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Advocacy, one of the five domains of global neurosurgery, represents a powerful avenue to influence public policy to expand access to safe, timely, and affordable neurosurgical care. In this manuscript, we characterize advocacy in global neurosurgery, describe specific neurosurgeon-led initiatives, and delineate how neurosurgeons can become involved in global neurosurgery advocacy efforts. Advocacy in global neurosurgery involves working together in organized neurosurgery with organizations focused on clinical provisions, training, and policy initiatives. Effective advocacy uses a data-driven approach with myriad facilitators, including collaboration and approach strategies for sharing information and a variety of contextual, ideological, and practical barriers. The main action fronts for global neurosurgery include identifying needs, broadening access, and assuring quality. Neurosurgery-led initiatives transforming public policy have occurred on regional and global scales and accelerated since 2019. Folate fortification of staple foods to prevent neural tube defects represents a recent and notably successful area of advocacy and remains in progress. Neurosurgeons who aspire to become involved in advocacy efforts must obtain competencies and skills distinct from, yet complementary to, the traditional neurosurgical training curriculum.

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Since 2015, there has been a notable increase in global efforts by various stakeholders to promote and advance surgical care policies, as proposed by the Lancet Commission on Global Surgery (LCoGS) namely, the development of the National Surgical Obstetric Anesthesia Planning (NSOAP), a country- driven framework that offers a comprehensive approach to health ministries to enhance their surgical systems. Ecuador has affirmed its position as a leading advocate for surgical care in Latin America. Following a two-year process, Ecuador is the first country in the Region of the Americas to launch an NSSP as a key component of a robust health system, including improving emergency responsiveness and pre- paredness

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Programas Nacionales de Salud , Especialidades Quirúrgicas , Ecuador

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PURPOSE: Musculoskeletal complaints (MSCs), a leading contributor to disability worldwide, have a major impact on health-related quality of life (HRQoL). Poor general health related to lifestyle factors such as smoking, alcohol consumption and physical inactivity can lead to a higher risk to suffer MSCs. For minority groups in Suriname such as the Maroons and the Indigenous peoples no research has been conducted regarding prevalence of MSCs, HRQoL and various lifestyle factors. The aims were to determine the prevalence of MSCs and HRQoL in two rural tribal villages in the forested interior of Suriname and to identify various lifestyle factors associated with HRQoL in these communities. METHOD: This was a cross-sectional community-based study using the Community Oriented Program for the Control of Rheumatic Diseases stage 1, phase 1 & 2 methodology in Goejaba, a Maroon village and Galibi, an Indigenous rural village. Sociodemographic data, self-reported comorbidities, past MSCs (for longer than seven days), lifestyle factors including smoking, alcohol use, body mass index (BMI) and physical activity (PA), and HRQoL (using the 36-item Short Form Survey (SF-36)) data were gathered among 153 Indigenous individuals in Galibi, and 516 Maroons in Goejaba. Regression models were constructed to explore associations between presence of MSCs, lifestyle factors and HRQoL. RESULTS: High prevalence rates for past MSCs were reported in Galibi (72.4%) and Goejaba (58.3%). In both communities, respondents with MSCs reported significantly worse HRQoL than persons without MSCs. MSCs and the presence of comorbidities had a strong negative association with HRQoL, whereas PA positively influenced the physical and mental health domains of the SF-36. Smoking, alcohol use and BMI showed no association with HRQoL. CONCLUSIONS: In this first study, a high prevalence for MSCs was reported in an Indigenous and Maroon rural community in Suriname. MSCs and comorbidities had a significant negative impact on HRQoL. PA was associated with higher self-reported HRQoL.

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Calidad de Vida , Población Rural , Humanos , Calidad de Vida/psicología , Suriname/epidemiología , Prevalencia , Estudios Transversales , Encuestas y Cuestionarios

RESUMEN

•Neurosurgical training in the Caribbean has not been well-defined in published data.•Neurosurgical programs are the framework for the delivery of surgical care.•Maldistribution of the neurosurgery workforce is one of the challenges faced.•Facilitating partnerships within the Caribbean would enhance regional solidarity.

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Background: Two-hour and 30 min travel times to a hospital capable of performing emergency general surgery and cesarean section are benchmarks for timely surgical access. This study aimed to estimate the population of Guatemala with timely access to surgical care and identify existing hospitals where the expansion of surgical services would increase access. Methods: The World Federation of Societies of Anaesthesiologists (WFSA) Anesthesia Facility Assessment Tool (AFAT) previously identified 37 public Guatemalan hospitals that provide surgical care. Nine additional public non-surgical hospitals were also identified. Geospatial analysis was performed to estimate walking and driving geographic access to all 46 hospitals. We calculated the potential increase in access that would accompany the expansion of surgical services at each of the nine non-surgical hospitals. Findings: The percentage of the population with walking access to a surgical hospital within 30 min, 1 h, and 2 h are 5·1%, 12·9%, and 27·3%, respectively. The percentage of people within 30 min, 1 h, and 2 h driving times are 27·3%, 41·1%, and 53·1%, respectively. The median percentage of the population within each of Guatemala's 22 administrative departments with 2 h walking access was 19·0% [IQR 14·1-30·7] and 2 h driving access was 52·4% [IQR 30·5-62·8]. Expansion of surgical care at existing public Guatemalan hospitals in Guatemala would result in a minimal increase in overall geographic access compared to current availability. Interpretation: While Guatemala provides universal health coverage, geographic access to surgical care remains inadequate. Geospatial mapping and survey data work synergistically to assess surgical system strength and identify gaps in geographic access to essential surgical care. Funding: None.

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Background: Worldwide, neurological disorders are the leading cause of disability-adjusted life years lost and the second leading cause of death. Despite global health capacity-building efforts, each year, 22.6 million individuals worldwide require neurosurgeon's care due to diseases such as traumatic brain injury and hydrocephalus, and 13.8 million of these individuals require surgery. It is clear that neurosurgical care is indispensable in both national and international public health discussions. This study highlights the role neurosurgeons can play in supporting the global health agenda, national surgical plans, and health strengthening systems (HSS) interventions. Methods: Guided by a literature review, the authors discuss key topics such as the global burden of neurosurgical diseases, the current state of neurosurgical care around the world and the inherent benefits of strong neurosurgical capability for health systems. Results: Neurosurgical diseases make up an important part of the global burden of diseases. Many neurosurgeons possess the sustained passion, resilience, and leadership needed to advocate for improved neurosurgical care worldwide. Neurosurgical care has been linked to 14 of the 17 Sustainable Development Goals (SDGs), thus highlighting the tremendous impact neurosurgeons can have upon HSS initiatives. Conclusion: We recommend policymakers and global health actors to: (i) increase the involvement of neurosurgeons within the global health dialogue; (ii) involve neurosurgeons in the national surgical system strengthening process; (iii) integrate neurosurgical care within the global surgery movement; and (iv) promote the training and education of neurosurgeons, especially those residing in Low-and middle-income countries, in the field of global public health.

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Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care-from prevention to acute care to rehabilitation. Integration of the various healthcare systems-governmental, non-governmental and military-is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds-trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration-creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

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The footnote of Fig. 2 in the published original version of the above article went missing and the correct figure is presented in this article.].

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INTRODUCTION/OBJECTIVES: Musculoskeletal complaints (MSCs) are a major burden worldwide. In Suriname, a South American developing country, the epidemiology of MSCs and its related disorders is still unknown. Therefore, a cross-sectional survey was carried out to determine prevalence and risk factors of MSCs in urban areas of Suriname. METHODS: This is the first Community Oriented Program for the Control of Rheumatic Diseases survey in a Caribbean Community. Trained interviewers collecting self-reported data conducted this house-to-house community-based survey. Data was analyzed using SPSS version 23 and Stata version 14.1. RESULTS: The prevalence of MSCs was 62.1% with a higher prevalence rate among women compared with men (resp. 64.3% vs. 58.6%) (Odds ratio = 1.185; p ≤ 0.05). The most decisive self-reported variables associated with MSCs were older age (defined as ≥ 45 years) and moderate to heavy physical workload. The prevalence of MSCs was also associated with women, low educational level, smoking, alcohol use, high-intensity physical activity level, and body mass index (≥ 25 kg/m2). The highest prevalence of MSCs was found among African descendants (Maroons (68.8%) and Creoles (68.0%)), followed by the Indigenous (65.0%) and Asian descendants (Hindustani (64.3%) and Javanese (49.5%)). Most persons with MSCs (75.7%) reported multisite complaints with lower back, knee, and shoulder being the most frequently reported sites. In our study population, MSCs were not considered disabling (mean Health Assessment Questionnaire Disability Index score of 0.23). CONCLUSIONS: The prevalence of MSCs in this urban multi-ethnic Surinamese community is high; therefore, future research is needed to further explore the burden of MSCs in Suriname.Key Points• Musculoskeletal complaints are highly prevalent in different ethnic groups in an urban Surinamese community; almost two-thirds of the population reported MSCs with the highest prevalence rate among women and African descendants.• The most decisive self-reported variables associated with MSCs were older age (defined as ≥ 45 years) and moderate to heavy physical workload. Gender, educational level, smoking, alcohol use, high-intensity physical activity, and body mass index were also significantly associated with musculoskeletal complaints.

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Etnicidad/estadística & datos numéricos , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Reumáticas/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/etnología , Prevalencia , Enfermedades Reumáticas/etnología , Factores de Riesgo , Distribución por Sexo , Suriname/epidemiología , Adulto Joven

RESUMEN

BACKGROUND: Even though surgical conditions account for as much as 32% of the global burden of disease, 5 billion people worldwide do not have access to timely, affordable surgical and anesthetic care. Access to surgical care is separated along socioeconomic divides, and these disparities are most pronounced in low-and middle-income countries, such as the Caribbean nation of Haiti, where the availability of specialty surgical services like neurosurgery are scant, or completely absent. METHODS: This paper provides a narrative account of current neurosurgery-related activity in Haiti, a nation whose social, political, and economic context is unique in the Americas. RESULTS: After some background information and a bibliometric analysis of recent research efforts, we provide brief biographical sketches of Haiti's local neurosurgical leaders and an overview of recent initiatives in Haitian neurosurgical capacity building. CONCLUSIONS: The paper concludes with recommendations to guide the international neurosurgery community in future contributions.

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Regulated on activation, normal T-cell expressed and secreted (RANTES) and stromal cell-derived factor 1 (SDF-1) are members of the CC- and CXC-chemokine families, respectively. Both genes have been postulated to be involved in the pathogenesis of systemic lupus erythematosus (SLE). We analyzed position 28 of the RANTES gene promoter region, as well as the SNP observed in the 3' UTR of the SDF-1 gene at position 801, in 130 patients presenting SLE at the Malaya University Medical Centre. Screening of 130 healthy volunteer controls using RFLP was also performed. RANTES-28 polymorphism analysis showed no significant (P = 0.3520) relationship, even though homozygous C/C was more frequent in SLE patients (OR = 1.4183) and heterozygous C/G was more frequent in healthy controls (OR = 0.7051). There were no significant (P = 0.2650) associations between A/A (OR = 0.783), G/G (OR = 1.5914) and G/A (OR = 0.8289) genotypes in the SDF-1 gene polymorphism with SLE. We conclude that there is no significant association of RANTES-28 and SDF-1 gene polymorphisms and occurrence of SLE in Malaysia.

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Quimiocina CCL5/genética , Quimiocina CXCL12/genética , Lupus Eritematoso Sistémico/genética , Polimorfismo de Longitud del Fragmento de Restricción , Polimorfismo de Nucleótido Simple , Regiones no Traducidas 3'/genética , Adolescente , Adulto , Pueblo Asiatico/etnología , Pueblo Asiatico/genética , Femenino , Humanos , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/etnología , Malasia/epidemiología , Malasia/etnología , Masculino , Persona de Mediana Edad , Regiones Promotoras Genéticas/genética

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Allele frequencies of 15 short tandem repeat (STR) loci, namely D5S818, D7S820, D13S317, D16S539, TH01, TPOX, Penta D, Penta E, D3S1358, D8S1179, D18S51, D21S11, CSF1PO, vWA, and FGA, were determined for 154 individuals from the Kadazan-Dusun tribe, an indigenous population of East Malaysia. All loci were amplified by polymerase chain reaction, using the Powerplex 16 system. Alleles were typed using a gene analyzer and the Genemapper ID software. Various statistical parameters were calculated and the combined power of discrimination for the 15 loci in the population was calculated as 0.999999999999999. These loci are thus, informative and can be used effectively in forensic and genetic studies of this indigenous population.

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Frecuencia de los Genes/genética , Repeticiones de Microsatélite , Alelos , Sitios Genéticos , Genética de Población , Humanos , Malasia/etnología , Reacción en Cadena de la Polimerasa

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves the inflammation of various organs upon deposition of immune complexes and is characterized by uncontrolled B cell hyperactivity. Despite intensive research on the etiology of the disease, the exact cause of the onset of SLE is unknown. The pathogenesis of the disease has been proposed to be associated with the imbalance of T helper type 1 (Th1) and Th2 cytokine activities. Elevated serum levels of interleukin-6 (IL-6), a Th2 cytokine with various functions in the regulation of human biological systems, are observed in SLE patients. In the present study, 100 Malaysian SLE patients and 100 controls were evaluated in order to determine the association of polymorphisms existing in the promoter region of the IL-6 gene with the onset of SLE. The homozygous G genotype was found to be significant in SLE patients (χ² = 33.754; P = 0.00000000625), whereas the heterozygous G/C genotype was significant in the controls (χ²= 25.087; P = 0.000000548). We suggest that the C allele might have a masking effect on the G allele when both alleles are present in heterozygous individuals. However, we did not observe any significant association of the homozygous C allele with the onset of SLE or with protection from the disease (χ² = 1.684; P = 0.194366).

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Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , /genética , Lupus Eritematoso Sistémico/genética , Estudios de Casos y Controles , Frecuencia de los Genes , Homocigoto , /sangre , Lupus Eritematoso Sistémico/sangre , Malasia , Reacción en Cadena de la Polimerasa , Regiones Promotoras Genéticas , Polimorfismo de Nucleótido Simple/genética , Adulto Joven

RESUMEN

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves the inflammation of various organs upon deposition of immune complexes and is characterized by uncontrolled B cell hyperactivity. Despite intensive research on the etiology of the disease, the exact cause of the onset of SLE is unknown. The pathogenesis of the disease has been proposed to be associated with the imbalance of T helper type 1 (Th1) and Th2 cytokine activities. Elevated serum levels of interleukin-6 (IL-6), a Th2 cytokine with various functions in the regulation of human biological systems, are observed in SLE patients. In the present study, 100 Malaysian SLE patients and 100 controls were evaluated in order to determine the association of polymorphisms existing in the promoter region of the IL-6 gene with the onset of SLE. The homozygous G genotype was found to be significant in SLE patients (chi(2) = 33.754; P = 0.00000000625), whereas the heterozygous G/C genotype was significant in the controls (chi(2)= 25.087; P = 0.000000548). We suggest that the C allele might have a masking effect on the G allele when both alleles are present in heterozygous individuals. However, we did not observe any significant association of the homozygous C allele with the onset of SLE or with protection from the disease (chi(2) = 1.684; P = 0.194366).

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Interleucina-6/genética , Lupus Eritematoso Sistémico/genética , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Frecuencia de los Genes , Homocigoto , Humanos , Interleucina-6/sangre , Lupus Eritematoso Sistémico/sangre , Malasia , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Polimorfismo de Nucleótido Simple/genética , Regiones Promotoras Genéticas , Adulto Joven