John Y. Rhee

Prediabetes and diabetes among HIV‐infected adults in Cameroon

Human immunodeficiency virus (HIV) and certain antiretrovirals are associated with diabetes. Few studies have examined the prevalence of and factors associated with diabetes among HIV‐infected individuals on combination antiretroviral therapy (cART) in sub‐Saharan Africa; some report prevalence estimates between 3.5–26.5% for diabetes in Cameroon and 20.2–43.5% for prediabetes in sub‐Saharan Africa.

Palliative medicine in Mediterranean countries: different approaches, same philosophy

Despite the fact that Italy and Spain are culturally similar, there are important differences in palliative care services development. For example, Italy has a greater proportion of hospice teams compared with Spain, while Spain has a greater proportion of hospital support teams.1 Noting these differences, we decided to compare a major palliative care service model from each country: the Seragnoli Hospice Foundation (FHS), Italy, and the Palliative Care Support Team (PCST) at the Clinica Universidad de Navarra (CUN), Spain, where an oncologist from FHS recently completed a 4-week rotation. We compare the institutions according to symptom assessment and management, psychological and spiritual care, caregiver support and impact on the rest of the hospital. Initially, the differences between the two teams, such as culture and practice, were more noticeable, but by the end of the rotation the shared values were what stood out. FHS is a private non-profit foundation in Italy composed of three hospices that care for advanced and terminal patients, each with a …

A Medical Student Perspective on Physician-Assisted Suicide

Physician-assisted suicide and euthanasia (PAS/E) has been increasingly discussed and debated in the public arena, including in professional medical organizations. However, the medical student perspective on the debate has essentially been absent. We present a medical student perspective on the PAS/E debate as future doctors and those about to enter the profession. We argue that PAS/E is not in line with the core principles of medicine and that the focus should be rather on providing high-quality end-of-life and palliative care.

The African Palliative Care Association (APCA) Atlas of Palliative Care Development in Africa: a comparative analysis

Abstract Background Although there are global studies on palliative care development, none report region-specific indicators of development for each country in Africa. We aimed to develop and deploy a set of indicators to measure the current state of palliative care development in Africa according to WHOs Public Health Strategy for integrating palliative care, including policies, availability and access to medicines, education, and service provision. Methods Qualitative interviews were conducted with 16 country experts between March and August, 2016. From those interviews, 367 indicators were derived, 130 after exclusion criteria and content analysis were performed. The country experts rated the indicators for validity and feasibility, a 14-member international committee of experts participated in a two-round modified UCLA-RAND Delphi consensus, and the coauthors ranked the indicators during November–December 2016. The final 19 indicators were further defined and sent to 66 key country informants from 51 African countries during January–March 2017. Findings Surveys were received from 48 countries. Uganda, South Africa, and Kenya have the highest number of specialised hospice and palliative care services (71% of identified palliative care services); 19% (9/48) have no identified hospice and palliative care services. 22% (12/48) indicated having stand-alone palliative care policies, and 42% (20/48) reported having a dedicated person for palliative care in the Ministry. Zambia, Uganda, South Africa, Kenya, Ghana, and Egypt reported some official form of physician accreditation. Opioid consumption per capita was low (75% of countries had Interpretation There is limited palliative care development in Africa, but there is also a significant improvement in the number of countries with hospice and palliative care services, compared to previous reports. Improvements in advocacy were identified, with more than half of countries reporting a national palliative care association. Governments need to take the steps to improve education, increase the number of services, and ensure safe access to opioids. Funding Arnhold Institute of Global Health at the Icahn School of Medicine at Mount Sinai, the African Palliative Care Association, the International Association for Hospice and Palliative Care, and the Institute for Culture and Society at the University of Navarra.

An Analysis of Palliative Care Development in Africa: A Ranking Based on Region-Specific Macroindicators

CONTEXT To date, there is no study comparing palliative care (PC) development among African countries. OBJECTIVES To analyze comparatively PC development in African countries based on region-specific indicators. METHODS Data were obtained from the African PC Association Atlas of PC in Africa, and a comparative analysis was conducted. Nineteen indicators were developed and defined through qualitative interviews with African PC experts and a two-round modified Delphi consensus process with international experts on global PC indicators. Indicators were grouped by the World Health Organization public health strategy for PC dimensions. These indicators were then sent as a survey to key informants in 52 of 54 African countries. Through an expert weighting process and ratings from the modified Delphi, weights were assigned to each indicator. RESULTS Surveys were received from 89% (48 of 54) of African countries. The top three countries in overall PC development were, in order, Uganda, South Africa, and Kenya. Variability existed by dimension. The top three countries in specialized services were Uganda, South Africa, and Nigeria; in policies, it was Botswana followed by parity among Ethiopia, Rwanda, and Swaziland; in medicines, it was Swaziland, South Africa, then Malawi; and in education, it was equivalent between Uganda and Kenya, then Ghana and Zambia. CONCLUSION Uganda, South Africa, and Kenya are the highest performing countries and were the only ones with composite scores greater than 0.5 (50%). However, not one country universally supersedes all others across all four PC dimensions. The breakdown of rankings by dimension highlights where even high-performing African countries can focus their efforts to further PC development.