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  • Of indicators in the Index ten fulfilled


    Of 101 indicators in the Index, ten fulfilled all comparability criteria for the detailed longitudinal analysis, and CGP41251 six core-scored indicators with the highest correlation with overall scores were used for the detailed longitudinal analysis. We made several important observations. First, the crude analysis of all 101 indicator scores showed that 17 of 20 companies increased the overall score underlying their Index ranking between 2010 and 2012 (). Although many indicators cannot be compared fully, this finding presents a first indication of change. Second, 50 (42%) of 120 company scores for the six core indicators increased in value, whereas only two (2%) of 120 decreased. These changes represent a very strong signal on the direction of change in company behaviour. The size of this change is not easy to measure, but an observed 84% rise in the overall average of the six indicators from 1·45 to 2·67 (scale 0–5) is the best available estimate. This difference is not significant because of the wide variation between the companies, but all six underlying average scores are also rising (). Finally, we found that all six average numbers underlying the research indicators are also increasing, with a median increase of 132% (range 49–348%), suggesting that companies have more than doubled their research and development activities in diseases covered by the Index. These average values mask many differences between technical areas and between companies. For example, the industry seems well advanced in the area of governance and donations, but has a long way to go in data exclusivity and patents. Differences between companies are presented in the full report.
    Rheumatic CGP41251 disease (RHD) is an acquired cardiac disease that can arise from untreated streptococcal pharyngitis. Often thought of as a disease of poverty and childhood—when access to education, infrastructure, medical facilities, and care is poor—this largely preventable disease has become a major cause of morbidity, incapacity, and death. Whereas enhanced socioeconomic conditions and population-based prevention strategies have decreased if not completely absolved developed countries of RHD, low-income and middle-income regions, such as those in sub-Saharan Africa, are still highly burdened with the disease. In Rwanda\'s public sector, there are only four native cardiologists (two paediatric and two adult), supported by health-worker colleagues, to serve a population of more than 10 million. Although candidates are being identified to pursue advanced cardiology and cardiac surgery training, it will be 3–5 years before these individuals might avail their services to the country. In November, 2006, the Rwandan Government began to decentralise chronic care for non-communicable diseases, including cardiovascular conditions, placing RHD eradication as a national priority. Aligned with this target, a collaborative effort was initiated between the Rwandan Ministry of Health, the Rwanda Heart Foundation, and four international humanitarian organisations to address the escalating cardiac disease burden. The first team in the country was Open Heart International from Australia in 2006, followed by Chain of Hope Belgium in 2007. Team Heart Inc from Boston, MA, USA and Healing Hearts Northwest from Spokane, WA, USA completed the partnership in 2008 and 2010, respectively. These four teams—in partnership with the Rwandan Ministry of Health and King Faisal Hospital, Kigali—have collaboratively shown the feasibility of modern cardiac surgery in Rwanda. More than 400 patients have received cardiac interventions, including 330 heart surgeries (178 children and 152 adults), most for valve repair or replacement in patients with class III or IV heart failure. The Chain of Hope team has also done 79 paediatric interventional catheterisations. Other patients have received pacemakers, had pericardectomies, or received minor cardiac interventions ().
    Motivated by the summary of the global burden of blindness by Rupert Bourne and colleagues (December, p e339), we believe an opportunity exists to reduce preventable blindness and potentially loss of life through development of interventions informed by public health theory. Retinoblastoma—a diagnosis that affects not only vision but also survival for many individuals—is the most common intraocular tumour of childhood. Although approaches that improve how health care is delivered have been a focus for management of paediatric oncology in low-income and middle-income settings, this essential focus is not sufficient. We propose a comprehensive approach to improve paediatric oncology outcomes in low-resource settings through a stage-based model that incorporates both social determinants of health and health behaviour theory.