Crisis leadership: a case for inclusion in accredited Master of Public Health program curricula.

OBJECTIVES: To evaluate the exposure to crisis leadership theory already present in Council on Education for Public Health (CEPH) accredited Master of Public Health (MPH) programs in the United States and provide a compelling case for its future inclusion. STUDY DESIGN: This was a narrative review. METHODS: We compiled a comprehensive list of 179 CEPH schools that offered an MPH program. During January through March 2021, we examined 179 websites for the core courses and elective courses offered in the MPH degree program to determine if any courses covered the topics of leadership, crisis leadership, or crisis management in either the course title or description. RESULTS: Leadership courses were available in only 55.31% of CEPH-accredited schools. Only a single program (0.56%) offers a crisis leadership course. CONCLUSIONS: The current global COVID-19 pandemic and reality of climate-induced disasters have brought crises to the forefront for health systems. Successful leadership for the future requires public health leaders to have training in crisis leadership. The evaluation and revision of public health curricula must focus on leadership competency development to prepare graduates to lead complex multiple crisis events and system shocks simultaneously.

Correlation between Serum Vitamin D and Calcium Levels in Missed Miscarriage.

Pregnancy is considered physiological stress, during which a woman's normal static metabolism becomes dynamic anabolism and significant changes are observed in biochemical factors. This study aimed to assess the relationship of serum vitamin D and calcium levels in a pregnant woman with a missed miscarriage. A comparison was performed among 160 women, including 80 females with missed miscarriage (as the study group) and 80 pregnant women (as the control group) in the first and second trimester of pregnancy (before the end of the 24th week of the pregnancy). The results of the comparison showed that there was an insignificant change in serum calcium, while there was a significant reduction in serum vitamin D (P≤0.05). It was also revealed that, in comparison to normal controls, there was a significant increase in the ratio of serum calcium/vitamin D ratio in cases of missed miscarriage (P≤0.05). Based on the results of the study, it can be concluded that the estimations of serum vitamin D and calcium/vitamin D ratio in certain pregnancies can be considered valuable parameters in predicting missed miscarriage.

Knowledge, attitude, perception and practice regarding antimicrobial use in upper respiratory tract infections in Qatar: a systematic review.

OBJECTIVE: To explore the knowledge, attitude, perception and practice towards antimicrobial use in upper respiratory tract infections in patients visiting healthcare settings in Qatar. DESIGN: Systematic review was performed using a predetermined protocol and in accordance with standardized reporting guidelines. MEDLINE, PubMed, EMBASE, Global Health and PsycINFO were searched for relevant published studies using relevant MESH terms and keywords. SETTING: All healthcare settings in Qatar including both inpatient and ambulatory care. PARTICIPANTS: All published articles exploring the antimicrobial use in upper respiratory tract infections at any health setting in Qatar were considered for inclusion in the study. No age, gender or population were excluded. MAIN OUTCOME MEASURES: The outcome of interest was antimicrobial use in upper respiratory tract infections in Qatar. We included all related studies to explore the knowledge, attitude, perception and practice for patients visiting all health care settings. RESULTS: Three articles were included, one in a primary care setting, one in a secondary care setting and one in the private sector. Overprescribing was noted in all settings. Our findings demonstrate low expectations to receive antibiotics, among the Qatari population, in primary care (28.1%). In fact, the majority of patients would be satisfied with reassurance rather than receiving antimicrobials. Many patients were satisfied with explanation from physicians and counselling. Private sector registered high prevalence of antimicrobial misuse for respiratory tract infections in which 85% deemed inappropriate. This finding was also noted at a medical intensive care unit which showed high antimicrobial use (76%) and respiratory tract infections accounted for 57% of prescriptions. CONCLUSION: Studies are needed to determine factors and population-based rates of antimicrobial use in all healthcare settings. There is also a need for interventional programs for both physicians and public on appropriate use of antimicrobials to combat global antimicrobial resistance.

Factors influencing the tobacco control policy process in Egypt and Iran: a scoping review.

INTRODUCTION: Tobacco control policy is essential for addressing the growing tobacco consumption seen in the Eastern Mediterranean Region, the single greatest preventable contributor to the non-communicable disease epidemic. Egypt and Iran have had varied success in using policy to combat this issue. The study aims to identify and compare the factors which have influenced different stages of the policy process - evidence generation, development and implementation. METHODS: A scoping review was conducted with a systematic search of 7 databases which was conducted along with searches of Google Scholar, and the World Health Organisation and Eastern Mediterranean Regional Office websites to identify influencing factors at each stage of the policy process. RESULTS: Twenty-seven relevant articles were identified from the literature search. Factors identified as influencing tobacco control policy in these countries were lobbying by the tobacco industry, the rise of water-pipe smoking, lack of political commitment and the lack of resources to for policy implementation. Iran was found to be leading Egypt on all three areas of the policy process. Implementation was found to be the most pivotal part of the policy process and the area in which Egypt was weakest compared to Iran. CONCLUSION: This study addresses a gap in knowledge concerning tobacco control in the Middle East and has identified multiple factors which are potentially slowing the process of enforcing policy to address tobacco consumption. Iran is the regional leader for tobacco control and it is important for Egypt to assess the transferability of its tactics and immediately start implementing measures to control tobacco use.

Tobacco control efforts in the Gulf Cooperation Council countries: achievements and challenges.

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council (GCC) member states and Yemen. It further reviews structured policy-oriented interventions (in line with the MPOWER package of 6 evidence-based tobacco control measures) that represent government actions to strengthen, implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witnessed real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally available tobacco cessation services are essential to sustain and strengthen tobacco control in the GCC region.

Living conditions in Iraq: 10 years after the US-led invasion.

In the early 1980s, Iraq was a middle-income and rapidly developing country with a well-developed health system. A few decades later - after wars, sanctions and a violent sectarian upsurge - child and maternal health indicators have deteriorated, its poverty headcount index is at 22.9% and diseases such as cholera have remerged. Today Iraq is beset by chronic political deadlock and a complexity of economic challenges; accordingly, all aspects of life are suffering, including health. Irrespective of the monumental investment to improve components of the health system, via national and international efforts, the health status of the population can only advance through resounding and synergistic effort in other aspects of life affecting health: the social determinants of health.

Tobacco control efforts in the Gulf Cooperation Council countries: achievements and challenges

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council [GCC] member states and Yemen. It further reviews structured policy-oriented interventions [in line with the MPOWER package of 6 evidence-based tobacco control measures] that represent government actions to strengthen,implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witnessed real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally available tobacco cessation services are essential to sustain and strengthen tobacco control in the GCC region

Le présent article expose un état des lieux de la consommation de tabac, de la gouvernance, de l'engagement national dans la lutte antitabac, et les cadres d'intervention actuellement en place destinés à réduire la consommation de tabac dans les populations des Etats membres du Conseil de Coopération du Golfe et du Yémen. II examine également les interventions structurées pour l'élaboration de politiques [conformément au programme MPOWER qui est compose de six mesures de lutte antitabac fondées sur des données probantes] qui représentent des actions gouvernementales destinées à renforcer, mettre en oeuvre et gérer des programmes de lutte antitabac et à s'attaquer à l'épidémie croissante de tabagisme. Nos résultats révèlent que la lutte antitabac dans les pays membres du Conseil de Coopération du Golfe a réalisé des progrès tangibles au cours des dernières décennies. Toutefois, il ne s'agit que d'un début montrant la voie à suivre. De nouveaux investissements dans la mise en oeuvre et l'application de la Convention-cadre pour la lutte antitabac, la proposition d'une législation antitabac solide et l'offre de services de sevrage tabagique d'accès universel sont essentiels pour appuyer et renforcer la lutte antitabac dans la région du Conseil de Coopération du Golfe

Assessing the state of health research in the Eastern Mediterranean Region.

Member states across the Eastern Mediterranean region face unprecedented health challenges, buffeted by demographic change, a dual disease burden, rising health costs, and the effects of ongoing conflict and population movements - exacerbated in the near-term by instability arising from recent political upheaval in the Middle East. However, health actors in the region are not well positioned to respond to these challenges because of a dearth of good quality health research. This review presents an assessment of the current state of health research systems across the Eastern Mediterranean based on publicly available literature and data sources. The review finds that - while there have been important improvements in productivity in the Region since the early 1990s - overall research performance is poor with critical deficits in system stewardship, research training and human resource development, and basic data surveillance. Translation of research into policy and practice is hampered by weak institutional and financial incentives, and concerns over the political sensitivity of findings. These problems are attributable primarily to chronic under-investment - both financial and political - in Research and Development systems. This review identifies key areas for a regional strategy and how to address challenges, including increased funding, research capacity-building, reform of governance arrangements and sustained political investment in research support. A central finding is that the poverty of publicly available data on research systems makes meaningful cross-comparisons of performance within the EMR difficult. We therefore conclude by calling for work to improve understanding of health research systems across the region as a matter of urgency.

Diabetes or war? Incidence of and indications for limb amputation in Lebanon, 2007.

Chronic diseases such as diabetes and vascular disease are a major public health problem in Lebanon, where primary care is not well developed. This study aimed to describe the incidence and indications for limb amputation in Lebanon and identify associated factors (age, sex, level of surgery, length of hospital stay). There were 1.6 amputations per 10 000 persons. The rate of amputation was highest in southern Lebanon at 3.8 per 10 000. The most important indication for surgery was diabetes (59%). Diabetic patients were older (mean age 73 years versus 30 years), more likely to have major surgery (OR = 7.87; 95% CI: 2.83-21.9) and stay in hospital longer (RR = 4.56, 95% CI: 2.41-8.64) than patients with trauma-related amputation. Diabetes prevention, detection and management should be prioritized in any attempt to reduce the current incidence of amputation in Lebanon.

Diabetes or war? Incidence of and indications for limb amputation in Lebanon, 2007

Chronic diseases such as diabetes and vascular disease are a major public health problem in Lebanon, where primary care is not well developed. This study aimed to describe the incidence and indications for limb amputation in Lebanon and identify associated factors [age, sex, level of surgery, length of hospital stay]. There were 1.6 amputations per 10 000 persons. The rate of amputation was highest in southern Lebanon at 3.8 per 10 000. The most important indication for surgery was diabetes [59%]. Diabetic patients were older [mean age 73 years versus 30 years], more likely to have major surgery [OR = 7.87; 95% CI: 2.83-21.9] and stay in hospital longer [RR = 4.56, 95% CI: 2.41-8.64] than patients with trauma-related amputation. Diabetes prevention, detection and management should be prioritized in any attempt to reduce the current incidence of amputation in Lebanon

Ethnic and gender differences in drinking and smoking among London adolescents.

OBJECTIVES: The study examines stages of drinking and smoking careers and transitions from initiation to regular use among adolescents, as a function of ethnic status and gender. DESIGN: The data were collected using a confidential, self-completion questionnaire assessing onset and frequency of drinking and smoking. The sample consisted of 1777 adolescents, between the ages of 11 and 14, drawn from eight secondary schools in south-west London. RESULTS: For both smoking and drinking, white children were more likely to have ever smoked tobacco and drunk alcohol, and were also more likely to progress from initiation to regular use than were either black or Asian children. Asian children reported the latest onset and the lowest prevalence rates for both drinking and smoking. Males reported experimenting with both cigarettes and alcohol at an earlier age than females, although a lower proportion of males report regular and lifetime involvement with both alcohol and tobacco. Furthermore, a significantly higher proportion of females who try smoking go on to do so regularly. DISCUSSION: The importance of sociocultural factors in relation to race and gender in predicting onset and escalation of substance use is discussed. The fact that age of onset does not appear to be a significant determinant of transition rate from initiation to regular use is also explored.

Drinking and smoking as concurrent predictors of illicit drug use and positive drug attitudes in adolescents.

The study investigates the relationship between smoking and drinking, and the use of illicit drugs in a cohort of London adolescents. A high prevalence of drug experimentation and positive attitudes to illicit drug use were characteristic of those who both drank alcohol and smoked cigarettes on a regular basis. There was then a clear hierarchy in which lower prevalence of use and more negative attitudes marked those who only smoked, then those who only drank, while non-smokers and non-drinkers (the largest group) had lowest lifetime and recent drug use prevalence and the most negative attitudes about drug use.

Extracontractual referrals in first three months of NHS reforms.

OBJECTIVE: To describe the extracontractual referrals of residents of Merton and Sutton Health Authority during the first three months of the NHS reforms in terms of the nature of the referral (elective or emergency), the specialty referred to, and the source of and reason for referral. DESIGN: Descriptive analysis of all extracontractual referrals submitted to the health authority between 1 April and 30 June 1991. SETTING: Merton and Sutton Health Authority. RESULTS: 247 extracontractual referrals were notified to Merton and Sutton Health Authority; 83 invoices for emergency treatment and 109 elective referrals were authorised at a total cost of 190,000 pounds. Of the elective referrals, 59 were to ear, nose, and throat; orthopaedic; or general surgery departments. Local general practitioners made only two thirds of the elective referrals, at least 15 of which were made at the patient's request. Four admissions accounted for a quarter of the total cost of the emergency admissions. CONCLUSIONS: Extracontractual referrals are unpredictable in terms of both their number and their cost. They provide a necessary safeguard for patient and general practitioner choice at the price of a considerable administrative workload. The fact that these referrals are income generating for providers means that additional safeguards may be necessary to prevent abuse of the system.

Large outbreaks of Clostridium perfringens food poisoning associated with the consumption of boiled salmon.

Five large outbreaks of food poisoning are described in which clinical, epidemiological or laboratory data indicated Clostridium perfringens as the causative organism. The foodstuff common to all incidents was boiled salmon served cold as an hors d 'oeuvre. In all cases the fish had been subject to a long period of cooling or storage between boiling and consumption. It is thought that multiplication of the organism occurred during this time. Recommendations are made for the avoidance of further similar incidents.