Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017

ContextPalliative care is gaining ground globally and is endorsed in high-level policy commitments, but service provision, supporting policies, education, and funding are incommensurate with rapidly growing needs.ObjectivesThe objective of this study was to describe current levels of global palliative care development and report on changes since 2006.MethodsAn online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI), and Universal Health Coverage (UHC).ResultsNumbers (percentages) of countries in each development category were as follows: 1) no known palliative care activity, 47 (24%); 2) capacity-building, 13 (7%); 3a) isolated provision, 65 (33%); 3b) generalized provision, 22 (11%); 4a) preliminary integration into mainstream provision, 21 (11%); 4b) advanced integration, 30 (15%). Development levels were significantly associated with WBIL (r_S = 0.4785), UHC (r_S = 0.5558), and HDI (r_S = 0.5426) with P < 0.001. Net improvement between 2006 and 2017 saw 32 fewer countries in Categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b.ConclusionPalliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health-related suffering amenable to palliative care interventions is predicted by 2060. With an increasing need, palliative care is not reaching the levels required by at least half of the global population.     

Atención prehospitalaria urgente de los pacientes pediátricos expuestos a tóxicos: características epidemiológico-clínicas y evaluación de la calidad asistencial

ObjectiveTo describe the characteristics of paediatric patients with suspected poisoning treated by advanced life support (ALS) units, and to evaluate quality indicators (QI) for the prehospital emergency care of these patients.MethodA one-year observational study of patients under 18 years of age exposed to poisoning and treated by an ALS unit of the Medical Emergency System in Catalonia. Severe clinical criteria were defined, with 8 QI being evaluated for prehospital emergency care of poisoned paediatric patients.ResultsThe study included a total of 254 patients, with a median age of 14 years-old (p25-75 = 7-16), with intentional poisoning in 50.8% of cases. The most frequently involved toxic agent was carbon monoxide (CO) (33.8%). Poisoning was found in 48.8% of those patients, being serious in 16.5%. Intentionally (OR 5.1; 95% CI: 1.9-13.8) and knowledge of the time of exposure (OD 3.1; 95% CI: 1.3-7.3) were independent risk factors associated with the appearance of severe clinical symptoms. Five QI did not reach the quality standard and included, availability of specific clinical guidelines, activated charcoal administration in selected patients, oxygen therapy administration at maximum possible concentration in carbon monoxide poisoning, electrocardiographic assessment in patients exposed to cardiotoxic substances, and recording of the minimum data set.ConclusionsPaediatric patients attended by ALS units showed specific characteristics, highlighting the involvement of CO and adolescents with voluntary poisoning. The QI assessment was useful to detect weak points in the quality of care of these patients and to develop strategies for improvement.     

Optimizing Prescribing and Deprescribing of Proton Pump Inhibitors

Prescribing of proton pump inhibitors (PPIs) has markedly increased since their inception more than 30 years ago. The increase is related to inappropriate and long-term prescribing of PPIs, associated with a lack of education and unclear prescribing and deprescribing guidelines. The implementation of prescribing stewardship programs influences the reduction and inappropriate use of this medication. The purpose of this review is to address the gaps that exist regarding the use of PPIs along with determining methods for deprescribing. Guidelines and stewardship programs, along with education, are needed to reduce the adverse health effects of long-term PPI therapy.     

The scope of the cataract problem in the Middle East and the Mediterranean

The region is characterized by diversity in cultural, political, economic and health conditions. Blindness in the region varies from 6.4% to 0.2% with cataract ranking highly as an underlying cause. There is a need to develop national policies to deliver affordable, technically suitable, and cost effective management plans to reduce cataract. Economic, demographic, health, and manpower statistics are essential information to be considered in formulating such policies.     

Targeting access to reproductive health: giving contraception more prominence and using indicators to monitor progress

Unmet need for contraception represents a major failure in the provision of reproductive health services and reflects the extent of access to services for spacing and limiting births, which are also affected by personal, partner, community and health system factors. In the context of the Millennium Development Goals, family planning has been given insufficient attention compared to maternal health and the control of sexually transmitted infections. As this omission is being redressed, efforts should be directed towards ensuring that an indicator of unmet need is used as a measure of access to services. The availability of data on unmet need must also be increased to enable national comparisons and facilitate resource mobilisation. Unmet need is a vital component in monitoring the proportion of women able to space and limit births. Unmet need for contraception is a measure conditioned by people's preferences and choices and therefore firmly introduces a rights perspective into development discourse and serves as an important instrument to improve the sensitivity of policy dialogue. The new reproductive health target and the opportunity it offers to give appropriate attention to unmet need for contraception will allow the entry of other considerations vital to ensuring universal access to reproductive health.