Barriers to accessing health care among young people in 30 low-middle income countries.

Background: Previous studies focusing on high-income countries have shown that young people often face greater barriers to accessing healthcare than older adults. However, in low-middle income countries (LMICs), there have been a paucity of cross-country, quantitative studies highlighting these barriers. Aim: This exploratory study aims to provide a scoping review of the publicly available Demographic and Heath Survey (DHS) data with a view to form the basis for further work. Materials and methods: Data on insurance coverage, agency, and access to evidence-based family planning from 30 countries in the DHS were compared between age groups. Data on 586,250 participants 15-24 years (33% male) and 854,660 participants 25-49 years (16% male) from 30 LMICs were analyzed. Results: Significantly greater barriers to accessing healthcare were observed across six variables in younger population when compared to older adults across all survey questions with an average of 8.4% point difference. Also, there was wide country-level variation: the maximum differences between age groups were 33% points; Rwanda was the only country with no age differences. Discussion: This study highlights several possible themes for future research into improving access to healthcare for young people. These themes include more detailed evaluation of country-specific policies to reduced barriers to healthcare for young people and further research into the causative factors that can influence healthcare utilization by young people. Conclusion: Our analysis showcases increased barriers to healthcare access for young people in LMICs. We argue that they can only be improved by targeted policies and direct community engagement.

A low-cost field ventilator: An urgent global need.

Modern ventilators are increasingly compact and able to deliver a wide range of ventilator modes and sophisticated monitoring capabilities. However, the global availability of ventilators is woefully short of demand. Data on intensive care units (ICUs), a proxy measure for hospital ventilator capacity in low and middle-income countries (LMIC's), suggest that capacity is extremely limited where it exists at all. In LMIC's, the four most common indications for mechanical ventilation (MV) in ICUs are post-surgical care, sepsis, trauma, and maternal peripartum or neonatal complications. A significant majority of these cases can be managed with intervention involving a short course of MV. Widespread and timely access to MV can thus effectively be used to help patients in these settings and improve outcomes. This paper implores this need and highlights the requirements for a low-cost ventilator or a respiratory support device.

Voltage gated sodium channels as therapeutic targets for chronic pain.

Being maladaptive and frequently unresponsive to pharmacotherapy, chronic pain presents a major unmet clinical need. While an intact central nervous system is required for conscious pain perception, nociceptor hyperexcitability induced by nerve injury in the peripheral nervous system (PNS) is sufficient and necessary to initiate and maintain neuropathic pain. The genesis and propagation of action potentials is dependent on voltage-gated sodium channels, in particular, Nav1.7, Nav1.8 and Nav1.9. However, nerve injury triggers changes in their distribution, expression and/or biophysical properties, leading to aberrant excitability. Most existing treatment for pain relief acts through non-selective, state-dependent sodium channel blockage and have narrow therapeutic windows. Natural toxins and developing subtype-specific and molecular-specific sodium channel blockers show promise for treatment of neuropathic pain with minimal side effects. New approaches to analgesia include combination therapy and gene therapy. Here, we review how individual sodium channel subtypes contribute to pain, and the attempts made to develop more effective analgesics for the treatment of chronic pain.

Genes regulating the hypothalamic-pituitary- -gonadal axis and its impact on pubertal onset in mammals.

Puberty in mammals is defined as the development of fertility, which involves the maturation of secondary sex characteristics and reproductive organs. This phenomenon is controlled by the Hypothalamic-Pituitary-Gonadal (HPG) axis. However, the timing of puberty differs greatly among individuals, and it is thought that a combination of genetic and environmental factors governs its onset. Advances in genetic analysis has allowed the identification of many more gene loci involved in regulating puberty. Understanding the genetics regulating the mammalian reproductive cycle can open novel therapeutic avenues for the treatment of human infertility. This review aims to explore the genes currently thought to regulate pubertal onset, in particular the KISS-1, and TAC-3 genes. Moreover, this review aims to provide insight into the emerging roles of the genes which usually regulate nutritional status including the FGF21 gene and how they may impact pubertal onset.