Health innovations in response to the COVID-19 pandemic: perspectives from the Eastern Mediterranean Region.

BACKGROUND: This paper aims to document the numerous health innovations developed in response to the COVID-19 crisis in the Eastern Mediterranean Region (EMR) using a scoping review approach. METHODS: A literature search was conducted using PubMed, the Eastern Mediterranean Health Journal, the Index Medicus for EMR to identify peer-reviewed articles between December 2019 and November 2020 and WHO and ministries of health websites for grey literature. Following an initial review, full-text screening identified studies reporting on health innovations in response to the COVID-19 pandemic in the region. RESULTS: This review describes 82 health innovations reported from 20 countries across the region: 80% (n = 66) were digital and technology-based products and services including health care delivery (n = 25), public health informatics (n = 24) and prevention (n = 17); 20% (n = 16) were innovative processes including health care delivery (n = 8), educational programmes (n = 6) and community engagement (n = 2). CONCLUSION: The speed with which these technologies were deployed in different contexts demonstrates their ease of adoption and manageability and thus can be considered as the most scalable. Strengthened frameworks to protect users' privacy, documentation and evaluation of impact of innovations, and training of health care professionals are fundamental for promoting health innovations in the EMR.

Eastern Mediterranean Health Journal (EMHJ): a 20-year overview (1995-2014).

The EMHJ was established in 1995 to provide a peer-reviewed platform for health professionals to share their research with the scientific community. The objective of this review was to examine EMR public health research trends, as reflected by EMHJ publications in 20 years (1995-2014), through secondary data analysis. Published articles were categorized according to EMR strategic priority areas (93%), i.e. health systems strengthening (25%); reproductive and child health (22%); communicable diseases (26%); noncommunicable diseases (25%); emergency preparedness (1.5%). Most papers were original research articles (85 %), published in English (94 %), but just over half (52 %) mentioned obtaining a form of ethical clearance in the text. Six countries had each over 100 papers published during the study period, i.e. Iran, Egypt, Saudi Arabia, Jordan, Iraq, Pakistan. Half EMHJ publications during this period came from 4 countries only (Iran, Egypt, Saudi Arabia, Jordan), which calls for further study to evaluate why other EMR nations are less well represented and how to encourage greater contribution from them over the coming years.

Eastern Mediterranean Health Journal [EMHJ]: a 20-year overview [1995-2014]

The EMHJ was established in 1995 to provide a peer-reviewed platform for health professionals to share their research with the scientific community. The objective of this review was to examine EMR public health research trends, as reflected by EMHJ publications in 20 years [1995-2014], through secondary data analysis. Published articles were categorized according to EMR strategic priority areas [93%], i.e. health systems strengthening [25%]; reproductive and child health [22%]; communicable diseases [26%]; noncommunicable diseases [25%]; emergency preparedness [1.5%]. Most papers were original research articles [85 %], published in English [94 %], but just over half [52 %] mentioned obtaining a form of ethical clearance in the text. Six countries had each over 100 papers published during the study period, i.e. Iran, Egypt, Saudi Arabia, Jordan, Iraq, Pakistan. Half EMHJ publications during this period came from 4 countries only [Iran, Egypt, Saudi Arabia, Jordan], which calls for further study to evaluate why other EMR nations are less well represented and how to encourage greater contribution from them over the coming years

La Revue de Santé de la Méditerranée orientale a été créée en 1995 afin de servir de plateforme avec examen collégial où les professionnels de la santé peuvent partager leurs travaux de recherche avec la communauté scientifique. L'objectif de la présente étude était d'examiner les tendances de recherche en santé publique dans la Région de la Méditerranée orientale, telles que reflétées par les publications de la Revue sur 20 ans [1995-2014], au moyen d'une analyse des données secondaires. Les articles publiés ont été catégorisés selon les domaines de priorités stratégiques de la Région de la Méditerranée orientale [93%], à savoir le renforcement des systèmes de santé [25%], la santé génésique et infantile [22%], les maladies transmissibles [26%], les maladies non transmissibles [25%], et la préparation aux situations d'urgence [1,5%]. La plupart des publications étaient des articles de recherché originaux [85%] publiés en anglais [94%], mais seulement un peu plus de la moitié [52%] ont mentionné avoir obtenu une forme d'approbation éthique dans le texte. Six pays ont publié plus de 100 articles chacun au cours de la période étudiée [Arabie saoudite, Egypte, République islamique d'Iran, Jordanie, Iraq, Pakistan]. La moitié des publications de la Revue durant cette période ont été produites par quatre pays [l'Arabie saoudite, l'Egypte, la République islamique d'Iran et la Jordanie]. Il serait donc intéressant d'étudier les raisons pour lesquelles d'autres pays de la Région de la Méditerranée orientale sont moins représentés, ainsi que la façon de les encourager à contribuer davantage dans les années à venir

Towards an electronic national injury surveillance system in Saudi Arabia.

Given the need for a uniform, comprehensive, electronic nationwide surveillance system for injuries in Saudi Arabia, a system was designed with the objectives of establishing an epidemiologic profile of injuries in the country; evaluating injury indicators on an ongoing basis; identifying high-risk groups requiring specific interventions; monitoring and evaluating interventions for effectiveness; and producing reports to assist in planning and resource allocation. A special form for this purpose was designed, modified from validated forms used elsewhere for injury surveillance. This initiative of the Ministry of Health is also expected to help validate data collected by other sectors, such as the Ministry of Interior. This paper reviews the milestones of building the system and aims to prompt a debate within the scientific community, especially within the Eastern Mediterranean Region, about the best way to design injury surveillance systems for the Region in order to fine-tune the proposed system before its full-scale implementation.

Smoking among Saudi university students: consumption patterns and risk factors.

Tobacco use is increasing among young people, especially in Gulf nations such as Saudi Arabia. The objectives of this study were to estimate the prevalence and behavioural patterns of tobacco use among undergraduate students at King Saud University, Riyadh, Saudi Arabia during the academic year 2008/09 and investigate factors that influenced their tobacco use. A cross-sectional study was done of a representative sample (n = 6793) of the undergraduate student population using a modified version of the global youth tobacco survey questionnaire. The prevalence of smoking was 14.5% among students, 22.2% and 2.2% among fathers and mothers and 43.1% and 14.8% for male and female siblings; 15.0% reported all or most of their friends smoked. The most important independent predictors of smoking were: friends' smoking (some: OR = 6.7 and all: OR = 54.9), sister's smoking (OR = 2.2), mother's smoking (OR = 2.1), single status (OR = 1.7) and age (OR = 1.18).

Smoking among Saudi university students: consumption patterns and risk factors

Tobacco use is increasing among young people, especially in Gulf nations such as Saudi Arabia. The objectives of this study were to estimate the prevalence and behavioural patterns of tobacco use among undergraduate students at King Saud University, Riyadh, Saudi Arabia during the academic year 2008/09 and investigate factors that influenced their tobacco use. A cross-sectional study was done of a representative sample [n = 6793] of the undergraduate student population using a modified version of the global youth tobacco survey questionnaire. The prevalence of smoking was 14.5% among students, 22.2% and 2.2% among fathers and mothers and 43.1% and 14.8% for male and female siblings; 15.0% reported all or most of theirfriends smoked. The most important independent predictors of smoking were: friends' smoking [some: OR - 6.7 and all: OR - 54.9], sister's smoking [OR - 2.2], mother's smoking [OR = 2.1], single status [OR -1.7] and age [OR -1.18]

Splenic artery steal syndrome after liver transplantation: an alternative technique of embolization.

Arterial steal syndrome after orthotopic liver transplantation (OLT) is characterized by arterial hypoperfusion of the graft, which is caused by a shift in blood flow into the splenic or gastroduodenal arteries. It causes hepatic hypoperfusion with attendant clinical manifestations of elevated liver function enzymes, allograft dysfunction, and cholestasis. Left untreated, the condition has a significant potential risk for postoperative morbidity and graft loss. Herein we have reported the case of a 68-year-old woman who developed splenic artery steal syndrome (SASS) after deceased donor liver transplantation. She was diagnosed by duplex Doppler ultrasonography and celiac trunk angiography, and subsequently treated with splenic artery embolization.

Noninvasive assessment of endothelial function and ST segment changes during exercise testing in coronary artery disease

Endothelial function (EF) plays an important role in the onset and clinical course of atherosclerosis, although its relationship with the presence and extent of coronary artery disease (CAD) has not been well defined. We evaluated EF and the ST segment response to an exercise test in patients with a broad spectrum of CAD defined by coronary angiography. Sixty-two patients submitted to diagnostic catheterization for the evaluation of chest pain or ischemia in a provocative test were divided into three groups according to the presence and severity of atherosclerotic lesions (AL): group 1: normal coronaries (N = 19); group 2: CAD with AL <70 percent (N = 17); group 3: CAD with AL ¡Ý70 percent (N = 26). EF was evaluated by the percentage of flow-mediated dilatation ( percentFMD) in the brachial artery during reactive hyperemia induced by occlusion of the forearm with a pneumatic cuff for 5 min. Fifty-four patients were subjected to an exercise test. Gender and age were not significantly correlated with percentFMD. EF was markedly reduced in both groups with CAD (76.5 and 73.1 percent vs 31.6 percent in group 1) and a higher frequency of ischemic alterations in the ST segment (70.8 percent) was observed in the group with obstructive CAD with AL ¡Ý70 percent during the exercise test. Endothelial dysfunction was observed in patients with CAD, irrespective of the severity of injury. A significantly higher frequency of ischemic alterations in the ST segment was observed in the group with obstructive CAD. EF and exercise ECG differed among the three groups and may provide complementary information for the assessment of CAD.

Noninvasive assessment of endothelial function and ST segment changes during exercise testing in coronary artery disease.

Endothelial function (EF) plays an important role in the onset and clinical course of atherosclerosis, although its relationship with the presence and extent of coronary artery disease (CAD) has not been well defined. We evaluated EF and the ST segment response to an exercise test in patients with a broad spectrum of CAD defined by coronary angiography. Sixty-two patients submitted to diagnostic catheterization for the evaluation of chest pain or ischemia in a provocative test were divided into three groups according to the presence and severity of atherosclerotic lesions (AL): group 1: normal coronaries (N = 19); group 2: CAD with AL <70% (N = 17); group 3: CAD with AL > or = 70% (N = 26). EF was evaluated by the percentage of flow-mediated dilatation (%FMD) in the brachial artery during reactive hyperemia induced by occlusion of the forearm with a pneumatic cuff for 5 min. Fifty-four patients were subjected to an exercise test. Gender and age were not significantly correlated with %FMD. EF was markedly reduced in both groups with CAD (76.5 and 73.1% vs 31.6% in group 1) and a higher frequency of ischemic alterations in the ST segment (70.8%) was observed in the group with obstructive CAD with AL > or = 70% during the exercise test. Endothelial dysfunction was observed in patients with CAD, irrespective of the severity of injury. A significantly higher frequency of ischemic alterations in the ST segment was observed in the group with obstructive CAD. EF and exercise ECG differed among the three groups and may provide complementary information for the assessment of CAD.

Can we measure the ankle-brachial index using only a stethoscope? A pilot study.

BACKGROUND: Ankle-brachial index (ABI) is an excellent method for the diagnosis of peripheral arterial disease (PAD) when it is performed with Doppler. However, this device is not always available for primary care physicians. The ABI measured with stethoscope is an easy alternative approach, but have not been proved to be useful. OBJECTIVE: To assess the accuracy of the ABI measured using a stethoscope comparatively to that of the current eligible method for the diagnosis of PAD, the Doppler ABI, and describe the characteristics of this new approach. METHODS: We conducted a diagnostic study of ABI measured with a stethoscope and a Doppler probe and compared the results. Eighty-eight patients were accessed by both methods. RESULTS: Mean stethoscope ABI, 1.01 +/- 0.15, and mean Doppler ABI, 1.03 +/- 0.20, (P = 0.047) displayed a good correlation. Measurements of stethoscope ABI diagnostic accuracy in recognizing a Doppler ABI are described. The comparison of this data with the current gold standard method results gave a sensitivity of 71.4% [95% confidence interval (CI), 41.9-91.6] and specificity of 91.0% (95% CI, 81.5-96.6), with predictive positive value of 62.5% (95% CI, 38.6-81.5) and negative predictive value of 93.8% (95% CI, 85.2-97.6). The study accuracy was 87.7%. The area under the ROC curve was 0.895 (95% CI, 0.804-0.986, P < 0.0001). CONCLUSIONS: According to our study, the stethoscope ABI is a useful method to detect PAD and it may be suitable for its screening in the primary care setting.

Characteristics and risk factors of tobacco consumption among University of Sharjah students, 2005.

This study aimed to estimate the prevalence, patterns and risk factors of tobacco consumption among a stratified random sample of students at University of Sharjah, United Arab Emirates (UAE), during 2005. The overall reported smoking prevalence among 1057 sampled students was 15.1%; cigarette smokers were 9.4% and waterpipe smokers 5.6%. While women comprised only 8.9% of cigarette smokers, they were 26.2% of waterpipe smokers. Multiple linear regression analysis showed that the most important predictors for smoking among the students were: male sex, having a smoking friend, having a smoking family member (father/mother/both), non-UAE nationality and older age. There is a need to intensify efforts to prevent young people from starting smoking and to help young smokers to stop.

Characteristics and risk factors of tobacco consumption among University of Sharjah students, 2005

This study aimed to estimate the prevalence, patterns and risk factors of tobacco consumption among a stratified random sample of students at University of Sharjah, United Arab Emirates [UAE], during 2005. The overall reported smoking prevalence among 1057 sampled students was 15.1%; cigarette smokers were 9.4% and waterpipe smokers 5.6%. While women comprised only 8.9% of cigarette smokers, they were 26.2% of waterpipe smokers. Multiple linear regression analysis showed that the most important predictors for smoking among the students were: male sex, having a smoking friend, having a smoking family member [father/mother/both], non-UAE nationality and older age. There is a need to intensify efforts to prevent young people from starting smoking and to help young smokers to stop

Epidemiological profile of malaria in a university hospital in the eastern region of Saudi Arabia.

OBJECTIVE: To study the epidemiological, clinical and hematological profile of laboratory-diagnosed malaria cases at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, during the period from January 1990 to December 1999, and to provide suitable recommendations accordingly. METHODS: This was a clinical case series study of confirmed cases presenting to King Fahd Hospital of the University during the period from January 1990 to December 1999. A specially designed form was used for data collection and 602, laboratory-confirmed cases of malaria were retrospectively analyzed. RESULTS: There were 602 cases with a mean age of 25.8 + 14.3 and a male to female ratio of 2.9:1. Less than half the cases were Saudis (42%), most of whom (93%) reported a history of travel to the Southwestern part of the Kingdom. The highest frequency of cases was observed in the years 1992, 1994 and 1998 and 40% of the cases were diagnosed during the months of February, March and September. Plasmodium falciparum was the most common species among Saudi (83%), Sudanese (72%) and Yemeni (64%) patients, while Plasmodium vivax was predominant among others. Most of these cases (75%) had a history of travel to their home countries (endemic areas). The most common clinical presentation was fever (97%), while the most common clinical signs were splenomegaly (9%) and jaundice (8%). Anemia (60%) and thrombocytopenia (53%) were the most common hematological findings. CONCLUSION: Although it appears that the Eastern Province is still free of indigenous malaria transmission, this could not be confirmed by the data. Imported cases, however represent a continuous threat due to the existence of such vectors as Anopheles stephensi, Anopheles fluviatilis, Anopheles sergentii and Anopheles superpictus and a large number of non-immune persons. It is recommended that malaria be always considered in the differential diagnosis of all acute fevers, especially among those with a history of travel to an endemic area. Prompt diagnosis and treatment is necessary. Chemoprophylaxis, when traveling to endemic areas is mandatory, as well as the use of other primary preventive measures to protect against mosquito bites.

[Intestinal parasitosis and environmental pollution: 1343 pediatric cases in Beni-Mellal, Morocco]. / Parasitoses intestinales et pollution de l'environnement: cas de 1343 enfants à Beni-Mellal--Maroc.

This study was undertaken to determine the possible health risk associated with raw wastewater use in agricultural purposes, particularly, the transmission of parasite infections among children of five regions in Beni-Mellal, Morocco. In a randomly-selected sample of 1343 children, 740 of them were from five regions using raw wastewater for agriculture, and 603 were from 4 control regions that do not practice wastewater irrigation. One or more parasite infections were identified in 50.8% of the children living in the wastewater re-use regions and in 8.2% only of the others. The seven parasites identified were Entamoeba histolytica, Giardia intestinalis, Ascaris lumbricoides, Trichuris trichiura, Enterobius vermicularis, Hymenolepis nana, Taenia saginata, which infected 34.3%, 5.1%, 20.5%, 0.4%, 5.2%, 7.2%, 0.5% in the exposed population and 4.3%, 0.3%, 3.8%, 0.3%, 1.0%, 0.6% and 0.0% in the control population respectively. In conclusion, raw wastewater use in Beni-Mellal lead to a high risk of parasite infections. Adequate treatment of wastewater is highly recommended.

Geohelminthic infections associated with raw wastewater reuse for agricultural purposes in Beni-Mellal, Morocco.

This study was undertaken to determine the possible risk associated with raw wastewater use for agricultural purposes, particularly, the transmission of geohelminthic infections among children of five regions in Beni-Mellal, Morocco. In a randomly selected sample of 1343 children, 740 of them were from five communities using raw wastewater for agriculture, and 603 were from four control communities that do not practice wastewater irrigation. A questionnaire-interview with children and parents was used to collect data on possible demographic, hygiene and behavioral-contact risk factors such as sex, age, family size, parental education, parental occupation, source of water, toilet in house, hand-washing, contact with wastewater and contact with wastewater irrigated land. Ascariasis prevalence was found to be approximately five times higher among children in wastewater-impacted regions compared to control regions. Contact with wastewater and wastewater irrigated land and public water supply were found to be associated with higher infection rates. Trichuris rates did not show a statistically significant difference between the wastewater-impacted and the control regions. In conclusion, raw wastewater use in Beni-Mellal can lead to a high risk of geohelminthic infections. Adequate treatment of wastewater and public health education are highly recommended.

Anaemia among Egyptian adolescents: prevalence and determinants.

We aimed to estimate the nationwide prevalence of anaemia among adolescents in Egypt and to study possible risk factors. A cross-sectional approach was used. Blood samples were collected from 1980 adolescents for haemoglobin estimation. The overall prevalence of anaemia was 46.6%, most of which was mild or moderate, with severe cases in less than 1.0% of the sample. Gender difference was almost nonexistent. A significant inverse relationship was observed between the level of anaemia and age (especially among boys), socioeconomic level and educational level. Anaemia was more prevalent in rural areas and in Upper (southern) Egypt. Anaemia is a major public health problem among Egyptian adolescents and wide-scale public health education is warranted.

Predictive models for mortality and length of hospital stay in an Egyptian burns centre.

Our aim was to obtain a statistical profile of survivors and deaths among burn victims and to develop predictive models for mortality and length of hospital stay. All patients admitted to the Burns Unit of Alexandria Main University Hospital over a 1-year period were included. Of 533 cases, mean length of hospital stay was 15.5 +/- 21.6 days and the mortality rate was 33%. Total surface area burnt, inhalation burns, age, sex, depth and degree of burn wounds were the significant independent predictors of mortality in multiple logistic regression analysis. The significant independent predictors of the length of hospital stay were clothing ignition, total surface area burnt, sex, degree and depth of burn and inhalation burns.

Raw wastewater agricultural re-use and risk of protozoal infection in Beni-Mellal, Morocco.

This study was carried out to determine the potential risk of protozoal infection associated with raw wastewater use for agricultural purposes, among children of Beni-Mellal, Morocco. In a randomly-selected sample of 1343 children 740 from 5 regions which use raw wastewater for agriculture (exposed), while 603 were from 4 control regions that do not practice wastewater irrigation (unexposed). A questionnaire-interview with children and parents was used to collect data on demographic, hygienic, and risky water contact risk factors One or more protozoal infection was identified among 276(37.2%) of children living in the wastewater re-use regions, versus only among 22 (3.6%) living in control regions. The overall prevalence of 40.1% was observed among boys, and 33.3% among girls residing in exposed areas. The two identified protozoa were Entaemoeba histolytica and Giardia intestinalis, which infected 34.3% and 5.1% in the exposed population compared to only 3.3% and 0.3% in the control population, respectively. We also noted that the G. intestinalis prevalence was more than 40% among the children under 9 years, but less than 17% for those who were more than 12 years. Also, a significant excess of protozoal infection was observed among children who had risky contact with agricultural lands (p<0.001). In conclusion, raw wastewater use in Beni-Mellal can lead to a high risk of protozoal infections. Adequate treatment of wastewater prior to re-use, as well as public health education are highly recommended.

Knowledge, attitude and smoking patterns among nursing and laboratory technology students, dammam, saudi arabia.

OBJECTIVE: To study the reported practices of knowledge about and attitude towards smoking among nursing and medical laboratory technology (MLT) students, College of Medicine, King Faisal University at Dammam and Al-Khobar. SETTING: College of Medicine, Dammam and King Fahd Hospital of the University, Al-Khobar, Saudi Arabia METHODS: A cross-sectional approach involving a sample of 266 students and interns (152 nursing and 114 MLT), which included all enrolled students in the academic year (1998/1999). A self-administered questionnaire was used to collect data covering knowledge, practice and attitude to smoking. SPSS was used for statistical analysis. RESULTS: The overall smoking prevalence was low (5.6%), slightly higher among nursing (6.6%) versus MLT (4.4%) students. Knowledge of and attitude towards smoking was generally satisfactory in both groups, although deficient in some key areas, such as the addictive nature of smoking, some of its consequences on health, and difficulty of quitting. CONCLUSION AND RECOMMENDATIONS: The prevalence of smoking among nursing and MLT students is generally low but their knowledge and attitude need improvement. Health education on facts, dangers and consequences of smoking should start as early as the primary school, and should continue throughout the education of future health professionals (role models for the community).