Where Are the NGOs and Why? The Distribution of Health and Development NGOs in Bolivia

Background The presence and influence of nongovernmental organizations (NGOs) in the landscape of global health and development have dramatically increased over the past several decades. The distribution of NGO activity and the ways in which contextual factors influence the distribution of NGO activity across geographies merit study. This paper explores the distribution of NGO activity, using Bolivia as a case study, and identifies local factors that are related to the distribution of NGO activity across municipalities in Bolivia. Methods The research question is addressed using a geographic information system (GIS) and multiple regression analyses of count data. We used count data of the total number of NGO projects across Bolivian municipalities to measure NGO activity both in general and in the health sector specifically and national census data for explanatory variables of interest. Results This study provides one of the first empirical analyses exploring factors related to the distribution of NGO activity at the national scale. Our analyses show that NGO activity in Bolivia, both in general and health-sector specific, is distributed unevenly across the country. Results indicate that NGO activity is related to population size, extent of urbanization, size of the indigenous population, and health system coverage. Results for NGO activity in general and health-sector specific NGO activity were similar. Conclusions The uneven distribution of NGO activity may suggest a lack of co-ordination among NGOs working in Bolivia as well as a lack of co-ordination among NGO funders. Co-ordination of NGO activity is most needed in regions characterized by high NGO activity in order to avoid duplication of services and programmes and inefficient use of limited resources. Our findings also indicate that neither general nor health specific NGO activity is related to population need, when defined as population health status or education level or poverty levels. Considering these results we discuss broader implications for global health and development and make several recommendations relevant for development and health practice and research

A Two-Stage Cluster Sampling Method Using Gridded Population Data, A GIS, And Google Earthtm Imagery in a Population-Based Mortality Survey in Iraq

Background Mortality estimates can measure and monitor the impacts of conflict on a population, guide humanitarian efforts, and help to better understand the public health impacts of conflict. Vital statistics registration and surveillance systems are rarely functional in conflict settings, posing a challenge of estimating mortality using retrospective population-based surveys. Results We present a two-stage cluster sampling method for application in population-based mortality surveys. The sampling method utilizes gridded population data and a geographic information system (GIS) to select clusters in the first sampling stage and Google Earth TM imagery and sampling grids to select households in the second sampling stage. The sampling method is implemented in a household mortality study in Iraq in 2011. Factors affecting feasibility and methodological quality are described. Conclusion Sampling is a challenge in retrospective population-based mortality studies and alternatives that improve on the conventional approaches are needed. The sampling strategy presented here was designed to generate a representative sample of the Iraqi population while reducing the potential for bias and considering the context specific challenges of the study setting. This sampling strategy, or variations on it, are adaptable and should be considered and tested in other conflict settings

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Boiling over: A Descriptive Analysis of Drinking Water Advisories in First Nations Communities in Ontario, Canada

Access to safe and reliable drinking water is commonplace for most Canadians. However, the right to safe and reliable drinking water is denied to many First Nations peoples across the country, highlighting a priority public health and environmental justice issue in Canada. This paper describes trends and characteristics of drinking water advisories, used as a proxy for reliable access to safe drinking water, among First Nations communities in the province of Ontario. Visual and statistical tools were used to summarize the advisory data in general, temporal trends, and characteristics of the drinking water systems in which advisories were issued. Overall, 402 advisories were issued during the study period. The number of advisories increased from 25 in 2004 to 75 in 2013. The average advisory duration was 294 days. Most advisories were reported in summer months and equipment malfunction was the most commonly reported reason for issuing an advisory. Nearly half of all advisories occurred in drinking water systems where additional operator training was needed. These findings underscore that the prevalence of drinking water advisories in First Nations communities is a problem that must be addressed. Concerted and multi-faceted efforts are called for to improve the provision of safe and reliable drinking water First Nations communities

Where are the nongovernmental organizations and why? Mapping and exploring the distribution of NGO activity in Bolivia

The presence and influence of NGOs in the landscape of global health and development has dramatically proliferated since the 1980s. However, little is known about the distribution of NGO activity. This paper explores the distribution of NGO activity, using Bolivia as a case study, and examines the question: what factors are related to the distribution of NGO activity across municipalities in Bolivia? A geographic information system (GIS) and a multiple regression analysis of count data are utilized to answer the questions at hand. These analyses show that NGO activity is uneven distributed across municipalities and that NGO activity is related to population size, extent of urbanization, size of the indigenous population, and health system coverage. The literature and the case study results inform three main recommendations: 1) Create and implement national NGO Codes of Conduct, 2) Improve surveillance of NGO activity, and 3) Re-focus and re-orient NGO related research

The climate change, water, and health nexus: an interdisciplinary inquiry

Climate change is an issue of unprecedented complexity and a major threat to ecosystem function, water resources, and human health. Although important knowledge gaps exist at the interface of climate change, water, and health, it is increasingly clear that water is a primary medium through which climate change affects health and that knowledge integration and collaboration are needed to understand and address climate change.This dissertation explores the links among climate change, water, and health drawing on interdisciplinary and ecohealth approaches and presents three individual research papers. The first two papers use eleven-years of acute gastro-intestinal illness (AGI) data to generate knowledge about the potential impacts of climate change on waterborne AGI in British Colombia (BC). Using a Geographic Information System and a suite of descriptive methods, the seasonality of AGI is characterized across BC’s major drinking water sources (surface water, groundwater, and mixed water) and hydroclimatic regimes (snowmelt-dominated and rainfall-dominated). Associations between hydroclimatic variables and AGI are assessed using times-series regression analysis. The results show that AGI exhibits seasonality and that hydroclimatic variables play a role in driving the occurrence and variability of AGI. Moreover, the relationships between hydroclimatic variables and AGI differ in the context of the two major hydroclimatic regimes in BC. These results suggest that future climate change will likely lead to a higher burden of AGI in BC, with impacts mediated by context and ecological factors. The third paper is oriented towards climate change policy and action and uses qualitative data and the method of frame analysis to describe the ways in which climate change is framed in public health and water resource management texts. Results show that climate change is framed in numerous ways both within and across these sectors. The notion of frames and the process of frame-reflection may be useful tools to promote integration and collaboration and an opportunity to foster enabling conditions for climate change policy and action.Finally, through a critical reflection on the research findings and the research process, implications for interdisciplinary research and collaborative action are synthesized and presented

The Role of Emotions in Generating and Sustaining Climate Action for Youth Climate Champions: An Exploratory Study in Northern Ontario

Young people are frequently positioned at the forefront of the climate movement while also often being considered vulnerable to the mental and emotional impacts of climate change. While climate emotions research is rapidly increasing, little is known about young peoples’ lived emotional experiences of climate change and climate action. This research, grounded in social constructivism, aimed to explore the emotions, supports, and experiences that are generative and supportive of climate action for youth climate champions in Northern Ontario, Canada. In the spring of 2022, 12 youth climate champions (ages 15-24) participated in semi-structured interviews and asynchronous letter writing. This paper describes two thematic networks that were derived using thematic network analysis. The first network, climate emotions, is characterized by five organizing themes: 1) ecoanxiety, 2) emerging loss and grief, 3) triggers, 4) coping strategies, and 5) impacts on living and life. The second network, motivations and support for youth climate action, is described through three organizing themes: 1) action is unique to person and place, 2) intersections of emotion and action, and 3) key relationships and supports. Reflecting on this research, we offer two insights relevant to those engaging in health and education spaces with youth. First, there is a need to establish accessible, safe spaces for young people to collectively recognize, explore, and process complex climate emotions. Second, education systems across rural and remote regions are strategically positioned to support the health and wellbeing of young people through the implementation of holistic climate education that includes opportunities for engaging in collective climate action