Open access for operational research publications from low- and middle-income countries: who pays?

Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people''s health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the ‘open-access spectrum’. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access.     

Evaluation of cluster randomized controlled trials in sub-Saharan Africa

Cluster randomized controlled trials (CRCTs) are attractive in settings in which individual randomization is difficult or impossible. This issue is common when studying several health problems in developing countries. The authors aimed to assess empirically the extent to which the prerequisite design and analysis aspects of cluster randomization were taken into account and reported properly in CRCTs conducted in sub-Saharan Africa. CRCTs published in the last three decades were evaluated by using a checklist based on the Consolidated Standards of Reporting Trials (CONSORT) statement. The authors identified 51 eligible CRCTs; 40 of them (78%) had been published after 1990. Only 10 (20%) studies took clustering into account in sample size or power calculations, and only 19 (37%) took clustering into account in the analysis. Intracluster correlation coefficients and design effects were reported in only one (2%) and three (6%) trials, respectively. An increasing number of CRCTs are conducted in sub-Saharan Africa, but many are not analyzed and reported properly. The special features stemming from cluster randomization need to be addressed in the design, analysis, and reporting of these studies.     

Psychosocial impact of amblyopia and its treatment: a multidisciplinary study

BACKGROUND: To explore the meaning of amblyopia from both parents' and children's perspectives and to seek correlations between the experiential aspects of the condition and its treatment, the clinical characteristics of amblyopia and any apparent psychopathology. METHODS: Children with amblyopia and their parents were engaged in semistructured in-depth interviews. Children also underwent a vision assessment and, where applicable, parents and children completed a psychological inventory, the Behaviour Assessment System for Children. RESULTS: Dealing with stigma and the perceptions and responses of peers were found to be of central significance to the experience of amblyopia therapy. This had adverse consequences for some children's identity and psychosocial well-being. The clinical manifestations of amblyopia did not correlate with the social implications of the condition. However, children with strabismus were noted to have significantly greater conduct and externalizing problems. CONCLUSIONS: Given that amblyopia can affect children's psychosocial well-being, health outcomes need to integrate both vision and psychosocial implications of treatment. Although treatment should aim to reverse amblyopia and restore visual acuity, efforts to minimise any negative psychosocial consequences of treatment should be made. A way to balance managing amblyopia and ensuring children's psychosocial well-being should to be considered by clinicians and included in treatment guidelines.     

Coexistence of spinal intramedullary teratoma and diastematomyelia in an adult

STUDY DESIGN: A case report of intramedullary spinal cord teratoma with remote diastematomyelia in a female adult. OBJECTIVE: To present a rare case of a dysembryogenic spinal tumor with concurrent split cord malformation and to define the importance of early surgical removal of the tumor. SETTING: A department of neurosurgery in Greece. METHODS: A 44-year old woman, presented with progressive lower limb muscle weakness, gait disturbances and dysesthesias in the trunk and lower extremity. She underwent plain radiographs, CT and MRI scan, which revealed an exophytic intramedullary spinal cord tumor at the level of T8-T10 and distant diastematomyelia in the upper lumbar spine (L2-L3). She underwent surgical intervention. The tumor was subtotally removed. No attempt was made to treat diastematomyelia. RESULTS: Postoperatively, the patient's neurological status started to improve gradually. After 1 year she exhibited better strength in the lower limb muscles and improved sensation. The histological examination demonstrated mature spinal teratoma consisting of ectodermal, mesodermal and endodermal elements. CONCLUSIONS: In adult patients with intramedullary masses of possible dysembryogenic origin, the whole spine must be examined for additional dysraphic lesions. The choice and the timing of a surgical intervention are strongly dependent on the clinical picture.