HINARI: bridging the global information divide

Are open access article processing charges affordable for otolaryngologists in low-income and middle-income countries?

PURPOSE OF REVIEW

Open access articles are more frequently read and cited, and hence promote access to knowledge and new advances in healthcare. Unaffordability of open access article processing charges (APCs) may create a barrier to sharing research. We set out to assess the affordability of APCs and impact on publishing for otolaryngology trainees and otolaryngologists in low-income and middle-income countries (LMICs).

RECENT FINDINGS

A cross-sectional online survey was conducted among otolaryngology trainees and otolaryngologists in LMICs globally. Seventy-nine participants from 21 LMICs participated in the study, with the majority from lower middle-income status (66%). Fifty-four percent were otolaryngology lecturers while 30% were trainees. Eighty-seven percent of participants received a gross monthly salary of less than USD 1500. Fifty-two percent of trainees did not receive a salary. Ninety-one percent and 96% of all study participants believed APCs limit publication in open access journals and influence choice of journal for publication, respectively. Eighty percent and 95% believed APCs hinder career progression and impede sharing of research that influences patient care, respectively.

SUMMARY

APCs are unaffordable for LMIC otolaryngology researchers, hinder career progression and inhibit the dissemination of LMIC-specific research that can improve patient care. Novel models should be developed to support open access publishing in LMICs.

Towards a collaborative-integrative model of education and training in neurosurgery in low and middle-income countries

BACKGROUND

Neurosurgery inequity between High-Income Countries and Low- and Middle-Income Countries is striking. Currently, several models of education and training are available each has advantages and limitations. Our goal is to suggest an integrative model of Education and Training with international collaboration which will assure the most cost-effective Training Model.

MATERIALS AND METHODS

The authors reviewed the literature narratively and examined in broad stroke the different existing models of international education and training programs to analyze their strengths, limitations, and cost-effectiveness in addressing the needs of Neurosurgery in Low and middle-Income Countries.

RESULTS

Several international institutions have been involved in Education and Training in Global Neurosurgery. The most common models for international education include short-term surgical mission and boot camps, a full residency training program in HICs, and a full residency training Program in Local or regional World Federation of Neurosurgical Societies (WFNS) reference centers in Low and Middle-Income Countries, and online education. In Africa, both Local residency training centers and WFNS reference centers are available and provide full training programs in Neurosurgery. Among them, WFNS Rabat Training Center is the first established center in Africa in 2002. This program is supported by the WFNS Foundation and by the Africa 100 Project. Some of these education models face currently challenges such as sustainability, financial support, and ethical issues.

CONCLUSION

Training neurosurgeons from Low and Middle-Income countries in local and regional WFNS Training centers might be the most cost-effective model of training that helps close the gap in neurosurgery. This training Model is duplicable and may be integrated into a global cohesive and collaborative model of education with international institutions.

Global Oncology Authorship and Readership Patterns

PURPOSE

Global Oncology is the movement to improve equitable access to cancer control and care, recognizing challenges because of economic and social factors between high-, middle-, and low-income countries (HIC, MIC, and LIC, respectively). The JCO Global Oncology (JCO GO) is a major platform dedicated to publishing peer-reviewed research relevant to populations with limited resources. To assess the success of its goals of encouraging global interaction and increasing MIC and LIC engagement, we analyzed authorship and readership patterns.

METHODS

Metadata of logged views between January 1, 2018, and June 30, 2019, of articles published in 2018 by JCO GO were identified using Google Analytics. The country of origin of each author and those who accessed the journal were categorized according to the 2019 income group World Bank Classification (WBC).

RESULTS

One hundred thirty-two articles were published in JCO GO in 2018. Corresponding authors came from 34 nations: 35% HIC, 47% MIC, and 18% LIC. The top publishing countries were the United States, India, Brazil, Mexico, and Nigeria. Article authors were solely from within one WBC group in 41% (23% HIC, 16% MIC, and 2% LIC). In those with mixed-WBC authorship origins, collaborations were 42% HIC + MIC, 11% HIC + LIC, and 6% HIC + MIC + LIC, but none with MIC + LIC. Regarding viewing, 87,860 views originated from 180 countries (82% of the WBC list): 35% HIC, 51% MIC, and 14% LIC. The most common accessing nations were the United States, India, the United Kingdom, Brazil, and Ethiopia.

CONCLUSION

More than half of JCO GO's authorship comes from mixed WBC groups, with viewership extending to most of the world's nations. Areas to address are low level of LIC corresponding authors, few papers from authors across all WBC groups, no publications from MIC + LIC collaborations, and a low percentage of readership by LIC. These data provide focus to target interventions aimed at reducing the academic segregation of LIC and improving interactions across all WBC countries.

Information access and sharing among prosthetics and orthotics faculty in Ghana and the United States

BACKGROUND

Information access is essential for quality healthcare provision and education. Despite technological advances, access to prosthetics and orthotics information in low- and middle-income countries is not ubiquitous. The current state of information access, availability, and exchange among prosthetics and orthotics faculty is unknown.

OBJECTIVES

Describe information exchange networks and access at two prosthetics and orthotics programs in Ghana and the United States.

STUDY DESIGN

Cross-sectional survey, social network analysis.

METHODS

An online survey of faculty at two prosthetics and orthotics programs using REDCap. The survey included a social network analysis, demographics, and prosthetics and orthotics information resources and frequency of use. Descriptive statistics were calculated.

RESULTS

Twenty-one faculty members completed the survey (84% response). Ghanaian faculty were on average younger (median Ghana: 27 years, United States: 43 years), had less teaching experience, and had less education than US faculty. Textbooks were the most commonly used resource at both programs. The Ghanaian network had more internal connections with few outside sources. The US network had fewer internal connections, relied heavily upon four key players, and had numerous outside contacts.

CONCLUSION

Ghana and US faculty have two distinct information exchange networks. These networks identify key players and barriers to dissemination among faculty to promote successful knowledge translation of current scientific literature and technology development. Social network analysis may be a useful method to explore information sharing among prosthetics and orthotics faculty, and identify areas for further study.

Palliative Care Information Needs in Central and Eastern Europe and the Commonwealth of Independent States

In a cross-national survey, we examined the information needs and barriers to accessing palliative care information in Central and Eastern Europe (CEE) and the Commonwealth of Independent States (CIS). In total, 584 healthcare professionals from 22 countries completed the questionnaire. Information on legislation and official papers (67 percent) and information on education courses in palliative care (65 percent) were the most frequently reported information needs. Major barriers to accessing palliative care information were language and a lack of easily accessible and affordable, clinically relevant information. An informative Web site, an electronic newsletter, and regular meetings or conferences were rated as the most important information channels. We concluded that access to reliable and well-structured information should be facilitated for healthcare professionals in CEE and CIS countries to assist them in their clinical decision making. Most importantly, more in-depth qualitative research and dialogue with stakeholders in the different countries are needed to develop context-specific, tailor-made strategies.

Use and Impact of HINARI: An Observation in Bangladesh with Special Reference to icddr,b

This paper analyses the impact of the use of electronic resources and Health InterNetwork Access to Research Initiative (HINARI) services for medical research libraries in Bangladesh, emphasising the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Purposeful use of e-resources, time and cost-saving benefits, research impact, and challenges of using HINARI are discussed. The basic study was conducted at icddr,b in January–February 2014, using a mixed methodology, combining qualitative and quantitative approaches, including a background literature review, usage data shared from the HINARI secretariat at the World Health Organization (WHO), questionnaires, personal observations, and interviews with staff members of icddr,b. Findings revealed that icddr,b is the heaviest user of HINARI (a major source of public health and medical e-resources) in Bangladesh, with demonstrable increases of health research journal articles after introducing HINARI in 2003.

Epidemiology of dry eye disease in Africa: The sparse information, gaps and opportunities

Dry eye disease (DED) is an increasingly significant clinical problem in developing countries and/or emerging economies. Existing studies on DED conducted in these areas have largely reported on associations between DED and infectious disease (trachoma) and malnutrition (hypovitaminosis A), but current trends of industrialization, urbanization, and modernization in these areas could result in a shift to other forms of DED. Herein, we review the epidemiology of DED in these geographic areas, highlighting potential causes and risk factors of DED while presenting information on diagnostic tools and algorithms and insight into some treatment modalities of DED that could prove useful to clinicians and investigators in these regions.

Access, attitudes and training in information technologies and evidence-based medicine among medical students at University of Zimbabwe College of Health Sciences

BACKGROUND

The Medical Education Partnership Initiative, has helped to mitigate the digital divide in Africa. The aim of the study was to assess the level of access, attitude, and training concerning meaningful use of electronic resources and EBM among medical students at an African medical school.

METHODS

The study involved medical students at the University of Zimbabwe College of Health Sciences, Harare. The needs assessment tool consisted of a 21-question, paper-based, voluntary and anonymous survey.

RESULTS

A total of 61/67 (91%), responded to the survey. 60% of the medical students were 'third-year medical students'. Among medical students, 85% of responders had access to digital medical resources, but 54% still preferred printed medical textbooks. Although 25% of responders had received training in EBM, but only 7% found it adequate. 98% of the participants did not receive formal training in journal club presentation or analytical reading of medical literature, but 77 % of them showed interest in learning these skills.

CONCLUSION

Lack of training in EBM, journal club presentation and analytical reading skills have limited the impact of upgraded technology in enhancing the level of knowledge. This impact can be boosted by developing a curriculum with skills necessary in using EBM.

Building global capacity for brain and nervous system disorders research

The global burden of neurological, neuropsychiatric, substance-use and neurodevelopmental disorders in low- and middle-income countries is worsened, not only by the lack of targeted research funding, but also by the lack of relevant in-country research capacity. Such capacity, from the individual to the national level, is necessary to address the problems within a local context. As for many health issues in these countries, the ability to address this burden requires development of research infrastructure and a trained cadre of clinicians and scientists who can ask the right questions, and conduct, manage, apply and disseminate research for practice and policy. This Review describes some of the evolving issues, knowledge and programmes focused on building research capacity in low- and middle-income countries in general and for brain and nervous system disorders in particular.

Building capacity in a health sciences library to support global health projects

This paper describes how a large, academic health sciences library built capacity for supporting global health at its university and discusses related outcomes. Lean budgets require prioritization and organizational strategy. A committee, with leadership responsibilities assigned to one librarian, guided strategic planning and the pursuit of collaborative, global health outreach activities. A website features case studies and videos of user stories to promote how library partnerships successfully contributed to global health projects. Collaborative partnerships were formed through outreach activities and from follow-up to reference questions. The committee and a librarian's dedicated time established the library's commitment to help the university carry out its ambitious global agenda.

Measuring HINARI use in Nigeria through a citation analysis of Nigerian Journal of Clinical Practice

BACKGROUND

HINARI is one of the four programmes of Research4Life managed by the World Health Organization in partnership with Yale University Library. HINARI provides online access to the world's health-related scientific literature free or at very low cost to researchers in developing countries. The research examined the use of HINARI through a 5-year (2007-2011) citation analysis of Nigerian Journal of Clinical Practice.

METHOD

The study was a citation analysis of 5 years of published volumes of Nigerian Journal of Clinical Practice. The analysis was carried out using issues ranging from volume 10 (2007) to 14 (2011). The use of HINARI was determined by comparing the total journal titles and articles cited from HINARI with non-HINARI journals in the five volumes of Nigerian Journal of Clinical Practice (NJCP).

RESULTS

Results show that only 42.8% of the journal titles cited are available in HINARI. On the contrary, in terms of total articles cited from the journals, HINARI had a higher citation of 56.1% with a greater citation frequency of individual titles.

CONCLUSION

The higher article citations and repeated use of individual titles available in HINARI suggest that health researchers in Nigeria are using the HINARI resource to a measurable extent.

Open access: academic publishing and its implications for knowledge equity in Kenya

Traditional, subscription-based scientific publishing has its limitations: often, articles are inaccessible to the majority of researchers in low- and middle-income countries (LMICs), where journal subscriptions or one-time access fees are cost-prohibitive. Open access (OA) publishing, in which journals provide online access to articles free of charge, breaks this barrier and allows unrestricted access to scientific and scholarly information to researchers all over the globe. At the same time, one major limitation to OA is a high publishing cost that is placed on authors. Following recent developments to OA publishing policies in the UK and even LMICs, this article highlights the current status and future challenges of OA in Africa. We place particular emphasis on Kenya, where multidisciplinary efforts to improve access have been established. We note that these efforts in Kenya can be further strengthened and potentially replicated in other African countries, with the goal of elevating the visibility of African research and improving access for African researchers to global research, and, ultimately, bring social and economic benefits to the region. We (1) offer recommendations for overcoming the challenges of implementing OA in Africa and (2) call for urgent action by African governments to follow the suit of high-income countries like the UK and Australia, mandating OA for publicly-funded research in their region and supporting future research into how OA might bring social and economic benefits to Africa.

Profiling e-health projects in Africa: trends and funding patterns

There is a severe shortage of healthcare provision in Africa. e-Health, the use of Information and Communication Technologies (ICT) to support healthcare, may help to ease this problem. e-Health projects support a wide range of applications ranging from telemedicine to global research collaborations made possible via e-Infrastructures, worldwide systems of integrated advanced high performance networking and computing ICT. To try to understand the state of e-Health in Africa, this paper aims to create a picture and to present an analytical review of some of these initiatives in Africa. A review framework composed of multiple search methods is developed and applied to yield a broad coverage of e-Health projects over the African continent. Seven quantitative analyses on the projects are presented. Major observations include that there is a tendency for e-Health projects to grow in number in some African countries over time; that African countries with larger Gross National Incomes tend to attract more e-Health projects; that e-Health projects in Africa focus on telemedicine, health education and health-related research; that there is a wide range of funding bodies, some of which have a geographical focus, and that the number of m-Health projects has been rising sharply.

Mobile learning in resource-constrained environments: a case study of medical education

BACKGROUND

The achievement of the millennium development goals may be facilitated by the use of information and communication technology in medical and health education.

AIMS

This study intended to explore the use and impact of educational technology in medical education in resource-constrained environments.

METHODS

A multiple case study was conducted in two Nepalese teaching hospitals. The data were analysed using activity theory as an analytical basis.

RESULTS

There was little evidence for formal e-learning, but the findings indicate that students and residents adopted mobile technologies, such as mobile phones and small laptops, as cultural tools for surprisingly rich 'informal' learning in a very short time. These tools allowed learners to enhance (a) situated learning, by immediately connecting virtual information sources to their situated experiences; (b) cross-contextual learning by documenting situated experiences in the form of images and videos and re-using the material for later reflection and discussion and (c) engagement with educational content in social network communities.

CONCLUSION

By placing the students and residents at the centre of the new learning activities, this development has begun to affect the overall educational system. Leveraging these tools is closely linked to the development of broad media literacy, including awareness of ethical and privacy issues.

Information seeking behaviour of physicians in Tanzania

The study investigated the information seeking behaviour of physicians at the Muhimbili National Hospital (MNH) in Tanzania. Questionnaires were personally distributed to all physicians ( n = 259) at MNH. The rate of response was 83 percent ( n = 215). Based on the literature review, a Wilson (1996) model was used to systematically guide the assessment of the physicians’ information seeking behaviour at MNH. The study found that physicians needed specific medical information to enhance their knowledge on a daily basis, particularly they needed information on patient care, rather than information for research and further education purposes. In order to fulfil their information needs, physicians preferred to seek information from formal sources, which included printed textbooks, electronic resources and printed journals. However, there was low use of the Internet for prescribing various drugs and diagnosis. Factors such as poor ICT infrastructure, lack of access to a computer, frequent power cuts and lack of time were the major barriers that inhibited physicians to seek information. It is thus important for the MNH management to promote information literacy (IL) issues, improve ICT infrastructure, establish a resource centre, and integrate use of the Internet and e-resources for patient care within clinicians working hours; and for the government to improve the supply of reliable electricity at MNH for effective medical practices.

The growth of a culture of evidence-based obstetrics in South Africa: a qualitative case study

BACKGROUND

While the past two decades have seen a shift towards evidence-based obstetrics and midwifery, the process through which a culture of evidence-based practice develops and is sustained within particular fields of clinical practice has not been well documented, particularly in LMICs (low- and middle-income countries). Forming part of a broader qualitative study of evidence-based policy making, this paper describes the development of a culture of evidence-based practice amongst maternal health policy makers and senior academic obstetricians in South Africa.

METHODS

A qualitative case-study approach was used. This included a literature review, a policy document review, a timeline of key events and the collection and analysis of 15 interviews with policy makers and academic clinicians involved in these policy processes and sampled using a purposive approach. The data was analysed thematically.

RESULTS

The concept of evidence-based medicine became embedded in South African academic obstetrics at a very early stage in relation to the development of the concept internationally. The diffusion of this concept into local academic obstetrics was facilitated by contact and exchange between local academic obstetricians, opinion leaders in international research and structures promoting evidence-based practice. Furthermore the growing acceptance of the concept was stimulated locally through the use of existing professional networks and meetings to share ideas and the contribution of local researchers to building the evidence base for obstetrics both locally and internationally. As a testimony to the extent of the diffusion of evidence-based medicine, South Africa has strongly evidence-based policies for maternal health.

CONCLUSION

This case study shows that the combined efforts of local and international researchers can create a culture of evidence-based medicine within one country. It also shows that doing so required time and perseverance from international researchers combined with a readiness by local researchers to receive and actively promote the practice.

Reflections on clinical research in sub-Saharan Africa

The urgent need for new, safe and sustainable interventions against diseases that disproportionally affect the poor is finally receiving global attention and the funding landscape for development projects has significantly improved during the past decade. For the development of new drug and vaccine candidates, clinical trials have become the most important tool to assess their safety and efficacy. Recently, there has been a seismic shift in the number of clinical trials conducted in resource-limited settings. We discuss the current framework of clinical research in sub-Saharan Africa, from building product pipelines to the capacities needed for the conduct of trials according the harmonised Good Clinical Practice (GCP) ICH E6 guideline. We place emphasis on clinical research in neglected tropical diseases which still frequently has to be conducted with limited financial, logistical and human resources. Given those short-comings we recommend minimum standards needed at the local, national and sponsor levels to provide GCP-compliant clinical research.

Do knowledge infrastructure facilities support evidence-based practice in occupational health? An exploratory study across countries among occupational physicians enrolled on Evidence-Based Medicine courses

Background

Evidence-Based Medicine (EBM) is an important method used by occupational physicians (OPs) to deliver high quality health care. The presence and quality of a knowledge infrastructure is thought to influence the practice of EBM in occupational health care. This study explores the facilities in the knowledge infrastructure being used by OPs in different countries, and their perceived importance for EBM practice.

Methods

Thirty-six OPs from ten countries, planning to attend an EBM course and to a large extent recruited via the European Association of Schools of Occupational Medicine (EASOM), participated in a cross-sectional study.

Results

Research and development institutes, and knowledge products and tools are used by respectively more than 72% and more than 80% of the OPs and they are rated as being important for EBM practice (more than 65 points (range 0–100)). Conventional knowledge access facilities, like traditional libraries, are used often (69%) but are rated as less important (46.8 points (range 0–100)) compared to the use of more novel facilities, like question-and-answer facilities (25%) that are rated as more important (48.9 points (range 0–100)). To solve cases, OPs mostly use non evidence-based sources. However, they regard the evidence-based sources that are not often used, e.g. the Cochrane library, as important enablers for practising EBM. The main barriers are lack of time, payment for full-text articles, language barrier (most texts are in English), and lack of skills and support.

Conclusion

This first exploratory study shows that OPs use many knowledge infrastructure facilities and rate them as being important for their EBM practice. However, they are not used to use evidence-based sources in their practice and face many barriers that are comparable to the barriers physicians face in primary health care.

Access and use of medicines information sources by physicians in public hospitals in Uganda: a cross-sectional survey

BACKGROUND

Rational and cost-effective prescription of medicines requires up-to-date and readily accessible medicines information. There are several studies on availability and access to medicines information sources, but have been conducted only in high-income countries.

OBJECTIVE

To assess medicines information sources accessed by physicians in public hospitals in Uganda, and physicians' opinion on establishment of a medicines information centre in the country.

METHODS

A cross-sectional survey including 369 physicians from six district, six regional and two university hospitals. Data was collected using a semi-structured self-administered questionnaire.

RESULTS

Response rate was 91%. This included 31, 136 and 168 physicians from the district, regional and university hospitals, respectively. In the district hospitals the source of medicines information reported to be most available was colleagues (100%), while in the regional and university hospitals it was literature from pharmaceutical companies (98%) and hard copy of research publications (99%) respectively. The most frequently used source in the district and regional hospitals was National Standard Treatment Guideline (90% and 73% respectively), and colleagues in university hospitals (89%). Accessibility problems with reported available sources were commonest with research publications in medical journals, both hard copy and through the internet, MIMS, pharmacists and pharmacologists. Need for a medicines information centre was indicated by 80% of the respondents.

CONCLUSION

Majority of the physicians in public hospitals in Uganda have limited access to unbiased drug information. Therefore, there is need to assess the feasibility of establishing a drug information centre, and then assess its use during a trial period.

Information technology for health in developing countries

Poverty has deepened the crisis in health-care delivery in developing countries, particularly sub-Saharan Africa, which is a region facing a disease burden that is unmatched in the world. Whether access to proven and powerful information and communication technologies (ICTs) can improve health indicators is an ongoing debate. However, this brief review shows that in the last decade there has been significant growth in Internet access in urban areas; health-care workers now use it for communication, access to relevant health-care information, and international collaboration. The central message learned during this period about the application of ICTs is that infrastructural and cultural contexts vary and require different models and approaches. Thus, to harness the full potential of ICTs to the benefit of health systems, health workers, and patients will demand an intricate mix of old and new technologies.

Rising expectations: access to biomedical information

OBJECTIVE

To provide an overview of the expansion in public access to electronic biomedical information over the past two decades, with an emphasis on developments to which the U.S. National Library of Medicine contributed.

METHODS

Review of the increasingly broad spectrum of web-accessible genomic data, biomedical literature, consumer health information, clinical trials data, and images.

RESULTS

The amount of publicly available electronic biomedical information has increased dramatically over the past twenty years. Rising expectations regarding access to biomedical information were stimulated by the spread of the Internet, the World Wide Web, advanced searching and linking techniques. These informatics advances simplified and improved access to electronic information and reduced costs, which enabled inter-organizational collaborations to build and maintain large international information resources and also aided outreach and education efforts The demonstrated benefits of free access to electronic biomedical information encouraged the development of public policies that further increase the amount of information available.

CONCLUSIONS

Continuing rapid growth of publicly accessible electronic biomedical information presents tremendous opportunities and challenges, including the need to ensure uninterrupted access during disasters or emergencies and to manage digital resources so they remain available for future generations.

Challenges and issues in health professions education in Africa

The challenges facing health professions education in Africa focus on physical infrastructure, accreditation systems, student selection and faculty recruitment, retention, and development. Higher education in the health professions must be closely aligned with community health needs, and with the training and support of community health workers. A key ingredient in changing institutions in this way is implementation of effective strategies for strengthening the faculty. In addition, information systems, and their prerequisite stable electric power supply, must be supported by internal public resources combined with external aid. These infrastructure investments will facilitate better quality education, improved diffusion of information among schools, and more useful data for self study by institutions.

Access to electronic health knowledge in five countries in Africa: a descriptive study

Background

Access to medical literature in developing countries is helped by open access publishing and initiatives to allow free access to subscription only journals. The effectiveness of these initiatives in Africa has not been assessed. This study describes awareness, reported use and factors influencing use of on-line medical literature via free access initiatives.

Methods

Descriptive study in four teaching hospitals in Cameroon, Nigeria, Tanzania and Uganda plus one externally funded research institution in The Gambia. Survey with postgraduate doctors and research scientists to determine Internet access patterns, reported awareness of on-line medical information and free access initiatives; semi structured interviews with a sub-sample of survey participants to explore factors influencing use.

Results

In the four African teaching hospitals, 70% of the 305 postgraduate doctors reported textbooks as their main source of information; 66% had used the Internet for health information in the last week. In two hospitals, Internet cafés were the main Internet access point. For researchers at the externally-funded research institution, electronic resources were their main source, and almost all had used the Internet in the last week. Across all 333 respondents, 90% had heard of PubMed, 78% of BMJ on line, 49% the Cochrane Library, 47% HINARI, and 19% BioMedCentral. HINARI use correlates with accessing the Internet on computers located in institutions. Qualitative data suggested there are difficulties logging into HINARI and that sometimes it is librarians that limit access to passwords.

Conclusion

Text books remain an important resource for postgraduate doctors in training. Internet use is common, but awareness of free-access initiatives is limited. HINARI and other initiatives could be more effective with strong institutional endorsement and management to promote and ensure access.

Prevention of renal disease progression and renal replacement therapy in emerging countries

Chronic kidney disease is increasing in both developed and emerging countries with progressive encroachment on health services budgets. In spite of the lack of accurate registries, we tried to focus on the magnitude of the problem on different continents. Prevention of progression has been a remote but reachable goal. Many health foundations including the International Society of Nephrology gave recommendations for prevention and slowing progression, but these are again confronted by lack of resources. Integration of governmental, community, and expert efforts is necessary to set prevention priorities including affordable screening programs and increasing access to renal replacement therapy by different modalities.

Open access: implications for scholarly publishing and medical libraries

PURPOSE

The paper reviews and analyzes the evolution of the open access (OA) publishing movement and its impact on the traditional scholarly publishing model.

PROCEDURES

A literature survey and analysis of definitions of OA, problems with the current publishing model, historical developments, funding agency responses, stakeholder viewpoints, and implications for scientific libraries and publishing are performed.

FINDINGS

The Internet's transformation of information access has fueled interest in reshaping what many see as a dysfunctional, high-cost system of scholarly publishing. For years, librarians alone advocated for change, until relatively recently when interest in OA and related initiatives spread to the scientific community, governmental groups, funding agencies, publishers, and the general public.

CONCLUSIONS

Most stakeholders acknowledge that change in the publishing landscape is inevitable, but heated debate continues over what form this transformation will take. The most frequently discussed remedies for the troubled current system are the "green" road (self-archiving articles published in non-OA journals) and the "gold" road (publishing in OA journals). Both movements will likely intensify, with a multiplicity of models and initiatives coexisting for some time.

Health practitioners' and health planners' information needs and seeking behavior for decision making in Uganda

BACKGROUND

Access to reliable information is the most cost-effective and achievable strategy for sustainable improvement in health care. While several studies have described practitioners' information seeking behavior in developed countries, literature from developing countries is lacking. The aims of the study were: (i) to determine the most influential type of information for health workers' and planners' decision making; (ii) to establish the practitioners' evaluation of the availability and quality of this important information; and (iii) to establish the most commonly used/accessible sources of the information relevant for decision making in Uganda.

METHODS

Self-administered questionnaires were sent to 610 health workers, planners, and administrators at the national, district and health facility levels in four districts in Uganda. Respondents were reminded three times, after which non-response was registered. Data were entered, cleaned and analysed using SPSS version 12.0. Logistic regression analysis was used to test for differences in responses.

RESULTS

The response rate was 67.7% (413). The respondents indicated that personal experience (79%), discussion with colleagues (76%) and national policy and treatment guidelines (75%) were most influential when making decisions in health care and planning. They reported that most of the epidemiological information was available and of relatively good quality but there was lack of information about distribution of benefit, segregated demographic data, and social values. The most often used sources of information included; discussions with colleagues (89%), doctors' statements (85%) and text books (77%). The least frequently used sources were the internet and the library. This varied with respondents' designation and region of origin.

CONCLUSIONS

Health planners and practitioners lack some of the information relevant for decision making. They tend to rely on the national policy and treatment guidelines, discussion with colleagues, and personal experience. Most frequently used sources of information are similar to previous studies. The variation in the frequency of use of the different sources of research information necessitates research to understand the barriers and careful planning of health information delivery to ensure equitable access.

Prevention of chronic kidney and vascular disease: Toward global health equity—The Bellagio 2004 Declaration

Chronic kidney disease (CKD) not only reflects target organ injury in systemic vascular disease in the general population and in association with diabetes, hypertension, and smoking, but it is recognized as one of the major risk factors in the pathogenesis and outcome of cardiovascular disease. Recent surveys have revealed that the prevalence of CKD, particularly the hidden mild form (mildly elevated levels of serum creatinine or urinary albumin excretion), is surprisingly high in the general population. In recent years, the global epidemic of type 2 diabetes has led to an alarming increase in the number of patients with CKD. Most patients with CKD (over 50 million individuals worldwide) succumb to cardiovascular events, while each year over 1 million develop end-stage renal failure, which requires costly treatment and in many countries of the world, unaffordable renal replacement therapy by chronic dialysis or renal transplantation. Alarmed by the immense challenge to human morbidity and the economic burden of CKD and ensuing systemic cardiovascular disease, the International Society of Nephrology convened a multidisciplinary group of expert physicians and public health leaders from around the world to develop strategies to delay and avert this bleak future by effective prevention of CKD based on awareness, early detection, and effective treatment.

Electronic strategies for information and research: cyberNephrology/cyberMedicine in the emerging world

Communication and medicine have evolved together. Internet resources now provide an unprecedented opportunity to provide health assistance to the developing world. The International Society of Nephrology Informatics Commission and National Kidney Foundation cyberNephrology initiative (http://www.cybernephrology.org) have created e-mail discussion groups (e.g., NEPHROL, NEPHKIDS, and so forth) and online texts and web resources (e.g., the Schrier Atlas: http://www.kidneyatlas.org) that are, in many respects, ahead of other areas of medicine. On the other hand, nephrology is quite behind in its embrace of some specific communications initiatives that could benefit emerging nations: the Health InterNetwork Access to Research Initiative program, which provides free full-text access to medical journals and books in poorer countries; the Global Health Network Supercourse, which provides specially designed online lectures for the developing world; and Internet2/Abilene and similar research networks around the world, which provide reliable, guaranteed bandwidth for high-quality Internet videoconferencing as an alternative to face-to-face lectures and meetings. The intent of many educational ventures in nephrology, particularly in the clinical practice guideline realm (National Kidney Foundation Kidney Disease Outcomes Quality Initiative, Kidney Disease Improving Global Outcomes, and so forth), is not just to disseminate information but to change human behavior: physician practice and referral patterns, patient compliance, and so forth. Concepts from the worlds of marketing and entertainment, where the science of changing human behavior is highly evolved, can be used to create high-impact, educational offerings to promote health. They can also be highly beneficial to share Internet educational innovations and future vision across boundaries of medical specialties, which is part of the intent of the cyberMedicine joint venture (http://www.cyber-medicine.org).