Under-representation of low and middle income countries (LMIC) in the research literature: Ethical issues arising from a survey of five leading medical journals: have the trends changed?

Despite many initiatives taken by funding bodies and health care organisations, the 10/90 gap in health care and health system research between low and middle-income countries (LIMC) and high income countries is still widely recognised. We aimed to quantify the contribution of LMIC in high impact medical journals and compare the results with the previous survey conducted in 2000. Research articles were anaylsed to determine the origin of data and authorship affiliated countries in a calendar year (2017) for five journals: British Medical Journal, The Lancet, New England Journal of Medicine (NEJM), Annals of Internal Medicine and the Journal of the American Medical Association. Contributing countries were categorised into four regions; USA, UK, Other Euro-American countries (OEAC) and rest of the world (RoW). A total of 6491 articles were categorised where USA, UK and OEAC contributed 39.7%, 28.5% and 19.9% respectively. RoW countries contributed 11.9% of articles surveyed. The Lancet and NJEM had the highest numbers from RoW with 22.1% and 17.3% respectively. After 17 years, the trend remained comparable with the original survey carried out in 2000. RoW contributions increased from 6.5% to only 11.9% of the published articles from countries accounting for 88.3% of the world's population.

The long-term quality of life following liver transplantation in a developing country with a free health care system

Introduction

Developing countries with limited resources are yet to establish universal liver transplant (LT) services to cater to their population free of charge. In this unique setting, no data are published on the long-term Quality of life (QOL) of LT survivors.

Objectives

Compare the long-term quality of life of post-liver transplant patients with a matching cohort of pretransplant cirrhotic patients and a matching non cirrhotic control group. Methods: Of the 45 liver transplants that were performed there were 24 patients who completed over 6 months of follow-up. Of these, 4 patients died (including one lost to follow-up) after six months. The remaining 20 post-transplant patients were the subjects for QOL assessment. One post-transplant recipient was matched with two pre-transplant cirrhotic patients and non-cirrhotic healthy control group. QOL was evaluated by the SF-36 questionnaire.

Results and conclusions

The median age was 54 years (27-67) and 85% (n=17) were male. The median follow up was 24 months (6- 94 months). The median MELD score was 17 (11-22) and 75% (n=15) were due to cryptogenic cirrhosis. Post-operatively three (15%) developed graft rejection, five (25%) had infections and ten (50%) suffered drug related complications. 95% (n= 19) of the population had satisfactory drug compliance. The study population had significantly better QOL compared to control in all eight domains (p<0.05) including physical functioning (76% vs 52.7%), physical health (80% vs 7.9%), emotional problems (93% vs 17.1%), energy (77% vs 47%), emotional wellbeing (80% vs 61.1%), social functioning (86.9% vs 56.9%), pain (82% vs 47.5%) and general health (67.5% vs 37.5%). The study population had similar quality of life compared to the healthy control group with better-perceived emotional well-being.

Conclusion

Long-term survivors after LT have significantly improved QOL in a setting with limited resources.

Mental health impact of the Middle East respiratory syndrome, SARS, and COVID-19: A comparative systematic review and meta-analysis

BACKGROUND

Over the last few decades, 3 pathogenic pandemics have impacted the global population; severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV-2. The global disease burden has attributed to millions of deaths and morbidities, with the majority being attributed to SARS-CoV-2. As such, the evaluation of the mental health (MH) impact across healthcare professionals (HCPs), patients and the general public would be an important facet to evaluate to better understand short, medium and long-term exposures.

AIM

To identify and report: (1) MH conditions commonly observed across all 3 pandemics; (2) Impact of MH outcomes across HCPs, patients and the general public associated with all 3 pandemics; and (3) The prevalence of the MH impact and clinical epidemiological significance.

METHODS

A systematic methodology was developed and published on PROSPERO (CRD42021228697). The databases PubMed, EMBASE, ScienceDirect and the Cochrane Central Register of Controlled Trials were used as part of the data extraction process, and publications from January 1, 1990 to August 1, 2021 were searched. MeSH terms and keywords used included Mood disorders, PTSD, Anxiety, Depression, Psychological stress, Psychosis, Bipolar, Mental Health, Unipolar, Self-harm, BAME, Psychiatry disorders and Psychological distress. The terms were expanded with a ‘snowballing’ method. Cox-regression and the Monte-Carlo simulation method was used in addition to I² and Egger’s tests to determine heterogeneity and publication bias.

RESULTS

In comparison to MERS and SARS-CoV, it is evident SAR-CoV-2 has an ongoing MH impact, with emphasis on depression, anxiety and post-traumatic stress disorder.

CONCLUSION

It was evident MH studies during MERS and SARS-CoV was limited in comparison to SARS-CoV-2, with much emphasis on reporting symptoms of depression, anxiety, stress and sleep disturbances. The lack of comprehensive studies conducted during previous pandemics have introduced limitations to the “know-how” for clinicians and researchers to better support patients and deliver care with limited healthcare resources.

The impact of breastfeeding practices on respiratory and diarrhoeal disease in infancy: a study from Sri Lanka

A hospital-based descriptive recall study was conducted to assess the relationship, if any, between breastfeeding practices and morbidity from respiratory and diarrhoeal diseases in infants. A total of 343 infants (285 admitted patients and 58 controls) were recruited. Clinical and sociodemographic data and details regarding breastfeeding practices, timing of the first respiratory or diarrhoeal illness, and the timing of the first admission for a respiratory or diarrhoeal illness, were carefully documented. Three broad groups of those who were exclusively breastfed for 3 months or less, 4 months or more, and those who were never breastfed were identified. There was no significant difference in the numbers of infants who developed a respiratory or diarrhoeal illness or were admitted to hospital with a respiratory or diarrhoeal illness during the period of exclusive breastfeeding, irrespective of the period of exclusive breastfeeding. However, significant numbers of patients who were breastfed for 3 months or less developed the first respiratory infection, the first episode of diarrhoea, and the first hospital admission for respiratory or diarrhoeal disease during the first 3 months following the introduction of other foods and in the subsequent 3 months following this period. Those who were never breastfed showed the worst results. Significantly fewer of those who were breastfed for 4 months or more fulfilled the same criteria. Identical findings were noted whether the additional feeds used to terminate exclusive breastfeeding were water, herbal tea, native medicines, or formula milk. Similar results were obtained in the control group. This study reiterates the extended protective effects of exclusive breastfeeding for periods of over 4 months against respiratory and diarrhoeal diseases using a novel set of outcome measures.