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Following the Alma Ata declaration, SAARC countries have established their workforce of community health workers (CHWs) to address primary healthcare needs. Initially focused on maternal and child health, the countries now confront a changing healthcare landscape characterized by noncommunicable diseases (NCDs), mental health issues, and surgical conditions. These developments have led to the emergence of specialized CHWs tasked with managing NCDs and mental health concerns, prompting a reevaluation of the balance between specialization and maintaining a generalist approach. The effectiveness of CHWs during crises hinges on critical factors such as standardized training, opportunities for career advancement, and equitable compensation. This viewpoint makes a call to introduce a specialist category of CHW to align with evolving healthcare requirements in SAARC countries.

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South Asia, consisting of Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka, spreads between the Himalayan base and the Indian Ocean and shares identical geophysical characteristics. With the inclusion of its newest member Afghanistan, these 8 member nations of the South Asian Association for Regional Cooperation (SAARC) share more or less a homogenous geographical, political, and historical background and cultural heritage, with a significant role in shaping the world. This densely populated area is home to around a quarter of the world's total population. From the ancient ages, the neurosurgical practice has paced relentlessly and in the last 100 years, it has reached its zenith. With modern advancements, neurosurgery has developed in its diagnostic and treatment modalities along with facilities for training and education. Despite falling behind owing to economic, educational, and geopolitical constraints, the pioneers of the SAARC region have established the fields of neurosurgery in their respective countries with command. No constraint could stop them from educating and training young physicians to make competent neurosurgeons to evolve the field of neurosurgery in their countries. Their firm determination and hard work paved the way to keep this field striving and thriving, to serve a substantial volume of the world population with their neurosurgical insight and skill. However, this region needs to go a long way as the number of neurosurgeons and facilities is still insufficient. This can be achieved with the guidance and collaboration among the neurosurgeons of the SAARC region as the youth here are talented and hardworking.

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OBJECTIVES: The Cancer Control Act requires the maintenance of regional cooperation pathways (RCP) for cancer treatment. In 2008, we started RCP for early detection of new gastric cancer after endoscopic submucosal dissection (ESD). In gastric cancer treatment, RCP after surgical resection had been widely used, but little is known about RCP after ESD. This study aimed to evaluate the effectiveness of RCP after ESD. METHODS: This study included 465 patients on whom our RCP was implemented from 2008 to 2018. A regional family physician performed surveillance endoscopy at 3 months and 1 year after ESD and annually thereafter. We retrospectively evaluated the cumulative incidence and treatment outcomes of new gastric cancer and compared them with previous reports. RESULTS: During a median follow-up period of 70.5 months (3-120 months), 58 patients developed new gastric cancers, and metachronous gastric cancer was detected in 55 patients more than 1 year after ESD. The 5-year cumulative incidence rate was 9.8%. Three patients did not want treatment. Among the remaining 55 patients, the initial treatment was ESD in 51 and surgical resection in 4. Eventually, 50 patients (48 in the ESD group and 2 in the surgical resection group) fulfilled the pathologic criteria for curative ESD. There were no deaths due to gastric cancer. CONCLUSION: Our study was the first to reveal the incidence of new gastric cancer after ESD using RCP. Most lesions were cured with ESD, and no patients died of gastric cancer. Therefore, we consider RCPs to be an option for surveillance after ESD.

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Amidst escalating environmental concerns, regional cooperation has emerged as a potent strategy for environmental preservation. Yet, the potency of such cooperation in curbing air pollution remains largely unexplored and nebulous. Drawing upon a decade-long (2010-2019) new data from the dynamic Guangdong-Hong Kong-Macao Greater Bay Area (GBA), this study seeks to fill these knowledge gaps. Our findings underscore the transformative potential of regional cooperation in mitigating air pollution. By catalyzing technological advancements, fostering structural shifts in businesses, and reshaping land-use patterns, regional cooperation paves the way for a cleaner, healthier environment. A deeper dive into the heterogeneity reveals that "top to bottom" city agreements within regional cooperation frameworks significantly enhance air quality. While institutional and economic collaborations prove instrumental in reducing air pollution, social cooperation appears to have a lesser impact. Research findings indicate that the future will necessitate strengthening formal, institutionalized regional cooperation to address potential challenges posed by environmental pollution.

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The Postpartum Care Services (PCS) programme in Japan is intended to promote physical recovery and psychological rest for mothers and their children after discharge from the delivery facility, as well as nurture the mothers' own self-care skills and support healthy childrearing for mothers, children and their families. The subsidies for PCS are based on cooperation between psychiatry and obstetrics and between multiple professions, including the local government. The services should also be implemented based on the instruction to medical institutions and the local governments that they should actively screen and approach pregnant women in need of support. This narrative review describes the challenges of expanding the PCS programme nationwide in Japan.

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Background: Rare cancers (RCs) are challenging to manage and are "forgotten cancers" though they collectively constitute a significant proportion of all cancers (∼20%). As a first step towards streamlining care, there is an unmet need to map the epidemiology of RCs in South Asian Association for Regional Collaboration (SAARC) countries. Methods: The authors collected data from 30 Population-Based Cancer Registries (PBCR) of India and the published national registries of Nepal, Bhutan and Sri Lanka (SL) and compared them with the standard RARECAREnet RC list. Findings: With the standard definition of crude incidence rates (CR) ≤6/100,0000 per population, 67.5%, 68.3%, 62.3% and 37% of all incident cancers qualify as RCs in India, Bhutan, Nepal and SL, respectively. An arbitrary cut-off CR ≤3 appears more appropriate with 43%, 39.5%, 51.8% and 17.2% of cancers identified as RCs, respectively, due to the lower cancer incidence.There are similarities and notable differences between the RC lists of the SAARC region with that of the European RC list. Oral cavity cancers are rare in Europe, while pancreas, rectum, urinary bladder and melanomas are common. In addition, uterine, colon and prostatic cancers are rare in India, Nepal and Bhutan. In SL, thyroid cancer is common. There are gender-related and regional differences in RC trends in the SAARC countries. Interpretation: There is an unmet need in SAARC nations to capture epidemiological nuances in rare cancers. Understanding the unique issues in the developing world may guide policymakers to adopt appropriate measures to improve RC care and tailor public health interventions. Funding: None.

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The cross-regional transfer of food safety risks has become more prominent, bringing new challenges to food safety regulation. This study used a social network analysis to delve into the nuanced features and determinants of the cross-regional transfer of food safety risks based on the food safety inspection data of five provinces in East China from 2016 to 2020, thus contributing to the establishment of effective cross-regional cooperation in food safety regulation. The main findings are as follows: First, the cross-regional transfer of unqualified products accounts for 36.09% of all unqualified products. Second, the food safety risk transfer network presents a typical complex network-a relatively low but increasing network density, heterogeneous nodes, numerous subgroups, and a dynamic structure-bringing more difficulties to food safety cross-regional cooperation. Third, territorial regulation and intelligent supervision both contribute to restricting cross-regional transfers. However, the advantages of intelligent supervision have not yet been brought into play due to low data utilization. Fourth, the development of the food industry helps to mitigate the cross-regional transfer of food safety risks. To achieve effective cross-regional cooperation in food safety risks, it is essential to use food safety big data as a guide and to maintain synchronization between the development of the food industry and the improvement of regulations.

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Mitigating regional air pollution involves multifaceted trade-offs, including long-term versus short-term development versus emission-reduction among different regions. Considering the heterogeneity of levels of regional economic development and capacity for environmental governance as well as the spatial spillover effect of pollution, the game theory method can explore each region's dynamic emission-reduction path. In this article, the dynamic game mechanism (Regional Environment Economy Game Modeling model) is incorporated into the environment economy system to solve the Nash equilibrium under dynamic conditions and explore the game strategies of each region. Taking air pollution mitigation in North China as an example, this article compares the emission-reduction effect and social welfare under regional cooperative and noncooperative game scenarios and clarifies the abatement-sharing mechanism between provinces. The results show that a noncooperative policy is strictly inferior to a cooperative policy for achieving given emission-reduction goals and maximizing social welfare. Our findings offer evidence for strengthening regional cooperation in reducing carbon emissions and provide policy recommendations for synergistic pollution abatement and joint regional pollution mitigation. Integr Environ Assess Manag 2023;19:1555-1569. © 2023 SETAC.

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The Chinese central government has been running an intensive exchange program called the Mainland China-Hong Kong Ten Thousand Student Exchange Program since 2012 to support local Hong Kong university students' visits to mainland China, with the aim of promoting exchange and regional cooperation between Hong Kong and mainland China. However, little is known about local Hong Kong university students' views on regional cooperation and whether the program is effective in changing their views. Using a randomized experimental design, we find that most students hold positive views on regional cooperation between Hong Kong and mainland China, but a considerable percentage of students oppose integration with mainland China. We also find that the program is effective in positively changing students' views on certain aspects of regional cooperation related to the free trade zones and the Hong Kong-Zhuhai-Macau Bridge, but is not significantly effective on other aspects of regional cooperation. This study provides the first causal quantitative evidence regarding the impact of the mainland China-Hong Kong exchange program on local university students' views regarding regional cooperation. The findings help inform the public about the prospect of regional cooperation and offer policy implications on youth exchange between mainland China and Hong Kong.

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Machine learning (ML) has proved to be a prominent study field while solving complex real-world problems. The whole globe has suffered and continues suffering from Coronavirus disease 2019 (COVID-19), and its projections need to be forecasted. In this article, we propose and derive an autoregressive modeling framework based on ML and statistical methods to predict confirmed cases of COVID-19 in the South Asian Association for Regional Cooperation (SAARC) countries. Automatic forecasting models based on autoregressive integrated moving average (ARIMA) and Prophet time series structures, as well as extreme gradient boosting, generalized linear model elastic net (GLMNet), and random forest ML techniques, are introduced and applied to COVID-19 data from the SAARC countries. Different forecasting models are compared by means of selection criteria. By using evaluation metrics, the best and suitable models are selected. Results prove that the ARIMA model is found to be suitable and ideal for forecasting confirmed infected cases of COVID-19 in these countries. For the confirmed cases in Afghanistan, Bangladesh, India, Maldives, and Sri Lanka, the ARIMA model is superior to the other models. In Bhutan, the Prophet time series model is appropriate for predicting such cases. The GLMNet model is more accurate than other time-series models for Nepal and Pakistan. The random forest model is excluded from forecasting because of its poor fit.

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To improve the quality of palliative care in the Kyoto region, we thought that closely connecting hospice and palliative care units (PCU) is necessary. Subsequently, we established the Kyoto PCU Liaison Committee in September 2017. This committee was created as a place to casually discuss the problems that individual PCU facilities have, deliberate on their worries together, grow and develop, and support newly launched facilities. Furthermore, discussions were held on current topics (emergency hospitalization, blood transfusion, smoking, bereaved family meetings, etc.) at the liaison meetings. While meetings were adjourned in 2020 due to the COVID-19 pandemic, we continued to exchange opinions on infection control, PCU management, etc., using the email network at first. Later, these meetings resumed via web conference systems. Thus, by having face-to-face relationships on a daily basis, we were able to maintain cooperation between PCUs even during the pandemic, and collaborate with cancer treatment hospitals. Overall, by forming a team of PCUs in Kyoto Prefecture, we aim to enable patients and their families to live with peace of mind wherever they are.

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In this study, we introduced the realistic problem of a dynamic carbon tax, built several evolutionary game models for cooperative emission reduction by local governments, and determined the factors that influence governments' willingness to cooperate in emission reduction. The findings revealed that, first, the probability of governments opting for cooperative emission reduction strategies increases at different rates depending on the benefits and costs of cooperation. Second, externalities influence governments' willingness to cooperate in emission reduction during cooperative carbon emission reduction. Furthermore, the emergence of a free-riding situation reduces the effectiveness of intergovernmental cooperation in reducing carbon emissions. Third, carbon tax policy can influence the likelihood that local governments will choose cooperative emission reduction, and different carbon tax sizes have different effects on their willingness to choose cooperative emission reduction.

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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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The Southern Region has reported a large number of contagious pandemic outbreaks. These epidemics brought threats to human health and resulted in serious economic losses. The COVID-19 is a global virus and has weakened the global financial markets with significant effect on stock returns and market volatilities. The study obtained a dataset about the financial market structure of South Asian Association for Regional Cooperation (SAARC) Countries. The purpose of the study is to determine the effect of 2019-nCov on stock market performance of SAARC member states. The study considered indexes of the National Stock Exchanges of each country and applied an event study approach for estimating the impact of Mad COVID-19 on the stock returns and market volatilities with an event window of 25 days of severe pandemic hits. The CAR approach proved the declining effect of Mad COVID-19 on the stock returns of SAARC countries. Asymmetric GJR-GARCH Model estimated the changeable volatility and proved the increase in volatility with COVID-19 as a negative shock. SAARC Region significantly reacts to Mad COVID-19 with falling markets and rising volatility.

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Revised: Nov 6 2021The shortfalls of multilateral and regional organizations in respect of handling the COVID-19 pandemic have been well rehearsed by scholars and policy makers in multiple publications and statements. While the World Health Organization (WHO) and its regional offices have coordinated global responses, regional organizations, like the European Union, Association of Southeast Asian Nations, or African Union, have played complementary roles. However, the response of different regions has varied, revealing multiple deficits in the structures of regional governance. The Middle East and North Africa (MENA) is a region affected by chronic ongoing conflicts and serious inequalities in health and welfare provision, reflected in the absence of concerted responses to the pandemic. Its young population has meant lower comparative mortality rates, but the socio-economic spill-over effects are grave in terms of interrupted education, high unemployment, particularly in respect to vulnerable communities like refugees and migrant workers. With the current situation remaining critical, this paper reviews the impact of COVID-19 on MENA and considers the variable performance of states and institutions to the pandemic, highlighting the shortfalls, but also opportunities for collective action. Drawing on data from the WHO, United Nations (UN), regional organizations, media and secondary sources, it first discusses the wider global-regional context; second, reviews the actions of regional bodies, like the League of Arab States, Gulf Cooperation Council and the cross-regional Organization of Islamic Cooperation; and third, looks at some country-specific situations where both evidence of good practice and the absence of appropriate regional level provision have exposed deep regional divides. It concludes with a call for more collaboration between states and international organizations: better regional coordination is urgently needed to supplement existing multilateral efforts. A collective local response to the COVID-19 pandemic could help transcend regional divides and spur much-needed security cooperation in other areas.

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The Upper Indus Basin's (UIB) unique geographical positioning and its ecosystem contributions to the downstream basin in the form of water and energy are of critical importance. UIB is also among the most vulnerable water towers in the world vis-a-vis climate as well as a host of environmental and socio-economic changes. The paucity of ground observations and their associated unknowns make it imperative to study and highlight the grey areas for attention and action by policy planners and basin government and management at different levels in order to improve the management and the governance structures for better water resource management. As this river basin is shared between countries, enhanced co-creation of knowledge can provide greater understanding of the challenges to stakeholders so that they can make better decisions regarding the development of the region. With this in view, the UIB network, comprising four national chapters (Afghanistan, China, India and Pakistan) linked strategically at regional level, was conceived to provide better understanding of the critical issues associated with the UIB. The network strives for a resilient and empowered UIB region through science-based regional cooperation, which promotes coordination and collaboration among organizations working in the UIB to ensure improved understanding of present and future water availability, demand and hazards and to develop gender sensitive solutions for all stakeholders. The special issue is one of such efforts from the network in knowledge generation, exchange, and dissemination to contribute towards an enhanced understanding of climate change impacts in the Indus. The paper presents a time-wise evolution of the network to highlight the importance of cross boundary knowledge and the relevance of such networks. Such a science-based network can provide important information for science-backed policies for the basin countries. It also details the achievements of the network, lessons learnt from such knowledge networks, and the potential for future contributions to basin countries taking into consideration the transboundary nature of the UIB.

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BACKGROUND: The Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS+) was established in 1998, which has developed close partnerships with Asian countries endemic for schistosomiasis and other helminthiasis in Asia. RNAS+ has provided an ideal regional platform for policy-makers, practitioners and researchers on the prevention, control and research of parasitic diseases in Asian countries. China, one of the initiating countries, has provided significant technical and financial support to the regional network. However, its roles and contributions have not been explored so far. The purpose of this study was to assess China's contributions on the supporting of RNAS+ development. METHODS: An assessment research framework was developed to evaluate China's contributions to RNAS+ in four aspects, including capacity building, funding support, coordination, and cooperation. An anonymous web-based questionnaire was designed to acquire respondents' basic information, and information on China's contributions, challenges and recommendations for RNAS+development. Each participant scored from 0 to 10 to assess China's contribution: "0" represents no contribution, and "10" represents 100% contribution. Participants who included their e-mail address in the 2017-2019 RNAS+ annual workshops were invited to participate in the assessment. RESULTS: Of 71 participants enrolled, 41 responded to the survey. 37 (37/41, 90.24%) of them were from RNAS+ member countries, while the other 4 (4/41, 9.76%) were international observers. Most of the respondents (38/41, 92.68%) were familiar with RNAS+. Respondents reported that China's contributions mainly focused on improving capacity building, providing funding support, coordination responsibility, and joint application of cooperation programs on RNAS+ development. The average scores of China's contributions in the above four fields were 8.92, 8.64, 8.75, and 8.67, respectively, with an overall assessment score of 8.81 (10 for a maximum score). The challenge of RNAS+ included the lack of sustainable funding, skills, etc. and most participants expressed their continual need of China's support. CONCLUSIONS: This survey showed that China has played an important role in the development of RNAS+ since its establishment. This network-type organization for disease control and research can yet be regarded as a great potential pattern for China to enhance regional cooperation. These findings can be used to promote future cooperation between China and other RNAS+ member countries.

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Introduction: The purpose of this study was to clarify the issues for nurses in neurology departments of medical clinics in building a comprehensive community care system based on the implementation status of regional cooperation and individual support for hospitalized patients. We selected neurology as the subject of our study because patients who visit the neurology department are in the medical clinic for an extended period, and we believe that regional cooperation and individual support are implemented more than in other departments.Methods: A self-administered questionnaire survey was conducted by mail in February 2020 among nurses at 1,052 clinics, which were randomly selected from 2,104 clinics with neurology departments among medical institutions designated for intractable diseases.Results: We collected 174 responses (16.5% collection rate), 164 of which were valid (15.5% valid response rate). The regional cooperation rate was 71.3% and individual support by nurses was implemented at 29.9% of the clinics in the past year. Clinical physicians often sought "patient support in collaboration with related parties" and "patient guidance". Free descriptions included five categories such as [strengthening the awareness and abilities of nurses who are responsible for community healthcare] and [training nurses who can promote comprehensive community care].Conclusion: Regional cooperation and individual support are necessary as nursing activities linked to the functions of family physicians.

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Abstract Tracing the pathways of cooperation in health in sub-Saharan Africa from hesitant exchanges to institutionalized dimensions from the 1920s to the early 1960s, this article addresses regional dynamics in health diplomacy which have so far been under-researched. The evolution thereof from early beginnings with the League of Nations Health Organization to the Commission for Technical Assistance South of the Sahara and the World Health Organization's Regional Office for Africa, shows how bilateral dimensions were superseded by WHO's multilateral model of regional cooperation in health. Alignments, divergences, and outcomes are explored with respect to the strategies and policies pursued by colonial powers and independent African states regarding inter-regional relations, and their implications for public health and epidemiological interventions.

Resumo Trilhando os caminhos da cooperação sanitária na África subsaariana, de intercâmbios incertos a dimensões institucionalizadas dos anos 1920 até início dos anos 1960, este artigo aborda a dinâmica regional na diplomacia sanitária que, até o momento, carece de pesquisas. A evolução, desde os primórdios da Organização da Saúde da Liga das Nações até a Cooperação Técnica na África Subsaariana e o Escritório Regional da África da OMS, demonstra como dimensões bilaterais foram substituídas pelo modelo multilateral da OMS de cooperação sanitária regional. São analisados alinhamentos, divergências e resultados de estratégias e políticas empregados por potências coloniais e Estados africanos independentes em relações inter-regionais, bem como suas implicações em intervenções epidemiológicas e de saúde pública.

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The rate of detection of various resistant bacteria has recently increased, though the development of antimicrobial agents has been delayed. In the hospital setting, an antimicrobial stewardship team (AST) works to assure that resistant bacteria do not appear, while an infection control team (ICT) works to assure these resistant bacteria do not spread. Additionally, ICT and AST work together on the appropriate use of antimicrobial agents. In order to combat infectious diseases regionally, it will be important for hospitals and pharmacies to share such information as infection control, consumption trends of each antimicrobial agent, and the susceptibility rate of antimicrobial agents. In addition, cooperation between hospitals and community pharmacies is important to assure patients can receive appropriate medical treatment after leaving the hospital. It is essential to have a common understanding of the prevalent infectious disease in order to continuously provide safe and effective drug treatment in the region. Therefore, we propose educating health care professionals about the proper use of antimicrobial drugs through cooperation between hospitals and community pharmacies. In this symposium, we will introduce those infectious control activities a pharmacist will focus on, as well as the proper use of antimicrobial agents, and regional cooperation activities.

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