Closing the antimicrobial stewardship gap - a call for LMICs to embrace the global antimicrobial stewardship accreditation scheme.

The escalating challenge of antimicrobial resistance (AMR) poses a considerable concern for global health, particularly impacting low- and middle-income countries (LMICs). This article highlights the critical importance of tackling AMR in LMICs by adopting the Global Antimicrobial Stewardship Accreditation Scheme (GAMSAS). GAMSAS is portrayed as a holistic and sustainable strategy for antimicrobial stewardship, extending beyond accreditation to include educational programs, capacity enhancement, improved surveillance, and support for AMS policy research. While acknowledging the global uptake of the scheme, the article highlights its preliminary phase of adoption in LMICs, particularly in high-AMR burden regions like Sub-Saharan Africa. The piece stresses the imperative for LMICs to integrate GAMSAS, underscoring its significance in optimizing antimicrobial usage and patient health outcomes. It advocates for an all-encompassing approach that leverages international cooperation and sustained financial backing, crucial for the effective deployment and enduring success of antimicrobial stewardship efforts in these key areas.

Global synergistic actions to improve brain health for human development.

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.

Using Collaborative Online International Learning to Support Global Midwifery Education.

BACKGROUND AND LOCAL PROBLEM: The COVID-19 pandemic created a gap in global health learning, requiring creative solutions to bridge the divide. Collaborative online international learning (COIL) is a program between universities located in different geographic areas that aims to build cross-cultural learning and collaboration. INTERVENTION: Faculty members from Uganda and the United States worked collaboratively to plan a 2-session COIL activity for nursing and midwifery students. Twenty-eight students from the United States and Uganda participated in the pilot quality improvement project. MEASURES: Students completed a 13-question REDCap survey measuring satisfaction, time commitment for the activity, and increase in knowledge about differently resourced healthcare systems. Students also were asked to provide qualitative feedback in that survey. RESULTS: Survey results indicate a high level of satisfaction and an increased understanding of a new healthcare system. The majority of students wanted more scheduled activity times, the opportunity to meet face to face, and/or more robust sessions in the future. CONCLUSION: This COIL activity between students in the United States and Uganda was a no-cost activity that provided global health learning opportunities for students during the global pandemic. The COIL model is replicable, adaptable, and customizable for a variety of courses and time spans.

A bibliometric analysis of COVID-19 publications in nursing by visual mapping method.

AIM: This study conducted a bibliometric analysis of nursing publications on the COVID-19 between 1 January 2020, and 24 October 2021. BACKGROUND: COVID-19 has been a hot research topic that has attracted many researchers from various disciplines. One of the ways to combat the COVID-19 pandemic is to produce knowledge and present it with a holistic approach. Therefore, it is crucial to make bibliometric and content analyses of scientific publications. Scientific data should be evaluated to keep up with the developments in the nursing profession and practices during the COVID-19 pandemic. METHODS: Data were collected from the Web of Science database. The sample consisted of 1280 publications that met the inclusion criteria. The data were analysed using descriptive content and bibliometric analysis. The VOSviewer, a mapping and visualization software program, was used for bibliometric analysis. RESULTS: The United States is one of the countries with the highest number of publications, citations and international cooperation during the pandemic. Of all these publications, 1183 (92.42%) are original articles. The Journal of Nursing Management has the highest number of publications and citations. The publications focus primarily on the topics of COVID-19, pandemic, nursing, coronavirus and nurses. The current topics that the publications address are online education, online learning, practice, nursing student, perceived stress, stress, fear, quality of life and experience to determine the impacts of the pandemic on mental health nursing education. CONCLUSIONS: The COVID-19 pandemic has an impact on nursing, and the number of publications is increasing worldwide. In the early days of the pandemic, researchers focused on the topics of coronavirus infections, infection control, global health, health policy and nursing policy. Afterward, they addressed current topics, such as education and the psychological effects of the pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Our results will help nurse managers identify issues related to COVID-19 that have not been researched yet and have not been adequately explained in their own institutions. They will also help them choose appropriate journals to get their studies published, appropriate countries to cooperate with and access information about the studies on the subject matter. Our results will also help them make evidence-based decisions about mental health and nursing education.

The European Union's development assistance for health (DAH) in Vietnam: any other purposes than health improvement?

Development Assistance for health (DAH) has increased dramatically these last two decades. While according to the official rhetoric, it aims at 'health improvement' and 'poverty reduction', such apolitical purposes have been questioned by scholars who identified other major objectives. However, few studies have sought to uncover the motivations behind EU's health assistance.To fill such academic gap, this article explores the main drivers that have guided the EU's DAH in Vietnam where the EU celebrated in 2020 its 25 years of health cooperation. Opting for a 'multiple sources of foreign aid model' that considers that no single factor can explain foreign aid decision, and adopting a 'holistic approach' that focuses on the modalities, the narratives, the allocation, and the terms of health assistance, as well as the international and domestic contexts in which it has taken place, this study identifies four major purposes: (a) the confirmation of EU's identities within the global health community. (b) the defense of the relevance of its approach of health assistance to influence international norms framing international health aid, (c) its support to the leading role of the WHO in global health, and (d) the facilitation of trade and investment opportunities for European companies.

From concept to action: a united, holistic and One Health approach to respond to the climate change crisis.

It is unequivocal that human influence has warmed the planet, which is seriously affecting the planetary health including human health. Adapting climate change should not only be a slogan, but requires a united, holistic action and a paradigm shift from crisis response to an ambitious and integrated approach immediately. Recognizing the urgent needs to tackle the risk connection between climate change and One Health, the four key messages and recommendations that with the intent to guide further research and to promote international cooperation to achieve a more climate-resilient world are provided.

A Pandemic Instrument Can Start Turning Collective Problems into Collective Solutions by Governing the Common-Pool Resource of Antimicrobial Effectiveness.

To address the complex challenge of global antimicrobial resistance (AMR), a pandemic treaty should include mechanisms that 1) equitably address the access gap for antimicrobials, diagnostic technologies, and alternative therapies; 2) equitably conserve antimicrobials to sustain effectiveness and access across time and space; 3) equitably finance the investment, discovery, development, and distribution of new technologies; and 4) equitably finance and establish greater upstream and midstream infection prevention measures globally. Biodiversity, climate, and nuclear governance offer lessons for addressing these challenges.

Japan's development cooperation for health in Vietnam: a first holistic assessment on Japan's ODA and non-ODA public resources cooperation.

BACKGROUND: Japan strives to strengthen its development cooperation by mobilizing various resources to assist partner countries advance on Universal Health Coverage by 2030. However, the involvement and roles of various actors for health are not clear. This study is the first to map Japan's publicly funded projects by both Official Development Assistance (ODA) and other non-ODA public funds, and to describe the intervention areas. Further, the policy implications for country-specific cooperation strategies are discussed. The development cooperation for health in Vietnam is used as a case in this study. METHODS: A cross-sectional analysis of the Japanese publicly funded health projects that were being implemented in Vietnam during December 2016 was conducted. A framework of analysis based on the World Health Organization six health systems building blocks was adopted. The projects' qualitative information was also assessed. RESULTS: Overall, 68 projects implemented through Japanese public funding were analyzed. These 68 projects under 15 types of schemes were managed by seven different scheme-operating organizations and funded by five ministries. Of these 44 (64.7%) were ODA and 24 (35.3%) were non-ODA projects. Among the recategorized six building blocks of the health system, the largest proportion of projects was health service delivery (44%), followed by health workforces (25%), and health information systems (15%). Almost half the projects were implemented together with the central hospitals as Vietnamese counterparts, which suggests that this is one area in which the specificities of Japanese cooperation are demonstrated. No synergetic effects of potential collaboration or harmonization among Japanese funded projects were captured. CONCLUSIONS: Several Japanese-funded projects addressed a wide range of health issues across all six building blocks of the health system in Vietnam. However, there is room for improvement in developing coordination and harmonization among the diversified Japanese projects. Establishing a country-specific mechanism for strategic coordination across Japanese ministries' schemes can yield efficient and effective development cooperation for health. While Vietnam's dependence on external funding is low, the importance of coordination across domestic actors of the donor countries can serve as an important lesson, especially in beneficiary countries with high external funding dependency.

Considerations for Updates to ICH Q1 and Q5C Stability Guidelines: Embracing Current Technology and Risk Assessment Strategies.

In consideration of the recent ICH Quality Discussion Group (QDG) recommended revision to the ICH series of stability guidelines, the IQ Consortium (International Consortium for Innovation and Quality in Pharmaceutical Development) Science- and Risk-based Stability Working Group conducted a comprehensive review of ICH Q1A, Q1B, Q1C, Q1D, Q1E, and Q5C to identify areas where the guidelines could be clarified, updated, and amended to reflect the potential knowledge gained from current risk-based predictive stability tools and to consider other science- and risk-based stability strategies in accordance with ICH Q8-12. The recommendations propose a holistic approach to stability understanding, utilizing historical data, prior knowledge, modeling, and a risk assessment process to expand the concept of what could be included (or would be acceptable) in the core stability data package, including type and amount of stability evidence, assignment of retest period and shelf-life for a new product, and assessment of the impact of post-approval changes.

The Modernization of Radiation Therapy Services in Cambodia: A Model of International Collaboration.

PURPOSE: Cambodia is a Southeast Asian low-middle-income country with a population of >15 million. In 2020, Cambodia was estimated to have 18,375 new diagnoses of cancer and 12,638 deaths attributable to cancer. Cambodia was estimated to have a deficit of 16 megavoltage machines in 2012. Cambodia's radiation therapy services have suffered through the tumultuous events of the country's history, with intermittent services until the last decade. In recent years, Cambodia has undergone rapid economic growth and, with this, the development of its first comprehensive cancer center, the National Cancer Centre (NCC). METHODS AND MATERIALS: Planning for NCC began in the early 2000s, with the aim to provide comprehensive care, including modern radiation therapy services, to the public. Funding for the center was supplied primarily by the Cambodian government, assisted by donations from partners including the International Atomic Energy Agency. Training collaborations were formed with international partners, including the Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) of the Royal Australian and New Zealand College of Radiologists and the Asia-Pacific Special Interest Group (APSIG) of the Australasian College of Physical Scientists and Engineers in Medicine. RESULTS: The main model of APROSIG/APSIG collaboration has been in-country training, including the posting of an Australian medical physicist and radiation therapist in Phnom Penh for a year's duration to oversee a safe and sustainable start to the radiation therapy program. The first linear accelerator patient was treated at NCC in March 2018 and the first brachytherapy patient in September 2018. Since that time, the department has treated to capacity, with very little machine downtime. NCC provides comprehensive cancer services including medical oncology, pediatric oncology, hematology, palliative care, surgical oncology, and nuclear medicine. Several challenges to expanding radiation therapy services currently exist, including human resources and cultural stigma. CONCLUSION: Despite many decades of tragedy and suffering, Cambodia serves as an example of successful implementation of modern radiation therapy in a low- and middle-income country. The keys to success have included local champions, support of the Ministry of Health, and willingness to embrace collaboration. The pandemic brings yet another challenge to cancer control in Cambodia, and novel training platforms are being explored.

Orthopaedic Disorders in Cerebral Palsy in International Cooperation Projects: A Descriptive Cross-Sectional Study.

BACKGROUND: In international cooperation projects that are carried out in less developed and developing countries, a large number of children with disabilities present cerebral palsy (CP). Orthopaedic disorders are frequent complications associated with this disorder. Their prevention and early intervention are essential to achieve an appropriate therapeutic approach for children with PC and to improve their quality of life. OBJECTIVE: To describe the treatment approach that is currently used in international cooperation projects for the rehabilitation management of the orthopaedic disorders in children with cerebral palsy. METHODS: This is an observational, descriptive, cross-sectional study, carried out by means of an online questionnaire to professionals in the field of Physiotherapy and Rehabilitation working in international cooperation projects. The inclusion criteria were professionals working in the rehabilitation field in development aid, humanitarian action or emergency projects that provided rehabilitation services, working with children with cerebral palsy from 0 to 18 years old. RESULTS: Ninety-eight questionnaires were analysed. The average age of the participants was 33.2 years, they were mainly working in development cooperation projects (83.33%) that were implemented in rehabilitation centres and through community-based rehabilitation services (60%). The projects were located in countries all over the world but mainly on the Asian continent (71.4%). Physiotherapists and orthopaedic technicians (72.22%) were the main professionals working in these projects, followed by occupational therapists and social workers (55.56%). The results indicated that the orthopaedic disorders were very frequent in the sample (66.67%), with hip subluxation (50%), scoliosis (77.78%), kyphosis (61.1%), clubfoot (88.7%) and varus foot (61.11%) standing out. The most commonly used treatment approaches were positioning (88.89%) and the Bobath concept (83.33%). The technical aids that were used by the professionals were ankle foot orthosis (AFO) (94.44%), bracing (66.67%), standing frames (83.33%), moulded seats (100%), corner seats (93.75%) and adapted seats (92.85%). CONCLUSIONS: In international cooperation projects, the rehabilitation treatment of children with cerebral palsy is based on a holistic approach. This is reflected in the interventions that are carried out to treat their orthopaedic disorders and in locally produced devices, awareness raising and community education. However, the professionals surveyed considered that the aids or orthoses used are insufficient in the treatment and prevention of orthopaedic disorders in cerebral palsy.

Collective insights of public-private partnership impacts and sustainability: A qualitative analysis.

The global Coronavirus or COVID-19 pandemic exposed the weakness of healthcare systems including laboratory systems and is a call to action for unprecedented collaboration and partnerships to deal with the global crisis. The United States (U.S.) President's Emergency Plan for AIDS Relief (PEPFAR) establishes the global HIV/AIDS treatment agenda in alignment with the UNAIDS 90-90-90 treatment targets to achieve epidemic control related to enhanced testing, treatment, and viral suppression. A strategic PEPFAR priority area recognizes that large-scale collective efforts and sharing of resources bear greater potential impact for lasting change than any single organization or entity can achieve alone. An important vehicle utilized within the global public health context is the public-private partnership (PPP) model whereby multiple international organizations forge unified project charters to collectively reach mutually agreed goals. While touted as an ideal mechanism to synthesize resources and maximize gain in numerous applications, little is known from a seasoned stakeholder perspective regarding PPP implementation and sustainability issues. The purpose of this research is to holistically examine perceptions of PPP model sustainability related to inputs and impacts among a collective network of stakeholders experienced with PEPFAR workforce development, laboratory-system strengthening project implementation. Interviews were conducted with frontline stakeholders from public and private sector organizations based in the US and select PEPFAR-supported priority countries. Analysis revealed three dominant themes: PPP impacts, keys of successful collaboration, and logistical challenges and opportunities to enhance sustainability of PPP outcomes in the future.

Usage and promotion on Chinese medicine in Portuguese-speaking countries.

As the continuous opening-up and communication have been seen between China and other countries, traditional Chinese medical science and Chinese medicine now have gain popularity in China as well as the surrounding countries. As a window that China's opening-up through, Macau has been serving as a link between China and Portuguese language countries. The Forum for Economic and Trade Co-operation between China and Portuguese-speaking Countries (Macau), also known as Forum Macau, since it was established in 2003, has further enhanced the mutual exchange of commerce, culture and technologies. Promoting the industry of Chinese medical science among Portuguese-speaking countries has become one of the priorities of the Forum Macau. With multiple years of collaboration, among the Portuguese-speaking countries, Chinese medical science has gained promotion to some extent, as well as recognition from the government and people. The current study introduced the development of Chinese medical science among Portuguese-speaking countries from aspects such as legislation, cooperation and promotion, medical assistance, and clinical usage.

Unhealthy geopolitics: can the response to COVID-19 reform climate change policy?

The geopolitics of pandemics and climate change intersect. Both are complex and urgent problems that demand collective action in the light of their global and trans-boundary scope. In this article we use a geopolitical framework to examine some of the tensions and contradictions in global governance and cooperation that are revealed by the pandemic of coronavirus disease 2019 (COVID-19). We argue that the pandemic provides an early warning of the dangers inherent in weakened international cooperation. The world's states, with their distinct national territories, are reacting individually rather than collectively to the COVID-19 pandemic. Many countries have introduced extraordinary measures that have closed, rather than opened up, international partnership and cooperation. Border closures, restrictions on social mixing, domestic purchase of public health supplies and subsidies for local industry and commerce may offer solutions at the national level but they do not address the global strategic issues. For the poorest countries of the world, pandemics join a list of other challenges that are exacerbated by pressures of scarce resources, population density and climate disruption. COVID-19's disproportionate impact on those living with environmental stresses, such as poor air quality, should guide more holistic approaches to the geopolitical intersection of public health and climate change. By discussing unhealthy geopolitics, we highlight the urgent need for a coordinated global response to addressing challenges that cannot be approached unilaterally.

La géopolitique en matière de pandémie partage nombre de similitudes avec celle pratiquée face au changement climatique. Toutes deux sont liées à des problèmes complexes et urgents qui requièrent une action collective en raison de leur portée internationale, qui ne tient compte d'aucune frontière. Dans cet article, nous utilisons un cadre géopolitique pour examiner certaines tensions et contradictions observées dans la gouvernance et la coopération mondiales, et mises en lumière par la pandémie de maladie à coronavirus 2019 (COVID-19). Nous estimons que cette pandémie équivaut à un premier avertissement quant aux dangers inhérents à une faible coopération internationale. Les États de la planète et les territoires nationaux placés sous leur autorité réagissent chacun de leur côté à la pandémie de COVID-19, alors qu'ils devraient adopter une approche commune. De nombreux pays ont instauré des mesures exceptionnelles qui ont entraîné la disparition des partenariats existants au lieu de les renforcer. Fermer les frontières, restreindre la mixité sociale, acheter des fournitures médicales pour les hôpitaux à l'intérieur du pays et subventionner l'industrie et les commerces locaux peuvent certes apporter des solutions à l'échelle nationale, mais ces décisions ne s'attaquent pas aux problèmes stratégiques à l'échelle mondiale. Pour les pays les plus pauvres de la planète, la pandémie s'ajoute à une longue liste de défis exacerbés par la pression qu'exercent la pénurie de ressources, la densité de population et le dérèglement climatique. L'impact disproportionné de la COVID-19 sur celles et ceux qui subissent déjà un stress environnemental, dû par exemple à la mauvaise qualité de l'air, devrait servir de guide à une série d'approches holistiques reflétant le rapport entre santé publique et changement climatique. En abordant le thème d'une géopolitique néfaste, nous attirons l'attention sur l'urgence d'une réponse globale coordonnée qui permettra de relever des défis qui ne peuvent être affrontés unilatéralement.

La geopolítica en materia de pandemias comparte muchas similitudes con la del cambio climático. Ambos son problemas complejos y urgentes que exigen una acción colectiva debido a su alcance global y transfronterizo. En este artículo utilizamos un marco geopolítico para examinar algunas de las tensiones y contradicciones en la gobernanza y la cooperación mundiales que pone de manifiesto la pandemia de la enfermedad del coronavirus de 2019 (COVID-19). Consideramos que la pandemia proporciona una alerta temprana de los peligros inherentes a una cooperación internacional debilitada. Los Estados del mundo, con sus distintos territorios nacionales, están reaccionando individualmente en lugar de colectivamente a la pandemia de la COVID-19. Muchos países han introducido medidas extraordinarias que han cerrado, en lugar de abrir, la asociación y la cooperación internacionales. El cierre de fronteras, las restricciones a la mezcla social, la compra interna de suministros de salud pública y las subvenciones a la industria y el comercio locales pueden ofrecer soluciones a nivel nacional, pero no abordan las cuestiones estratégicas mundiales. En el caso de los países más pobres del mundo, las pandemias se suman a una lista de otros problemas que se ven agravados por las presiones de la escasez de recursos, la densidad demográfica y los trastornos climáticos. El impacto desproporcionado de la COVID-19 en quienes viven con tensiones ambientales, como la mala calidad del aire, debería orientar los enfoques más holísticos de la intersección geopolítica de la salud pública y el cambio climático. Al examinar la geopolítica dañina, ponemos de relieve la urgente necesidad de una respuesta mundial coordinada para hacer frente a los desafíos que no pueden abordarse unilateralmente.

Key factors influencing the TCM nomenclature in international standards.

Amid the globalization of traditional Chinese medicine (TCM), the English translation of related texts is in full swing. Several representative international organizations in fields regarding standardization and healthcare, one after another, have published a series of international standards for TCM nomenclature. With these efforts, the internationalization of TCM has been dramatically advanced. When selecting parallel texts for reference, translators need to be aware of key factors influencing the English translation of TCM terms in international standards, including the distinctive characteristics of this discipline and relevant influences of international standard makers. In this way, proper standards and reasonable English expression can be chosen for specific terms, thus stimulating the effective use of TCM nomenclature with consensus.

COVID-19 Pandemic and Africa: From the Situation in Zimbabwe to a Case for Precision Herbal Medicine.

This opinion commentary on the coronavirus disease 2019 (COVID-19) pandemic brings together observations from Zimbabwe specifically, and Africa broadly, drawing from the fields of pharmacogenomics, precision herbal medicine, and responsible innovation so as to respond to the pandemic in ways that are efficient, critically informed, principled, and responsive to needs in rural and urban communities across Africa. With new findings suggesting that COVID-19 is a systemic disease, impacting the respiratory system and beyond in some individuals, we need new molecular targets for therapeutics innovation more than ever. We argue that the current pandemic will likely strip the limited resources from other diseases such as malaria, human immunodeficiency virus (HIV) infection, and among others affecting the African continent. Hence, we need to address not only COVID-19 but also its broader health care and societal impacts in Africa. Extensive diagnostic testing to trace and isolate the COVID-19 cases as well as basic income and economic support for those who are unable to work will be needed. A critically informed and democratic governance that builds on transparency and trust for the elected leaders is crucial. Finally, the pandemic offers a silver lining for Africa: the prospects to integrate omics research with long-standing expertise in herbal medicine in Africa, thus accelerating the advances toward novel molecular therapeutic targets for COVID-19 and precision herbal medicine worldwide.