Rapid response teams in the Eastern Mediterranean Region: Results from the baseline survey of country-level capacities, operations and outbreak response capabilities.

The aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response.

Naturalization of treated wastewater by a constructed wetland in a water-scarce Mediterranean region.

The effluents from conventional wastewater treatment plants (WWTP), even if accomplishing quality regulations, substantially differ in their characteristics with those of waters in natural environments. Constructed wetlands (CWs) serve as transitional ecosystems within WWTPs, mitigating these differences and restoring natural features before water is poured into the natural environment. Our study focused on an experimental surface-flow CW naturalizing the WWTP effluent in a semiarid area in Eastern Spain. Despite relatively low pollutant concentrations entering the CW, it effectively further reduced settled organic matter and nitrogen. Dissolved organic matter (DOM) reaching the CW was mainly protein-like, yet optical property changes in the DOM indicated increased humification, aromaticity, and stabilization as it flowed through the CW. Flow cytometry analysis revealed that the CW released less abundant but more active bacterial populations than those received. MiSeq Illumina sequencing highlighted changes in the prokaryotic community composition, with phyla Proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria dominating the CW outflow. Functional prediction tools (FaproTax and PICRUSt2) demonstrated a shift towards microbial guilds aligned with those of the natural aquatic environments, increased aerobic chemoheterotrophs, photoautotrophs, and metabolic reactions at higher redox potentials. Enhanced capabilities for degrading plant material correlated well with changes in the DOM pool. Our findings emphasize the role of CWs in releasing biochemically stable DOM and functionally suited microbial populations for natural receiving environments. Consequently, we propose CWs as a naturalization nature-based solution (NBS) in water-scarce regions like the Mediterranean, where reclaimed discharged water can significantly contribute to ecosystem's water resources compared to natural flows.

National public health institutes in the Eastern Mediterranean Region: Insights from experts in the field.

National public health institutes (NPHIs) are crucial to the effectiveness of public health systems, including delivering essential public health functions and generating evidence for national health policies, strategies and plans. Currently, there is a significant lack of information regarding NPHI or NPHI-like organisations in Eastern Mediterranean Region (EMR) countries, including how they fit into their broader health systems governance landscape. NPHIs exist in 12 out of 22 EMR countries, yet there is no official International Association of National Public Health Institutes (IANPHI) regional network for the EMR, despite established IANPHI networks in four other regions. In 2022, the WHO's Eastern Mediterranean Regional Office led a study comprising an online survey and key informant interviews, which synthesised expert insights and summarised recommendations to strengthen the health systems governance-related role of NPHIs in EMR countries. Study participants included current and former high-level representatives of NPHIs, the government (eg, Ministries of Health, health regulatory authorities), multilateral organisations or non-governmental organisations focusing on health, and others identified as senior health systems governance experts from EMR. Insights and recommendations from experts varied widely, but there were also many common elements and overlaps. These included the need for enhancing NPHI functionalities and collaborative efforts with the public health sector (eg, Ministry of Health, Health Council) in health policy and decision-making formulation and implementation. This, in turn, requires advancing NPHI's fit-for-purpose and sustainable governance and financing arrangements, improving the accessibility and transparency of health data for NPHIs, strengthening engagement and collaboration between NPHIs and other health system actors (including the private sector), and promoting a more prominent role for NPHIs in the development and implementation of public health-related policies and legislation. While many excellent insights and thoughtful strategic guidance are provided, further adaptation may be needed to implement the proposed recommendations in different EMR country contexts going forward.

Effect of Physical Performance Levels of Elderly Living in Urban and Rural Areas on Social Participation, Social Functioning, and Quality of Life: A Cross-sectional Study from the Mediterranean Region of Turkey.

BACKGROUND: Social interaction is a very important subject for the elderly, especially in the context of active aging. AIM: This study aims to investigate the effect of physical performance levels of the elderly living in rural and urban areas on social participation, social functioning, and quality of life. METHODS: A total of 418 volunteer elderly aged 65 and over, living in rural (42.3%) and urban (57.7%) areas, participated in this study. The Mini-Mental State Examination, Short Physical Performance Battery, the World Health Organization Quality of Life Scale for Older Adults, Social Functioning Scale, and the Community Integration Questionnaire were applied to participants. RESULTS: The scores of social functioning (P = 0.027) and the social network subscale of social participation (P = 0.001) were significantly higher among participants living in urban areas compared to those living in rural areas. Physical performance was positively correlated with social participation (r = 0.404) and social functioning (r = 0.324) at a moderate level (P = 0.000), and with quality of life at a low level (r = 0.158) (P = 0.001). Social participation was positively correlated with social functioning at a high level (r = 0.572) and with quality of life at a moderate level (r = 0.300) (P = 0.000). Social functioning was positively correlated with quality of life at a low level (r = 0.234) (P < 0.01). CONCLUSION: To increase social participation, social functioning, and quality of life among the elderly, it is necessary to keep physical performance levels higher. In addition, in the planning of social participation, it is crucial to take into account where the elderly live in.

Exploring the Biological and Phytochemical Potential of Jordan's Flora: A Review and Update of Eight Selected Genera from Mediterranean Region.

Jordan's flora is known for its rich diversity, with a grand sum of 2978 plant species that span 142 families and 868 genera across four different zones. Eight genera belonging to four different plant families have been recognized for their potential natural medicinal properties within the Mediterranean region. These genera include Chrysanthemum L., Onopordum Vaill. Ex. L., Phagnalon Cass., and Senecio L. from the Asteraceae family, in addition to Clematis L. and Ranunculus L. from the Ranunculaceae family, Anchusa L. from the Boraginaceae family, and Eryngium L. from the Apiaceae family. The selected genera show a wide variety of secondary metabolites with encouraging pharmacological characteristics including antioxidant, antibacterial, cytotoxic, anti-inflammatory, antidiabetic, anti-ulcer, and neuroprotective actions. Further research on these genera and their extracts will potentially result in the formulation of novel and potent natural pharmaceuticals. Overall, Jordan's rich flora provides a valuable resource for exploring and discovering new plant-based medicines.

The Mediterranean diet: a historical perspective.

The Mediterranean diet, which was born in the Mediterranean basin, was initially quite poor and simple, essentially based on the products that grew almost spontaneously along the shores of the Mediterranean, i.e., olives, grapes, and wheat, which were long cultivated in the Mediterranean region. The invasions of the Roman Empire by barbarian populations, between 400 and 800 AD, made the diet enriched with products from wild uncultivated areas, meat from game and pigs, and vegetables. With the arrival of the Arabs in southern Italy in the ninth century, the focus of the diet shifted to carbohydrates, particularly to dried pasta and to other new ingredients. The Arabs primarily brought a new imaginative spirit to the kitchen by introducing and using an infinity of condiments and seasonings. The discovery of the Americas and the arrival of new ingredients from the New World brought the final adjustments to the Mediterranean diet: new meat (turkey), new vegetables (potatoes, broad beans, corn, tomatoes,) new fruits (strawberries, pineapples, coconuts, peanuts), chocolate, coffee and sugar completed the list of components of the Mediterranean diet as we know it today.

Reviewing essential public health functions in the Eastern Mediterranean Region post COVID-19 pandemic: a foundation for system resilience.

The COVID-19 pandemic exposed vulnerabilities in many health systems worldwide with profound implications for health and society. The public health challenges experienced during the pandemic have highlighted the importance of resilient health systems, that can adapt and transform to meet the population's evolving health needs. Essential public health functions (EPHFs) offer a holistic, integrated and sustainable approach to public health by contributing to achieving several health priorities and goals. In recent years, there has been a focused effort to conceptualise and define the EPHFs. In this paper, we describe the collaborative approach undertaken by the WHO Eastern Mediterranean Region (EMR) and UK Health Security Agency and present the findings and results of the revised EPHFs, in view of lessons learnt from the COVID-19 pandemic and the current priorities for countries across the EMR. This included conducting a desktop review, a gap and bottleneck analysis and stakeholder consultation to arrive at the revised EPHF model including four enablers and nine core functions, including a new function: public health services. The EPHFs will offer countries a complementary and synergistic approach to strengthen health systems and public health capacities and contribute to the region's ability to effectively respond to future health challenges and emergencies. By focusing on the EPHFs, countries can work towards ensuring health security as an integral goal for the health system besides universal health coverage, thus strengthening and building more resilient and equitable health systems.

Increasing access to healthcare in the Eastern Mediterranean Region.

Lessons learnt from the COVID-19 pandemic have provided an opportunity to intensify efforts towards the health-related Sustainable Development Goals (SDGs). Innovations in digital health and advances in science witnessed during the pandemic can be harnessed to improve equitable access to healthcare and build resilient health systems. We also have stark reminders that without addressing the needs of the most vulnerable groups and societies, a simple expansion of service delivery efforts may even exacerbate existing inequities in healthcare.

Geographical distribution of Bartonella spp in the countries of the WHO Eastern Mediterranean Region (WHO-EMRO).

Bartonellosis is a vector-borne and zoonotic diseases in humans, especially in immunocompromised individuals. However, there is no complete data about the geographical distribution of different species of Bartonella, as well as the status of its reservoirs, vectors, and human cases in most parts of the world. In this study, published reports related to Bartonella species from WHO-EMRO region countries were searched in different databases until October 2023. The eighteens different species of Bartonella were reported in WHO-EMRO countries including Bartonella henselae, Bartonella quintana, Bartonella elizabethae, Bartonella bovis, Bartonella clarridgeiae, Bartonella vinsonii, Bartonella doshiae, Bartonella taylorii, Bartonella rochalimae, Bartonella tribocorum, Bartonella rattimassiliensis, candidatus Bartonella merieuxii, candidatus Bartonella dromedarii, Bartonella acomydis, Bartonella jaculi, Bartonella coopersplainsensis and Bartonella koehlerae. Also, only human cases of B. henselae and B. quintana infections were reported from WHO-EMRO countries. The infections of Bartonella are important in the WHO-EMRO region, but they have been neglected by clinicians and healthcare systems.

Progress Toward Measles Elimination - World Health Organization Eastern Mediterranean Region, 2019-2022.

In 2015, all 22 World Health Organization Eastern Mediterranean Region (EMR) countries and areas (countries) pledged to achieve measles elimination by 2020. Despite success in several countries, most countries in the region still have not eliminated measles. This report updates a previous report and describes progress toward measles elimination in EMR during 2019-2022. During that period, estimated regional coverage with the first and second doses of a measles-containing vaccine (MCV) was 82%-83% and 76%-78%, respectively. During 2019-2022, approximately 160 million children were vaccinated during national or subnational supplementary immunization activities. Reported confirmed regional measles incidence decreased from 29.8 cases per 1 million population in 2019 to 7.4 in 2020, but then increased 68%, to 50.0 in 2022 because of challenges providing immunization services and conducting surveillance during the COVID-19 pandemic. Surveillance indicators deteriorated in 11 (50%) of the 22 EMR countries. During 2019-2022, four countries in the region were verified as having achieved measles elimination, but other countries reported immunity gaps and increased measles incidence in 2022. To achieve measles elimination in EMR, national immunization programs, especially in those countries with high measles incidence, will need to continue to recover from the COVID-19 pandemic, increase overall vaccination coverage to close immunity gaps, and maintain high-quality disease surveillance.