Nanotechnology and the Developing World

How nanotechnology can be harnessed to address some of the world's most critical development problem

The Ethical, Social, and Cultural Dimensions of Screening for Mental Health of Children and Adolescents in the Developing World

This thesis formally and systematically identifies and prioritizes, for the first time, the most pressing ethical, social, and cultural challenges related to the screening for mental, neurological, and substance abuse disorders (MNSDs) in children and adolescents (C&A) living in the developing world, and proposes targeted strategies to address them. C&A mental health has been sadly neglected despite the severe life-long burden of C&A MNSDs and the large and growing number of C&A living in low- and middle-income countries. I carried out a three-round international Delphi survey completed by 135 experts from 37 countries. This multi- and inter-disciplinary panel selected and ranked 39 challenges, organized into eight themes, and 32 related solutions, arranged into seven topics. A 100% response rate was attained in Round 3. Near consensus was achieved in several areas, and a high degree of correlation was found between the challenges and their proposed solutions. The experts recommended integrating screening into primary health care; addressing potential sociocultural dissonances by designing and implementing accessible, affordable, cost-effective, and culturally and socially appropriate screening tools and programs, and post-screening follow-up; addressing resource issues by securing long-term programs funding, strengthening education and training for mental health, and incorporating well-supervised local non-specialists and lay individuals in the screening programs; increasing trust and decreasing stigmatization of at-risk C&A, their families, and their communities by engaging stakeholders throughout the screening initiatives, protecting the rights of the C&A screened, guaranteeing privacy, confidentiality, and free, uncoerced informed consent and assent, and determining the baseline acceptance, motivation, and support for screening programs in target populations; and regularly implementing empowering, culturally sensitive public and community engagement initiatives. My findings encompass all MNSDs, focus on developing countries, and represent the combined global wisdom of the leading authorities in C&A mental health. They can become a guide for policy- and decision-making, resource allocation, and international cooperation in global mental health, offering a novel approach to reduce the burden of C&A MNSDs by encouraging timely and context-sensitive prevention and management of MNSDs, and helping to mitigate the lifelong suffering that they inflict on C&A and their families in the developing world.Ph.D

Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing

PURPOSE: Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health. METHOD: In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis. RESULTS: Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement. CONCLUSIONS: Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits

The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world.

Despite their burden and high prevalence, mental health disorders of children and adolescents remain neglected in many parts of the world. In developing countries, where half of the population is younger than 18 years old, one of every five children and adolescents is estimated to suffer from a mental health disorder. It is then essential to detect these conditions through screening in a timely and accurate manner. But such screening is fraught with considerable ethical, social, and cultural challenges. This study systematically identifies, for the first time, these challenges, along with potential solutions to address them. We report on the results of an international multi- and inter-disciplinary three-round Delphi survey completed by 135 mental health experts from 37 countries. We asked these experts to identify and rank the main ethical, social, and cultural challenges of screening for child and adolescent mental health problems in developing nations, and to propose solutions for each challenge. Thirty-nine significant challenges emerged around eight themes, along with 32 potential solutions organized into seven themes. There was a high degree of consensus among the experts, but a few interesting disagreements arose between members of the panel from high-income countries and those from low- and middle-income nations. The panelists overwhelmingly supported mental health screening for children and adolescents. They recommended ensuring local acceptance and support for screening prior to program initiation, along with careful and comprehensive protection of human rights; integrating screening procedures into primary care; designing and implementing culturally appropriate screening tools, programs, and follow-up; securing long-term funding; expanding capacity building; and task-shifting screening to local non-specialists. These recommendations can serve as a guide for policy and decision-making, resource allocation, and international cooperation. They also offer a novel approach to reduce the burden of these disorders by encouraging their timely and context-sensitive prevention and management

Mal/adaptations: A qualitative evidence synthesis of opioid agonist therapy during major disruptions

Opioid agonist therapy (OAT) has been severely disrupted by the COVID-19 pandemic. The risks of opioid withdrawal, overdose, and diversion have increased, so there is an urgent need to adapt OAT to best support people who use drugs (PWUD). This review examines the views and experiences of PWUD, health care providers, and health system administrators on OAT during major disruptions to medical care to inform appropriate health system responses during the current pandemic and beyond.This review was completed with funding support from the Canadian Institutes of Health Research Operating Grant: Knowledge Synthesis: COVID-19 in Mental Health and Substance Use [reference number: CMS-171725]. The funding source had no involvement in study design, data collection, analysis, interpretation, report writing, or decision to submit

(AC)n Dinucleotide Repeat Polymorphism in 5′ β-Globin Gene in Native and Mestizo Mexican Populations

Repeated sequences are dispersed along the human genome. These sequences are useful as markers in diagnosis of inherited diseases, in forensic medicine, and in tracking the origin and evolution of human populations. The (AC)n repeated element is the most frequent in the human genome. In this paper, the (AC)n repeated element located in the 5′ flanking region of the β-globin gene was studied by single-strand conformation polymorphism (SSCP). Four ethnic Mexican groups (Mixteca, Nahua, Otomí, Purépecha) and a Mestizo population were analyzed. We observed three alleles, A [(AC)16], B [(AC)14], and C [(AC)18], with a frequency of between 68.2% and 86.9%, 13.1% and 18.2%, and 6.7% and 13.7%, respectively. Allele C was present only in Purépecha and Mestizo groups. The absence of this allele in the other ethnic groups studied suggests that there is low genetic admixture of Purépecha and that this is a relatively isolated population. However, it could be that the C allele occurs in low frequencies in the other groups as a result of small sample sizes. The (AC)n repeat polymorphism in the β-globin gene has not been previously studied in Amerindian populations

R&D during public health emergencies: the value(s) of trust, governance and collaboration

In January 2021, Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, warned that the world was 'on the brink of a catastrophic moral failure [that] will be paid with lives and livelihoods in the world's poorest countries'. We are now past the brink. Many high-income countries have vaccinated their populations (which, in some cases, includes third and even fourth doses) and are loosening public health and social measures, while low-income and middle-income countries are struggling to secure enough supply of vaccines to administer first doses. While injustices abound in the deployment and allocation of COVID-19 vaccines, therapies and diagnostics, an area that has hitherto received inadequate ethical scrutiny concerns the upstream structures and mechanisms that govern and facilitate the research and development (R&D) associated with these novel therapies, vaccines and diagnostics. Much can be learnt by looking to past experiences with the rapid deployment of R&D in the context of public health emergencies. Yet, much of the 'learning' from past epidemics and outbreaks has largely focused on technical or technological innovations and overlooked the essential role of important normative developments; namely, the importance of fostering multiple levels of trust, strong and fair governance, and broad research collaborations. In this paper, we argue that normative lessons pertaining to the conduct of R&D during the 2014-2016 Ebola epidemic in West Africa provide important insights for how R&D ought to proceed to combat the current COVID-19 pandemic and future infectious disease threats