Development of the Systems Thinking for Health Actions framework: a literature review and a case study.

BACKGROUND: Systems thinking is an approach that views systems with a holistic lens, focusing on how components of systems are interconnected. Specifically, the application of systems thinking has proven to be beneficial when applied to health systems. Although there is plenty of theory surrounding systems thinking, there is a gap between the theoretical use of systems thinking and its actual application to tackle health challenges. This study aimed to create a framework to expose systems thinking characteristics in the design and implementation of actions to improve health. METHODS: A systematised literature review was conducted and a Taxonomy of Systems Thinking Objectives was adapted to develop the new 'Systems Thinking for Health Actions' (STHA) framework. The applicability of the framework was tested using the COVID-19 response in Pakistan as a case study. RESULTS: The framework identifies six key characteristics of systems thinking: (1) recognising and understanding interconnections and system structure, (2) identifying and understanding feedback, (3) identifying leverage points, (4) understanding dynamic behaviour, (5) using mental models to suggest possible solutions to a problem and (6) creating simulation models to test policies. The STHA framework proved beneficial in identifying systems thinking characteristics in the COVID-19 national health response in Pakistan. CONCLUSION: The proposed framework can provide support for those aiming to applying systems thinking while developing and implementing health actions. We also envision this framework as a retrospective tool that can help assess if systems thinking was applied in health actions.

Knowledge, Attitude and Practices of Self-Medication Including Antibiotics among Health Care Professionals during the COVID-19 Pandemic in Pakistan: Findings and Implications.

Since the emergence of COVID-19, several different medicines including antimicrobials have been administered to patients to treat COVID-19. This is despite limited evidence of the effectiveness of many of these, fueled by misinformation. These utilization patterns have resulted in concerns for patients' safety and a rise in antimicrobial resistance (AMR). Healthcare workers (HCWs) were required to serve in high-risk areas throughout the pandemic. Consequently, they may be inclined towards self-medication. However, they have a responsibility to ensure any medicines recommended or prescribed for the management of patients with COVID-19 are evidence-based. However, this is not always the case. A descriptive cross-sectional study was conducted among HCWs in six districts of the Punjab to assess their knowledge, attitude and practices of self-medication during the ongoing pandemic. This included HCWs working a range of public sector hospitals in the Punjab Province. A total of 1173 HCWs were included in the final analysis. The majority of HCWs possessed good knowledge regarding self-medication and good attitudes. However, 60% were practicing self-medication amid the COVID-19 pandemic. The most frequent medicines consumed by the HCWs under self-medication were antipyretics (100%), antibiotics (80.4%) and vitamins (59.9%). Azithromycin was the most commonly purchase antibiotic (35.1%). In conclusion, HCWs possess good knowledge of, and attitude regarding, medicines they purchased. However, there are concerns that high rates of purchasing antibiotics, especially "Watch" antibiotics, for self-medication may enhance AMR. This needs addressing.

The impact of the COVID-19 pandemic on non-national doctors in Ireland.

BACKGROUND: International doctors make up nearly half of the physicians working in Ireland and are an integral part of the health service. The COVID-19 pandemic declared in March 2020 led to a global healthcare emergency. Resulting national lockdowns precluded travel at a time of need for family support. AIM: We aimed to measure the professional, psychosocial, and financial impact of the COVID-19 pandemic on non-EEA doctors working in Ireland. METHODS: An 88-item online survey of demographics, well-being, and financial resilience was circulated nationally between November 2021 and January 2022. The results were analysed using RStudio and Microsoft Excel 365. RESULTS: One hundred thirty-eight responses were received. Sixty-two percent of responders reported wishing to stay in Ireland long-term and 44% had applied for citizenship. Despite 80% of responders working in their desired speciality, only 36% were on a specialist training scheme. Forty-seven percent felt their career was affected by the COVID-19 pandemic. Seventy-three percent of respondents reported missing significant events in their home country. Over 50% reported significant mental health issues personally or in their families; however, only a minority sought professional help. Financial issues were a source of anxiety for 15% of respondents. Financial resilience was poor, 20% of respondents cited a 1-month financial reserve, 10% had a personal pension, and 9% had made a will. CONCLUSIONS: The COVID-19 pandemic has had a multifactorial negative impact on non-national doctors working in Ireland. More must be done to offer multidimensional support to this cohort who are a crucial part of the underserviced Irish healthcare system.

SARS-CoV-2 in Soil: A Microbial Perspective

SARS-CoV-2 has been found in soil and aquatic environments in addition to aerosols. SARS-CoV-2 enters the soil from various sources, including organic amendments and waste irrigation water. The virus counts and virulence in soil depend on spillover routes and soil properties. Organic matter (OM) and clay minerals protect and enable SARS-CoV-2 to survive for longer periods in soil. Therefore, life forms residing in soil may be at risk, but there is a paucity of scientific interest in such interactions. With this perspective, we aim to provide a new viewpoint on the effects of SARS-CoV-2 on soil microbes. In particular, we present a conceptual model showing how successive mutations within soil animals having the SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) may change its characteristics and, thus, enable it to infect micro- and macroorganisms and be transferred by them. SARS-CoV-2 particles could be adsorbed on mineral or OM surfaces, and these surfaces could serve as encounter sites for infectious attacks. SARS-CoV-2 accumulation in soil over time can perturb bacteria and other microbes, leading to imbalances in microbial diversity and activities. Thus, SARS-CoV-2 and its interactions with biotic and abiotic soil components should be a future research priority.

Lessons learnt of the COVID-19 contact tracing strategy in Islamabad Capital Territory, Pakistan using systems thinking processes

The strategy of test, trace and isolate has been promoted and seen as a crucial tool in the fight against the COVID-19 pandemic. As simple as the slogan sounds, effectively implementing it turns into a complex endeavor with multiple moving parts and the need for multisector collaboration. In this study, we apply a systems thinking lens to analyse the design and implementation of the contact tracing strategy for COVID-19 in the district of Islamabad, Pakistan. The data collection included participatory observation, reflective exercises, key informant interviews and participatory workshops with district health managers and health providers. The information gathered was structured using process and stakeholder mapping to identify the lessons learned of the COVID-19 contact tracing strategy. The results showed that the elements crucial for implementation were, good coordination during a crisis, available resources mobilized effectively and establishment of early active surveillance for contact tracing. Furthermore, the main aspects to be improved were lack of preparedness and existing surveillance systems and task shifting leading to impact on regular health services. The results of this study highlight the importance of developing information systems that are coherent with existing processes and resources, even in times of crisis.

Global overview of SARS-CoV-2 induced COVID-19 in 2020: biological characterization, epidemiology with social, economic and environmental implications

Background: COVID-19 is a global pandemic initiated in January 2020 that caused 79 million cases and more than 1.7 million deaths worldwide. The causative agent of COVID-19 is Severe Acute Respiratory Syndrome Coronavirus-2, a member of Betacoronvirus. COVID-19 patients are classified into asymptomatic, mild symptomatic, and severe symptomatic cases. Objectives: To review the prevalence, therapeutic interventions for the treatment, vaccination, and containment of COVID-19 in four quarters of 2020, emphasizing the advancements in biological studies, and the social, economic, and environmental impact of the pandemic. Methodology: Data of COVID-19 spread, identification, prevention, and control measures was analyzed. The impacts of pandemic on society, economy, and the environment were assessed.

Professional and personal opinions of doctors in training during the first wave of the COVID19 pandemic.

BACKGROUND: The COVID19 pandemic is one of the greatest modern global healthcare crises. The resultant morbidity and mortality of public and healthcare professionals has led to psychological impacts and economic repercussions. We set out to assess the concerns of doctors in training during this crisis. METHODS: A questionnaire was developed and delivered via Survey Monkey to doctors in training from 27 March to 6 April 2020, 2 weeks prior to the expected surge in Ireland and UK. The Perceived Stress Scale (PSS) was incorporated to gauge respondent stress as they prepared for the COVID19 impact. RESULTS: A total of 285 participants engaged with 197 (69%) completing all questions. Almost 86% of respondents had been trained in donning and doffing personal protective equipment (PPE), and nearly 85% felt confident in the process. Overall, most respondents felt somewhat prepared (60%) or well prepared (20%) to treat COVID19 patients. However, 42% worried that their hospital would struggle, or not cope at all; in particular, 91% highlighted the risk of running out of PPE. Family health (86%), personal health (72%), and social life (47%) topped the list of junior doctor concerns. According to the PSS, the majority of respondents (62%) had moderate stress. CONCLUSIONS: This survey is the first to measure the concerns of doctors in training in Ireland as regards the COVID19 pandemic. Worries included PPE exhaustion and personal and family health. A significant majority had moderate stress. Additional supports for doctors in training are essential to aid stress and manage concerns better.

Epidemic Spread and Its Management Through Governance and Leadership Response Influencing the Arising Challenges Around COVID-19 in Pakistan-A Lesson Learnt for Low Income Countries With Limited Resource.

The coronavirus disease (COVID-19) was first reported in China (Wuhan) at the end of 2019. It has rapidly spread over 216 countries, including the USA, UK, Europe, Russia, and many Asian countries. It has affected more than 4.5 million people, and around 0.3 million deaths have been reported globally. Many preventive measures have been adopted worldwide to mitigate its spread. The government of Pakistan has also taken many preventive measures to combat the COVID-19 outbreak, such as rapid response by governance, continuous monitoring of the pandemic spread in the affected areas, and integration of resources from multiple sectors, including health, education, defense, and media. According to global statistics, the number of COVID-19 cases in the country remained remarkably lower than the expected number for the first 169 days, as compared to other countries. A total of 286,674 confirmed cases, including 16,475 active, 6,139 deaths, and 264,060 (92%) recoveries were reported. The study finds that strict adherence to national policies, effective governance, and unity at the national level resulted in better outcomes. Hence, the preventive measures, rapid responses, and strategies adopted for combating the challenges could be adopted as a learning tool for other countries having similar work environments and financial constraints. This paper can help and guide governance/public actions in response to the possible rebound of coronavirus this fall/winter.

Validating a Phenomenological Mathematical Model for Public Health and Safety Interventions Influencing the Evolutionary Stages of Recent Outbreak for Long-Term and Short-Term Domains in Pakistan

During the outbreak of an epidemic, it becomes significantly essential to monitor the effects of containment measures and forecast the outbreak, including the epidemic peak. Many countries have either implemented strict lockdown to counter the spread of coronavirus disease or taken necessary preventive measures across the world to reduce the outbreak of this epidemic war. Several epidemic models have been presented across the world to examine the effects of public health-related strategies on mitigating the spread of current infectious disease, yet no reputable model has been presented for Pakistan as well as other South-Asian developing countries as per the authors’ knowledge. In this research, an actual coronavirus prediction in Pakistan is presented, which may guide the decision-makers as to how this pandemic has spread across the country and how it can be controlled. Furthermore, in the absence of targeted medicines, the analysis helps to develop a precise plan for the eradication of the outbreak by adopting the calculated steps at the right time. The mathematical phenomenological models have been adopted in this study to predict, project, and simulate the overall affected cases reflected due to the recent outbreak in Pakistan. These models predict the expected growth, and the estimated results are almost well matched with the real cases. Through the calibration of parameters and analyzing the current situation, forecast for the appearance of new cases in Pakistan is reported till the end of this year. The constant level of number of patients and time to reach specific levels are also reported through the simulations. The drastic conditions are also discussed which may occur if all the preventive restraints are removed. This research quantitatively describes the significant characteristics of the spread of corona cases. It acknowledges and provides an understanding of a short-term and long-term transmission of coronavirus outbreak in the country as three evolutionary phases. Therefore, this research provides a pathway to cope with the emerging threat of a severe outbreak in developing and nondeveloping countries.