Practical strategies to achieve resilient health systems: results from a scoping review.

BACKGROUND: This paper presents the results of a systematic review to identify practical strategies to create the institutions, skills, values, and norms that will improve health systems resilience. METHODS: A PRISMA 2020 compliant systematic review identified peer-reviewed and gray literature on practical strategies to make health systems more resilient. Investigators screened 970 papers to identify 65 English language papers published since 2015. RESULTS: Practical strategies focus efforts on system changes to improve a health system's resilience components of collective knowing, collective thinking, and collaborative doing. The most helpful studies identified potential lead organizations to serve as the stewards of resilience improvement, and these were commonly in national and local departments of public health. Papers on practical strategies suggested possible measurement tools to benchmark resilience components in efforts to focus on performance improvement and ways to sustain their use. Essential Public Health Function (EPHF) measurement and improvement tools are well-aligned to the resilience agenda. The field of health systems resilience lacks empirical trials linking resilience improvement interventions to outcomes. CONCLUSIONS: The rigorous assessment of practical strategies to improve resilience based on cycles of measurement should be a high priority.

Mapping of national population-based surveys for better reporting of health-related indicators in the Eastern Mediterranean Region.

BACKGROUND: Population-based surveys are the main data source to generate health-related indicators required to monitor progress toward national, regional and global goals effectively. Although the Eastern Mediterranean Region of World Health Organization (WHO) member states conduct many population-based surveys, they are not led regularly and fail to provide relevant indicators appropriately. Therefore, this study aims two-fold: to map out population-based surveys to be conducted data for the health-related indicators in the Region and propose a timetable for conducting national population-based surveys in the Region. METHODS: The study was conducted in six phases: 1) Selecting survey-based indicators; 2) Extracting and comparing relevant survey modules; 3) Identifying sources of data for the indicators; 4) Assessing countries' status in reporting on core health indicators; 5) Review and confirmation of the results by the experts. RESULTS: Population-based surveys are the sources of data for 44 (65%) out of 68 regional core health indicators and two (18%) out of 11 health-related Sustainable Development Goals (SDG) 3 indicators. The Health Examination Survey (HES) could cover 65% of the survey-based indicators. A total of 91% of survey-based indicators are obtained by a combination of HES, Demographic and Health Survey (DHS), Multiple Indicator Cluster Survey (MICS) and Global School-based Student Health Survey (GSHS). CONCLUSION: In order to effectively report health-related indicators, HES, DHS/MICS and GSHS are considered essential in national survey timetables. Each country needs to devise and implement a plan for population-based surveys by considering factors such as national health priorities, financial and human capacities, and previous experiences.

Randomized Clinical Trial Visual Abstract Display and Social Media-Driven Website Traffic.

In this study, the authors assessed whether publication of a visual abstract on social media was associated with reader engagement online.

Apoptosis and electroretinogram after intravitreal injection of methotrexate in an experimental rabbit model.

The aim of this study was to explore the changes in electroretinogram of rabbit retina and apoptosis in methotrexate-induced toxicity. Rabbits were divided into 5 groups. Group I served as control in which saline solutions was injected intravitreally. Methotrexate (800 µg, 1.76 µmol) was injected into the vitreous of both eyes of rabbits groups II, III, IV and V by an insulin injector with a 26 gauge needle under general anesthesia. Retinal function was assessed by electroretinogram (ERG) after 2, 4, 10 days and one month then animals were decapitated. The eyes were enucleated and processed for DNA fragmentation studies by gel electrophoresis to retinae and measurement of caspase-3 activities. The results indicated a significant reduction (p ˂ 0.05) in a- and b-wave, a time-dependent appearance of the typical ladder pattern of internucleosomal fragmentation, a characteristic of apoptosis and increase of relative caspase-3 activity after methotrexate intravitreal injection. Methotrexate lead to apoptosis, increase of caspase-3 and affect retinal function.

Effects of bilberry on deoxyribonucleic Acid damage and oxidant-antioxidant balance in the lens, induced by ultraviolet radiation.

BACKGROUND: This study investigated the possible protective effects of bilberry extract after exposing rat eyes to ultraviolet-B (UV-B) radiation. METHODS: Four groups of rats were included in this study, each consisting of 10 Wistar rats. The first group acted as the control, and the second group was exposed to UV-B, 5 KJ/m(2) (λm = 300 nm), for 15 minutes. The third group was orally administered bilberry extract (160 mg twice per day) for two weeks before exposure to the UV-B, while the fourth group was administered the same dose of bilberry extract for two weeks before euthanisation. A comet assay was used to examine DNA damage, while the malondialdehyde (MDA) level and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT), activities were measured in the lens. RESULTS: After exposing the rats to UV-B radiation, the mean percentage tail DNA and tail moment were significantly increased (P < 0.001) when compared to the control group. In the same context, the lens tissue MDA levels and CAT activity were also significantly increased (P < 0.001). The supplementation of the bilberry extract was found to improve the comet assay parameters and enzymatic activity of the rat lens tissue. CONCLUSION: The administration of bilberry led to a decrease in the oxidative stress in the lens tissues and DNA damage induced by UV-B radiation in the lenses of Wistar rats.

Bio-spectroscopic analysis of corneal structural alterations in dry eye disease: A study of collagen, co-enzymes, lipids, and proteins with emphasis on phytotherapy intervention.

Dry eye disease (DED) stands as a prevalent cause for ophthalmology consultations, securing the third position following refractive errors and cataracts. Moreover, the likelihood of experiencing DED escalates with advancing age. In this experimental study corneal tissue alterations due to DED were investigated over different periods by applying both infrared and synchronous fluorescence spectroscopy. The potential effects of instillation of pomegranate and green tea water extracts as green-friendly treatment modalities were also evaluated. The obtained results collectively indicate that DED affects the OH bearing constituents (collagen, glycosaminoglycans, and proteoglycans) of cornea leading to changes in protein secondary structure and the collagen fibrils. Additionally, enhanced dehydrated environment, and reduced energetic/metabolic state, as indicated by co-enzymes, was observed. Phyto-therapeutic administration can contain these alterations with enhanced energetic/metabolic state and increased hydration environment. In conclusion, instillation of green tea extract can protect/restore the collagen fibrils and its potential effects, in general, exceeds that of pomegranate extract.

The impact of photoreceptor layer loss on different ocular tissues: Insights from FTIR spectroscopy.

Photoreceptor loss has significant consequences for visual function, and its management is a critical component for treating not only retinal diseases such as age-related macular degeneration and retinitis pigmentosa but also its ocular consequences. On the other hand, Fourier transform infrared spectroscopy is an excellent tool to investigate molecular structure and dynamics of biological samples, and as a non-destructive and label free measurement, it does not perturb the samples. In this study, detailed analyses of the recorded FTIR spectra from cornea, lens and sclera were performed to monitor the distribution of ocular abnormalities due to photoreceptor layer loss after 1, 3 and 6 days. FTIR data were statistically evaluated by multivariate analysis and Bonferroni means comparison. The obtained results revealed that ocular abnormalities associated with photoreceptor layer loss are varied among the investigated tissues, and comprise changes in both hydrogen bond network around proteins and lipid disorder. Structural modifications of protein secondary structure were reported in all investigated tissues. Clinically, the concluded information from FTIR data and its statistical evaluation can contribute to the development of therapeutic strategies for these heterogeneous changes.

Bio-spectroscopic investigation linking changes of retinal structure with short-term administration of Amiodarone and revealing the ameliorative effect of vitamin E supplementation.

Long term use of Amiodarone (AMIO) is associated with the development of ocular adverse effects. This study investigates the short term effects, and the ameliorative consequence of vitamin E on retinal changes that were associated with administration of AMIO. This is accomplished by investigating both retinal structural and conformational characteristics using Fourier transform infrared spectroscopy (FTIR) and Fundus examination. Three groups of healthy rabbits of both sexes were used; the first group served as control. The second group was orally treated with AMIO (160 mg /kg body weight) in a daily basis for two weeks. The last group orally received AMIO as the second group for two weeks then, oral administration of vitamin E (100 mg/kg body weight) for another two weeks as well. FTIR results revealed significant structural and conformational changes in retinal tissue constituents that include lipids and proteins due to AMIO administration. AMIO treatment was associated with fluctuated changes (increased/decreased) in the band position and bandwidth of NH, OH, and CH bonds. This was concomitant with changes in the percentage of retinal protein constituents in particularly α-helix and Turns. AMIO facilitates the formation of intra-molecular hydrogen bonding and turned retinal lipids to be more disordered structure. In conclusion, the obtained FTIR data together with principal component analysis provide evidence that administration of vitamin E following the treatment with AMIO can ameliorate these retinal changes and, these biophysical changes are too early to be detected by Fundus examination.

Analyzing Tear Fluid Composition by Synchronous Fluorescence for Diagnosing Dry Eye Disease and the Role of Phytotherapy Intervention.

PURPOSE: Tear fluid gained attention as a representative biological fluid. Its simple and non-invasive collection methods as well as richness of candidate biomarkers made it a potential diagnostic tool for different diseases such as dry eye. Synchronous fluorescence spectroscopy is a highly sensitive analytical tool that results in narrowing and enhanced peak resolution, and has a potential role in disease diagnosis, biomarker identification, and therapeutic monitoring. We applied synchronous fluorescence spectroscopy to monitor variations of tear fluid composition during the development of dry eye disease and to evaluate the potential effects of phytotherapy. METHODS: Dry eye model was induced in Chinchilla rabbits by instillation of 1% atropine sulfate ophthalmic solution. Then, the tear fluid was collected at 3, 7, and 14 days and subjected to synchronous fluorescence spectroscopy. Phytotherapy was achieved by topical instillation of 20 µl of water extracts of pomegranate peel or green tea powders. RESULTS: The fluorescence results revealed changes in the structure of tear fluid over time and the eye is subjected to toxification due to oxidative stress. In addition, dry eye disease was found to affect the metabolic/energetic state of the eye. On the other hand, phytotherapy led to enhancement of the metabolic/biosynthesis state due to activation of flavin adenine dinucleotide-associated proteins. CONCLUSION: There was change in the electrical conductivity of tear fluid proteins. In the case of dry eyes, they became electrical insulators, while in the case of treatment with extracts, their electrical conductivity properties improved. The effects of phytotherapy can be related to the high content of ellagic acid and anthocyanin of pomegranate extract, while in green tea, they are related to catechins and phenolic compounds.

Advancing Refugee Health Data Management: The Implementation of ICD-11 in UNRWA's Primary Care System.

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was one of the earliest healthcare systems globally to implement the International Classification of Diseases, Eleventh Revision (ICD-11) across its 140 clinics serving 5.9 million Palestine refugees. This paper discusses the integration of ICD-11 into UNRWA's cloud-based electronic medical record (EMR) system, identifying both the barriers and facilitators involved and analyzing trends in clinical documentation and healthcare utilization. The key challenges included data privacy provisions, integration into a coordinated care model, complex classification schema for primary care settings, frequent staff turnover, and limited data analysis capabilities. Conversely, facilitators included physician-tailored training and on-site support, system compatibility, a multidisciplinary team approach, policy support from UNRWA and the World Health Organization (WHO), and leadership commitment and effective change management. Medical officers (MOs) using ICD-11 reported greater satisfaction with the system's capabilities in managing and visualizing health information. This article contributes to the discourse on health data management in complex humanitarian settings, offering insights into the benefits and challenges of implementing advanced classification systems like ICD-11. Future research should explore longitudinal impacts and further integration with global health systems, ensuring that the advancements in classification continue to support the overarching goal of health equity and access in vulnerable and hard-to-reach populations.

Achieving integrated disease surveillance in the Eastern Mediterranean Region.

Access to reliable and timely information is key for healthcare decision-making at the regional, national and sub-national levels. However, lack of access to such information hampers to progress towards achievement of the Sustainable Development Goals (SDGs) in the Eastern Mediterranean Region (EMR), as indicated in the Regional Progress Report on Health-Related Sustainable Development Goals.

WHO's Investigations and Studies, Unity Studies: A global initiative creating equitable opportunities for enhanced surveillance, operational research, capacity building, and global knowledge sharing.

The World Health Organization's Unity Studies global initiative provides a generic preparedness and readiness framework for conducting detailed investigations and epidemiological studies critical for the early and ongoing assessment of emerging respiratory pathogens of pandemic potential. During the COVID-19 pandemic, the initiative produced standardized investigation protocols and supported Member States to generate robust and comparable data to inform public health decision making. The subsequent iteration of the initiative is being implemented to develop revised and new investigation protocols, implementation toolkits and work to build a sustainable global network of sites, enabling the global community to be better prepared for the next emerging respiratory pathogen with epidemic or pandemic potential.

Measuring availability of and facility readiness to deliver comprehensive abortion care: experiences and lessons learnt from integrating abortion into WHO's health facility assessments.

Routine assessment of health facility capacity to provide abortion and post-abortion care can inform policy and programmes to expand access and improve quality. Since 2018, abortion and/or post-abortion care have been integrated into two WHO health facility assessment tools: the Service Availability and Readiness Assessment and the Harmonised Health Facility Assessment. We discuss lessons learnt through experiences integrating abortion into these standardised tools. Our experiences highlight the feasibility of including abortion in health facility assessments across a range of legal contexts. Factors facilitating the integration of abortion include cross-country collaboration and experience sharing, timely inputs into tool adaptations, clear leadership, close relationships among key stakeholders as in assessment coordination groups, use of locally appropriate terminology to refer to abortion and reference to national policies and guidelines. To facilitate high-quality data collection, we identify considerations around question sequencing in tool design, appropriate terminology and the need to balance the normalisation of abortion with adequate sensitisation and education of data collectors. To facilitate appropriate and consistent analysis, future work must ensure adequate disaggregation of recommended and non-recommended abortion methods, alignment with national guidelines and development of a standardised approach for measuring abortion service readiness. Measurement of abortion service availability and readiness should be a routine practice and a standardised component of health facility assessment tools. Evidence generated by health facility assessments that include abortion monitoring can guide efforts to expand access to timely and effective care and help normalise abortion as a core component of sexual and reproductive healthcare.

Potential role of blood constituents in pain-relief associated with fibromyalgia treatment with extremely low magnetic field: Spectroscopic investigation.

Magnetic field is used as an adjunct therapy for pain control and relief of musculoskeletal pain conditions as Fibromyalgia. It is regarded as more natural and less harmful alternative to analgesic compounds. The exact mechanism underlying these positive effects is still to be determined. Twenty-three patients diagnosed with Fibromyalgia condition were included in this study, and subjected to extremely low magnetic field treatment sessions. The treatment protocol based on exposing patients to gradually increased magnetic field strength that starts with 0.1 µT at the beginning, and increased gradually to 100 µT (3.33 µT/min). UV-Visible, mid-IR and fluorescence characteristics of whole blood, erythrocytes and hemoglobin were investigated; in addition to RBCs-osmotic fragility measurements. The obtained results were analyzed according to control-sham exposed patients. We observed marked changes in the blood (and/or its constituents) absorption spectra of fibromyalgia patients that indicate an enhancement in the energetic pathways and increased hemoglobin-oxygen affinity; in addition, the osmotic fragility measurements show that erythrocytes were characterized by increased elasticity and rehydration. The analyses of infrared spectra show that magnetic field treatment was associated with changes in the erythrocytes skeleton where α-helix component of protein secondary structure is dominant. This study provides scientific evidence that pain relief associated with extremely low magnetic field treatment can be directly related to its systemic effects as well as the enhancement of the cellular activities.

Linking Cognitive Impairment with Amyloid-ß Accumulation in Alzheimer's Disease: Insights from Behavioral Tests and FTIR Spectroscopy.

Background: Alzheimer's disease (AD) is a neurodegenerative disorder that progresses over time. Fourier Transform Infrared Spectroscopy (FTIR) analysis gives identification of the main metabolic changes that happen during neurodegeneration, by monitoring biochemical and molecular structure alterations that can help in AD diagnosis or treatment approach. Objective: The aim of the present work is to assess AD hallmarks in molecular structure of retina and monitor accumulation of amyloid beta42(Aß42) in brain and retina during disease progression. Methods: AD induced in rats by Aluminum Chloride (AlCl3). Retinal molecular structure during disease progression for 2,4,6 and 8 weeks was assessed by Fourier-transform infrared spectroscopy (FTIR) and the incidence of the disease was confirmed by a behavioural assessment; the Morris Water Maze test. Aß42 levels in the brain and retina were also measured. Results: The results indicated that cognitive impairment starting from 6 weeks of AlCl3 administration. Retinal concentration of Aß42 was significant increase (p < 0.05) from 2 weeks that precedes the observed increase of Aß42 in the brain which appeared after 4 weeks of AlCl3 administration. Multivariate principal component analysis discovers that the variance noticed in the infrared spectra due to AD condition and it is time dependent for progression of the disease. Conclusions: The accumulation of Aß42 is a sensitive early biomarker in retina for AD. FTIR analysis of the retina revealed changes in hydrogen bond formation or destruction, alterations in lipid chain length and branching accompanied by depleted lipid content and carbonization, as well as degeneration of the retinal tissue due to AD.

Prognosis of Biomarker of Alzheimer's Disease in the Function of the Retina and Secondary Molecular Structure Variation of the Retina and Brain.

Alzheimer's disease (AD) is one of the most serious neurodegenerative diseases in the globe. As a result, there is an acute need to discover indications that allow for early disease detection. There is growing scientific data showing the similarities between the eye and other central nervous system components, suggesting that information obtained in ophthalmic research might be valuable in the study and diagnosis of AD. Fifty male albino Wistar rats were separated into five groups: the first group served as control, and the other four groups of animals were administrated aluminium chloride (AlCl3) in a dose of 100 mg/kg body weight (b.w.) for 2, 4, 6, and 8 weeks, respectively. Insights into the function of the retina by electroretinogram (ERG) and the changes thought to have occurred in the molecular structure of the retina and brain using Fourier transform infrared spectroscopy (FTIR) as a result of AD progression induced by AlCl3 in rats were done. Moreover, the measurement of acetylcholinesterase (AchE) was done. After 6 and 8 weeks of AlCl3 injection, there was a substantial reduction (p ≤ 0.05) in a- and b-wave amplitudes and a significant rise (p ≤ 0.05) in implicit time compared to controls. A significant elevation (p ≤ 0.05) of AchE content was observed after 4, 6, and 8 weeks. FTIR revealed a significant increase (p ≤ 0.05) of ß-turn and ß-sheet content associated with significant decrease (p ≤ 0.05) of α-helix content for all groups administrated with AlCl3. Our findings suggest that retinal biomarkers such as ERG of the retina may be used as a screening tool for detection of AD. Secondary structural changes in the proteins of the retina and the brain were similar in AD rats' model and precede retinal dysfunction.

Spectroscopic investigation of retinal degeneration unravel molecular changes associated with vision impairment.

Although retinal degeneration is one of the causes of blindness worldwide and involve the loss of the photoreceptors of the retina, the cause(s) of its development still need to be determined in order to reach an effective treatment instead of trying to slow the progression of the disease. Retinal degeneration condition was induced by intravitreal injection of 2 µl of adenosine triphosphate (ATP) solution. The progress of the disease was monitored by retinal imaging (ocular coherence tomography, OCT) after 1, 8 and 15 days of injecting ATP. At the end of each period, retinal tissue was obtained where retinal proteins were extracted and then subjected to spectroscopic studies. Another part of the retinal tissue was investigated by Fourier transform infrared spectroscopy. The OCT images reflect significant reduction in retinal full thickness and provide evidence of intraretinal inflammation while; the obtained results indicate that both primarily and secondary structure of retinal proteins are influenced by the degeneration condition and, the electrical conductance of retinal proteins is decreased due to degeneration condition. Multivariate principal component analysis identifies that the variance noticed in the infrared spectra due to degeneration condition is not time dependent and revealed intra-groups structural dissimilarity. This dissimilarity was clearly resolved by fluorescence study where the content of amino acids phenylalanine, tryptophan and tyrosine varies with the progress of the degeneration condition. All together provide scientific facts that vision impairment is due to loss of signal transduction and formation of protein aggregates as well.

WHO's support for COVID-19 research and knowledge management in the Eastern Mediterranean Region.

Health research, innovation and knowledge management remain major priorities of the WHO's response to the COVID-19 pandemic. WHO's Eastern Mediterranean Regional Office (EMRO) supports priority research initiatives that address gaps in current knowledge regarding the COVID-19 pandemic. Through a specific call for proposals, 122 research proposals were received and reviewed in 2020, of which 17 were recommended for funding from eight countries. Ten countries in the region participated in the global solidarity trial to assess potential therapies for COVID-19. In addition, WHO advocated for early serological and epidemiological investigations ('COVID-19 Unity Studies') on the general population, healthcare workers, pregnant women and neonates, and extending technical, financial and material support for them.Starting in early 2020, scholarly articles on COVID-19 have been published in every issue of the Eastern Mediterranean Health Journal More than 6300 publications on COVID-19 were made available on the WHO knowledge management portal in the last year alone. WHO is also supporting countries in conducting studies to assess the field effectiveness of vaccines deployed nationally. To build and strengthen country capacities, regional webinars and intercountry meetings were conducted on research ethics, national health information systems and evidence-based health policy making. With support from WHO EMRO's new research and knowledge management pillar, countries in the region were well equipped to contribute to a global understanding of the novel virus's characteristics, as well as employ a national response based on informed evidence.

COVID-19 morbidity in Afghanistan: a nationwide, population-based seroepidemiological study.

OBJECTIVE: The primary objectives were to determine the magnitude of COVID-19 infections in the general population and age-specific cumulative incidence, as determined by seropositivity and clinical symptoms of COVID-19, and to determine the magnitude of asymptomatic or subclinical infections. DESIGN, SETTING AND PARTICIPANTS: We describe a population-based, cross-sectional, age-stratified seroepidemiological study conducted throughout Afghanistan during June/July 2020. Participants were interviewed to complete a questionnaire, and rapid diagnostic tests were used to test for SARS-CoV-2 antibodies. This national study was conducted in eight regions of Afghanistan plus Kabul province, considered a separate region. The total sample size was 9514, and the number of participants required in each region was estimated proportionally to the population size of each region. For each region, 31-44 enumeration areas (EAs) were randomly selected, and a total of 360 clusters and 16 households per EA were selected using random sampling. To adjust the seroprevalence for test sensitivity and specificity, and seroreversion, Bernoulli's model methodology was used to infer the population exposure in Afghanistan. OUTCOME MEASURES: The main outcome was to determine the prevalence of current or past COVID-19 infection. RESULTS: The survey revealed that, to July 2020, around 10 million people in Afghanistan (31.5% of the population) had either current or previous COVID-19 infection. By age group, COVID-19 seroprevalence was reported to be 35.1% and 25.3% among participants aged ≥18 and 5-17 years, respectively. This implies that most of the population remained at risk of infection. However, a large proportion of the population had been infected in some localities, for example, Kabul province, where more than half of the population had been infected with COVID-19. CONCLUSION: As most of the population remained at risk of infection at the time of the study, any lifting of public health and social measures needed to be considered gradually.

SARS-CoV-2 seroprevalence in Aden, Yemen: a population-based study.

BACKGROUND: In Yemen, initial surveillance of coronavirus disease 2019 (COVID-19) focused primarily on patients with symptoms or severe disease. The full spectrum of the disease remains unclear. To the best of the authors' knowledge, this is the first seroprevalence study performed in Yemen. METHODS: This cross-sectional investigation included 2001 participants from all age groups from four districts in Aden, southern Yemen. A multi-stage sampling method was used. Data were collected using a well-structured questionnaire, and blood samples were taken. Healgen COVID-19 IgG/IgM Rapid Diagnostic Test (RDT) Cassettes were used in all participants. All positive RDTs and 14% of negative RDTs underwent enzyme-linked immunosorbent assay (ELISA) testing (WANTAI SARS-CoV-2 Ab ELISA Kit) for confirmation. RESULTS: In total, 549 of 2001 participants were RDT positive and confirmed by ELISA, giving a prevalence of COVID-19 of 27.4%. The prevalence of immunoglobulin G was 25%. The prevalence of asymptomatic COVID-19 in the entire study group was 7.9%. The highest prevalence was observed in Al-Mansurah district (33.4%). Regarding sociodemographic factors, the prevalence of COVID-19 was significantly higher among females, housewives and subjects with a history of contact with a COVID-19 patient: 32%, 31% and 39%, respectively. CONCLUSION: This study found high prevalence of COVID-19 in the study population. Household transmission was common.