in WASH protocols

2018 ◽  
Vol 23 (3) ◽  
pp. 129-134 ◽  
Author(s):  
Andrea Guzman
Keyword(s):  
Low Income ◽  
Low Cost ◽  
Disease Outbreaks ◽  
Health Care Facilities ◽  
Low Income Countries ◽  
Water Access ◽  
Healthcare Facilities ◽  
Record Keeping ◽  
Hygiene Practices

Problem A lack of proper water, sanitation, and hygiene (WASH) infrastructure and poor hygiene practices reduce the preparedness and response of health care facilities (HCFs) in low-income countries to infection and disease outbreaks. According to a World Bank Service Provision Assessment conducted in 2007, only 28% of HCFs in Rwanda had water access throughout the year supplied by tap and 58% of HCFs provided functioning latrines. 1 This evaluation of services and infrastructure in HCFs in Rwanda indicates that targets for WASH in-country need to be enhanced. Objectives To present a case study of the causes and management of sepsis during delivery that led to the death of a 27-year-old woman, and propose a WASH protocol to be implemented in HCFs in Rwanda. Methods The state of WASH services used by staff, caregivers, and patients in HCFs was assessed in 2009 in national evaluations conducted by the Ministry of Infrastructure of Rwanda. Site selection was purposive, based on the presence of both water and power supply. Direct observation was used to assess water treatment, presence and condition of sanitation facilities and sterile equipment in the delivery room, provision of soap and water, gloves, alcohol-based hand rub, and WASH-related record keeping. Results All healthcare facilities met Ministry policies for water access, but WHO guidelines for environmental standards, including for water quality, were not fully satisfied. Conclusions The promotion and provision of low-cost technologies that enable improved WASH practices could help to reduce high rates of morbidity and mortality due to infection in low-income countries.

Mental Ills for All

2021 ◽  
Author(s):  
Stefan Ecks
Keyword(s):  
Sustainable Development ◽  
Human Rights ◽  
Low Income ◽  
Policy Instruments ◽  
Psychiatric Epidemiology ◽  
Low Income Countries ◽  
Health Improvement ◽  
Evidence Based ◽  
Systems Research ◽  
Treatment Provision

MGMH was created by reassembling psychiatric epidemiology, health economics, health systems research, evidence-based therapeutics, lay awareness, human rights, and sustainable development into an set of policy instruments. I retrace the emergence and crisis of three “pillars” of MGMH: epidemiology, economics of minds and moods, and the gap in treatment provision. I argue that MGMH remains limited by its strategic ignorance of flaws in the data, of paradoxical relations between economic development and health improvement, and of how people actually seek help in low income countries. I conclude by arguing that MGMH policies are bound to fail if they fail to reckon with the contradictions in its approach.

scholarly journals Optimizing the Multisectoral Nutrition Policy Cycle

2016 ◽  
Vol 37 (4_suppl) ◽  
pp. S107-S114 ◽  
Author(s):  
Sascha Lamstein ◽  
Amanda Pomeroy-Stevens ◽  
Patrick Webb ◽  
Eileen Kennedy
Keyword(s):  
Low Income ◽  
Nutrition Policy ◽  
Low Income Countries ◽  
Accurate Information ◽  
Evidence Based ◽  
Policy Cycle ◽  
Critical Gap ◽  
Country Level ◽  
Routine Monitoring ◽  
New Thinking

Based on the data collected in Uganda, Nepal, and Ethiopia, the papers included in this supplement fill a critical gap in evidence regarding multisectoral National Nutrition Action Plans. The studies offer new data and new thinking on how and why governance, effective financial decentralization, and improved accountability all matter for nutrition actions in low-income countries. This introductory paper offers an overview of the current state of evidence and thinking on the multisectoral nutrition policy cycle, including how governance and financing support that process. It also explores the benefits of applying a systems lens to understand the dynamic, enabling processes of the policy cycle—from research to knowledge and ultimately action—and to provide more dynamic and accurate information for nutrition advocacy and evidence-based decision-making. It concludes with key findings from the 5 country-level studies included. Several important themes emerge: the egregious gap in human resources needed for effective nutrition actions in most low-income settings, the value of research on bottlenecks and successes, and the need for routine monitoring of national policies and plans to measure their effectiveness in achieving both their own stated goals and global sustainable development goals. Reviewing these studies together provides a path forward in building stronger, evidence-based multisectoral nutrition policies and supporting implementation of the nutrition activities included within them.

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