Can You Hear Us Now? Equity in Global Advocacy for Palliative Care.

Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.

Environmental impacts of FDI: evidence from heterogeneous panel methods.

This paper investigates the effect of foreign direct investment (FDI) on environmental quality for 123 nations over the period 1996 to 2018. The study also conducts a comparative analysis for 45 developing and 78 developed nations to better understand the environmental impacts of foreign direct investment. The study employs pooled mean group (PMG) and mean group (MG) estimation techniques for investigating the impacts of FDI on environmental quality as the slope heterogeneity test rejects the null hypothesis of homogenous slope coefficients for the cross-sectional units in all country groupings. In addition, the study employs common correlated effect pooled mean group (CCEPMG) and common correlated effect mean group (CCEMG) estimation methods to tackle cross-sectional dependence in all country groupings. The results indicate that the impact of FDI on environmental emission is negative and significant for the global sample. Furthermore, the comparative analysis for developed and developing countries indicates that FDI improves environmental quality in developed nations as it leads to a lower level of CO2 emissions whereas it leads to adverse environmental impacts in the developing nations as it leads to a higher level of CO2 emissions. The empirical findings for developed and developing countries confirm pollution haven hypothesis (PHH) for developing countries while pollution halo hypothesis for developed countries. This study may help the policy makers to better understand the attributes of FDI and to devise such type of policies and regulatory framework which encourages environmentally friendly FDI or the FDI that take care of environmental quality.

Information and communication technology (ICT) and environmental sustainability: a panel data analysis.

This study investigates the impact of information and communication technology (ICT) on carbon dioxide emissions for a panel of 91 countries over the period 1990 to 2017. The study constructs an ICT index through principal component analysis and tests for the presence of cross-sectional dependence (CSD) in the data. The study employs pooled ordinary least squares, fixed-effects model, and system-generalized method of moments estimation techniques with panel-corrected standard errors (PCSE) to tackle the issues of CSD in the data. The findings of the study show that ICT reduces CO2 emissions for the full sample of countries. However, the comparative study of developed and developing countries depicts that ICT encourages environmental sustainability in developed countries whereas opposite results are found for developing countries. Moreover, presence of the environmental Kuznets curve is confirmed for the full sample as well as for developed and developing countries. It suggests that with higher levels of development of a country, it would be possible to contribute towards environmental sustainability along with ICT diffusion. Therefore, the outcome of this study may be helpful for policymaker and policies may be designed to encourage ICT investments in developing countries, as ICT will take care of environmental sustainability with higher levels of development.

Illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh: A cross-sectional study.

BACKGROUND: Despite recognition that palliative care is an essential component of any humanitarian response, serious illness-related suffering continues to be pervasive in these settings. There is very limited evidence about the need for palliative care and symptom relief to guide the implementation of programs to alleviate the burden of serious illness-related suffering in these settings. A basic package of essential medications and supplies can provide pain relief and palliative care; however, the practical availability of these items has not been assessed. This study aimed to describe the illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh. METHODS AND FINDINGS: Between November 20 and 24, 2017, we conducted a cross-sectional study of individuals with serious health problems (n = 156, 53% male) and caregivers (n = 155, 69% female) living in Rohingya refugee camps in Bangladesh, using convenience sampling to recruit participants at the community level (i.e., going house to house to identify eligible individuals). The serious health problems, recent healthcare experiences, need for medications and medical supplies, and basic needs of participants were explored through interviews with trained Rohingya community members, using an interview guide that had been piloted with Rohingya individuals to ensure it reflected the specificities of their refugee experience and culture. The most common diagnoses were significant physical disabilities (n = 100, 64.1%), treatment-resistant tuberculosis (TB) (n = 32, 20.5%), cancer (n = 15, 9.6%), and HIV infection (n = 3, 1.9%). Many individuals with serious health problems were experiencing significant pain (62%, n = 96), and pain treatments were largely ineffective (70%, n = 58). The average age was 44.8 years (range 2-100 years) for those with serious health problems and 34.9 years (range 8-75 years) for caregivers. Caregivers reported providing an average of 13.8 hours of care per day. Sleep difficulties (87.1%, n = 108), lack of appetite (58.1%, n = 72), and lack of pleasure in life (53.2%, n = 66) were the most commonly reported problems related to the caregiving role. The main limitations of this study were the use of convenience sampling and closed-ended interview questioning. CONCLUSIONS: In this study we found that many individuals with serious health problems experienced significant physical, emotional, and social suffering due to a lack of access to pain and symptom relief and other essential components of palliative care. Humanitarian responses should develop and incorporate palliative care and symptom relief strategies that address the needs of all people with serious illness-related suffering and their caregivers.

Assessment of in-vitro cholinesterase inhibitory and thrombolytic potential of bark and seed extracts of Tamarindus indica (L.) relevant to the treatment of Alzheimer's disease and clotting disorders.

BACKGROUND: Low level of acetylcholine (ACh) is an important hallmark of Alzheimer's disease (AD), a common type of progressive neurodegenerative disorder. Effective treatment strategies rely mostly on either enhancing the cholinergic function of the brain by improving the level of ACh from being a breakdown by cholinesterase enzymes. Again atherothrombosis is major life-threatening cerebral diseases. Traditionally Tamarindus indica (L.) has widely known for its medicinal values. Our aim is to investigate the cholinesterase inhibitory activities as well as thrombolytic activities of the bark and seeds crude methanolic extracts (CMEs) in the treatment of AD and clotting disorder. MATERIALS AND METHODS: The crude methanol extract was prepared by cold extraction method and was assessed for acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) inhibitory activities by the Ellman's method. For thrombolytic activity clot lysis method was applied. RESULTS: To compare both the fractions, extracts from the bark got more AChE inhibitory activity than the seed with the inhibitory concentration 50% IC50 values of 268.09 and 287.15 µg/ml, respectively. The inhibitory activity of BuChE was quiet similar to that of AChE as IC50 values of both the fractions were 201.25 and 254.71 µg/ml. Again in-vitro thrombolytic activity of bark was 30.17% and of seed it was 22.53%. CONCLUSION: The results revealed that the CME of bark and seed both have moderate cholinesterases inhibitory activities as well as thrombolytic activities, worth of further investigations to identify the promising molecule(s) potentially useful in the treatment of AD as well as in clotting disorders.