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.

Descriptive epidemiology of physical activity among Omani adults: the Oman World Health Survey, 2008.

There is an increasing burden of obesity and obesity-related noncommunicable diseases in Gulf Cooperation Council countries, including Oman. This descriptive, epidemiological study assessed physical activity among 2977 Omani adults using a population-based household survey in 2008. Overall, 54.2% of men and 41.6% of women were physically active; the rate was higher in younger cohorts and varied significantly by region of residence. Physical activity related to the transportation (walking and cycling) domain was higher than in the leisure or work domains. Unmarried men aged 30-39 years were twice as likely to be physically active (OR 2.25) and unmarried women aged 40+ years were half as likely to be active (OR 0.58) than their married counterparts. Young women not working were less active (OR 0.18) than working women. Higher education was significantly associated with leisure activity for men aged 30+ years and women aged 40+ years. Further research to understand regional variations and to identify culturally appropriate strategies to promote physical activity is required.

Descriptive epidemiology of physical activity among Omani adults:the Oman World Health Survey, 2008

هناك تزايد في عبء السمنه والامراض غير الساريه المرتبطة بالسمنه في بلدان مجلس التعاون الخليجي بما فيها سلطنه عمان وقد قيمت هذه الدراسة الوبائيه الوصفيه النشاط البدني لدى 2977 بالغا عمانيا باستخدام مسح اسري سكاني في عام 2008 فكان بالاجمال 54.2% من الرجال و 41.6% من النساء نشيطين بدنيا وكان المعدل أعلى لدى الفئات الاصغر سنا وشديد التباين باختلاف منطقة الاقامه وكان النشاط البدني المرتبط بمجال المواصلات ( المشي وركوب الدراجات ) اعلى من النشاط الذي يبذل في مجالات الترفيه او العمل وكان النشاط البدني لدي الرجال غير المتزوجين ممن هم باعمار 39-30 عاما ضعف نشاط نظرائهم المتزوجين OR=2.25 ولدي النساء غير المتزوجات اللواتي تجاوزن الـ 40 سنه نصف نشاط نظيراتهن المتزوجات OR=0.58 وكانت الشابات اللواتي لايعملن اقل نشاطا OR=0.18 من النساء العاملات وكان هناك ارتباط كبير بين التعليم العالي وبين النشاط الترفيهي لدى الرجال الذين تزيد اعمارهم عن 30 سنه والنساء اللواتي تجاوزن الـ 40 سنه هناك حاجة الى مزيد من البحوث لفهم التباينات الاقليميه ولتحديد استراتيجيات ملائمه ثقافيا لتعزيز النشاط البدني

There is an increasing burden of obesity and obesity-related noncommunicable diseases in Gulf Cooperation Council countries, including Oman. This descriptive, epidemiological study assessed physical activity among 2977 Omani adults using a population-based household survey in 2008. Overall, 54.2% of men and41.6% of women were physically active; the rate was higher in younger cohorts and varied significantly by region of residence. Physical activity related to the transportation (walking and cycling) domain was higher than in the leisure or work domains. Unmarried men aged 30–39 years were twice as likely to be physically active (OR 2.25) and unmarried women aged 40+ years were half as likely to be active (OR 0.58) than their married counterparts. Young women not working were less active (OR 0.18) than working women. Higher education was significantlyassociated with leisure activity for men aged 30+ years and women aged 40+ years. Further research to understand regional variations and to identify culturally appropriate strategies to promote physical activity is required.

Le fardeau de l’obésité et des maladies non transmissibles liées à l’obésité est en augmentation dans les pays du Conseil de Coopération du Golfe, notamment à Oman. La présente étude épidémiologique descriptive a évalué l’activité physique de 2977 adultes omanais à l’aide d’une enquête de population auprès des ménagesen 2008. Globalement, 54,2 % des hommes et 41,6 % des femmes avaient une activité physique ; le taux était supérieur dans les cohortes plus jeunes et variait significativement en fonction de la région de résidence. L’activité physique liée aux déplacements (marche et vélo) était plus fréquente que l’activité physique professionnelle ou de loisir. Les hommes célibataires entre 30 et 39 ans étaient deux fois plus susceptibles d’être physiquement actifs (OR 2,25) alors que les femmes célibataires âgées de plus de 40 ans étaient deux fois moins actives (OR0,58) que les femmes mariées. Les femmes jeunes sans emploi étaient moins actives physiquement (OR 0,18) que les femmes occupant un emploi. Un niveau d’études supérieur était nettement associé à une activité physique de loisir chez les hommes de plus de 30 ans et les femmes de plus de 40 ans. Des recherches plus approfondies pour comprendre les variations régionales et identifier des stratégies culturellement appropriées visant à promouvoir l’activité physique sont nécessaires.

Gender differences in prevalence of the metabolic syndrome in Gulf Cooperation Council Countries: a systematic review.

AIMS: To systematically review studies documenting the prevalence of the metabolic syndrome among men and women in Member States of the Gulf Cooperative Council (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates)-countries in which obesity, Type 2 diabetes and related metabolic and cardiovascular diseases are highly prevalent. METHODS: A search was conducted on PubMed and CINAHL using the term 'metabolic syndrome' and the country name of each GCC Member State. The search was limited to studies published in the English language. The metabolic syndrome was defined according to the Third Adult Treatment Panel (ATPIII) of the National Cholesterol Education Program (NCEP) and/or International Diabetes Federation (IDF) definitions. The methodological quality of each study was evaluated based on four criteria: a national-level population sample; equal gender representation; robustness of the sample size; an explicit sampling methodology. RESULTS: PubMed, CINAHL and reference list searches identified nine relevant studies. Only four were considered high quality and found that, for men, the prevalence of the metabolic syndrome ranged from 20.7% to 37.2% (ATPIII definition) and from 29.6% to 36.2% (IDF definition); and, for women, from 32.1% to 42.7% (ATPIII definition) and from 36.1% to 45.9% (IDF definition). CONCLUSIONS: Overall, the prevalence of the metabolic syndrome in the GCC states is some 10-15% higher than in most developed countries, with generally higher prevalence rates for women. Preventive strategies will require identifying socio-demographic and environmental correlates (particularly those influencing women) and addressing modifiable risk behaviours, including lack of physical activity, prolonged sitting time and dietary intake.

Evidence of physical activity participation among men and women in the countries of the Gulf cooperation council: a review.

Rapid socioeconomic development in the countries of the Gulf Cooperation Council (GCC) has resulted in demographic and epidemiological transitions, with obesity, diabetes and other chronic diseases becoming the leading causes of morbidity and mortality. This emerging disease pattern is often attributed to physically inactive lifestyles. Given that there is no consolidated evidence on physical activity participation, we reviewed studies to examine prevalence and gender differences among GCC adults. PubMed, CINAHL and reference list searches identified eight relevant studies. Based on the best-available data, the prevalence of adults being physically active for at least 150 min week(-1) (based on the international standard definition) ranged from 39.0% to 42.1% for men and 26.3% to 28.4% for women. Men were significantly more active than were women. Prevalence estimates for participation in physical activity in the GCC States are considerably lower than those for many developed countries. Studies using standardized methodologies with nationally representative samples are urgently required. Identifying prevalence and gender variations provides the basis for understanding the unique socio-cultural and environmental factors contributing to physical inactivity among adults in the countries of the GCC. This understanding must then inform population-health strategies to address the rising prevalence of obesity, type 2 diabetes and other chronic diseases.

Active trachoma, face washing (F) and environmental improvement (E) in a high-risk population in Oman.

Oman aims to eliminate blinding trachoma by 2010. As a part of a study to review the health institution approach of trachoma surveillance, "F" (facial cleanliness) and "E" (environmental improvement) components of the SAFE trachoma control strategy were assessed in a high-risk population in Nizwa wilayat. Thus 50 households with 1 member treated for active trachoma in the last 6 months were evaluated for active trachoma and forwater and sanitation facilities. In all, 229 children under 15 years of age were clinically examined; the rate of active trachoma was 3.5% in the children. Clean face was found in 97.8% of the children and 70% of houses had piped water or water supplied by tankers. The status of "F" and "E" in the study area was generally high.

Active trachoma, face washing [F] and environmental improvement [E] in a high-risk population in Oman

Oman aims to eliminate blinding trachoma by 2010. As a part of a study to review the health institution approach of trachoma surveillance, "F" [facial cleanliness] and "E" [environmental improvement] components of the SAFE trachoma control strategy were assessed in a high-risk population in Nizwa wilayat. Thus 50 households with 1 member treated for active trachoma in the last 6 months were evaluated for active trachoma and for water and sanitation facilities. In all, 229 children under 15 years of age were clinically examined; the rate of active trachoma was 3.5% in the children. Clean face was found in 97.8% of the children and 70% of houses had piped water or water supplied by tankers. The status of "F" and "E" in the study area was generally high

Socioeconomic predictors of unconstrained child growth in Muscat, Oman.

We conducted a study to identify socioeconomic factors associated with unconstrained growth among preschoolers in Muscat, Oman. A sample of children born in 1995 and aged 28-43 months was drawn from the Child Health Registers of 2 health care centres. Sociodemographic data were collected by oral interview and maternal and child anthropometry measured. Regression analysis was used to identify socioeconomic indicators and cut-offs associated with unconstrained growth. Children from households with a monthly income > or = 800 Omani rials and mother's education > or = 4 years attained height-for-age levels comparable to the current international growth reference. By screening using this criterion, we could obtain a suitable sample for the World Health Organization Multicentre Growth Reference Study in Muscat.

Socioeconomic predictors of unconstrained child growth in Muscat, Oman

We conducted a study to identify socioeconomic factors associated with unconstrained growth among preschoolers in Muscat, Oman. A sample of children born in 1995 and aged 28-43 months was drawn from the Child Health Registers of 2 health care centres. Sociodemographic data were collected by oral interview and maternal and child anthropometry measured. Regression analysis was used to identify socioeconomic indicators and cut-offs associated with unconstrained growth. Children from households with a monthly income > or = 800 Omani rials and mother's education > or = 4 years attained height-for-age levels comparable to the current international growth reference. By screening using this criterion, we could obtain a suitable sample for the World Health Organization Multicentre Growth Reference Study in Muscat

Use of immunotherapy in previously treated patients with allergic fungal sinusitis.

OBJECTIVE: Sixty patients with a diagnosis of allergic fungal sinusitis were studied. The objective was to show whether, after initial surgical removal of allergic mucin and polyps, immunotherapy decreases re-operation rates and office visits that require medical intervention. STUDY DESIGN AND SETTING: Sixty patients with adequate follow-up for at least 1 year were evaluated: 24 patients who did not receive immunotherapy and 36 patients whose treatment included postoperative immunotherapy. RESULTS: The re-operation rates were 33.0% in those not receiving immunotherapy versus 11.1% in the treated group. Furthermore, the total number of postoperative office visits that required medical therapy decreased from 4.79 per patient to 3.17 with the addition of immunotherapy. CONCLUSION/SIGNIFICANCE: These results indicate that immunotherapy is a beneficial part of the overall treatment regimen for allergic fungal sinusitis.

Inhalant allergy and Meniere's disease: Use of electrocochleography and intranasal allergen challenge as investigational tools.

INTRODUCTION: In an earlier study, we demonstrated the feasibility of using electrocochleography (ECoG) to document changes in inner ear function objectively after intranasal challenge of patients with inhalant allergy (with no prior immunotherapy) and Meniere's disease, using the antigen to which they were most sensitive. OBJECTIVE: We expand on this earlier study and continue to investigate the feasibility of this model in a subset of patients with inhalant allergy and Meniere's disease after immunotherapy. STUDY DESIGN: Prospective study of 11 patients identified with both Meniere's disease and inhalant allergy in the practices of 2 neurotologists at our institution. Patients underwent a baseline ECoG, followed by intranasal challenge with the allergen to which they were most sensitive. This was followed by a second ECoG. RESULTS: Six of 11 patients had at least 1 year of immunotherapy (group 1), and 5 of 11 had had 0 to 6 months of immunotherapy (group 2). Four of 6 group 1 patients had a >15% increase in SP/AP ratio after immunotherapy. In group 2, 2 patients increased the SP/AP in at least 1 ear. No patient with a normal ECoG experienced vestibular symptoms after allergen challenge, whereas 2 of group 1 and 2 of group 2 had vestibular symptoms with abnormal ECoGs. CONCLUSION: This protocol is a useful tool for investigating the relationship of inhalant allergy and Meniere's disease, but needs a larger group of patients and further study to draw valid statistical conclusions.

United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield.

BACKGROUND: This study was undertaken to determined the differences in injury patterns between soldiers equipped with modern body armor in an urban environment compared with the soldiers of the Vietnam War. METHODS: From July 1998 to March 1999, data were collected for a retrospective analysis on all combat casualties sustained by United States military forces in Mogadishu, Somalia, on October 3 and 4, 1993. This was the largest and most recent urban battle involving United States ground forces since the Vietnam War. RESULTS: There were 125 combat casualties. Casualty distribution was similar to that of Vietnam; 11% died on the battlefield, 3% died after reaching a medical facility, 47% were evacuated, and 39% returned to duty. The incidence of bullet wounds in Somalia was higher than in Vietnam (55% vs. 30%), whereas there were fewer fragment injuries (31% vs. 48%). Blunt injury (12%) and burns (2%) caused the remaining injuries in Somalia. Fatal penetrating injuries in Somalia compared with Vietnam included wounds to the head and face (36% vs. 35%), neck (7% vs. 8%), thorax (14% vs. 39%), abdomen (14% vs. 7%), thoracoabdominal (7% vs. 2%), pelvis (14% vs. 2%), and extremities (7% vs. 7%). No missiles penetrated the solid armor plate protecting the combatants' anterior chests and upper abdomens. Most fatal penetrating injuries were caused by missiles entering through areas not protected by body armor, such as the face, neck, pelvis, and groin. Three patients with penetrating abdominal wounds died from exsanguination, and two of these three died after damage-control procedures. CONCLUSION: The incidence of fatal head wounds was similar to that in Vietnam in spite of modern Kevlar helmets. Body armor reduced the number of fatal penetrating chest injuries. Penetrating wounds to the unprotected face, groin, and pelvis caused significant mortality. These data may be used to design improved body armor.

Allergic fungal sinusitis: learning from our failures.

For more than five years, patients referred to the Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern Medical Center at Dallas with allergic fungal sinusitis (AFS) have been managed using a regimen combining surgery, perioperative corticosteroids, and immunotherapy for relevant antigens (fungal and non-fungal). The initial success of this program has been previously reported. Continued experience with this treatment plan, however, has yielded some cases of recurrence of AFS. Careful review of these cases implicate two major factors associated with treatment failure: (1) lack of compliance with immunotherapy, and (2) inadequate initial surgical extirpation of all allergic mucin. These cases and associated factors will be discussed.

Allergic fungal sinusitis: the role of immunotherapy.

The role of surgery and anti-inflammatory therapy (such as corticosteroids) in the management of allergic fungal sinusitis is accepted fairly universally. Although once thought to be contraindicated in the treatment of allergic fungal sinusitis, specific immunotherapy with fungal antigens has been shown to be extremely beneficial to these patients, when combined with surgery and adjunctive medical management. Recurrences have been prevented and systemic corticosteroid requirements virtually eliminated in an experience that now spans over 4 years.

Outcomes after discontinuing immunotherapy for allergic fungal sinusitis.

Although the treatment of allergic fungal sinusitis with specific immunotherapy after surgical intervention has proved successful, the question of what happens when such injections are discontinued remains unanswered. In this initial, admittedly small series, no recurrence has been noted in follow-up of 7 to 17 months.

Mold testing by RAST and skin test methods in patients with allergic fungal sinusitis.

RAST tests have traditionally been considered less sensitive than skin tests during investigation of atopy involving molds. This has been attributed to technical problems such as difficulty in binding the mold antigen to the carrier substrate. Ten patients with proven allergic fungal sinusitis were evaluated for sensitivity to 11 important molds by both RAST and dilutional intradermal testing. A predictable correlation between RAST and skin test scores was observed in many, but not all, cases. Most often this disparity was in the form of greater sensitivity indicated by skin testing than by RAST, sometimes differing by as many as 3 classes. The lack of concordance was not confined to testing for the fungi cultured from the sinuses, nor was it more or less pronounced in the case of dematiaceous fungi. The most likely causes for the disparity noted in this series are subtle differences in antigens used in skin test material and for RAST standards. Skin tests allow for evaluation of delayed and late-phase reactions, a measurement not possible by specific IgE testing with RAST. Delayed skin test reactions were not noted in this series of patients. An additional important finding was the sensitivity of patients with allergic fungal sinusitis to virtually every fungal antigen to which they were tested.

Electrocochleographic changes after intranasal allergen challenge: A possible diagnostic tool in patients with Meniere's disease.

Numerous observers have suggested a relationship between allergy and Meniere's disease, but objective proof has heretofore been limited. Using standard criteria, we studied a group of 7 patients with previously diagnosed Meniere's disease in whom significant allergy to 1 or more inhalants had also been diagnosed. Patients underwent a baseline electrocochleographic study followed by intranasal challenge with a carefully quantified amount of the allergen to which they were most sensitive. This was followed by a second electrocochleogram. Four of the 7 patients demonstrated at least a 15% increase in the summating potential/action potential ratio in 1 ear, associated with the production of subjective inner ear symptoms. We present this protocol as a potentially useful tool to further study whether inhalant allergy may be a causative factor in patients with Meniere's disease.

Allergic fungal sinusitis-induced visual loss.

In this report we review 56 adult and 26 pediatric patients who presented to our practice with pathologically confirmed allergic fungal sinusitis from 1989 to 1997. Of this group, three patients presented with visual loss and were treated with prompt surgical decompression followed by immunomodulation.