Digital psychiatry in low-and-middle-income countries:New developments and the way forward

Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.

Adapting chronic care models for diabetes care delivery in low-and-middle-income countries:A review

A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of a low-to-middle-income country.A context-based narrative review of existing models for chronic care was conducted.A situational analysis was done at thegrassroots level,involving the leaders and members of the community,the patients,the local health system and the healthcare providers.A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions.The analyses indicated that care for chronic conditions may be introduced,considering the needs of people with diabetes in particular and the community in general as recipients of care,and the issues and factors that may affect the healthcare workers and the health system as providers of this care.The context-adapted chronic care model-based service delivery model was constructed accordingly.Key features are:incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population,risk identification,screening,counseling including self-care development,and clinical management of the chronic condition and any co-morbidities,regardless of level of control of the condition.This way,low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.

Nutrition impacts of non-solid cooking fuel adoption on under-five children in developing countries

This paper examines the nutrition impacts of using non-solid cooking fuel on under-five children in developing countries.We draw on data from more than 1.12 million children in 62 developing countries from the Demographic and Health Surveys(DHS).Results from both fixed effects(FE)and instrumental variable(IV)estimates show that using non-solid cooking fuel significantly improves the nutrition outcomes of under-five children.Compared with their peers from households mainly using solid fuel,children from households mainly using non-solid fuel exhibit a lower probability of experiencing stunting(by 5.9 percentage points)and being underweight(by 1.2 percentage points).Our further investigation provides evidence for several underlying mechanisms,such as improved indoor air quality,induced reduction in children’s respiratory symptoms,benefits on maternal health,and reduction in maternal time spent on fuel collection or cooking.Heterogenous analyses suggest that the nutrition benefits of using non-solid cooking fuel are more prominent among boys,children above three years old,and those from households of lower socioeconomic status,rural areas,and Southeast Asia.

Informing policy makers in developing countries:Practices and limitations of geriatric home medication review in Malaysia-A qualitative inquiry

Objective:To explore existing practices and challenges in the delivery of geriatric home medication review(HMR).The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR.Methods:This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals.The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR.Results:Based on the emerging themes from the qualitative data,the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits,encompassing a diverse patient population with various healthcare needs.However,it faces challenges such as the lack of outcome monitoring,formal training,and workforce constraints.Despite these hurdles,there is a pressing need for the expansion of this service to better serve the community,and collaboration with community pharmacists holds potential to broaden its scope.Ultimately,the findings suggest that pharmacist-led HMR is both warranted and feasible within the Malaysian healthcare context.In order to optimize medicine-use among older people living in the community,approaches for expanding geriatric HMR services in Malaysia must be developed.Conclusions:This study holds profound implications as it attempts to illuminate policy makers in developing countries,enabling them to formulate effective HMR plans.By considering the challenges highlighted within this research,policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population.

Food Security in Developing Countries: Factors and Mitigation

Since 1976, eradicating hunger has become one of the priority objectives of the United Nations, which is included in the Charter of Human Rights;the right to get adequate food. The qualification of food security in time and space must analyze not only the three components it covers but also the relationships that these three components maintain. Climate change contributes to food insecurity, but it is not the only factor. To address food insecurity in various forms, greater food security must be combined with improved sustainable agricultural practices with minimal strain on the environment. This review of literature insists on the principles of food security, which in particular allows a better understanding of food insecurity in developing countries and favors a greater contribution of agriculture and food systems in general to nutritional progress.

A harmonisation approach to traditional Chinese medicine registration in Asian countries

The traditional Chinese medicine(TCM)industry is critical to not only for public health but also for economic growth.According to the European Union(EU)directives,under the EU framework for(traditional)herbal medicinal products,herbal medicines with long history of use can be registered in EU.However,there is a condition in this directive in which only those that have at least 10e15 years in the EU market are accepted for registration and/or marketing authorization.In author opinion,the condition of 10-15 years of use in EU countries set within the EU regulatory framework is with consideration of the genetic differences which can result in variation in adverse drug responses among different world populations.With this concept in mind,it is reasonable to project the principal of the EU directive to the Asian countries where TCM is originated.Countries like China,Singapore,Japan and South Korea that have well established drug registration framework are in best position in executing the best practice and facilitate harmonization of registration for TCM within the region.Furthermore,the registration process itself allows more safety and efficacy data to be collected systemically before and after product registration/marketing authorization.These are valuable information for future drug development.The therapeutic value of TCM is limitless,it has been left out in the EU regulatory framework,and the opportunity for it to be expanded and carried forward in modern medicines is shadowed by the limited number of TCM that are qualified to be registered under the EU regulatory framework.An early establishment of a harmonized risk-based registration process for TCM in Asian countries is important.This will strengthen the database to substantiate the history of safe use and further preserving and expanding the therapeutic values of TCM within and beyond the Asian region.

Production and trade trend of oils and oilseeds in BRICS countries

In order to promote agricultural production and trade cooperation among BRICS countries,and ensure the security and stability of the oils and oilseeds industrial and supply chains in China and the world,the production,consumption,trade trend,and cooperation potential of oils and oilseeds in BRICS countries were expounded,and relevant policy recommendations were put forward.Most of the BRICS countries are major agricultural producers,and they are also important agricultural product consumption markets in the world.In 2023/2024,the production and consumption of oilseeds in BRICS countries account for nearly half of the world's total;the production of vegetable oils exceeds a quarter of the world's total,and the consumption of vegetable oils accounts for 40%of the world's total.In 2023/2024,the import and export volume of oilseeds exceeds half of the world's total;vegetable oil imports account for 40%of the world's total,and exports account for about one tenth of the world's total.China's imports of oilseeds and oils from BRICS countries account for 68%and 29%of its global imports in 2023,respectively.BRICS countries are rich in agricultural land resources,have great potential for oils and oilseeds production,obvious complementary advantages in trade structure,and huge space for future cooperation.It is suggested that Brazil should be included in the"Belt and Road"co-construction category to promote the continuous deepening of agricultural cooperation between China and Brazil.It is suggested to explore regional agricultural trade agreements among BRICS countries,promote currency settlement and exchange among BRICS countries,and enhance the facilitation and stability of BRICS trade.It is suggested that China should increase its investment in BRICS countries and export advanced technology and management experience to benefit local agricultural development and achieve a mutually beneficial and win-win situation.

An Analysis of Liberia’s Vulnerability to Climate Change in the Context of Least Developed Countries (LDCs): A Review

Climate change is an alarming global challenge, particularly affecting the least developed countries (LDCs) including Liberia. These countries, located in regions prone to unpredictable temperature and precipitation changes, are facing significant challenges, particularly in climate-sensitive sectors such as mining and agriculture. LDCs need more resilience to adverse climate shocks but have limited capacity for adaptation compared to other developed and developing nations. This paper examines Liberia’s susceptibility to climate change as a least developed country, focusing on its exposure, sensitivity, and adaptive capacity. It provides an overview of LDCs and outlines the global distribution of carbon dioxide emissions. The paper also evaluates specific challenges that amplify Liberia’s vulnerability and constrain sustainable adaptation, providing insight into climate change’s existing and potential effects. The paper emphasizes the urgency of addressing climate impacts on Liberia and calls for concerted local and international efforts for effective and sustainable mitigation efforts. It provides recommendations for policy decisions and calls for further research on climate change mitigation and adaptation.

ASEAN Countries' Perceptions and Responses to US Construction of “Indo–Pacific” Minilateral Framework

ASEAN countries are important targets for the United States to promote the “Indo–Pacific” minilateral framework. Their official, think tank, and media opinions regard this as an important opportunity to enhance their national status and promote their national interests, which will be beneficial to peace and stability in the “Indo–Pacific” region. However, they are worried that it will damage the “ASEAN centrality.” ASEAN has responded positively and is committed to reshaping its “central position” and regional leadership and improving regional governance capabilities, but there are differences in the responses of various countries. In the future, ASEAN countries will seek to achieve direct and practical interests through the US “Indo–Pacific” minilateral framework, but they are more wor ried that the “central position of ASEAN” will be replaced and its “neutral and balanced” position will be threatened.

The Implications of Urbanization Processes in Developed Countries for Africa

Urbanization is the inevitable path of national economic development,and the level of urbanization development in most African countries is still low.By analyzing five typical developed countries in the United States,Britain,France,Germany,and Japan,this paper discusses the promoting factors and problems of the rapid urbanization development in their specific years,as well as the experiences and lessons that Africa can learn,so as to prevent Africa from taking the detour in the urbanization process of Western developed countries and promote the balanced regional development of various African countries.

First experience in laparoscopic surgery in low and middle income countries: A systematic review

BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open surgery.It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources.However,introducing laparoscopic surgery in low-and-middle-income countries(LMIC)can be expensive and requires resour-ces,equipment,and trainers.AIM To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.METHODS MEDLINE,EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC.Included studies were published between 1996 and 2022 with full text available in English.Exclusion criteria were studies considering only open surgery,ear,nose,and throat,endoscopy,arthro-scopy,hysteroscopy,cystoscopy,transplant,or bariatric surgery.RESULTS Ten studies out of 3409 screened papers,from eight LMIC were eligible for inclusion in the final analysis,totaling 2497 patients.Most reported challenges were related to costs of equipment and training programmes,equipment pro-blems such as faulty equipment,and access to surgical kits.Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff.The benefits of introducing laparoscopic surgery were economic and clinical,including a reduction in hospital stay,complications,and morbidi-ty/mortality.The introduction of laparoscopic surgery also provided training opportunities for junior doctors.CONCLUSION Despite financial and technical challenges,many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients.While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported,more support is critically required,in particular regarding training.

Socialization Development of ESG Business Models in Representative Asia-Pacific Countries:A State-of-the-Art Review and Recommendation

The integration of environmental,social,and governance(ESG)principles has become a pivotal factor in shaping sustainable and responsible corporate practices.The present study investigates the integration of ESG principles within corporate governance models in Asia-Pacific countries,focusing on socialization.By examining the governance culture,legal frameworks,and corporate practices in these representative countries,the paper delineates a strategic framework for embedding social governance into corporate strategies.The study introduces a Cultural,Economic,Legal,and Political(CELP)framework to assess corporate social governance,investigating the correlation between business practices and social changes.Through a systematic literature review and detailed thematic analysis,this paper aims to offer actionable insights and recommendations,guiding corporations in their transition towards more sustainable and socially responsible business practices.

Research on groundwater ecological environment mapping based on ecological service function:A case study of five Central Asian countries and neighboring regions of China

The groundwater system is a unique ecosystem that serves both resource and ecological functions.Hydrogeologists have conducted extensive theoretical research and practical work on groundwater ecological mapping.This paper,based on the study of groundwater resources and surface ecology in the five Central Asian countries and adjacent areas of China,introduces the concept of ecosystem service functions.It establishes a groundwater ecological zoning index system and conducts research of ecological mapping using the five Central Asian countries and adjacent areas of China as examples.Through this process,the ecosystem service functions of groundwater can be more comprehensively reflected,which can better guide regional geological environment protection and industrial planning.This approach helps coordinate the relationship between socio-economic development and water resource protection,maintain the health of the groundwater ecological environment,enhance the value of groundwater ecological services,and promote the sustainable development of regional economies and societies.

Challenges to establishing and maintaining kidney transplantation programs in developing countries:What are the coping strategies?

Kidney transplantation(KT)is the optimal form of renal replacement therapy for patients with end-stage renal diseases.However,this health service is not available to all patients,especially in developing countries.The deceased donor KT programs are mostly absent,and the living donor KT centers are scarce.Single-center studies presenting experiences from developing countries usually report a variety of challenges.This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries.The financial challenges hamper the infrastructural and material availability,coverage of transplant costs,and qualification of medical personnel.The sociocultural challenges influence organ donation,equity of beneficence,and regular follow-up work.Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice,intense potential psychosocial burdens,complex qualification protocols,and low productivity or compensation for KT practice.Low medical literacy about KT advantages is prevalent among clinicians,patients,and the public.The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems,absent national KT programs and registries,uncoordinated job descriptions and qualification protocols,uncoordinated on-site investigations with regulatory constraints,and the prevalence of commercial KT practices.These challenges resulted in noticeable differences between KT services in developed and developing countries.The coping strategies can be summarized in two main mechanisms:The first mechanism is maximizing the available resources by increasing the rates of living kidney donation,promoting the expertise of medical personnel,reducing material consumption,and supporting the establishment and maintenance of KT programs.The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices.The second mechanism is recruiting external resources,including financial,experience,and training agreements.

Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries

BACKGROUND Colorectal cancer(CRC)plays a significant role in morbidity,mortality,and economic cost in the Belt and Road Initiative(“B and R”)countries.In addition,these countries have a substantial consumption of processed meat.However,the burden and trend of CRC in relation to the consumption of a diet high in processed meat(DHPM-CRC)in these“B and R”countries remain unknown.AIM To analyze the burden and trend of DHPM-CRC in the“B and R”countries from 1990 to 2019.METHODS We used the 2019 Global Burden of Disease Study to collate information regarding the burden of DHPM-CRC.Numbers and age-standardized rates(ASRs)of deaths along with the disability-adjusted life years(DALYs)were determined among the“B and R”countries in 1990 and 2019.Using joinpoint regression analysis,the average annual percent change(AAPC)was used to analyze the temporal trends of age-standardized DALYs rate(ASDALR)from 1990 to 2019 and in the final decade(2010–2019).RESULTS We found geographical differences in the burden of DHPM-CRC among“B and R”countries,with the three highest-ranking countries being the Russian Federation,China,and Ukraine in 1990,and China,the Russian Federation,and Poland in 2019.The burden of DHPM-CRC generally increased in most member countries from 1990 to 2019(all P<0.05).The absolute number of deaths and DALYs in DHPM-CRC were 3151.15[95%uncertainty interval(UI)665.74-5696.64]and 83249.31(95%UI 15628.64-151956.31)in China in 2019.However,the number of deaths(2627.57-2528.51)and DALYs(65867.39-55378.65)for DHPM-CRC in the Russian Federation has declined.The fastest increase in ASDALR for DHPM-CRC was observed in Vietnam,Southeast Asia,with an AAPC value of 3.90%[95%confidence interval(CI):3.63%-4.16%],whereas the fastest decline was observed in Kyrgyzstan,Central Asia,with an AAPC value of-2.05%(95%CI:-2.37%to-1.73%).A substantial upward trend in ASR of mortality,years lived with disability,years of life lost,and DALYs from DHPM-CRC changes in 1990-2019 and the final decade(2010-2019)for most Maritime Silk Route members in East Asia,South Asia,Southeast Asia,North Africa,and the Middle East,as well as Central Europe,while those of the most Land Silk Route members in Central Asia and Eastern Europe have decreased markedly(all P<0.05).The ASDALR for DHPM-CRC increased more in males than in females(all P<0.05).For those aged 50-74 years,the ASDALR for DHPM-CRC in 40 members exhibited an increasing trend,except for 20 members,including 7 members in Central Asia,Maldives,and 12 high or high-middle social development index(SDI)members in other regions(all P<0.05).CONCLUSION The burden of DHPM-CRC varies substantially across“B and R”countries and threatens public health.Relevant evidence-based policies and interventions tailored to the different trends of countries in SDIs or Silk Routes should be adopted to reduce the future burden of CRC in“B and R”countries via extensive collaboration.

Breast cancer awareness in reproductive women in the low-and middle-income countries:a scoping review

Objective:This study aimed to assess breast cancer(BC)awareness among reproductive women in low-and middle-income countries(LMICs),identify influencing factors,and propose feasible interventions or programs.Methods:We followed a 5-step process using a modified version of Arksey and O’Malley framework methodology.A comprehensive search was conducted on the Embase,PubMed,and CINAHL electronic databases for literature published within 10 years(from 2012 to 2022).Results:Thirty-three papers published between 2012 and 2020,spanning 18 countries,were included.Of these,45.6%described a good level of knowledge,while 24.2%reported that women at reproductive ages had good awareness.Twelve influencing factors were identified in 3 categories:socio-demographic(family history,personal history,marital status,age,religion,income status,living place,and occupation),personal(self-efficacy,education,and perceived level),and external(advertisements promoting awareness).Educational programs were recommended in most(>72%)of the included studies.Conclusions:While most studies reported high levels of knowledge and awareness,some found low prevalence among certain groups.Factors affecting knowledge and awareness were classified into socio-demographic,personal,and external categories,with socio-demographic factors such as age,education,income,and marital status being the most frequently cited.The studies recommended implementing educational programs,health prevention strategies,and social interventions to increase BC knowledge and awareness.

Discourse Analysis of the Belt and Road Initiative From the Perspective of Central Asian Countries: A Case Study of the Republic of Kazakhstan

This study employs Norman Fairclough’s Critical Discourse Analysis(CDA)three-dimensional model,using the Republic of Kazakhstan as a case study,to delve into the discourse construction of China’s Belt and Road Initiative(BRI)in Central Asian countries.Through detailed analysis of policy documents,media reports,and public discussions in Central Asian countries,this paper reveals how the BRI constructs specific social practices,discourse events,and textual meanings within these nations.The findings indicate that through this global development strategy,China has not only strengthened its economic ties with Central Asian countries but has also exerted profound influences on political,cultural,and social levels.

Impact of Plastic Waste on the Human Health in Low-Income Countries: A Systematic Review

Background: Plastic pollution is the accumulation of waste composed of plastic and its derivatives all over the environment. Whether in the form of visible garbage or microparticles, as it slowly degrades, plastic pollution poses significant threats to terrestrial and aquatic habitats and the wildlife that call them home, whether through ingestion, entanglement or exposure to the chemicals contained in the material. Unfortunately, there is a lack of documentation on the impact of plastic waste on human health in low- and middle-income countries (LMICs). Methods: We searched five electronic databases (PubMed, Embase, Global Health, CINAHL and Web of Science) and gray literature, following the preferred reporting elements for systematic reviews and meta-analyses (PRISMA), for the impact of plastic waste on human health in developing countries. We included quantitative and qualitative studies written in English and French. We assessed the quality of the included articles using the Mixed Methods Appraisal tool (MMAT). Results: A total of 3779 articles were initially identified by searching electronic databases. After eliminating duplicates, 3167 articles were reviewed based on title and abstract, and 26 were selected for full-text review. Only three articles were retained. The three articles dealt with practices likely to lead to oral exposure to plastic chemicals in human health, as well as the level of awareness of participants concerning the possible impact of plastic on human health, namely, the use of plastic baby bottles, the use of microwaves to cook food and reheat precooked food, the use of plastic bottles to store water in the refrigerator, water purifier containers with plastic bodies and plastic lunch boxes, the reuse of plastic bags and the inadequacy of treatment facilities. Conclusion: Plastic waste poses different risks to human health at every stage of its life cycle. Hence, strategies must be adopted to raise public awareness of the dangers of plastic waste to their health. Trial registration: The review protocol is registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42023409087).

Nexus between air travel and environmental degradation in BRICS Countries:A tourism perspective

International tourism is highly dependent on air travel,which enhances destination countries’economic growth and living standards while causing environmental degradation.This study investigates the effect of air travel on environmental degradation in BRICS nations.The study used feasible generalized least squares(FGLS)to evaluate the environmental Kuznets curve using data spanning 1995 to 2018.The study finds evidence of N-shaped EKC in the economies of the BRICS nations.We also find a positive relationship between tourism,urbanization,and environmental degradation(as measured by CO_(2) and SO_(2) emissions from civil aviation)and a negative relationship between economic development and environmental degradation.To achieve sustainable growth and environmental protection and promote green technology,the BRICS governments should devise policies that address the aviation industry’s short-and long-term needs.

Environmental Impact Assessment System and Process in Developing Countries

Environmental impact assessment (EIA), a decision-making process for project appraisal and sustainability adopted globally as an administrative process to identify, predict, evaluate, and monitor projects from their feasibility, preconstruction, construction, and operation stages to mitigate the adverse impacts and enhance the beneficial impacts for the protection of the affected environment, The study objective is to explore global EIA systems and processes and find shortcomings and implications for making the best instrument or tool to protect the natural environment from man-made activities over the project cycle. For this, the relevant literature on the EIA system and process was reviewed and evaluated through the application of quantitative and qualitative approaches, including the assessment of legal instruments and the adoption of EIA methodologies in developing countries. EIA, initiated in the 1970s in the US and Australia, expanded to developing countries and was amended in East and Southeast Asia from the 1970s to the 2000s. The evaluation assessed that the South Asian countries follow UNEP and IAIA guidelines, utilizing national laws and expert consultations, with screening criteria and administrative processes based on established environmental legislation. Ad hoc, checklist, matrix, network, overlay, cost-benefit analysis, and predictive or simulation in EIA practice are used to assess the environmental impacts of development activities. Failure to recommend major projects undermines public trust and prevents mitigation measures from being implemented. Most developing countries have followed EIA to fulfill the legal requirement with shadow-off monitoring and follow-up rather than to upset, reduce, or compensate for the project impacts as per size, location, and severity of the project area. The research and guidelines outlined in the IAIA principles and process have synthesized the best EIA practices worldwide. Public participation, impact coverage, scientific mitigation, transparent evidence-based approaches, monitoring, follow-up, legitimate approaches, and future appraisal opportunities are major concerns to be included in best EIA practice.