Eastern Mediterranean Health Journal [2023; Vol.29, Issue 4]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Thromboprophylaxis for Coagulopathy Related to COVID-19 in Pediatrics: A Narrative Review.

In addition to harming the respiratory system, COVID-19 can affect multiple organs. Children may develop a specific complication of COVID-19 called multisystem inflammatory syndrome in children (MIS-C) which could influence the vascular system of children and cause multiple coagulopathies in the body. Information on the use of thromboprophylaxis in this condition was collected via the review of various articles. In general, different factors in immune system responses can trigger the initiation of thrombotic events. Studies have shown that starting anticoagulant prophylaxis, which contributes to decreased thrombotic events, is dependent on the patient's condition and D-dimer levels. However, further studies on pediatric populations are needed to establish the role of anticoagulants in children with this condition.

[Pneumococcal conjugate vaccines in pediatrics, its impact on Public Health]. / Vacunas conjugadas contra neumococo en pediatría, su impacto en la Salud Pública.

Streptococcus pneumoniae (also known as pneumococcus) is part of the natural bacterial flora of the nasal and pharyngeal mucosa, colonizes mainly the nasopharynx, and causes this carriage to precede pneumococcal disease, thus becoming the main source of propagation among people, especially in children. Since 1983, when the first 23-component anti-pneumococcal vaccine was authorized, different conjugated vaccines have been developed according to the circulating serotypes that cause invasive pneumococcal diseases (IPD), reducing the incidence and mortality of these diseases considerably. In November 2021, a group of experts held a virtual meeting to update and analyze the impact that pneumococcal vaccines have generated on the countries' public health, especially during the COVID-19 pandemic. The recommendations that emerged included the need to look for alternatives in serotype-independent vaccines after the introduction of pneumococcal conjugate vaccines (PCV) in the national immunization schedules, as well as to strengthen the surveillance of serotypes, focusing on those not included in the current vaccines. The objective of this report is to communicate the conclusions of the group of experts that in November 2021 analyzed the impact of pneumococcal vaccines on public health in the countries, in order to generate recommendations applicable in Latin America.

Telerehabilitation in pediatric neurofunctional physical therapy during the COVID-19 pandemics: parent's perception, challenges and contributions / Telerreabilitação na fisioterapia neurofuncional pediátrica durante a pandemia de COVID-19: percepção dos pais, desafios e contribuições

INTRODUÇÃO: A telerreabilitação é uma modalidade de atendimento realizado à distância que foi considerada um recurso fundamental durante a pandemia da COVID-19. Entretanto, era uma modalidade ainda não vivenciada por muitos profissionais e familiares. OBJETIVO: Descrever a percepção dos pais ou responsáveis por crianças em tratamento fisioterapêutico, sobre os desafios e as contribuições da experiência com a telerreabilitação realizada em serviço ambulatorial durante a pandemia de COVID-19. MATERIAIS E MÉTODOS: Estudo observacional transversal exploratório, realizado com pais ou responsáveis por crianças, com idade entre 0 a 12 anos, com qualquer condição de saúde neurológica ou musculoesquelética em acompanhamento fisioterapêutico por telerreabilitação, no período de junho a agosto de 2021. Um questionário elaborado pelas autoras com perguntas sobre a percepção dos responsáveis, desafios e contribuições da telerreabilitação foi encaminhado para os responsáveis por meio de um link do Google Forms, via e-mail ou aplicativo de mensagem no celular, e foi auto aplicado. Realizaramse análises descritivas dos dados coletados por meio da frequência de respostas dos pais ou responsáveis nas questões específicas. As variáveis numéricas foram apresentadas como média ± desvio-padrão e as variáveis categóricas, como frequências absolutas e relativas. RESULTADOS: Dezoito responsáveis receberam e responderam o questionário completamente. A mãe foi a responsável mais citada, a maioria das crianças recebeu atendimento duas vezes na semana e o diagnóstico mais prevalente foi paralisia cerebral. Setenta e três por cento dos responsáveis avaliaram a telerreabilitação como acima do nível esperado e com contribuição além de suas expectativas. CONCLUSÃO: De acordo com a percepção dos pais, sobre os desafios e as contribuições da experiência com a telerreabilitação realizada em serviço ambulatorial, os benefícios parecem superar os desafios.

INTRODUCTION: Telerehabilitation is a modality of care provided remotely that was considered a fundamental resource during the COVID-19 pandemic. However, it was a modality not yet experienced by many professionals and family members. OBJECTIVE: To describe the perception of parents or guardians of children undergoing physical therapy, about the challenges and contributions of the experience with telerehabilitation performed in an outpatient service during the COVID-19 pandemics. MATERIAL AND METHODS: An exploratory crosssectional observational study carried out with parents or guardians of children, aged between 0 and 12 years old, with any neurological or musculoskeletal health condition in physiotherapeutic treatment by telerehabilitation, from June to August 2021. A questionnaire prepared by the authors with questions about the perception of those responsible, challenges and contributions of telerehabilitation was sent to those responsible through a Google Forms link, by email or mobile messaging app and was self-applied. Descriptive analysis of the data collected was carried out through the frequency of responses from parents or guardians on specific questions. Numerical variables were presented as mean ± standard deviation and categorical variables as absolute and relative frequencies. RESULTS: Eighteen guardians received and answered the questionnaire completely. The mother was the most cited guardian, most children received care twice a week and the most prevalent diagnosis was cerebral palsy. Seventythree percent of those responsible rated telerehabilitation as above the expected level and with a contribution beyond their expectations. According to them, the greatest contribution of telerehabilitation was the satisfactory motor development presented by the children during the period of social isolation. CONCLUSION: According to the parents' perception of the challenges and contributions of the experience with telerehabilitation performed in outpatient service, the benefits seem to outweigh the challenges.

Potential use of telemedicine in paediatrics: a single-centre retrospective review.

Recent advancements and adoption of telemedicine have affected all aspects of healthcare including paediatrics. While telemedicine has the potential to increase access to paediatric care, the limitations of this service in its current iteration bring into question its usefulness for direct replacement of in-person care, particularly in an acute or urgent care setting. This retrospective review demonstrates that only a small percentage of in-person visits to our practice would have resulted in definitive diagnosis and treatment if facilitated via telemedicine. There is a need for better and more widespread data collection techniques and tools suitable for paediatric remote care implementation before telemedicine becomes a useful diagnostic and treatment tool in an acute or urgent care setting.

How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency.

INTRODUCTION: The exponential growth of telehealth services during the COVID-19 pandemic led to the implementation of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a training aimed at remote care within the pediatric emergency rotation program. OBJECTIVE: To describe the implementation of a telemedicine training for pediatric residents and present the preliminary results. METHODS: Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception questionnaire at the end of the training. RESULTS: There was a significant difference in the resident's perception of experience and safety after initial training. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experience contributed to their learning on the subject. CONCLUSION: This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.

Pediatrics, Students, Allied Health and COVID-19.

This second issue of JORH for 2023 considers research relating to (1) pediatrics, (2) students, (3) various allied health professions and their related practices, and lastly, (4) COVID-19. An additional reminder is also provided to readers on the call for papers regarding a future issue on "Religion, Spirituality, Suicide, and its Prevention", as well as a new call for papers with respect to "Spiritual Care for People with Parkinson's Disease and their Caregivers".

COVID-19 Pandemic Impact on Pediatricians Entering the Pediatric Workforce.

OBJECTIVE: Determine extent of impact of coronavirus disease 2019 (COVID-19) pandemic on career choice and employment of pediatricians entering pediatric workforce. METHODS: A national, cross-sectional electronic survey of pediatricians registering for the 2021 American Board of Pediatrics initial general certifying examination on the impact of the COVID-19 pandemic on 3 aspects of career (career choice, employment search, employment offers) was performed. Data were analyzed using descriptive statistics and multivariate logistic regression to determine factors associated with the pandemic's impact on career. Thematic analysis was used to generate themes for open-ended survey questions. RESULTS: Over half (52.3%, 1767 of 3380) of pediatricians responded. Overall, 29.1% reported that the pandemic impacted their career (career choice [10.4%], employment search [15.6%], or employment offers [19.0%]); applicants to general pediatrics (GP) (52.9%) or pediatric hospitalist (PH) positions (49.3%) were most affected. Multivariate logistic regression modeling found those applying to GP (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 2.22-6.60), PH (OR: 9.02, 95% CI: 5.60-14.52), and International Medical Graduates (IMGs) (OR: 1.90; 95% CI: 1.39-2.59) most likely to experience any career impact. CONCLUSIONS: Almost one third of pediatricians registering for the initial general pediatrics certifying examination reported their careers were impacted by the COVID-19 pandemic, with 10% of respondents reporting the pandemic impacted their career choice. Half of new pediatricians seeking employment reported being impacted by the pandemic, particularly IMGs. As the pandemic evolves, career advising will continue to be critical to support trainees in their career choices and employment.

Patient and family perceptions of the provision of medicines as part of virtual outpatient consultations for children during COVID-19 pandemic.

OBJECTIVES: To evaluate (1) views and perceptions of patients/parents/carers and healthcare professionals on the medicines optimisation (MO) process following virtual outpatient clinic (VOC) during the COVID-19 pandemic and (2) the processes introduced at this time, identifying areas for improvements and suggest potential solutions. DESIGN: A mixed-methods service evaluation using qualitative and quantitative methods of the MO pathway in children aged 0-18 years following VOC across three specialist children's units.Semi-structured interviews were conducted over the telephone with the participants exploring their experiences and categorised into themes.Process mapping sessions with the multidisciplinary team identified areas for improvement and an ease impact framework developed for potential solutions.Outcome measures included: (1) themes from interviews, (2) patients satisfaction rates, (3) process maps and (4) development of a simplified future process. RESULTS: One hundred and twenty-five patients' families were contacted: 71 families consented to participate and their views were categorised into four main themes: (1) patient experience, (2) communication, (3) need for virtual video consultations for patient education by hospital pharmacists and (4) need for electronic processes to send prescriptions to local pharmacies.Median patient satisfaction rate was 96% (range 67%-100%). The convenience of receiving medications directly to patient's homes; access to medicines information helplines and education provided by pharmacists were regarded as valuable. Communication between care providers, development of virtual video consultations by hospital pharmacists and electronic transfer of some prescriptions directly to community pharmacies were identified as areas of improvement. CONCLUSIONS: Participants appreciated the pharmacy processes adopted during the pandemic, however, challenges and recommendations for improvement in delivering MO VOC were identified. As digital innovations evolve within the NHS, future research should focus on integrated care and improved communication between care providers with selected medications prescribed directly to community pharmacies using electronic prescription service, with clinical screening and education provided by hospital pharmacists.

Psychology and Developmental-Behavioral Pediatrics: Interprofessional Collaboration in Clinical Practice.

Providing high-quality clinical services to patients with neurodevelopmental disabilities (NDDs) requires interprofessional collaboration. This article highlights the importance of collaboration between psychology and developmental-behavioral pediatrics (DBP) to promote diagnosis, treatment recommendations, and integrated care for patients and their families. Interprofessional collaboration requires health care providers to work together toward solutions, including diagnosis, treatment recommendations, and ongoing care coordination. Case examples are presented to capture collaborative practice between psychology and DBP. Several established programs for providing interprofessional collaboration are highlighted, with noted benefits and barriers to collaborative care for NDD patients.