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In March 2020, WHO declared COVID-19 a global pandemic which led to many countries closing their borders to contain the spread of the virus, stay-at-home mandates were announced and governmental entities started working on minimal capacity. Delays in visa processing and renewal is one aspect that was hugely impacted by the pandemic and led to interruption in the training of many international medical graduates (IMGs). In this manuscript, we share our stories and perspective on the challenges faced by IMGs holding J-1 visa during COVID-19 pandemic.
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BACKGROUND: Regional cooperation on health in Africa is not new. The institutional landscape of regional cooperation for health and health research, however, has seen important changes. Recent health emergencies have focussed regional bodies' attention on supporting aspects of national health preparedness and response. The state of national health research systems is a key element of capacity to plan and respond to health needs - raising questions about the roles African regional bodies can or should play in strengthening health research systems. METHODS: We mapped regional organisations involved in health research across Africa and conducted 18 interviews with informants from 15 regional organisations. We investigated the roles, challenges, and opportunities of these bodies in strengthening health research. We deductively coded interview data using themes from established pillars of health research systems - governance, creating resources, research production and use, and financing. We analysed organisations' relevant activities in these areas, how they do this work, and where they perceive impact. RESULTS: Regional organisations with technical foci on health or higher education (versus economic or political remits) were involved in all four areas. Most organisations reported activities in governance and research use. Involvement in governance centred mainly around agenda-setting and policy harmonisation. For organisations involved in creating resources, activities focused on strengthening human resources, but few reported developing research institutions, networks, or infrastructure. Organisations reported more involvement in disseminating than producing research. Generally, few have directly contributed to financing health research. Informants reported gaps in research coordination, infrastructure, and advocacy at regional level. Finally, we found regional bodies' mandates, authority, and collaborations influence their activities in supporting national health research systems. CONCLUSION: Continued strengthening of health research on the African continent requires strategic thinking about the roles, comparative advantages, and capability of regional organisations to facilitate capacity and growth of health research systems.
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Política de Salud , Investigación en Sistemas de Salud Pública , Humanos , ÁfricaRESUMEN
BACKGROUND: In recent years there have been calls to strengthen health sciences research capacity in African countries. This capacity can contribute to improvements in health, social welfare and poverty reduction through domestic application of research findings; it is increasingly seen as critical to pandemic preparedness and response. Developing research infrastructure and performance may reduce national economies' reliance on primary commodity and agricultural production, as countries strive to develop knowledge-based economies to help drive macroeconomic growth. Yet efforts to date to understand health sciences research capacity are limited to output metrics of journal citations and publications, failing to reflect the complexity of the health sciences research landscape in many settings. METHODS: We map and assess current capacity for health sciences research across all 54 countries of Africa by collecting a range of available data. This included structural indicators (research institutions and research funding), process indicators (clinical trial infrastructures, intellectual property rights and regulatory capacities) and output indicators (publications and citations). RESULTS: While there are some countries which perform well across the range of indicators used, for most countries the results are varied-suggesting high relative performance in some indicators, but lower in others. Missing data for key measures of capacity or performance is also a key concern. Taken as a whole, existing data suggest a nuanced view of the current health sciences research landscape on the African continent. CONCLUSION: Mapping existing data may enable governments and international organizations to identify where gaps in health sciences research capacity lie, particularly in comparison to other countries in the region. It also highlights gaps where more data are needed. These data can help to inform investment priorities and future system needs.
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Pandemias , Investigación , África , HumanosRESUMEN
Cancer treatment by magnetic hyperthermia offers numerous advantages, but for practical applications many variables still need to be adjusted before developing a controlled and reproducible cancer treatment that is bio-compatible (non-damaging) to healthy cells. In this work, Fe3O4 and CoFe2O4 were synthesized and systematically studied for the development of efficient therapeutic agents for applications in hyperthermia. The biocompatibility of the materials was further evaluated using HepG2 cells as biological model. Colorimetric and microscopic techniques were used to evaluate the interaction of magnetic nano-materials (MNMs) and HepG2 cells. Finally, the behavior of MNMs was evaluated under the influence of an alternating magnetic field (AMF), observing a more efficient temperature increment for CoFe2O4, a desirable behavior for biomedical applications since lower doses and shorter expositions to alternating magnetic field might be required.
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Hipertermia Inducida/métodos , Nanopartículas de Magnetita/administración & dosificación , Nanomedicina/métodos , Neoplasias/terapia , Animales , Materiales Biocompatibles/administración & dosificación , Materiales Biocompatibles/química , Materiales Biocompatibles/toxicidad , Cobalto/administración & dosificación , Cobalto/química , Cobalto/toxicidad , Colorimetría , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Compuestos Férricos/administración & dosificación , Compuestos Férricos/química , Compuestos Férricos/toxicidad , Óxido Ferrosoférrico/administración & dosificación , Óxido Ferrosoférrico/química , Óxido Ferrosoférrico/toxicidad , Células Hep G2 , Humanos , Hipertermia Inducida/efectos adversos , Hígado/efectos de la radiación , Magnetoterapia/efectos adversos , Magnetoterapia/métodos , Nanopartículas de Magnetita/química , Nanopartículas de Magnetita/toxicidad , Masculino , Ensayo de Materiales/métodos , Ratas , Factores de Tiempo , Pruebas de Toxicidad/métodosRESUMEN
Reducing delays related to inpatient chemotherapy may reduce healthcare costs. Using a national database, we identified patients with lymphoma/leukemia with ≥1 etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) chemotherapy claim and evaluated chemotherapy initiation delay (ID), >1 day from admission. Standard tests/procedures prior to initiation were evaluated. Among 4453 inpatient cycles, 19.7% had ID, odds ratio 2.28 (95% confidence interval: 1.83-2.85) with cycle 1 compared to cycle 2, and mean costs were higher in patients with ID than without ID (p < .0001). Prior to cycle 1, patients were more likely to undergo routine diagnostic procedures compared to subsequent cycles. Efforts to perform routine procedures prior to admission may reduce hospital length of stay and costs.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tiempo de Internación/economía , Leucemia/tratamiento farmacológico , Linfoma/tratamiento farmacológico , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Ciclofosfamida/economía , Ciclofosfamida/uso terapéutico , Doxorrubicina/economía , Doxorrubicina/uso terapéutico , Etopósido/economía , Etopósido/uso terapéutico , Femenino , Costos de la Atención en Salud , Humanos , Pacientes Internos , Leucemia/economía , Linfoma/economía , Masculino , Persona de Mediana Edad , Prednisona/economía , Prednisona/uso terapéutico , Resultado del Tratamiento , Vincristina/economía , Vincristina/uso terapéuticoRESUMEN
Image-guided percutaneous liver biopsy (PLB) is a diagnostic tool for lesions in the liver. Hemorrhage is the most common complication. We selected patients with a diagnostic claim for cancer who had undergone PLB. There were a total of 26,941 patients who underwent PLB. Hemorrhage risk was 1.43% among patients undergoing PLB. When stratified by setting, odds of hemorrhage were 4.5 times higher when biopsy was performed in an inpatient setting (p < .001). Risk factors associated with hemorrhage included marital status, liver cancer and comorbidity score. The use of PLB has increased over time. Reassuringly, the hemorrhage risk associated with PLB is low.
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Biopsia Guiada por Imagen/efectos adversos , Biopsia Guiada por Imagen/estadística & datos numéricos , Neoplasias Hepáticas/patología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Hemorragia/epidemiología , Hemorragia/etiología , Humanos , Biopsia Guiada por Imagen/economía , Biopsia Guiada por Imagen/métodos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiologíaRESUMEN
This study examines factors associated with prolonged radiation duration and its impact on survival in women with cervical cancer treated with primary chemoradiation. Women in the National Cancer Database with stage IB2-IVA cervical cancer from 2003 to 2011 who received radiation and chemotherapy were included. Of 7209 women, who met inclusion criteria, 3401 (47.1%) and 3808 (52.8%) completed radiation in ≤ 8 and > 8 weeks, respectively. There was no overall survival difference for radiation duration ≤ 8 vs. > 8 weeks. Sensitivity analyses showed that inferior overall survival is only seen with radiation duration of > 10-12 weeks.
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Carcinoma de Células Escamosas/terapia , Neoplasias del Cuello Uterino/terapia , Adulto , Carcinoma de Células Escamosas/mortalidad , Quimioradioterapia , Estudios de Cohortes , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Resultado del Tratamiento , Neoplasias del Cuello Uterino/mortalidadRESUMEN
OBJECTIVE: Multimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions. RESEARCH DESIGN AND METHODS: This is an exploratory retrospective analysis of electronic health record data for 23â 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors. RESULTS: The 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality. CONCLUSIONS: Future interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities.
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A health science researcher may sometimes wonder "why statistical methods are so important in research?" Simple answer is that, statistical methods are used throughout a study that includes planning, designing, collecting data, analyzing and drawing meaningful interpretation and report the findings. Hence, it is important that a researcher knows the concepts of at least basic statistical methods used at various stages of a research study. This helps the researcher in the conduct of an appropriately well-designed study leading to valid and reliable results that can be generalized to the population. A well-designed study possesses fewer biases, which intern gives precise, valid and reliable results. There are many statistical methods and tests that are used at various stages of a research. In this communication, we discuss the overall importance of statistical considerations in medical research with the main emphasis on estimating minimum sample size for different study objectives.