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https://openalex.org/W4250814013
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Development of a targeted client communication intervention to women using an electronic maternal and child health registry: a qualitative study
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"West Bank",
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https://api.openalex.org/works?filter=cites:W4250814013
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Abstract Background: Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based interventions that are co-design with users. The aim of this paper is to describe the planning, development, and evaluation of a theory led TCC intervention, tailored to pregnant and postpartum women and automated from the Palestinian electronic maternal and child health registry. Methods: We used the Health Belief Model to develop interview guides to explore women’s perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction), and untimely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women, and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Grounding on the results of the in-depth interviews, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent as text messages. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. Results: We found low awareness of the importance of timely attendance to ANC, and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, anemia, hypertension, and diabetes complications in pregnancy. To increase the utilization of ANC and bridge the identified gaps, we iteratively composed actionable text messages with users, using recommended message framing models. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile documented in the electronic health registry. Conclusions: We developed an optimized TCC intervention underpinned by behavior change theory and concepts, and co-designed with users following an iterative process. The electronic maternal and child health registry can serve as a unique platform for TCC interventions using text messages.
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https://openalex.org/W3090374435
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Devi Sridhar: illuminating global health governance
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https://api.openalex.org/works?filter=cites:W3090374435
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Devi Sridhar has travelled far in her fairly short career. She was the youngest Rhodes Scholar, aged just 18 years, and became Professor of Global Public Health at the University of Edinburgh, UK, when she was 30. But milestones are of little interest to her, especially as her role as a leader in global health governance has been accelerated by the impacts of the COVID-19 pandemic. “This is the time for the global public health community to step up”, she comments. “We have never before been required to work so intensively and as rapidly as in today's environment, where effective public health responses and global health governance are having an impact on the entire world's population. Pre-COVID-19 we would work in timeframes of weeks and months; this year it has been about minutes and hours”, she says. Sridhar is optimistic about scientific progress during the pandemic, including more rapid testing and potential COVID-19 vaccines, but she cautions: “implementation will be the challenge, as it always is in global health—not so much in the finding of technical solutions, but being able to implement them on an enormous scale that does not leave behind the poorest regions of the world”. More locally, she has been vocal about Scotland's focus on aiming for no acceptable incidence and lowest levels of COVID-19, in contrast to the approach in England. “What Scotland has shown is the effectiveness of clear messaging, local testing and tracing, and rapid, pre-emptive action, such as temporary closure of the hospitality sector in high transmission areas, in order to enable schools to stay open. Compared with earlier in the pandemic, we can now see how earlier and targeted public health interventions with more nuanced restrictions are more effective than delayed responses, which will cause more severe lockdowns later”, she says. Her passion for public health stems from her adolescence in Florida, USA, where Sridhar's father died from cancer after years of illness. “Even as a teenager I could see that health was the definition of true wealth”, she recalls. It was an intercalated bachelors and medical school programme at the University of Miami that led her to the Rhodes Scholarship at the University of Oxford, UK, in 2003. There, she realised that a PhD would be most relevant for her chosen path in population health. She spent 8 months of her PhD in India studying malnutrition and infectious diseases in settings that ranged from rural villages to slum housing in Delhi. “This is where I realised the importance of global health governance, as I could not understand why a country like India, with its relative wealth, could have so much of its population living with chronic malnourishment. I realised that to understand malnutrition, it was necessary to be knowledgeable about public health systems, and the interconnection with political and financial mechanisms”, she says. Her research also led to her first book in 2008, The Battle Against Hunger. While at Oxford's Blavatnik School of Government, Sridhar analysed the reach, effectiveness, and interdependency of supranational agencies like WHO, other UN health agencies, and organisations such as Gavi, The Vaccine Alliance and the World Bank. “The aim was to better understand the strengths and weaknesses of these organisations, and their comparative advantages and relevance to health ministries, especially in low-income and middle-income countries”, she explains. This work informed her 2017 book, co-authored with Chelsea Clinton, Governing Global Health: Who Runs the World and Why? With Peter Piot, Sridhar co-led an independent evaluation of the 2014 outbreak of Ebola virus disease in west Africa, culminating in ten key recommendations for future pandemic preparedness. In 2014, she became Reader and Senior Lecturer in Global Public Health at the University of Edinburgh and full Professor there a year later. Here, she established and directs the Global Health Governance Programme, overseeing a team of postdoctoral and postgraduate research students who analyse health systems and governance in diverse regions, from Haiti to Bangladesh. “Our work analysing health system recovery post-Ebola virus disease in west Africa is now assessing public health responses in relation to COVID-19. It is incredible to work with such a dedicated team, which has worked tirelessly since the start of the pandemic to realign its work and to take on an inevitable increase in analysis, given current circumstances”, she says. Lawrence Gostin, Professor and Director of the O'Neill Institute for National and Global Health Law at Georgetown University in Washington, DC, USA, has collaborated with Sridhar over many years and comments: “Devi is among the most inspirational and impactful global health leaders in the world…All of Devi's work is guided by the core values of achieving a healthier and safer world with equity and justice. Her work on global governance is exceptional, illuminating the importance of global institutions like WHO, while proposing powerful reforms. Devi is a respected scholar while also being a public intellectual, guiding national and global responses to health threats.” In this public role, Sridhar is an expert adviser on Scottish and UK governmental COVID-19 committees and also spends time on media work and public health messaging related to the pandemic. “COVID-19 has exposed deep inequalities within our global society, as well as diverse government responses balancing health, economic, ethical, political, and moral concerns. Our team has followed the unfolding of the pandemic across the world. There is no returning to life in 2019: we need to look forward, not back”, she says.
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https://openalex.org/W2087142023
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Affordable Warmth Interventions in North Lancashire: winner of the post award ‘Best for Visual Impact’ at Public Health England 2013 Annual Conference
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https://api.openalex.org/works?filter=cites:W2087142023
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In 2012, Lancashire County Council launched a programme to improve public health, by reducing hospital admissions, and to decrease excess winter illness/ deaths among vulnerable households at risk of severe cold in Lancaster, Wyre and Fylde. Interventions included providing practical help and information together with preventative and remedial support services.Local needs assessments identified vulnerable groups, and services were commissioned to build their resilience to cold weather. Public health messages were communicated and immediate advice and practical support services were provided to the isolated and vulnerable throughout the winter. The project ensured that more long term sustainable measures are in place to protect those most vulnerable to the cold. As a result strong partnerships have been created for the future with several agencies. These include: District and City Councils; Care and Repair Wyre and Fylde; Home Improvement Agency Lancaster; Citizens Advice Bureaux; Age UK Lancashire; LESS Community Interest Company; North West Ambulance Service; Groundworks and New Progress Housing; Lancashire Fire and Rescue Service; Energy Inform; Food Banks; Help Direct; and Lifeline Pendant Alarms.INTERVENTIONThe programme initially used funds made available for local authorities to bid for through the Department of Health's 2011/12 Warm Homes Healthy People (WHHP) initiative. As funding was announced in December when winter was already upon us, there was little time for planning. There was also no requirement to monitor or evaluate the intervention.Despite this, North Lancashire monitored the interventions provided to support some of the vulnerable members of the community and found evidence of partnership working and benefits to the local population from the interventions delivered with WHHP money. This evidence prompted NHS North Lancashire to further invest approximately £150,000 in projects across the Primary Care Trust (PCT) footprint by securing significant funding for Affordable Warmth. Therefore, for the first time it was possible to plan ahead in 2012/13 prior to the winter months and offer preventative up-stream measures, rather than taking the usual reactive approach. A referral criterion was set identifying Care and Repair and the Home Improvement Agency as the single points of access for front line agencies. Historically, referrals from health staffwere few in number during previous initiatives. On investigation, it was found that front line staffhad limited time to explore what measures were available or where to refer to, so they rarely did so. Providing one contact number for each locality would ensure access to support and give staffconfidence that an assessment would be carried out to determine the level of support needed. For the purpose of the project, the definition of 'vulnerable' used to ensure funding reached those whose health and wellbeing would be most affected by cold, damp living conditions is identified below as:* A person who is receiving services such as:* personal care or nursing or support to live independently in his/her own home; or* social care services;* A person who is affected by the following conditions:* learning or physical disability;* physical or mental illness, chronic or otherwise, including those receiving treatment for cancer and palliative care; or* reduction in physical or mental capacity.* A person with a disability of the type listed below:* dependency upon others in the performance of, or a requirement for assistance in the performance of, basic physical functions; or* severe impairment in the ability to communicate with others; or* A person with an impaired ability to protect him/herself from assault, abuse or neglect.When planning the second phase of the intervention funded by NHS North Lancashire, the Affordable Warmth team was able to build on lessons learnt in the first interventions of 2011/12. …
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https://openalex.org/W2808884797
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Health care access and satisfaction in Judean and Samarian communities: opportunities for improving care
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There are distinctive potential barriers to optimal health care in Judea and Samaria because of access and satisfaction levels, including obstacles such as its isolation and health care capacity. However, there is a lack of research focusing on health care for the Jewish communities in this region, often referred to as the West Bank. What is the level of health care access and satisfaction for Israelis living in the Jewish communities in Judea and Samaria? How do these results compare to parallel results for Israelis in general? How do these results vary by subgroups, in particular by location? Two hundred fourty six residents of Judea and Samaria in six diverse, Jewish communities were surveyed, with a 76% response rate. Descriptive analyses were performed for all variables. Bivariate analyses for access and satisfaction measures were performed by key demographic variables. Comparisons were also made with Israelis in general (the vast majority of whom do not live in Judea or Samaria), by comparing our survey results to the results of 2016 Myers-JDC-Brookdale Institute national satisfaction survey. Our survey questions were based on this national survey, tested and used for several cohorts. Of those surveyed, 14% decided to forego treatment because of the distance, although only 3% declined treatment because of cost. There was a diversity of results in terms of satisfaction measures, although in no categories were even half of respondents very satisfied; results ranged from 7% very satisfied with health care system overall to 47% very satisfied with their family physician’s attitude. Variations were found by community with local council communities generally, but not always, having the highest satisfaction. Compared to Israelis in general, Israeli residents of Judea and Samaria reported generally lower satisfaction, including 9% fewer being very satisfied with the health plan overall and 10% fewer being very satisfied with referrals. However, 7% more had confidence in getting the best treatment. Access to care involves more than just coverage. Health care system problems among Israelis living in Judea and Samaria include not just quantity, but quality of services offered. There is a need for improvement not only in health care resources, but also in the level of access and satisfaction in this region.
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first_page settings Order Article Reprints Font Type: Arial Georgia Verdana Font Size: Aa Aa Aa Line Spacing: Column Width: Background: Open AccessEditorial Towards the Integrated Study of Urban Climate, Air Pollution, and Public Health by Jennifer Salmond 1, Clive E. Sabel 2 and Sotiris Vardoulakis 3,* 1 School of Environment, Faculty of Science, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand 2 Department of Environmental Sciences, Aarhus University, 4000 Roskilde, Denmark 3 Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh EH14 4AP, UK * Author to whom correspondence should be addressed. Climate 2018, 6(1), 14; https://doi.org/10.3390/cli6010014 Received: 20 February 2018 / Revised: 24 February 2018 / Accepted: 25 February 2018 / Published: 26 February 2018 (This article belongs to the Special Issue Urban Climate, Air Pollution, and Public Health) Download Download PDF Download PDF with Cover Download XML Download Epub Versions Notes Globally, cities are growing at an unprecedented pace, putting pressure on space, existing infrastructure, and resources. At the same time, the function and form of cities is rapidly evolving as planners and decision makers race to meet the changing needs of the population within the context of unequal resource allocation and variable risks imposed by environmental threats such as climate change and air pollution [1,2]. Designing and planning sustainable cities, resilient to environmental and population change, which also promote human wellbeing and healthy lifestyles, is therefore one of the greatest challenges of the 21st Century. This Special Issue, edited by the Healthy-Polis International Consortium for Urban Environmental Health and Sustainability (www.healthy-polis.org), aims to explore these interactions between urban climate, air pollution, and public health in cities around the world.Air pollution remains one of the biggest threats to human health and wellbeing in cities. Outdoor air pollution causes approximately 4.2 million premature deaths annually worldwide [3]. Pressure is greatest in urban areas of rapidly developing countries such as China and India [4]. The indirect health consequences of air pollution are maybe just as costly from an economic, social, and health perspective, including loss of productivity and reduced educational performance [5,6]. Given the dynamic physical and social conditions of urban environments, it is perhaps not surprising that the complex interactions between urban climate, air pollution, and public health remain poorly understood and difficult to predict. Multiple feedback processes, driven by the unique and location-specific characteristics of urban surfaces and the ways we use urban land, further complicate the links between climate, air pollution, and public health. Urban structures, materials, vegetation, and traffic modify climatic conditions, creating strong spatial gradients of air pollution and heat, which may exacerbate health risks and social inequalities in temporally and spatially disparate ways [7]. Planned or unplanned changes in the built environment and demographics (which determine mobility, vulnerability, and occupation) can change patterns of exposure to environmental hazards such as air pollution and temperature extremes, and in some cases intensify health effects. The interaction between the outdoor and indoor environment can also influence exposure patterns to both climate and air pollution variables and thus affect health impacts [8]. Although the health impacts of air pollution on urban populations are nuanced by socio-economic factors [9], climate, and pollution severity, the consequences can be observed in cities around the world. In this special issue, the effects of air pollution on urban populations are explored in a range of locations including the heavily polluted city of Kolkata (India) [10], where respiratory illnesses now exceed waterborne illness by a factor of five. Further examples are provided by Xu et al. [11] and Guariso and Malvestiti [12] who examine the social, economic, and health consequences of pollution in the comparatively moderately polluted urban areas of Hong Kong (China) and Milan (Italy), respectively. However, the impacts of pollution are significant even where much lower air pollution levels are reported, in Kuopio (Finland) [13] and Auckland (New Zealand) where Dirks et al. [14] demonstrate the relation between daily mortality and local traffic-related air pollutants. Air pollution is not only toxic to the human body but also interacts with climate. Short lived climate pollutants (SLCP), such as black carbon and ozone, can exacerbate climate change, altering the frequency, duration, and location of heatwaves and cold spells, storm intensity, precipitation patterns, and, possibly, ultra-violet radiation exposure, indirectly threatening urban lives and livelihoods [15]. On the other hand, a warmer climate can have an impact on biogenic volatile organic compound emissions, the rate of atmospheric chemical reactions, and the depth of the atmospheric boundary layer, which all affect surface pollutant concentrations [16]. Using a meta-analysis of 246 cities and 18 different climate model scenarios, Milner et al. [17] illustrate the high probability of climate change that presents significant challenges to the future resilience of urban areas and the protection of public health, as urban populations are projected to be exposed to higher temperatures than are currently experienced. Several papers in the special issue provide examples that demonstrate the importance of tackling urban climate, air pollution, and public health issues together, particularly in cities where multiple co-benefits of targeted strategies can be realised and the dangers of attempting to mitigate environmental pollution using single parameter optimization can be avoided [18]. Naik et al. [19] show how effective a multi-parameter health assessment methodology is for determining the net impact of low emission zones in cities. They demonstrate significant health and environmental co-benefits from the implementation of such measures for a city in the UK. In contrast, Asikainen et al. [13] demonstrate that policies that are intended to reduce greenhouse gas (GHG) emissions may have unintended impacts on local air quality. They show that mitigation by the transition to alternative fuels and energy sources, energy conservation, and land use modification may have significantly different outcomes for human health and wellbeing. They also highlight the importance of assessing local scale impacts, suggesting that whilst the increased use of domestic wood burners would likely result in negative impacts on health, there are significant economic and health gains to be made by promoting strategies that reduce traffic-related emissions by promoting active transport modes such as cycling and walking. Milner et al. [20] further demonstrate the need for careful consideration of the links between climate, air pollution, and health. They argue that whilst reductions in GHG emissions through improvements in residential energy efficiency achieved by increased insulation may have appreciable near-term net benefits to health due to better indoor thermal regulation and reduced exposure to outdoor pollutants, these may be offset by increased exposure to indoor sources of pollution due to reduced ventilation.Attempts to effectively manage urban air pollution require careful resolution of the challenges, tensions, and conflicts between different social, economic, and environmental priorities at different scales. Using a combined approach, the benefits to public health and the environment associated with increased use of cycling are explored by Guariso and Malvestiti [12]. They examine the trade-offs between increased physical exercise and reduced emissions of pollutants (especially GHG) versus potentially increased exposure of commuters to air pollution associated with switching from motor vehicles to bicycles. Their modelling shows that when just taking into consideration these parameters, the overall balance for public health in Milan, Italy, was always in favour of cycling. Guariso and Malvestiti [12] further demonstrate that when factors such as road space and economic factors were taken into consideration, the balance in favour of cycling was even stronger. Again, this paper reveals that tackling climate, air pollution, and public health (through promotion of increased physical activity) together can result in significant overall gains.This special issue also suggests that one of the keys to managing air pollution, climate change, and public health concerns effectively in urban areas is to improve our understanding of the ways in which urban land use affects human health outcomes. Xu et al. [11] address the challenges associated with quantifying the effect of green space on air pollution exposure, climate, and health. In the densely populated sub-tropical city of Hong Kong, China, they show that greater provision of green space has the potential to reduce mortality due to beneficial effects on exercise and stress, improved air quality, and reduced urban heat islands. They note the socio-economic differences in health outcomes, with the greatest benefits realised by males and those living in areas with below-average median household income. The importance of understanding the impact of air pollution on health in the context of total personal exposure and, particularly, the quality of the indoor environment is also highlighted in a methodological analysis by Milner et al. [20].Effective urban planning therefore requires a clear understanding of the interactions between the social, economic, and physical process operating in cities and how these play out in the ways urban land is used in space and time. As cities and populations become increasingly ‘digital’, the amount of data available to describe human interactions with different urban microenvironments has increased exponentially, and the potential for new insights is unprecedented. However, a better description of urban environments alone has yet to deliver an improved understanding of processes that lead to better urban planning and development. Rather, we need innovative ways to explore and analyse this explosion of data (“Big Data”) if we are to see any real changes in the ways we plan, manage, and mitigate air pollution, climate change, and their impacts on cities [21]. Mahmood et al. [22] show how large data sets from routinely collected sources, in this case ambulance call outs, can be combined with climate data to provide an improved understanding of the impact of climate extremes on ambulance response times in London, UK. Their results demonstrate that not only can such near real time data provide pathways for improved urban management, but new understandings also offer the potential for improved health service provision. As we adapt to a warmer climate, we need to ensure that our urban atmospheres are treated as a resource and sustainably managed. The papers in this issue enrich the current interdisciplinary, multi-parameter evidence base for decision making in urban planning and design, environmental protection, and public health. Effective urban growth and regeneration planning, which pays attention to the creation of more sustainable transportation options and building climate control measures, is required to maintain and improve public health in cities. Efforts need to target reduced emissions through the promotion of active modes of transport and home heating/cooling measures [13,20]. The provision of less polluted [19] and less noisy outdoor spaces, which promote exercise and wellbeing, will ultimately reduce the burden of non-communicable diseases [11,12]. ReferencesVardoulakis, S.; Dear, K.; Wilkinson, P. Challenges and opportunities for urban environmental health and sustainability: The HEALTHY-POLIS initiative. Environ. Health 2016, 15, S30. [Google Scholar] [CrossRef] [PubMed]Thomas, F.; Sabel, C.E.; Morton, K.; Hiscock, R.; Depledge, M. Extended impacts of climate change on health and wellbeing. Environ. Sci. Policy 2014, 44, 271–278. [Google Scholar] [CrossRef]Cohen, A.J.; Brauer, M.; Burnett, R.; Anderson, H.R.; Frostad, J.; Estep, K.; Balakrishnan, K.; Brunekreef, B.; Dandona, L.; Dandona, R.; et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: An analysis of data from the Global Burden of Diseases Study 2015. Lancet 2017, 389, 1907–1918. 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Assessing urban population vulnerability and environmental risks across an urban area during heatwaves—Implications for health protection. Sci. Total Environ. 2018, 610–611, 678–690. [Google Scholar] [CrossRef] [PubMed]Vardoulakis, S.; Dimitroulopoulou, S.; Thornes, J.E.; Lai, K.-M.; Taylor, J.; Myers, I.; Heaviside, C.; Mavrogianni, A.; Shrubsole, C.; Chalabi, Z.; Davies, M.; Wilkinson, P. Impact of climate change on the domestic indoor environment and associated health risks in the UK. Environ. Int. 2015, 85, 299–313. [Google Scholar] [CrossRef] [PubMed]Hiscock, R.; Mudu, P.; Braubach, M.; Martuzzi, M.; Perez, L.; Sabel, C.E. Wellbeing impacts of city policies for reducing greenhouse gas emissions. Int. J. Environ. Res. Public Health 2014, 11, 12312–12345. [Google Scholar] [CrossRef]Haque, M.S.; Singh, R.B. Air pollution and human health in Kolkata, India: A case study. Climate 2017, 5, 77. [Google Scholar] [CrossRef]Xu, L.; Ren, C.; Yuan, C.; Nichol, J.E.; Goggins, W.B. An ecological study of the association between area-level green space and adult mortality in Hong Kong. Climate 2017, 5, 55. [Google Scholar] [CrossRef]Guariso, G.; Malvestiti, G. Assessing the value of systematic cycling in a polluted urban environment. Climate 2017, 5, 65. [Google Scholar] [CrossRef]Asikainen, A.; Pärjälä, E.; Jantunen, M.; Tuomisto, J.T.; Sabel, C.E. Effects of local greenhouse gas abatement strategies on air pollutant emissions and on health in Kuopio, Finland. Climate 2017, 5, 43. [Google Scholar] [CrossRef]Dirks, K.N.; Scarfe, J.; Talbot, N.P.; Marshall, R.; Salmond, J.A. A statistical analysis of the relationship between brown haze and surface air pollution levels on respiratory hospital admissions in Auckland, New Zealand. Climate 2017, 5, 86. [Google Scholar] [CrossRef]Mitchell, D.; Heaviside, C.; Vardoulakis, S.; Huntingford, C.; Masato, G.; Guillod, B.P.; Frumho, P.; Bowery, A.; Allen, M. Attributing human mortality during extreme heatwaves to anthropogenic climate change. Environ. Res. Lett. 2016, 11, 074006. [Google Scholar] [CrossRef]Heal, M.R.; Heaviside, C.; Doherty, R.M.; Vieno, M.; Stevenson, D.S.; Vardoulakis, S. Health burdens of surface ozone in the UK for a range of future scenarios. Environ. Int. 2013, 61, 36–44. [Google Scholar] [CrossRef] [PubMed][Green Version]Milner, J.; Harpham, C.; Taylor, J.; Davies, M.; Le Quéré, C.; Haines, A.; Wilkinson, P. The challenge of urban heat exposure under climate change: An analysis of cities in the Sustainable Healthy Urban Environments (SHUE) database. Climate 2017, 5, 93. [Google Scholar] [CrossRef]Salmond, J.A.; Tadaki, M.; Vardoularkis, S.; Arbuthnott, K.; Coutts, A.; Demuzere, M.; Dirks, K.N.; Heaviside, C.; Lim, S.; Macintyre, H.; McInnes, R.; Wheeler, B. Ecosystem services provided by street trees in the urban environment and their implications for human health in a changing climate. Environ. Health 2016, 15, S36. [Google Scholar] [CrossRef] [PubMed][Green Version]Naik, Y.; Jones, S.; Christmas, H.; Roderick, P.; Cooper, D.; McGready, K.; Gent, M. Collaborative health impact assessment and policy development to improve air quality in West Yorkshire—A Case Study and Critical Reflection. Climate 2017, 5, 62. [Google Scholar] [CrossRef]Milner, J.; Armstrong, B.; Davies, M.; Ridley, I.; Chalabi, Z.; Shrubsole, C.; Vardoulakis, S.; Wilkinson, P. An Exposure-Mortality Relationship for Residential Indoor PM2.5 Exposure from Outdoor Sources. Climate 2017, 5, 66. [Google Scholar] [CrossRef]Salmond, J.A.; Tadaki, M.; Dickson, M. Can big data tame a ‘naughty’ world? Can. Geogr. 2017, 61, 52–63. [Google Scholar] [CrossRef]Mahmood, M.A.; Thornes, J.E.; Pope, F.D.; Fisher, P.A.; Vardoulakis, S. Impact of air temperature on London ambulance call-out incidents and response times. Climate 2017, 5, 61. [Google Scholar] [CrossRef] © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Share and Cite MDPI and ACS Style Salmond, J.; Sabel, C.E.; Vardoulakis, S. Towards the Integrated Study of Urban Climate, Air Pollution, and Public Health. Climate 2018, 6, 14. https://doi.org/10.3390/cli6010014 AMA Style Salmond J, Sabel CE, Vardoulakis S. Towards the Integrated Study of Urban Climate, Air Pollution, and Public Health. Climate. 2018; 6(1):14. https://doi.org/10.3390/cli6010014 Chicago/Turabian Style Salmond, Jennifer, Clive E. Sabel, and Sotiris Vardoulakis. 2018. "Towards the Integrated Study of Urban Climate, Air Pollution, and Public Health" Climate 6, no. 1: 14. https://doi.org/10.3390/cli6010014 Find Other Styles Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here. Article Metrics No No Article Access Statistics For more information on the journal statistics, click here. Multiple requests from the same IP address are counted as one view.
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During a two-decade battle against polio, the Chinese government has saved more than one million children from physical disability caused by wild poliovirus infection. Today, the Chinese government still faces an arduous task in (1) preventing the entry and transmission of wild poliovirus from surrounding polio-endemic countries, (2) finding and stopping the outbreak of polio caused by the recycling of vaccine-derived poliovirus, (3) reducing vaccine-associated paralytic poliomyelitis (VAPP) cases, and (4) improving the State compensation system. The scientific monitoring system established in China and the immunity strategy implemented not only allow children in China to avoid lifelong disability or premature death due to polio infection, but also provide success stories for the World Health Organization that can be used for the specification of quality control indices for monitoring polio, classification and diagnosis criteria for acute flaccid paralysis cases, and identification and emergency treatment principles for imported wild poliovirus. During a two-decade battle against polio, the Chinese government has saved more than one million children from physical disability caused by wild poliovirus infection. Today, the Chinese government still faces an arduous task in (1) preventing the entry and transmission of wild poliovirus from surrounding polio-endemic countries, (2) finding and stopping the outbreak of polio caused by the recycling of vaccine-derived poliovirus, (3) reducing vaccine-associated paralytic poliomyelitis (VAPP) cases, and (4) improving the State compensation system. The scientific monitoring system established in China and the immunity strategy implemented not only allow children in China to avoid lifelong disability or premature death due to polio infection, but also provide success stories for the World Health Organization that can be used for the specification of quality control indices for monitoring polio, classification and diagnosis criteria for acute flaccid paralysis cases, and identification and emergency treatment principles for imported wild poliovirus. The World Health Organization (WHO) released the “Global polio eradication initiative, strategic plan 2004–2008” in 2004 and planned to intercept the transmission of wild poliovirus (WPV) by 2004/2005, certify the global eradication of polio by 2006/2008, and stop the use of the poliomyelitis live oral vaccine by 2009.1World Health Organization Global polio eradication initiative, strategic plan 2004–2008.Wkly Epidemiol Rec. 2004; 79: 55-57PubMed Google Scholar However, the schedule has been subject to delay. As reported by the WHO, four countries still need to curb the local spread of poliovirus, i.e., the endemic countries of Afghanistan, India, Nigeria, and Pakistan.2Liang X.F. The status in China of job analysis after non-implementation of polio immunization program (in Chinese).Chinese J Vaccines Immunization. 2005; 11: 333-338Google Scholar The global eradication of polio will be a long journey. The Ministry of Health of the People's Republic of China, along with several government departments, released the “Instruction advice on verification of cases related to polio vaccines and handling of remaining problems” on July 17, 2008 (Wei Ban Fa [2008] No. 40). The four-year incident wherein the oral polio vaccines caused disabilities among Chinese children has ended for the time being, but is far from being completely resolved. During a two-decade battle against polio, the Chinese government has saved more than one million children from physical disability brought about by infection with the wild poliovirus.1World Health Organization Global polio eradication initiative, strategic plan 2004–2008.Wkly Epidemiol Rec. 2004; 79: 55-57PubMed Google Scholar, 2Liang X.F. The status in China of job analysis after non-implementation of polio immunization program (in Chinese).Chinese J Vaccines Immunization. 2005; 11: 333-338Google Scholar, 3WHO, Programmes and projects, Media centre, Fact sheets, Poliomyelitis. Available at: http://www.who.int/mediacentre/factsheets/fs114/en/index.html (accessed).Google Scholar, 4Yang JJ, Li HF. The first national immunization day polio eradication activities. International organizations to support polio eradication activities in our country (in Chinese). Chinese Health Yearbook; 1993, p. 94–5.Google Scholar The scientific monitoring system established and the immunity strategy implemented in China are included in the first law on the prevention and treatment of epidemic diseases promulgated in 1989 – “The People's Republic of China Epidemic Disease Prevention and Treatment Law”. The law requires governments at all levels to organize and lead vaccination based on the immunization program and guarantees the funds related to this for training, technical guidance, monitoring, appraisal, epidemiological survey, and emergency treatment within the administrative regions. Only the Ministry of Health and the health agencies of the provincial (autonomous region, municipality directly under the direction of Central government) government can specify the immunization program, while its health institutions organize implementation.5Li S.M. The People's Republic of China Communicable Disease Prevention Act in the management features (in Chinese).Chinese J Public Health Management. 1989; 16: 55-57Google Scholar The strategy not only allows children in China to avoid lifelong disability or premature death due to polio infection, but also provides the WHO with successful experiences that can be used for the specification of quality control indices for monitoring polio, classification and diagnosis criteria for acute flaccid paralysis (AFP) cases, and identification and emergency treatment principles for imported wild poliovirus. China reported 20 000 to 43 000 polio cases each year in the early 1960s, making it a major affected area. At this time, China successfully developed an attenuated live polio vaccine through its own efforts, and the number of polio cases and deaths dropped sharply along the course of its promotion. In 1978, China started to implement the planned immunization schedule, further reducing the incidence rate. Figure 1 presents the number of polio cases each year from 1989 to 2006. The data come from the “WHO vaccine-preventable diseases: monitoring system 2008 global summary”.3WHO, Programmes and projects, Media centre, Fact sheets, Poliomyelitis. Available at: http://www.who.int/mediacentre/factsheets/fs114/en/index.html (accessed).Google Scholar At the 41st World Health Conference in 1988 , a target date of 2000 was proposed for the global eradication of polio. However, The West Pacific Area, to which China belongs, aimed to eradicate polio by 1995. To meet this target, the Chinese government established the national AFP monitoring system and polio laboratory network in 1991, adopted a uniform definition for AFP cases, and developed the active monitoring and ‘zero’ case reporting of such cases. Dead zones, highly dangerous areas, and weakly monitored areas were identified by analysis through computer network management and geographical information systems. The first round vaccination campaign to eradicate polio and boost the immunity of children aged less than 4 years was launched nationwide on December 5, 1993.4Yang JJ, Li HF. The first national immunization day polio eradication activities. International organizations to support polio eradication activities in our country (in Chinese). Chinese Health Yearbook; 1993, p. 94–5.Google Scholar Party and State leaders and friends from international organizations in China attended this campaign. International organizations supported the Chinese government's commitment to the world to eradicate polio. Launching the national campaign to boost immunity in this populous state was a critical and decisive measure required for China to eradicate polio as scheduled.3WHO, Programmes and projects, Media centre, Fact sheets, Poliomyelitis. Available at: http://www.who.int/mediacentre/factsheets/fs114/en/index.html (accessed).Google Scholar The presence of State leaders at each activity of the Immunity Boost Campaign aided its promotion (Figure 2). The Chinese government carried out enhanced immunization2Liang X.F. The status in China of job analysis after non-implementation of polio immunization program (in Chinese).Chinese J Vaccines Immunization. 2005; 11: 333-338Google Scholar (Table 1). Firstly there was a strengthening of the national immunization program. Secondly immunization surveillance was implemented with the following results: the incidence rate of non-polio AFP cases among children aged <15 years was maintained above 1/100 000. A review of the quality of the AFP surveillance system in China for 1998–2007 is shown in Table 2. For example, 3001 AFP cases were reported in 2007. Based on the virological classification standard, 3000 cases were discarded as non-polio cases and one case was classified as polio compatible. No indigenous or imported WPV was found in China in 2007. The AFP system ran well in 2007, and all the surveillance indicators met the requirements of the Ministry of Health in China and the WHO (Table 2).6Li L. Wen N. Xia W. Analysis on working status of acute flaccid paralysis case surveillance system in China in 2006 (in Chinese).Chinese J Vaccines Immunization. 2007; 13: 518-521Google Scholar, 7World Health Organization Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2007.Weekly Epidemiol Rec. 2007; 82: 395-398PubMed Google ScholarTable 1Report of oral poliomyelitis vaccine (OPV) immunization coverage in China, 1993–2004aSee reference 2.YearFirst round of OPV immunizationSecond round of OPV immunizationNumber of vaccinationsActual number of vaccinationsVaccine coverage %Number of vaccinationsActual number of vaccinationsVaccine coverage %93/9475 414 90673 948 55798.181 684 79274 471 26891.294/9569 356 58168 053 71398.171 639 27269 248 83596.795/9664 102 72962 551 29897.664 558 00764 326 90799.696/9756 345 42655 444 38098.457 270 56256 454 61098.697/9854 409 72353 240 02197.955 039 31153 991 48998.198/9946 436 34445 683 79298.447 387 68146 668 26498.599/0041 185 15940 418 52598.141 378 50840 684 50098.300/0129 309 25625 799 92298.126 251 68425 762 14998.101/0231 931 97031 313 18598.137 175 85736 507 45998.202/0336 376 29735 702 61798.137 119 77436 419 10498.103/0433 583 07432 665 42197.334 048 67333 097 37597.2a See reference 2Liang X.F. The status in China of job analysis after non-implementation of polio immunization program (in Chinese).Chinese J Vaccines Immunization. 2005; 11: 333-338Google Scholar. Open table in a new tab Table 2Classification of AFP reported cases in China, 1998–2007aSee references 6 and 7.YearAFP reported incidence rate/100 000AFP reported casesAFP classified resultWild virus polio casesPolio compatible casesDiseased cases20071.373001013000bImmunodeficiency vaccine-derived polio cases (iVDPV).20062.0256350105625bImmunodeficiency vaccine-derived polio cases (iVDPV).20051.9454250165409bImmunodeficiency vaccine-derived polio cases (iVDPV).20041.8652850195266cThree VDPV cases.20031.795107021508620021.895415020539520011.885395019537620001.855332017531519991.7650791dPolio case due to infection with imported wild polio virus.33504519981.7250090444965AFP, acute flaccid paralysis.a See references 6Li L. Wen N. Xia W. Analysis on working status of acute flaccid paralysis case surveillance system in China in 2006 (in Chinese).Chinese J Vaccines Immunization. 2007; 13: 518-521Google Scholar, 7World Health Organization Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2007.Weekly Epidemiol Rec. 2007; 82: 395-398PubMed Google Scholar.b Immunodeficiency vaccine-derived polio cases (iVDPV).c Three VDPV cases.d Polio case due to infection with imported wild polio virus. Open table in a new tab AFP, acute flaccid paralysis. China has established a poliomyelitis laboratory network, which has been incorporated into the WHO's Global Poliomyelitis Laboratory Network. Whether or not AFP is caused by WPV must be determined by etiological diagnosis in laboratories. Poliomyelitis was the first disease among viral infections that took etiological diagnosis as its monitoring basis. China built its poliomyelitis laboratory network in 1992, comprising the National Poliomyelitis Laboratory and provincial laboratories established in the provinces. Provincial laboratories are responsible for virus isolation and identification. The National Poliomyelitis Laboratory is responsible for reviewing and identifying whether the virus is a WPV through molecular virological methods. Provincial laboratories in China implement quality control as per WHO requirements for national poliomyelitis laboratories, including the following: laboratories should report the results of at least 80% of all AFP feces samples within 30 days of receipt; the laboratory must complete virus isolation of 150 feces samples each year; the laboratory should have a 10% or higher correct identification rate for non-polio enterovirus and 80% or higher rate for isolated poliomyelitis virus; the pass rate of professional skill reviews must be ≥80% and the pass rate of laboratory skill tests must be ≥80%. After having received the isolated virus from provincial laboratories, the National Poliomyelitis Laboratory completes the type identification within 30 days. The entire laboratory network adopts the same records, forms, and sensitive cells from the same source in conformity with international rules for virus isolation. The same blood serum for virus identification is also used to guarantee the quality of etiological monitoring. The poliomyelitis laboratory network in China tests about 10 000 samples each year. The annual testing volume of isolated polio virus and wild strains detected by restriction fragment length polymorphism–polymerase chain reaction (RFLP–PCR) accounts for 85% of the total work volume in the WHO West Pacific Region. In 1992, the National Poliomyelitis Laboratory in China started sequencing the virogene of epidemic WPV strains collected up until 1989 and built a gene bank of Chinese local WPV sequences through sequential analysis. The laboratory also conducted molecular epidemiological work on WPV and proved that the last case of indigenous WPV in China occurred in September 1994.8Wang K. Zhang L.B. Otten Jr., M.W. Zhang X.L. Yasuo C. Zhang R.Z. et al.Status of the eradication of indigenous wild poliomyelitis in the People's Republic of China.J Infect Dis. 1997; 175: S105-S112Crossref PubMed Google Scholar In 1995–1996, overseas cases of WPV were found in Yunnan Province. A few years later, in 1999, WPV was isolated in Qinghai Province. In a timely manner, the laboratory correctly identified the WPV isolated in Yunnan as being the same as the earlier imported cases. This was done by comparing the newly isolated WPV with the local epidemic WPV found in the past; results were reviewed and confirmed by the international laboratory. This also provided important, scientific, and reliable evidence for the WHO (West Pacific) Polio Eradication Committee to endorse China as a polio-free area. Following this, vaccine recombinant virus was reported for the first time; recombinant strains of different types of virus. This virus has greater virulence and shows local circulation in Mainland China, which has led to heightened international concern.9Liu H.M. Zheng D.P. Zhang L.B. Oberste M.S. Kew O.M. Pallansch M.A. Serial recombination during circulation of type 1 wild-vaccine recombinant polioviruses in China.J Virol. 2003; 77: 10994-11005Crossref PubMed Scopus (69) Google Scholar As estimated by the WHO, the minimum demand for polio vaccine in China in 1993 was 410 million units per year or 510 million units if an ideal plan was adopted. The maximum capacity in China at that time was 325 million units. The serious inadequacy of vaccine supplies affected the Immunity Boost Campaign for the eradication of polio in China. Therefore, the Japanese government and the Japan International Cooperation Agency (JICA) donated more than US$ 2.7 million, while the Rotary International, Rotary Club in Japan and UNICEF donated more than US$ 2.7 million for the purchase of polio vaccines in 1993, totaling 120 million units. This had an immediate effect on the two rounds of the national campaign (winter and spring) from 1994 to 1995. The Luxembourg government donated US$ 2 million worth of vaccine cold storage systems to the epidemic prevention departments in counties and towns that were short of, or urgently demanding, new cold chain equipment in the campaign to eradicate polio.2Liang X.F. The status in China of job analysis after non-implementation of polio immunization program (in Chinese).Chinese J Vaccines Immunization. 2005; 11: 333-338Google Scholar The West Pacific Certification Commission on Poliomyelitis Eradication officially signed in October 2000, confirmed that China and the West Pacific region it belongs to were polio-free. No indigenous and oversea WPV case has been reported in China since 2000. However, polio cases have been reported in China's neighbors, including India, Pakistan, and Afghanistan. In addition, the low poliomyelitis live oral vaccine inoculation rate in polio-free countries like Indonesia has caused the outbreak of imported WPV in this area. Aside from its critical role in boosting immunity, for the first time in 1996, the Chinese government also applied the industrial ‘Batch Quality Sampling Inspection Method’ to survey and appraise the inoculation rate and effectively solved the appraisal of the small-sample inoculation rate in towns. Researchers adopted the virology classification criteria for AFP in 1997 to make the monitoring results more accurate and complete. The State Polio Laboratory established the gene pool of the local wild virus sequence through sequence analysis and the ELISA method for the inspection of polio IgM and IgG antibodies during the ‘9th five-year’ period. China was also the first country to discover and report the existence of the recombinant virus of wild virus and vaccine virus and the natural recombinant virus from the different types of vaccines, and their significance to epidemiology.10Zhu S.L. Wang D.Y. Zhang Y. et al.Running status and evaluation of the Chinese Polio Laboratories Network in 2007 (in Chinese).Chinese J Vaccines Immunization. 2008; 14: 528-533Google Scholar To rapidly intercept the transmission of WPV and meet the polio-free target, the Chinese government continuously improved the methods and quality of the Immunity Boost national campaign. When it was especially close to certification, China adjusted the strategy and introduced the ‘Sub-National Immunity Boost’ campaign, developed 10 rounds (five times) of immunity boost, inoculated children a total of 500 million person-times, and guaranteed the health of children in this populous country. To avoid the recurrence of polio, uptake of the oral polio vaccine became a statutory obligation after two month yeas old in China 1993. However, the oral pill triggers abnormal reactions and even causes serious consequences, such as disability. Hence, this aroused social conflicts, which became serious as more children were affected. This raised new issues for the Chinese government to consider. In the second half of 2005, parents from different provinces took their children with abnormal limbs to seek medical treatment in Beijing. They were surprised to find that their children had all taken the poliomyelitis live oral vaccine after birth. Despite this, the incidence rate of vaccine-associated paralytic poliomyelitis (VAPP) was quite low. The total incidence rate of VAPP cases in Beijing from 1989 to 2002 was 1.2/million and that of contact VAPP cases was 0.16/million.11Liu D.W. Sun M.P. Chen L.J. Surveillance of vaccine-associated paralytic poliomyelitis in Beijing, 1989-2002 (in Chinese).Chinese J Vaccines Immunization. 2003; 9: 201-204Google Scholar VAPP cases in China were estimated to be between 0.27 and 2.82/million in 2007 .12Zhou S. Current situation of research on vaccine-associated paralytic poliomyelitis of oral polio vaccine (in Chinese).J Prev Med Inf. 2007; 123: 436-440Google Scholar Since the immunity plan benefits the majority of children, the state should improve laws and statutes and reasonably compensate the unavoidable ‘one-in-a-million’ victims. However, China did not have such a policy or laws for reference. From July 2006 to July 2008, The Ministry of Health of the People's Republic of China held demonstration and coordination meetings involving many experts from the relevant departments. The Ministry persisted with the national inoculation policy, but also analyzed how to recognize and avoid VAPP in China. In coordination with several government departments, the Ministry likewise issued the ‘Instruction advice on verification of cases related to polio vaccines and handling of remaining problems’ (Wei Ban Fa [2008] No. 40) on July 17, 2008 and proposed solutions for the VAPP issues. The Chinese government established suitable insurance and guarantee mechanisms, and truly guaranteed the rights of each VAPP patient. The continuous use of the poliomyelitis live oral vaccine is contradictory to the eradication of polio. The poliomyelitis live oral vaccine can trigger polio, as the poliovirus may originate from the poliomyelitis live oral vaccine. This may then be transmitted extensively, resulting in the failure of the eradication plan. To ensure the permanent eradication of polio, the regular use of the poliomyelitis live oral vaccine must be stopped; this needs political support and resource guarantees. Only then will mankind stop being paralyzed as a result of poliovirus infection. The continuous use of the poliomyelitis live oral vaccine after intercepting the transmission of WPV could cause polio through: (1) VAPP,12Zhou S. Current situation of research on vaccine-associated paralytic poliomyelitis of oral polio vaccine (in Chinese).J Prev Med Inf. 2007; 123: 436-440Google Scholar (2) an outbreak due to vaccine-derived poliovirus circulation,13Zhang L.B. Hou X.H. Chen L. An analysis of AFP cases induced by vaccine-recombinant polioviruses (in Chinese).Chinese J Vaccines Immunization. 2003; 9: 189-192Google Scholar, 14Liang X. Zhang Y. Xu W. Wen N. Zuo S. Lee L.A. Yu J. An outbreak of poliomyelitis caused by type 1 vaccine-derived poliovirus in China.J Infect Dis. 2006; 194: 545-551Crossref PubMed Scopus (74) Google Scholar, 15Liang X.F. Tong Y.B. Feng Z.J. Firstly detecting and conducting of circulating type I vaccine-derived poliovirus in China (in Chinese).Chinese J Vaccines Immunization. 2005; 11: 245-247Google Scholar and (3) the excreta of the population with primary immunodeficiency containing vaccine-derived poliovirus, for years to come. The advantage of the inactivated poliovirus vaccine (IPV) is that it is safe; however the period of immunity retention is short and hence it has to be injected repeatedly. Moreover, the intestinal tract cannot acquire local immunological competence. China is surrounded by four countries that are still polio-endemic. Aside from expense concerns, the Chinese government is worried that the current high-coverage of antibody cannot be maintained if the poliomyelitis live oral vaccine is stopped, and as a result the disease will recur. After two decades of fighting against polio, the Chinese government still faces an arduous task as a result of the need to (1) prevent the entry and transmission of WPV from the polio-endemic surrounding countries, (2) detect and stop outbreaks of polio caused by the recycling vaccine-derived poliovirus, (3) reduce VAPP cases, and (4) improve the State compensation system.
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Is the global measles resurgence a “public health emergency of international concern”?
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•Public Health Emergencies of International Concern require coordinated international responses.•There has been a recent alarming global increase in measles deaths and unprecedented rapid international spread.•Measles is re-established in the Americas, and in certain Western Pacific and European countries.•Mobilisation of extraordinary resources by the international community is urgently required. The 2005 revision of the International Health Regulations (IHR) came into force on 15 June 2007 and is legally binding on 196 countries, including all the Member States of World Health Organization (WHO). In the IHR, a public health emergency of international concern (PHEIC) is defined as: “an extraordinary event that may constitute a public health risk to other countries through international spread of disease and may require an international coordinated response.” (World Health Organization, 2005World Health Organization International Health Regulations.3rd ed. 2005https://www.who.int/ihr/publications/9789241580496/en/Google Scholar). The IHR requires that countries notify the WHO of any public health event that meets any two of the following four criteria: Is the public health impact of this event potentially serious?; Is this event unusual or unexpected?; Is there the potential for international spread?; or Is there the potential for travel and trade restrictions? The purpose of declaring a PHEIC is to focus attention on those acute public health risks that have the potential to cross borders and threaten people worldwide, and “require coordinated mobilisation of extraordinary resources by the international community” for prevention and response. The decision to declare a PHEIC rests with the WHO Director-General. To date four PHEICs have been declared; the: 2009 H1N1 influenza pandemic declaration; 2014 polio declaration; 2014 Ebola declaration with the outbreak in West Africa; and 2016 Zika virus declaration. The polio PHEIC declaration stands apart as poliovirus is certainly not a novel or emerging pathogen, but it sets an interesting and laudable precedent. The PHEIC issued on 5 May 2014 references the resurgence of polio after its near-eradication, deeming this an “extraordinary event and a public health risk to other States for which a coordinated international response is essential” (World Health Organization, 2014World Health Organization WHO statement on the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus.2014https://www.who.int/mediacentre/news/statements/2014/polio-20140505/en/Google Scholar). This is the only PHEIC that remains in effect, five years after it was first declared. How does the global measles situation measure up against the four PHEIC criteria considering the poliovirus precedent? Firstly, is the public health impact of this event potentially serious? There was considerable fanfare following the release of the 2016 estimated global measles deaths. In a joint press statement, the United States CDC, GAVI, UNICEF and WHO, lauded the 84% decline in measles deaths from 550,000 in 2000 to 89,780 in 2016, the first time that there had been less than 100,000 measles deaths recorded globally in a particular year (World Health Organization, 2017World Health Organization Substantial decline in global measles deaths, but disease still kills 90000 per year.2017https://www.who.int/news-room/detail/26-10-2017-substantial-decline-in-global-measles-deaths-but-disease-still-kills-90-000-per-yearGoogle Scholar). Tragically the 2017 figures are far less rosy, with 109,638 deaths reported due to measles (Dabbagh et al., 2018Dabbagh A. Laws R.L. Steulet C. Dumolard L. Gacic-Dobo M. Mulders M.N. et al.Progress toward regional measles elimination — worldwide, 2000–2017.Wkly Epidemiol Rec. 2018; 93: 649-659Google Scholar); almost 20,000 additional deaths over 2016, an increase of 22%! This upsurge in deaths is unrelenting. It suggests that current strategies are either ineffective or ineffectually implemented. This is an enormous public health impact and undoubtedly serious. Secondly, is this event unusual or unexpected? A global expert consultation in 2010 concluded that measles eradication was technically and programmatically feasible with existing tools and should be pursued (World Health Organization, 2011World Health Organization Proceedings of the Global Technical Consultation to assess the feasibility of measles eradication, 28–30 July 2010.J Infect Dis. 2011; 204: S4-S13Google Scholar). At the World Health Assembly in 2012, 198 countries committed to achieving interruption of measles virus circulation in four World Health Organization (WHO) Regions by 2015 and in five Regions by 2020 (Global Vaccine Action Plan, 2012Decade of vaccines – Global Vaccine Action Plan 2011–2020. https://www.who.int/immunization/global_vaccine_action_plan/DoV_GVAP_2012_2020/en/.Google Scholar). There was encouraging progress with the Americas verified as having interrupted endemic measles transmission in 2016, and elimination verified in 37 (of 53) European, 7 (of 27) Western Pacific, and 4 (of 11) South East Asian countries by the end of 2018. However, four Regions (the Americas, Europe, South East Asia and Eastern Mediterranean) experienced massive measles outbreaks in 2017. The Americas was the only Region to have achieved measles elimination and was celebrating that accomplishment in 2016, the same year that measles deaths reached a nadir. However, the region lost that status in 2017 with re-established transmission in Venezuela and Brazil as well as measles outbreaks in many other countries throughout 2018. The Americas have led the world in being the first Region to achieve smallpox, polio and measles elimination. This failure to sustain measles elimination stands in stark contrast to the previous achievements, underlining the current crisis. In the European Region both Germany and Russia re-established measles transmission for more than 12 months after previously interrupting transmission for 24 months, and Europe experienced record numbers of measles cases with 72 deaths in 2018 (EURO, 2019World Health Organization European Regional Office (EURO). Measles in Europe: record number of both sick and immunized.2019http://www.euro.who.int/en/media-centre/sections/press-releases/2019/measles-in-europe-record-number-of-both-sick-and-immunizedGoogle Scholar). The UNICEF announcement that global measles cases had increased by 48.1% between 2017 and 2018, with 98 countries reporting measles cases in 2018 compared to 2017 is profoundly alarming (UNICEF, 2019United Nations International Children’s Emergency Fund Alarming global surge of measles cases a growing threat to children.2019https://www.unicef.org/press-releases/alarming-global-surge-measles-cases-growing-threat-children-unicef-0Google Scholar). Thus it is hard to argue that this event is not extraordinarily unusual and unexpected. Thirdly, is there the potential for international spread? There is probably no better recent illustration of the ability of measles virus to rapidly spread globally than the 2014 outbreak in the Philippines. This outbreak saw the B3 measles genotype seeded into the vast majority of countries contributing to the Measles Nucleotide Surveillance (MeaNS) database. The 2019 Philippines B3 and Thailand D8 measles outbreaks are providing a startling déjà vu experience with all countries that have been verified to have eliminated measles in the Western Pacific Region currently being inundated with importations. Similarly, the outbreak in Venezuela that started in 2017 spread to surrounding countries, with the worst impact in Brazil where PAHO reported 10,334 confirmed cases and 12 deaths in a little over a year, including amongst vulnerable Indigenous communities (PAHO, 2019Pan American Health Organization, Epidemiological Update Measles, 4 March 2019, https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=measles-2204&alias=47907-4-march-2019-measles-epidemiological-update&Itemid=270&lang=en.Google Scholar). Outbreaks have flared constantly since then, affecting 12 countries of the Americas in 2018. Measles is uniquely transmissible. This is graphically illustrated by comparing measles’ basis reproduction number (R0), or the number of secondary cases on average resulting from the introduction of an infectious case into a fully susceptible population, with those of the specific infectious diseases previously declared as PHEICs. Although population density, birth rates and opportunities for transmission result in some variation between countries, the R0 for measles is generally considered to be about 16 (Guerra et al., 2017Guerra F.M. Bolotin S. Lim G. Heffernan J. Deeks S.L. Crowcroft N.S. The basic reproduction number (R0) of measles: a systematic review.Lancet Infect Dis. 2017; 17: e420-428Abstract Full Text Full Text PDF PubMed Scopus (258) Google Scholar). In comparison, polio has an R0 of 6.0, H1N1 2009 of 1.3, Ebola of 1.5, and Zika virus of 2.1 (Van den Driessche, 2017Van den Driessche P. Reproduction numbers of infectious disease models.Infect Dis Model. 2017; 2: 288-303PubMed Google Scholar). Measles’ phenomenal transmissibility coupled with the unbridled volume and speed of international travel, and the inadequately immunised status of many international travellers, guarantees not only a potential but a reality of vast international measles spread as currently being experienced. Fourthly, is there the potential for travel and trade restrictions? It is hard to imagine that any government would impose travel or trade restrictions on the basis of current measles epidemiology, although there is clear recognition by some verified countries that international workers, business and recreational travellers, and economic migrants are a major source of virus importation (WPRO, 2018World Health Organization Regional Office for the Western Pacific (WPRO). Meeting report of the seventh annual meeting of the Regional Verification Commission for measles elimination in the Western Pacific, Kuala Lumpur, Malaysia, 24–28 September.2018https://iris.wpro.who.int/handle/10665.1/14333Google Scholar, EURO, 2018World Health Organization European Regional Office (EURO) 7th meeting of the European Regional Verification Commission for Measles and Rubella Elimination (RVC) Report.2018http://www.euro.who.int/en/health-topics/communicable-diseases/measles-and-rubella/publications/2018/7th-meeting-of-the-european-regional-verification-commission-for-measles-and-rubella-elimination-rvc.-reportGoogle Scholar). There have even been suggestions recently by some countries that international travellers should provide proof of measles vaccination or proof of immunity as an entry or visa requirement. A key characteristic of a PHEIC is the requirement for extraordinary resources. The cost of firefighting measles is extremely high when compared with the cost of prevention (Sundaram et al., 2019Sundaram M.E. Guterman L.B. Omer S.B. The true cost of measles outbreaks during the postelimination era.JAMA. 2019; ([Epub ahead of print])https://doi.org/10.1001/jama.2019.1506Crossref Scopus (18) Google Scholar, Ramsay et al., 2019Ramsay L.C. Crowcroft N.S. Thomas S. Aruffo E. Teslya A. Hefferman J.M. et al.Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015.Euro Surveill. 2019; 24https://doi.org/10.2807/1560-7917.ES.2019.24.11.1800370Crossref Scopus (3) Google Scholar). Indeed by conventional economic metrics, it is not cost-effective to respond to measles outbreaks in the way that is recommended in elimination settings (Gastañaduy et al., 2018Gastañaduy P.A. Banerjee E. DeBolt C. Bravo-Alcántara P. Samad S.A. Pastor D. et al.Public health responses during measles outbreaks in elimination settings: strategies and challenges.Hum Vaccin Immunother. 2018; 14: 2222-2238Google Scholar). However, this level of response is justified by the need to sustain elimination for the good of everyone, but relies on countries co-operating with each other and having the political support to make it happen. The situation in the Americas and Europe dramatically illustrates the result of a few countries dropping the ball – everyone suffers the colossal direct and opportunistic health costs, not to mention personal suffering, because other countries have gifted them measles outbreaks. The IHR is the best, and perhaps only, tool for dealing with this situation effectively, and the question arises, Why has measles not already been declared a PHEIC? What is constraining global public health leaders and why does measles command so little support from global donors, the United Nations and national governments when compared with other public health crises? The public health urgency of the current global measles situation has been recognised by technical experts involved in all aspects of measles elimination. The stagnation of measles first dose coverage at approximately 85% for the past eight years is dismally less than the 95% homogeneous coverage of each birth cohort recommended by SAGE. Globally, 20.8 million infants did not receive measles vaccine through routine immunization services in 2017. The inadequacy of measles surveillance in many countries has further severely hampered progress towards elimination goals (SAGE, 2018Strategic Advisory Group of Experts on Immunization 2018 assessment report of the Global Vaccine Action Plan. World Health Organization, 2018https://www.who.int/immunization/global_vaccine_action_plan/SAGE_GVAP_Assessment_Report_2018_EN.pdfGoogle Scholar). What we observe is the predictable result of the system we have created; interludes of relative tranquillity followed by massive measles outbreaks, often affecting older age groups than were historically impacted, which consume huge amounts of public health resources and undermine confidence in immunization. In a recent call to action, the six chairpersons of Regional Verification Commissions for Measles and Rubella elimination discussed the compelling epidemiological, economic and ethical arguments for setting a global measles eradication goal and strongly advocated that it was urgent that exceptional coordinated efforts were made to ensure a world where no child dies of measles (Durrheim et al., 2019Durrheim D.N. Andrus J.K. Pfaff G. Tabassum S. Bashour H. Githanga D. Eradicating measles — a call for an exceptional coordinated global effort.J Infect Dis. 2019; (Published on 7 January 2019)https://doi.org/10.1093/infdis/jiz011Crossref Scopus (9) Google Scholar). So is a PHEIC declaration justified in response to the global measles resurgence? Three of four diagnostic criteria appear satisfied and the current deteriorating situation is placing many young lives at grave risk. A PHEIC declaration could: reenergize the global community to urgently strengthen health systems to ensure that every child born is reached with two potent doses of measles-containing vaccine; rapidly stimulate communication innovation to effectively engage migrants and travellers on the risks of measles as well as the benefits and safety of immunisation; refocus weary donors on the incredible return that increased investment in measles immunisation and accelerated elimination achievement would deliver; and release emergency funding from the Pandemic Emergency Financing Facility of the World Bank Group (Gostin and Katz, 2016Gostin L.O. Katz R. The International Health Regulations: The governing framework for global health security.Milbank Q. 2016; 94: 264-313Crossref PubMed Scopus (93) Google Scholar). Should “extraordinary resources” be mobilised by the international community to respond to this public health risk that has the potential to cross borders and threaten people worldwide? If we follow the advice that Plato put in the mouth of Socrates, “we must go wherever the wind of the argument carries us.” (Plato, 1974Plato The Republic, translated by Lee D.2nd ed. Penguin, Hammondsworth1974Google Scholar) Thus the answer must be “yes” – measles is a de facto PHEIC – it should be declared!. No conflict of interest to declare. None.
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A Role for Public Health History
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Mixed in with the rich and varied articles on global health themes in this issue of the Journal are 6 articles based on historical research. Five of the articles originated in the History Working Group of the Joint Learning Initiative (JLI) “Human Resources for Health and Development,” a major international policy and planning initiative undertaken by the Rockefeller Foundation and several partners.1 The sixth, by Didier Fassin and Anne-Jeanne Naude, was submitted independently but fits here nicely along with the other historical articles.2
The purpose of the History Working Group was to contribute to the JLI’s overall objectives by critically reviewing international public health initiatives during the 20th century and uncovering new insights into their successes and failures. Members were urged to illuminate through historical study the motives, context, and local complexity of these international programs. Elizabeth Fee and Marcos Cueto served as cochairs of the group, and Theodore M. Brown was senior advisor. From March 2003 to May 2004 the group held 2 meetings in Bellagio, Italy, planned and prepared papers, and helped to develop the recommendations of the final JLI report.
The 5 JLI contributions in this issue represent current concerns in the historical study of international health. For many years, scholarship in the field focused on the role played by colonial and postcolonial medicine, US philanthropies, and the first international health agencies during the early decades of the 20th century.3–8 Few studies examined developments in international health in the second half of the century. This has begun to change, and the later period is now drawing increased attention from historians, especially because recent decades have been marked by the tense encounter of cultures in the context of international public health, a changing political climate reflecting the vicissitudes of the Cold War, the emergence of neoliberalism, and the boom of economic “globalization.”9–12
Marcos Cueto, in “The Origins of Primary Health Care and Selective Primary Health Care,” underscores the dynamics of the Cold War in the 1970s as the major contextual source for the World Health Organization’s (WHO’s) 1978 Alma-Ata declaration on primary health care.13 Cueto suggests that shifts in the international power balance between the United States and the Soviet Union, the new assertiveness of recently decolonized developing nations, and the ascent of China as a geopolitical player explain the relative decline of Western technologically based approaches and the rise of comprehensive, grassroots, and socio-political alternatives. The location of the famous meeting at Alma-Ata in Soviet Kazakhstan was itself reflective of the Cold War context and Soviet versus Chinese maneuvering. Given the circumstances, it was no surprise that “selective primary care,” the alternative to primary health care promoted by UNICEF, USAID, and other backers, was perceived by some as a staged “counterrevolution.”
Socrates Litsios explores other dimensions of the emergence of primary health care as WHO policy in the 1970s. In “The Christian Medical Commission and the Development of WHO’s Primary Health Care Approach,”14 he traces 2 streams of thinking that converged in 1974, when a critical meeting took place in Geneva, Switzerland, between the staff of the Christian Medical Commission (CMC) and senior WHO staff. A few years before, the CMC had begun to refocus on preventive services for communities at large. Working from principles of human rights and distributive justice, CMC leaders deemphasized technical care and gave priority to comprehensive health care as one part of a general plan for the development of society.
Within WHO, Kenneth Newell and Halfdan T. Mahler began to shift attention toward plans for the integration of preventive and curative care. The World Health Assembly in May 1973 adopted a resolution confirming that countries must develop health services suited to their needs and socioeconomic conditions and use an appropriate level of technology. This resolution provided the basis for a close collaboration between the CMC and WHO, cemented by Mahler’s election as director general of WHO and leading ultimately to Alma-Ata.
Sanjoy Bhattacharya turns from intra- and interorganizational dynamics to issues of bureaucratic complexity and resistance in his article, “Uncertain Advances: A Review of the Final Phases of the Smallpox Eradication Program in India, 1960–1980.”15 He explores unpublished correspondence to show that varying levels of programmatic commitment and belief, jurisdictional conflicts, and just plain local sabotage often undermined the supposedly smoothly run, carefully orchestrated, and centrally directed campaign. Bhattacharya documents the ways in which WHO headquarters in Geneva, the South East Asia Regional Office in New Delhi, the Indian central government, and local Indian state governments often got in one another’s way and could be brought into efficient operating relationships—for limited periods—only by concerted diplomacy, financial blandishments, and threats of political embarrassment. Bhattacharya thus offers a nuanced account of the final stages of one of the major international health programs in the later 20th century and reminds us that things are rarely as simple as they are sometimes portrayed and that politics and public health are inextricably interwoven.
Stephen J. Kunitz also highlights the inextricable interweaving of politics and public health. In “The Making and Breaking of Federated Yugoslavia, and Its Impact on Health,”16 he traces the formation and fragmentation of the Yugoslav nation, emphasizing the roles of deep-seated ethnic tensions, regional economic disparities, and the devastating inflationary consequences of a calculated turn to the West. According to Kunitz, the eruption of a bloody civil war in 1991 was inevitable, as were the health consequences of the downward economic spiral that led up to it. He shows that in the 1980s, as inflation exploded, the postwar decline in infant mortality stagnated while mortality in the elderly and mortality due to cardiovascular disease increased. Global economics, more than local ethnic conflict, was the real villain in the piece, because the policies of the International Monetary Fund led to forced under-spending on social services and failed to curb inflation, thus leading to deteriorating health and intensifying ethnic antagonisms.
William Muraskin’s article “The Global Alliance for Vaccines and Immunization (GAVI): Is It a New Model for Effective Public Private Cooperation in International Public Health?”17 completes the set of JLI contributions in this issue. Muraskin strongly argues the case that GAVI, created in late 1999, is riddled with substantial and quite possibly fatal flaws that will undermine the success it has thus far enjoyed. He contends that GAVI is an enterprise built on “top-down globalism” and that its promoters in the Gates Foundation, the International Federation of Pharmaceutical Manufacturers Association, the World Bank, and elsewhere push immunization as a nonnegotiable goal. The allies recruited into GAVI by financial inducements are weak allies at best. They have their own priorities and they realize the full extent of the enormously complex problems “on the ground,” not least of them the “human capacity problem,” which makes it difficult to implement GAVI initiatives in recipient nations. Because of the top-down imposition of the “policy of the month,” Muraskin argues, it is difficult to respond to new initiatives without seriously disrupting existing programs and priorities. He suggests that a little humility and a lot more consultation would go a very long way.
What are the take-home lessons of these 5 contributions? First, that international public health efforts are deeply influenced and critically shaped by their political context. Programs cannot be created in a vacuum or applied in isolation. They are of this world and, like it, they constantly change and thus need to be frequently renegotiated. Second, the culture of international health organizations must be acknowledged in order to understand what priorities will emerge at any particular time and which will survive intra- and interagency competition. Programmatic ideas are always contested and rise and fall with shifting political alliances.
Third, ideas are applied in a world governed by administrative and bureaucratic realities. The translation of plans into actual programs requires a great deal of persistence and negotiating skill to make them real and keep them functioning. Fourth, international health initiatives must reckon with deep-seated historical and cultural traditions, local realities, and global forces. All play roles in the success and failure of public health activities, and no success is likely to last forever, especially when the world changes in dramatic ways. Fifth, top-down initiatives cannot expect to succeed without real bottom-up support. Because people at the local level understand how programs need to function to address their particular needs, there can be no simple formula for international public health success. A single agenda or set of priorities cannot suit all circumstances.
Clearly, there is an important role for history in global public health. Studying history carefully and generalizing from its particulars may not necessarily help us avoid repeating the mistakes of the past, but by distilling the lessons of history, we can certainly learn more clearly where we have been and, as a consequence, become more aware of where we are.
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Preventing zoonotic pandemics: are we there yet?
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Since the beginning of the COVID-19 pandemic, approximately 4 million people have died of the disease and more than 190 million have been infected with SARS-CoV-2, with numbers rising in many countries. These grave outcomes have as much to do with the biological properties of SARS-CoV-2 as with human failures in the social, political, and health-care spheres. Across the world, health-care facilities have collapsed, vaccines are being inequitably distributed, and the implementation of non-pharmaceutical interventions to curb the spread of the virus has been often inconsistent. “The disastrous failure to control COVID-19 across Europe and USA reflects the lack of a more inclusive effective coordinated global surveillance, pandemic preparedness and response plans at national, regional, and international levels”, said Alimuddin Zumla (University College London, London, UK). “Central to these limitations have been a catalogue of failures to provide adequate medical care to patients at many different levels (hospital, territory, community), diagnostic capacity, availability and supply chains of medical devices and PPE, as well as the inability of public health systems to rapidly implement infection prevention and control activities in critical areas such as nursing homes”, he added. Zoonotic outbreaks occurring in different parts of the world over the past two decades (eg, SARS, Nipah, MERS, H7N7, Ebola, and H1N1 viruses) offered warnings of the potential for a major outbreak, but not enough was learned from them. Furthermore, with the COVID-19 pandemic still ongoing, the risk of a new zoonotic agent starting another outbreak remains possible. “The number of new infectious diseases with epidemic potential has increased nearly four-fold over the past six decades. Since 1980, the number of new outbreaks per year has more than tripled” said Zumla. And Jonna Mazet, principal investigator at the PREDICT project (One Health Institute, University of California, Davis, CA, USA) added, “it will happen again and we will either be prepared or we won’t be prepared”. PREDICT, part of USAID's Emerging Pandemic Threats Program, was the world's largest effort to identify animal pathogens with potential to jump into humans. The project concluded in 2020, after working in more than 30 countries for over 10 years. Their final report shared some worrisome findings: PREDICT identified 949 novel viruses, including 18 new coronaviruses in Latin America, 42 in Africa, and 55 in Asia. Now that PREDICT is no longer funded, it will be up to another agency or initiative to use this information to prevent future zoonotic events. Other efforts have been made and new ones are starting. Following the Ebola outbreak in 2014, the World Bank launched the Regional Disease Surveillance Systems Enhancement programme, currently focusing on 16 countries in west and central Africa, with a dedicated budget of about US$662 million that has funded different projects since 2016. The programme funds disease surveillance systems and increased laboratory capacity in the region. The recently launched One Health High-Level Expert Panel seeks to provide high-level advice on managing future zoonotic pandemics. Other relevant projects include the Coalition for Epidemic Preparedness Innovations, which works towards the development of vaccines and notably contributed to the unprecedented speed in the development of COVID-19 vaccines. The Alliance for Pandemic Preparedness, based at the University of Washington (Seattle, WA, USA), is taking a local and international approach on various fronts, including risk assessment and vulnerability mapping as well as policy and behavioural interventions. Although still in the works, other promising projects are emerging elsewhere. The University of Oxford (Oxford, UK) has recently announced the launch of the Pandemic Sciences Centre, which aims to secure at least UK£500 million to pursue pandemic data analysis, translational research, and social and political engagement. Germany and WHO have joined forces to develop the WHO Hub for Pandemic and Epidemic Intelligence, which aims to serve as a globally accessible platform for research on pandemic and epidemic intelligence, data, surveillance, and analytics innovation. Another WHO initiative, the Department of Global Infectious Hazard Preparedness (WHO, Geneva, Switzerland), led by Sylvie Briand, tackles global infectious diseases, currently focusing on about 17 known pathogens, including SARS-CoV-2. “For these pathogens, what we are doing is first pushing the research for countermeasures, for instance, new antivirals, new diagnostic tests, new therapeutics, new vaccines, etc. We are also pushing for a better surveillance of those diseases and a better risk assessment when we have the emergence of pathogens”, Briand said. Despite all these promising initiatives, however, several issues need to be solved. A big problem is short memory: when interest fades, so does funding. “It is very hard to maintain the interest of donors and experts. When [a] disease has not created any major event for 10 years, the workforce interested in this disease disappear as well as the funding”, said Briand. Furthermore, many efforts lack continuity, as they rely on projects limited in time and funding and depend entirely on the will of affected countries to collaborate. For more on PREDICT see https://p2.predict.global/For more on USAID's Emerging Pandemic Threats Program see https://www.usaid.gov/ept2For PREDICT's final report see http://www.legacy.predict.global/For more on the Regional Disease Surveillance Systems Enhancement see https://www.worldbank.org/en/results/2020/10/12/epidemic-preparedness-and-responseFor more on the One Health High-Level Expert Panel see https://worldhealthorganization.cmail19.com/t/ViewEmail/d/FBFE668AA0AD447F2540EF23F30FEDED/DE999BCE132B71D3DCCB6820C4466A74For the Coalition for Epidemic Preparedness Innovations see https://cepi.net/For more on The Alliance for Pandemic Preparedness see https://depts.washington.edu/pandemicalliance/what-we-do/projects/For more on the WHO Hub for Pandemic and Epidemic Intelligence see https://www.who.int/news/item/05-05-2021-who-germany-launch-new-global-hub-for-pandemic-and-epidemic-intelligenceFor more on the Pandemic Sciences Centre see https://www.ox.ac.uk/news/2021-05-28-university-oxford-launch-pandemic-sciences-centre For more on PREDICT see https://p2.predict.global/ For more on USAID's Emerging Pandemic Threats Program see https://www.usaid.gov/ept2 For PREDICT's final report see http://www.legacy.predict.global/ For more on the Regional Disease Surveillance Systems Enhancement see https://www.worldbank.org/en/results/2020/10/12/epidemic-preparedness-and-response For more on the One Health High-Level Expert Panel see https://worldhealthorganization.cmail19.com/t/ViewEmail/d/FBFE668AA0AD447F2540EF23F30FEDED/DE999BCE132B71D3DCCB6820C4466A74 For the Coalition for Epidemic Preparedness Innovations see https://cepi.net/ For more on The Alliance for Pandemic Preparedness see https://depts.washington.edu/pandemicalliance/what-we-do/projects/ For more on the WHO Hub for Pandemic and Epidemic Intelligence see https://www.who.int/news/item/05-05-2021-who-germany-launch-new-global-hub-for-pandemic-and-epidemic-intelligence For more on the Pandemic Sciences Centre see https://www.ox.ac.uk/news/2021-05-28-university-oxford-launch-pandemic-sciences-centre
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Catching outbreaks wherever they occur
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Communicable diseases have no respect for boundaries. As pandemic influenza A (H1N1) swept the globe this year, WHO's Member States could take comfort in the legal requirements of the International Health Regulations (IHR), which were updated in 2005 to require countries to report certain disease outbreaks to the World Health Organization (WHO). not all parts of the world are or may be parties to the IHR, and where there is a gap in surveillance there is always the possibility that an outbreak can slip through the net. For example, the West Bank and the Gaza Strip--though not party to the IHR--are covered by the Middle East Consortium on Infectious Disease Surveillance (MECIDS). This coordination mechanism of Israeli, Jordanian and Palestinian health officials shares information and takes coordinated action to help detect and respond to infectious disease outbreaks. It is one example of how regional disease surveillance can be achieved in difficult political environments, and also of how such cooperation works to implement the requirements of the IHR. When WHO declared Phase 6 of the A (H1N1) virus in June, we found we needed an urgent meeting, says Dr Bassam al-Hijawi, head of the Disease Control Directorate at Jordan's Ministry of Health. Increasing the capabilities of laboratories in the region posed one challenge for which it was necessary to hold face-to-face talks, even if it meant travelling to a third location because of political tensions between the sides. But we succeeded in going to Jerusalem to discuss it, says al-Hijawi, an epidemiologist, who serves on the executive board of MECIDS. We started [working according to] the same rules together, even though Israel reported the first A (H1N1) case. This was in compliance with the International Health Regulations, he says. MECIDS was established in 2003, when nongovernmental organizations Search for Common Ground and Washington-based Nuclear Threat Initiative began facilitating regional cooperation in public health. MECIDS was established as part of those efforts, in which the Ministry of Health of Israel, the Palestinian Authority, and Jordan were initially sharing data on foodborne disease outbreaks. Since then, data sharing has expanded to other disease areas, including vector-borne diseases and pandemic influenza. MECIDS partners have protocols for cross-border collaboration for investigating infectious disease outbreaks, including a bird culling radius across the borders, an automatic system for notifying each and tested collaboration for general preparedness for pandemic influenza. [ILLUSTRATION OMITTED] Harmonizing diagnostic and reporting methodologies, sharing training programmes and facilitating cross-border communication between laboratory technicians and public health officials are other important activities. It's just not a talking organization. This is a direct action organization, says Terence Taylor, who is vice-president of Global Health and Security, at the Nuclear Threat Initiative, that is helping MECIDS implement its plans. idea behind MECIDS is that everybody is equal, says Dr Alex Leventhal, the director of Israel's Health Ministry Department of International Relations and the consortium's first chair. Leventhal is joined by Dr Adel Belbesi, assistant secretary-general for primary health care at Jordan's Ministry of Health. Dr Assad Ramlawi, the Palestinian Authority Ministry of Healths director of primary care and public health, is the third principal and currently holds the year-long rotating post. The three principals are the heads of their respective delegations to MECIDS and they take turns in occupying the rotating chair. We have to exchange information and support each other, Ramlawi says of the need for health professionals to protect their respective communities from the outbreak of infectious diseases. …
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Health SecurityVol. 16, No. S1 Building the Evidence Base for Global Health Security ImplementationOpen AccessGlobal Health Security Implementation: Expanding the Evidence BaseErin D. Kennedy, Juliette Morgan, and Nancy W. KnightErin D. KennedyErin D. Kennedy, DVM, MS, MPH, is Associate Director for Science, Epidemiology, Informatics, Surveillance, and Laboratory Branch, Division of Global Health Protection, Center for Global Health, the Centers for Disease Control and Prevention, Atlanta, GA.Search for more papers by this author, Juliette MorganJuliette Morgan, MD, was Associate Director for Science, Division of Global Health Protection, Center for Global Health, the Centers for Disease Control and Prevention, Atlanta, GA.Search for more papers by this author, and Nancy W. KnightNancy W. Knight, MD, is a captain in the US Public Health Service and Director, Division of Global Health Protection, Center for Global Health, the Centers for Disease Control and Prevention, Atlanta, GA.Search for more papers by this authorPublished Online:27 Nov 2018https://doi.org/10.1089/hs.2018.0120AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail In recent years, the world has seen a series of alarming public health emergencies across the globe that have resulted in thousands of lives lost and billions of dollars in economic losses.1-8 The frequency and impact of these emergencies, coupled with the ease and reach of international travel and rapidly expanding global commerce and trade, have raised the urgency for all countries to prepare for future emergencies. As we write this piece, the second Ebola outbreak in 2018 in the Democratic Republic of the Congo (DRC) is accelerating in a resource-limited environment and armed conflict zone. This outbreak represents another test of the global health community's ability to contain this threat and prevent global spread.9The severe acute respiratory syndrome (SARS) outbreak in 2002-03 highlighted the need for updated international guidance for cooperation between countries and the need for all countries to develop core capacities to detect, report, and respond to infectious disease threats at the source.10,11 The impact of SARS highlighted the importance of improving global health security and accelerated the adoption of the revised International Health Regulations (IHR 2005). By 2007, all 196 World Health Organization (WHO) member states had committed to reaching compliance with these regulations by 2012.12 However, more than two-thirds of countries had failed to meet these standards by 2014.13Global deficiencies in preparedness for infectious disease threats were clear during the 2009 influenza A(H1N1) pandemic, the 2014-2016 Ebola epidemics, the global spread of Zika and chikungunya, and multiple other outbreaks.10 One factor impeding progress is limited published evidence regarding what specific approaches and interventions are most effective and have the most impact in enhancing a country's capacity for health security.14To address this evidence gap, the US Centers for Disease Control and Prevention (CDC), as a WHO Collaborating Center for the Implementation of IHR Core Capacities, works with its partners to develop the evidence base for effective global health security interventions. At CDC, the efforts to improve global health security implementation are primarily focused on strengthening public health systems to increase the capacity to prevent, detect, and respond to public health threats. These capacities include surveillance, public health laboratory systems, workforce development, outbreak investigation, and emergency response. Through CDC's direct engagement and collaboration with partners, CDC provides technical, scientific, and fiscal support to a number of countries to implement activities that build toward sustainable global health security systems in countries and regions.15,16This supplement shares the lessons learned from efforts to build global health security capacity in multiple countries spanning Africa, Asia, and Latin America. We grouped the articles in the supplement into 4 sections: Overview, Prevent, Detect, and Response, in alignment with the Global Health Security Agenda action packages.17The Overview section contains articles relevant to the foundational capacities needed to meet compliance with IHR 2005. In this section, Menon et al present 3 case studies to describe a role for law in IHR 2005 implementation.18 Liberia is in the process of updating their 1976 public health law to reflect current public health practices and strengthen IHR 2005 implementation. Côte d'Ivoire and Togo are using law to operationalize their public health emergency operations centers in order to respond to outbreaks in a timely and efficient manner. Cambodia is developing a proclamation designed to strengthen laboratory biosafety and biosecurity practices.This section also includes an article that describes Pakistan's use of the Joint External Evaluation continuum to develop a costed national action plan for health security (NAPHS).19,20 The article describes the lessons learned during the process, which may help countries using the process to develop their own NAPHS. Another article in this section describes how the Staged Development Tool (SDT) and process can be used to help national public health institutes (NPHIs) assess their current capacity and develop plans for addressing identified gaps and moving the country closer to achieving their global health security goals.21 The Staged Development Tool and process can also be used to determine the effectiveness of the interventions and changes made by NPHIs to address gaps identified during the original assessment.The Prevent section contains articles describing specific interventions and assessments designed to strengthen a country's ability to prevent avoidable outbreaks and drive health security planning in countries. Weber et al describe a pilot implementation of the WHO and United Nations Children's Fund's Water and Sanitation for Health Facility Improvement Tool (WASH FIT) in Togo.22 While using WASH FIT, internal teams regularly perform self-assessments at their facilities using water, sanitation, and hygiene (WASH) and related management indicators to develop and implement an improvement plan. Facilities made improvements without significant external financial or material support, such that the percent of facilities meeting baseline standards increased from 18% to 44% after only 7 months. This pilot evaluation suggests that WASH FIT may help facilities improve WASH services and practices. Applying WASH FIT and the implementation lessons learned can contribute to global health security by helping health facilities in Togo and other countries be more prepared to prevent healthcare-associated infections by limiting the spread of infectious diseases, such as Ebola and other diseases of epidemic and pandemic concern.Antimicrobial resistance (AMR) and zoonotic disease are 2 key action packages that fall within the Prevent priority area.17Another article included in this section describes the establishment of a laboratory-based AMR surveillance system in Ethiopia; lessons learned from implementation of this system can help guide other countries in implementing similar systems.23 This section also includes 2 articles focused on prevention and control of zoonotic diseases. Machalaba et al provide a description of how a multisectoral One Health approach can enhance global health security.24 An article by Stolka et al describes an assessment of a priority zoonotic disease surveillance system in the DRC.25 The articles by Stolka and Weber are examples of the use of implementation science to conduct structured evaluations that can be used to guide future global health security activities.The Detect section includes articles that describe the implementation and evaluation of surveillance systems that both enhance the ability to detect public health threats early and build laboratory capacity. In this section, Clara et al describe an evaluation of a community event-based surveillance system in Vietnam implemented to improve the early detection of public health threats.26 The evaluation showed the importance of supervision and monitoring of healthcare workers; it also emphasized the need to conduct surveillance evaluations to identify implementation barriers.Lamorde et al describe a cross-cutting approach to building multisectoral surveillance and laboratory capacity in Uganda by leveraging an existing pediatric inpatient malaria surveillance platform to develop an integrated platform.27 Development of this integrated platform has improved Uganda's ability to detect pathogens of public health importance by strengthening surveillance, increasing laboratory capacity, and supporting timely submission of testing data to public health authorities.Another key factor in a country's ability to detect public health threats is the existence of a workforce trained to recognize outbreaks and conduct investigations. Ario et al describe accomplishments of the Uganda Public Health Fellowship Program, an inservice post-master's advanced Field Epidemiology Training Program (FETP) established in 2015.28 The program has been fully integrated into the public health emergency response system. As of the end of 2017, FETP advanced fellows had conducted more than 60 outbreak investigations, 12 public health emergency assessments, 40 surveillance projects, and 31 applied epidemiologic studies, of which 49 involved potential bioterrorism agents or epidemic-prone diseases. The investigations conducted by fellows have resulted in shortened time to identify pathogens responsible for outbreaks, thereby preventing the potential spread of these outbreaks. Fellows graduate with the necessary skills and experiences in field epidemiology and public health leadership to make a significant impact on Uganda's ability to prevent, detect, and respond to public health threats.The Response section includes articles focused on implementation of programs designed to build capacities for rapid and effective responses to public health emergencies. Hanson et al describe the implementation and evaluation of a regional training pilot designed by CDC to build the capacities in the ministries of health in 4 Latin American countries (Colombia, Dominican Republic, Guatemala, and Panama) to design, facilitate, and evaluate simulation exercises.29 Six months after the training, 87.5% of respondents reported that they had applied the concepts learned in their day-to-day jobs. This pilot program helped these 4 countries meet the IHR 2005 requirement of having the ability to conduct exercises and enhance their public health emergency preparedness capacity, thus making them better prepared to respond to public health threats. Sanou et al describe implementation and associated costs of enhanced laboratory-based arbovirus surveillance in Burkina Faso during a dengue outbreak.30 This work built on existing infrastructure in Burkina Faso to rapidly respond to the outbreak.The articles in this supplement provide outcomes and lessons learned from the past 4 years of Global Health Security Agenda implementation, which can provide guidance to other countries implementing similar efforts to build capacities to prevent, detect, and respond to public health threats. The findings presented in these articles begin to provide the information needed to fill the lack of evidence base for global health security implementation.14So that we continue to build on the momentum established through investments to date and do not lose ground on the progress made, it is critical that CDC and partners incorporate the implementation science aspect of the scientific framework suggested by Morgan et al into all global health security capacity-building efforts.31 The evidence base needed can be generated through the use of implementation science to evaluate new and existing public health programs and systems. Implementation science can provide evidence on the most effective, efficient, feasible, and sustainable implementation approaches to global health security, which can in turn help strengthen existing programs or be used to develop new programs and move countries toward IHR 2005 compliance.AcknowledgmentsWe would like to thank the authors who have contributed their work to this supplement, the WHO, partner organizations, and the leadership in other countries' governments for their commitment to IHR 2005 and achieving a world that is safer from public health threats. We also thank Keisha Bohannon, Zara Ahmed, Ruth Cooke Gibbs, Jessica Gershick, Diane Brodalski, and Becky Bunnell for their assistance with this commentary.References1. Peiris JS, Yuen KY, Osterhaus AD, Stöhr K. The severe acute respiratory syndrome. N Engl J Med 2003;349(25):2431-2441. doi:10.1056/NEJMra032498. Crossref, Medline, Google Scholar2. Fineberg HV. Pandemic preparedness and response—lessons from the H1N1 influenza of 2009. N Engl J Med 2014;370(14):1335-1342. doi: 10.1056/NEJMra1208802 Crossref, Medline, Google Scholar3. Assiri A, McGeer A, Perl TM, et al.; KSA MERS-CoV Investigation Team. Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med 2013;369(5):407-416. doi: 10.1056/NEJMoa1306742. Crossref, Medline, Google Scholar4. Bell DM, Damon I, Bedrosian SR, Johnson VR, McQuiston JH, O'Connor J. CDC's response to the 2014-2016 Ebola epidemic—West Africa and United States. MMWR Suppl 2016;65(3):1-106. https://www.cdc.gov/mmwr/volumes/65/su/pdfs/su6503.pdf. Accessed November 7, 2018. Google Scholar5. Ikejezie J, Shapiro CN, Kim J, et al. Zika virus transmission—region of the Americas, May 15, 2015-December 15, 2016. MMWR Morb Mortal Wkly Rep 2017;66(12):329-334. doi: dx.doi.org/10.15585/mmwr.mm6612a4. Crossref, Medline, Google Scholar6. Cassell CH, Bambery Z, Roy K, et al. Relevance of global health security to the US export economy. Health Secur 2017;15(6):563-568. doi: 10.1089/hs.2017.0051. Link, Google Scholar7. The World Bank. The Economic Impact of the 2014 Ebola Epidemic: Short and Medium Term Estimates for West Africa. 2014. http://documents.Worldbank.org/curated/en/ 524521468141287875/. Accessed November 8, 2018. Google Scholar8. Bambery Z, Cassell CH, Bunnell RE, et al. Impact of a hypothetical infectious disease outbreak on US exports and export-based jobs. Health Secur 2018;16(1):1-7. doi: 10.1089/hs.2017.0052. Link, Google Scholar9. Nakkazi E. DR Congo Ebola virus outbreak: responding in a conflict zone. Lancet 2018;392(10148):623. doi: 10.1016/S0140-6736(18)31981-0. Crossref, Medline, Google Scholar10. Tappero JW, Cassell CH, Bunnell RE, et al.; Global Health Security Science Group. US Centers for Disease Control and Prevention and its partners' contributions to global health security. Emerg Infect Dis 2017;23(Suppl 1). doi: 10.3201/eid2313.170946. Crossref, Google Scholar11. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Global Health; Committee on Global Health and the Future of the United States. Global Health and the Future Role of the United States. Washington, DC: National Academies Press; 2017. Google Scholar12. Rodier G, Greenspan AL, Hughes JM, Heymann DL. Global public health security. Emerg Infect Dis 2007;13(10):1447-1452. doi: 10.3201/eid1013.070732. Crossref, Medline, Google Scholar13. Gostin LO, Katz R. The International Health Regulations: the governing framework for global health security. Milbank Q 2016;94(2):264-313. Crossref, Medline, Google Scholar14. Angulo FJ, Cassell CH, Tappero JW, Bunnell RE. Progress and opportunities for strengthening global health security. Emerg Infect Dis 2017;23(Suppl 1):S1-S4. doi:10.3201/eid2313.171758. Crossref, Medline, Google Scholar15. Fitzmaurice AG, Mahar M, Moriarty LF, et al.; GHSA Implementation Group. Contributions of the US Centers for Disease Control and Prevention in implementing the Global Health Security Agenda in 17 partner countries. Emerg Infect Dis 2017;23(Suppl 1). doi: 10.3201/eid2313.170898. Crossref, Medline, Google Scholar16. Shoemaker TR, Balinandi S, Tumusiime A, et al. Impact of enhanced viral haemorrhagic fever surveillance on outbreak detection and response in Uganda. Lancet Infect Dis 2018;18(4):373-375. doi: 10.1016/S1473-3099(18)30164-6. Crossref, Medline, Google Scholar17. US Centers for Disease Control and Prevention. Global Health Security Agenda: action packages CDC website. Updated January 21, 2016. https://www.cdc.gov/globalhealth/security/actionpackages/default.htm. Accessed November 8, 2018. Google Scholar18. Menon AN, Rosenfield E, Brush CA. Law and the JEE: lessons for IHR implementation. Health Secur 2018;16(Suppl 1):S11-S17. Link, Google Scholar19. Barzilay EJ, Vandi H, Binder S, et al. Use of the staged development tool for assessing, planning, and measuring progress in the development of national public health institutes. Health Secur 2018;16(Suppl 1):S18-S24. Link, Google Scholar20. Bell E, Tappero JW, Ijaz K, et al. Joint external evaluation—development and scale-up of global multisectoral health capacity evaluation process. Emerg Infect Dis 2017;23(Suppl 1). doi: 10.3201/eid2313.170949. Crossref, Google Scholar21. Safi M, Ijaz K, Samhouri D, et al. Development of a costed national action plan for health security in Pakistan: lessons learned. Health Secur 2018;16(Suppl 1):S25-S29. Link, Google Scholar22. Weber N, Martinsen AL, Sani A, et al. Strengthening healthcare facilities through water, sanitation, and hygiene (WASH) improvements: a pilot evaluation of “WASH FIT” in Togo. Health Secur 2018;16(Suppl 1):S54-S65. Link, Google Scholar23. Hazim C, Ibrahim RA, Westercamp M, et al. Establishment of a sentinel laboratory-based antimicrobial resistance surveillance network in Ethiopia. Health Secur 2018;16(Suppl 1):S30-S36. Link, Google Scholar24. Machalaba CC, Salerno RH, Behravesh CB, et al. Institutionalizing One Health: from assessment to action. Health Secur 2018;16(Suppl 1):S37-S43. Link, Google Scholar25. Stolka KB, Ngoyi BF, Grimes KEL, et al. Assessing the surveillance system for priority zoonotic diseases in the Democratic Republic of the Congo, 2017. Health Secur 2018;16(Suppl 1):S44-S53. Link, Google Scholar26. Clara A, Dao ATP, Do TT, et al. Factors influencing community event-based surveillance: lessons learned from pilot implementation in Vietnam. Health Secur 2018;16(Suppl 1):S66-S75. Link, Google Scholar27. Lamorde M, Mpimbaza A, Walwema R, et al. A cross-cutting approach to surveillance and laboratory capacity as a platform to improve health security in Uganda. Health Secur 2018;16(Suppl 1):S76-S86. Link, Google Scholar28. Ario AR, Wanyenze RK, Opio A, et al. Strengthening global health security through Africa's first absolute post-master's fellowship program in field epidemiology in Uganda. Health Secur 2018;16(Suppl 1):S87-S97. Link, Google Scholar29. Hanson K, Hernandez L, Banaski J Jr. Building simulation exercise capacity in Latin America to manage public health emergencies. Health Secur 2018;16(Suppl 1):S98-S102. Link, Google Scholar30. Sanou AS, Dirlikov E, Sondo KA, et al. Building laboratory-based arbovirus sentinel surveillance capacity during an ongoing dengue outbreak, Burkina Faso, 2017. Health Secur 2018;16(Suppl 1):S103-S110. Link, Google Scholar31. Morgan J, Kennedy ED, Pesik N, Angulo FJ, Craig AS, Knight NW, Bunnell RE. Building global health security capacity: the role for implementation science. Health Secur 2018;16(Suppl 1):S5-S7. Link, Google ScholarFiguresReferencesRelatedDetails Volume 16Issue S1Dec 2018 InformationCopyright 2018, Mary Ann Liebert, Inc., publishersTo cite this article:Erin D. Kennedy, Juliette Morgan, and Nancy W. Knight.Global Health Security Implementation: Expanding the Evidence Base.Health Security.Dec 2018.S-1-S-4.http://doi.org/10.1089/hs.2018.0120creative commons licensePublished in Volume: 16 Issue S1: November 27, 2018PDF download
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Health economics is a relatively new and fast-developing academic discipline, influencing many areas of clinical practice, including nursing and nurse management. To some, this is an unwelcome intrusion, to be treated with suspicion and mistrust. Others seem to think that the subject begins, and ends, with methods of economic evaluation narrowly applied to skill-mix in health care. The World Bank (http://www.worldbank.org) however, define health economics as an applied subdiscipline of economics, grounded in theories of finance and insurance, industrial organization, labour economics, and public finance. Since its origin, attributable to Kenneth Arrow's (1963) paper ‘Uncertainty and the welfare economics of medical care’ (see Savedoff 2004), the subject has expanded and forms an integral part of applied health policy, and is increasingly applicable to clinical nursing at the bedside. The purpose of this edition is then, to widen the perception of the topic and its content amongst nurses and nurse managers, by considering some of the major theories and concepts in health economics, their implementation in policy, and impact on staff and patients. I hope that these papers also stimulate readers to engage with the subject at a wider level, applying it to research and practice domains alike. The first paper by Russell Mannion et al. (2005), shows just how broad the subject of health economics actually is, and contains some important messages regarding possible futures for nursing and nurse managers. According to Mannion et al. (2005), although there are several relevant economic paradigms available, such as the Austrian school, postmodernist, feminist, communitarian and new economic sociology, health economics is currently dominated by the ‘neoclassical’ paradigm. It is suggested that this model makes heroic – and sometimes wrong – assumptions about the (hyper)rationality of individuals in the market place, their purely self-interested motivation and the behaviour of markets. Mannion et al. (2005) quote Keynes, and suggest that economic ideas – even when wrong – are powerful and have the potential to enslave. Citing Foucault, they suggest use of neoclassical economics has helped shaped the discourse of nursing, to produce a micropolitics of surveillance and control, a ‘carceral’ society in which nurses are immersed and have contributed to. Furthermore, they suggest this has become more acute in the face of increasing privatization, deregulation and, citing Beck, the emergence of a ‘risk society’, generating multiple regulatory systems on the shop floor. Of course health care should be regulated but, for nurses, they suggest the unwelcome paradox is that expansion of nursing into broader and more advanced roles has occurred at the same time as a narrowing of its operational discretion (Mannion et al. 2005). Moira Attree's (2005 ) study is the case in point. In her sample, 142 nurses of varied experience, gender and seniority, working in three National Health Service (NHS) acute hospitals, described how, in spite of the definition of self-governance (autonomy) as the hallmark of a profession, and the expectation to have control over practice, nurses described an inability to influence key decisions that affect everyday standards of nursing practice, especially those which concerned resource allocation. Instead, nurses reported increased responsibility, but a feeling of disempowerment and lack of say. Some senior nurses in Attree's (2005) sample reported an ‘illusion of control’ over work and resources. There are striking parallels between these findings, and Mannion et al.'s (2005) argument that neoclassically oriented managers in a modernized, risk society may ‘crowd out’ the intrinsic motivation of nurses. This is the adoption of ‘regulated authority’ (Attree 2005), by another name. Empirical evidence on the ‘efficiency’ of service provision is a very important part of health economics, and one given extensive coverage later in this issue. But I have deliberately given Alan Williams’ paper on distributive justice in health care, otherwise known as ‘equity’, a higher priority here. I asked Alan to write a didactic paper on the subject, to enhance understanding of how these principles may apply to clinical nursing and the actions of managers. At one level this is a beguilingly easy paper to read, and in his inimitable style, Alan asks us to consider hard moral questions about whether some people are more deserving than others and challenges us all to consider where we stand as nurses and nurse managers. This paper has hidden depths, however. In the face of a limited budget, as nurse managers do we take a forgiving stance, and allocate scarce nursing resources to those who have damaged their own health, knowing that as a result care will be denied to those who haven't? Or do the opposite on efficiency grounds? To some health economists, the twin goals of equity and efficiency are often in direct conflict with each other, i.e. if we achieve more of one it is at the price of less of the other. In such circumstances a ‘trade-off’ is needed, informed by some or other value system. If decisions are made using a ‘covert and capricious’ process, based on implicit values, it could also mean they are unfair. In his paper, Alan invites the reader to examine just how egalitarian they are, compared with a sample of health professionals on three different policy choices. In terms of leading us through the ‘policy maze’ to think about equity in health care, Alan Williams has done a fine job, on what must have been one of his last papers. It is with great sadness that I report Prof. Alan Williams FBA, one of the founding fathers of health economics, died on 2 June of this year. In his obituary* he is fittingly described as a visionary economist, one who transformed the way health care decisions are taken. Applying the principle of competition to the delivery of health care is simply an anathema to many people. In the British health care system, the Labour Government under Blair was opposed to competition and sought initially to replace the internal-market type competition of their political predecessors, with collaboration between providers. However, as Alan Maynard reports, there has been a significant reversal of this policy, largely due to the failure of NHS providers to ‘act smarter’ and perform better. Instead, the system continued to absorb significant amounts of taxpayer's money with no increment in performance or output. How can this be? Maynard suggests that many of the persistent problems faced by the UK are common to health systems worldwide, such as: variations in clinical practice; errors and untoward incidents; the failure to deliver cost-effective treatments coupled with the persistence of ineffective ones; and difficulties in measuring performance in accurate, transparent ways which facilitate informed decisions. He sees some of these problems as partly due to the untamed exercise of a medical monopoly, so-called ‘clinical freedom’, and an absence of managerial control of the clinical and financial situation. A key question emerges, namely, will competition work in producing smarter action and change in the desired direction? To Maynard, many of the skill-mix reforms around doctor–nurse substitution are, in context, a way of dealing with the entrenched medical monopoly, by diluting their stranglehold over practice. Arguably this paves the way for competition. Although extra money is available at a rate of over 7% per annum until 2008 (Moore 2002), the deliberate introduction of ‘excess’ capacity from private sector involvement (induced by extra payment of 15% above the tariff for five years), and the introduction of Diagnostic and Treatment Centres (DTCs), means that NHS Foundation Trusts will have to compete hard on their outcomes to attract enough patients just to break even. And for some of these providers, as Maynard suggests, ‘…the impact of competition on a market with excess capacity would be that failure will lead to closure and transfer of facilities’. Evidence from other markets (including health care) suggests that providers actively resist competition and act to limit its effect on them, even if this means increased social inefficiency. Such behaviour will need to be regulated, and to Maynard, the challenges are also how to manage clinical failures, bankruptcy, mergers and ‘anti-trust’ behaviour (collusion between providers). Also, in order to work as a device to increase efficient production and allocation of resources, markets rely on the ‘price mechanism’, where the price acts as a signal of the relative scarcity of a good and is determined by market conditions. But to Maynard, the imposition of a national tariff will only create competition on price if providers break the regulations! The alternative, quality competition outside clinical goals, may have no impact on outcomes. So, although a desired effect of competition might be to compel providers to address persistent problems, a robust regulatory framework is needed, (which may be expensive) to prevent the undesired effects. Also, as Maynard suggests, much of this reform is social experimentation with no evidence base, done in haste, and with uncertainty over the likelihood of universal success. Will it work? The working conditions and occupational stressors facing nurses, and other health care professionals, is a recurring theme in both the organizational, and workforce, research literature worldwide. The thorough study by Majella Albion et al., of health professionals in the Queensland Health Service District is a matter of concern for those involved in the recruitment and retention of staff, especially nurses. When compared with administrative; medical/professional and operational/technical workforce categories, using the Queensland Public Agency Staff Survey (QPASS) Instrument, these researchers found nurses reported statistically stable and consistently less favourable outcomes across a number of organizational climate subscales. Of the nurses, those working in mental health and a large regional hospital reported the least favourable scores. Although Albion et al. do not claim their findings are generalizable and they recommend wider study, these findings do appear broadly similar to aspects of staff satisfaction and retention reported previously in this Journal (Fochsen et al. 2005, Gardulf et al. 2005), and elsewhere (Barron & West 2005). The obvious economic impact of such studies for service organization and delivery, is likely to be found in terms of the inefficiency of training staff, only to lose them later from the workforce, and suboptimal patient outcomes via care delivery by inexperienced and/or demoralized staff. Hannah-Rose Douglas and Charles Normand provide us with a cogent account of the different methods of economic evaluation, and examine their suitability for use in the appraisal of health technologies, particularly nursing. The nurse manager is directly affected by such appraisal from the top–down, in terms of cost-effective practice guidelines, to be implemented by government diktat. However, it is becoming increasingly likely that nurse managers also need to understand and use newer economic techniques, to assist local resource allocation. Although not the totality of health economics, Douglas and Normand starkly suggest that the failure to embrace these techniques may lead to nurse managers being marginalized from resource allocation decisions which directly affect them – a process which Attree's (2005) study suggests might have already begun. The study of Nursing-led Inpatient Units (NLIU) reported by Harris et al. raises some interesting issues for researchers involved in the economic evaluation of nursing, and those more generally engaged in evaluating organizational aspects of service delivery. The economic component of the study was conducted as part of a funded randomized-controlled trial (RCT) evaluating the NLIU. This conventionally accepted method of conducting a full economic evaluation, is achieved by adding a cost analysis to the methods used in the RCT. Harris et al. are to be praised for the rigorous and thoughtful approach taken in costing resource use, in the two arms of the trial, and their finding that NLIUs can provide safe and effective patient care. But, by the time their study was completed, Harris et al. describe how the climate of health provision had changed, with a general policy switch towards earlier discharge from hospital, along with the emergence of alternative models of intermediate care. It became more difficult to fill NLIU beds with suitable patients and service managers eventually had little option but to reconfigure most of the nursing led-beds, despite the study findings. In my own paper I have set out to identify numerous economic theories of the firm and how they relate to the theory of the hospital. Considerable empirical evidence has been collected on the economic behaviour of hospitals, seeking to establish a normative theory of hospital behaviour. With the establishment of Foundation Trust Hospitals in the UK, possessing increased financial autonomy, along with a more market-oriented health care system, it is very important to examine this literature for evidence of how they might perform. On the demand side of health care, there is a decreasing deference from patients to sources of scientific or medical authority, and a stronger voice about the quality of their inpatient experience. As patients have more choice in the new system, Foundation Hospitals cannot ignore this ‘demand’. Foundation Hospitals face similar issues with their staff. The welter of evidence which suggests that happy and job-satisfied nursing staff are linked to better patient outcomes is at odds with other evidence suggesting nurses, and even their line managers, are less than satisfied at work and expressing an intention to leave. West (2005), suggests that managers must create working environments which foster: autonomy; control; growth and development; and a sense of belonging. He further suggests that managers should be judged on this. Instead of looking for a single economic model of hospital behaviour to use, Foundation Hospitals need to engage with several at once, innovating to produce staff-friendly modes of working which can deliver ‘a mass-customized, quality experience, transparently and at least cost’, as fairly as possible. Faced with competition, their survival may depend upon it. Driven by policy, health care systems the world over are engaged in continuous reform in order to improve service delivery and lower the costs. Many of these top-down policies and reforms directly affect the role of the nurse manager and are shaped, at more than one level, by theories in health economics. Also, on the shop floor, every decision a nurse manager takes has an economic impact, ranging from patient and ward level, through to the wider impact on the organisation and community. To achieve reform, and because of the increasing complexity of health care delivery, it is becoming essential that nurse managers, through formal training and tuition, understand the theories, tools and concepts in health economics, and are empowered to use them wisely to inform their workaday decision making processes.
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{
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https://openalex.org/W4385376822
|
Confirmation of Soil-Transmitted-Helminths Infection Prevalence by Kato-Katz Kit Diagnostic in Elementary School Children in West Martapura River Banks, South Kalimantan Indonesia
|
[
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{
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{
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https://api.openalex.org/works?filter=cites:W4385376822
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Soil-Transmitted Helminths (STH) infections are the most widespread neglected tropical diseases, primarily affecting morbidity in School Age Children (SAC). STH infection in SAC remains a public health problem in Martapura River Banks. Early and accurate STH detection is essential to determine an effective treatment for reducing morbidity. The Health Department recommends detecting STH infection by Kato Katz (KK) but in public health centers only by the direct method. This research objective is to confirm STH infection prevalence by Kato-Katz (KK) in elementary school children in West Martapura River Banks, South Kalimantan, Indonesia, against the direct method. The modified KK templates were developed from acrylic material. A total number of 253 children 7-12 years old in four West Martapura elementary schools were examined for STHs eggs using both microscopies modified KK against direct method by two trained laboratory technicians. STHs infection prevalence was 50 (19.76%), interpreted as low prevalence by direct and 78 (30.83%), moderate by KK. The concordance between both methods was significantly based on Cohen’s kappa (?=0.682). Even though the concordance of both methods was strong, the prevalence of STHs by modified KK was 30.08% higher than by Direct, which was only 20.33% positive. This study recommended using the KK for STHs diagnostic for prevalence measurement in low STHs infection.
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[
{
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|
https://openalex.org/W2184040621
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The Gambia - Impact evaluation baseline report : child health and nutrition
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{
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"id": "https://openalex.org/C187212893"
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{
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{
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{
"display_name": "Philosophy",
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[] |
https://api.openalex.org/works?filter=cites:W2184040621
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The government of The Gambia is implementing the maternal and child nutrition and health results project (MCNHRP) to increase the use of community nutrition and primary maternal and child health services. In collaboration with the government, the World Bank is conducting an impact evaluation to assess the project’s impact on key aspects of maternal and child nutrition and health. The MCNHRP baseline evaluation was conducted between November 2014 and February 2015. Quantitative and qualitative data were collected on three regions: Central River Region (CRR), North Bank Region West (NBR-W), and Upper River Region (URR). Its purpose was to establish a baseline against which project performance will be assessed in the future. This technical brief summarizes the baseline report findings related to child health and nutrition.
|
[] |
|
https://openalex.org/W2187527979
|
The Gambia - Impact evaluation baseline report : health system
|
[
{
"affiliations": [],
"display_name": "Chantelle Boudreaux",
"id": "https://openalex.org/A5064023757"
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{
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"display_name": "Laura Ferguson",
"id": "https://openalex.org/A5022838561"
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{
"affiliations": [],
"display_name": "Rifat Afifa Hasan",
"id": "https://openalex.org/A5063473949"
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{
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{
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{
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"id": "https://openalex.org/C159110408"
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{
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"id": "https://openalex.org/C162324750"
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{
"display_name": "Philosophy",
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"id": "https://openalex.org/C41895202"
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{
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"id": "https://openalex.org/C199539241"
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[
"West Bank"
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[] |
https://api.openalex.org/works?filter=cites:W2187527979
|
The government of The Gambia is implementing the maternal and child nutrition and health results project (MCNHRP) to increase the use of community nutrition and primary maternal and child health services. In collaboration with the government, the World Bank is conducting an impact evaluation to assess the project’s impact on key aspects of maternal and child nutrition and health. The MCNHRP baseline evaluation was conducted between November 2014 and February 2015. Quantitative and qualitative data were collected on three regions: Central River Region (CRR), North Bank Region West (NBR-W), and Upper River Region (URR). Its purpose was to establish a baseline against which project performance will be assessed in the future. This technical brief summarizes the baseline report findings related to the health system.
|
[] |
|
https://openalex.org/W4390078179
|
Public health expenditure, government effectiveness and labour productivity in West Africa
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"display_name": "Okpechi Philip Abane",
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{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Politics",
"id": "https://openalex.org/C94625758"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W4390078179
|
Purpose: This study aimed at empirically exploring how the expenditure of public health and the effectiveness of government impacted the productivity of labour in West Africa.
 Design/Methodology/Approach: This study used data from 1980 to 2022 generated by the World Bank and adopted multiple regression, mediation and correlation analysis. Additionally, the co-integration test of Johansen and the residual-based test using the Engel-Granger approach were used. 
 Findings: Expenditures on the health of the public and the effectiveness of government indicated some positive but insignificant impacts on labour productivity in the short run. At the same time, the expenditure on public health indicated a long-term, significant and adverse impact on labour productivity in Nigeria, Togo, Guinea, Senegal and Mali.
 Conclusion: The present study explored how expenditure on public health and the effectiveness of the government impacted the productivity of labour in West Africa. Apparently, the level of public health expenditure and government effectiveness are yet to positively impact the productivity of labour.
 Practical Implications: These results presented the critical role of public health expenditure and government effectiveness in enhancing the productivity of labour. Therefore, the study suggests that the government invest significantly in healthcare services in order to promote and safeguard the health of the people.
 Contribution to the Literature: This study offers an innovative perspective on labour productivity by highlighting the crucial roles played by governments in public health investment for productivity.
|
[
{
"display_name": "NURTURE",
"id": "https://openalex.org/S4387284754",
"type": "journal"
}
] |
|
https://openalex.org/W2949622269
|
Studies on the trends of transfusion-transmissible infections in a district-level hospital in West Bengal, India
|
[
{
"affiliations": [],
"display_name": "Gopeswar Mukherjee",
"id": "https://openalex.org/A5010301350"
},
{
"affiliations": [],
"display_name": "Sumon Ghosh",
"id": "https://openalex.org/A5082650807"
},
{
"affiliations": [],
"display_name": "A. K. Mukherjee",
"id": "https://openalex.org/A5054492463"
},
{
"affiliations": [],
"display_name": "Tushar Kanti Mondal",
"id": "https://openalex.org/A5090453191"
},
{
"affiliations": [],
"display_name": "Soumitra Mondal",
"id": "https://openalex.org/A5011146262"
}
] |
[
{
"display_name": "Syphilis",
"id": "https://openalex.org/C2776983459"
},
{
"display_name": "Rapid plasma reagin",
"id": "https://openalex.org/C2776687281"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "West bengal",
"id": "https://openalex.org/C3020376007"
},
{
"display_name": "Blood transfusion",
"id": "https://openalex.org/C2780014101"
},
{
"display_name": "Incidence (geometry)",
"id": "https://openalex.org/C61511704"
},
{
"display_name": "Malaria",
"id": "https://openalex.org/C2778048844"
},
{
"display_name": "HBsAg",
"id": "https://openalex.org/C2777410769"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
},
{
"display_name": "Transfusion medicine",
"id": "https://openalex.org/C79592252"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Human immunodeficiency virus (HIV)",
"id": "https://openalex.org/C3013748606"
},
{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
},
{
"display_name": "Surgery",
"id": "https://openalex.org/C141071460"
},
{
"display_name": "Immunology",
"id": "https://openalex.org/C203014093"
},
{
"display_name": "Internal medicine",
"id": "https://openalex.org/C126322002"
},
{
"display_name": "Socioeconomics",
"id": "https://openalex.org/C45355965"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Hepatitis B virus",
"id": "https://openalex.org/C2780593183"
},
{
"display_name": "Virus",
"id": "https://openalex.org/C2522874641"
},
{
"display_name": "Physics",
"id": "https://openalex.org/C121332964"
},
{
"display_name": "Treponema",
"id": "https://openalex.org/C2780187896"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Optics",
"id": "https://openalex.org/C120665830"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W2949622269
|
BACKGROUND: Therapeutic use of blood is the most sophisticated part of treatments in medical sciences. Transfusion of blood saves patients' lives as well as it has also the risk of infective disease, if it is contaminated. AIMS AND OBJECTIVES: The current study focuses on the status of TTI amongst the voluntary Blood donors over a period of time.MATERIALS AND METHODS: In this study, HIV, HCV, HBsAg and Syphilis (by RPR) screening test report for the year 2011 to 2017 of a district Hospital Blood Bank in West Bengal has been presented. Tests were done by ELISA and Syphilis by Rapid Plasma Reagin test.RESULTS: No significant changes in the incidence of above noted cases have been observed and no Malaria positive case was detected.CONCLUSION: This indicates a good awareness amongst the people regarding these diseases having immense public health importance.
|
[
{
"display_name": "BLDE university journal of health sciences",
"id": "https://openalex.org/S4210168843",
"type": "journal"
},
{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
"type": "repository"
}
] |
|
https://openalex.org/W4243533888
|
Seeking Research Questions from Implementers: Considerations for Leveraging Ground Actors Research Needs in the Fight against Malaria in West Africa.
|
[
{
"affiliations": [
{
"country": "United States",
"display_name": "EvergreenHealth",
"id": "https://openalex.org/I4210132715",
"lat": 47.716568,
"long": -122.17959,
"type": "healthcare"
},
{
"country": "United Kingdom",
"display_name": "Shine",
"id": "https://openalex.org/I4210099448",
"lat": 52.576206,
"long": -0.242278,
"type": "nonprofit"
}
],
"display_name": "Tete Sitou Amouh",
"id": "https://openalex.org/A5079864241"
},
{
"affiliations": [],
"display_name": "Saidou Malam Ekoye",
"id": "https://openalex.org/A5083769411"
},
{
"affiliations": [
{
"country": "Burkina Faso",
"display_name": "West African Health Organisation",
"id": "https://openalex.org/I4210156508",
"lat": 11.178934,
"long": -4.304139,
"type": "government"
}
],
"display_name": "Césaire Damien Ahanhanzo",
"id": "https://openalex.org/A5056674277"
},
{
"affiliations": [
{
"country": "Burkina Faso",
"display_name": "Nazi Boni University",
"id": "https://openalex.org/I3131918342",
"lat": 11.17715,
"long": -4.2979,
"type": "education"
}
],
"display_name": "T. R. Guiguemdé",
"id": "https://openalex.org/A5062124729"
},
{
"affiliations": [
{
"country": "Burkina Faso",
"display_name": "West African Health Organisation",
"id": "https://openalex.org/I4210156508",
"lat": 11.178934,
"long": -4.304139,
"type": "government"
}
],
"display_name": "Issiaka Sombié",
"id": "https://openalex.org/A5015631627"
}
] |
[
{
"display_name": "Malaria",
"id": "https://openalex.org/C2778048844"
},
{
"display_name": "Prioritization",
"id": "https://openalex.org/C2777615720"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Work (physics)",
"id": "https://openalex.org/C18762648"
},
{
"display_name": "Public relations",
"id": "https://openalex.org/C39549134"
},
{
"display_name": "Business",
"id": "https://openalex.org/C144133560"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Process management",
"id": "https://openalex.org/C195094911"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Engineering",
"id": "https://openalex.org/C127413603"
},
{
"display_name": "Mechanical engineering",
"id": "https://openalex.org/C78519656"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Immunology",
"id": "https://openalex.org/C203014093"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W4243533888
|
Abstract In the Sahel countries of West Africa, malaria remains a public health scourge. To strengthen the fight against malaria, it is imperative to identify weaknesses and possible solutions before programs implementation. This study reports experiences gained from collaboration between decision-makers and researchers from a project undertaken by the World Bank, titled: Malaria and Neglected Tropical Diseases in the Sahel (SM/NTD). The objectives of this World Bank project were to identify bottlenecks in malaria program implementation as well as related research questions they bring up. Questionnaire addressed to National Malaria Control Program managers and prioritization workshops were used as a medium to identify research questions. Identified research questions were implemented in selected countries and the results, as presented in this study showed that priority issues were those related to prevention, governance, drugs, monitoring and evaluation. The first five priority questions were: (1) compliance with drug doses on the second and third days during the seasonal chemoprevention (SMC) campaigns, (2) the contribution of community-based distributors to the management of severe cases of malaria in children under 5 years, (3) the SMC efficacy, (4) artemisinin-based combination therapy (ACTs) tolerance and efficacy according to existing guidelines, and (5) the quality of malaria control at all levels of the health system. In conclusion, this work showed the effectiveness of collaboration between implementers, programs managers, and researchers in identifying research questions. Furthermore, the results of this study will contribute to improving the implementation of malaria control programs across African countries.
|
[
{
"display_name": "Research Square (Research Square)",
"id": "https://openalex.org/S4306402450",
"type": "repository"
}
] |
|
https://openalex.org/W4252515763
|
Seeking Research Questions from Implementers: Considerations for Leveraging Ground Actors Research Needs in the Fight against Malaria in West Africa.
|
[
{
"affiliations": [
{
"country": "United States",
"display_name": "EvergreenHealth",
"id": "https://openalex.org/I4210132715",
"lat": 47.716568,
"long": -122.17959,
"type": "healthcare"
},
{
"country": "United Kingdom",
"display_name": "Shine",
"id": "https://openalex.org/I4210099448",
"lat": 52.576206,
"long": -0.242278,
"type": "nonprofit"
}
],
"display_name": "Tete Sitou Amouh",
"id": "https://openalex.org/A5079864241"
},
{
"affiliations": [],
"display_name": "Saidou Malam Ekoye",
"id": "https://openalex.org/A5083769411"
},
{
"affiliations": [
{
"country": "Burkina Faso",
"display_name": "West African Health Organisation",
"id": "https://openalex.org/I4210156508",
"lat": 11.178934,
"long": -4.304139,
"type": "government"
}
],
"display_name": "Césaire Damien Ahanhanzo",
"id": "https://openalex.org/A5056674277"
},
{
"affiliations": [
{
"country": "Burkina Faso",
"display_name": "Nazi Boni University",
"id": "https://openalex.org/I3131918342",
"lat": 11.17715,
"long": -4.2979,
"type": "education"
}
],
"display_name": "T. R. Guiguemdé",
"id": "https://openalex.org/A5062124729"
},
{
"affiliations": [
{
"country": "Burkina Faso",
"display_name": "West African Health Organisation",
"id": "https://openalex.org/I4210156508",
"lat": 11.178934,
"long": -4.304139,
"type": "government"
}
],
"display_name": "Issiaka Sombié",
"id": "https://openalex.org/A5015631627"
}
] |
[
{
"display_name": "Malaria",
"id": "https://openalex.org/C2778048844"
},
{
"display_name": "Prioritization",
"id": "https://openalex.org/C2777615720"
},
{
"display_name": "Work (physics)",
"id": "https://openalex.org/C18762648"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Quality (philosophy)",
"id": "https://openalex.org/C2779530757"
},
{
"display_name": "Corporate governance",
"id": "https://openalex.org/C39389867"
},
{
"display_name": "Business",
"id": "https://openalex.org/C144133560"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Control (management)",
"id": "https://openalex.org/C2775924081"
},
{
"display_name": "Public relations",
"id": "https://openalex.org/C39549134"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Process management",
"id": "https://openalex.org/C195094911"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Engineering",
"id": "https://openalex.org/C127413603"
},
{
"display_name": "Management",
"id": "https://openalex.org/C187736073"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Mechanical engineering",
"id": "https://openalex.org/C78519656"
},
{
"display_name": "Philosophy",
"id": "https://openalex.org/C138885662"
},
{
"display_name": "Epistemology",
"id": "https://openalex.org/C111472728"
},
{
"display_name": "Finance",
"id": "https://openalex.org/C10138342"
},
{
"display_name": "Immunology",
"id": "https://openalex.org/C203014093"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W4252515763
|
Abstract In Sahel countries in West Africa malaria remains a public health scourge. To strengthen the fight against malaria, weaknesses, and solutions must be identified before programs implementation. This study reports experiences gained from collaborations between decision-makers and researchers. This project was undertaken in the framework of the regional World Bank funded project titled: Malaria and Neglected Tropical Diseases in the Sahel (SM/NTD). The objectives of this World Bank program are to identifying bottlenecks in program implementation as well as the related research questions they enticed. National malaria control program managers and prioritization workshops were used as working method to identify research questions. These identified priority research questions were implemented in selected countries. The results of this study showed that priority issues were related to prevention, governance, drugs, monitoring, and evaluation of programs. The first five priority questions were related to (1) factors of compliance with drug doses for the second and third days during the seasonal chemoprevention (SMC) campaigns, (2) the contribution of community-based distributors to the management of severe cases of malaria in under 5 years-old children, (3) the SMC efficacy, (4) artemisinin-based combination therapy (ACTs) tolerance and efficacy according to existing guidelines, and (5) the quality of malaria control at all levels of the health system. In conclusion, this work showed the effectiveness of collaboration between implementers, programs managers, and researchers in identifying research questions. Furthermore, the results of this study will contribute to improve the implementation of malaria control programs across African countries.
|
[
{
"display_name": "Research Square (Research Square)",
"id": "https://openalex.org/S4306402450",
"type": "repository"
}
] |
|
https://openalex.org/W253189427
|
Rivers of disease
|
[
{
"affiliations": [],
"display_name": "Thomas A. Blinkhorn",
"id": "https://openalex.org/A5028232939"
}
] |
[
{
"display_name": "Commission",
"id": "https://openalex.org/C2776034101"
},
{
"display_name": "Onchocerciasis",
"id": "https://openalex.org/C2780727990"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Blindness",
"id": "https://openalex.org/C2780929884"
},
{
"display_name": "Disease control",
"id": "https://openalex.org/C2987315675"
},
{
"display_name": "Geography",
"id": "https://openalex.org/C205649164"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Socioeconomics",
"id": "https://openalex.org/C45355965"
},
{
"display_name": "Environmental protection",
"id": "https://openalex.org/C526734887"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Optometry",
"id": "https://openalex.org/C119767625"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W253189427
|
Eight years ago last month (May 1974), the World Health Organization (WHO) announced the formal launching of an unprecedented international campaign to control in seven West African countries a disease called Onchocerciasis, or River Blindness. The disease was endemic in the area-about one million out of the more than 10 million people living in the seven countries were estimated to have the disease and at least 70, 000 were blind or had serious sight impairment. The disease was also considered a serious impediment to development of large areas of the Volta river basin system of West Africa. At the time, the effort to control the disease was considered one of the most detailed and far reaching public health campaigns ever undertaken. It was also significant because it was the first time that, the World Bank became so intimately involved in a health project. The program also has a potential catalytic role for health personnel and health system development in the entire area. In 1979, WHO established an independent commission on the long-term prospects of the Onchocerciasis control program to review the long-term objectives and strategies of the campaign, the commission presented its final report late last year and it concluded that, despite the serious problems of reinvasion and resistance, the control program is proceeding satisfactorily and on schedule.
|
[] |
|
https://openalex.org/W4244903393
|
A comparative study of the epidemiology of Treponemal Infection in the Volta Region of Ghana: A Five-Year Multisite Parallel Population-Based Analysis vis-à-vis the Sentinel Survey
|
[
{
"affiliations": [
{
"country": "Ghana",
"display_name": "University of Health and Allied Sciences",
"id": "https://openalex.org/I254651091",
"lat": 6.60084,
"long": 0.4713,
"type": "education"
}
],
"display_name": "Sylvester Yao Lokpo",
"id": "https://openalex.org/A5091849555"
},
{
"affiliations": [
{
"country": "Zambia",
"display_name": "Kwame Nkrumah University",
"id": "https://openalex.org/I4210132509",
"lat": -14.444722,
"long": 28.467222,
"type": "education"
},
{
"country": "Ghana",
"display_name": "Kwame Nkrumah University of Science and Technology",
"id": "https://openalex.org/I28046988",
"lat": 6.68848,
"long": -1.62443,
"type": "education"
}
],
"display_name": "Ellis Owusu‐Dabo",
"id": "https://openalex.org/A5089366070"
},
{
"affiliations": [
{
"country": "Ghana",
"display_name": "University of Health and Allied Sciences",
"id": "https://openalex.org/I254651091",
"lat": 6.60084,
"long": 0.4713,
"type": "education"
}
],
"display_name": "John Gameli Deku",
"id": "https://openalex.org/A5048272787"
},
{
"affiliations": [
{
"country": "Ghana",
"display_name": "University of Health and Allied Sciences",
"id": "https://openalex.org/I254651091",
"lat": 6.60084,
"long": 0.4713,
"type": "education"
}
],
"display_name": "Verner N. Orish",
"id": "https://openalex.org/A5048249422"
},
{
"affiliations": [
{
"country": "Ghana",
"display_name": "University of Health and Allied Sciences",
"id": "https://openalex.org/I254651091",
"lat": 6.60084,
"long": 0.4713,
"type": "education"
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],
"display_name": "Gideon Kye-Duodu",
"id": "https://openalex.org/A5049823581"
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{
"affiliations": [
{
"country": "Ghana",
"display_name": "Koforidua Technical University",
"id": "https://openalex.org/I4210151633",
"lat": 6.065079,
"long": -0.262792,
"type": "education"
}
],
"display_name": "Francis Abeku Ussher",
"id": "https://openalex.org/A5007374182"
},
{
"affiliations": [
{
"country": "Ghana",
"display_name": "University of Health and Allied Sciences",
"id": "https://openalex.org/I254651091",
"lat": 6.60084,
"long": 0.4713,
"type": "education"
}
],
"display_name": "Thomas Boakye",
"id": "https://openalex.org/A5072436571"
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{
"affiliations": [],
"display_name": "Daniel Adigbli",
"id": "https://openalex.org/A5028917507"
},
{
"affiliations": [],
"display_name": "Louis Selasi Ameke",
"id": "https://openalex.org/A5040010432"
},
{
"affiliations": [],
"display_name": "William Klutse Fianko",
"id": "https://openalex.org/A5060657569"
},
{
"affiliations": [],
"display_name": "Robert Adedze-Kpodo",
"id": "https://openalex.org/A5070349187"
},
{
"affiliations": [],
"display_name": "Henry Komla Letsa",
"id": "https://openalex.org/A5086953876"
},
{
"affiliations": [],
"display_name": "Worlanyo Tashie",
"id": "https://openalex.org/A5062386128"
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{
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https://api.openalex.org/works?filter=cites:W4244903393
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Abstract Abstract Background: Treponemal infection is contagious and one of the oldest blood-borne infections, with great public health consequences. This study aimed to comparatively describe the five–year (2013-2017) regional epidemiology of Treponemal infection using pregnant women in the Sentinel Survey and apparently healthy blood donors as proxy for the general population at the four sentinel sites in the Volta Region of Ghana. Method: We analysed retrospectively data from 17,744 prospective blood donors aged between 18 to 58 years and 7,805 pregnant women in a Sentinel Survey who fell within the 15 and 49 years age bracket at Hohoe, Ho, Tongu and Krachi-West sentinel sites in the Volta Region. Data extracted included age, gender, date of blood donation and Treponena pallidum chromatographic immunoassay results from the blood banks of the four study sites. Published reports of Sentinel Surveys conducted at the four sentinel sites from the years 2013-2017 were retrieved. Results: The cumulative five-year prevalence of Treponemal infections among the pregnant women in the Sentinel Survey and prospective blood donors was 0.38% and 2.38% respectively. Site-specific prevalence for population-base/Sentinel survey was 4.6%/0.4%, 2.0%/0.2%, 1.3%/0.8 and 1.2%/0.2 for Hohoe, Ho, Krachi-West and Tongu respectively. Treponemal infection rates among the younger age groups (15-24years) were 0.31% in the sentinel survey and 2.22% in the general population. Significant gender disparity in Treponemal infection exist with male preponderance. Conclusion: The regional prevalence of Treponemal infection in the Sentinel Survey is lower compared to the general population. Therefore, the use of pregnant women as proxy for population estimate could lead to underestimation of the burden in the study jurisdiction.
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https://openalex.org/W3004339035
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Crisis Management Public Relations of PT KAI Commuter Jabodetabek on Handling KRL Cross Accident September 2015
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[] |
https://api.openalex.org/works?filter=cites:W3004339035
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This study titled “Crisis Management Public Relations of PT KAI Commuter Jabodetabek on Handling KRL Cross Accident September 2015” the problem of the research is the management crisis, crisis management strategy efforts to crisis, the role when crisis that is enforceable by the division of Public Relations PT KAI Commuter Jabodetabek (KCJ) in resolving the crisis accident of 2 KRL at Juanda Station. This research uses the Gonzales-Herero and Pratt crises method management who analogous a crisis like the stages of life.This research used qualitative case study research accompanied by descriptive exposure. The data was obtained through direct observation, interviews and literature studies, while the informants in this research was Assistant Communication Manager PT KCJ and Public Relations Manager of the Central Bank Republic of Indonesia West Java Province as the source triangulation.The results of this study shows that crisis management conducted by PT KCJ has been carried out starting from the victims evacuation, evacuation of the damaged wagon train, the recovery location of the accident, to the process of health settlement costs for the victims of accident. Keywords: Crisis Management, KRL Cross Accident, PT KAI Commuter Jabodetabek, Public Relations, Gonzales-Herero and Pratt Method
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[
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https://openalex.org/W4232746625
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Economic and Other Societal Determinants of the Prevalence of HIV: A Test of Competing Hypotheses
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The spread of human immunodeficiency virus (HIV) is believed to result from HIV-infected individuals who are unaware of their infection and, thus, the possible consequences of their sexual behavior for others. However, differential rates of HIV infection between countries may reflect a different set of circumstances. We obtained data from the World Bank and several other sources to test eight alternative explanations for the global differences in prevalence of HIV infection: (1) economic underdevelopment, (2) inadequate public health care, (3) insufficient media, (4) political instability, (5) overurbanization, (6) social inequity, (7) religion, and (8) region. Our regression findings showed that income inequality and political instability had statistically significant positive effects on HIV/AIDS prevalence and that gender equality had a negative effect on HIV/AIDS prevalence. Religion and region were also important predictors, as countries that were predominately Muslim and Christian Orthodox generally had lower prevalence of HIV/AIDS, whereas West Africa, Central Africa, and Southern Africa had a higher prevalence of HIV/AIDS. None of the public health and media indicators were statistically relevant.
|
[
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https://openalex.org/W1979930129
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Russia's health promotion efforts blossom
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[] |
https://api.openalex.org/works?filter=cites:W1979930129
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In a bid to reduce Russia's high rates of preventable disease, the government, with the help of non-governmental organisations, is bringing health promotion to the people. Tom Parfitt reports. Russia is seeing its first green shoots in the area of health promotion as non- governmental organisations (NGOs) lead the fight to erode the country's traditional emphasis on curative care. A vigorous anti-alcohol campaign, new road safety measures, and a programme of health awareness workshops for teenagers are among the positive signs 6 months after the Kremlin introduced a new 12-year health-care blueprint which identified the “formation of health as a priority in the social and spiritual values of Russian society” as a key task. Health and social welfare minister Tatyana Golikova announced the first sizeable state-funded project in line with that aim last month: the creation of a chain of 500 “prophylactic health advice rooms” in medical institutions as part of 830 million roubles (US$26 million) to be spent on health promotion in 2009. She also gave details of a new campaign to improve school meals. But health-care experts say there is a mountain to climb with immense opposition from powerful cigarette and vodka companies, open hostility among doctors to some WHO-recommended disease prevention measures, and a structurally segregated system of care which hinders radical intersectoral efforts. President Dmitry Medvedev pleased advocates of change last month, however, when he chose health care as the topic for one of his series of “fireside chats” that have been running weekly on state television. Medvedev went out of his way to stress that “the overall state of our health can be attributed two-thirds to our lifestyle, that is to say, what we eat, what water we drink, what kind of lifestyle we lead in general, and only 10–15% to the medical care we receive”. Yelena Dmitriyeva, director of Healthy Russia Foundation, an NGO that is cooperating with the state to run workshops for teenagers called “Everything That Concerns You”, believes only a transformation in thinking will bring success. She says the notion of health promotion is “totally unfamiliar” to most Russians, who are more used to terms such as “sanitary education” and “propaganda of a healthy lifestyle”. “The western tradition [of health care] is less biomedical, more human-centred, while the Russian tradition is more about curative medicine”, says Dmitriyeva. “So you will treat very serious diseases but you think less about prevention and you will not motivate people to take care of their own health.” Surveys show Russians expect the state to have a deeply paternalistic role in looking after their health, and there is widespread suspicion of NGOs, both among patients and health-care providers. But organisations like Healthy Russia Foundation are slowly making inroads with training sessions for health-care professionals on unfamiliar topics such as psychosocial support, rehabilitation for drug users and community mobilisation. “People in Russia are better educated, than, say, people in Africa, about HIV and drug use but we have a real problem with transforming knowledge and attitudes into changed behaviour”, says programme director, Sergey Frolov. Much of Russia's punishing mortality rate can be attributed to non-communicable diseases that could be eroded fast if personal habits were altered. A World Bank report published in 2005, found that cardiovascular diseases, cancer, and injuries account for 78% of deaths in Russia. High blood pressure, high cholesterol, and tobacco are the three leading risk factors. Alcohol—mostly consumed as spirits like vodka—kills an estimated 600 000 people per year. Motivated by that last statistic, the Orthodox Church initiated an anti-alcohol campaign earlier this year with a high-profile series on state television. Presented by Father Tikhon, abbot of Sretensky monastery in Moscow, the programmes showed graphic images of damaged livers and brain cells decaying as a result of alcohol abuse. “We realised that it was very important for people to understand the process of degradation and destruction of a person, of society, caused by alcohol”, Father Tikhon explained to the Izvestiya newspaper. “Most people acknowledge that alcohol causes harm, but not many can imagine the internal catastrophe that it wreaks on an individual level.” Anti-tobacco campaigners celebrated in June last year when Russia approved WHO's Framework Convention on Tobacco Control, although there were concerns in December when new control measures were watered down under heavy pressure from cigarette company lobbyists. Aleksey Bobrik, deputy director of the Moscow-based Open Health Institute (OHI), says there have been other isolated successes in health promotion. One major sign was the recent ten-fold increase in fines for driving without a seatbelt, and the change in the law to make crossing into the oncoming lane an offence punishable by removing the driver's licence. “Taking such unpopular steps demonstrates serious intent on the part of the government”, he says. More than 30 000 Russians have died annually in traffic accidents in recent years, almost double the average among other G8 countries. Bobrik says NGOs such as OHI are beginning to overcome hostility from state bodies who not long ago were nonplussed at their desire to participate in health promotion and disease prevention. OHI and four partner organisations received $89 million in 2003, the first large tranche of money for work in Russia from the Global Fund to Fight AIDS, Tuberculosis and Malaria. “We started in an environment of envy and hatred”, he recalls. “I was invited to the ministry of health when we learned about the grant and people yelled at me, saying ‘Who do you think you are? Do you think you will get this money?’ Now we are winning multi-million dollar tenders for projects from the same ministry.” Yet the progress is patchy. Professional associations of health-care providers are slow to get involved in social activism, and the rigidly compartmentalised structure of government means that education initiatives can fail because of poor coordination between the ministries of health, education, and sport. Meanwhile, subjects such as sex, contraception, and drug use are explosive and anyone broaching them with children can expect determined opposition. A conservative pressure group called the Parents' Committee recently branded sex education “a looming evil” and in 2006, NGOs supporting it were labelled paedophiles by an influential deputy in the Moscow city parliament. “There has been an increasing tendency to shy away from these issues”, says Bobrik. “Condoms are a taboo subject in schools. It's so sensitive that even the attempts to introduce sex education which existed 3 or 4 years ago have basically stopped. Now the HIV prevention curriculum is about family values. There's no real teaching of practical information or skills.” In fact, it is around HIV/AIDS prevention that experts paint the darkest picture. Joost van der Meer, executive director of AIDS Foundation East West, says Russia has “come a long way” since he first started working in the country a decade ago but budgets for tackling the epidemic remain small and are largely consumed by paying for expensive antiretroviral drugs. About 45 000 people are receiving antiretrovirals, 450 000 people are officially living with HIV, and there are 1·8 million injecting drug users (IDUs), with about 70% of new HIV/AIDS cases each year originating from drug use. Annual state spending on tackling HIV/AIDS is about 3 billion roubles ($97 million) on treatment and only 400 million roubles ($12 million) on prevention measures such as needle exchange. “Prevention spending needs to be at least brought in line with that on treatment”, says van der Meer. “The government should look at the epidemiological reality and spend its money on those groups that are at risk for HIV and then there would still really be a chance to stem the epidemic before it crosses into the general population and it's too late. At the moment it's failing massively. Even by the time the Global Fund finishes all its projects it estimates it may only reach 9% of Russia's IDUs. There needs to be a ramping up in harm reduction.” A key stumbling block is implacable opposition to methadone substitution therapy. Although WHO considers methadone “one of the most effective treatment options for opioid dependence” and a method for reducing heroin use, associated deaths and HIV risk behaviours, Russia's health establishment believes its use is unethical and wrong-headed because it replaces one addiction with another. Dmitriyeva says she is hopeful for progress after the government's Healthcare Development Concept to 2020, published in December, pledged to create “a fashion for healthiness, especially among the teenage generation” as an urgent priority. “The road from the concept to real government orders is very long”, she says. “But it's a great step forward that there is political commitment and health promotion has become a priority for the state. Leadership from the top is absolutely essential in Russia.” Alcohol and harm reduction in RussiaThe Series on alcohol and global health, published in The Lancet today, draws attention to one of the most pressing public health problems in the world. Alcohol promotes inequities and accounts for substantial harm to individuals, families, and communities, most of which could be prevented or reduced. The three Series papers address the burden of alcohol, strategies for harm reduction, and future actions. By way of an example, an Article analyses the influence of alcohol on cause-specific mortality in Russia. Full-Text PDF Russia releases draft health-care planLast month, the Russian Government drafted a health-care blueprint for the next 12 years to reduce the country's punishing mortality rate and increase longevity. Tom Parfitt reports. Full-Text PDF
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https://openalex.org/W91991105
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Descriptive Study of Community Health Education Jobs in the U.S.A., May – December 1998
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"https://openalex.org/W2026259201",
"https://openalex.org/W2043738566",
"https://openalex.org/W2063205562",
"https://openalex.org/W2107031757",
"https://openalex.org/W2170679011",
"https://openalex.org/W2796443302",
"https://openalex.org/W2827504245"
] |
https://api.openalex.org/works?filter=cites:W91991105
|
The purpose of this study was to explore the community health education jobs in the USA and to provide relevant workforce information to community health education professionals and students. Two hundred fifty community health education announcements out of 908 were randomly selected from the Heath Education Professional Resources (HEPR) Job Bank for the periods May to December of 1998. Job information such as job searching methods, working environments, job qualifications, job descriptions, salaries, and benefits of community health education professionals were characterized. RESULTS: October had the highest number of job announcements during eighth-month period. There were more job announcements from the Northeast and West. Many of the job announcements were obtained through CareerPath® and America’s Job Bank®. There were at least 137 different job titles. The majority of institutions hiring health educators were either non-profit or government. About two-thirds were public organizations. The majority of the positions (86%) required applicants to have either a baccalaureate or master’s degree. There were diverse job qualifications. College majors other than health education or community health were acceptable. Work experience in descending order were: program planning and evaluation, program management, working with diverse populations, community organization and coordination, and working with multicultural populations in descending order. One to five years of working experience was required for the job positions. Target population and target issues were diverse. Almost half of the health educators served general health issues in their community. Computer skills, particularly word processing and Internet skills, were required. The capacity for working independently and self-motivation were significant factors in the hiring for most of the employers. Communication skills were required in 80% of the job announcements. Other required skills included program assessment, planning, implementation, evaluation, and teaching. For full-time employees, the median salary was $36,000. Other employee compensation information is also reported.
|
[
{
"display_name": "Californian journal of health promotion",
"id": "https://openalex.org/S4210210863",
"type": "journal"
}
] |
|
https://openalex.org/W4299937620
|
Motherhood can be safer -- even where conditions are hard.
|
[] |
[
{
"display_name": "SAFER",
"id": "https://openalex.org/C2776654903"
},
{
"display_name": "Truck",
"id": "https://openalex.org/C52121051"
},
{
"display_name": "Corporation",
"id": "https://openalex.org/C2778348171"
},
{
"display_name": "Sierra leone",
"id": "https://openalex.org/C3018567284"
},
{
"display_name": "Business",
"id": "https://openalex.org/C144133560"
},
{
"display_name": "Health facility",
"id": "https://openalex.org/C2775949068"
},
{
"display_name": "Health care",
"id": "https://openalex.org/C160735492"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Medical emergency",
"id": "https://openalex.org/C545542383"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Finance",
"id": "https://openalex.org/C10138342"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Engineering",
"id": "https://openalex.org/C127413603"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Socioeconomics",
"id": "https://openalex.org/C45355965"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Health services",
"id": "https://openalex.org/C2986740045"
},
{
"display_name": "Computer security",
"id": "https://openalex.org/C38652104"
},
{
"display_name": "Computer science",
"id": "https://openalex.org/C41008148"
},
{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Aerospace engineering",
"id": "https://openalex.org/C146978453"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W4299937620
|
The Prevention of Maternal Mortality (PMM) Network in West Africa has demonstrated that, even under sub-optimal conditions, motherhood can be safer and needless deaths can be avoided. The PMM Network's 10 teams from Ghana, Nigeria, and Sierra Leone designed projects to enable women with complications during pregnancy or delivery to overcome delays in deciding to seek medical help, travelling to a health facility, and receiving help after arriving at the facility. Operating rooms and blood banks were opened in some hospitals and health centers were upgraded at a cost under US $15,000. In one case, an abandoned warehouse was turned into a health center. Other PMM activities included staff training, making drugs more readily available, setting up a fund to lower drug prices, and increasing stocks of safe blood. The teams arranged for local truck drivers' unions to provide emergency transport and organized groups of men in remote villages to carry women in hammocks to motorized transport. The teams worked with traditional leaders and held educational sessions at community gatherings. Even in the poorest areas, the number of women seeking care for obstetric complications increased and their risk of dying dropped. The PMM Network is supported by Columbia University's School of Public Health, with funding from the Carnegie Corporation.
|
[
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W4220840958
|
Impact of Covid-19 among Women of Reproductive Age in Nigeria
|
[
{
"affiliations": [],
"display_name": "Goodluck Azuonwu",
"id": "https://openalex.org/A5049214788"
},
{
"affiliations": [],
"display_name": "M.Jemima Mercy",
"id": "https://openalex.org/A5091274986"
}
] |
[
{
"display_name": "Pandemic",
"id": "https://openalex.org/C89623803"
},
{
"display_name": "Government (linguistics)",
"id": "https://openalex.org/C2778137410"
},
{
"display_name": "Psychological intervention",
"id": "https://openalex.org/C27415008"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Civil society",
"id": "https://openalex.org/C513891491"
},
{
"display_name": "Reproductive health",
"id": "https://openalex.org/C121752807"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Grey literature",
"id": "https://openalex.org/C61904560"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Socioeconomics",
"id": "https://openalex.org/C45355965"
},
{
"display_name": "Coronavirus disease 2019 (COVID-19)",
"id": "https://openalex.org/C3008058167"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "MEDLINE",
"id": "https://openalex.org/C2779473830"
},
{
"display_name": "Politics",
"id": "https://openalex.org/C94625758"
},
{
"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Linguistics",
"id": "https://openalex.org/C41895202"
},
{
"display_name": "Philosophy",
"id": "https://openalex.org/C138885662"
},
{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Infectious disease (medical specialty)",
"id": "https://openalex.org/C524204448"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W4220840958
|
Background: This paper examined the impact of the covid-19 pandemic among women of reproductive age in Nigeria. Pandemics however, are not new to the human society. Nevertheless, humanitarian crises, including health emergencies like covid-19 affect men and women differently. The pandemic exposed sharp economic and social inequalities and widened the already existing gap with the most vulnerable in society, including unequal impacts affecting women and girls by virtue of their gender. This review provided information on the physical, economic and social impact of covid-19 pandemic among women of reproductive age in Nigeria. Methods: Grey literature such as reports and research briefs from WHO, UN, UNICEF, World Bank, Care International, Plan International. Partners West Africa Nigeria and National Demographic Health Survey Nigeria was used for this review. In addition literature searches from peer-reviewed articles published between 2001 to date in databases such as Pubmed and Google Scholar were also used for this review. Conclusion: Some of these impacts, as this review has found, include different types of social and economic problems such as loss of jobs, income decline, increased stress, worries, increase in sexual and gender-based violence and concerns that have had significant impact on the mental health and social well-being of women, children, and other vulnerable groups. Recommendation: Civil Society Organizations and Development Partners should lead interventions around the many forms of violence that women face across their life cycle and in all contexts of their lives- private, public and technology driven spaces. Furthermore, Government should develop operational plans that will include capacity assessments and risk analyses by the State and Local Government authorities; and extending the reach of public health and socioeconomic interventions by civil society and Non-governmental organization.
|
[
{
"display_name": "International journal of research publications",
"id": "https://openalex.org/S4210238074",
"type": "journal"
}
] |
|
https://openalex.org/W2596698339
|
The Global Relationship between the Prevalence of Diabetes Mellitus and Incidence of Tuberculosis: 2000-2012
|
[
{
"affiliations": [],
"display_name": "Alaa Badawi",
"id": "https://openalex.org/A5081025860"
},
{
"affiliations": [],
"display_name": "Suzan Sayegh",
"id": "https://openalex.org/A5090781050"
},
{
"affiliations": [],
"display_name": "Mohamed Sallam",
"id": "https://openalex.org/A5018233561"
},
{
"affiliations": [],
"display_name": "Eman Sadoun",
"id": "https://openalex.org/A5076660623"
},
{
"affiliations": [],
"display_name": "Mohamed H. Al‐Thani",
"id": "https://openalex.org/A5013564766"
},
{
"affiliations": [],
"display_name": "Muhammad Alam",
"id": "https://openalex.org/A5070601917"
},
{
"affiliations": [],
"display_name": "Paul Arora",
"id": "https://openalex.org/A5069729871"
}
] |
[
{
"display_name": "Incidence (geometry)",
"id": "https://openalex.org/C61511704"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
},
{
"display_name": "Tuberculosis",
"id": "https://openalex.org/C2781069245"
},
{
"display_name": "Diabetes mellitus",
"id": "https://openalex.org/C555293320"
},
{
"display_name": "Quartile",
"id": "https://openalex.org/C68443243"
},
{
"display_name": "Prevalence",
"id": "https://openalex.org/C186079640"
},
{
"display_name": "Ecological study",
"id": "https://openalex.org/C25511272"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Epidemiology",
"id": "https://openalex.org/C107130276"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Internal medicine",
"id": "https://openalex.org/C126322002"
},
{
"display_name": "Confidence interval",
"id": "https://openalex.org/C44249647"
},
{
"display_name": "Physics",
"id": "https://openalex.org/C121332964"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Optics",
"id": "https://openalex.org/C120665830"
},
{
"display_name": "Endocrinology",
"id": "https://openalex.org/C134018914"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W2596698339
|
Background: The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has increased over the past decade with DM prevalence increasing in countries already afflicted with a high burden of TB. The coexistence of the two conditions presents a serious threat to global public health. Objective: The present study examines the global relationship between the prevalence of DM and the incidence of TB to evaluate their coexistence worldwide and their contribution to one another. Methods: This is an ecological longitudinal study covering the period between years 2000 to 2012. We utilized data from the WHO and World Bank sources and International Diabetes Federation to estimate prevalence of DM (%) and the incidence of TB (per 100,000). Measures of central tendency and dispersion as well as the harmonic mean and linear regression were used for different WHO regions. The association between DM prevalence and TB incidence was examined by quartile of DM prevalence. Results: The worldwide average (±S.D.) prevalence of DM within the study period was 6.6±3.8% whereas TB incidence was 135.0±190.5 per 100,000. DM prevalence was highest in the Eastern Mediterranean (8.3±4.1) and West Pacific (8.2±5.6) regions and lowest in the Africa (3.5±2.6). TB incidence was highest in Africa (313.1±275.9 per 100,000) and South-East Asia (216.7±124.9) and lowest in the European (46.5±68.6) and American (47.2±52.9) regions. Only countries with high DM prevalence (>7.6%) showed a significant positive association with TB incidence (r=0.17, p=0.013). Conclusion: A positive association between DM and TB may exist in some – but not all – world regions, a dual burden that necessitates identifying the nature of this coexistence to assist in developing public health approaches that curb their rising burden.
|
[
{
"display_name": "World Academy of Science, Engineering and Technology, International Journal of Medical and Health Sciences",
"id": "https://openalex.org/S2764579048",
"type": "journal"
}
] |
|
https://openalex.org/W1978868061
|
Missing HIV kits in Pakistan
|
[
{
"affiliations": [
{
"country": "Pakistan",
"display_name": "Aga Khan University",
"id": "https://openalex.org/I118185606",
"lat": 24.8608,
"long": 67.0104,
"type": "education"
}
],
"display_name": "Khabir Ahmad",
"id": "https://openalex.org/A5044109633"
}
] |
[
{
"display_name": "Government (linguistics)",
"id": "https://openalex.org/C2778137410"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Human immunodeficiency virus (HIV)",
"id": "https://openalex.org/C3013748606"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Christian ministry",
"id": "https://openalex.org/C521751864"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Philosophy",
"id": "https://openalex.org/C138885662"
},
{
"display_name": "Linguistics",
"id": "https://openalex.org/C41895202"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W1978868061
|
Author's reply Sir—The intention of my news item, contrary to Athar Saeed Dil's belief, was not to throw doubts on the performance of any individual or institute, but to bring to light an important public-health issue that, if not addressed, is likely to have enormous health, social, and economic implications for Pakistan and the rest of the world. I based the item on a confessional news report1Testing kits worth millions stolen in the AIDS Division of National Institute of Health.Ausaf Islamabad. 2001; 4: 7-8Google Scholar, 2Drugs worth millions stolen in National Institute of Health. Storekeeper sold 380 AIDS testing kits on black market.Kainat Islamabad. 2001; 3: 7-8Google Scholar which has not yet been contradicted or clarified by the NIH; an official document on the HIV/AIDS situation in Pakistan;3HIV/AIDS in Pakistan: a situation and response analysis. Ministry of Health Government of Pakistan and UNAIDS, Islamabad2000Google Scholar and on interviews with the auditor, officials of the National AIDS Programme and donor agencies, including the World Bank and UNAIDS. By stating that the missing kits were for hepatitis B screening and not HIV, Dil contradicts his own statement,2Drugs worth millions stolen in National Institute of Health. Storekeeper sold 380 AIDS testing kits on black market.Kainat Islamabad. 2001; 3: 7-8Google Scholar in which he said that an inquiry into the missing HIV/AIDS kits had been completed and that people involved would be brought to the book. The confession, made by an NIH staff member, Bilal Ahmed Malik mentions only HIV kits. The auditor I interviewed a week before my news item was published revealed that the kits were for HIV and that the auditors were being pressured to withdraw the inquiry or soften the accusations. The chief of the National AIDS Programme, as I mention, claimed that the missing kits were for hepatitis B and not HIV. But, as The Nation, one of Pakistan's leading newspapers said in May, based on my news item, as if the kits being for hepatitis B is any less important: “In a country where hepatitis has increased to dreaded proportions, it is equally worrying that test kits meant for public use have been handed over to the money-minting private laboratories. But obviously one should not expect NAP [National AIDS Programme], which believes that the controversy was a systematic attempt to damage NAP, to feel that way.”4The missing HIV kits.The Nation. May 14, 2001; 4Google Scholar I agree with Dil that the kits were procured through WHO by use of government funds, and apologise. Unfortunately, as a journalist in Pakistan, it can be difficult to obtain clear information. Much information is classed as confidential by health officials. Dil says National AIDS Programme data are based on millions of tests done over many years. Sharaf Ali Shah (also a key official of the National AIDS Programme) and colleagues, however, claim that, since 1996, when the HIV testing centres were established in Sindh province, only 41 000 diagnostic tests have been done by the provincial programme, which is deemed a model for the rest of the provinces. On May 18, 2001, Abid Hasan, a World Bank official, wrote to Ijaz Rahim, Secretary for Health in the Pakistan Government about the findings of its technical assistance mission to review the HIV/AIDS situation in Pakistan and the government's response to the threat posed by this disease. The findings show deficiencies in blood screening in public and private blood banks. In Sindh, no more than 50% of blood transfusions in public-sector hospitals are thought to be screened for HIV. Sindh's HIV/AIDS control and prevention programme is thought to be the best of those in the three provinces, Punjab, North West Frontier, and Sindh. Missing HIV kits in PakistanIn his April 21 news item,1 Khabir Ahmad refers to an investigation by Pakistan's National Institute of Health (NIH) into the alleged black market sale of HIV kits. I believe he has dealt with this issue in an irresponsible way. Full-Text PDF Missing HIV kits in PakistanThe number of 2·5 million HIV-1 tests done in Pakistan since 1985 given by Khabir Ahmad1 is debatable since it is based on blood-bank data and reflects only the number of blood bags screened for HIV-1 since 1985. The data do not reflect HIV testing in the general population. Full-Text PDF
|
[
{
"display_name": "The Lancet",
"id": "https://openalex.org/S49861241",
"type": "journal"
}
] |
|
https://openalex.org/W2267163328
|
Wasser für Gesundheit in Entwicklungsländern: Herausforderungen am Beispiel Jemen
|
[
{
"affiliations": [],
"display_name": "Kristina Meier",
"id": "https://openalex.org/A5022427763"
},
{
"affiliations": [],
"display_name": "Johannes Rieckmann",
"id": "https://openalex.org/A5069903349"
}
] |
[
{
"display_name": "Water supply",
"id": "https://openalex.org/C97053079"
},
{
"display_name": "Business",
"id": "https://openalex.org/C144133560"
},
{
"display_name": "Hygiene",
"id": "https://openalex.org/C547646559"
},
{
"display_name": "Water quality",
"id": "https://openalex.org/C2780797713"
},
{
"display_name": "Government (linguistics)",
"id": "https://openalex.org/C2778137410"
},
{
"display_name": "Sanitation",
"id": "https://openalex.org/C2780151969"
},
{
"display_name": "German",
"id": "https://openalex.org/C154775046"
},
{
"display_name": "Environmental planning",
"id": "https://openalex.org/C91375879"
},
{
"display_name": "Sewage",
"id": "https://openalex.org/C58790150"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Water resource management",
"id": "https://openalex.org/C524765639"
},
{
"display_name": "Geography",
"id": "https://openalex.org/C205649164"
},
{
"display_name": "Environmental protection",
"id": "https://openalex.org/C526734887"
},
{
"display_name": "Environmental engineering",
"id": "https://openalex.org/C87717796"
},
{
"display_name": "Environmental science",
"id": "https://openalex.org/C39432304"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Ecology",
"id": "https://openalex.org/C18903297"
},
{
"display_name": "Linguistics",
"id": "https://openalex.org/C41895202"
},
{
"display_name": "Philosophy",
"id": "https://openalex.org/C138885662"
},
{
"display_name": "Archaeology",
"id": "https://openalex.org/C166957645"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Biology",
"id": "https://openalex.org/C86803240"
}
] |
[
"West Bank",
"Yemen"
] |
[] |
https://api.openalex.org/works?filter=cites:W2267163328
|
Improved drinking water supply and sewage disposal are among the top priorities for developing and expanding infrastructures in emerging economies. However, infrastructure projects do not always achieve the desired improvement in water quality for households connected to piped water, for example, if drinking water is contaminated with high levels of bacteria. Yet the lowest possible contamination level is an essential prerequisite for preventing diseases such as diarrhea, which significantly increases the risk of mortality, particularly in children under five. In certain circumstances, the positive impact on the health of the inhabitants that had originally been anticipated as a result of the infrastructure measures fails to materialize and, in the worst case scenario, the situation might even deteriorate. The Provincial Towns Program (PTP) implemented by the Yemeni government and funded through German development cooperation via the German Development Bank (KfW Entwicklungsbank) aimed to improve and expand the water infrastructure. Once the program was completed, an evaluation of its impact on the health of the inhabitants of the two provincial project towns was conducted in cooperation with the University of Gottingen. Data for this study were collected in 2009. As well as assessing the health impacts, the evaluation also examined bacterial contamination along the supply chain. In a third step, determinants of certain types of household behavior with regard to hygiene and drinking water handling practices were also analyzed. In Amran, a town situated in the Yemen's mountainous region, where water is in short supply, households connected to the water infrastructure reported deterioration in health. For Zabid, on the other hand, a coastal town located in the west of the country, there was no evidence of this negative correlation. The discrepancy in the health effectiveness of this project for the development of water supply and sewage disposal can probably be explained by the frequent interruptions to the water supply to the mountainous areas of the country, resulting in impurities in the pipe system. The problem is further exacerbated by the inadequate hygiene practices of inhabitants and project households.
|
[
{
"display_name": "DIW-Wochenbericht",
"id": "https://openalex.org/S4306508190",
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https://openalex.org/W2935824914
|
F-105 Surveillance of viral zoonoses in Africa
|
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{
"affiliations": [
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"country": "Zambia",
"display_name": "University of Zambia",
"id": "https://openalex.org/I33278361",
"lat": -15.4,
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"display_name": "Aaron S. Mweene",
"id": "https://openalex.org/A5064617048"
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"affiliations": [
{
"country": "Japan",
"display_name": "Hokkaido University",
"id": "https://openalex.org/I205349734",
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"long": 141.33997,
"type": "education"
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],
"display_name": "Ayato Takada",
"id": "https://openalex.org/A5042389718"
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"display_name": "Biosecurity",
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{
"display_name": "Ebola virus",
"id": "https://openalex.org/C2777469322"
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{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
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{
"display_name": "General partnership",
"id": "https://openalex.org/C71750763"
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{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
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{
"display_name": "Influenza A virus subtype H5N1",
"id": "https://openalex.org/C519248777"
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"display_name": "Global health",
"id": "https://openalex.org/C46578552"
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"id": "https://openalex.org/C17744445"
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{
"display_name": "Outbreak",
"id": "https://openalex.org/C116675565"
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{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
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{
"display_name": "Virology",
"id": "https://openalex.org/C159047783"
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"display_name": "Virus",
"id": "https://openalex.org/C2522874641"
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"display_name": "Philosophy",
"id": "https://openalex.org/C138885662"
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"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
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{
"display_name": "Epistemology",
"id": "https://openalex.org/C111472728"
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"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
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"display_name": "Law",
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"display_name": "Economics",
"id": "https://openalex.org/C162324750"
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[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W2935824914
|
In recent years, the increased rates in the mergence and re-emergence of highly infectious diseases of humans and animals, with high health and socio-economic impacts and serious biosafety and biosecurity challenges have been observed, worldwide. In Africa, highly dangerous pathogens even unpredictably re-emerge or emerge in new geographic areas or are newly discovered. Most recent examples include discovery of highly pathogenic Old World arenavirus (Lujo virus) following air transport of a fatally ill patient from Zambia to South Africa and the spread of Zaire ebolavirus associated with severe and widespread outbreaks of Ebola viral haemorrhagic fever in West Africa in 2014. To strengthen the research and surveillance capacity for viral zoonosis in Zambia, a 5 year (2013–2018) project entitled “Surveillance of viral zoonoses in Africa” was implemented through collaborative research between Zambia and Japanese Research Institutions. This is supported through a Technical Cooperation Project by the Japan International Cooperation Agency (JICA) and the Agency for Medical Research and Development (AMED)/Japan Science and Technology Agency (JST) under the framework of the Science and Technology Research Partnership for Sustainable Development (SATREPS). The University of Zambia (UNZA) with financing from the World Bank has established the Africa Centre of Excellence for Infectious Diseases of Humans and Animals (ACEIDHA) to address some of the public health challenges. ACEIDHA endeavours to achieve the regional goal of understanding the natural history of some infectious diseases, through new evidence-based, cost effective, multi-disciplinary, multi-sectoral, and collaborative strategies to be implemented by well-trained and skilled scientists. It will, subsequently, increase the sub-region's human resource capacity to deal with these problems by training a pool of scientists at MSc and PhD levels. Recently, ACEIDHA has been accepted as a GVN Affiliate Centre of Excellence. This status will enable ACEIDHA to better train virologists at MSc, PhD and post-doctoral levels. It will, further, help to facilitate interactions of other GVN members with a number of partners in Africa, which is critical to GVN's mission in preparing the world for future outbreaks of viral diseases. Considering that zoonoses cannot be eradicated, it is imperative to take pre-emptive action to determine the circulation of the related pathogens in the environment. In this regard, biological samples from potential hosts (wild animals, livestock and human) are collected and examined for the status of the known and unknowns pathogens. We, also, embark on establishment an/or improvement of detection methods for known viral zoonoses. In this regard, inter alia, a simple, reliable, low cost immunochromatographic assay, named QuickNaviTMEbola, for rapid diagnosis of Ebola virus disease (EVD) has been developed. Furthermore, working together in a multidisciplinary One Health platform, activities are conducted to identify natural reservoirs for the elucidation of transmission pathways of zoonotic viruses and risk factors as well as drivers for emergence of known and/or unknown viruses in communities and our work has potential for discovery of novel viruses originating from animals. Incidentally, since the outbreak of 2014 EVD in West Africa, all samples from cases of suspected EVD in Zambia are tested under our project working with the Ministry responsible for Health in Zambia. This work contributes to building the capacity for Africa to be better prepared for any eventual outbreak of highly infectious diseases of humans and animals.
|
[
{
"display_name": "Journal of Acquired Immune Deficiency Syndromes",
"id": "https://openalex.org/S157460402",
"type": "journal"
}
] |
|
https://openalex.org/W2924939802
|
3232 Translational Science 2019
|
[
{
"affiliations": [
{
"country": "United States",
"display_name": "Tufts Medical Center",
"id": "https://openalex.org/I1290900354",
"lat": 42.34951,
"long": -71.06331,
"type": "healthcare"
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],
"display_name": "Paul Adjei",
"id": "https://openalex.org/A5024200609"
},
{
"affiliations": [
{
"country": "United States",
"display_name": "Tufts Medical Center",
"id": "https://openalex.org/I1290900354",
"lat": 42.34951,
"long": -71.06331,
"type": "healthcare"
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],
"display_name": "Michael R. Jordan",
"id": "https://openalex.org/A5052083685"
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{
"affiliations": [
{
"country": "United States",
"display_name": "Tufts Medical Center",
"id": "https://openalex.org/I1290900354",
"lat": 42.34951,
"long": -71.06331,
"type": "healthcare"
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],
"display_name": "Jennifer Chow",
"id": "https://openalex.org/A5019618774"
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{
"affiliations": [
{
"country": "United States",
"display_name": "Tufts Medical Center",
"id": "https://openalex.org/I1290900354",
"lat": 42.34951,
"long": -71.06331,
"type": "healthcare"
}
],
"display_name": "Janis L. Breeze",
"id": "https://openalex.org/A5074401925"
}
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[
{
"display_name": "Attendance",
"id": "https://openalex.org/C2778173179"
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{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
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{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
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{
"display_name": "Viral load",
"id": "https://openalex.org/C142462285"
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{
"display_name": "European union",
"id": "https://openalex.org/C2910001868"
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{
"display_name": "Transmission (telecommunications)",
"id": "https://openalex.org/C761482"
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{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
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{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
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{
"display_name": "Cohort",
"id": "https://openalex.org/C72563966"
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{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
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{
"display_name": "Pediatrics",
"id": "https://openalex.org/C187212893"
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{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
},
{
"display_name": "Human immunodeficiency virus (HIV)",
"id": "https://openalex.org/C3013748606"
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{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Internal medicine",
"id": "https://openalex.org/C126322002"
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{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
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{
"display_name": "Business",
"id": "https://openalex.org/C144133560"
},
{
"display_name": "Engineering",
"id": "https://openalex.org/C127413603"
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{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Electrical engineering",
"id": "https://openalex.org/C119599485"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Economic policy",
"id": "https://openalex.org/C105639569"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W2924939802
|
OBJECTIVES/SPECIFIC AIMS: We hypothesize that VL testing varies by geographic sub-region, country, age, gender, mode of transmission, year of diagnosis, and country of origin; and also that a higher prevalence of VL testing may be associated with higher prevalence of population-level VL suppression. Our primary aim is to determine country- and regional-level factors that are associated with viral load testing amongst HIV patients. Our secondary aim is to explore the association between prevalence of viral load testing and viral load suppression at the population level. METHODS/STUDY POPULATION: This is a retrospective analysis of de-identified individual-level data reported to the European Surveillance System (TESSy). The TESSy is a database of communicable diseases (including HIV) for the ECDC and WHO European Regional Office. It captures data from 31 European Union/European Economic Area (EU/EEA) countries and 23 non-EU/EEA countries. Stored data is from year 2000. TESSy is used for data analysis and production of outputs for public health action. The patient cohort include adults older 18 years, whose last clinic attendance was reported in 2014 or later, or whose viral load test was reported in the year of the visit or the year before the year of their last reported clinic attendance. Patient demographic data include age, sex, mode of transmission, country of origin (migrants), country of diagnosis, geographic region, last clinic attendance, viral load and therapy status. Geographic region will be categorized into East, West and Centre as per WHO guidelines. Countries will be categorized and analyzed according to their European Union (EU)-, European Economic Area (EEA)- and income (GDP)-status, using current World Bank and International Monetary Fund (IMF) guidelines. All statistical analysis will be performed in R-Studio and R i386 3.0.2. Missing data will be characterized in terms of quantity (how much is missing) and pattern (random versus non-random) and impact on covariates to be tested. Multiple data imputations would be used in cases where missing data is found to be at random. Data from external sources like UNAIDS, World Bank and IMF will also be used for comparison and validation of TESSy data for imputation of missing data. Continuous variables will be analyzed through appropriate parametric and non-parametric tests while categorical variables will be analyzed through methods of proportion. Multivariate logistic regression methods will be used to explore the associations between VL testing and VL suppression separately with age, sex, year of diagnosis, country of origin (migrants), mode of transmission, in the total population, then at country- and regional-level. The same associations will be explored using a country’s EU and EEA status (EU versus EEA versus non-EU/EEA), and income status (high versus upper middle versus lower middle versus low). DISCUSSION/SIGNIFICANCE OF IMPACT: Even though this is a retrospective analysis of a database with likely significant missing data that may affect analysis of data and interpretation of results, our study will impact all levels of HIV policy across Europe. The strengths of this study likely outweigh the limitation imposed by missing data and include potential regional-, country- and demographic-specific public health, epidemiologic and ART program policy initiatives. Also our analysis of pattern of missing data may inform a more efficient and meaningful data collection and input into TESSy database.
|
[
{
"display_name": "Journal of Clinical and Translational Science",
"id": "https://openalex.org/S4210205013",
"type": "journal"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
}
] |
|
https://openalex.org/W2276061579
|
Making pregnancy and childbearing safer for women in West Africa.
|
[
{
"affiliations": [],
"display_name": "Andrew F. Russell",
"id": "https://openalex.org/A5059438590"
}
] |
[
{
"display_name": "Childbirth",
"id": "https://openalex.org/C2779703513"
},
{
"display_name": "SAFER",
"id": "https://openalex.org/C2776654903"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Health care",
"id": "https://openalex.org/C160735492"
},
{
"display_name": "Breastfeeding",
"id": "https://openalex.org/C2776283161"
},
{
"display_name": "Pregnancy",
"id": "https://openalex.org/C2779234561"
},
{
"display_name": "Unrest",
"id": "https://openalex.org/C2778358470"
},
{
"display_name": "Medical emergency",
"id": "https://openalex.org/C545542383"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Politics",
"id": "https://openalex.org/C94625758"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Pediatrics",
"id": "https://openalex.org/C187212893"
},
{
"display_name": "Genetics",
"id": "https://openalex.org/C54355233"
},
{
"display_name": "Computer security",
"id": "https://openalex.org/C38652104"
},
{
"display_name": "Computer science",
"id": "https://openalex.org/C41008148"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Biology",
"id": "https://openalex.org/C86803240"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W2276061579
|
The discussion of maternal mortality in West Africa and the efforts of the Prevention of Maternal Mortality (PMM) Network to reduce effectively and inexpensively maternal mortality are presented. There are numerous examples given of women's obstetric experiences, the experiences of prominent health and political personnel, and accounts by PMM network officials. Advice is given on how best to direct efforts to reduce maternal mortality, once the realities are recognized. Approaches, such as placing specialists in decentralized settings, does not recognize the shortage of specialists or the inability to retain specialists under conditions of civil unrest or budgetary restraints. Training nonspecialist doctors or nurse-midwives does not recognize the resistance to this idea among the medical community, or the preferences of women for home delivery. Women report the deficiencies in the medical care system as: hours of operation that do not conform to the unscheduled natural of childbirth, lack of availability of transportation, and high costs of transportation and care. There were also complaints about privacy and lack of adequate hospital supplies and equipment. Public awareness of the potential for serious complications of pregnancy is lacking. Local practices can either be beneficial or destructive. Risk assessment is not a foolproof means of averting mortality, because women themselves are unaware of life-threatening symptoms, and because a large minority of women are in good health prior to serious labor complications. The operations research analysis of medical care revealed 1) that waiting times for hospital admission and treatment needed to be reduced; 2) that obstetric complications need to be reported correctly on medical records; 3) that renovations are needed in rooms used for cesarean and other obstetric surgery; 4) that a continuous supply of drugs needs to be secured through a hospital revolving fund; and 5) that equipment and supplies for blood banks and transfusions needs to be secured. Community health messages on warning signs of complications need to be promoted. A PMM Network team member proposed that improving obstetric services was more cost effective than prevention. The PMM Networks history and accomplishments in their models of reducing maternal mortality and development of hum,an resources are presented.
|
[
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2982883728
|
Infectious disease research and vaccine development using animal BSL-3 facility
|
[
{
"affiliations": [],
"display_name": "Dongseob Tark",
"id": "https://openalex.org/A5038676593"
}
] |
[
{
"display_name": "Outbreak",
"id": "https://openalex.org/C116675565"
},
{
"display_name": "Biosafety",
"id": "https://openalex.org/C52384281"
},
{
"display_name": "Infectious disease (medical specialty)",
"id": "https://openalex.org/C524204448"
},
{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Emerging infectious disease",
"id": "https://openalex.org/C2779973787"
},
{
"display_name": "Global health",
"id": "https://openalex.org/C46578552"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Malaria",
"id": "https://openalex.org/C2778048844"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Virology",
"id": "https://openalex.org/C159047783"
},
{
"display_name": "Immunology",
"id": "https://openalex.org/C203014093"
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{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W2982883728
|
Despite remarkable advances in medical science during the 20th century, infectious diseases remain leading causes of death worldwide for reason such as emergence of new infectious diseases, re-emergence of old infectious diseases, and persistence of endemic diseases. Emerging diseases include outbreaks of unknown diseases or known diseases whose incidence in humans has significantly increased in the past two decades. Re-emerging diseases are known diseases that have reappeared after a significant decline in incidence. There are many infectious diseases that continue to be significant global events and the emergence and re-emergence of pathogens can be threatening the health throughout the 21st century. A large majority of these diseases are occurred by zoonotic microbes, such as HIV, avian influenza, SARS, Ebola, West Nile, Hantavirus, hepatitis E, and many others. Particularly, in South Korea, Middle East respiratory syndrome coronavirus (MERS-CoV) infection outbreak was reported in 2015. A total of 186 MERS-CoV cases, including 36 deaths, have been associated with the outbreak in the country. According to Korea economy research institute report, South Korea`s central bank cut interest rates to stem the economic fallout, and national economy was damaged with US $20 billion from the outbreak.
For the research of emerging zoonotic diseases, air-borne disease, arthropod-borne diseases, and food- and water-borne diseases, it is regulated that national biosafety guidelines have been established that promote safe microbiological practices and safety standards to prevent infections disease acquired from laboratory and laboratory animals. Therefore, facilities that licensed animal biosafety level 3 (ABSL-3) or biosafety level 3 (BSL-3) are essential for the infectious disease research. Recently, Korea Zoonosis Research Institute was launched in 2015, and the facilities of BSL-3 and ABSL-3 are certificating by government office. In this paper, I am going to introduce the facility to give attention of international collaboration in the research filed.
Regulations in South Korea require guidelines for many zoonotic pathogens or high-pathogenic agents of animal disease to use ABSL-3 or BSL-3 facilities. Many additional issues should be considered in designing and managing large animal-containment facilities. Particularly, technical knowledges and a great amount of budget are essential for the facilities. Most researchers have explained that studies with zoonotic pathogens using ABSL-3 or BSL-3 can be safely conducted after completing numerous studies over many years. For that, national support and policy from the government of each country are essential to solve global public health issues. We have to emphasize that there are public health benefits when the prevalence of zoonotic pathogens such as FMD, MERS, and AI are reduced, leading to reductions in human infection and associated economic costs.
|
[
{
"display_name": "대한인수공통전염병학회 학술발표초록집",
"id": "https://openalex.org/S4306496895",
"type": "journal"
}
] |
|
https://openalex.org/W4243599000
|
Smarajit Jana
|
[
{
"affiliations": [],
"display_name": "Andrew Green",
"id": "https://openalex.org/A5000005180"
}
] |
[
{
"display_name": "Sex work",
"id": "https://openalex.org/C2780100914"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
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{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Gender studies",
"id": "https://openalex.org/C107993555"
},
{
"display_name": "Human immunodeficiency virus (HIV)",
"id": "https://openalex.org/C3013748606"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
}
] |
[
"West Bank"
] |
[] |
https://api.openalex.org/works?filter=cites:W4243599000
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Physician and public health specialist who championed HIV prevention. Born on July 21, 1952, in rural West Bengal, India, he died from COVID-19 on May 8, 2021, in Kolkata, India, aged 68 years old. In 1992, Smarajit Jana was tapped to lead the first population-based HIV survey among sex workers in Kolkata's Sonagachi neighbourhood. He was an unusual choice, colleagues said, as a physician who had been teaching occupational health and epidemiology at Kolkata's All India Institute of Hygiene and Public Health (AIIH&PH). “He started going to the red-light area and began engaging with sex workers and others”, said Sushena Reza-Paul, an Assistant Professor in the Department of Community Health Sciences at the University of Manitoba, Canada. Jana began to reframe “sex work as work, looking at it from a workers' rights perspective, with HIV as an occupational hazard”, she said. Those early efforts, which became known as the Sonagachi Project, were the start of Jana's decades-long involvement with the community. “He started discussions with the sex workers to understand them and the power structures that govern their lives”, Reza-Paul said, and sought collectivised responses. That work included the formation of the Durbar Mahila Samanwaya Committee (DMSC) in 1995. DMSC is now a collective of more than 65 000 sex workers in West Bengal. “He really did change the nature of how communities can organise themselves and agitate and advocate for their own health and welfare”, said Kevin O'Reilly, formerly with WHO's Department of HIV/AIDS and now an Affiliate Associate Clinical Professor at the Department of Psychiatry and Behavioral Science at the Medical University of South Carolina in Charleston, USA. Jana received a bachelor of medicine and bachelor of surgery from the University of Calcutta in 1978, and his doctor of medicine degree from AIIH&PH in 1984. After working briefly as a physician, he returned to AIIH&PH to teach and would remain on the faculty as a field epidemiologist even as he began to develop the Sonagachi Project and DMSC. His early efforts in Sonagachi involved innovative approaches to HIV prevention that saw sex workers take responsibility for educating their colleagues and distributing condoms. “He understood that if people have access to services in their preferred way, they will do everything that is needed to protect their own health”, said Swarup Sarkar, a former adviser to several UN organisations and the Indian Government. Between 1992 and 1999, condom use among sex workers in Kolkata increased substantially and HIV seroprevalence never climbed above 10%. Those achievements were only possible, Reza-Paul said, because of Jana's efforts to empower the people he worked with. “He used to always tell me, we cannot just prevent HIV by promoting condoms or doing check-ups”, she said. “People need to have control over their lives.” Jana helped DMSC strategise and secure funding to address the myriad problems the sex workers faced. They were able to build nurseries and boarding schools for their children and to establish an independent cooperative bank so they would have access to accounts and affordable loans. Literacy increased and violence declined. Jana “showed us the path of light, a life of dignity like any other in the country”, said Bharati Dey, DMSC's Mentor. Jana made sure the sex workers and their children “are recognised as being integral to the society and he devoted his life to that”, said Dey. Jana stepped down from a leadership position in the DMSC in the late 1990s but remained an adviser. “His model really shifted the whole strategy for HIV/AIDS in India, in terms of getting them collectivised and able to negotiate their terms of survival”, said K Sujatha Rao, the former Union Secretary of India's Ministry of Health and Family Welfare and the former Director General of the National AIDS Control Organization. “His work has shaped international thinking about working with very marginalised, very disempowered groups, including sex workers, but many other groups as well”, said Isabelle de Zoysa, the former Senior HIV/AIDS Adviser to the WHO Assistant Director-General for Family and Community Health. Jana also exported the lessons from Sonagachi. In his work for the humanitarian organisation CARE Bangladesh from 1999 to 2003, he helped expand HIV interventions to sex workers and also to people who inject drugs and truck drivers. He returned to India to take over as CARE India's Assistant Country Director and was based in the country, moving between government and international advisory positions and teaching roles. Jana is survived by his wife, Madhulina, daughter, Samaita, and son, Sambit.
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https://openalex.org/W2045456302
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UK banking on consent
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Britain has won both academic and public support for a major human genomics and health project. Nigel Williams reports. Britain has won both academic and public support for a major human genomics and health project. Nigel Williams reports. A UK project to study genetics alongside health and lifestyle data, piloted in Manchester, has proved a success in no small part to the specific consent sought from participants by researchers. This pilot has now turned into the largest study of the genetic and environmental causes of disease rolled out across the UK. The UK Biobank aims to obtain DNA samples from up to 500,000 people aged 40–69 and track their health. It is hoped the database will be used to find cures for killer illnesses such as heart disease, diabetes and cancer. The project received unanimous support from a team of international experts and its backers this summer following the Manchester pilot. Letters will be sent to men and women in the target group by the end of the year, inviting them to attend one of a network of assessment centres to be set up in locations around the UK. Over the next three to four years, there will be around 35 centres in the UK, each open for about six months. The centres will be located in areas where there are about 150,000 men and women aged 40–69 living within a 15 kilometre radius. The project will gather, store and protect a vast bank of medical data and material. The aim is to give accredited researchers a rich resource which they can use to examine how the complex interplay of genes, lifestyle and environment affects our risk of disease. The £61 million project is being funded by the Medical Research Council, the Wellcome Trust, the Department of Health, the Scottish Executive and the North West Regional Development Agency. A final protocol has been closely assessed by an independent international review panel set up by the funders. In its report the panel concluded that “UK Biobank has the potential, in ways that are not currently available elsewhere, to support a wide range of research”. It also praised the planning of the project, and the way it had dealt with potential ethical problems. The key role of participant consent has been highlighted by concerns raised last month that patient records in the UK's National Health Service are planned to be loaded onto a national database. A survey amongst doctors and other health professionals found many uneasy about the storage of data without patients' consent. The development of the Biobank is therefore likely to highlight the issue of consent, flagged up in the international review, as a key basis of its operation. Rory Collins, UK Biobank's principal investigator, was delighted that the project had been given the thumbs up this summer. He said: “For decades to come, the UK Biobank resource should provide researchers around the world with vital insights into some of the most distressing diseases of middle and old age”. Colin Blakemore, MRC chief executive, said that the Biobank “offers enormous potential to find out more about the complex links between our genes, the lives we lead and our health.” Health minister Andy Burnham said the endorsement of Biobank showed the UK was at the forefront of applying new genetics-based knowledge for the benefit of patients. But there remain some worries. Helen Wallace, of the group GeneWatch, said there was concern that research funding might be better used elsewhere. She said: “We would still like to see a much more open process of decision-making which actively involves members of the public.”
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https://openalex.org/W3122043528
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Adetokunbo Oluwole Lucas
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"display_name": "Geoff Watts",
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Leading expert in global health. He was born in Lagos, Nigeria, on Nov 25, 1931, and died in Ibadan, Nigeria, on Dec 25, 2020, aged 89 years. Adetokunbo (Ade) Lucas, described by colleagues as a giant of global health, entered the field not of his own volition, but by invitation and not without a degree of doubt. In 1962, as a senior registrar at Ibadan's University College Hospital in Nigeria, he was asked by his vice-chancellor to switch from clinical medicine to public health. Admittedly, he had already picked up some of the basics: a course in epidemiology and statistics, and a diploma in public health, both acquired during postgraduate training at Queen's University Belfast in the UK. Even so, by Lucas's own admission he only accepted the new Ibadan post as Senior Lecturer in the Department of Preventive and Social Medicine after “much consideration”. But the move was an outstanding success. Within 3 years, aged 33 years, he was appointed Professor and Head of the Department: the first step in a career that was to include key administrative and academic jobs ranging from WHO to Harvard University. A childhood ambition to become a lawyer having been displaced by an interest in doctoring, the young Lucas started his career by moving to the UK to study medicine at Durham University. Further training in Newcastle, at the London School of Hygiene & Tropical Medicine, and in Belfast preceded his return to Nigeria in 1960 and the subsequent switch to public health. Through the 1960s and early 1970s he did clinical, laboratory, and epidemiological studies on pneumococcal meningitis, histoplasmosis, schistosomiasis, malaria, and tetanus. In 1973, with his reputation established, Lucas became the first Chair of what is now the Nigerian Institute of Medical Research. This job served as a proving ground for his next and much larger task. In 1976, he became Director of the Special Programme for Research and Training in Tropical Diseases (TDR), which is co-sponsored by WHO, the World Bank, UNICEF, and the UN Development Programme. “He helped to shape TDR into a global force for advancing research into diseases of poverty”, says Michael Reich, the Taro Takemi Research Professor of International Health Policy at the Harvard T H Chan School of Public Health. Among many other achievements, Lucas initiated the celebrated scheme under which the Merck corporation donates its drug ivermectin for the treatment of onchocerciasis. “Besides funding research on the problems that affect poor countries”, adds Julio Frenk, President and Professor of Public Health Sciences at the University of Miami, “TDR aimed to build capacity in those countries for conducting research themselves…[Ade] wanted to overturn the idea that research was something rich countries did and then exported knowledge to poor countries.” On leaving TDR in 1986, Lucas spent several years in the USA at the Carnegie Corporation of New York, where he supported programmes for reducing maternal mortality, and also taught at the Rockefeller University. He was an adviser to the Bill & Melinda Gates Foundation and the Carter Center. His last full-time post, from 1990 to 1995, was as Professor of International Health at Harvard University. Among his notable achievements there was the organisation of an international leadership programme: a week-long seminar for ministers of health on the challenges of their task and how to address them. Lucas may have spent long periods away from Nigeria, Reich reflects, “but his heart remained in his home and his family, and his commitment to what makes a difference in people's lives”. “A towering figure in the field of global health,” says Frenk. “One of the pioneer figures in shaping it.” Reich agrees: “He was the most gracious, loyal, and wise person, and with the highest moral integrity.” Reich adds that Lucas was renowned for his story-telling. “I remember one public health researcher saying that he was with Professor Lucas somewhere in west Africa when their plane was cancelled and he spent 10 hours in the airport listening to Ade's stories. He recalled it as one of the great experiences of his life.” Lola Dare, a community physician and President of a Nigerian-based, not-for-profit social enterprise, CHESTRAD Global, who first met Lucas when she was studying at Harvard, has another perspective. “Everybody talks about his intelligence, but his humanity was perhaps the best part of him”, she says. “If he was your mentor, whatever you had to handle, whether personal or professional, he would be part of it…He was a person of deep religious faith, and he expressed it in a very practical way through his work.” Lucas leaves his wife, Stella Kofoworola, daughter, Ekundayo, and sons, Olufunmilade and Oladipo.
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https://openalex.org/W2614842762
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Health Transitions in Sub-Saharan Africa: Overview of Mortality Trends in Children under 5 Years Old (1950-2000)/transitions Sanitaires En Afrique Sub-Saharienne : Presentation Succincte Des Tendances De la Mortalite Chez Les Enfants De Moins De 5 Ans (1950-2000)/transiciones Sanitarias En El Africa Subsahariana: Panorama De Las Tendencias De la Mortalidad En Los Menores De 5 Anos (1950-2000)
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[TEXT NOT REPRODUCIBLE IN ASCII] Introduction The health transition, defined as a steady decline in mortality, has been one of the most important features of demographic changes in the twentieth century, and has had many economic and social consequences. (1-5) In sub-Saharan Africa, the health transition began somewhat later than in other countries. Although much change has occurred there since 1930, most African countries still have high levels of infant and child mortality compared with other regions, with much variation between countries. To judge the health transition in Africa fairly, it seems most appropriate to consider trends in mortality rather than simply looking at current mortality. In countries where the health transition started later, a relatively high death rate after a period a steady decline in mortality could still indicate a favourable health transition, as is the case in some west African countries. By contrast, a situation of increasing mortality, but with a relatively low current mortality could hide a negative change, as is the case in some countries in southern Africa. Documentation of mortality trends will allow a better understanding of the status of the health transition in Africa, and help to identify gaps where further action is needed. The monitoring of mortality trends is particularly important in children younger than 5 years old, a group that is the main target of public health policies and the most common indicator of mortality levels in developing countries. Comprehensive vital registration data remain the best source for assessing mortality trends, but these data are not currently available in most African countries. To assess mortality trends, analysts rely on data from demographic sample surveys, or other sources such as mortality data collected in censuses. (6-10) A synthesis of indirect mortality estimates in Africa was conducted at the World Bank for the period before 1985, (11-12) and showed a steady decline in mortality in almost all countries investigated. This study was repeated and extended to other countries, and included new estimates for African countries. (13-14) However, these syntheses suffer from the lack of precision associated with the use of indirect methods to estimate trends, and especially trend reversals. Ahmad et al. have completed analysis using direct and indirect estimates, and reconstructing trends by 5-year periods from 1955-59 to 1995-99. (15) This compendium made better use of all available data, in particular direct estimates provided by Demographic and Health Surveys (DHS). However, although the use of 5-year time periods provided reasonable estimates of mortality levels and major trends, it often obscured the specific time periods when changes in mortality trends occurred. Being able to establish the precise date of reversals in mortality trends is important if the cause of these changes is to be identified. In this study we aimed to provide new estimates of trends in mortality in children younger than 5 years in African countries with data from demographic sample surveys. The rationale of this analysis is to identify periods of monotonic change, and precise times at which trend changes occur. Here, we present a synthesis of our work; more details at country level are provided in a companion working paper. (16) Methods To reconstruct mortality trends, we used data from demographic sample surveys with maternity histories. These data provide dates of birth, and when applicable, age at death, for large samples of live births, which allowed us to compute age-specific death rates for periods many years before the survey. A total of 56 DHS and 10 World Fertility Surveys (WFS) were selected, covering 32 sub-Saharan Africa countries. In addition, a Multiple Indicator Cluster Survey (MICS) was included to cover Angola, which had no DHS or WFS survey. This MICS survey was based on a simplified methodology: only birth histories of the last three pregnancies were included, which shortens the retrospective period for estimating mortality trends. …
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https://openalex.org/W2102581604
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SARS: 1918 Revisited? The Urgent Need for Global Collaboration in Public Health
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Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever. Sir William Osler Humanity has been profoundly affected by plagues since the dawn of recorded history. The mother of all plagues, the Black Death, killed more than one third of the population of Europe in the 14th century.1Gottfried RS The Black Death: Natural and Unnatural Human Disaster in Medieval Europe. Free Press, New York, NY1983Google Scholar In more recent times, the great influenza epidemic of 1918, which had an inexplicably devastating mortality in persons between the ages of 20 and 40 years,2Pyle GF The Diffusion of Influenza: Patterns and Paradigms. Rowman & Littlefield, Totowa, NJ1986Google Scholar claimed the lives of 4 times as many soldiers as died on the battlefields of France at the height of World War I, and 25 to 50 million persons worldwide died of H1N1 influenza A.2Pyle GF The Diffusion of Influenza: Patterns and Paradigms. Rowman & Littlefield, Totowa, NJ1986Google Scholar, 3Crosby AW America's Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, England1989Google Scholar The world now faces a new apocalyptic horseman, severe acute respiratory syndrome (SARS), caused by a new human coronavirus (SARS-CoV). Genetic evidence suggests that SARS-CoV is a human-animal recombinant4Peiris JSM Lai ST Poon LL SARS study group et al.Coronavirus as a possible cause of severe acute respiratory syndrome.Lancet. 2003; 361: 1319-1325Abstract Full Text Full Text PDF PubMed Scopus (2444) Google Scholar, 5Ksiazek TG Erdman D Goldsmith CS SARS Working Group et al.A novel coronavirus associated with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1953-1966Crossref PubMed Scopus (3511) Google Scholar, 6Drosten C Günther S Preiser W et al.Identification of a novel coronavirus in patients with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1967-1976Crossref PubMed Scopus (3630) Google Scholar, 7Ruan Y Wei CL Ling AE et al.Comparative full-length genome sequence analysis of 14 SARS coronavirus isolates and common mutations associated with putative origins of infection. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4454web.pdfDate: May 2003Google Scholar that made the leap, possibly from a civet or other smaller mammal, to humans in Guangdong Province, southern China.7Ruan Y Wei CL Ling AE et al.Comparative full-length genome sequence analysis of 14 SARS coronavirus isolates and common mutations associated with putative origins of infection. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4454web.pdfDate: May 2003Google Scholar Between November 2002 and June 5, 2003, 8402 persons worldwide have acquired SARS, the vast majority in China (5329 infected; 334 deaths), Taiwan (678; 81), Hong Kong (1748; 283), Singapore (206; 31), Vietnam (63; 5), or Toronto, Canada (216; 31).8World Health Organization Cumulative number of reported probable cases of SARS.Available at: www.who.int/csr/sars/country/2003_06_04/en/print.htmlGoogle Scholar In keeping with its infamous historical predecessors, SARS has resulted in the deaths of 12% of patients with this disease,8World Health Organization Cumulative number of reported probable cases of SARS.Available at: www.who.int/csr/sars/country/2003_06_04/en/print.htmlGoogle Scholar many in some of the most advanced hospitals in the world.9Lee N Hui D Wu A et al.A major outbreak of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1986-1994Available at: www.nejm.orgCrossref PubMed Scopus (1966) Google Scholar, 10Tsang KW Ho PL Ooi GC et al.A cluster of cases of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1977-1985Available at: www.nejm.orgCrossref PubMed Scopus (941) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar, 12Booth CM Matukas LM Tomlinson GA et al.Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.JAMA. 2003; 289 (Accessibility verified June 4, 2003.): 2801-2809Available at: http://jama.ama-assn.org/cgi/search?fulltext=greater+toronto+areaCrossref PubMed Scopus (1157) Google Scholar Mortality in persons older than 60 years has exceeded 40%.13Donnelly CA Ghani AC Leung GM et al.Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4453web.pdfDate: May 2003Google Scholar SARS, which produces an unusually severe form of atypical pneumonia, is only the latest in a growing list of emerging infectious diseases detected and characterized since 1977, including legionnaires' disease; Clostridium difficile antibiotic-associated colitis; toxic shock syndrome caused by unique strains of Staphylococcus aureus or Streptococcus pyogenes; hemolytic uremic syndrome and thrombotic thrombocytopenic purpura deriving from food-borne infection caused by Escherichia coli O157:H7; human immunodeficiency virus infection and acquired immunodeficiency syndrome (AIDS); the blurring spectrum of human and animal prion diseases-Creutzfeld-Jakob disease, bovine spongiform encephalopathy, and chronic wasting disease of cervids; and in North America, Hantavirus pneumonitis and West Nile encephalitis. It has become clear that a large and highly developed country such as the United States not only has a powerful self-interest but also a moral obligation to invest in a world-class communicable disease center, such as the Centers for Disease Control and Prevention, to be able to detect and characterize new infectious diseases and contain their spread. The importance and impact of nationally funded organizations of excellence, staffed by the best and brightest and working in global concert with other like-minded organizations, also cannot be overstated. SARS was recognized as a distinct new infectious disease syndrome by Dr Carlo Urbani on February 28, 2003; the viral causation was identified and confirmed by scientists around the world within a month.4Peiris JSM Lai ST Poon LL SARS study group et al.Coronavirus as a possible cause of severe acute respiratory syndrome.Lancet. 2003; 361: 1319-1325Abstract Full Text Full Text PDF PubMed Scopus (2444) Google Scholar, 5Ksiazek TG Erdman D Goldsmith CS SARS Working Group et al.A novel coronavirus associated with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1953-1966Crossref PubMed Scopus (3511) Google Scholar, 6Drosten C Günther S Preiser W et al.Identification of a novel coronavirus in patients with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1967-1976Crossref PubMed Scopus (3630) Google Scholar International scientific collaboration, championed by epidemiologists and virologists at the World Health Organization, the US Centers for Disease Control and Prevention, and centers in Singapore, Hong Kong, Canada, and Germany, has been unprecedented14World Health Organization A multicentre collaboration to investigate the cause of severe acute respiratory syndrome.Lancet. 2003; 361: 1730-1733Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar, 15Gerberding JL Faster…but fast enough? responding to the epidemic of severe acute respiratory syndrome [editorial].N Engl J Med. 2003; 348: 2030-2031Crossref PubMed Scopus (89) Google Scholar and has led to containment of SARS in most of the affected countries, particularly Vietnam, Singapore, and Hong Kong, at the time this editorial was written.8World Health Organization Cumulative number of reported probable cases of SARS.Available at: www.who.int/csr/sars/country/2003_06_04/en/print.htmlGoogle Scholar, 16World Health Organization Update 73 - No new deaths, but vigilance needed for imported cases.Available at: www.who.int/csr/don/2003_06_04/en/print.htmlDate: June 4, 2003Google Scholar SARS is unique among the numerous types of community-acquired pneumonia: (1) it has a prohibitive mortality, considerably higher than most other viral or bacterial community-acquired pneumonias, with the exception of pneumonitis caused by Legionella pneumophila or Hantavirus; (2) mortality has been high in adults, especially those older than 60 years, but clinical disease has been uncommon and mild in children17Hon KLE Leung CW Cheng WTF et al.Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet [serial online].Available at: http://image.thelancet.com/extras/03let4127web.pdfDate: April 2003Google Scholar; (3) early microbiologic confirmation of SARS has been difficult because the virus is hard to culture in vitro, conventional DNA/RNA detection techniques such as reverse-transcriptase polymerase chain reaction have been relatively insensitive in the early phase of infection,4Peiris JSM Lai ST Poon LL SARS study group et al.Coronavirus as a possible cause of severe acute respiratory syndrome.Lancet. 2003; 361: 1319-1325Abstract Full Text Full Text PDF PubMed Scopus (2444) Google Scholar, 5Ksiazek TG Erdman D Goldsmith CS SARS Working Group et al.A novel coronavirus associated with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1953-1966Crossref PubMed Scopus (3511) Google Scholar, 6Drosten C Günther S Preiser W et al.Identification of a novel coronavirus in patients with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1967-1976Crossref PubMed Scopus (3630) Google Scholar, 10Tsang KW Ho PL Ooi GC et al.A cluster of cases of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1977-1985Available at: www.nejm.orgCrossref PubMed Scopus (941) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar, 12Booth CM Matukas LM Tomlinson GA et al.Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.JAMA. 2003; 289 (Accessibility verified June 4, 2003.): 2801-2809Available at: http://jama.ama-assn.org/cgi/search?fulltext=greater+toronto+areaCrossref PubMed Scopus (1157) Google Scholar and seroconversion, which ultimately occurs in nearly all infected individuals, takes up to 20 days11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar; (4) SARS can be extraordinarily contagious,18Centers for Disease Control and Prevention Severe acute respiratory syndrome—Singapore, 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 405-411PubMed Google Scholar, 19Centers for Disease Control and Prevention Severe acute respiratory syndrome—Taiwan, 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 461-466PubMed Google Scholar with more than one half of the early cases involving health care workers9Lee N Hui D Wu A et al.A major outbreak of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1986-1994Available at: www.nejm.orgCrossref PubMed Scopus (1966) Google Scholar, 10Tsang KW Ho PL Ooi GC et al.A cluster of cases of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1977-1985Available at: www.nejm.orgCrossref PubMed Scopus (941) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar, 12Booth CM Matukas LM Tomlinson GA et al.Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.JAMA. 2003; 289 (Accessibility verified June 4, 2003.): 2801-2809Available at: http://jama.ama-assn.org/cgi/search?fulltext=greater+toronto+areaCrossref PubMed Scopus (1157) Google Scholar; (5) the incubation period of SARS (mean, 6.4 days13Donnelly CA Ghani AC Leung GM et al.Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4453web.pdfDate: May 2003Google Scholar) is much longer than that for other respiratory viruses, and it appears that infected persons are not contagious until they become symptomatic; and (6) most cases probably become infected by droplet spread20Seto WH Tsang D Yung RW Expert SARS Group of Hospital Authority et al.Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS).Lancet. 2003; 361: 1519-1520Abstract Full Text Full Text PDF PubMed Scopus (706) Google Scholar (<10μM respiratory particles inhaled within 2 m of the source), but SARS-CoV can survive for hours on environmental surfaces,21World Health Organization First data on stability and resistance of SARS coronavirus compiled by members of WHO laboratory network.Available at: www.who.int/csr/sars/survival_2003_05_04/enGoogle Scholar and, at least in theory, there appears to be potential for contact transmission and even fecal-oral spread.9Lee N Hui D Wu A et al.A major outbreak of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1986-1994Available at: www.nejm.orgCrossref PubMed Scopus (1966) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar, 19Centers for Disease Control and Prevention Severe acute respiratory syndrome—Taiwan, 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 461-466PubMed Google Scholar, 22Hong Kong Department of Health Report Main findings of an investigation into the outbreak of severe acute respiratory syndrome at Amoy Gardens.Available at: www.info.gov.hk/dh/ap.htmGoogle Scholar In this issue of the Mayo Clinic Proceedings, Sampathkumar et al23Sampathkumar P Temesgen Z Smith TF Thompson RL SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar provide a succinct review of SARS and a valuable primer for clinicians and infection control practitioners. Although clinical features of SARS are nonspecific, with near-ubiquitous fever and cough, it must be emphasized that coryza and sore throat, which are common with most other human respiratory virus infections, are uncommon in SARS, and the cough is characteristically nonproductive.9Lee N Hui D Wu A et al.A major outbreak of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1986-1994Available at: www.nejm.orgCrossref PubMed Scopus (1966) Google Scholar, 10Tsang KW Ho PL Ooi GC et al.A cluster of cases of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1977-1985Available at: www.nejm.orgCrossref PubMed Scopus (941) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar, 12Booth CM Matukas LM Tomlinson GA et al.Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.JAMA. 2003; 289 (Accessibility verified June 4, 2003.): 2801-2809Available at: http://jama.ama-assn.org/cgi/search?fulltext=greater+toronto+areaCrossref PubMed Scopus (1157) Google Scholar In contrast, gastrointestinal symptoms such as diarrhea are common and in some cases may predominate without respiratory symptoms.11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar, 19Centers for Disease Control and Prevention Severe acute respiratory syndrome—Taiwan, 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 461-466PubMed Google Scholar Notably, several laboratory findings, rarely seen with other types of community-acquired pneumonia, may prove to be of considerable value as surrogate markers of early SARS: lymphopenia (<1000/μL); mild thrombocytopenia (<150,000/μL); evidence of disseminated intravascular coagulation with elevated D-dimer levels; low-grade rhabdomyolysis with elevated creatine phosphokinase levels; and especially an elevated lactic dehydrogenase level; 1 or more of these abnormalities are seen in up to 90% of patients, particularly in sicker patients.9Lee N Hui D Wu A et al.A major outbreak of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1986-1994Available at: www.nejm.orgCrossref PubMed Scopus (1966) Google Scholar, 10Tsang KW Ho PL Ooi GC et al.A cluster of cases of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1977-1985Available at: www.nejm.orgCrossref PubMed Scopus (941) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar, 12Booth CM Matukas LM Tomlinson GA et al.Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.JAMA. 2003; 289 (Accessibility verified June 4, 2003.): 2801-2809Available at: http://jama.ama-assn.org/cgi/search?fulltext=greater+toronto+areaCrossref PubMed Scopus (1157) Google Scholar Until a sensitive, specific, and rapid confirmatory diagnostic test becomes available, for any febrile patient with cough, especially with radiological evidence of pneumonia or acute respiratory distress syndrome (ARDS), who has recently returned from a country where community transmission of SARS is occurring or has occurred or who has had recent close contact with another person suspected of having SARS, an immediate algorithmic approach must be initiated to prevent nosocomial spread. Specific measures include segregating patients with suspected SARS from other patients, ideally in a negative-pressure isolation room; masking the patient; and requiring all health care workers attending to the patient to wear a fit-tested N-95 respirator mask (or powered air-purifying system), a full-length long-sleeved gown and nonsterile gloves, and eye protection with goggles or a face shield.24Centers for Disease Control and Prevention Interim guidance on infection control precautions for patients with suspected severe acute respiratory syndrome (SARS) and close contacts in house-holds.Available at: www.cdc.gov/ncidod/sars/ic-closecontacts.htmDate: April 29, 2003Google Scholar, 25Centers for Disease Control and Prevention Updated interim domestic infection control guidance in the health-care and community setting for patients with suspected SARS.Available at: www.cdc.gov/ncidod/sars/infectioncontrol.htmDate: May 1, 2003Google Scholar Suspicion of SARS must be recorded on all specimens sent to the diagnostic laboratory. As Sampathkumar et al point out, all health care workers attending to the patient must be noted and monitored closely for fever, the earliest sign of occupationally acquired infection. The importance of measures to prevent droplet airborne spread cannot be overemphasized. In a novel analysis of a large cohort of health care workers who had had extensive contact with patients with SARS in 5 Hong Kong hospitals, Seto et al20Seto WH Tsang D Yung RW Expert SARS Group of Hospital Authority et al.Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS).Lancet. 2003; 361: 1519-1520Abstract Full Text Full Text PDF PubMed Scopus (706) Google Scholar found that no health care worker who consistently used a mask, either an N-95 respirator mask or a high-quality surgical mask, became infected (P<.01), even if he or she did not always wear gloves. Hand washing and wearing a gown also appeared to be important in protection against occupationally acquired infection. To prevent spread of SARS in the community, public health authorities must strive to identify every contact of the presumed case, especially health care workers exposed without the benefit of barrier precautions, and place them on home quarantine.24Centers for Disease Control and Prevention Interim guidance on infection control precautions for patients with suspected severe acute respiratory syndrome (SARS) and close contacts in house-holds.Available at: www.cdc.gov/ncidod/sars/ic-closecontacts.htmDate: April 29, 2003Google Scholar, 25Centers for Disease Control and Prevention Updated interim domestic infection control guidance in the health-care and community setting for patients with suspected SARS.Available at: www.cdc.gov/ncidod/sars/infectioncontrol.htmDate: May 1, 2003Google Scholar The epidemiological feature of SARS that gives greatest hope for containing spread is the prolonged incubation period, which allows case-contact investigation and quarantine to be instituted before contacts destined to become ill can spread SARS-CoV to others. Whereas quarantine was ineffective in preventing spread of influenza during the great epidemic of 19182Pyle GF The Diffusion of Influenza: Patterns and Paradigms. Rowman & Littlefield, Totowa, NJ1986Google Scholar, 3Crosby AW America's Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, England1989Google Scholar because of its extremely brief incubation period, isolation of actively infected patients and stringent quarantine of those exposed have been the linchpin of control of SARS in Vietnam, Hong Kong, Singapore, Canada, and perhaps even China.9Lee N Hui D Wu A et al.A major outbreak of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1986-1994Available at: www.nejm.orgCrossref PubMed Scopus (1966) Google Scholar, 10Tsang KW Ho PL Ooi GC et al.A cluster of cases of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1977-1985Available at: www.nejm.orgCrossref PubMed Scopus (941) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar, 12Booth CM Matukas LM Tomlinson GA et al.Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.JAMA. 2003; 289 (Accessibility verified June 4, 2003.): 2801-2809Available at: http://jama.ama-assn.org/cgi/search?fulltext=greater+toronto+areaCrossref PubMed Scopus (1157) Google Scholar, 13Donnelly CA Ghani AC Leung GM et al.Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4453web.pdfDate: May 2003Google Scholar, 16World Health Organization Update 73 - No new deaths, but vigilance needed for imported cases.Available at: www.who.int/csr/don/2003_06_04/en/print.htmlDate: June 4, 2003Google Scholar Beyond ruling out other treatable causes of community-acquired pneumonia and cutting-edge supportive care for critical illness,26Maki DG Management of life-threatening infection in the ICU.in: Murray MJ Coursin DB Pearl RG Prough DS Critical Care Medicine: Perioperative Management. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, Pa2002: 616-648Google Scholar including lung-protective low-tidal-volume mechanical ventilatory support,27Acute Respiratory Distress Syndrome Network Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.N Engl J Med. 2000; 342: 1301-1308Crossref PubMed Scopus (10580) Google Scholar stringent glycemic control,28van den Berghe G Wouters P Weekers F et al.Intensive insulin therapy in critically ill patients.N Engl J Med. 2001; 345: 1359-1367Crossref PubMed Scopus (8361) Google Scholar restrictive use of packed red blood cell transfusions,29Hebert PC Wells G Blajchman MA Transfusion Requirements in Critical Care Investigators Canadian Critical Care Trials Group et al.A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care [published correction appears in N Engl J Med. 1999;340:1056].N Engl J Med. 1999; 340: 409-417Crossref PubMed Scopus (4197) Google Scholar and uncompromising adherence to basic infection control precautions,26Maki DG Management of life-threatening infection in the ICU.in: Murray MJ Coursin DB Pearl RG Prough DS Critical Care Medicine: Perioperative Management. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, Pa2002: 616-648Google Scholar it is still uncertain whether corticosteroids or antivirals, such as ribavirin, both recommended anecdotally by Hong Kong physician-investigators who have treated large numbers of patients,9Lee N Hui D Wu A et al.A major outbreak of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1986-1994Available at: www.nejm.orgCrossref PubMed Scopus (1966) Google Scholar, 10Tsang KW Ho PL Ooi GC et al.A cluster of cases of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1977-1985Available at: www.nejm.orgCrossref PubMed Scopus (941) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar will improve outcome in terms of reducing mortality and length of hospitalization. The exuberant, proliferative inflammatory response with alveolar membrane formation seen histopatho-logically5Ksiazek TG Erdman D Goldsmith CS SARS Working Group et al.A novel coronavirus associated with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1953-1966Crossref PubMed Scopus (3511) Google Scholar, 10Tsang KW Ho PL Ooi GC et al.A cluster of cases of severe acute respiratory syndrome in Hong Kong.N Engl J Med. 2003; 348 (Accessibility verified June 5, 2003.): 1977-1985Available at: www.nejm.orgCrossref PubMed Scopus (941) Google Scholar, 11Peiris JSM Chu CM Cheng VCC et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4432web.pdfDate: May 2003Google Scholar is extremely similar to that seen in gardenvariety ARDS but also not unlike desquamative interstitial pneumonitis or organizing pneumonia,30Cordier JF Organising pneumonia.Thorax. 2000; 55: 318-328Crossref PubMed Scopus (289) Google Scholar with or without bronchiolitis obliterans,31Epler GR Bronchiolitis obliterans organizing pneumonia.Arch Intern Med. 2001; 161: 158-164Crossref PubMed Scopus (239) Google Scholar conditions that usually respond favorably to corticosteroids. Evidence that moderate doses of corticosteroids may be of benefit in refractory late-phase severe ARDS32Meduri GU Headley AS Golden E et al.Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial.JAMA. 1998; 280: 159-165Crossref PubMed Scopus (855) Google Scholar and unequivocally improve survival in patients with AIDS and severe Pneumocystis carinii pneumonia33Gagnon S Boota AM Fischl MA Baier H Kirksey OW La Voie L Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: a double-blind, placebo-controlled trial.N Engl J Med. 1990; 323: 1444-1450Crossref PubMed Scopus (323) Google Scholar further suggests that, in patients with SARS and progressive hypoxemic respiratory failure, early treatment with prednisone at a dose of 1 to 2 mg/kg per day may improve survival. In contrast, the efficacy of antivirals such as ribavirin, which has substantial toxicity,12Booth CM Matukas LM Tomlinson GA et al.Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.JAMA. 2003; 289 (Accessibility verified June 4, 2003.): 2801-2809Available at: http://jama.ama-assn.org/cgi/search?fulltext=greater+toronto+areaCrossref PubMed Scopus (1157) Google Scholar is far less clear, and no antiviral drug or drugs can be recommended at this time. Prospective multicenter randomized trials are urgently needed to determine conclusively the therapeutic role of early use of corticosteroids as well as ribavirin and other candidate antiviral drugs. However, the burning question remains: Will SARS continue to spread? Might it even explode on the world in the coming fall and winter months in the Northern Hemisphere (Table 1)? The huge negative economic impact of SARS in Asia and Canada to date has been sobering,38Simon B The cost of a virus.New York Times. May 23, 2003; Sect W: 1Google Scholar but the very real potential for uncontained global spread is even more sobering. Accelerated efforts to develop a vaccine, with trials in animal models under way, are encouraging. We can take heart that SARS has been successfully contained in most affected countries,8World Health Organization Cumulative number of reported probable cases of SARS.Available at: www.who.int/csr/sars/country/2003_06_04/en/print.htmlGoogle Scholar, 16World Health Organization Update 73 - No new deaths, but vigilance needed for imported cases.Available at: www.who.int/csr/don/2003_06_04/en/print.htmlDate: June 4, 2003Google Scholar at least for now, but most importantly, SARS may have launched a new era of international cooperation in communicable disease control and public health in general.14World Health Organization A multicentre collaboration to investigate the cause of severe acute respiratory syndrome.Lancet. 2003; 361: 1730-1733Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar, 15Gerberding JL Faster…but fast enough? responding to the epidemic of severe acute respiratory syndrome [editorial].N Engl J Med. 2003; 348: 2030-2031Crossref PubMed Scopus (89) Google Scholar It is no longer acceptable for countries to conceal their outbreaks or other health care problems.39Benitez MA Beijing doctor alleges SARS cases cover-up in China.Lancet. 2003; 361: 1357Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Realizing that each day hundreds of thousands of people from every corner of the globe fly transcontinentally, the world is a rapidly shrinking global village in regard to infectious diseases. It is in every country's selfinterest to be forthcoming and work collaboratively toward a common goal-the prevention of communicable diseases and improvement of the health of every citizen of the world.Table 1Parallels Between 1918 Influenza and SARS*CDC = Centers for Disease Control and Prevention; SARS = severe acute respiratory syndrome.Like more recent strains of the influenza A virus,34Treanor JT Influenza virus.in: Mandell GL Bennett JE Dolin R Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Churchill Livingstone, Philadelphia, Pa2000: 1823-1849Google Scholar the 1918 (H1N1) strain was almost certainly a human-animal recombinant that originated in southern China 35Brownlee GG Fodor E The predicted antigenicity of the haemagglutinin of the 1918 Spanish influenza pandemic suggests an avian origin.Philos Trans R Soc Lond B Biol Sci. 2001; 356: 1871-1876Crossref PubMed Scopus (87) Google Scholar, 36Hilleman MR Realities and enigmas of human viral influenza: pathogenesis, epidemiology and control.Vaccine. 2002; 20: 3068-3087Crossref PubMed Scopus (258) Google ScholarIn all likelihood, so is the SARS coronavirus (SARS-CoV)4Peiris JSM Lai ST Poon LL SARS study group et al.Coronavirus as a possible cause of severe acute respiratory syndrome.Lancet. 2003; 361: 1319-1325Abstract Full Text Full Text PDF PubMed Scopus (2444) Google Scholar, 5Ksiazek TG Erdman D Goldsmith CS SARS Working Group et al.A novel coronavirus associated with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1953-1966Crossref PubMed Scopus (3511) Google Scholar, 6Drosten C Günther S Preiser W et al.Identification of a novel coronavirus in patients with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1967-1976Crossref PubMed Scopus (3630) Google Scholar, 7Ruan Y Wei CL Ling AE et al.Comparative full-length genome sequence analysis of 14 SARS coronavirus isolates and common mutations associated with putative origins of infection. Lancet [serial online].Available at: http://image.thelancet.com/extras/03art4454web.pdfDate: May 2003Google ScholarH1N1 influenza was extraordinarily contagious presumably because there was so little natural immunity in the general population worldwide36Hilleman MR Realities and enigmas of human viral influenza: pathogenesis, epidemiology and control.Vaccine. 2002; 20: 3068-3087Crossref PubMed Scopus (258) Google ScholarSerologic surveys by the CDC using specimens from US serum banks show no persons with preexisting antibodies to the new SARS virus5Ksiazek TG Erdman D Goldsmith CS SARS Working Group et al.A novel coronavirus associated with severe acute respiratory syndrome.N Engl J Med. 2003; 348: 1953-1966Crossref PubMed Scopus (3511) Google ScholarH1N1 influenza A had high mortality among young and healthy individuals2Pyle GF The Diffusion of Influenza: Patterns and Paradigms. Rowman & Littlefield, Totowa, NJ1986Google Scholar, 3Crosby AW America's Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, England1989Google ScholarSARS has also had a prohibitive mortality8World Health Organization Cumulative number of reported probable cases of SARS.Available at: www.who.int/csr/sars/country/2003_06_04/en/print.htmlGoogle Scholar and has killed previously well health care workers, including the discoverer of SARS, Dr Carlo Urbani37Reilley B Van Herp M Sermand D Dentico N SARS and Carlo Urbani.N Engl J Med. 2003; 348: 1951-1952Crossref PubMed Scopus (72) Google ScholarInfluenza A classically spreads in the late fall and winter months and is rarely seen during the late spring and summer months34Treanor JT Influenza virus.in: Mandell GL Bennett JE Dolin R Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Churchill Livingstone, Philadelphia, Pa2000: 1823-1849Google Scholar; in 1918, influenza continued to occur, inexplicably, all summer3Crosby AW America's Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, England1989Google ScholarSARS has caused epidemic disease all spring and will likely continue to spread slowly throughout the summer monthsIn 1918, pandemic influenza surged worldwide in late August and the fall2Pyle GF The Diffusion of Influenza: Patterns and Paradigms. Rowman & Littlefield, Totowa, NJ1986Google Scholar, 3Crosby AW America's Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, England1989Google ScholarWith SARS, we do not know what will occur, but we must be prepared for the worst; countries, regional and municipal health departments, hospitals, and individual practitioners must be informed and prepared* CDC = Centers for Disease Control and Prevention; SARS = severe acute respiratory syndrome. Open table in a new tab We must hang together or assuredly we shall all hang separately. Benjamin Franklin SARS: Epidemiology, Clinical Presentation, Management, and Infection Control MeasuresMayo Clinic ProceedingsVol. 78Issue 7PreviewSevere acute respiratory syndrome (SARS) is a recently recognized febrile respiratory illness that first appeared in southern China in November 2002, has since spread to several countries, and has resulted in more than 8000 cases and more than 750 deaths. The disease has been etiologically linked to a novel coronavirus that has been named the SARS-associated coronavirus. It appears to be spread primarily by large droplet transmission. There is no specific therapy, and management consists of supportive care. Full-Text PDF
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Public Health Shifts Focus To Preventing Chronic Illness
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Back to table of contents Previous article Next article Health Care EconomicsFull AccessPublic Health Shifts Focus To Preventing Chronic IllnessMark MoranMark MoranSearch for more papers by this authorPublished Online:1 Dec 2006https://doi.org/10.1176/pn.41.23.0015American public health, long focused on control of infectious disease, is undergoing a fundamental change in outlook as it turns its attention to chronic disease, including mental illness.So said psychiatrist Neil Cohen, M.D., New York City's former commissioner of health, during a lecture on public health challenges in psychiatry at the APA institute on Psychiatric Services in New York in October.Cohen said the success of American public health measures over the last 100 years in controlling infectious disease, combined with the increase in prevalence of chronic conditions, is forcing a change in the priorities of public health departments across the country. And with this change has come a recognition of the pervasiveness of mental illness.Meanwhile, psychiatric epidemiology research has advanced to the point that risk factors can be identified. “Psychiatric epidemiology is not just about counting anymore,” Cohen said. “We are at the dawn of an era when we can now look at risk-factor epidemiology, examining the causes that contribute to—and the protective factors that decrease risks for—mental illness in communities.“The knowledge to be gained from modern-day psychiatric epidemiology is as much about psychopathology and understanding the roots of mental illness as it is about epidemiology,” he said. “The advances that derive from this approach allow us to look at subthreshold syndromes, at the number of factors at play that put an individual at risk for advancing pathology.”Cohen was the city's health commissioner from 1998 to 2002. In that post, he oversaw the public health responses to several crises: the outbreak of West Nile virus, the attacks on the World Trade Center, and anthrax-laced letters sent to media outlets in the city. He also served as commissioner of the New York Department of Mental Health, Mental Retardation, and Alcoholism Services, and he oversaw the merger of the health and mental health departments into a unified public health agency. He is currently clinical director and vice chair of the department of Psychiatry at mt. Sinai Medical Center and director of its Division of Community Medicine.Infectious-Disease Focus Has a PriceCohen noted that the significant extension of life expectancy for Americans during the 20th century was due not so much to medical advances as to the success of core public health activities such as improvements in nutrition and hygiene and the monitoring and control of infectious diseases.“But the preoccupation with infectious disease came with a cost,” Cohen said. “it slowed the development of measures to deal with stroke, heart disease, and diabetes. And it limited the amount of attention that was paid to curtailing high-risk behaviors that contribute to prevalence of chronic conditions.”The focus began to shift in the early 1990s, with the emergence of several lines of research demonstrating the profound effect of behavior on human health.“Despite the need for public health interventions to address behavior, only 5 percent of each health care dollar is devoted to behavior modification,” Cohen stated.Related to this have been the historic neglect of mental health and illness and the segregation of public mental health activities from the rest of public health and medicine. These too have begun to change in the wake of studies in the early 1990s by the World Bank and Harvard School of Public Health showing the enormous burden of disease related to mental illness.That research found that major depression trailed behind only ischemic heart disease in terms of lost years of productivity due to death or disability and that depressive disorders, taken together, are the leading cause of disability worldwide.Satcher Reports Changed ThinkingEven more powerful were the reports on mental health and illness by former Surgeon General David Satcher, M.D. Along with President Bush's New Freedom Commission on Mental Health and the enormous strides made in biomedical research on mental illness, the result has been a slow but certain realignment of priorities.Cohen said the threat of terrorism and bioterrorism has also galvanized the integration of mental health and public health. Drawing on his experience helping to coordinate the response to the terrorist attacks on September 11, 2001, Cohen said there has been an effort to “bring mental health issues to bear on the larger public health response” to the threat of terrorism and bioterrorism.And those threats have raised the profile of public health departments.“ In this post-9/11 world, the decades-long neglect of the public health system has been changing,” Cohen said. “Increasingly, the public and government are aware that a robust public health infrastructure is critical to the capacity to respond to a whole host of emerging threats.”Cohen believes that a principal public health challenge facing psychiatry today is to draw on the new power of psychiatric epidemiology to develop models that focus on maintenance of positive mental health and prevention of mental illness rather than merely the treatment of disease when it appears. And he cited satcher in pointing out that “successful performance really rests on a foundation of successful mental health.”Neil Cohen, M.D.: “Increasingly, the public and government are aware that a robust public health infrastructure is critical to the capacity to respond to a whole host of emerging threats.” Ellen Dallager“What I've been talking about is an alignment with the larger public health system and a greater focus on community well-being than has heretofore been our focus,” Cohen said. “The relationship between physical and mental disorders is profoundly influential with respect to morbidity and mortality and could very well be the core of a new model of public mental health...[that will] really take up the challenge of improving quality of life not only for individuals but entire communities.” ▪ ISSUES NewArchived
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Forging new partnerships
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With health care reform in the news daily, this is an exciting time to be an RD. We have an unprecedented opportunity to broaden our influence, shape our future role on the health care team, and establish ourselves as the nutrition experts. Forging partnerships with other health care professionals is one way to reach these goals. In her president's page (p 697), Susan Finn shows how establishing partnerships with physicians gives us visibility outside the traditional dietetics roles. We want physicians to think “dietitian” when they hear the word “nutrition.” Aspects of the RD's professional image are explored on page 684. Creating partnerships with other professional groups strengthens our message. For the first time, ADA has developed a joint position with The Canadian Dietetic Association — Nutrition for physical fitness and athletic performance (p 691). Also in this issue is our health care reform platform, which was endorsed by a coalition consisting of ADA, Association of the Faculties of Graduate Programs in Public Health Nutrition, Association of State and Territorial Public Health Nutrition Directors, and the Society for Nutrition Education. The platform focuses on the cost-effective and preventive aspects of nutrition services. Our message is that nutrition care is a critical component of medical care and that including preventive nutrition services in the standard health benefits package has economic and health benefits. Finn's testimony before Congress (p 640) explores the specific benefits of preventive nutrition services in disease prevention and in a variety of settings: acute care, outpatient and home care, and managed care. Finn calls for reimbursement for nutrition services as a way to extend nutrition care to all. Gilbert Omenn's commentary (p 643) brings the public health perspective to health care reform and highlights yet another area for potential partnerships. Home health care will be an important part of health care reform as we move to more outpatient services. The article by McCrae et al (p 664) explores how parenteral nutrition is moving from hospital to home. In an accompanying interview (p 667), Laurie Mello Udine asserts that extending reimbursement to nutrition services will open up areas such as home health care to dietitians. The strength of the Journal, too, is in its partnerships. We accomplish our goals through teamwork. However, the team has gone through some changes in the past months. We bid farewell to Christine Beuoy, who served so capably as Managing Editor for the past years and as a Journal staff member for 4 years before that. She shepherded us through a major redesign and a partial transition to desktop publishing. Christine has left the Chicago area and is working for the publications office of the University of Illinois. We wish her the best. We are using the strength, commitment, and experience of our existing staff to maintain the quality of the Journal without missing a step. Betsy Crist, an Assistant Editor for years, will take over as Managing Editor. Betsy came to ADA with extensive editing experience from another medical association journal. She has an MA in English from the University of Virginia and a BA in English and history from Eastern Illinois University. Nancy Hahn, also an Assistant Editor for years, will take on some additional duties as Associate Managing Editor. Nancy has a background in media relations at the Federal Reserve Bank. She has a BA degree in English with a concentration in journalism from the University of Illinois. Audrey Nagelberg has joined our staff as an Assistant Editor. Previously, she worked as an editorial assistant for a large magazine publishing company. Audrey has a BA in English from Indiana University. We will continue to complete the transition to desktop publishing and to explore ways to become more user-friendly for our readers. By the fall we will implement structured abstracts for research articles, which will help the reader focus on results and implications. As always, we are interested in our readers' opinions and ideas for the improvement of the Journal. Write us and let us know what you think. Judith V. Anderson, DrPH, RD, Michigan Department of Public Health, Lansing Susan I. Barr, PhD, University of British Columbia, Vancouver Mary Ruth Bedford, PhD, RD, Consultant, El Paso, Tex Sue Brady, DMSc, RD, James Whitcomb Riley Hospital, Indiana University Medical Center, Indianapolis Linda J. Brinkley, RD, University of Texas Health Sciences Center, Dallas Martha T. Conklin, PhD, RD, Montclair State College, Upper Montclair, NJ Rebecca A. Dowling, PhD, RD, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill John P. Foreyt, PhD, Baylor College of Medicine, Houston, Tex Judith Gilbride, PhD, RD, New York Univeristy, New York Susan M. Krebs-Smith, PhD, RD, National Cancer Institute, Bethesda, Md Debra A. Krummel, PhD, RD, Hershey Foods Corporation, Hershey, Pa Janet Mcdonald, PhD, RD, US Food and Drug Administration, San Francisco, Calif Alanna Moshfegh, MS, RD, US Department of Agriculture, Hyattsville, Md Suzanne P. Murphy, PhD, RD, University of California, Berkeley Debe Nagy-Nero, MS, RD, Consultant, Vancouver, Wash Grace Ostenso, PhD, RD, US House of Representatives, Washington, DC Ellen Parham, PhD, RD, Northern Illinois University, De Kalb Patt Queen Samour, MMSc, RD, New England Deaconess Hospital, Boston, Mass Linda V. Van Horn, PhD, RD, Northwestern University Medical School, Chicago, Ill Madelyn L. Wheeler, MS, RD, Indiana University Medical Center & Diabetes Research and Training Center, Indianapolis Olivia B. Wood, MPH, RD, Purdue University, West Lafayette, Ind
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Gaps between the rich and the poor: The widening differences in wealth, life expectancy, public health infrastructure and perception of threats, and the consequences for global security
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Science & Society9 May 2003free access Gaps between the rich and the poor The widening differences in wealth, life expectancy, public health infrastructure and perception of threats, and the consequences for global security Laurie Garrett Laurie Garrett Newsday, New York Search for more papers by this author Laurie Garrett Laurie Garrett Newsday, New York Search for more papers by this author Author Information Laurie Garrett1 1Newsday, New York EMBO Reports (2003)4:S15-S19https://doi.org/10.1038/sj.embor.embor859 PDFDownload PDF of article text and main figures. ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinked InMendeleyWechatReddit Figures & Info Our world was shaken on 11 September 2001 as we watched hijacked aeroplanes crash into the World Trade Center, the Pentagon and a grassy field in Pennsylvania. In ways far too numerous to count, we are still experiencing the ripples—social, political, religious and economic—from the events of that day. Even now, more than a year after these tragedies, we can barely imagine where these terrorist attacks will lead the world. Certainly, their historic impact was compounded less than a month later by the death of photo editor Robert K. Stevens, a victim of an anthrax-poisoned letter. Since then, it seems that life in the USA has been turned upside-down. Subjects once considered the purview of paranoids, quacks and troublesome scientists are now the foci of orange alerts, billions of dollars in government security spending, intense public fear and a newfound interest in public health. The USA has become a fearful nation. And that fear is driving billions of dollars into spending on bioterrorism research, improvements in public health infrastructure, preparedness for epidemics and the study of microbes. The microbes are hitchhikers on human frailty, prejudice, inequity and filth Although scientists have long warned about emerging infectious diseases, it was only recently—in the second administration of President Bill Clinton—that microbes received serious attention from the federal government. The Clinton administration classified emerging diseases and the AIDS pandemic as national security concerns, giving mandates for their scrutiny by agencies as far from basic science as the Central Intelligence Agency (CIA), the National Security Administration, the Federal Bureau of Investigation and the State Department. By the late 1990s, the CIA in particular had developed a vigorous division for analysing global disease trends (Working Group on Emerging and Reemerging Infectious Diseases, 1995). But all this was abandoned when George W. Bush acceded to the Presidency in 2001. His national security advisors, particularly Condoleeza Rice, rejected the notion of non-nation-state definitions of national security, such as international drug and weapons trafficking, resource scarcities and emerging diseases. The blossoming divisions devoted to such issues at the CIA and other government agencies were shut down. This happened despite a strongly worded CIA report that was handed to Bush shortly after his inauguration (National Intelligence Council, 2002a), which warned of impending global instability due to pandemics and bioterrorist threats. The Bush administration altered its assessment of such risks shortly after the attacks on the World Trade Center and the Pentagon, and today bioterrorism and threats to public health rank among the US government's top priorities. If we look closely at these threats, nearly all of the factors responsible for promoting the emergence of microbes in new ecologies, such as that of Africa's West Nile Virus in the concrete jungle of New York City, or the re-emergence of microbes in ecologies from which they had long been vanquished, are of man's creation (United States General Accounting Office, 2000). We aid and abet the microbes. We create our own risks. Yes, the microbes have the advantage of evolutionary speed, but we offer them ample selection pressure, mobility, new vectors and fantastic conditions for replication and zoonosis. In the most extreme cases, we use microbes to further political or terrorist causes. The microbes are hitchhikers on human frailty, prejudice, inequity and filth. Fifteen-year-old Zimbabwean boys face a 74% chance of dying of AIDS before their 30th birthdays The travels of Christopher Columbus, Captain Cook and the seventeenth-century slave traders carried microbes to human beings whose immune systems had neither innate nor acquired resistance to measles, influenza, syphilis, smallpox, yellow fever and a host of other killers. The result was unparalleled carnage (Watts, 1997). Surely, that can never happen again. Theoretically, globalization will, in the long run, spread microbes to so many ecologies that our species will develop a sort of uniform level of immunity, rendering a level playing field for all healthy Homo sapiens, regardless of where they live or travel. But we are still many generations away from this scenario. Furthermore, a uniformity of human acquired immunity might also be interpreted as a uniform susceptibility. Microbes are able to develop new methods of bypassing our immune responses, either through novel approaches to infection or through the direct assault, or even manipulation, of our own immune systems. The HIV pandemic might simply be the first of a new set of microbial threats that effectively exploit human frailties—in this case, sexual promiscuity, non-sterile syringe use and contaminated blood transfusions—to infect our species. Since 1996, when highly active anti-retroviral therapy (HAART) was widely introduced in the developed world, death rates due to AIDS have plummeted in the USA, Canada, Western Europe, Japan and other wealthy areas. Whereas this boon has markedly affected the lives of these HIV-positive individuals, it has not registered as so much as a statistical blip in the overall, global pandemic (Weiss, 2001; United Nations AIDS Programme (UNAIDS), 2002a). This is, of course, because HAART is unaffordable and unavailable to most people who are suffering from AIDS at present. Today, the HIV pandemic is out of control in sub-Saharan Africa, with some regions of the continent suffering adult infection rates as high as 45% (UNAIDS, 2002b). If uncurbed, the pandemic will grow to astounding proportions. Karen Stanecki from the US Census Bureau predicts that by 2020, at least 6,427,000 Africans will die every year from AIDS if no effective vaccine becomes available. Bearing in mind that there are, at present, only 360 million Africans, this will constitute an extraordinary annual toll. On 3 October 2002, the Zimbabwe National AIDS Council adjusted its estimate of the national HIV prevalence across all age groups. The prevalence was already a sorry 25% in 2000, but became a breathtaking 34% for 2002. Fifteen-year-old Zimbabwean boys face a 74% chance of dying of AIDS before their 30th birthdays. A survey in South Africa found that 72% of the nation's households are now headed by women, and 31% of all heads of households are HIV positive. Government surveys of pregnant women in Botswana last year found that 81% of them were unmarried, and 44% were HIV positive. By the end of this decade, 70% of HIV-positive individuals will be female, according to UNAIDS forecasts, meaning that millions of children will be left motherless (UNAIDS, 2002b). Who will raise all those babies? Total HIV infection rates are rising most rapidly in the east and south of the continent, whereas they have remained remarkably stable in central Africa and have only recently started to increase in the west. The gender bias might be softened in the west of the continent because of a long tradition there of female entrepreneurship and the power that comes with money (Human Rights Watch, 2003). Researchers from the Institute of Tropical Medicine in Antwerp have compared HIV trends in women from West Africa—from Cotonou in Benin and Yaounde in Cameroon—with those from the east—Kisumu in Kenya and Ndola in Zambia. Whereas infection rates have remained below 5% in all female age groups in the west, they have approached 60% in Zambian women and 48% in Kenya (Buve et al., 2001). The most disturbing new trend was discerned by Glynn and colleagues, working in Kenya and Zambia (Glynn et al., 2001), who found that girls who had fewer lifetime incidents of sexual intercourse and had lost their virginity within the previous 12 months were more likely to be infected than their more experienced counterparts. At first glance, this seems counterintuitive. Why should younger, sexually naive girls have the higher infection rates? The terrible answer lies in the fact that violent sex against women has increased markedly in the region, mainly because of the belief that sex with a virgin removes a man's HIV infection (PlusNews, 2002; Burkhalter, 2002). A recent survey in Capetown (Jewkes et al., 2002) found that 60% of teenaged girls said they had been victims of rape. And UNICEF reports that increasing numbers of school girls in the region are experiencing their first sexual encounters at the hands of their male teachers (Human Rights Watch, 2002). A study in Tanzania and Uganda shows that HIV-positive women are 7–10 times more likely to have been the victim of rape (Quigley et al., 2000). Clearly, HIV is a virus that is spreading fastest in societies with the most severe imbalances of power between the genders: not in political power, but in the power of the bed. The key to reversing this trend is in a woman's right to say who she has sex with, when she has sex and under what circumstances. HIV is spreading where women cannot possibly insist that their partners use condoms. It is cruel, indeed, to cry “safe sex” or “sexual abstinence” in the face of widespread rape and coercive sex. In some of the countries hardest hit by HIV, life expectancies are plummeting to levels last seen before the Second World War (Table 1; Fig. 1) and child survival rates are also reversing (UNAIDS, 2002b; Walker et al., 2002). These terrible numbers represent a complete negation of decades of investment—billions of dollars, marks, francs and pounds—in these nations. They also represent a grave threat to their stability. In national security circles in Washington, at the World Bank and the International Monetary Fund, so-called ‘chimney effect’ charts (Lamptey, 2002) are bringing economists and security analysts to the AIDS table (Fig. 2). On the x axis, separated into genders, are population numbers, and on the y axis is age. One colour depicts a demographic projection for an African country's population distribution in 2020 in the absence of HIV. Overlaid in a darker colour is the continent's projection with HIV. The HIV epidemic is producing a demographic ‘chimney’ so that by 2020 the most severely affected countries will have roughly the same numbers of elderly people as would have been the case in the absence of HIV. But the middle-aged, productive labour force, professionals, leaders and parents will be diminished to a narrow band. And below them will be a massive population of young adults and adolescents—unsupervised, orphaned, and increasingly without values or education. Figure 1.Decreasing life expectancy caused by the HIV/AIDS epidemic Download figure Download PowerPoint Figure 2.The ‘chimney’ effect. Download figure Download PowerPoint Table 1. Global life expectancies Rank Country Years 1 Japan 74.5 24 USA 70 40 Costa Rica 66.7 70 Ukraine 63 81 China 62.3 91 Russia 61.3 134 India 53.2 160 South Africa 39.8 161 Kenya 39.3 163 Nigeria 38.3 176 Tanzania 36 180 Mozambique 34.4 184 Zimbabwe 32.9 186 Uganda 32.7 187 Botswana 32.3 188 Zambia 32.3 191 Sierra Leone 30.3 Source: The World Health Report 2001, http://www.who.int/whr/en In the Lake Victoria area, where this epidemic is in its fourth human generation, the chimney effect is already a reality. It is illustrated by an 83-year-old woman I met in the village of Kyebe, Uganda, who took me on a tour of her small plot of banana trees. Throughout the grove were mounds of stone, under which were buried her husband, 10 out of 12 of her children and 10 out of 33 of her grandchildren. And with only bananas to sell, she is raising the remaining 23. Her plight is hardly a rarity. Indeed, from house to house in Kyebe and neighbouring villages the horrors of the chimney effect can be seen. In many parts of sub-Saharan Africa, AIDS is called ‘Grandmothers’ disease’ in reference to the millions of youngsters now being reared by destitute, grief-stricken, elderly women. With more than 14 million children orphaned by this plague so far (UNAIDS, 2002b), we are witnessing a genuine collapse of cultures. For example, I visited an orphanage in Tanzania that exclusively raises infants under two years of age, most of them orphaned by the AIDS pandemic. When the toddlers reach the age of two the orphanage turns them over to little girls from the same clans to raise them thereafter. Most of these girls are themselves AIDS orphans. As resourceful as they are, they cannot comprehend immunizations, and do not have the strength to carry their little charges dozens of kilometres to clinics for vaccination. The re-emergence of measles, polio and other childhood diseases is inevitable in the region. More importantly, these girls cannot tell their charges who their ancestors were, what is the history of their people, and what spiritual and cultural values they ought to believe. And so, before our very eyes, precious elements of African culture are disappearing. HIV is hastening what anthropologist Wade Davis of the National Geographic Society, USA, called “ethnospheric extinction”. …fearfulness is not a good prism through which to view microbial threats The economic impact of this pandemic might hit sooner than expected. According to James Morris, head of the World Food Programme, the famine of southern Africa that now threatens the lives of 16 million people is more about AIDS than about drought and politics. “HIV/AIDS is a fundamental, underlying cause of vulnerability in the region”, Morris said (Wurst, 2002). Alex De Waal and Alan Whiteside argue that HIV has created a new form of famine, the like of which has never faced humanity before (De Waal, 2002; Barnett & Whiteside, 2002). From my own observations, fields all over Africa are now fallow because of the lack of a workforce. Agriculture is women's work and, with rape a constant danger, fewer women are willing to work alone in the fields. In Zimbabwe I encountered a gang of roving rapists who marauded the fields in search of virgin girls. In late September, the National Intelligence Council (NIC) of the CIA released an important report on ‘the Next Wave of AIDS’ (National Intelligence Council, 2002b)—the epidemics that are only now emerging, and could well define the future of this scourge. The report focused on China, India, Nigeria, Ethiopia and Russia, which in 2002 had a total of 14–23 million people infected with HIV. The NIC report estimates that by 2010 there will be 50–75 million individuals in these countries with HIV. In India, about 4 million people are believed to be infected, and the bulk of all transmission is due to the same primary factor that underlies the African epidemic: gender. India's vast sex industry is fuelling the epidemic, although intravenous drug use is a component, and the country has an unsafe blood industry. The NIC report predicts that there will be up to 25 million HIV-infected Indians in 2010, with a national seroprevalence of 3–4%. China's epidemic is extremely complicated, because human beings there are affording HIV many different options for transmission. These include heterosexual and homosexual intercourse, hospital-acquired transmission through blood and non-sterile needles, a booming narcotics abuse problem and an extraordinary imbalance of genders owing to the one-child policy and parental preference for male offspring. These boys are now of age, cannot find brides, and are fuelling a booming brothel industry. The NIC report forecasts that China will have up to 15 million infected citizens in 2010, with an adult prevalence approaching 2%. Nigeria, Africa's most populous nation, will also have 15 million HIV-positive citizens and an adult prevalence of up to 26% in 2010. This will affect the stability of the region because Nigerian troops are the major peacekeepers in western Africa. HIV has recently reached the critical 5% nationwide prevalence mark, and infection rates in 15–30-year-olds in urban areas now exceed 15%, according to the nation's AIDS control board (National Intelligence Council, 2002b). Given that Nigeria has the largest standing army on the continent and is the world's sixth biggest oil producer, this rising tide of infection has prompted serious concerns about national security in Washington. Over on the Horn of Africa, Ethiopia now has an adult prevalence of about 18%, and this is forecast to reach 27% by 2010. And then there is Russia. Although the NIC report focuses on this country, my investigations have revealed that the entire former Soviet Union, particularly the Baltics, Ukraine and Belarus, are following the same trend (Garrett, 2000). Here, the epidemic would be comparatively easy to stop because it is not sexual—not yet. Today, more than 90% of all new infections are acquired through the injection of narcotics, and victims are predominately young adults (Grisin & Wallander, 2002). The vector is clear: only politics stands in the way of slowing the disaster through the provision of sterile syringes. Russia already has the highest adult prevalence in the northern hemisphere, of about 2.5%. By 2010, both the Russian Ministry and the NIC Report estimate that 8 million Russians, or 11–12% of all adults, will be infected (Feshbach, 2002). The loss of an educated, productive adult labour force is a catastrophe wherever it occurs. Russia, in particular, is experiencing a marked reversal in population size, predicted to fall below 1917 levels within a generation (Feshbach, 2002). As a result, the country's primary industries are witnessing acute labour shortages, and this will reach critical proportions within a decade. The added burden of HIV, which is predominately afflicting young adult males, could well cripple any prospects for economic growth in this nation. Of greater concern in national security circles are the differentially high losses in the upper tiers of the militaries of China, Russia and India—all of them nations with nuclear weapons (Eberstadt, 2002; Xinhua News Agency, 2002; Makiese, 2002). The HIV pandemic has caused an upsurge in other diseases as well, most notably tuberculosis (TB). TB is out of control, now claiming more people's lives than at any time in the history of our species (World Health Organization, 2001). The distressing rise in multidrug-resistant forms of the TB microbe is forcing doctors to resort to early twentieth-century treatments, such as complete lung removal. In addition, the world's blood supply remains largely untested for HIV and hepatitis B and C. As more of the global population is rendered immunodeficient, we might see far more obscure organisms entering the blood supply, having opportunistically infected blood donors who are HIV positive, the elderly, or patients after organ transplantation or during cancer chemotherapy. At least 18 deaths from West Nile Virus in the USA in 2002 were due to blood transmission. What will be next? And AIDS itself is already sapping the resources of health care systems throughout the developing world. In Malawi's capital, for example, patients are now ‘warehoused’ three to a bed. Health care workers are themselves dying of the disease. As we prepare to create mass distribution systems for dispensing anti-HIV drugs in poor countries, competition is rising. Botswana, for example, has accused South Africa of poaching its nurses and doctors, leaving the tiny country with no health providers. South Africa's nurses are, in turn, being recruited to the UK and the USA, where hospitals are experiencing acute shortages in nursing personnel. Ethiopia already has a rural doctor-to-patient ratio of 1:50,000; how much worse can this get before hospital-acquired disease, rampant drug resistance and unnoticed epidemics become the norm in hospital settings that are grossly understaffed and packed with dying, immunodeficient patients? History will look back with wonder—and judgement. It might ask how it could be that this great HIV plague swept over the world, almost unnoticed by the dominant cultures, the wealthy and powerful, while more exotic and unremarkable outbreaks garnered vast resources and mobilized the public imagination. History will undoubtedly recall that nearly everybody in the medical and scientific communities pooh-poohed reports in 1981 and 1982 of unusual pneumonia and skin cancers in gay men in the USA and Europe. Those handfuls of cases have now become 65 million cumulative HIV-positive individuals. We fear infectious diseases of all kinds and we have rational reasons for this. But fearfulness is not a good prism through which to view microbial threats. Humans have a tendency to nonchalantly play down the significance and ability of microbes when we feel secure—even smug—in the superiority of our species. Conversely, when threatened, humans tend to exaggerate microbial threats, so that an Ebola virus outbreak in remote Kikwit, Zaire, is perceived as a direct danger to the global populace. However, we have entered new territory: anthrax; bioterrorism; HIV—this is our twenty-first century. And it is the new age of globalization for microbes. As the events of the autumn of 2001 illustrate, human beings are willing to exact unimaginable tolls from one another. And they are willing to use microbes as weapons. But perhaps history will record that the more important, vital basis for human fearfulness in the early twenty-first century was signalled by the arrival of HIV and its opportunistic companions. Biography Laurie Garrett is Science and Medical Writer for Newsday, New York, and author of The Coming Plague: Newly Emerging Diseases in a World out of Balance and Betrayal of Trust: The Collapse of Global Public Health. E-mail: [email protected] References Barnett T. & Whiteside A. (2002) AIDS in the Twenty-First Century: Disease and Globalization. Palgrave MacMillan, London, UK.CrossrefGoogle Scholar Burkhalter H.J. (2002) The Violent Transmission of HIV/AIDS. CSIS HIV/AIDS Task Force, Washington DC, USA.Google Scholar Buve A. et al. (2001) Multicentre study on factors determining differences in rate of spread of HIV in sub-Saharan Africa: methods and prevalence of HIV infection. AIDS, 15 ( Suppl. 4), S5–S14.CrossrefPubMedWeb of Science®Google Scholar De Waal A. (2002) ‘New variant’ famine: how AIDS has changed the hunger equation. All Africa Global Media <www.AllAfrica.com>, 20 November 2002.Google Scholar Eberstadt N. (2002) The future of AIDS. Foreign Affairs, November/December.Google Scholar Feshbach M. (2002) Russia's Health and Demographic Crises: Policy Implications and Consequences. Chemical and Biological Arms Control Institute Series on Health and National Security, Washington DC, USA.Google Scholar Garrett L. (2000) Betrayal of Trust: The Collapse of Global Public Health. Hyperion, New York, USA.Google Scholar Glynn J.R., Carael M., Auvert B., Kahindo M., Chege J., Musonda R., Kaona F. & /buve A. (2001) Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia. AIDS, 15 ( Suppl. 4), S51–S60.CrossrefPubMedWeb of Science®Google Scholar Grisin S.A. & Wallander C.A. (2002) Russia's HIV/AIDS Crisis. Center for Strategic and International Studies, Washington DC, USA.Google Scholar Human Rights Watch (2002) Suffering in Silence: the Links Between Human Rights Abuses and HIV Transmission to Girls in Zambia. Human Rights Watch, New York, USA.Google Scholar Human Rights Watch (2003) Double Standards: Women's Property Rights Violations in Kenya. Human Rights Watch, New York, USA.Google Scholar Jewkes R., Levin J., Mbanaga N. & Bradshaw D. (2002) Rape of girls in South Africa. Lancet, 359, 319–320.CrossrefPubMedWeb of Science®Google Scholar Lamptey P.R. (2002) Reducing heterosexual transmission of HIV in poor countries. BMJ, 324, 207–211.CrossrefPubMedWeb of Science®Google Scholar Makiese P. (2002) Le FNUAP sensibilise les militaires et les policiers sur la pandémie. Le Phare (Congo), 4 December.Google Scholar National Intelligence Council (2002a) Global Trends 2015: a Dialogue About the Future With Nongovernmental Experts. NIC 2000–2002, Washington DC, USA.Google Scholar National Intelligence Council (2002b) The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India and China. ICA 2002-04D, Washington DC, USA.Google Scholar PlusNews (2002) South Africa: Focus on the Virgin Myth of HIV/AIDS, 24 April 2002. Integrated Regional Information Networks, UN Office for the Coordination of Humanitarian Affairs, Nairobi, Kenya.Google Scholar Quigley M.A., Morgan D., Malamba S.S., Mayanja B., Okongo M.J., Carpenter L.M. & Whitworth J.A. (2000) Case–control study of risk factors for incident HIV infection in rural Uganda. J. Acquir. Immune Defic. Syndr., 23, 418–425.CASPubMedWeb of Science®Google Scholar UNAIDS (2002a) AIDS Epidemic Update 2002. UNAIDS, Geneva, Switzerland.Google Scholar UNAIDS (2002b) Report on the Global HIV/AIDS Epidemic. UNAIDS, Geneva, Switzerland.Google Scholar United States General Accounting Office (2000) West Nile Virus Outbreak: Lessons for Public Health Preparedness. GAO/HEHS-00-180, Washington DC, USA.Google Scholar Walker N., Schwartlander B. & Bryce J. (2002) Meeting international goals in child survival and HIV/AIDS. Lancet, 360, 284–289.CrossrefPubMedWeb of Science®Google Scholar Watts S. (1997) Epidemics and History: Disease, Power and Imperialism. Yale Univ. Press, New Haven, Connecticut, USA.Google Scholar Weiss R. (2001) AIDS: unbeatable 20 years on. Lancet, 357, 2073–2074.CrossrefCASPubMedWeb of Science®Google Scholar Working Group on Emerging and Reemerging Infectious Diseases (1995) Global Microbial Threats in the 1990s. NSTC Committee on International Science, Engineering and Technology (CISET), Washington DC, USA.Google Scholar World Health Organization (2001) Macroeconomics and Health: Investing in Health for Economic Development. World Health Organization Commission of Macroeconomics and Health, Geneva, Switzerland.Google Scholar Wurst J. (2002) Africa faces unprecedented crisis. UN Wire, 4 December. United Nations Foundation, Washington DC, USAGoogle Scholar Xinhua News Agency (2002) About 50 percent of Zimbabwe soldiers HIV positive. Xinhua, 29 December.Google Scholar Previous ArticleNext Article Volume 4Issue S11 June 2003In this issue FiguresReferencesRelatedDetailsLoading ...
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Science & Society9 May 2003free access Malaria: past problems and future prospects After more than a decade of neglect, malaria is finally back on the agenda for both biomedical research and public health politics Janet Hemingway Corresponding Author Janet Hemingway Liverpool School of Tropical Medicine, Liverpool, UK Search for more papers by this author Imelda Bates Imelda Bates Liverpool School of Tropical Medicine, Liverpool, UK Search for more papers by this author Janet Hemingway Corresponding Author Janet Hemingway Liverpool School of Tropical Medicine, Liverpool, UK Search for more papers by this author Imelda Bates Imelda Bates Liverpool School of Tropical Medicine, Liverpool, UK Search for more papers by this author Author Information Janet Hemingway 1 and Imelda Bates1 1Liverpool School of Tropical Medicine, Liverpool, UK *Corresponding author. E-mail: [email protected] EMBO Reports (2003)4:S29-S31https://doi.org/10.1038/sj.embor.embor841 PDFDownload PDF of article text and main figures. ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinked InMendeleyWechatReddit Figures & Info Malaria is one of the world's biggest killers. In areas where it is highly endemic, young children bear the brunt of the disease. Last year, between 1 and 2 million children below the age of 5 years died of malaria, most of them in Africa. The statistic itself is telling: if malaria were a disease found predominantly in developed countries, then this huge margin of error would be much smaller. The reality is that in the poorest countries, where malaria takes its highest toll, it is difficult to collect accurate data and to derive meaningful statistics about malaria (Trigg & Kondrachine, 1998). Most malaria deaths occur at home, without confirmation of the diagnosis. During their illness, many patients struggle, often unsuccesfully, to access even basic health care. For those that succeed, the care they receive may be of dubious quality and ineffective. To tackle these important problems there is an obvious need for better implementation of our current methods for malaria prevention, diagnosis and treatment, as well as an urgent requirement for new methods to reduce the malaria burden (Hommel, 2002). The publication of the genomes of Plasmodium falciparum and Anopheles gambiae in October 2002 has given new hope for the development of new anti-malarial drugs that may ultimately help to control the disease. …in the African and Asian malaria heartlands, it soon became clear that eradication with the available tools, expertise, manpower and funding would be impossible Why is malaria still such a huge problem, 105 years after Ross discovered how the malaria parasite is transmitted by the mosquito vector and a century after he received a Nobel Prize for this seminal discovery? Eradication of malaria was promoted in the 1960s, when indoor residual spraying with DDT and prophylaxis using chloroquine were a powerful combination for reducing malaria transmission. On the fringes of the malaria belt in Europe and in parts of Southeast Asia, this campaign was a spectacular success, but in the African and Asian malaria heartlands, it soon became clear that eradication with the available tools, expertise, manpower and funding would be impossible. The emerging resistance of the parasites to the available drugs and of the mosquito vectors to DDT compounded the situation, and the euphoria about the proposed eradication gave way to efforts to sustainably control malaria. Furthermore, the poverty of the areas where malaria transmission is highest, and the unwillingness of richer countries to support open-ended control programmes, means that it is crucial to allocate resources for malaria control to clearly defined priorities that are based on established evidence. Good leadership and political will are essential to implement evidence-based malaria control on a national scale, but these are often lacking. In April 2000 in Abuja, Nigeria, delegations from 44 African nations met in the largest-ever heads-of-state summit focused on a single health issue. They pledged to take decisive steps towards halving the world's malaria burden by 2010, and to ensure that 60% of those affected have access to treatment, are particularly protected during pregnancy, and sleep under insecticide-treated nets (ITNs; Figs 1,2). These promises were made as the African leaders signed up to ‘Roll Back Malaria’ (RBM), a global partnership created in 1998 by the World Health Organization (WHO), the United Nations (UN) Development Programme, the UN Children's Fund and the World Bank. Despite such initiatives, there is little sign of progress towards the Abuja goals. Figure 1.Insecticide-impregnated bednet trials are underway in Nane-Janania village near Navrongo, Ghana. Drying the nets on sleeping mats also helps to kill any insects in the mat. © WHO/TDR/Ane Haaland. Download figure Download PowerPoint Figure 2.Ronei do Silva Rodrigues and his migrant parents in Candeias township close to Porto Velho, Brazil, habitually sleep under bednets to avoid being bitten by mosquitoes. © WHO/TDR/Mark Edwards. Download figure Download PowerPoint Current malaria programmes attempt to address both prevention and treatment. Prevention of disease transmission is through the control of the insect vectors at the population level, and through the use of ITNs and other materials to prevent mosquito biting at the individual and household level (Neville et al., 1996; Curtis & Townson, 1998). Prophylaxis of malaria with drugs can be used to provide additional protection for groups at particular risk, such as pregnant women living in, and travellers to, countries where the disease is endemic. Successful operational implementation of each of these malaria prevention strategies is subject to constraints, with problems occurring in some areas more than others. For example, a central plank of RBM strategy is the operational, large-scale use of ITNs; the only insecticides authorized by the WHO for use on nets, at present, are the pyrethroids. In 1998, when large-scale ITN use was proposed, it was assumed that the main African vectors (Anopheles gambiae (Fig. 3) and A. funestus) were fully susceptible to these insecticides (Malcolm, 1988). Since 1998, monitoring through the Multilateral Initiative on Malaria (MIM) scheme has demonstrated that serious resistance problems are present in both vectors. A. gambiae has a high frequency of kdr (knock-down resistance) throughout much of West Africa; this resistance results from a point mutation in the sodium channels that are the target sites of pyrethroids and DDT. A. funestus, by contrast, produces detoxifying enzymes, which also gives rise to metabolic resistance to pyrethroids (Chandre et al., 1999; Brooke et al., 2001). We may have been lucky with A. gambiae, because the kdr mechanism is functionally recessive and the behavioural change it produces in the homozygous kdr mosquitoes results in only minor changes in the efficacy of ITNs to reduce malarial transmission. Nevertheless, the situation in southern Africa is more worrying because resistance in A. funestus has severely compromised the use of pyrethroids for both residual spraying and the impregnation of ITNs. An obvious fear is that this metabolic pyrethroid resistance mechanism will eventually be selected in A. gambiae, and there is now evidence of this in parts of West Africa and in Kenya (Ranson et al., 2002). Figure 3.Female Anopheles gambiae mosquito feeding. © WHO/TDR/Sinclair Stammers. Download figure Download PowerPoint One of the main goals of malaria control programmes is to improve access to prompt drug treatment for initial infections, to prevent the development of life-threatening complications requiring hospital admission. But access to treatment is often problematic, particularly in low-income areas. The problem is compounded by the spread of drug resistance, which affects many malaria-endemic countries. Chloroquine, the cheapest of the anti-malarial drugs, is now ineffective in many regions. Several African countries have replaced it with sulphadoxine pyrimethamine, but this too has been associated with reduced efficacy during the past few years, with evidence that resistant parasites are being spread rapidly throughout the world. New cost-effective and simple drug regimes are urgently needed; to reduce the development of resistance they will need to be based on rational combinations of drugs (that is, combinations that are affordable, that, ideally, act both synergistically and within similar time-frames, and that can be co-formulated), rather than single agents (Mutabingwa et al., 2001). What prospects are there for overcoming these and other problems involved in malaria, so that we can make progress towards the now seemingly idealistic targets that were set in Abuja? A malaria vaccine has been a long-standing research goal, but there is little prospect of one becoming available within the next decade (Riley, 1997). Delivery of such a vaccine into poor rural areas, particularly if regular boosters are required, will also need a much better logistical framework than exists at present. In addition, change is needed in many countries to improve the acceptance of ITNs, and we need to resolve the long-standing debates over who should pay for this type of intervention. Long-lasting nets that do not need regular retreatment with insecticide every six months would increase their effectiveness and open up the possibility of using mosaic treatments on nets as a form of resistance management. This would allow carbamates, for example, to be used on the upper sections of nets, and pyrethroids on the lower sections that are more likely to come into contact with the skin. Many of the current treatments depend on a presumptive diagnosis of malaria based on a combination of clinical features. As there are no features that are specific for malaria this results in considerable overdiagnosis, particularly where malaria is seasonal. We therefore need better methods to diagnose malaria accurately, especially in rural settings where microscopy is impractical. Promising, rapid diagnostic tests are being developed and their relatively high cost might be offset by reducing the waste associated with using anti-malarial drugs to treat non-malarial illness. This balance might be tilted further in favour of these tests if expensive drug combinations are introduced as first-line therapy for malaria. The availability of the genome sequence might also allow us to rapidly develop novel synergists, or ‘resistance breakers’, to restore the efficacy of the pyrethroids and other insecticides In addition, there is a need to ascertain drug resistance patterns regularly so that treatment recommendations can be adjusted appropriately. Although combination therapy, using a mixture of anti-malarial drugs, should slow down the development of drug resistance, this comes at a significant financial cost. There are other issues, such as correct dosage and compliance, adequate financing of drugs for poor communities and quality control of drugs sold over the counter, that need to be tackled urgently. On a positive note, the recent publication of the P. falciparum and A. gambiae genomes will facilitate the rapid identification of targets for the development of new drugs and insecticides (Hemingway et al., 2002; Holt et al., 2002). Proteomic approaches will speed up the process of designing small-molecule inhibitors against these targets, and initiatives such as the ‘Medicines for Malaria’ public–private partnership should ensure the rapid development and production of these new drugs. Their introduction then needs to be managed in a cost-effective and appropriate manner to achieve maximum long-term sustainable malaria control benefits. The availability of the genome sequence might also allow us to rapidly develop novel synergists, or ‘resistance breakers’, to restore the efficacy of the pyrethroids and other insecticides. Targeting such molecules against the insect-specific regulators of the metabolic resistance mechanism should avoid the problems of increased human toxicity that are common to synergists available at present. We also need new approaches to address the lack of blood available for emergency transfusions. Anaemia is one of the main life-threatening complications of malaria, and one that mostly affects young children who do not receive adequate early treatment (Fig. 4). Children with severe anaemia have a high mortality rate if a blood transfusion is not available within the first few hours after admission to hospital (Fig. 5; English et al., 2002). However, the marked increase in HIV has made this process far more risky in rural African settings. The reorganization of transfusion services to facilitate the screening of donors for viral markers could improve the safety and reduce the overall costs of the service. This approach needs to be evaluated in a typical developing- country setting. Transfusions of blood from newborn umbilical cords could save the lives of children in hospital with acute anaemia due to malaria when emergency supplies of donated blood are not available. Sufficient blood can be collected from an umbilical cord to save the life of a child with severe malaria-related anaemia. A study in a large hospital in Ghana showed that umbilical cord blood collected from 67% of vaginal deliveries could provide all the transfusion requirements for the paediatric unit at the same hospital. Figure 4.A young girl experiencing a clinical attack of malaria in a Health Centre in The Gambia. © WHO/TDR/Dr Steven Lindsay. Download figure Download PowerPoint Figure 5.Relatives carry a young Yanomami girl, seriously ill with cerebral malaria, from a field clinic to an aeroplane for transfer to a hospital. © WHO/TDR/Mark Edwards. Download figure Download PowerPoint Other potential uses of modern genomic and transgenic technology might provide new solutions to malaria control in the longer term. Not all mosquito species are able to transmit the malaria parasite, and we are now about to characterize the genes that encode the refractory phenotype (Collins, 1994). These genes, or genes that encode single-chain variant-fragment antibodies against the parasite, could be inserted into the genomes of major mosquito vectors to block transmission (Capurro et al., 2000). Although such transgenic technology was close to science fiction a decade ago, we now have all the necessary technology to produce refractory mosquitoes and a proof of principle in both A. gambiae and A. aegypti—the latter for bird malaria—that the technology will work. However, the main hurdles that still need to be overcome before it can be introduced are the development of rapid mosquito population replacement and the acceptance of the technology by the human population living in the regions where malaria is endemic. After a decade or more of neglect and underfunding, malaria is now firmly back on the political and health agendas After a decade or more of neglect and underfunding, malaria is now firmly back on political and health agendas. New alliances and funding initiatives, such as RBM, the Global Fund for HIV/AIDs, TB and Malaria, Medicines for Malaria and MIM, should provide the impetus to strive to achieve the Abuja targets and support the development of new tools and techniques for the control and treatment of malaria. These initiatives also provide a much-needed opportunity to train the next generation of African malaria researchers, technicians and operational control specialists, and should start to redress the loss of capacity in this area that has been apparent in the past decade. Biographies Janet Hemingway and Imelda Bates are at the Liverpool School of Tropical Medicine, Liverpool, UK. E-mail: [email protected] Imelda Bates References Brooke B.D. et al. (2001) Bioassay and biochemical analysis of insecticide resistance in southern African Anopheles funestus (Diptera: Culicidae). Bull. Entomol. Res., 91, 265–273.CrossrefCASPubMedWeb of Science®Google Scholar Capurro H. et al. 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Science, 298, 96–97.CrossrefCASPubMedWeb of Science®Google Scholar Holt R.A. et al. (2002) The genome sequence of the malaria mosquito Anopheles gambiae. Science, 298, 29–149.Google Scholar Hommel M. (2002) in Essential Malariology 4th edn (eds Warrell, D.A. & Gillies, H.M.), 35–58. Arnold International/Oxford Univ. Press, Oxford, UK.Google Scholar Malcolm C.A. (1988) Current status of pyrethroid resistance in anophelines. Parasitol. Today, 4, 13–15.CrossrefCASPubMedWeb of Science®Google Scholar Mutabingwa T. et al. (2001) Chlorproguanil–dapsone for treatment of drug-resistant falciparum malaria in Tanzania. Lancet, 358, 1218–1223.CrossrefCASPubMedWeb of Science®Google Scholar Neville C.G. et al. (1996) Insecticide-treated bednets reduce severe morbidity from malaria among children on the Kenyan coast. Trop. Med. Int. Health, 1, 139–146.Wiley Online LibraryPubMedGoogle Scholar Ranson H. et al. (2003) Genetic mapping of genes conferring permethrin resistance in the malaria vector Anopheles gambiae. Insect Mol. Biol. (in the press).Google Scholar Riley E. (1997) Malaria vaccines: current status and future prospects. J. Pharm. Pharmacol., 49, 21–27.Wiley Online LibraryGoogle Scholar Trigg P.I. & Kondrachine A.V. (1998) in Malaria: Parasite Biology, Pathogenesis and Protection (ed. Sherman, I.W.), 11–22. ASM, Washington DC, USA.Google Scholar Previous ArticleNext Article Volume 4Issue S11 June 2003In this issue FiguresReferencesRelatedDetailsLoading ...
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Melanoma ManagementVol. 5, No. 3 CommentaryOpen AccessNext-generation melanoma prevention efforts for overlooked populations and populations with health disparities: a South African perspectiveCaradee Y WrightCaradee Y Wright*Author for correspondence: Tel.: +27 12 339 8543; E-mail Address: [email protected] Environment & Health Research Unit, South African Medical Research Council, Pretoria, South Africa Department of Geography, Geoinformatics & Meteorology, University of Pretoria, Pretoria, South AfricaSearch for more papers by this authorPublished Online:10 Jul 2018https://doi.org/10.2217/mmt-2018-0006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit Keywords: health disparitiesmelanomaminority groupspigmented skinskin cancerOver the past 25 years, we have made progress in melanoma treatment, screening, diagnosis and prevention, however, addressing melanoma health disparities in some population groups is an area in which progress has not kept up [1]. In general, poorer outcomes for melanoma exist for ethnic minorities, people who are less educated, people of lower socio-economic status, the elderly and the uninsured [2]. Ethnic minorities are thought to be about two- to three-times as likely to die from melanoma as age- and sex-matched individuals from nonminority groups [3]. Biological factors may account for some of these differences but several of the underlying mechanisms of these disparities are unclear and under-researched. Furthermore, while numerous epidemiological studies have been carried out on melanoma and its prevention [4,5] we lack comprehensive research on melanoma in ethnic minorities and other overlooked population groups in countries around the world [2].There is a need to address these disparities in melanoma in overlooked population groups. In countries where there are typically few dermatologists serving the population, the existing dermatology workforce may face additional pressure if melanoma incidence increases and the patient load increases [1]. We may see more overlooked populations seeking assistance with screening and detection of melanoma. In some countries, changing demographics may also mean larger proportions of the population falling into ethnic minority groups, therefore numbers of people seeking healthcare visits may increase. In addition to these pressures, premature deaths [6], lost productivity due to years of life lost [7] and impacts on communities and families are also costs associated with melanoma disparities in overlooked groups.In general, primary and secondary melanoma prevention has focused most of its attention on specific populations and at-risk groups based on the known nonmodifiable and modifiable risk factors for melanoma, among others, presence of naevi, sun exposure, sunbed use, sunburns and phenotype [8,9]. Population-based melanoma prevention messages alerting the public to these risk factors have been largely directed to the general population as well as to high-risk outdoor occupations, high-risk recreation groups, patients postskin cancer diagnosis and organ transplant recipients [10]. Overlooked groups include ethnic minorities, the elderly, the military, the uninsured and people with disabilities [11,12]. Among the elderly, the perceived risk for developing melanoma and inclination to seek a skin examination tends to be low [1]. Health insurance status also influences melanoma outcomes where people seeing their primary care physician in the private sector are more likely to use skin cancer prevention screening, for example, compared with patients using public healthcare [13].Freeman and Chu's health disparities cancer model is based on the premise that social setting, incorporating poverty, culture and social justice, plays a part in disease outcome [14]. The model infers a relation between social determinants of health and health inequities [15]. Many of the factors related to the successful implementation of cancer prevention, control, and treatment are affected by socially determined factors. One can consider poverty-related barriers that influence melanoma outcomes such as income, education and health insurance, as well as barriers related to social injustice, for example, incorrect assumptions and mistrust [2]. Some barriers influencing melanoma outcomes pertain to culture including risk behaviors, acculturation, skin cancer awareness and knowledge, language fluency and perceptions of skin cancer risk [2]. In general, people with deeply pigmented skin usually perceive that skin cancer is a disease that only affects people with fair skin [16] and while this is in part true since melanoma incidence is higher in people with fair skin [17], melanoma does occur in people with deeply pigmented skin. However, the risk factors associated with melanoma in people with deeply pigmented skin are, in general, poorly understood.Exploring melanoma disparities in people with deeply pigmented skin: a South African perspectiveSouth Africa has a dual economy with both formal and informal sectors and is a country with one of the highest inequality rates in the world. In 2014, the Gini coefficient measuring relative wealth for South Africa was 0.69 (1 is perfectly unequal) based on income data including salaries, wages and social grants [18]. In addition to an unequal economy, the South African population of 55.7 million comprises four population groups: 80% Black African, 9% colored (of mixed ancestry), 8% White and 3% Indian/Asian [19]. About 82 out of every 100 people of the country's population seek healthcare in the public sector and only 18 in 100 people have private medical insurance [20]. Furthermore, South Africa is said to battle a quadruple burden of disease that includes HIV/AIDS, high-material and child mortality, high levels of violence and injuries and a growing burden from noncommunicable diseases [21].Finding studies and data on melanoma morbidity and mortality for overlooked groups in South Africans is challenging. National Cancer Registry data show that melanoma incidence is lower among Black Africans in South Africa compared with White South Africans [17]. The type of melanoma and the anatomic site of melanoma occurrence also differs between population groups, where this information is available. Melanoma in Black Africans is usually acral lentigenous melanoma and commonly occurs on the upper limb/shoulder and lower limb/hip compared with the occurrence on the head and trunk anatomic sites of White South Africans [17]. The 5-year melanoma survival for people with deeply pigmented skin is typically lower compared with that for White populations [2]. The few published studies show later stage of cutaneous melanoma at diagnosis and lower 5-year survival rates among Black South Africans compared with White South Africans [22]. The risk factors for melanoma in people with dark skin are complex and not well understood. It is unlikely that sun exposure plays an important role in the epidemiology of acral lentigenous melanoma, however, trauma, such as insect bites, wounds and scar tissue, may be an important risk factor warranting further research for this population group [22]. Other risk factors such as sex, age and genetics are also important [22].Contributing factors related to delayed diagnosis seen among Black South Africans are likely to include low-perceived melanoma risk, low index of suspicion of melanoma among healthcare providers and in some cases, suboptimal access to healthcare [22]. If efforts were made to increase secondary melanoma prevention in South Africa and improve early detection of thin melanomas, there may be some pressure placed on the 180 dermatologists practicing in the public and private sectors in the country [23]. If we are to try and address melanoma in Black South Africans, a comprehensive, holistic approach will be needed.What can be done to reduce health disparities in melanoma in overlooked populations?The complexities of preventing melanoma in overlooked population groups, such as Black South Africans and in countries with wide disparities in inequality are challenging [24]. Three board areas, namely research, skills development and treatment, and education and raising awareness need to be addressed if we are to reduce the health disparities that are seen in overlooked populations and minority groups in relation to melanoma. Reliable data and research are needed on the epidemiology of melanoma in overlooked population groups in different countries around the world. For example, we need to explore how socially determined factors influence the inequities that exist in stage of melanoma and survival rates among individuals with dark versus fair skin. There is work to be done to better understand emerging issues, such as the implications of skin bleaching among individuals with dark skin and the subsequent risk, if any, of skin cancer [25]. It would also be helpful if cancer registry records include data about personal ancestry, population group and skin color. This information would be valuable for developing effective interventions and developing melanoma prevention measures and strategies that target vulnerable groups.We need to improve knowledge and awareness of melanoma among medical professionals [12] as well as familiarize clinicians with important features that characterize melanoma and the different forms of melanoma in patients across all Fitzpatrick phototypes with different skin colors [12]. It is also important that we aim to raise awareness about dermatologic health disparities in melanoma among overlooked populations themselves and ensure high-quality treatment and healthcare services for all groups.Many primary and secondary population-based melanoma prevention campaigns have focused on targeting the general population and provided specific messages, such as to check moles, to avoid sunburn and to use sun protection. Messages about sunburn, for example, might not be relevant in terms of melanoma prevention among some overlooked groups, especially for individuals with deeply pigmented skin. Sunburn as a term is not commonly understood among individuals with deeply pigmented skin [26] therefore, messages about sun protection related to sunburn are not helpful to all individuals in a population in relation to melanoma prevention. We need to enhance and expand our efforts to raise awareness about melanoma among ethnic minorities and overlooked groups and include information on early signs of melanoma in pigmented skin [12]. This information needs to be in appropriate formats for different cultures and languages too [16].ConclusionThe complexities of preventing skin cancers in countries with multiethnic populations and wide disparities in inequality, wealth, health status and access to health services are challenging. Several factors contribute to these disparities in melanoma outcomes including social determinants of health and various barriers such as the lack of training for diagnosis and treatment of melanoma among healthcare professionals in public healthcare settings. Next generation melanoma prevention research should include, among others, efforts to identify risk factors for melanoma in overlooked population and populations with disparities in melanoma outcomes. Several of the barriers, while undoubtedly complex, are potentially modifiable and additional research will help to better understand how to tackle these complexities with the end goal of reducing the burden of melanoma morbidity and mortality in overlooked populations and ethnic minorities.AcknowledgementsThis commentary was developed from a plenary presentation given at the 4th International UV and Skin Cancer Prevention conference held at Ryerson University in Toronto, Ontario, Canada from the 1–4 May 2018.Financial & competing interests disclosureCY Wright receives research funding support from the South African Medical Research Council and the National Research Foundation of South Africa. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.Conflict of interestThe author declares that there are no conflicts of interest.Open accessThis work is licensed under the Attribution-Noncommercial-Noderivatives 4.0 Unported license. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/Papers of special note have been highlighted as: • of interest; •• of considerable interestReferences1 Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol. Clin. 30, 53–58 (2012).Crossref, Medline, CAS, Google Scholar2 Harvey VM, Patel H, Sandhu S et al. Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes. Cancer Control 21, 343–349 (2014). •• Provides in-depth detail of the social determinants of and disparities in melanoma outcomes and gives excellent examples.Crossref, Medline, Google Scholar3 Kundu RV, Kamaria M, Ortiz S, West DP, Rademaker AW, Robinson JK. Effectiveness of a knowledge-based intervention for melanoma among those with ethnic skin. J. Am. Acad. Dermatol. 62(5), 777–784 (2010).Crossref, Medline, Google Scholar4 Berwick M, Buller DB, Cust A et al. Melanoma epidemiology and prevention. Melanoma 167, 17–49 (2015).Crossref, Google Scholar5 Rastrelli M, Tropea S, Rossi CR, Alaibac M. Melanoma: epidemiology, factors, pathogenesis, diagnoses and classification. In vivo 28, 1005–1011 (2014).Medline, Google Scholar6 Ekwueme DU, Guy GP, Lu C, Rim SH, Parelkar P, Chen SC. The health burden and economic costs of cutaneous melanoma mortality by race/ethnicity-United States, 2000–2006. J. Am. Acad. Dermatol. 65, S133.e1–S133.e12 (2011).Crossref, Google Scholar7 Hanly PA, Sharp L. The cost of lost productivity due to premature cancer-related mortality: an economic measure of the cancer burden. BMC Cancer 14, 224 (2014).Crossref, Medline, Google Scholar8 Gandini S, Sera F, Cattaruzza MS et al. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur. J. Cancer. 41, 2040–2059 (2005).Crossref, Medline, Google Scholar9 Gandini S, Sera F, Cattaruzza MS et al. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur. J. Cancer. 41, 45–60 (2005).Crossref, Medline, Google Scholar10 Chung CL, Nadhan KS, Shaver CM et al. Comparison of post-transplant dermatologic disease by race. JAMA Dermatol. 153, 552–558 (2017).Crossref, Medline, Google Scholar11 Riemenschneider K, Liu J, Powers JG. Skin cancer in the military: a systematic review of melanoma and nonmelanoma skin cancer incidence, prevention, and screening among active duty and veteran personnel. J. Am. Acad. Dermatol. 78(6), 1185–1192 (2018).Crossref, Medline, Google Scholar12 Hu S. Are we overlooking skin cancer in ethnic minorities? Cutaneous Oncol. Today 11, 5–8 (2011). •• Provides insight into skin cancer disparities in ethnic minorities and suggestions with which to address inequalities.Google Scholar13 Roetzheim RG, Pal N, Tennant C et al. Effects of health insurance and race on early detection of cancer. J. Natl Cancer Inst. 91(17), 1409–1415 (1999).Crossref, Medline, CAS, Google Scholar14 Freeman HP, Chu KC. Determinants of cancer disparities: barriers to cancer screening, diagnosis, and treatment. Surg. Oncol. Clin. N. Am. 14, 655–669 (2002).Crossref, Google Scholar15 Marmot M. Social determinants of health inequities. Lancet 9464, 1099–1104 (2005).Crossref, Google Scholar16 Ndlova NC, Gathers R, Tsoka-Gwegweni J, Hift RJ. Skin cancer awareness and sunscreen use among outpatients of a South African hospital: need for vigorous public education. S. Afr. Fam. Prac. 1(1), 1–5 (2018).Google Scholar17 Norval M, Kellet P, Wright CY. The incidence and body site of skin cancers in the population groups of South Africa. Photoderm. Photoimmunol. Photomed. 30(5), 262–265 (2014).Crossref, Medline, Google Scholar18 World Bank. South Africa overview (2018). www.worldbank.org/en/country/southafrica/overview.Google Scholar19 Statistics South Africa. Mid-year population estimates 2017 (2018). www.statssa.gov.za/publications/P0302/P03022017.pdf.Google Scholar20 Statistics South Africa. General household survey 2016 (2018). www.statssa.gov.za/?p=10548.Google Scholar21 Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. The burden of non-communicable diseases in South Africa. Lancet 374, 934–947 (2009).Crossref, Medline, Google Scholar22 Norval M, Wright CY. The epidemiology of cutaneous melanoma in the white and black african population groups in South Africa. In: Cutaneous Melanoma: Etiology and Therapy. Ward and Farma (Eds). Condon Publishers, Brisbane, Australia (2017).Crossref, Google Scholar23 Econex. Updated GP and Specialist Numbers: 2011 and 2012 (2018). www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/service_fees-tariff/submissions/sappf_f_econex_updated_gp_specialist_numbers_27%2003%202013.pdf.Google Scholar24 Benatar S. The challenges of health disparities in South Africa. S. Afr. Med. J. 103(3), 154–155 (2013). • Discusses health disparities in a wider context beyond those related to melanoma outcomes.Crossref, Medline, CAS, Google Scholar25 Benn EKT, Alexis A, Mohamed N, Wang Y-H, Khan IA, Liu B. Skin bleaching and dermatologic health of African and Afro-Caribbean populations in the US: new directions for methodologically rigorous, multidisciplinary and culturally sensitive research. Dermatol. Ther. (Heidelb) 6(4), 453–459 (2016).Crossref, Medline, Google Scholar26 Wilkes M, Wright CY, du Plessis JL, Reeder AI. Fitzpatrick skin type, individual typology angle and melanin index in an African population: taking steps toward universally applicable skin photosensitivity assessments. JAMA Dermatol. 151(8), 902–903 (2015).Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Vol. 5, No. 3 Follow us on social media for the latest updates Metrics History Received 29 May 2018 Accepted 31 May 2018 Published online 10 July 2018 Published in print September 2018 Information© 2018 Caradee Yael WrightKeywordshealth disparitiesmelanomaminority groupspigmented skinskin cancerAcknowledgementsThis commentary was developed from a plenary presentation given at the 4th International UV and Skin Cancer Prevention conference held at Ryerson University in Toronto, Ontario, Canada from the 1–4 May 2018.Financial & competing interests disclosureCY Wright receives research funding support from the South African Medical Research Council and the National Research Foundation of South Africa. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.Conflict of interestThe author declares that there are no conflicts of interest.Open accessThis work is licensed under the Attribution-Noncommercial-Noderivatives 4.0 Unported license. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/PDF download
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The objective of this study was to systematically review the medical literature for the prevalence of waterpipe tobacco use among the general and specific populations. We electronically searched MEDLINE, EMBASE, and the ISI the Web of Science. We selected studies using a two-stage duplicate and independent screening process. We included cohort studies and cross sectional studies assessing the prevalence of use of waterpipe in either the general population or a specific population of interest. Two reviewers used a standardized and pilot tested form to collect data from each eligible study using a duplicate and independent screening process. We stratified the data analysis by country and by age group. The study was not restricted to a specific context. Of a total of 38 studies, only 4 were national surveys; the rest assessed specific populations. The highest prevalence of current waterpipe smoking was among school students across countries: the United States, especially among Arab Americans (12%-15%) the Arabic Gulf region (9%-16%), Estonia (21%), and Lebanon (25%). Similarly, the prevalence of current waterpipe smoking among university students was high in the Arabic Gulf region (6%), the United Kingdom (8%), the United States (10%), Syria (15%), Lebanon (28%), and Pakistan (33%). The prevalence of current waterpipe smoking among adults was the following: Pakistan (6%), Arabic Gulf region (4%-12%), Australia (11% in Arab speaking adults), Syria (9%-12%), and Lebanon (15%). Group waterpipe smoking was high in Lebanon (5%), and Egypt (11%-15%). In Lebanon, 5%-6% pregnant women reported smoking waterpipe during pregnancy. The studies were all cross-sectional and varied by how they reported waterpipe smoking. While very few national surveys have been conducted, the prevalence of waterpipe smoking appears to be alarmingly high among school students and university students in Middle Eastern countries and among groups of Middle Eastern descent in Western countries.
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Revisiting leishmaniasis in the time of war: the Syrian conflict and the Lebanese outbreak
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Leishmaniasis is a neglected tropical disease, endemic in many worldwide foci including the Middle East. Several outbreaks have occurred in the Middle East over the past decades, mostly related to war-associated population migration. With the start of the Syrian war, the frequency and magnitude of these outbreaks increased alarmingly. We describe the epidemiology of Leishmania infection in Lebanon and the most recent outbreak relevant to the Syrian war.We reviewed all leishmaniasis cases reported to the Epidemiologic Surveillance Department at the Lebanese Ministry of Public Health between 2001 and the first quarter of 2014. The demographics and distribution of Syrian refugees in Lebanon were linked to reports of new Leishmania cases.In total, 1033 new cases of leishmaniasis were reported in 2013 compared to a previous annual number in the range of 0-6 cases. The majority of cases reported in 2013 involved Syrian refugees and their relevant areas of concentration.This new outbreak of leishmaniasis in Lebanon is the first of its kind for more than a decade. The sudden increase in Leishmania cases in Lebanon in 2013 is attributed to the increasing numbers and wide distribution of Syrian refugees in Lebanon. This serves as an example of the risks associated with military conflicts and the ability of communicable diseases to cross borders.
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https://openalex.org/W2107259975
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Toward a Global View of Alcohol, Tobacco, Cannabis, and Cocaine Use: Findings from the WHO World Mental Health Surveys
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[
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"Israel"
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https://api.openalex.org/works?filter=cites:W2107259975
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Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization's (WHO's) World Mental Health (WMH) Survey Initiative.Household surveys with a combined sample size of 85,052 were carried out in the Americas (Colombia, Mexico, United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), Middle East and Africa (Israel, Lebanon, Nigeria, South Africa), Asia (Japan, People's Republic of China), and Oceania (New Zealand). The WHO Composite International Diagnostic Interview (CIDI) was used to assess the prevalence and correlates of a wide variety of mental and substance disorders. This paper focuses on lifetime use and age of initiation of tobacco, alcohol, cannabis, and cocaine. Alcohol had been used by most in the Americas, Europe, Japan, and New Zealand, with smaller proportions in the Middle East, Africa, and China. Cannabis use in the US and New Zealand (both 42%) was far higher than in any other country. The US was also an outlier in cocaine use (16%). Males were more likely than females to have used drugs; and a sex-cohort interaction was observed, whereby not only were younger cohorts more likely to use all drugs, but the male-female gap was closing in more recent cohorts. The period of risk for drug initiation also appears to be lengthening longer into adulthood among more recent cohorts. Associations with sociodemographic variables were consistent across countries, as were the curves of incidence of lifetime use.Globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones. Sex differences were consistently documented, but are decreasing in more recent cohorts, who also have higher levels of illegal drug use and extensions in the period of risk for initiation.
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{
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"id": "https://openalex.org/S4306400806",
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{
"display_name": "Open University of Cape Town (University of Cape Town)",
"id": "https://openalex.org/S4306402129",
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{
"display_name": "University of Groningen research database (University of Groningen / Centre for Information Technology)",
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{
"display_name": "Digital Access to Scholarship at Harvard (DASH) (Harvard University)",
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{
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{
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"id": "https://openalex.org/S4306525036",
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|
https://openalex.org/W2345539730
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Syrian refugees in Lebanon: the search for universal health coverage
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],
"display_name": "Tejendra Pherali",
"id": "https://openalex.org/A5041279114"
}
] |
[
{
"display_name": "Refugee",
"id": "https://openalex.org/C173145845"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Humanitarian crisis",
"id": "https://openalex.org/C2777742874"
},
{
"display_name": "Syrian refugees",
"id": "https://openalex.org/C3018716944"
},
{
"display_name": "Refugee crisis",
"id": "https://openalex.org/C2778745634"
},
{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Internally displaced person",
"id": "https://openalex.org/C13934251"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Development economics",
"id": "https://openalex.org/C47768531"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
}
] |
[
"Lebanon",
"Syria"
] |
[
"https://openalex.org/W1536890004",
"https://openalex.org/W1954013677",
"https://openalex.org/W1967108202",
"https://openalex.org/W1981339794",
"https://openalex.org/W2008206813",
"https://openalex.org/W2029883138",
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"https://openalex.org/W2076173401",
"https://openalex.org/W2117155148",
"https://openalex.org/W2119472981",
"https://openalex.org/W2131436869",
"https://openalex.org/W2226643006",
"https://openalex.org/W3124210252"
] |
https://api.openalex.org/works?filter=cites:W2345539730
|
The crisis in Syria has forced more than 4 million people to find refuge outside Syria. In Lebanon, in 2015, the refugee population represented 30 % of the total population. International health assistance has been provided to refugee populations in Lebanon. However, the current humanitarian system has also contributed to increase fragmentation of the Lebanese health system. Ensuring universal health coverage to vulnerable Lebanese, Syrian and Palestinian refugees will require in Lebanon to redistribute the key functions and responsibilities of the Ministry of Health and its partners to generate more coherence and efficiency.
|
[
{
"display_name": "Conflict and Health",
"id": "https://openalex.org/S77607499",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "UCL Discovery (University College London)",
"id": "https://openalex.org/S4306400024",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "LSHTM Research Online (London School of Hygiene and Tropical Medicine)",
"id": "https://openalex.org/S4306402527",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2038401197
|
Predictors and outcomes of patient safety culture in hospitals
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Fadi El‐Jardali",
"id": "https://openalex.org/A5031532168"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Lebanese American University",
"id": "https://openalex.org/I56306041",
"lat": 33.892776,
"long": 35.47778,
"type": "education"
}
],
"display_name": "Hani Dimassi",
"id": "https://openalex.org/A5001367844"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Diana Jamal",
"id": "https://openalex.org/A5028434319"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Maha Jaafar",
"id": "https://openalex.org/A5060983090"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Nour Hemadeh",
"id": "https://openalex.org/A5035940210"
}
] |
[
{
"display_name": "Patient safety",
"id": "https://openalex.org/C2779328685"
},
{
"display_name": "Safety culture",
"id": "https://openalex.org/C2779240384"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Respondent",
"id": "https://openalex.org/C2776640315"
},
{
"display_name": "Health administration",
"id": "https://openalex.org/C137992405"
},
{
"display_name": "Operationalization",
"id": "https://openalex.org/C9354725"
},
{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Health care",
"id": "https://openalex.org/C160735492"
},
{
"display_name": "Philosophy",
"id": "https://openalex.org/C138885662"
},
{
"display_name": "Management",
"id": "https://openalex.org/C187736073"
},
{
"display_name": "Epistemology",
"id": "https://openalex.org/C111472728"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W275919675",
"https://openalex.org/W1995793930",
"https://openalex.org/W2030480279",
"https://openalex.org/W2048421003",
"https://openalex.org/W2052867931",
"https://openalex.org/W2096110018",
"https://openalex.org/W2123706776",
"https://openalex.org/W2127267205",
"https://openalex.org/W2156614374",
"https://openalex.org/W2159163237",
"https://openalex.org/W4240015571",
"https://openalex.org/W4255827324"
] |
https://api.openalex.org/works?filter=cites:W2038401197
|
Developing a patient safety culture was one of the recommendations made by the Institute of Medicine to assist hospitals in improving patient safety. In recent years, a multitude of evidence, mostly originating from developed countries, has been published on patient safety culture. One of the first efforts to assess the culture of safety in the Eastern Mediterranean Region was by El-Jardali et al. (2010) in Lebanon. The study entitled "The Current State of Patient Safety Culture: a study at baseline" assessed the culture of safety in Lebanese hospitals. Based on study findings, the objective of this paper is to explore the association between patient safety culture predictors and outcomes, taking into consideration respondent and hospital characteristics. In addition, it will examine the correlation between patient safety culture composites. Sixty-eight hospitals and 6,807 respondents participated in the study. The study which adopted a cross sectional research design utilized an Arabic-translated version of the Hospital Survey on Patient Safety Culture (HSOPSC). The HSOPSC measures 12 patient safety composites. Two of the composites, in addition to a patient safety grade and the number of events reported, represented the four outcome variables. Bivariate and mixed model regression analyses were used to examine the association between the patient safety culture predictors and outcomes. Significant correlations were observed among all patient safety culture composites but with differences in the strength of the correlation. Generalized Estimating Equations for the patient safety composite scores and respondent and hospital characteristics against the patient safety grade and the number of events reported revealed significant correlations. Significant correlations were also observed by linear mixed models of the same variables against the frequency of events reported and the overall perception of safety. Event reporting, communication, patient safety leadership and management, staffing, and accreditation were identified as major patient safety culture predictors. Investing in practices that tackle these issues and prioritizing patient safety is essential in Lebanese hospitals in order to improve patient safety. In addition, further research is needed to understand the association between patient safety culture and clinical outcomes.
|
[
{
"display_name": "BMC Health Services Research",
"id": "https://openalex.org/S12898181",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2165046389
|
Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009)
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Lara Nasreddine",
"id": "https://openalex.org/A5019744440"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Farah Naja",
"id": "https://openalex.org/A5067866379"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Marie Claire Chamieh",
"id": "https://openalex.org/A5044789380"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Nada Adra",
"id": "https://openalex.org/A5059801847"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Abla Mehio Sibai",
"id": "https://openalex.org/A5066629818"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Nahla Hwalla",
"id": "https://openalex.org/A5070535805"
}
] |
[
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Overweight",
"id": "https://openalex.org/C2780586474"
},
{
"display_name": "Obesity",
"id": "https://openalex.org/C511355011"
},
{
"display_name": "Biostatistics",
"id": "https://openalex.org/C140556311"
},
{
"display_name": "Cross-sectional study",
"id": "https://openalex.org/C142052008"
},
{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Epidemiology",
"id": "https://openalex.org/C107130276"
},
{
"display_name": "Body mass index",
"id": "https://openalex.org/C2780221984"
},
{
"display_name": "Odds ratio",
"id": "https://openalex.org/C156957248"
},
{
"display_name": "Odds",
"id": "https://openalex.org/C143095724"
},
{
"display_name": "National Health and Nutrition Examination Survey",
"id": "https://openalex.org/C2779874844"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Gerontology",
"id": "https://openalex.org/C74909509"
},
{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Logistic regression",
"id": "https://openalex.org/C151956035"
},
{
"display_name": "Internal medicine",
"id": "https://openalex.org/C126322002"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W178186896",
"https://openalex.org/W1916038286",
"https://openalex.org/W1964628115",
"https://openalex.org/W1971445485",
"https://openalex.org/W1983366920",
"https://openalex.org/W2010972693",
"https://openalex.org/W2034570279",
"https://openalex.org/W2037406895",
"https://openalex.org/W2046859247",
"https://openalex.org/W2056627439",
"https://openalex.org/W2072569976",
"https://openalex.org/W2075462459",
"https://openalex.org/W2083377550",
"https://openalex.org/W2094498344",
"https://openalex.org/W2098990415",
"https://openalex.org/W2101517600",
"https://openalex.org/W2104129218",
"https://openalex.org/W2105220751",
"https://openalex.org/W2106023093",
"https://openalex.org/W2124710341",
"https://openalex.org/W2129440867",
"https://openalex.org/W2142170772",
"https://openalex.org/W2148924243",
"https://openalex.org/W2154119914",
"https://openalex.org/W2155384223",
"https://openalex.org/W2158569927",
"https://openalex.org/W2171233986",
"https://openalex.org/W4248124851"
] |
https://api.openalex.org/works?filter=cites:W2165046389
|
Abstract Background Even though the obesity epidemic continues to grow in various parts of the world, recent reports have highlighted disparities in obesity trends across countries. There is little empirical evidence on the development and growth of obesity in Lebanon and other countries of the Eastern Mediterranean Region. Acknowledging the need for effective obesity preventive measures and for accurate assessment of trends in the obesity epidemic, this study aims at examining and analyzing secular trends in the prevalence of overweight and obesity over a 12-year period in Lebanon. Methods Based on weight and height measurements obtained from two national cross-sectional surveys conducted in 1997 and 2009 on subjects 6 years of age and older, BMI was calculated and the prevalence of obesity was determined based on BMI for adults and BMI z-scores for children and adolescents, according to WHO criteria. Age -and sex- adjusted odds ratios for overweight and obesity were determined, with the 1997 year as the referent category. Annual rates of change in obesity prevalence per sex and age group were also calculated. Results The study samples included a total of 2004 subjects in the 1997 survey and 3636 in the 2009 survey. Compared to 1997, mean BMI values were significantly higher in 2009 among all age and sex groups, except for 6–9 year old children. Whereas the prevalence of overweight appeared stable over the study period in both 6–19 year old subjects (20.0% vs. 21.2%) and adults aged 20 years and above (37.0% vs. 36.8%), the prevalence of obesity increased significantly (7.3% vs. 10.9% in 6–19 year olds; 17.4% vs. 28.2% in adults), with the odds of obesity being 2 times higher in 2009 compared to 1997, in both age groups (OR = 1.96, 95% CI:1.29-2.97 and OR = 2.01, 95% CI: 1.67-2.43, respectively). The annual rates of change in obesity prevalence ranged between +4.1% in children and adolescents and +5.2% in adults. Conclusion The study’s findings highlight an alarming increase in obesity prevalence in the Lebanese population, over the 12-year study period, and alert to the importance of formulating policies and nutritional strategies to curb the obesity rise in the country.
|
[
{
"display_name": "BMC Public Health",
"id": "https://openalex.org/S200437886",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2086416910
|
The rise in narghile (shisha, hookah) waterpipe tobacco smoking: A qualitative study of perceptions of smokers and non smokers
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Rima Nakkash",
"id": "https://openalex.org/A5025685233"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Joanna Khalil",
"id": "https://openalex.org/A5078245728"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Rima Afifi",
"id": "https://openalex.org/A5005338810"
}
] |
[
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Focus group",
"id": "https://openalex.org/C56995899"
},
{
"display_name": "Tobacco control",
"id": "https://openalex.org/C2780832096"
},
{
"display_name": "Biostatistics",
"id": "https://openalex.org/C140556311"
},
{
"display_name": "Qualitative research",
"id": "https://openalex.org/C190248442"
},
{
"display_name": "Psychological intervention",
"id": "https://openalex.org/C27415008"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Residence",
"id": "https://openalex.org/C2776269092"
},
{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Social science",
"id": "https://openalex.org/C36289849"
},
{
"display_name": "Marketing",
"id": "https://openalex.org/C162853370"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Business",
"id": "https://openalex.org/C144133560"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W14842245",
"https://openalex.org/W1565820293",
"https://openalex.org/W1963712501",
"https://openalex.org/W1975384409",
"https://openalex.org/W1982219320",
"https://openalex.org/W1989178763",
"https://openalex.org/W1994512507",
"https://openalex.org/W2025119436",
"https://openalex.org/W2043753707",
"https://openalex.org/W2046138823",
"https://openalex.org/W2048750714",
"https://openalex.org/W2063906172",
"https://openalex.org/W2064217914",
"https://openalex.org/W2071502303",
"https://openalex.org/W2071971444",
"https://openalex.org/W2104667268",
"https://openalex.org/W2122109523",
"https://openalex.org/W2124920375",
"https://openalex.org/W2126439676",
"https://openalex.org/W2135422535",
"https://openalex.org/W2136726456",
"https://openalex.org/W2142672288",
"https://openalex.org/W2146053639",
"https://openalex.org/W2158263689",
"https://openalex.org/W2159796817",
"https://openalex.org/W2164301943",
"https://openalex.org/W4245921937"
] |
https://api.openalex.org/works?filter=cites:W2086416910
|
The prevalence of waterpipe tobacco smoking (WTS) in the Middle East region and worldwide is increasing. There is evidence to indicate both short term and long term health effects of WTS, resulting in the issuance of an advisory note by the World Health Organization.This research aimed at gaining an in-depth understanding of the factors contributing to the rise in WTS in Lebanon. Qualitative focus groups (25) and in-depth interviews (9) were conducted with adults in Lebanon in 2007. Participants were recruited to represent diversity in smoking status, gender, age groups and urban/rural residence. The interviews and focus groups were thematically analyzed, and recurrent themes noted and summarized.The main themes identified were availability, affordability, innovation, influence of media, lack of a policy framework, and the sensory characteristics evoked from WTS. Men and women, smokers and non-smokers, and younger and older participants differed in their emphases on the above themes. These themes, though specific to waterpipe, are similar to themes manipulated by the cigarette industry, and eventually controlled through tobacco control policies.Understanding reasons behind the rise in waterpipe tobacco use is important if appropriate prevention, cessation, and policy interventions are to be formulated. Strict adherence to the FCTC is warranted, with careful and vigilant attention that all tobacco products are covered by laws in both high as well as middle to lower income countries.
|
[
{
"display_name": "BMC Public Health",
"id": "https://openalex.org/S200437886",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2495763977
|
Prevalence, care-seeking, and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon
|
[
{
"affiliations": [],
"display_name": "Shannon Doocy",
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{
"affiliations": [],
"display_name": "Emily Lyles",
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{
"affiliations": [],
"display_name": "Baptiste Hanquart",
"id": "https://openalex.org/A5061150250"
},
{
"affiliations": [],
"display_name": "Michael Woodman",
"id": "https://openalex.org/A5089030889"
}
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{
"display_name": "Refugee",
"id": "https://openalex.org/C173145845"
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{
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"id": "https://openalex.org/C71924100"
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"id": "https://openalex.org/C99454951"
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"id": "https://openalex.org/C138816342"
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"id": "https://openalex.org/C160735492"
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{
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"id": "https://openalex.org/C74909509"
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{
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"id": "https://openalex.org/C50522688"
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{
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"id": "https://openalex.org/C159110408"
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"id": "https://openalex.org/C205649164"
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"id": "https://openalex.org/C166957645"
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{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
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[
"Lebanon",
"Syria"
] |
[
"https://openalex.org/W1804760017",
"https://openalex.org/W1807773213",
"https://openalex.org/W1909865233",
"https://openalex.org/W2043839958",
"https://openalex.org/W2115357266",
"https://openalex.org/W2118133670",
"https://openalex.org/W2118653494",
"https://openalex.org/W2119472981",
"https://openalex.org/W2164132840"
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https://api.openalex.org/works?filter=cites:W2495763977
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Given the large burden of non-communicable diseases (NCDs) among both Syrian refugees and the host communities within which they are settled, humanitarian actors and the government of Lebanon face immense challenges in addressing health needs. This study assessed health status, unmet needs, and utilization of health services among Syrian refugees and host communities in Lebanon. A cross-sectional survey of Syrian refugees and host communities in Lebanon was conducted using a two-stage cluster survey design with probability proportional to size sampling. To obtain information on chronic NCDs, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences in household characteristics by care-seeking for these conditions were examined using chi-square, t-test, and adjusted logistic regression methods. Over half (50.4 %) of refugee and host community households (60.2 %) reported a member with one of the five NCDs. Host community prevalence rates were significantly higher than refugees for all conditions except chronic respiratory diseases (p = 0.08). Care-seeking for NCDs among refugees and host community households was high across all conditions with 82.9 and 97.8 %, respectively, having sought care in Lebanon for their condition. Refugees utilized primary health care centers (PHCC) (57.7 %) most often while host communities sought care most in private clinics (62.4 %). Overall, 69.7 % of refugees and 82.7 % of host community members reported an out-of-pocket consultation payment (p = 0.041) with an average payment of US$15 among refugees and US$42 for the host community (p <0.001). Given the protracted nature of the Syrian crisis and the burden on the Lebanese health system, implications for both individuals with NCDs and Lebanon’s health system are immense. The burden of out of pocket expenses on persons with NCDs are also substantial, especially given the tenuous economic status of many refugees and the less affluent segments of the Lebanese population. Greater investment in the public sector health system could benefit all parties. Efforts to improve quality of care for NCDs at the primary care level are also a critical component of preventing adverse outcomes and lowering the overall cost of care for NCDs.
|
[
{
"display_name": "Conflict and Health",
"id": "https://openalex.org/S77607499",
"type": "journal"
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{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
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"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2024116506
|
Health status and health needs of older refugees from Syria in Lebanon
|
[
{
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{
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"display_name": "Johns Hopkins University",
"id": "https://openalex.org/I145311948",
"lat": 39.29038,
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"display_name": "Jonathan Strong",
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{
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"display_name": "Christopher Varady",
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{
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"display_name": "Najla Chahda",
"id": "https://openalex.org/A5037787509"
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{
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{
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"display_name": "Johns Hopkins University",
"id": "https://openalex.org/I145311948",
"lat": 39.29038,
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"display_name": "Johns Hopkins University",
"id": "https://openalex.org/I145311948",
"lat": 39.29038,
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"type": "education"
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"display_name": "Gilbert Burnham",
"id": "https://openalex.org/A5020417588"
}
] |
[
{
"display_name": "Refugee",
"id": "https://openalex.org/C173145845"
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{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
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{
"display_name": "Loneliness",
"id": "https://openalex.org/C2779998236"
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{
"display_name": "Gerontology",
"id": "https://openalex.org/C74909509"
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{
"display_name": "Social isolation",
"id": "https://openalex.org/C2776893239"
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{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
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{
"display_name": "Coping (psychology)",
"id": "https://openalex.org/C73282008"
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{
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"id": "https://openalex.org/C190248442"
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{
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"id": "https://openalex.org/C2908647359"
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{
"display_name": "Feeling",
"id": "https://openalex.org/C122980154"
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{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
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{
"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
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{
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"id": "https://openalex.org/C15744967"
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{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
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{
"display_name": "Social psychology",
"id": "https://openalex.org/C77805123"
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{
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"id": "https://openalex.org/C36289849"
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{
"display_name": "Archaeology",
"id": "https://openalex.org/C166957645"
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{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
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{
"display_name": "History",
"id": "https://openalex.org/C95457728"
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] |
[
"Lebanon",
"Syria"
] |
[
"https://openalex.org/W1967974729",
"https://openalex.org/W2018584827",
"https://openalex.org/W2043674612",
"https://openalex.org/W2110400627",
"https://openalex.org/W2133704550",
"https://openalex.org/W2167733818",
"https://openalex.org/W2269681305",
"https://openalex.org/W4297697803"
] |
https://api.openalex.org/works?filter=cites:W2024116506
|
The flight of Syrian and Palestinian families into Lebanon from Syria included a number of older refugees. This study sought to characterize the physical and emotional conditions, dietary habits, coping practices, and living conditions of this elderly population arriving in Lebanon between March 2011 and March 2013. A systematic selection of 210 older refugees from Syria was drawn from a listing of 1800 refugees over age 60 receiving assistance from the Caritas Lebanon Migrant Center (CLMC) or the Palestinian Women’s Humanitarian Organization (PALWHO). CLMC and PALWHO social workers collected qualitative and quantitative information during 2013. Two-thirds of older refugees described their health status as poor or very poor. Most reported at least one non-communicable disease, with 60% having hypertension, 47% reporting diabetes, and 30% indicating some form of heart disease. Difficulties in affording medicines were reported by 87%. Physicial limitations were common: 47% reported difficulty walking and 24% reported vision loss. About 10% were physically unable to leave their homes and 4% were bedridden. Most required medical aids such as walking canes and eyeglasses. Diet was inadequate with older refugees reporting regularly reducing portion sizes, skipping meals, and limiting intake of fruits, vegetables, and meats. Often this was done to provide more food to younger family members. Some 61% of refugees reported feeling anxious, and significant proportions of older persons reported feelings of depression, loneliness, and believing they were a burden to their families. 74% of older refugees indicated varying degrees of dependency on humanitarian assistance. The study concluded older refugees from Syria are a highly vulnerable population needing health surveillance and targeted assistance. Programs assisting vulnerable populations may concentrate services on women and children leaving the elderly overlooked.
|
[
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"display_name": "Conflict and Health",
"id": "https://openalex.org/S77607499",
"type": "journal"
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"id": "https://openalex.org/S4306400806",
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"type": "repository"
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{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
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|
https://openalex.org/W2160298032
|
Post-graduation migration intentions of students of Lebanese medical schools: a survey study
|
[
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"display_name": "University at Buffalo, State University of New York",
"id": "https://openalex.org/I63190737",
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"display_name": "Elie A. Akl",
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"display_name": "University at Buffalo, State University of New York",
"id": "https://openalex.org/I63190737",
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"display_name": "Imperial College London",
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"display_name": "Stella Major",
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"country": "Lebanon",
"display_name": "University of Balamand",
"id": "https://openalex.org/I168913471",
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"display_name": "Lebanese University",
"id": "https://openalex.org/I160368002",
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"display_name": "Abir Abdo",
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"display_name": "Saint Joseph University",
"id": "https://openalex.org/I184679254",
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"display_name": "Jacques Choucair",
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"display_name": "Beirut Arab University",
"id": "https://openalex.org/I36314861",
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"display_name": "Mazen Sakr",
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"display_name": "University at Buffalo, State University of New York",
"id": "https://openalex.org/I63190737",
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"display_name": "Carl K. Li",
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{
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"display_name": "University at Buffalo, State University of New York",
"id": "https://openalex.org/I63190737",
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"display_name": "Holger J. Schünemann",
"id": "https://openalex.org/A5071868716"
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] |
[
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{
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{
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{
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{
"display_name": "Emigration",
"id": "https://openalex.org/C104151175"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Study abroad",
"id": "https://openalex.org/C2780814955"
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{
"display_name": "Medical education",
"id": "https://openalex.org/C509550671"
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{
"display_name": "Subspecialty",
"id": "https://openalex.org/C2780642338"
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{
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"id": "https://openalex.org/C2908647359"
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{
"display_name": "Curriculum",
"id": "https://openalex.org/C47177190"
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{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
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{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
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{
"display_name": "Psychology",
"id": "https://openalex.org/C15744967"
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{
"display_name": "Pedagogy",
"id": "https://openalex.org/C19417346"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Geography",
"id": "https://openalex.org/C205649164"
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{
"display_name": "Geometry",
"id": "https://openalex.org/C2524010"
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{
"display_name": "Mathematics",
"id": "https://openalex.org/C33923547"
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{
"display_name": "Archaeology",
"id": "https://openalex.org/C166957645"
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] |
[
"Lebanon"
] |
[
"https://openalex.org/W1536890004",
"https://openalex.org/W1572285114",
"https://openalex.org/W1973097985",
"https://openalex.org/W1974091590",
"https://openalex.org/W1981531743",
"https://openalex.org/W2007235638",
"https://openalex.org/W2011129764",
"https://openalex.org/W2022083275",
"https://openalex.org/W2052866703",
"https://openalex.org/W2062995668",
"https://openalex.org/W2085775162",
"https://openalex.org/W2093434026",
"https://openalex.org/W2112535297",
"https://openalex.org/W2117344745",
"https://openalex.org/W2153770828",
"https://openalex.org/W4242819162"
] |
https://api.openalex.org/works?filter=cites:W2160298032
|
The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans.Our target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about student's demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon.Of 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2nd citizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty.An alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.
|
[
{
"display_name": "BMC Public Health",
"id": "https://openalex.org/S200437886",
"type": "journal"
},
{
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"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
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"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W3043640656
|
COVID-19 Pandemic: An Insult Over Injury for Lebanon
|
[
{
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{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
"type": "healthcare"
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{
"country": "Lebanon",
"display_name": "National Council for Scientific Research",
"id": "https://openalex.org/I4210097719",
"lat": 33.89332,
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{
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"display_name": "Lebanese University",
"id": "https://openalex.org/I160368002",
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],
"display_name": "Abdul Rahman Bizri",
"id": "https://openalex.org/A5061182011"
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{
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{
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"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
"type": "healthcare"
},
{
"country": "Lebanon",
"display_name": "Lebanese University",
"id": "https://openalex.org/I160368002",
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"display_name": "Hussein H. Khachfe",
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{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
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{
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"display_name": "Lebanese University",
"id": "https://openalex.org/I160368002",
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{
"country": "United Kingdom",
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"display_name": "Mohamad Y. Fares",
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{
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"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
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],
"display_name": "Umayya Musharrafıeh",
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}
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{
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{
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{
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"id": "https://openalex.org/C149923435"
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{
"display_name": "Disease",
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{
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"id": "https://openalex.org/C50522688"
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{
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{
"display_name": "Infectious disease (medical specialty)",
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{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
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{
"display_name": "Linguistics",
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{
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{
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{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
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{
"display_name": "Physics",
"id": "https://openalex.org/C121332964"
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"display_name": "Optics",
"id": "https://openalex.org/C120665830"
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[
"Lebanon"
] |
[
"https://openalex.org/W1986605986",
"https://openalex.org/W2015590916",
"https://openalex.org/W2117801927",
"https://openalex.org/W2133094824",
"https://openalex.org/W2170812681",
"https://openalex.org/W2548791536",
"https://openalex.org/W2940608893",
"https://openalex.org/W2977861929",
"https://openalex.org/W2989940341",
"https://openalex.org/W3013245187"
] |
https://api.openalex.org/works?filter=cites:W3043640656
|
Abstract The outbreak of the novel coronavirus disease in 2019 (COVID-19) caused a plethora of challenges worldwide and tested healthcare systems across the six continents. Lebanon had recently faced harsh political and economic crises. We aim to describe the effect of COVID-19 on an already crisis-stricken country. A descriptive analysis of the burden of COVID-19 pandemic on Lebanon was performed. Relevant data on COVID-19 was retrieved from the Lebanese Ministry of Public Health from February 21 till June 13th, 2020. Results obtained were analyzed and a literature review was performed. 1422 confirmed COVID-19 cases were identified and reported in Lebanon by June 13th, 2020, comprising an incidence rate of 208/million persons. There has been a total of 31 deaths thus far, with a reported death rate of 5/million persons. The age group with the highest number of cases was 20–29 years. Beirut was the district with the highest number of cases (18%). The COVID-19 crisis has impacted the country on a multifactorial level. COVID-19 could not have come at a worse time for Lebanon. The country is on brink of bankruptcy, the healthcare system is struggling for survival and the government is striving to regain the trust of the population.
|
[
{
"display_name": "Journal of Community Health",
"id": "https://openalex.org/S173554290",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
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{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "Enlighten: Publications (The University of Glasgow)",
"id": "https://openalex.org/S4306400411",
"type": "repository"
}
] |
|
https://openalex.org/W2170210923
|
An assessment of antenatal care among Syrian refugees in Lebanon
|
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"country": "United States",
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"display_name": "Patrick Vinck",
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"affiliations": [],
"display_name": "Nada Omeira",
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"country": "United States",
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"type": "healthcare"
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],
"display_name": "Phuong Pham",
"id": "https://openalex.org/A5064897268"
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[
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"display_name": "Medicine",
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{
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"id": "https://openalex.org/C173145845"
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{
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"id": "https://openalex.org/C138816342"
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{
"display_name": "Prenatal care",
"id": "https://openalex.org/C2775887326"
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{
"display_name": "Population",
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{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
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{
"display_name": "Health care",
"id": "https://openalex.org/C160735492"
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{
"display_name": "Psychological intervention",
"id": "https://openalex.org/C27415008"
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{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
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{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
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{
"display_name": "Archaeology",
"id": "https://openalex.org/C166957645"
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{
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"id": "https://openalex.org/C162324750"
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{
"display_name": "History",
"id": "https://openalex.org/C95457728"
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{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
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[
"Lebanon",
"Syria"
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"https://openalex.org/W2130410555",
"https://openalex.org/W2131142764",
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"https://openalex.org/W2163900897",
"https://openalex.org/W2171382868",
"https://openalex.org/W4250125162",
"https://openalex.org/W4253636864",
"https://openalex.org/W4372228015"
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https://api.openalex.org/works?filter=cites:W2170210923
|
After more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian refugee women is critical to preventing maternal and fetal mortality but is not well characterized given the multiple factors obtaining health data in a displaced population. This study describes antenatal care access, the scope of existing antenatal care, and antenatal and family planning behaviors and practice among pregnant Syrian refugees in various living conditions and multiple geographic areas of Lebanon. A field-based survey was conducted between July and October 2013 in 14 main geographic sites of refugee concentration. The assessment evaluated antenatal services among a non-randomized sample of 420 self-identified pregnant Syrian refugee women that included demographics, gestational age, living accommodation, antenatal care coverage, antenatal care content, antenatal health behaviors, antenatal health literacy, and family planning perception and practices. In total, 420 pregnant Syrian refugees living in Lebanon completed the survey. Of these, 82.9% (348) received some antenatal care. Of those with at least one antenatal visit, 222 (63.8%) received care attended by a skilled professional three or more times, 111 (31.9%) 1–2 times, and 15 (4.3%) had never received skilled antenatal care. We assessed antenatal care content defined by blood pressure measurement, and urine and blood sample analyses. Of those who had received any antenatal care, only 31.2% received all three interventions, 18.2% received two out of three, 32.1% received one out of three, and 18.5% received no interventions. Only (41.2%) had an adequate diet of vitamins, minerals, and folic acid. Access, content and health behaviors varied by gestational age, type of accommodation and location in Lebanon. Standards of antenatal care are not being met for pregnant Syrian refugee women in Lebanon. This descriptive analysis of relative frequencies suggests reproductive health providers should focus attention on increasing antenatal care visits, particularly to third trimester and late gestational age patients and to those in less secure sheltering arrangements. With this approach they can improve care content by providing early testing and interventions per accepted guidelines designed to improve pregnancy outcomes.
|
[
{
"display_name": "Conflict and Health",
"id": "https://openalex.org/S77607499",
"type": "journal"
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{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
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{
"display_name": "Digital Access to Scholarship at Harvard (DASH) (Harvard University)",
"id": "https://openalex.org/S4306401540",
"type": "repository"
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{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
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{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W1964266667
|
The impact of war on the physical and mental health of the family: The Lebanese experience
|
[
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"display_name": "Laila Farhood",
"id": "https://openalex.org/A5034548826"
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{
"affiliations": [],
"display_name": "Huda Zurayk",
"id": "https://openalex.org/A5063358591"
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{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
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"display_name": "Monique Chaya",
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{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
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"display_name": "Fadia Saadeh",
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"display_name": "Garbis Meshefedjian",
"id": "https://openalex.org/A5042217104"
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{
"affiliations": [],
"display_name": "Thuraya Sidani",
"id": "https://openalex.org/A5037906154"
}
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[
{
"display_name": "Somatization",
"id": "https://openalex.org/C2777631960"
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{
"display_name": "Mental health",
"id": "https://openalex.org/C134362201"
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{
"display_name": "Psychology",
"id": "https://openalex.org/C15744967"
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{
"display_name": "Marital status",
"id": "https://openalex.org/C2781354955"
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{
"display_name": "Interpersonal relationship",
"id": "https://openalex.org/C91034043"
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{
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"id": "https://openalex.org/C110888244"
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{
"display_name": "Depression (economics)",
"id": "https://openalex.org/C2776867660"
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{
"display_name": "Physical health",
"id": "https://openalex.org/C2993280860"
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{
"display_name": "Social support",
"id": "https://openalex.org/C2778087770"
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{
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"id": "https://openalex.org/C138816342"
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{
"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
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{
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"id": "https://openalex.org/C70410870"
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{
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"id": "https://openalex.org/C74909509"
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{
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"id": "https://openalex.org/C71924100"
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{
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"id": "https://openalex.org/C77805123"
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{
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"id": "https://openalex.org/C99454951"
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{
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{
"display_name": "Macroeconomics",
"id": "https://openalex.org/C139719470"
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[
"Lebanon"
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https://api.openalex.org/works?filter=cites:W1964266667
|
This paper addresses the impact of war-related stressful life events on the health of families living through the war conditions prevailing in Lebanon for the past 12 years. Health outcome is represented by indicators of somatization, depression, psychological symptoms, interpersonal relations and marital relations. Associations are described between elements of war stress and the health outcome variables for mothers, fathers and adolescents in a sample of Beirut families. The role of the mediating factors of social support and social class is also discussed.
|
[
{
"display_name": "Social Science & Medicine",
"id": "https://openalex.org/S106822843",
"type": "journal"
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"id": "https://openalex.org/S4306525036",
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|
https://openalex.org/W2055559696
|
Occupational Violence at Lebanese Emergency Departments: Prevalence, Characteristics and Associated Factors
|
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"display_name": "American University of Beirut",
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"display_name": "Mohamad Alameddine",
"id": "https://openalex.org/A5062477410"
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{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
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"display_name": "Amin Kazzi",
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"display_name": "Fadi El‐Jardali",
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"affiliations": [
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"country": "Lebanon",
"display_name": "Lebanese American University",
"id": "https://openalex.org/I56306041",
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"display_name": "Hani Dimassi",
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"id": "https://openalex.org/I98635879",
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"display_name": "Salwa Maalouf",
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"display_name": "Workplace violence",
"id": "https://openalex.org/C2779919105"
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"display_name": "Verbal abuse",
"id": "https://openalex.org/C2780417328"
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"id": "https://openalex.org/C187155963"
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"id": "https://openalex.org/C71924100"
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"id": "https://openalex.org/C2718322"
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"display_name": "Occupational injury",
"id": "https://openalex.org/C2780763229"
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{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
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{
"display_name": "Logistic regression",
"id": "https://openalex.org/C151956035"
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{
"display_name": "Emergency department",
"id": "https://openalex.org/C2780724011"
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{
"display_name": "Burnout",
"id": "https://openalex.org/C143916079"
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"display_name": "Cross-sectional study",
"id": "https://openalex.org/C142052008"
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{
"display_name": "Injury prevention",
"id": "https://openalex.org/C190385971"
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{
"display_name": "Poison control",
"id": "https://openalex.org/C3017944768"
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{
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"id": "https://openalex.org/C99454951"
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{
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"id": "https://openalex.org/C159110408"
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{
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"id": "https://openalex.org/C15744967"
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{
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{
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"id": "https://openalex.org/C77805123"
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"id": "https://openalex.org/C142724271"
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{
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"id": "https://openalex.org/C126322002"
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[
"Lebanon"
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[
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"https://openalex.org/W2060388700",
"https://openalex.org/W2063247110",
"https://openalex.org/W2077309550",
"https://openalex.org/W2083202293",
"https://openalex.org/W2085200054",
"https://openalex.org/W2132475930",
"https://openalex.org/W2142739712",
"https://openalex.org/W2144164352",
"https://openalex.org/W2161837734",
"https://openalex.org/W2163044519",
"https://openalex.org/W2170560853"
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https://api.openalex.org/works?filter=cites:W2055559696
|
Occupational Violence at Lebanese Emergency Departments: Prevalence, Characteristics and Associated Factors: Mohamad Alameddine, et al. Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Lebanon— Background Emergency departments (EDs) workers are at increased risk of exposure to occupational violence. The prevalence of occupational violence is potentially higher and consequences are more serious in areas with poor security conditions. Objectives We investigated the prevalence, characteristics and factors associated with the exposure of ED workers to violence at Lebanese hospitals. Methods All ED employees at six tertiary hospitals in Lebanon were surveyed using a cross‐sectional design. The survey instrument included four sections collecting demographic/professional information and measuring exposure to violence, degree of job satisfaction and degree of professional burnout. The questionnaire was distributed to all ED employees at participating hospitals and was completed by 256 ED workers (70.3% response rate). Multinomial and binary logistic regressions were used to investigate factors significantly associated with verbal and physical violence. Results Over the past 12 mo, four in ive ED employees were verbally abused and one in four was physically assaulted. Exposure to verbal abuse was associated with serious outcomes including significantly higher levels of occupational burnout and an increased likelihood to quit current job. Exposure to physical violence was associated with increased likelihood‐to‐quit, nurse status and “public hospital” employment. Conclusion Violence largely prevails at Lebanese EDs. Most vulnerable are nurses and employees of public hospitals who are disproportionally exposed to violence. ED stakeholders must work collaboratively to investigate the root causes of violence and devise and implement effective antiviolence policies and measures. Such measures will be necessary to protect the well‐being and decrease the turnover of ED workers.
|
[
{
"display_name": "Journal of Occupational Health",
"id": "https://openalex.org/S27728379",
"type": "journal"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2034029286
|
Promoting healthy eating and physical activity among school children: findings from Health-E-PALS, the first pilot intervention from Lebanon
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Carla Habib-Mourad",
"id": "https://openalex.org/A5058991920"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Lilian Ghandour",
"id": "https://openalex.org/A5002210479"
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In Lebanon, childhood obesity doubled during the past decade. Preventive measures should start early in life and Schools are considered an important environment to promote energy balance health behaviours. School-based programmes promoting healthy lifestyles are lacking. The purpose of this study was to evaluate the feasibility and effectiveness of a multicomponent school-based intervention to promote healthy eating and physical activity (and prevent obesity) with school children aged 9-11 years in Lebanon.The intervention was developed based on the constructs of the Social Cognitive Theory and adapted to the culture of Lebanese and Arab populations. It consisted of three components: class curriculum, family involvement and food service. Eight schools were purposively selected from two communities of different socioeconomic status (SES) in Beirut and, within each school type, were matched on SES, religious sect profile, and then randomly assigned to either the intervention or control group. Anthropometric measurements and questionnaires on determinants of behavioural change, eating and physical activity habits were completed by the students in both groups at baseline and post intervention. Focus group interviews were conducted in intervention schools at the end of the study. Challenges encountered during the programme implementation were also identified, since Lebanon is considered a country with political unrest and no similar research projects were conducted in the area.Students in the intervention group reported purchasing and consuming less chips and sweetened drinks post-intervention compared with controls (86% & 88% less respectively p < 0.001). Knowledge and self-efficacy scores increased for the intervention (+2.8 & +1.7 points respectively p < 0.001) but not for the control group. There was no difference in physical activity and screen time habits and no changes in BMI between groups at post intervention. Interview data from focus groups showed that the programme was generally well accepted. Limitations for better outcomes include the length of the programme and the school environment."Health-E-PALS" intervention is a promising innovative, theory-based, culturally sensitive intervention to promote healthy eating habits and physical activity in Lebanese school children with a potential to be scaled up, replicated and sustained.
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https://openalex.org/W3030193482
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COVID-19 quarantine: Post-traumatic stress symptomatology among Lebanese citizens
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https://api.openalex.org/works?filter=cites:W3030193482
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Background: In the light of the global spread of the novel Coronavirus known as COVID-19 and in the absence of an approved treatment and vaccination, Lebanon has taken national measures, among which was home quarantine of the general public in an attempt to flatten the epidemic curve and avoid flooding the health care system. Aim: This study aimed at evaluating the prevalence of post-traumatic stress symptomatology (PTSS) during the times of COVID-19 quarantine among Lebanese citizens. Method: This quantitative cross-sectional study recruited 950 civilians and is aimed at measuring the prevalence of PTSS among the Lebanese citizens at an interval of 2 weeks and 1 month of COVID-19 quarantine. Results: The results have shown that quarantine in Lebanon has started to give rise to Post-traumatic Stress Disorder symptomatology during the second week which was worsened in the fourth week of COVID-19 quarantine. Conclusion: COVID-19 quarantine has influenced the psychology of Lebanese citizens and might have persistent effects after the end of this phase which is recommended to be explored.
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https://openalex.org/W2109228315
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The AMEL study, a cross sectional population-based survey on aging and malnutrition in 1200 elderly Lebanese living in rural settings: protocol and sample characteristics
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https://api.openalex.org/works?filter=cites:W2109228315
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Lebanon is faced with a particular challenge because of large socioeconomic inequality and accelerated demographic transition. Rural residents seem more vulnerable because of limited access to transport, health and social services. No information is available regarding health, nutrition and living conditions of this specific population. The purpose of the AMEL (Aging and Malnutrition in Elderly Lebanese) study is to assess the nutritional status of community dwelling elderly people, aged 65 years and above, living in a rural settings in Lebanon, in line of socioeconomic factors, health and living conditions. The present paper will describe the gender specific characteristics of the study population.AMEL is a cross-sectional population based study conducted between April 2011 and April 2012 including 1200 elderly individuals living in the 24 rural Caza (districts) of Lebanon. People aged greater than or equal to 65 y were randomly selected through multistage cluster sampling. Subjects were interviewed at their homes by trained interviewers. The questionnaire included the following measures: socio-demographic factors, nutritional status (Mini Nutritional Assessment, MNA), health related characteristics, functional ability, cognitive status, mood and social network.The sample included 591 men (49.3%) and 609 women (50.8%). Mean age was 75.32 years and similar between genders. Malnutrition (MNA < 17) and risk of malnutrition (MNA between 17 and 23.5) were present in 8.0% (95%CI 4.9%-11.1%) and 29.1% (95%CI 24.0%-34.2%) respectively of the participants, and more frequent in women (9.1% and 35.3% respectively). Regarding socio-demographic status, among women the level of illiteracy and poor income was significantly higher than in men. Moreover, chronic diseases, poor self perceived health, frailty, functional disability, depressive symptoms and cognitive impairment were particularly high and significantly more frequent in women than in men.The present study provides unique information about nutritional status, health and living conditions of community dwelling rural residents of Lebanon. These findings may alert policy makers to plan appropriate intervention in order to improve the quality of life and increase successful aging.
|
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https://openalex.org/W1992027590
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Wartime Civilian Injuries
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https://api.openalex.org/works?filter=cites:W1992027590
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Trauma is the most important public health risk in wartime. Most preventive effort have addressed the political etiology of armed conflicts and the secondary effects of war (food, water, shelter, sanitation, and vector control). Little to no efforts have addressed the direct prevention and control of war trauma.An extensive review of the literature, with compilation of the most important data.Civilians are the major wartime targets in recent wars, and account for most of the killed and wounded. The trend has been toward a greater proportion of injuries from powerful explosive devices such as artillery shells and mines. Lessons learned from Bosnia and Lebanon show that the most effective way to achieve successful surveillance and injury prevention is to enhance the local skills and resources.New approaches are needed to minimize trauma to civilians. Both political advocacy and local efforts (including modifying firearms and ammunition, bullet proof helmets for children, anti-sniper shields) are needed.
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https://openalex.org/W2511381813
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Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys
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"Lebanon",
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"Jordan",
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https://api.openalex.org/works?filter=cites:W2511381813
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Ongoing armed conflict in Syria has caused large scale displacement. Approximately half of the population of Syria have been displaced including the millions living as refugees in neighboring countries. We sought to assess the health and nutrition of Syrian refugees affected by the conflict. Representative cross-sectional surveys of Syrian refugees were conducted between October 2 and November 30, 2013 in Lebanon, April 12 and May 1, 2014 in Jordan, and May 20 and 31, 2013 in Iraq. Surveys in Lebanon were organized in four geographical regions (North, South, Beirut/Mount Lebanon and Bekaa). In Jordan, independent surveys assessed refugees residing in Za’atri refugee camp and refugees residing among host community nationwide. In Iraq, refugees residing in Domiz refugee camp in the Kurdistan region were assessed. Data collected on children aged 6 to 59 months included anthropometric indicators, morbidity and feeding practices. In Jordan and Lebanon, data collection also included hemoglobin concentration for children and non-pregnant women aged 15 to 49 years, anthropometric indicators for both pregnant and non-pregnant women, and household level indicators such as access to safe water and sanitation. The prevalence of global acute malnutrition among children 6 to 59 months of age was less than 5 % in all samples (range 0.3–4.4 %). Prevalence of acute malnutrition among women 15 to 49 years of age, defined as mid-upper arm circumference less than 23.0 cm, was also relatively low in all surveys (range 3.5–6.5 %). For both children and non-pregnant women, anemia prevalence was highest in Za’atri camp in Jordan (48.4 % and 44.8 %, respectively). Most anemia was mild or moderate; prevalence of severe anemia was less than or equal to 1.1 % in all samples of children and women. Despite the ongoing conflict, results from all surveys indicate that global acute malnutrition is relatively low in the assessed Syrian refugee populations. However, prevalence of anemia suggests a serious public health problem among women and children, especially in Za’atri camp. Based on these findings, nutrition partners in the region have reprioritized response interventions, focusing on activities to address micronutrient deficiencies such as food fortification.
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"display_name": "Conflict and Health",
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https://openalex.org/W1591208242
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The Use of Complementary and Alternative Medicine among Lebanese Adults: Results from a National Survey
|
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"display_name": "Dania Hariri",
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"display_name": "American University of Beirut",
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"id": "https://openalex.org/C50522688"
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https://api.openalex.org/works?filter=cites:W1591208242
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Objective. To examine the prevalence and correlates of Complementary and Alternative Medicine (CAM) use in Lebanon. Methods. A cross-sectional survey was conducted through face to face interviews on a nationally representative sample of 1,475 Lebanese adults. The survey questionnaire explored the sociodemographic and health related characteristics as well as the types and modes of CAM use. The main outcome in this study was the use of CAM during the last 12 months. Results. Prevalence of CAM use was 29.87% with "folk herbs" being the most commonly used (75%). Two out of five CAM users indicated using it as alternative to conventional therapies and only 28.4% of users disclosed the use of CAM to their physician. CAM use was significantly associated with higher income, presence of a chronic disease, and lack of access to needed health care. Lower odds of CAM use were observed among older adults and those with a higher education level. Conclusions. This study revealed a high prevalence of CAM use in Lebanon. Health policy and decision makers need to facilitate proper regulation and integration of CAM into mainstream medicine and educate health care providers and the public alike on the safe and effective use of CAM therapies.
|
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"display_name": "Evidence-based Complementary and Alternative Medicine",
"id": "https://openalex.org/S15444899",
"type": "journal"
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{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
"type": "repository"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
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{
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"type": "repository"
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{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W1584613316
|
High burden of rheumatic diseases in Lebanon: a COPCORD study
|
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{
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"display_name": "Zeinab N. Slim",
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"id": "https://openalex.org/I98635879",
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"display_name": "Zeinab Issa",
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https://api.openalex.org/works?filter=cites:W1584613316
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Abstract Aim: To estimate the prevalence of rheumatic diseases in Lebanon and to explore their distribution by geographic location, age, and gender. Method: Using the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology, a random sample of 3530 individuals aged 15 and above was interviewed from the six Lebanese governorates. Positive respondents were evaluated by rheumatologists using the internationally accepted classification criterion of the American College of Rheumatology for the diagnosis of rheumatic diseases. Results: Prevalence rates of current and past musculoskeletal problems were 24.4% and 8.4%, respectively. Shoulder (14.3%), knee (14.2%) and back (13.6%) were the most common pain sites. Point prevalence of rheumatic diseases was 15.0%. The most frequent types of rheumatic diseases were of mechanical origin, namely soft tissue rheumatism (5.8%) and osteoarthritis (4.0%). Rheumatoid arthritis (1.0%) and spondylathropathies (0.3%) constituted the most common inflammatory diseases. Coastal areas had the lowest prevalence of all diseases except for fibromyalgia. All diseases showed an increasing prevalence pattern with age and a higher prevalence among women than men. Conclusion: This is the first study to give population‐based estimates of rheumatic diseases in Lebanon. The high burden calls for public health attention for early detection, control and prevention of these conditions. Point prevalence of individual diseases was within the range of results from other COPCORD surveys with some variations that can be attributed to differences in methodology and geo‐ethnic factors.
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"type": "repository"
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https://openalex.org/W2128286256
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Diet, physical activity and socio-economic disparities of obesity in Lebanese adults: findings from a national study
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"display_name": "American University of Beirut Medical Center",
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"display_name": "Nahla Hwalla",
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"id": "https://openalex.org/C149923435"
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"id": "https://openalex.org/C2776193436"
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"id": "https://openalex.org/C138816342"
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{
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"id": "https://openalex.org/C61427482"
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{
"display_name": "Logistic regression",
"id": "https://openalex.org/C151956035"
},
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"display_name": "Abdominal obesity",
"id": "https://openalex.org/C2777693730"
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{
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"id": "https://openalex.org/C74909509"
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{
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"id": "https://openalex.org/C99454951"
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"id": "https://openalex.org/C159110408"
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"id": "https://openalex.org/C126322002"
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{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
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https://api.openalex.org/works?filter=cites:W2128286256
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The prevalence of obesity within countries varies by gender, age, lifestyle and socioeconomic factors. Identification of behavioural factors that are associated with obesity within the country’s context is critical for the development of effective public health programs which aim to prevent and manage obesity. The objective of this study was to assess age and gender differentials in the prevalence of obesity in Lebanon and examine correlates of obesity with a focus on socioeconomic disparities. Following the WHO STEPwise guidelines, a national survey was conducted in Lebanon in 2008–2009. Households were selected randomly from all Governorates based on stratified cluster sampling method. One adult aged 20 years and over was randomly selected from each household for the interview. Anthropometric measurements and 24 hour recall dietary intake were obtained. The final sample included 1244 men and 1453 women. Descriptive statistics were computed for BMI, waist circumference, and percent body fat. Multivariate logistic regression analysis was carried out to assess the relationship between energy intake and obesity adjusted for relevant co-variables. The prevalence of obesity among Lebanese adults was 26.1%. Gender differences in obesity estimates were observed across age groups and the three obesity classes, with men showing higher prevalence rates at the younger age groups (20–49 years), and women showing higher prevalence rates in older age groups (50 years and above). Obesity showed significant associations with socio-economic status in women; it decreased with higher educational attainment (OR = 0.54, 95% CI: 0.32, 0.91), greater household assets (OR = 0.26; 95% CI: 0.10, 0.72) and lower crowding index (OR = 0.62; 95% CI: 0.39, 0.98), net of the effect of other co-variates. There was a significant positive association between obesity and energy intake in both genders, and a negative association between obesity and physical activity, significantly among women. Lifestyle and socioeconomic determinants of obesity are identified in this Lebanese population. Policy makers and service providers need to tailor public health strategies to tackle obesity accordingly.
|
[
{
"display_name": "BMC Public Health",
"id": "https://openalex.org/S200437886",
"type": "journal"
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{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
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{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
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{
"display_name": "Durham Research Online (Durham University)",
"id": "https://openalex.org/S4377196258",
"type": "repository"
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{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
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|
https://openalex.org/W1654483068
|
Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region
|
[
{
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{
"country": "Egypt",
"display_name": "World Health Organization Regional Office for the Eastern Mediterranean",
"id": "https://openalex.org/I4210105726",
"lat": 30.06688,
"long": 31.35298,
"type": "government"
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"display_name": "Sameen Siddiqi",
"id": "https://openalex.org/A5043587359"
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{
"affiliations": [
{
"country": "United States",
"display_name": "Johns Hopkins University",
"id": "https://openalex.org/I145311948",
"lat": 39.29038,
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"display_name": "Tayyeb Masud",
"id": "https://openalex.org/A5041826948"
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{
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{
"country": "Egypt",
"display_name": "World Health Organization Regional Office for the Eastern Mediterranean",
"id": "https://openalex.org/I4210105726",
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"long": 31.35298,
"type": "government"
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"display_name": "Belgacem Sabri",
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"id": "https://openalex.org/C144133560"
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{
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{
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"id": "https://openalex.org/C121426985"
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"id": "https://openalex.org/C83864248"
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"id": "https://openalex.org/C46934059"
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"id": "https://openalex.org/C160735492"
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"id": "https://openalex.org/C50522688"
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"Lebanon",
"Islamic Republic of Iran",
"Bahrain",
"Tunisia",
"Syrian Arab Republic",
"Syria",
"Iran",
"Jordan",
"Egypt",
"Morocco"
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https://api.openalex.org/works?filter=cites:W1654483068
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The public sector in developing countries is increasingly contracting with the non-state sector to improve access, efficiency and quality of health services. We conducted a multicountry study to assess the range of health services contracted out, the process of contracting and its influencing factors in ten countries of the Eastern Mediterranean Region: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Morocco, Pakistan, the Syrian Arab Republic and Tunisia. Our results showed that Afghanistan, Egypt, Islamic Republic of Iran and Pakistan had experience with outsourcing of primary care services; Jordan, Lebanon and Tunisia extensively contracted out hospital and ambulatory care services; while Bahrain, Morocco and the Syrian Arab Republic outsourced mainly non-clinical services. The interest of the non-state sector in contracting was to secure a regular source of revenue and gain enhanced recognition and credibility. While most countries promoted contracting with the private sector, the legal and bureaucratic support in countries varied with the duration of experience with contracting. The inherent risks evident in the contracting process were reliance on donor funds, limited number of providers in rural areas, parties with vested interests gaining control over the contracting process, as well as poor monitoring and evaluation mechanisms. Contracting provides the opportunity to have greater control over private providers in countries with poor regulatory capacity, and if used judiciously can improve health system performance.
|
[
{
"display_name": "Bulletin of The World Health Organization",
"id": "https://openalex.org/S22004576",
"type": "journal"
},
{
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"id": "https://openalex.org/S4306400806",
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{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
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{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
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|
https://openalex.org/W2554420166
|
Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon
|
[
{
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"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
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"display_name": "Shadi Saleh",
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"long": 35.48153,
"type": "education"
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"display_name": "Maysa Baroud",
"id": "https://openalex.org/A5070859380"
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https://api.openalex.org/works?filter=cites:W2554420166
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eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools. A self-administered questionnaire was used to assess participants’ socio-demographics, computer use, literacy, and access, and participants’ readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane’s T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth. Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants’ level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and change efficacy; and between frequency of computer use and change efficacy. The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.
|
[
{
"display_name": "BMC Health Services Research",
"id": "https://openalex.org/S12898181",
"type": "journal"
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{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
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"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
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"id": "https://openalex.org/S2764455111",
"type": "repository"
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"id": "https://openalex.org/S4306525036",
"type": "repository"
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https://openalex.org/W2296253067
|
Mental Health among displaced Syrians: findings from the Syria Public Health Network
|
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"display_name": "Aula Abbara",
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"display_name": "Adam Coutts",
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"display_name": "Fouad M. Fouad",
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"display_name": "Sharif Ismail",
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"country": "United Kingdom",
"display_name": "King's College London",
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"type": "education"
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],
"display_name": "Miriam Orcutt",
"id": "https://openalex.org/A5063644370"
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[
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"display_name": "Public health",
"id": "https://openalex.org/C138816342"
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{
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"id": "https://openalex.org/C134362201"
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"display_name": "Data science",
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"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
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{
"display_name": "Computer science",
"id": "https://openalex.org/C41008148"
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{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
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{
"display_name": "World Wide Web",
"id": "https://openalex.org/C136764020"
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"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
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{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
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[
"Lebanon",
"Syria"
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"https://openalex.org/W2016760348",
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https://api.openalex.org/works?filter=cites:W2296253067
|
Aula Abbara, Adam Coutts, Fouad M Fouad, Sharif A Ismail, Miriam Orcutt; the Syria Public Health Network National Heart and Lung Institute, Imperial College London, London, UK Department of Politics and International Studies, University of Cambridge, Cambridge, UK Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon Department of Primary Care and Public Health, Imperial College London, London, UK Conflict and Health Research Group, King’s College London, London, UK Corresponding author: Sharif A Ismail. Email: [email protected]
|
[
{
"display_name": "Journal of the Royal Society of Medicine",
"id": "https://openalex.org/S49645005",
"type": "journal"
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{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
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{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
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{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
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|
https://openalex.org/W3165225148
|
Attitudes of Lebanese adults regarding COVID-19 vaccination
|
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"affiliations": [
{
"country": "Lebanon",
"display_name": "Holy Spirit University of Kaslik",
"id": "https://openalex.org/I189998669",
"lat": 33.89332,
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"display_name": "Carina Kasrine Al Halabi",
"id": "https://openalex.org/A5029396471"
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{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Holy Spirit University of Kaslik",
"id": "https://openalex.org/I189998669",
"lat": 33.89332,
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"display_name": "Sahar Obeïd",
"id": "https://openalex.org/A5018364968"
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"affiliations": [],
"display_name": "Hala Sacre",
"id": "https://openalex.org/A5088172147"
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{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Lebanese International University",
"id": "https://openalex.org/I911468752",
"lat": 33.88486,
"long": 35.49528,
"type": "education"
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"display_name": "Marwan Akel",
"id": "https://openalex.org/A5027904119"
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"affiliations": [
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"country": "Lebanon",
"display_name": "Holy Spirit University of Kaslik",
"id": "https://openalex.org/I189998669",
"lat": 33.89332,
"long": 35.50157,
"type": "education"
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{
"country": "Lebanon",
"display_name": "Centre Hospitalier Universitaire Notre Dame des Secours",
"id": "https://openalex.org/I4210123515",
"lat": 34.12808,
"long": 35.658985,
"type": "healthcare"
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"display_name": "Rabih Hallit",
"id": "https://openalex.org/A5001660443"
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{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Lebanese University",
"id": "https://openalex.org/I160368002",
"lat": 33.827816,
"long": 35.52219,
"type": "education"
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{
"country": "Cyprus",
"display_name": "University of Nicosia",
"id": "https://openalex.org/I17389662",
"lat": 35.17531,
"long": 33.3642,
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"display_name": "Pascale Salameh",
"id": "https://openalex.org/A5023182162"
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"affiliations": [
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"country": "Lebanon",
"display_name": "Holy Spirit University of Kaslik",
"id": "https://openalex.org/I189998669",
"lat": 33.89332,
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"type": "education"
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"display_name": "Souheil Hallit",
"id": "https://openalex.org/A5020046919"
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[
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"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
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{
"display_name": "Vaccination",
"id": "https://openalex.org/C22070199"
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{
"display_name": "Biostatistics",
"id": "https://openalex.org/C140556311"
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{
"display_name": "Coronavirus disease 2019 (COVID-19)",
"id": "https://openalex.org/C3008058167"
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{
"display_name": "Odds ratio",
"id": "https://openalex.org/C156957248"
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{
"display_name": "Odds",
"id": "https://openalex.org/C143095724"
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{
"display_name": "Snowball sampling",
"id": "https://openalex.org/C106399304"
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{
"display_name": "Cross-sectional study",
"id": "https://openalex.org/C142052008"
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{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
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{
"display_name": "Young adult",
"id": "https://openalex.org/C205545832"
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{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
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{
"display_name": "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)",
"id": "https://openalex.org/C3007834351"
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{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
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{
"display_name": "Epidemiology",
"id": "https://openalex.org/C107130276"
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{
"display_name": "Immunology",
"id": "https://openalex.org/C203014093"
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{
"display_name": "Gerontology",
"id": "https://openalex.org/C74909509"
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{
"display_name": "Logistic regression",
"id": "https://openalex.org/C151956035"
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"display_name": "Internal medicine",
"id": "https://openalex.org/C126322002"
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"id": "https://openalex.org/C159110408"
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{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
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"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
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"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
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{
"display_name": "Infectious disease (medical specialty)",
"id": "https://openalex.org/C524204448"
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[
"Lebanon"
] |
[
"https://openalex.org/W2099690490",
"https://openalex.org/W2777239471",
"https://openalex.org/W2995994767",
"https://openalex.org/W3006962945",
"https://openalex.org/W3013355453",
"https://openalex.org/W3017185871",
"https://openalex.org/W3028833561",
"https://openalex.org/W3029744473",
"https://openalex.org/W3080350053",
"https://openalex.org/W3082439375",
"https://openalex.org/W3084593143",
"https://openalex.org/W3093017530",
"https://openalex.org/W3107807236",
"https://openalex.org/W3108881073",
"https://openalex.org/W3111048826",
"https://openalex.org/W3121247321",
"https://openalex.org/W3128392043"
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https://api.openalex.org/works?filter=cites:W3165225148
|
Abstract Background COVID-19 was first detected in Lebanon on February 21, 2020; it reached its peak in January 2021, with a total number of 418,448 confirmed cases and 5380 deaths (until March 15, 2021). Gaining insight into factors regarding willingness or refusal for vaccination might guide our goals in raising the awareness and target efforts to increase acceptance of the COVID-19 vaccine and maximize the uptake. Therefore, this study aims to assess the intent to receive the COVID-19 vaccine among Lebanese adults and the factors associated with vaccine refusal. Methods We conducted a cross-sectional study during November–December 2020 among Lebanese adults from all Lebanese regions using a survey tool with closed-ended questions that included sociodemographic data and questions about vaccine hesitancy, knowledge, attitude, practice, and fear of COVID-19. We used the snowball technique to collect the data because of the COVID-19 imposed lockdown. Results Of the 579 participants, 21.4% were willing to receive the vaccine, 40.9% refused, and the remainder were unsure of their response. More vaccine hesitancy (adjusted odds ratio (aOR) = 1.06; 95% CI 1.03–1.09) was significantly associated with more odds of disagreeing/ strongly disagreeing on receiving the COVID-19 vaccine compared to being neutral. More vaccine hesitancy (aOR = 0.95; 95% CI 0.91–0.99), female gender compared to males (aOR = 0.53; 95% CI 0.32–0.87), and being married compared to single (aOR = 0.53; 95% CI 0.29–0.98) were significantly associated with lower odds of agreeing/strongly agreeing on receiving the COVID-19 vaccine compared to being neutral. Conclusion Overall, our findings revealed a high percentage of people (40%) who strongly disagreed with receiving the vaccine, mainly females, married participants, and those who have a general vaccine hesitancy. Moreover, no significant association was found with knowledge, attitude, or prevention practice regarding COVID-19. Targeted efforts are necessary to increase acceptance of a COVID-19 vaccine among the Lebanese population to control the COVID-19 pandemic. Further studies with a larger sample size are warranted to validate our results and provide better insights into the underlying reasons for refusing vaccination.
|
[
{
"display_name": "BMC Public Health",
"id": "https://openalex.org/S200437886",
"type": "journal"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
}
] |
|
https://openalex.org/W2117001437
|
Post-Traumatic Stress Disorder in Adolescents in Lebanon as Wars Gained in Ferocity: A Systematic Review
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Ministry of Public Health",
"id": "https://openalex.org/I4210097567",
"lat": 33.86422,
"long": 35.493645,
"type": "government"
}
],
"display_name": "Khuzama Shaar",
"id": "https://openalex.org/A5040314787"
}
] |
[
{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
},
{
"display_name": "Mental health",
"id": "https://openalex.org/C134362201"
},
{
"display_name": "Traumatic stress",
"id": "https://openalex.org/C2778159538"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Spanish Civil War",
"id": "https://openalex.org/C81631423"
},
{
"display_name": "Suicide prevention",
"id": "https://openalex.org/C526869908"
},
{
"display_name": "Poison control",
"id": "https://openalex.org/C3017944768"
},
{
"display_name": "Psychology",
"id": "https://openalex.org/C15744967"
},
{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
}
] |
[
"Lebanon"
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[
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"https://openalex.org/W1723388838",
"https://openalex.org/W1964266667",
"https://openalex.org/W1965451749",
"https://openalex.org/W1967631889",
"https://openalex.org/W1972622883",
"https://openalex.org/W1978011243",
"https://openalex.org/W1979261492",
"https://openalex.org/W1986496491",
"https://openalex.org/W1990472164",
"https://openalex.org/W1992113675",
"https://openalex.org/W2005876985",
"https://openalex.org/W2007786890",
"https://openalex.org/W2016448936",
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"https://openalex.org/W2036324564",
"https://openalex.org/W2052586622",
"https://openalex.org/W2075847293",
"https://openalex.org/W2076293645",
"https://openalex.org/W2076797897",
"https://openalex.org/W2082183651",
"https://openalex.org/W2087035564",
"https://openalex.org/W2088928227",
"https://openalex.org/W2091004594",
"https://openalex.org/W2097730572",
"https://openalex.org/W2121072935",
"https://openalex.org/W2123317856",
"https://openalex.org/W2142340227",
"https://openalex.org/W4230565321",
"https://openalex.org/W4232305499",
"https://openalex.org/W4249247534",
"https://openalex.org/W4252975490"
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https://api.openalex.org/works?filter=cites:W2117001437
|
For decades, Lebanon was war-torn by civil strife, and occupation and invasion by neighboring countries. In time, these wars have escalated in intensity from sniping, barricading streets and random shelling of residential quarters to the use of rockets, aerial bombing, and heavy artillery. Adverse mental health effects are noted in times of war with post traumatic stress disorder (PTSD) as a main outcome. The aim of this study was to carry out a systematic review of published studies documenting the prevalence of PTSD in the adolescent population of Lebanon, to investigate the increase in these rates with the escalation of war intensity, and to examine PTSD determinants. A search strategy was developed for online databases (PubMed and Google Scholar) between inception to the first week of January 2013. Search terms used were PTSD, adolescents and Lebanon. Eleven studies reporting PTSD in adolescents met the inclusion criteria for a total number of 5965 adolescents. Prevalence rates of PTSD ranged from 8.5% to 14.7% for the civil war, 3.7% for adolescents with sensory disabilities, 21.6% for the Grapes of Wrath War, and 15.4% to 35.0% for the 2006 July War. Some increase in PTSD rates in time is noted. Type of trauma such as bereavement, injury, house destruction, and economic problems, low self efficacy and scholastic impairment were related to PTSD. These findings may help in the development of public health policies for PTSD prevention and treatment for the protection of adolescents from war atrocities and their consequences.
|
[
{
"display_name": "Journal of Public Health Research",
"id": "https://openalex.org/S2736424777",
"type": "journal"
},
{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
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},
{
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"id": "https://openalex.org/S4306400806",
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{
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{
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"id": "https://openalex.org/S4306525036",
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|
https://openalex.org/W2894551922
|
Infectious diseases in the era of refugees: Hepatitis A outbreak in Lebanon
|
[
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"country": "United States",
"display_name": "American University",
"id": "https://openalex.org/I181401687",
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"display_name": "Abdul Rahman Bizri",
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{
"country": "United States",
"display_name": "Northwestern University",
"id": "https://openalex.org/I111979921",
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{
"country": "United States",
"display_name": "Neurological Surgery",
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"display_name": "Jawad Fares",
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"display_name": "American University",
"id": "https://openalex.org/I181401687",
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"type": "education"
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"display_name": "Umayya Musharrafıeh",
"id": "https://openalex.org/A5050182315"
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[
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"display_name": "Hepatitis A",
"id": "https://openalex.org/C2775876817"
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{
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"id": "https://openalex.org/C99454951"
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{
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"id": "https://openalex.org/C173145845"
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"id": "https://openalex.org/C71924100"
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{
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"id": "https://openalex.org/C116675565"
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{
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"id": "https://openalex.org/C138816342"
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{
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"id": "https://openalex.org/C2780151969"
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{
"display_name": "Epidemiology",
"id": "https://openalex.org/C107130276"
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{
"display_name": "Syrian refugees",
"id": "https://openalex.org/C3018716944"
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{
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"id": "https://openalex.org/C3018443061"
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{
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"id": "https://openalex.org/C2776029263"
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{
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"id": "https://openalex.org/C205649164"
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{
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{
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"id": "https://openalex.org/C166957645"
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"id": "https://openalex.org/C142724271"
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{
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"id": "https://openalex.org/C126322002"
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[
"Lebanon",
"Syria"
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https://api.openalex.org/works?filter=cites:W2894551922
|
Abstract Background: The Syrian crisis has altered the epidemiology of infectious diseases in countries hosting large numbers of refugees. Lebanon witnessed several outbreaks linked to the presence of significant numbers of Syrian refugees, namely, Hepatitis A virus (HAV). We explore the epidemiology of HAV in Lebanon and the impact of the Syrian war during the 2014 outbreak and suggest solutions to prevent and minimize the HAV spread amid the current socioeconomic conditions. Methods: We reviewed all HAV cases reported to the Epidemiologic Surveillance Unit at the Ministry of Public Health between January 2001 and December 2017. Demographics and distribution of Syrian refugees in Lebanon were linked to reports of new HAV cases. Results: A sharp rise in the number of reported HAV cases was observed in Lebanon in 2013, concurrent with the Syrian crisis and influx of refugees. Most cases reported in 2013 and 2014 involved Syrian refugees and their relevant areas of settlement in the Beqaa and North governorates. Conclusion: The influx of refugees strained overburdened sanitary infrastructure and overstretched existing public health services in Lebanon, which led to an increase in the incidence of reported HAV cases. The Lebanese health authorities and the international community need to intensify their efforts in surveillance and prevention of communicable diseases. Providing proper sanitation and free vaccination for affected communities are effective solutions to contain the HAV outbreak. Yet, financial constraints and the need to prioritize in the health budget put HAV-immunization at a lower priority. The Lebanese scenario could be reflective to other countries hosting sizeable numbers of refugees.
|
[
{
"display_name": "Avicenna Journal of Medicine",
"id": "https://openalex.org/S2764417561",
"type": "journal"
},
{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
"type": "repository"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W1988205467
|
The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon
|
[
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"display_name": "American University of Beirut",
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"display_name": "Fadi El‐Jardali",
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{
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{
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"display_name": "American University of Beirut",
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"display_name": "Nour Ataya",
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https://api.openalex.org/works?filter=cites:W1988205467
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In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC.The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors.The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages.To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well.
|
[
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{
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"id": "https://openalex.org/S4306400806",
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{
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{
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"id": "https://openalex.org/S4306525036",
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|
https://openalex.org/W2626373092
|
Household food insecurity is associated with a higher burden of obesity and risk of dietary inadequacies among mothers in Beirut, Lebanon
|
[
{
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{
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"type": "education"
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"display_name": "Nahla Hwalla",
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"id": "https://openalex.org/C142052008"
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{
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https://api.openalex.org/works?filter=cites:W2626373092
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Mixed evidence exists with respect to the association between household food insecurity (HFIS) and obesity in low-to-middle income countries (LMICs), particularly among women. This study aimed to measure socioeconomic correlates of HFIS and explores its association with dietary intake and odds of obesity among mothers in Lebanon, a middle-income country undergoing nutrition transition. A cross-sectional study was conducted among a representative sample of households (n = 378) in Beirut, Lebanon. Surveys were completed with mothers of children <18 years. HFIS was measured using a locally-validated, Arabic-translated Household Food Insecurity Access Scale (HFIAS). Dietary intake was assessed using the multiple pass 24-h recall method. Associations between HFIS (food vs food insecure) and socio-demographic characteristics were reported using crude and adjusted odds ratios. The odds of consuming <2/3rd Dietary Reference Intakes (DRIs) for nutrients among mothers from food secure and food insecure households were explored. In addition, logistic regression analyses were conducted to explore the association of HFIS with obesity (BMI ≥ 30 kg/m2) and at-risk waist circumference (WC ≥ 80 cm) among mothers. HFIS was found among 50% of study sample and was inversely associated with household income and mother’s educational level, even after adjusting for other socioeconomic variables (p < 0.01). Mothers in food insecure households reported consuming significantly less dairy products, fruits, and nuts yet more breads and sweets; and they had higher odds of consuming <2/3rd the DRI’s for key micronutrients (potassium, folate, and vitamin C) compared to secure ones. Adjusting for socioeconomic correlates, food insecure mothers had 1.73 odds of obesity (95% CI: 1.02–2.92) compared to food secure mothers. High HFIS prevalence was reported among urban Lebanese households. Mothers from food insecure households had a high risk of dietary inadequacy and obesity. Adequate evidence-based public health strategies are needed to reduce the vulnerability of mothers to food insecurity in LMIC settings and alleviate their risk of a high burden of nutrient insecurity and obesity.
|
[
{
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{
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{
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{
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|
https://openalex.org/W2123081027
|
Trends in Nutritional Intakes and Nutrition-Related Cardiovascular Disease Risk Factors in Lebanon : The Need for Immediate Action
|
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"id": "https://openalex.org/C71924100"
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https://api.openalex.org/works?filter=cites:W2123081027
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To examine the burden of cardiovascular disease (CVD) risk factors and their association with dietary variables in the Lebanese population while reviewing secular trends in the population's nutritional intakes and nutrition-related CVD risk factors.Data on CVD risk factors and food consumption patterns in Lebanon were collected from scholarly papers, including individual studies and systematic review articles. Electronic databases were searched using combinations of key terms.The prevalence of obesity in Lebanon followed an alarming increasing trend over time, paralleled by an escalation in the prevalence of hypertension, diabetes and hyperlipidemia. Food consumption surveys illustrate an increasing trend in energy intake and the proportion of energy derived from fat and animal products, with a concomitant decrease in carbohydrates and cereals intakes.The shift towards an atherogenic diet coupled with the alarming increase in nutrition-related cardiovascular risk factors suggest that the Lebanese population is at an increased risk for CVDs. This should alert to the importance of formulating multicomponent intervention strategies at both the individual and population levels to halt the progression of nutrition-related diseases in the country, while highlighting the need for immediate public health efforts to promote the adoption of healthy dietary habits.
|
[
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"display_name": "Le Journal médical libanais. The Lebanese medical journal",
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"id": "https://openalex.org/S4306525036",
"type": "repository"
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] |
|
https://openalex.org/W1998134822
|
Parental smoking and exposure to environmental tobacco smoke are associated with waterpipe smoking among youth: results from a national survey in Lebanon
|
[
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"display_name": "Rima Afifi",
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[
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{
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}
] |
[
"Lebanon"
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https://api.openalex.org/works?filter=cites:W1998134822
|
Waterpipe tobacco smoking (WTS) is a growing public health concern worldwide yet little is known about the epidemiology of use among young people. The objectives of this study were to examine the prevalence, patterns and correlates of WTS among students across Lebanon. The study design was a cross sectional survey. 126-item tobacco questionnaire was conducted among 1128 sixth and seventh grade students across Lebanon. Current patterns of use were descriptively analysed, and logistic regression models examined correlates of WTS. Ever WTS prevalence was 44.3%, current WTS prevalence was triple that of cigarettes (22.1% vs 7.4%), and 40.0% of current users were at least weekly or daily smokers. Initiation and patterns of use, as well as addiction and cessation attitudes have been reported. Significant correlates of current WTS included older age, reduced religiosity, peer and parent tobacco use, recent waterpipe advertisement exposure, increased pluralistic ignorance and current cigarette use. Significant correlates of ever WTS were similar to current WTS, but included second hand waterpipe tobacco smoke exposure at home and did not include recent waterpipe advertisement exposure. Neither gender nor socio-economic status were significant correlates of current or ever WTS. Waterpipe is the most common form of tobacco smoking, and is used regularly, among sixth and seventh grade Lebanese students. It should be considered a public health priority with increased tobacco surveillance and legislation. Widespread educational and policy interventions might help denormalize the social acceptability of WTS. Meanwhile, more research is needed to understand the changing paradigm of WTS epidemiology and the health outcomes among young smokers.
|
[
{
"display_name": "Public Health",
"id": "https://openalex.org/S11097115",
"type": "journal"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2015376828
|
Patient safety culture in a large teaching hospital in Riyadh: baseline assessment, comparative analysis and opportunities for improvement
|
[
{
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{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
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{
"country": "Canada",
"display_name": "McMaster University",
"id": "https://openalex.org/I98251732",
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"display_name": "Fadi El‐Jardali",
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{
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"display_name": "King Saud University",
"id": "https://openalex.org/I28022161",
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{
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"display_name": "King Saud University",
"id": "https://openalex.org/I28022161",
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"display_name": "Nereo A Garcia",
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"display_name": "American University of Beirut",
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"display_name": "Diana Jamal",
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{
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"display_name": "King Saud University",
"id": "https://openalex.org/I28022161",
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],
"display_name": "Ayman A. Abdo",
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] |
[
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{
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"id": "https://openalex.org/C2779328685"
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{
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"id": "https://openalex.org/C137992405"
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{
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"id": "https://openalex.org/C2779240384"
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{
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"id": "https://openalex.org/C2777512617"
},
{
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{
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{
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"id": "https://openalex.org/C159110408"
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{
"display_name": "Health care",
"id": "https://openalex.org/C160735492"
},
{
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{
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{
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{
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{
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"id": "https://openalex.org/C151730666"
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{
"display_name": "Management",
"id": "https://openalex.org/C187736073"
},
{
"display_name": "Economy",
"id": "https://openalex.org/C136264566"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
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{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
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{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
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{
"display_name": "Biology",
"id": "https://openalex.org/C86803240"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
}
] |
[
"Lebanon"
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[
"https://openalex.org/W1995793930",
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"https://openalex.org/W2038401197",
"https://openalex.org/W2048421003",
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"https://openalex.org/W2127267205",
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https://api.openalex.org/works?filter=cites:W2015376828
|
In light of the immense attention given to patient safety, this paper details the findings of a baseline assessment of the patient safety culture in a large hospital in Riyadh and compares results with regional and international studies that utilized the Hospital Survey on Patient Safety Culture. This study also aims to explore the association between patient safety culture predictors and outcomes, considering respondent characteristics and facility size.This cross sectional study adopted a customized version of the HSOPSC and targeted hospital staff fitting sampling criteria (physicians, nurses, clinical and non-clinical staff, pharmacy and laboratory staff, dietary and radiology staff, supervisors, and hospital managers).3000 questionnaires were sent and 2572 were returned (response rate of 85.7%). Areas of strength were Organizational Learning and Continuous Improvement and Teamwork within units whereas areas requiring improvement were hospital non-punitive response to error, staffing, and Communication Openness. The comparative analysis noted several areas requiring improvement when results on survey composites were compared with results from Lebanon, and the United States. Regression analysis showed associations between higher patient safety aggregate score and greater age (46 years and above), longer work experience, having a Baccalaureate degree, and being a physician or other health professional.Patient safety practices are crucial toward improving overall performance and quality of services in healthcare organizations. Much can be done in the sampled organizations and in the context of KSA in general to improve areas of weakness and further enhance areas of strength.
|
[
{
"display_name": "BMC Health Services Research",
"id": "https://openalex.org/S12898181",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
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{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2782565929
|
Lebanon: mental health system reform and the Syrian crisis
|
[
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{
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"display_name": "Saint George Hospital",
"id": "https://openalex.org/I2803082546",
"lat": 33.894,
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"type": "healthcare"
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{
"country": "Lebanon",
"display_name": "Institute for Development, Research, Advocacy and Applied Care",
"id": "https://openalex.org/I4210145405",
"lat": 33.894363,
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"type": "nonprofit"
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],
"display_name": "Elie G. Karam",
"id": "https://openalex.org/A5073750953"
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{
"affiliations": [
{
"country": "France",
"display_name": "Hôtel-Dieu de Paris",
"id": "https://openalex.org/I4210133078",
"lat": 48.85341,
"long": 2.3488,
"type": "healthcare"
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],
"display_name": "Rabih El Chammay",
"id": "https://openalex.org/A5009506191"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Saint Joseph University",
"id": "https://openalex.org/I184679254",
"lat": 33.89332,
"long": 35.50157,
"type": "education"
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{
"country": "Lebanon",
"display_name": "Hôtel-Dieu de France",
"id": "https://openalex.org/I4210152906",
"lat": 33.88146,
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"display_name": "Sami Richa",
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{
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{
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"display_name": "Lebanese University",
"id": "https://openalex.org/I160368002",
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"display_name": "Wadih Naja",
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"display_name": "Institute for Development, Research, Advocacy and Applied Care",
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{
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"display_name": "Saint George Hospital",
"id": "https://openalex.org/I2803082546",
"lat": 33.894,
"long": 35.523727,
"type": "healthcare"
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],
"display_name": "John Fayyad",
"id": "https://openalex.org/A5053005967"
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{
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{
"country": "Lebanon",
"display_name": "Ministry of Public Health",
"id": "https://openalex.org/I4210097567",
"lat": 33.86422,
"long": 35.493645,
"type": "government"
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{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Walid Ammar",
"id": "https://openalex.org/A5032289226"
}
] |
[
{
"display_name": "Mental health",
"id": "https://openalex.org/C134362201"
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{
"display_name": "Christian ministry",
"id": "https://openalex.org/C521751864"
},
{
"display_name": "Refugee",
"id": "https://openalex.org/C173145845"
},
{
"display_name": "Syrian refugees",
"id": "https://openalex.org/C3018716944"
},
{
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"id": "https://openalex.org/C138816342"
},
{
"display_name": "Refugee crisis",
"id": "https://openalex.org/C2778745634"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
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{
"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
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{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
}
] |
[
"Lebanon",
"Syria"
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[
"https://openalex.org/W1993229583",
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"https://openalex.org/W2146637767",
"https://openalex.org/W2254145373",
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https://api.openalex.org/works?filter=cites:W2782565929
|
The Lebanese Ministry of Public Health has launched a National Mental Health Programme, which in turn has established the Mental Health and Substance Use Strategy for Lebanon 2015-2020. In parallel, research involving refugees has been conducted since the onset of the Syrian crisis. The findings point to an increase in mental health disorders in the Syrian refugee population, which now numbers more than 1 million.
|
[
{
"display_name": "BJPsych International",
"id": "https://openalex.org/S4210183147",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2004332970
|
Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers
|
[
{
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{
"country": "Australia",
"display_name": "University of Melbourne",
"id": "https://openalex.org/I165779595",
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{
"country": "Australia",
"display_name": "Murdoch Children's Research Institute",
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],
"display_name": "Elisha Riggs",
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{
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{
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"display_name": "University of Melbourne",
"id": "https://openalex.org/I165779595",
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],
"display_name": "Elise Davis",
"id": "https://openalex.org/A5008445749"
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{
"affiliations": [
{
"country": "Australia",
"display_name": "University of Melbourne",
"id": "https://openalex.org/I165779595",
"lat": -37.814,
"long": 144.96332,
"type": "education"
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],
"display_name": "Lisa Gibbs",
"id": "https://openalex.org/A5027571819"
},
{
"affiliations": [
{
"country": "Australia",
"display_name": "University of Melbourne",
"id": "https://openalex.org/I165779595",
"lat": -37.814,
"long": 144.96332,
"type": "education"
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],
"display_name": "Karen Block",
"id": "https://openalex.org/A5053120787"
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https://api.openalex.org/works?filter=cites:W2004332970
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Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0-6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers.We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers.Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement.Although participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.
|
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"id": "https://openalex.org/S4306400806",
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"id": "https://openalex.org/S4306525036",
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|
https://openalex.org/W2029574137
|
A complex breastfeeding promotion and support intervention in a developing country: study protocol for a randomized clinical trial
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"display_name": "American University of Beirut",
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"display_name": "American University of Beirut",
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"display_name": "American University of Beirut",
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{
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"id": "https://openalex.org/C83864248"
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"id": "https://openalex.org/C99454951"
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"id": "https://openalex.org/C187212893"
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[
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https://api.openalex.org/works?filter=cites:W2029574137
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Breastfeeding has countless benefits to mothers, children and community at large, especially in developing countries. Studies from Lebanon report disappointingly low breastfeeding exclusivity and continuation rates. Evidence reveals that antenatal breastfeeding education, professional lactation support, and peer lay support are individually effective at increasing breastfeeding duration and exclusivity, particularly in low-income settings. Given the complex nature of the breastfeeding ecosystem and its barriers in Lebanon, we hypothesize that a complex breastfeeding support intervention, which is centered on the three components mentioned above, would significantly increase breastfeeding rates.A multi-center randomized controlled trial.443 healthy pregnant women in their first trimester will be randomized to control or intervention group.A "prenatal/postnatal" professional and peer breastfeeding support package continuing till 6 months postpartum, guided by the Social Network and Social Support Theory. Control group will receive standard prenatal and postnatal care. Mothers will be followed up from early pregnancy till five years after delivery.Total and exclusive breastfeeding rates, quality of life at 1, 3 and 6 months postpartum, maternal breastfeeding knowledge and attitudes at 6 months postpartum, maternal exclusive breastfeeding rates of future infants up to five years from baseline, cost-benefit and cost-effectiveness analyses of the intervention.Descriptive and regression analysis will be conducted under the intention to treat basis using the most recent version of SPSS.Exclusive breastfeeding is a cost-effective public health measure that has a significant impact on infant morbidity and mortality. In a country with limited healthcare resources like Lebanon, developing an effective breastfeeding promotion and support intervention that is easily replicated across various settings becomes a priority. If positive, the results of this study would provide a generalizable model to bolster breastfeeding promotion efforts and contribute to improved child health in Lebanon and the Middle East and North Africa (MENA) region.Current Controlled Trials ISRCTN17875591.
|
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"display_name": "BMC Public Health",
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|
https://openalex.org/W2006712684
|
The maternal health outcomes of paid maternity leave: A systematic review
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"display_name": "Anne Kavanagh",
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"id": "https://openalex.org/C142724271"
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{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
}
] |
[
"Lebanon"
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https://api.openalex.org/works?filter=cites:W2006712684
|
Paid maternity leave has become a standard benefit in many countries throughout the world. Although maternal health has been central to the rationale for paid maternity leave, no review has specifically examined the effect of paid maternity leave on maternal health. The aim of this paper is to provide a systematic review of studies that examine the association between paid maternity leave and maternal health. We conducted a comprehensive search of electronic databases (Medline, Embase, CINAHL, PsycINFO, Web of Science, Sociological Abstracts) and Google Scholar. We searched websites of relevant organisations, reference lists of key papers and journals, and citation indices for additional studies including those not in refereed journals. There were no language restrictions. Studies were included if they compared paid maternity leave versus no paid maternity leave, or different lengths of paid leave. Data were extracted and an assessment of bias was performed independently by authors. Seven studies were identified, with participants from Australia, Sweden, Norway, USA, Canada, and Lebanon. All studies used quantitative methodologies, including cohort, cross-sectional, and repeated cross-sectional designs. Outcomes included mental health and wellbeing, general health, physical wellbeing, and intimate partner violence. The four studies that examined leave at an individual level showed evidence of maternal health benefits, whereas the three studies conducting policy-level comparisons reported either no association or evidence of a negative association. The synthesis of the results suggested that paid maternity leave provided maternal health benefits, although this varied depending on the length of leave. This has important implications for public health and social policy. However, all studies were subject to confounding bias and many to reverse causation. Given the small number of studies and the methodological limitations of the evidence, longitudinal studies are needed to further clarify the effects of paid maternity leave on the health of mothers in paid employment.
|
[
{
"display_name": "Social Science & Medicine",
"id": "https://openalex.org/S106822843",
"type": "journal"
},
{
"display_name": "Minerva Access (University of Melbourne)",
"id": "https://openalex.org/S4377196259",
"type": "repository"
},
{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2903405248
|
Prevalence and correlates of food insecurity among Lebanese households with children aged 4–18 years: findings from a national cross-sectional study
|
[
{
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{
"country": "Lebanon",
"display_name": "American University of Beirut",
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],
"display_name": "Lamis Jomaa",
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{
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{
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"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
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"type": "education"
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],
"display_name": "Farah Naja",
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{
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{
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"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Samer A. Kharroubi",
"id": "https://openalex.org/A5077201683"
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{
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{
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"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Nahla Hwalla",
"id": "https://openalex.org/A5070535805"
}
] |
[
{
"display_name": "Food insecurity",
"id": "https://openalex.org/C2993342163"
},
{
"display_name": "Cross-sectional study",
"id": "https://openalex.org/C142052008"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Poverty",
"id": "https://openalex.org/C189326681"
},
{
"display_name": "Anthropometry",
"id": "https://openalex.org/C61427482"
},
{
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https://api.openalex.org/works?filter=cites:W2903405248
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Food insecurity (FI) is a major public health problem in Lebanon, a small middle-income country with the highest refugee per capita concentration worldwide and prolonged political and economic challenges. The present study aimed to measure the prevalence and sociodemographic correlates of household FI and to explore the association of household FI with anthropometric measures of children and their mothers.Cross-sectional survey (2014-2015).Lebanon.ParticipantsNationally representative sample of Lebanese households with 4-18-year-old-children and their mothers (n 1204).FI prevalence (95 % CI), measured using the Arabic-translated, validated Household Food Insecurity Access Scale, was found to be 49·3 (44·0, 54·6) % in the study sample. Mild, moderate and severe FI were found in 7·0 (5·5, 9·2) %, 23·3 (20·1, 26·8) % and 18·9 (14·9, 23·5) % of households, respectively. Multiple regression analysis showed that low maternal and paternal education, unemployment and crowding were significant correlates of household FI (P<0·05). No significant associations were observed between FI and anthropometric measures of children and their mothers, after adjusting for other socio-economic correlates. Food-insecure households reported various mechanisms to cope with food shortage, such as reducing the number of meals/d (49·6 %), borrowing food (54·4 %), spending savings (34·5 %) and withdrawing children from schools (8·0 %).FI exists among a remarkable proportion of Lebanese households with children. Correlates of household FI should be considered when designing social welfare policies and public health programmes to promote more sustainable, resilient and healthier livelihoods among vulnerable individuals.
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{
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"id": "https://openalex.org/S4306525036",
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https://openalex.org/W2017465135
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Physical activity in adults with and without diabetes: from the ‘high-risk’ approach to the ‘population-based’ approach of prevention
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[
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https://api.openalex.org/works?filter=cites:W2017465135
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The prevalence rates of physical inactivity and diabetes in the MENA region are among the highest in the world. However, studies that focus on factors that influence the pattern of physical activity in the region remain very scarce. This study aimed to determine the prevalence and correlates of physical activity in the general population and among subjects with and without diabetes in Lebanon, a small middle-income country in the MENA region. We conducted a cross-sectional nation-wide study of 2,195 randomly selected adults aged 25 years and older. Participants completed a comprehensive questionnaire based on the WHO-STEPwise guidelines. Physical activity was assessed using the International Physical Activity Questionnaire. Type 2 diabetes risk factors examined were age ≥ 45 years, BMI ≥ 25 kg/m2, hypertension, hyperlipidemia, cardiovascular disease and family history of diabetes. Close to 10% of adults with diabetes were physically active versus 23·4% without diabetes. Prevalence rates of physical activity declined consistently as the number of diabetes risk factors increased. Odds ratios for physical activity were lower among the educated (0.75, 95% CI= 0.57–0.98), those who owned at least one car (0.71, 95% CI= 0.57–0.88) and those who resided in the capital city (0.62, 95% CI 0.47–0.83). Health professionals gave ‘advice to exercise’ most to patients with or at highest risk for diabetes, and these were more likely to engage in physical activity than those without diabetes receiving the same advice, net of the effect of other covariates (OR=3.68 and 1.17, respectively). The inverse associations between physical activity and SES indicators suggest a negative influence of urbanization on activity levels of Lebanese adults. The missed opportunity for clinical primary preventive services for the majority non-diabetic population calls for population-based public health approaches that promote physical activity as a routine lifestyle in the general population.
|
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{
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|
https://openalex.org/W2032574531
|
Summer 2006 war on Lebanon: A lesson in community resilience
|
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{
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{
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{
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{
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{
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[
"Lebanon"
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[
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https://api.openalex.org/works?filter=cites:W2032574531
|
The internally displaced persons (IDPs) during the July 2006 war in Lebanon exhibited a high level of community resilience, affirmed by relief agencies and public health professionals. Data from personal observations, interviews, meetings and published material were used to examine factors contributing to this resilience. Findings suggested that community resilience is a process rather than an outcome. The sense of a collective identity, prior experience with wars and social support networks have contributed to building up IDP's resilience over time, while community cohesiveness, adequate public health interventions, social solidarity and a connected political leadership helped to sustain it during and shortly after the war. This paper examines implications for public health professionals and argues for a paradigm shift in disaster relief practice.
|
[
{
"display_name": "Global Public Health",
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{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2964990130
|
Factors associated with the public’s trust in physicians in the context of the Lebanese healthcare system: a qualitative study
|
[
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"display_name": "American University of Beirut",
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"display_name": "Bashir Shaya",
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"display_name": "American University of Beirut",
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"display_name": "Kevin Eid",
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"display_name": "Ali Khalil",
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{
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"id": "https://openalex.org/C159110408"
},
{
"display_name": "Public relations",
"id": "https://openalex.org/C39549134"
},
{
"display_name": "Psychology",
"id": "https://openalex.org/C15744967"
},
{
"display_name": "Medical education",
"id": "https://openalex.org/C509550671"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Paleontology",
"id": "https://openalex.org/C151730666"
},
{
"display_name": "Social science",
"id": "https://openalex.org/C36289849"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
},
{
"display_name": "Biology",
"id": "https://openalex.org/C86803240"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W79229537",
"https://openalex.org/W1970092277",
"https://openalex.org/W1970487056",
"https://openalex.org/W1986210793",
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"https://openalex.org/W2083579134",
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"https://openalex.org/W2135043968",
"https://openalex.org/W2136345758",
"https://openalex.org/W2136409470",
"https://openalex.org/W2138664283",
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"https://openalex.org/W2320704680",
"https://openalex.org/W2337763166",
"https://openalex.org/W2735744493",
"https://openalex.org/W2751809297",
"https://openalex.org/W2783650762",
"https://openalex.org/W2792427409",
"https://openalex.org/W2891555010",
"https://openalex.org/W2906151105",
"https://openalex.org/W4236881395",
"https://openalex.org/W4254932973"
] |
https://api.openalex.org/works?filter=cites:W2964990130
|
The Lebanese public perceives the physician-patient relationship as flawed. The objectives of this study are to assess factors associated with the public's trust in physicians in the context of the Lebanese healthcare system and to explore potential ways to enhance it.We conducted a qualitative study based on a grounded theory methodology using semi-structured interviews with members of the Lebanese public (not restricted to patients). We selected participants through convenience and maximum variation sampling approaches. The constant comparative analysis resulted in a theoretical framework that describes the factors influencing trust in physicians.Participants trusted an experienced, up-to-date, graduate of a North American or Western European school, working in a reputable hospital, with a high level of diagnostic skills. The personal characteristics that improved trust were physicians who are 'non-materialistic', have a good rapport, and have sufficient encounter time with patients. Social factors that enhance trust in the physician include: being a family member, recommended by a family member, featured in mainstream media, and/or having a good reputation. Trust increased compliance, loyalty despite occasional mistakes committed, high consultation fees, and negative attitudes towards the physician's institution. Conversely, no trust led to severed therapeutic relationship and seeking second opinions.The level of trust of members of the Lebanese public in physicians was affected by the personal characteristics of physicians, their practice or clinical skills, their interactions with the patient, finances, in addition to a number of social factors. Moreover, the level of trust had major implications on patients' interactions with their physicians.
|
[
{
"display_name": "BMC Health Services Research",
"id": "https://openalex.org/S12898181",
"type": "journal"
},
{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
"type": "repository"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2131436869
|
Health equity in Lebanon: a microeconomic analysis
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Nisreen Salti",
"id": "https://openalex.org/A5036090800"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Jad Chaaban",
"id": "https://openalex.org/A5063651514"
},
{
"affiliations": [
{
"country": "United States",
"display_name": "World Bank",
"id": "https://openalex.org/I1334329717",
"lat": 38.89511,
"long": -77.03637,
"type": "other"
}
],
"display_name": "Firas Raad",
"id": "https://openalex.org/A5057952594"
}
] |
[
{
"display_name": "Equity (law)",
"id": "https://openalex.org/C199728807"
},
{
"display_name": "Health care",
"id": "https://openalex.org/C160735492"
},
{
"display_name": "Health equity",
"id": "https://openalex.org/C2250968"
},
{
"display_name": "Public economics",
"id": "https://openalex.org/C100001284"
},
{
"display_name": "Health policy",
"id": "https://openalex.org/C47344431"
},
{
"display_name": "Disadvantaged",
"id": "https://openalex.org/C2780623907"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Health services research",
"id": "https://openalex.org/C2780877353"
},
{
"display_name": "Payment",
"id": "https://openalex.org/C145097563"
},
{
"display_name": "Business",
"id": "https://openalex.org/C144133560"
},
{
"display_name": "Social policy",
"id": "https://openalex.org/C19159745"
},
{
"display_name": "Social determinants of health",
"id": "https://openalex.org/C78491826"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Demographic economics",
"id": "https://openalex.org/C4249254"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Finance",
"id": "https://openalex.org/C10138342"
},
{
"display_name": "Market economy",
"id": "https://openalex.org/C34447519"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W1506964279",
"https://openalex.org/W1841733224",
"https://openalex.org/W1847070751",
"https://openalex.org/W1954013677",
"https://openalex.org/W2014224823",
"https://openalex.org/W2031460682",
"https://openalex.org/W2053083356",
"https://openalex.org/W2135216369",
"https://openalex.org/W2137321576",
"https://openalex.org/W2170964814"
] |
https://api.openalex.org/works?filter=cites:W2131436869
|
The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes.We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region.We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller proportion of their expenditures to health.The lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.
|
[
{
"display_name": "International Journal for Equity in Health",
"id": "https://openalex.org/S167257428",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2144883496
|
Blood Lead Concentrations in 1–3 Year Old Lebanese Children: A Cross-sectional study
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Iman Nuwayhid",
"id": "https://openalex.org/A5039759065"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
"type": "healthcare"
}
],
"display_name": "Mona Nabulsi",
"id": "https://openalex.org/A5016714379"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
"type": "healthcare"
}
],
"display_name": "Samar Muwakkit",
"id": "https://openalex.org/A5051866233"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Sarah Kouzi",
"id": "https://openalex.org/A5048432628"
},
{
"affiliations": [],
"display_name": "George J. Salem",
"id": "https://openalex.org/A5074602423"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
"type": "healthcare"
}
],
"display_name": "Mohamad A. Mikati",
"id": "https://openalex.org/A5036362648"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
"type": "healthcare"
}
],
"display_name": "M. Ariss",
"id": "https://openalex.org/A5037212009"
}
] |
[
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Cross-sectional study",
"id": "https://openalex.org/C142052008"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Lead poisoning",
"id": "https://openalex.org/C2781037878"
},
{
"display_name": "Residence",
"id": "https://openalex.org/C2776269092"
},
{
"display_name": "Blood lead level",
"id": "https://openalex.org/C2776431099"
},
{
"display_name": "Odds ratio",
"id": "https://openalex.org/C156957248"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Logistic regression",
"id": "https://openalex.org/C151956035"
},
{
"display_name": "Lead exposure",
"id": "https://openalex.org/C3020026551"
},
{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
},
{
"display_name": "Pediatrics",
"id": "https://openalex.org/C187212893"
},
{
"display_name": "Internal medicine",
"id": "https://openalex.org/C126322002"
},
{
"display_name": "CATS",
"id": "https://openalex.org/C2779904517"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
}
] |
[
"Lebanon"
] |
[
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"https://openalex.org/W2078403441",
"https://openalex.org/W2079306690",
"https://openalex.org/W2086741342",
"https://openalex.org/W2087183884",
"https://openalex.org/W2091817812",
"https://openalex.org/W2104345075",
"https://openalex.org/W2105642811",
"https://openalex.org/W2111776740",
"https://openalex.org/W2397072502",
"https://openalex.org/W2405626351",
"https://openalex.org/W2410052458",
"https://openalex.org/W2424790296",
"https://openalex.org/W2435822371",
"https://openalex.org/W4232336951",
"https://openalex.org/W4320300838"
] |
https://api.openalex.org/works?filter=cites:W2144883496
|
Childhood lead poisoning has not made the list of national public health priorities in Lebanon. This study aims at identifying the prevalence and risk factors for elevated blood lead concentrations (B-Pb >or= 100 microg/L) among 1-3 year old children. It also examines the need for universal blood lead screening.This is a cross-sectional study of 281 well children, presenting to the pediatric ambulatory services at the American University of Beirut Medical Center in 1997-98. Blood was drawn on participating children for lead analysis and a structured questionnaire was introduced to mothers asking about social, demographic, and residence characteristics, as well as potential risk factors for lead exposure. Children with B-Pb >or= 100 microg/L were compared to those with B-Pb < 100 microg/L.Mean B-Pb was 66.0 microg/L (median 60.0; range 10-160; standard deviation 26.3) with 39 (14%) children with B-Pb >or= 100 microg/L. Logistic regression analysis showed that elevated B-Pb was associated with paternal manual jobs (odds ratio [OR]: 4.74), residence being located in high traffic areas (OR: 4.59), summer season (OR: 4.39), using hot tap water for cooking (OR: 3.96), exposure to kohl (OR: 2.40), and living in older buildings (OR: 2.01).Lead screening should be offered to high-risk children. With the recent ban of leaded gasoline in Lebanon, emphasis should shift to other sources of exposure in children.
|
[
{
"display_name": "Environmental Health",
"id": "https://openalex.org/S191320764",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W3141659207
|
Impact of COVID-19 pandemic on medical waste management in Lebanon
|
[
{
"affiliations": [
{
"country": "United States",
"display_name": "Earth Island Institute",
"id": "https://openalex.org/I2802152550",
"lat": 37.86952,
"long": -122.26606,
"type": "nonprofit"
},
{
"country": "United States",
"display_name": "Columbia University",
"id": "https://openalex.org/I78577930",
"lat": 40.71427,
"long": -74.00597,
"type": "education"
}
],
"display_name": "Amani Maalouf",
"id": "https://openalex.org/A5037822592"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "University of Balamand",
"id": "https://openalex.org/I168913471",
"lat": 34.365208,
"long": 35.785675,
"type": "education"
},
{
"country": "Lebanon",
"display_name": "Saint George Hospital",
"id": "https://openalex.org/I2803082546",
"lat": 33.894,
"long": 35.523727,
"type": "healthcare"
}
],
"display_name": "Hani Maalouf",
"id": "https://openalex.org/A5028968182"
}
] |
[
{
"display_name": "Medical waste",
"id": "https://openalex.org/C2992940845"
},
{
"display_name": "Pandemic",
"id": "https://openalex.org/C89623803"
},
{
"display_name": "Health care",
"id": "https://openalex.org/C160735492"
},
{
"display_name": "Coronavirus disease 2019 (COVID-19)",
"id": "https://openalex.org/C3008058167"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Business",
"id": "https://openalex.org/C144133560"
},
{
"display_name": "Environmental planning",
"id": "https://openalex.org/C91375879"
},
{
"display_name": "Hazardous waste",
"id": "https://openalex.org/C22507642"
},
{
"display_name": "Waste disposal",
"id": "https://openalex.org/C3020383963"
},
{
"display_name": "Waste management",
"id": "https://openalex.org/C548081761"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Environmental science",
"id": "https://openalex.org/C39432304"
},
{
"display_name": "Engineering",
"id": "https://openalex.org/C127413603"
},
{
"display_name": "Infectious disease (medical specialty)",
"id": "https://openalex.org/C524204448"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W597491074",
"https://openalex.org/W2000564889",
"https://openalex.org/W2030737361",
"https://openalex.org/W2034942154",
"https://openalex.org/W2915027488",
"https://openalex.org/W2979746049",
"https://openalex.org/W2980790429",
"https://openalex.org/W3005057892",
"https://openalex.org/W3016757822",
"https://openalex.org/W3020606465",
"https://openalex.org/W3045780051",
"https://openalex.org/W3080681974",
"https://openalex.org/W3083070248",
"https://openalex.org/W3089292152",
"https://openalex.org/W3119972335"
] |
https://api.openalex.org/works?filter=cites:W3141659207
|
Worldwide, there is a growing concern about the negative effects of infectious medical waste produced during the COVID-19 pandemic and the contamination risks associated with waste management. Therefore, measures to ensure that medical waste is managed safely and in an environmentally sound manner will avoid negative health and environmental effects from such waste, thus protecting the health of patients, health workers and the public in general. Despite that infectious medical waste generation rate is important for management planning and policy development, there is a limitation on national data availability and its accuracy, particularly in developing economies. This study analyses the infectious healthcare waste generation rates and management patterns in Lebanon before and after the COVID-19 pandemic. The estimated average of COVID-19-related infectious healthcare waste generation in this study is 39,035 kg per month or 1.3 tonnes per day, which constitute between 5% and 20% of total infectious healthcare waste in Lebanon. This study illuminates on the impact of COVID-19 on the existing challenges of waste management in Lebanon. It highlights the need for proper management and disposal of the amounts of medical waste generated to reduce contamination risks or related environmental threats, particularly during the pandemic. It also shows that Lebanon has a defective system for monitoring of waste from healthcare institutions and gaps in waste statistics. Finally, the study summarizes recommendations related to medical waste management, which can provide valuable insight for policymakers.
|
[
{
"display_name": "Waste Management & Research",
"id": "https://openalex.org/S161551636",
"type": "journal"
}
] |
|
https://openalex.org/W3130342286
|
Impact of COVID-19 pandemic on the utilization of routine immunization services in Lebanon
|
[
{
"affiliations": [],
"display_name": "Ziad Mansour",
"id": "https://openalex.org/A5057978965"
},
{
"affiliations": [],
"display_name": "Jinan Arab",
"id": "https://openalex.org/A5071154119"
},
{
"affiliations": [],
"display_name": "Racha Said",
"id": "https://openalex.org/A5015950291"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "World Health Organization - Lebanon",
"id": "https://openalex.org/I4210128207",
"lat": 30.063627,
"long": 31.34717,
"type": "government"
}
],
"display_name": "Alissar Rady",
"id": "https://openalex.org/A5018635052"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Ministry of Public Health",
"id": "https://openalex.org/I4210097567",
"lat": 33.86422,
"long": 35.493645,
"type": "government"
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],
"display_name": "Randa Hamadeh",
"id": "https://openalex.org/A5063347956"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Hôtel-Dieu de France",
"id": "https://openalex.org/I4210152906",
"lat": 33.88146,
"long": 35.518627,
"type": "healthcare"
}
],
"display_name": "Bernard Gerbaka",
"id": "https://openalex.org/A5085254292"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
"type": "healthcare"
}
],
"display_name": "Abdul Rahman Bizri",
"id": "https://openalex.org/A5060673539"
}
] |
[
{
"display_name": "Vaccination",
"id": "https://openalex.org/C22070199"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Pandemic",
"id": "https://openalex.org/C89623803"
},
{
"display_name": "Measles",
"id": "https://openalex.org/C2776438120"
},
{
"display_name": "Outbreak",
"id": "https://openalex.org/C116675565"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Immunization",
"id": "https://openalex.org/C2780801004"
},
{
"display_name": "Poliomyelitis",
"id": "https://openalex.org/C4870876"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Private sector",
"id": "https://openalex.org/C121426985"
},
{
"display_name": "Public sector",
"id": "https://openalex.org/C147859227"
},
{
"display_name": "Coronavirus disease 2019 (COVID-19)",
"id": "https://openalex.org/C3008058167"
},
{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
},
{
"display_name": "Pediatrics",
"id": "https://openalex.org/C187212893"
},
{
"display_name": "Virology",
"id": "https://openalex.org/C159047783"
},
{
"display_name": "Immunology",
"id": "https://openalex.org/C203014093"
},
{
"display_name": "Economic growth",
"id": "https://openalex.org/C50522688"
},
{
"display_name": "Infectious disease (medical specialty)",
"id": "https://openalex.org/C524204448"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Antigen",
"id": "https://openalex.org/C147483822"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W2205556601",
"https://openalex.org/W2343874426",
"https://openalex.org/W3007966068",
"https://openalex.org/W3025947241"
] |
https://api.openalex.org/works?filter=cites:W3130342286
|
Introduction The global abrupt progression of the COVID-19 pandemic may disrupt critical life-saving services such as routine immunization (RI), thus increasing the susceptibility of countries to outbreaks of vaccine-preventable diseases (VPDs). Being endemic to several infectious diseases, Lebanon might be at increased risk of outbreaks as the utilization of RI services might have deteriorated due to the pandemic and the country’s political unrest following the October 2019 uprising. The aim of this study was to assess the changes in the utilization of RI services in both the public and private sectors following the COVID-19 pandemic. Methods A self-administered cross-sectional survey was completed electronically, in April 2020, by 345 private pediatricians who are registered in professional associations of physicians in Lebanon and provide immunization services at their clinics. Means of the reported percentages of decrease in the utilization of vaccination services by pediatricians were calculated. As for the public sector, an examination of the monthly differences in the number of administered vaccine doses in addition to their respective percentages of change was performed. Adjustment for the distribution of RI services between the sectors was performed to calculate the national decrease rate. Results The utilization of vaccination services at the national level decreased by 31%. In the private sector, immunization services provision diminished by 46.9% mainly between February and April 2020. The highest decrease rates were observed for oral poliovirus vaccine (OPV) and hepatitis A, followed by measles and pneumococcal conjugate vaccines. The number of vaccine doses administered in the public sector decreased by 20%. The most prominent reductions were detected for the OPV and measles vaccines, and during October 2019 and March 2020. Conclusion The substantial decrease in the utilization of RI as a result of the COVID-19 pandemic requires public health interventions to prevent future outbreaks of VPDs.
|
[
{
"display_name": "PLOS ONE",
"id": "https://openalex.org/S202381698",
"type": "journal"
},
{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
"type": "repository"
},
{
"display_name": "Informationszentrum Lebenswissenschaften (ZB MED)",
"id": "https://openalex.org/S4306402606",
"type": "repository"
},
{
"display_name": "PUBLISSO (German National Library of Medicine)",
"id": "https://openalex.org/S4377196269",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
}
] |
|
https://openalex.org/W3186410095
|
Health worries, life satisfaction, and social well-being concerns during the COVID-19 pandemic: Insights from Lebanon
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
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"type": "education"
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],
"display_name": "Imad Bou-Hamad",
"id": "https://openalex.org/A5011473596"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Reem Hoteit",
"id": "https://openalex.org/A5073914732"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Lebanese American University",
"id": "https://openalex.org/I56306041",
"lat": 33.892776,
"long": 35.47778,
"type": "education"
}
],
"display_name": "Dunia A. Harajli",
"id": "https://openalex.org/A5005277987"
}
] |
[
{
"display_name": "Pandemic",
"id": "https://openalex.org/C89623803"
},
{
"display_name": "Odds",
"id": "https://openalex.org/C143095724"
},
{
"display_name": "Mental health",
"id": "https://openalex.org/C134362201"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Descriptive statistics",
"id": "https://openalex.org/C39896193"
},
{
"display_name": "Psychology",
"id": "https://openalex.org/C15744967"
},
{
"display_name": "Young adult",
"id": "https://openalex.org/C205545832"
},
{
"display_name": "Odds ratio",
"id": "https://openalex.org/C156957248"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Coronavirus disease 2019 (COVID-19)",
"id": "https://openalex.org/C3008058167"
},
{
"display_name": "Distress",
"id": "https://openalex.org/C139265228"
},
{
"display_name": "Life satisfaction",
"id": "https://openalex.org/C2780945536"
},
{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
},
{
"display_name": "Gerontology",
"id": "https://openalex.org/C74909509"
},
{
"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
},
{
"display_name": "Clinical psychology",
"id": "https://openalex.org/C70410870"
},
{
"display_name": "Logistic regression",
"id": "https://openalex.org/C151956035"
},
{
"display_name": "Social psychology",
"id": "https://openalex.org/C77805123"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Statistics",
"id": "https://openalex.org/C105795698"
},
{
"display_name": "Mathematics",
"id": "https://openalex.org/C33923547"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Infectious disease (medical specialty)",
"id": "https://openalex.org/C524204448"
},
{
"display_name": "Internal medicine",
"id": "https://openalex.org/C126322002"
}
] |
[
"Lebanon"
] |
[
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"https://openalex.org/W3014271510",
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"https://openalex.org/W3023473831",
"https://openalex.org/W3024101118",
"https://openalex.org/W3026051564",
"https://openalex.org/W3039041384",
"https://openalex.org/W3044545080",
"https://openalex.org/W3046001566",
"https://openalex.org/W3047168709",
"https://openalex.org/W3047898105",
"https://openalex.org/W3069378728",
"https://openalex.org/W3081584854",
"https://openalex.org/W3083719831",
"https://openalex.org/W3084096474",
"https://openalex.org/W3089268210",
"https://openalex.org/W3089663200",
"https://openalex.org/W3091894475",
"https://openalex.org/W3095224534",
"https://openalex.org/W3100511295",
"https://openalex.org/W3111534396",
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"https://openalex.org/W3119212301",
"https://openalex.org/W3133587289",
"https://openalex.org/W3156778112",
"https://openalex.org/W4229573723",
"https://openalex.org/W4235898309"
] |
https://api.openalex.org/works?filter=cites:W3186410095
|
The COVID-19 outbreak has struck Lebanon in its worst period of instability, not only impacting physical health, but also increasing psychological distress. Using an online survey enhanced by response time measurement, this study describes the overall patterns in mental well-being outcomes and examines their association with sociodemographic characteristics during the COVID-19 pandemic. Furthermore, it identifies significant predictors for COVID-19 good practices. A total of 988 Lebanese were surveyed, with participants providing written online consent prior to filling the survey. Regression-based models were estimated. Findings show that individuals with higher education levels exhibit lower health concerns. People with children face higher health worries than those without. Men are more worried than women about their health and they are less satisfied with their lives during the pandemic. Descriptive statistics show that most Lebanese are very satisfied with their families (93.1%), but they are highly dissatisfied with their country (63%). Young adults and individuals who live alone exhibit significantly higher social well-being concerns. Age and having children were strong predictors for good COVID-19 practices. The odds of having good practices for older adults are 3.13 times higher than that of youth, while the odds for those with children are 3.18 times higher than those without. The findings of this study could pave the way for a well-coordinated national strategy and increased collaboration with public health professionals to mitigate the pandemic’s adverse effects on mental health in the long-term.
|
[
{
"display_name": "PLOS ONE",
"id": "https://openalex.org/S202381698",
"type": "journal"
},
{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W3119355167
|
Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon
|
[
{
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{
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"display_name": "American University of Beirut",
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"display_name": "Hady Naal",
"id": "https://openalex.org/A5089851582"
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{
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{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
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],
"display_name": "Dana Nabulsi",
"id": "https://openalex.org/A5076845101"
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{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Nour El Arnaout",
"id": "https://openalex.org/A5036190138"
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{
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{
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"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
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],
"display_name": "Lina Abdouni",
"id": "https://openalex.org/A5067037350"
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{
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{
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"display_name": "Lebanese American University",
"id": "https://openalex.org/I56306041",
"lat": 33.892776,
"long": 35.47778,
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"display_name": "Hani Dimassi",
"id": "https://openalex.org/A5001367844"
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{
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{
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"display_name": "Lebanese American University",
"id": "https://openalex.org/I56306041",
"lat": 33.892776,
"long": 35.47778,
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"display_name": "Ranime Harb",
"id": "https://openalex.org/A5070516186"
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{
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{
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"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
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"display_name": "Shadi Saleh",
"id": "https://openalex.org/A5050430870"
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] |
[
{
"display_name": "Refugee",
"id": "https://openalex.org/C173145845"
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{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
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{
"display_name": "Mental health",
"id": "https://openalex.org/C134362201"
},
{
"display_name": "Syrian refugees",
"id": "https://openalex.org/C3018716944"
},
{
"display_name": "Depression (economics)",
"id": "https://openalex.org/C2776867660"
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{
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{
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"id": "https://openalex.org/C142052008"
},
{
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"id": "https://openalex.org/C99454951"
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{
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"id": "https://openalex.org/C138816342"
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{
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{
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{
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{
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"id": "https://openalex.org/C3019858935"
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{
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"id": "https://openalex.org/C558461103"
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{
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{
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{
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{
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{
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[
"Lebanon",
"Syria"
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https://api.openalex.org/works?filter=cites:W3119355167
|
Since the outbreak of the Syrian war in 2011, close to 6 million Syrian refugees have escaped to Syria's neighbouring countries, including Lebanon. Evidence suggests rising levels of mental health disorders among Syrian refugee populations. Yet, to the best of our knowledge, large-scale studies addressing the mental health of adult Syrian refugees in Lebanon are lacking. We examined the prevalence of depression symptoms, which represent a common and debilitating mental health disorder among Syrian refugee populations in Lebanon, along with their sociodemographic and clinical correlates.A cross-sectional survey design was conducted as part of a collaborative project-"Sijilli"- led by the Global Health Institute at the American University of Beirut (Beirut, Lebanon) across 4 informal tented settlements for refugees (Beirut, Bekaa, North, South) in Lebanon among adult Syrian refugees (≥18), over a period extending from 2018 to 2020. The survey inquired about participants' sociodemographic and clinical characteristics, and screened participants for symptoms of depression through sequential methodology using the Patient Health Questionnaire (PHQ-2 and PHQ-9).A total of 3255 adult Syrian refugees were enrolled in the study. Of those refugees, 46.73% (n = 1521) screened positive on the PHQ-2 and were therefore eligible to complete the PHQ-9. In the entire sample (n = 3255), the prevalence of moderate to severe depression symptoms (PHQ-2 ≥ 2 and then PHQ-9 ≥ 10) was 22% (n = 706). Further analyses indicate that being ≥45 years of age (OR 1.61, 95% CI 1.13-2.30), a woman (OR 1.34, 95% CI 1.06-1.70), widowed (OR 2.88, 95% CI 1.31-6.32), reporting a neurological (OR 1.73, 95% CI 1.15-2.60) or a mental health condition (OR 3.98, 95% CI 1.76-8.97) are major risk factors for depression.Our study suggests that an estimated one in four Syrian refugees in Lebanon shows moderate to severe depression symptoms, and our findings have important public health and clinical implications on refugee health. There is a need to enhance screening efforts, to improve access and referral to mental health services, and to improve post-migration factors among Syrian refugees in Lebanon.
|
[
{
"display_name": "BMC Public Health",
"id": "https://openalex.org/S200437886",
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{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
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},
{
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"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W3128121578
|
An on-line survey of the behavioral changes in Lebanon, Jordan and Tunisia during the COVID-19 pandemic related to food shopping, food handling, and hygienic practices
|
[
{
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{
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The impact of the novel coronavirus pandemic (COVID-19) has spanned across the various aspects of life globally. Understanding public reactions is vital for effective risk communication and outbreak control and prevention. The Arab world has diverse cultural, economic, and social structures, so public choices and decisions also vary. To investigate the changes in behavior related to food shopping and handling, precautions measures, and hygiene practices of the public during the pandemic, a web-based survey tool was developed and conducted on 1074 subjects in three Arab countries, Lebanon, Jordan, and Tunisia, using a snowball sampling technique. The results showed a significant reduction in RTE consumption during the pandemic, as shown in the 19.2% and 12.2% rise in the proportion of respondents not ordering hot and cold RTE food delivery, respectively. Compared to pre-COVID-19 times, a substantial increase in behaviors related to hygiene and disinfection practices (22.0%-32.2%) was observed with a lesser increase (11.2%) in handwashing practices before food preparation. Moreover, public concerns about contracting COVID-19 from food led to almost doubling the number of Tunisians using cleaning agents for washing fresh fruits and vegetables (e.g., soaps, non-food grade chlorine bleach) besides a 16% and 26.1% increase in use among the Jordanian and Lebanese, respectively. However, a third of the respondents did not follow instructions on labels for the use of chemical products. In conclusion, this study identified culture-specific shortfalls in handwashing and unsafe food handling practices during COVID-19 in the Arab countries and sheds light on the paramount role of coordinated efforts between the local health authorities and the food safety and public health stakeholders in risk communication. To reduce health risks, there need to be rigorous educational campaigns and targeted messages that reach out to the general audience on hand hygiene, the health effects of haphazard use of unsafe chemical compounds on food, and recommendations on following label instructions.
|
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|
https://openalex.org/W4239600842
|
Linking Global Youth Tobacco Survey (GYTS) Data to the WHO Framework Convention on Tobacco Control (FCTC): The Case for Lebanon
|
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[
"Lebanon"
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"https://openalex.org/W4244719167"
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https://api.openalex.org/works?filter=cites:W4239600842
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The purpose of this paper is to use data collected in the 2001 and 2005 Lebanon Global Youth Tobacco Survey (GYTS) to monitor articles in the WHO Framework Convention on Tobacco Control (WHO FCTC). This information is necessary to enhance the capacity of the Ministry of Health and relevant organizations to design, implement, and evaluate tobacco control and prevention programs in Lebanon, especially among adolescents. The GYTS is a school-based survey which uses a two-stage sample design to produce representative, independent, cross-sectional estimates. The GYTS was conducted in 2001 and 2005 in Lebanon to produce representative national estimates. Data in this report are limited to students aged 13–15 years. In total, 5035 students from 50 schools participated in 2001; and 3341 students from 50 schools participated in 2005. The data in this report show that, in 2005, 8.6% of the students currently smoked cigarettes, but 33.9% currently smoked narguileh. Half of current smokers wanted to stop smoking and 6 in 10 have tried to stop during the past year but have failed. In 2005, exposure to SHS at home (78.4%) and in public places (74.4%) was very high; while 85.2% thought smoking should be banned in public places. Nearly 9 in 10 students who usually buy their cigarettes in stores were not refused purchase because of their age. Overall, only half of the students in Lebanon reported that during the past school year they had been taught about the dangers of smoking. Data in this report can be used as baseline measures for future evaluation of the tobacco control programs implemented by the Ministry of Health with particular attention to youth. The key for the Lebanese parliament is to develop, endorse, implement and enforce these new tobacco control laws and use the data from GYTS to monitor progress toward achieving the goals of the WHO FCTC. One key component of tobacco control needs to be the monitoring of Narguileh use among youth, a new emergency.
|
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https://openalex.org/W2073451894
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Health-Care Expenditures for Tuberculosis in the United States
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"id": "https://openalex.org/C50522688"
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https://api.openalex.org/works?filter=cites:W2073451894
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<h3>Background:</h3> The resurgence of tuberculosis (TB) and the increase in multidrug-resistant TB prompted this study, which estimates direct expenditures for TB treatment and public health activities in the United States. <h3>Methods:</h3> This retrospective cost of illness study estimated 1991 direct expenditures for TB-related outpatient and inpatient diagnosis and treatment, screening, preventive therapy, contact investigations, surveillance, and outbreak investigations. Existing databases at the Centers for Disease Control and Prevention (Atlanta, Ga) and the Codman Research Group, Lebanon, NH, were supplemented by surveys of state and local TB programs and interviews of organizations that conduct large-scale screening. No estimates of indirect costs were made. <h3>Results:</h3> The direct medical expenditures for TB in 1991 were estimated at $703.1 million. This cost includes $423.8 million for inpatient care, $182.3 million for outpatient care, $72.1 million for screening, $3.4 million for contact investigations, $17.9 for preventive therapy, and $3.6 million for surveillance and outbreak investigations. Sensitivity analyses yielded a range of expenditures between $515.7 million and $934.5 million. <h3>Conclusions:</h3> Treatment accounted for more than 86% of all TB-related expenditures; inpatient treatment accounted for 60% of the total. Prevention activities made up only 14% of all costs. Direct medical expenditures may be underestimated because of limitations in the database on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening activities. Greater emphasis should be placed on outpatient treatment and prevention in high-risk populations, and improved cost-accounting systems should be developed in state and local health department TB control programs to facilitate economic evaluation and improve the allocation of health dollars. (Arch Intern Med. 1995;155:1595-1600)
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https://openalex.org/W2170901864
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Is self-rated health a valid measure to use in social inequities and health research? Evidence from the PAPFAM women’s data in six Arab countries
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"https://openalex.org/W2106023686",
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"https://openalex.org/W2107212347",
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"https://openalex.org/W2167127253",
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"https://openalex.org/W2259194247"
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https://api.openalex.org/works?filter=cites:W2170901864
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Some evidence from high-income countries suggests that self-rated health (SRH) is not a consistent predictor of objective health across social groups, and that its use may lead to inaccurate estimates of the effects of inequities on health. Given increased interest in studying and monitoring social inequities in health worldwide, the aim of the present study was to evaluate the validity of SRH as a consistent measure of health across socioeconomic categories in six Arab countries. We employed the PAPFAM population-based survey data on women from Morocco, Algeria, Tunisia, Lebanon, Syria, and the Occupied Palestinian Territories (OPT). Multivariate logistic regression analyses were performed to assess the strength of the association between fair/poor SRH and objective health (reporting at least one chronic condition), adjusting for available socio-demographic and health-related variables. Analyses were then stratified by two socioeconomic indicators: education and household economic status. The association between SRH and objective health is strong in Algeria, Tunisia, Lebanon, Syria, and OPT, but weak in Morocco. The strength of the association between reporting fair/poor health and objective health was not moderated by education or household economic status in any of the six countries. As the SRH-objective health association does not vary across social categories, the use of the measure in social inequities in health research is justified. These results should not preclude the need to carry out other validation studies using longitudinal data on men and women, or the need to advocate for improving the quality of morbidity and mortality data in the Arab region.
|
[
{
"display_name": "International Journal for Equity in Health",
"id": "https://openalex.org/S167257428",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
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{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2754992645
|
Community-Based Noncommunicable Disease Care for Syrian Refugees in Lebanon
|
[
{
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{
"country": "United States",
"display_name": "Medical Teams International",
"id": "https://openalex.org/I4210119274",
"lat": 45.417194,
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"type": "other"
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"display_name": "Stephen Sethi",
"id": "https://openalex.org/A5056679527"
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{
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{
"country": "United States",
"display_name": "Medical Teams International",
"id": "https://openalex.org/I4210119274",
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"display_name": "Rebecka Jönsson",
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"display_name": "Medical Teams International",
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"display_name": "Rony Skaff",
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"id": "https://openalex.org/I4210119274",
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"type": "other"
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"display_name": "Frank H. Tyler",
"id": "https://openalex.org/A5078405852"
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[
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"display_name": "Refugee",
"id": "https://openalex.org/C173145845"
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"id": "https://openalex.org/C71924100"
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{
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"id": "https://openalex.org/C160735492"
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{
"display_name": "Outreach",
"id": "https://openalex.org/C2781400479"
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{
"display_name": "Humanitarian crisis",
"id": "https://openalex.org/C2777742874"
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{
"display_name": "Health promotion",
"id": "https://openalex.org/C185618831"
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{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
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{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
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{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
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[
"Lebanon",
"Syria"
] |
[
"https://openalex.org/W1482482267",
"https://openalex.org/W1953019363",
"https://openalex.org/W2037199403",
"https://openalex.org/W2067595233",
"https://openalex.org/W2096197603",
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"https://openalex.org/W2154711041",
"https://openalex.org/W2161155225",
"https://openalex.org/W2164132840",
"https://openalex.org/W2165046389",
"https://openalex.org/W2216994467",
"https://openalex.org/W2345539730",
"https://openalex.org/W2495763977",
"https://openalex.org/W2508300253",
"https://openalex.org/W2528385426",
"https://openalex.org/W2559837976",
"https://openalex.org/W4234106400"
] |
https://api.openalex.org/works?filter=cites:W2754992645
|
<h3>ABSTRACT</h3> In the sixth year of the Syrian conflict, 11 million people have been displaced, including more than 1.1 million seeking refuge in Lebanon. Prior to the crisis, noncommunicable diseases (NCDs) accounted for 80% of all deaths in Syria, and the underlying health behaviors such as tobacco use, obesity, and physical inactivity are still prevalent among Syrian refugees in Lebanon. Humanitarian agencies initially responded to the acute health care needs of refugees by delivering services to informal settlements via mobile medical clinics. As the crisis has become more protracted, humanitarian response plans have shifted their focus to strengthening local health systems in order to better address the needs of both the host and refugee populations. To that end, we identified gaps in care for NCDs and launched a program to deliver chronic disease care for refugees. Based on a participatory needs assessment and community surveys, and building on the success of community health programs in other contexts, we developed a network of 500 refugee outreach volunteers who are supported with training, supervision, and materials to facilitate health promotion and disease control for community members, target NCDs and other priority conditions, and make referrals to a primary health care center for subsidized care. This model demonstrates that volunteer refugee health workers can implement community-based primary health activities in a complex humanitarian emergency.
|
[
{
"display_name": "Global health, science and practice",
"id": "https://openalex.org/S2764781293",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2070043745
|
Determinants of university students physical exercise: a study from Lebanon
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut Medical Center",
"id": "https://openalex.org/I4210104580",
"lat": 33.897972,
"long": 35.485886,
"type": "healthcare"
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],
"display_name": "Umayya Musharrafıeh",
"id": "https://openalex.org/A5050182315"
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{
"affiliations": [
{
"country": "Canada",
"display_name": "Université de Montréal",
"id": "https://openalex.org/I70931966",
"lat": 45.50884,
"long": -73.58781,
"type": "education"
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],
"display_name": "Hani Tamim",
"id": "https://openalex.org/A5058429632"
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{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Amal C. Rahi",
"id": "https://openalex.org/A5018056455"
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{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Maria Atoui El-Hajj",
"id": "https://openalex.org/A5062406413"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Ban Al-Sahab",
"id": "https://openalex.org/A5067661604"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Khalil El‐Asmar",
"id": "https://openalex.org/A5000549385"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
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],
"display_name": "Hani Tamim",
"id": "https://openalex.org/A5005196213"
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] |
[
{
"display_name": "Physical exercise",
"id": "https://openalex.org/C181588539"
},
{
"display_name": "Cross-sectional study",
"id": "https://openalex.org/C142052008"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Physical activity",
"id": "https://openalex.org/C3020255362"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Weight control",
"id": "https://openalex.org/C3019408017"
},
{
"display_name": "Physical fitness",
"id": "https://openalex.org/C171687745"
},
{
"display_name": "Gerontology",
"id": "https://openalex.org/C74909509"
},
{
"display_name": "Physical therapy",
"id": "https://openalex.org/C1862650"
},
{
"display_name": "Psychology",
"id": "https://openalex.org/C15744967"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Obesity",
"id": "https://openalex.org/C511355011"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
},
{
"display_name": "Internal medicine",
"id": "https://openalex.org/C126322002"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W1582334185",
"https://openalex.org/W1964954892",
"https://openalex.org/W1978306710",
"https://openalex.org/W1979616508",
"https://openalex.org/W1991752402",
"https://openalex.org/W2013421561",
"https://openalex.org/W2027735146",
"https://openalex.org/W2041720375",
"https://openalex.org/W2048190137",
"https://openalex.org/W2050835966",
"https://openalex.org/W2056627439",
"https://openalex.org/W2069042373",
"https://openalex.org/W2073974842",
"https://openalex.org/W2079904248",
"https://openalex.org/W2092956258",
"https://openalex.org/W2123840543",
"https://openalex.org/W2131454803",
"https://openalex.org/W2170585622"
] |
https://api.openalex.org/works?filter=cites:W2070043745
|
Studies to assess the patterns of physical exercise among University students in Lebanon are lacking. The current study looks at the prevalence of physical exercise among university students in Beirut and predictors of performing physical exercise. In a cross-sectional study, a proportionate random sample of university students selected from five major universities were asked to complete a self-administered questionnaire related to physical exercise, demographic, scholastic, and health risk behavioral characteristics. Physical exercise was divided into: “No”” (<0.5 h) and “Yes” (>0.5 h) per week. Chisquare tests and binary regression were conducted to determine the predictors of performing physical exercise. Of 2,013 students, only 26.4 % engaged in physical exercise. Predictors of performing physical exercise for males, were adoption of exercise as the method of weight control, while for females, they were living abroad, drinking excessive alcohol, and adopting exercise for weight control. The prevalence of physical exercise among Lebanese university students is low. Weight control remains the most important predictor of physical activity in males and females.
|
[
{
"display_name": "International Journal of Public Health",
"id": "https://openalex.org/S196280712",
"type": "journal"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W3112887664
|
Knowledge, attitude and practices related to COVID-19 among young Lebanese population
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Lebanese International University",
"id": "https://openalex.org/I911468752",
"lat": 33.88486,
"long": 35.49528,
"type": "education"
}
],
"display_name": "Samer Sakr",
"id": "https://openalex.org/A5064424091"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Lebanese International University",
"id": "https://openalex.org/I911468752",
"lat": 33.88486,
"long": 35.49528,
"type": "education"
}
],
"display_name": "Ali Ghaddar",
"id": "https://openalex.org/A5013577917"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Lebanese International University",
"id": "https://openalex.org/I911468752",
"lat": 33.88486,
"long": 35.49528,
"type": "education"
}
],
"display_name": "Imtithal Sheet",
"id": "https://openalex.org/A5038792941"
},
{
"affiliations": [
{
"country": "Qatar",
"display_name": "Qatar University",
"id": "https://openalex.org/I60342839",
"lat": 25.377226,
"long": 51.48715,
"type": "education"
}
],
"display_name": "Ali H. Eid",
"id": "https://openalex.org/A5070363714"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "Lebanese International University",
"id": "https://openalex.org/I911468752",
"lat": 33.88486,
"long": 35.49528,
"type": "education"
}
],
"display_name": "Bassam Hamam",
"id": "https://openalex.org/A5040572989"
}
] |
[
{
"display_name": "Pandemic",
"id": "https://openalex.org/C89623803"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Biostatistics",
"id": "https://openalex.org/C140556311"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Population",
"id": "https://openalex.org/C2908647359"
},
{
"display_name": "Social distance",
"id": "https://openalex.org/C172656115"
},
{
"display_name": "Coronavirus disease 2019 (COVID-19)",
"id": "https://openalex.org/C3008058167"
},
{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
},
{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
},
{
"display_name": "Environmental health",
"id": "https://openalex.org/C99454951"
},
{
"display_name": "Disease",
"id": "https://openalex.org/C2779134260"
},
{
"display_name": "Infectious disease (medical specialty)",
"id": "https://openalex.org/C524204448"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Pathology",
"id": "https://openalex.org/C142724271"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W2059120605",
"https://openalex.org/W2539809602",
"https://openalex.org/W2764097711",
"https://openalex.org/W2974807232",
"https://openalex.org/W3001897055",
"https://openalex.org/W3005111420",
"https://openalex.org/W3009473592",
"https://openalex.org/W3012232836",
"https://openalex.org/W3012310159",
"https://openalex.org/W3012731499",
"https://openalex.org/W3014471946",
"https://openalex.org/W3015234525",
"https://openalex.org/W3016221129",
"https://openalex.org/W3016426103",
"https://openalex.org/W3022366800",
"https://openalex.org/W3024506939",
"https://openalex.org/W3025845666",
"https://openalex.org/W3026091149",
"https://openalex.org/W3031266243",
"https://openalex.org/W3034605705",
"https://openalex.org/W3069378728",
"https://openalex.org/W3116386201",
"https://openalex.org/W4210851642"
] |
https://api.openalex.org/works?filter=cites:W3112887664
|
Abstract Background As the world faces the most serious and widespread pandemic in recent history, claiming nearly 1,945,610 lives and infecting over 90 million individuals up to January 13, 2021, controlling the spread of COVID-19 is still limited to efforts done by the general population implementing rules and restrictions passed by world governments and organizations. As we wait for the approved vaccines to become widely distributed, the best approach to fighting the spread of this disease is mostly preventative depending largely on individuals’ compliance. This study aimed to determine the knowledge, attitude and practices (KAP) towards COVID-19 in Lebanon. Methods A descriptive analysis was performed to describe the outcome measures of knowledge, attitudes and practices towards COVID-19 on a convenience sample from the Lebanese population in relation to socio-demographic characteristics and level of concern towards COVID-19. One thousand eight hundred sixty-one participants filled in an online survey (response rate: 18.5%) distributed by social media to social networks of the research team members. Results Participants were mainly young (49.4% between 18 and 24 years) and males (73.7%). Participants showed an overall appropriate knowledge of COVID-19 (67.1%) and positive attitude (around 90% were optimistic about treatment and vaccination) and had good preventive practices towards COVID-19 (around 75% washed hands and avoided public places). Knowledge and practices correlated positively with marriage, age, education, working in a healthcare field and with the level of concern about getting COVID-19. Conclusions This study found good overall levels of KAP among the studied Lebanese population. This can help in controlling the spread of COVID-19 if individuals were forced to adhere to social distancing and appropriate preventative practices.
|
[
{
"display_name": "BMC Public Health",
"id": "https://openalex.org/S200437886",
"type": "journal"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
}
] |
|
https://openalex.org/W3013291720
|
A community–based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon
|
[
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
},
{
"country": "United Kingdom",
"display_name": "Queen Margaret University",
"id": "https://openalex.org/I181656237",
"lat": 55.95206,
"long": -3.19648,
"type": "education"
}
],
"display_name": "Aya Noubani",
"id": "https://openalex.org/A5053112250"
},
{
"affiliations": [
{
"country": "United Kingdom",
"display_name": "Queen Margaret University",
"id": "https://openalex.org/I181656237",
"lat": 55.95206,
"long": -3.19648,
"type": "education"
}
],
"display_name": "Karin Diaconu",
"id": "https://openalex.org/A5029674919"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
}
],
"display_name": "Lilian Ghandour",
"id": "https://openalex.org/A5002210479"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
},
{
"country": "United Kingdom",
"display_name": "Queen Margaret University",
"id": "https://openalex.org/I181656237",
"lat": 55.95206,
"long": -3.19648,
"type": "education"
}
],
"display_name": "Maria El Koussa",
"id": "https://openalex.org/A5075841116"
},
{
"affiliations": [
{
"country": "United Kingdom",
"display_name": "Queen Margaret University",
"id": "https://openalex.org/I181656237",
"lat": 55.95206,
"long": -3.19648,
"type": "education"
}
],
"display_name": "Giulia Loffreda",
"id": "https://openalex.org/A5077876478"
},
{
"affiliations": [
{
"country": "Lebanon",
"display_name": "American University of Beirut",
"id": "https://openalex.org/I98635879",
"lat": 33.901093,
"long": 35.48153,
"type": "education"
},
{
"country": "United Kingdom",
"display_name": "Queen Margaret University",
"id": "https://openalex.org/I181656237",
"lat": 55.95206,
"long": -3.19648,
"type": "education"
}
],
"display_name": "Shadi Saleh",
"id": "https://openalex.org/A5050430870"
}
] |
[
{
"display_name": "Mental health",
"id": "https://openalex.org/C134362201"
},
{
"display_name": "Psychosocial",
"id": "https://openalex.org/C150966472"
},
{
"display_name": "Refugee",
"id": "https://openalex.org/C173145845"
},
{
"display_name": "Psychology",
"id": "https://openalex.org/C15744967"
},
{
"display_name": "Social support",
"id": "https://openalex.org/C2778087770"
},
{
"display_name": "Health psychology",
"id": "https://openalex.org/C155164915"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Stressor",
"id": "https://openalex.org/C125370674"
},
{
"display_name": "Gerontology",
"id": "https://openalex.org/C74909509"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Clinical psychology",
"id": "https://openalex.org/C70410870"
},
{
"display_name": "Social psychology",
"id": "https://openalex.org/C77805123"
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"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Political science",
"id": "https://openalex.org/C17744445"
},
{
"display_name": "Law",
"id": "https://openalex.org/C199539241"
}
] |
[
"Lebanon",
"Syria"
] |
[
"https://openalex.org/W1912608078",
"https://openalex.org/W2029208909",
"https://openalex.org/W2034170211",
"https://openalex.org/W2040817872",
"https://openalex.org/W2116251861",
"https://openalex.org/W2129283428",
"https://openalex.org/W2133680877",
"https://openalex.org/W2146637767",
"https://openalex.org/W2176845058",
"https://openalex.org/W2206994836",
"https://openalex.org/W2298466493",
"https://openalex.org/W2340163462",
"https://openalex.org/W2415625350",
"https://openalex.org/W2480250532",
"https://openalex.org/W2495763977",
"https://openalex.org/W2521875030",
"https://openalex.org/W2561195546",
"https://openalex.org/W2589071554",
"https://openalex.org/W2791735926",
"https://openalex.org/W2800823254",
"https://openalex.org/W2995655166",
"https://openalex.org/W3121544683",
"https://openalex.org/W4230565321"
] |
https://api.openalex.org/works?filter=cites:W3013291720
|
Abstract Background Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. Methods A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees’ community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. Results Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. Conclusion Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.
|
[
{
"display_name": "Globalization and Health",
"id": "https://openalex.org/S112714904",
"type": "journal"
},
{
"display_name": "DOAJ (DOAJ: Directory of Open Access Journals)",
"id": "https://openalex.org/S4306401280",
"type": "repository"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "Queen Margaret University Publications Repository (Queen Margaret University)",
"id": "https://openalex.org/S4306402028",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "Research Square (Research Square)",
"id": "https://openalex.org/S4306402450",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
|
https://openalex.org/W2017116209
|
Attitudes of the Lebanese public regarding disclosure of serious illness.
|
[
{
"affiliations": [
{
"country": "Kuwait",
"display_name": "Kuwait University",
"id": "https://openalex.org/I36721946",
"lat": 29.339659,
"long": 47.913715,
"type": "education"
}
],
"display_name": "Salim M. Adib",
"id": "https://openalex.org/A5029957821"
},
{
"affiliations": [
{
"country": "Kuwait",
"display_name": "Kuwait University",
"id": "https://openalex.org/I36721946",
"lat": 29.339659,
"long": 47.913715,
"type": "education"
}
],
"display_name": "Ghassan Hamadeh",
"id": "https://openalex.org/A5087737307"
}
] |
[
{
"display_name": "Residence",
"id": "https://openalex.org/C2776269092"
},
{
"display_name": "Preference",
"id": "https://openalex.org/C2781249084"
},
{
"display_name": "Public health",
"id": "https://openalex.org/C138816342"
},
{
"display_name": "Coping (psychology)",
"id": "https://openalex.org/C73282008"
},
{
"display_name": "Psychology",
"id": "https://openalex.org/C15744967"
},
{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662"
},
{
"display_name": "Interpretation (philosophy)",
"id": "https://openalex.org/C527412718"
},
{
"display_name": "Medicine",
"id": "https://openalex.org/C71924100"
},
{
"display_name": "Social psychology",
"id": "https://openalex.org/C77805123"
},
{
"display_name": "Nursing",
"id": "https://openalex.org/C159110408"
},
{
"display_name": "Psychiatry",
"id": "https://openalex.org/C118552586"
},
{
"display_name": "Demography",
"id": "https://openalex.org/C149923435"
},
{
"display_name": "Sociology",
"id": "https://openalex.org/C144024400"
},
{
"display_name": "Computer science",
"id": "https://openalex.org/C41008148"
},
{
"display_name": "Programming language",
"id": "https://openalex.org/C199360897"
},
{
"display_name": "Economics",
"id": "https://openalex.org/C162324750"
},
{
"display_name": "Microeconomics",
"id": "https://openalex.org/C175444787"
}
] |
[
"Lebanon"
] |
[
"https://openalex.org/W1900446693",
"https://openalex.org/W2009162425",
"https://openalex.org/W2034394254",
"https://openalex.org/W2052843047",
"https://openalex.org/W2078819596",
"https://openalex.org/W2134691478",
"https://openalex.org/W2167769477",
"https://openalex.org/W2608893868",
"https://openalex.org/W4249633241"
] |
https://api.openalex.org/works?filter=cites:W2017116209
|
OBJECTIVES: To measure the preference regarding disclosure of a serious diagnosis, and its determinants, of the Lebanese public. DESIGN AND SETTING: Non-random sample survey of 400 persons interviewed in health care facilities in Beirut in 1995. RESULTS: Forty-two per cent of respondents generally preferred truth not to be disclosed directly to patients. Preference for disclosure was associated with younger age, better education and tendency to rapport-building with physicians. There were no meaningful associations between place of residence (urban/rural), level of religious practice, or religious affiliation, and preference for disclosure. CONCLUSIONS: Under one plausible interpretation, this survey suggests that the expectation for concealment will decrease as the advantage of knowledge in better coping with disease is understood by an increasingly better educated public, and that the Lebanese public will increasingly come to expect direct and full disclosure of serious diagnoses.
|
[
{
"display_name": "Journal of Medical Ethics",
"id": "https://openalex.org/S70185877",
"type": "journal"
},
{
"display_name": "Europe PMC (PubMed Central)",
"id": "https://openalex.org/S4306400806",
"type": "repository"
},
{
"display_name": "PubMed Central",
"id": "https://openalex.org/S2764455111",
"type": "repository"
},
{
"display_name": "PubMed",
"id": "https://openalex.org/S4306525036",
"type": "repository"
}
] |
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