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Utheim MN, Gawad M, Nygård K, Macdonald E, Falk M. Assessing public health preparedness and response in the European Union- a review of regional simulation exercises and after action reviews. Global Health 2023; 19:79. [PMID: 37898790 PMCID: PMC10612297 DOI: 10.1186/s12992-023-00977-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/28/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Improving response capacities in the EU requires a good overview of capacities at both country and Union level. The International Health Regulations (2005) Monitoring and Evaluation framework assesses capacities in countries. It includes semi-quantitative tools such as State Parties Annual Report (SPAR) and Joint External Evaluation (JEE). After Action Reviews (AAR) and Simulation Exercises (SimEx) were included to identify weaknesses in the functionality of capacities which are not addressed bySPAR and JEE. This study presents an analysis of the use of qualitative tools at regional level, in Europe. It aims to identify their added value by comparing them to standardised monitoring tools and lessons learned from COVID-19, and considers ways to improve their use in assessing capacities in the EU. METHODS We included 17 SimEx and 2 AAR organised by the European Commission between 2005 and 2018. We categorised a total of 357 recommendations according to the IHR (2005) core capacities and to the target audience of the recommendation. We analysed the data using language analysis software. Recommendations to countries were compared to SPAR and JEE indicators. Recommendations to EU agencies were compared to the current mandates of the EU agencies, and to lessons learnt during COVID-19. RESULTS Of all extracted recommendations from the exercises, 59% (211/357) targeted EU agencies, 18% (64/357) targeted countries, and 16% (57/357) targeted both. Recommendations mainly addressed areas of IHR coordination (C2), heath emergency management (C7) and risk communication (C10), and not low scoring areas. Recommendations complement SPAR indicators by identifying gaps in functionality. Eight out of ten early lessons learnt during the COVID-19 pandemic had been raised earlier as recommendations from exercises. Exercise reports did not include or result in action plans for implementation, but COVID-19 has accelerated implementation of some recommendations. CONCLUSION SimEx/AAR provide valuable insight into public health preparedness at EU level, as they assess functionality of preparedness and response mechanisms, point out gaps, and provide training and awareness on for participants, who often have key roles in public health emergencies. Better follow-up and implementation of recommendations is key to improve the regional preparedness for international public health incidents such as pandemics.
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Affiliation(s)
- Mari Nythun Utheim
- Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, 0213, Norway.
| | - Mohamed Gawad
- Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, 0213, Norway
| | - Karin Nygård
- Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, 0213, Norway
| | - Emily Macdonald
- Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, 0213, Norway
| | - Monica Falk
- Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, 0213, Norway
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Marziano V, Guzzetta G, Menegale F, Sacco C, Petrone D, Mateo Urdiales A, Del Manso M, Bella A, Fabiani M, Vescio MF, Riccardo F, Poletti P, Manica M, Zardini A, d'Andrea V, Trentini F, Stefanelli P, Rezza G, Palamara AT, Brusaferro S, Ajelli M, Pezzotti P, Merler S. Estimating SARS-CoV-2 infections and associated changes in COVID-19 severity and fatality. Influenza Other Respir Viruses 2023; 17:e13181. [PMID: 37599801 PMCID: PMC10432583 DOI: 10.1111/irv.13181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background The difficulty in identifying SARS-CoV-2 infections has not only been the major obstacle to control the COVID-19 pandemic but also to quantify changes in the proportion of infections resulting in hospitalization, intensive care unit (ICU) admission, or death. Methods We developed a model of SARS-CoV-2 transmission and vaccination informed by official estimates of the time-varying reproduction number to estimate infections that occurred in Italy between February 2020 and 2022. Model outcomes were compared with the Italian National surveillance data to estimate changes in the SARS-CoV-2 infection ascertainment ratio (IAR), infection hospitalization ratio (IHR), infection ICU ratio (IIR), and infection fatality ratio (IFR) in five different sub-periods associated with the dominance of the ancestral lineages and Alpha, Delta, and Omicron BA.1 variants. Results We estimate that, over the first 2 years of pandemic, the IAR ranged between 15% and 40% (range of 95%CI: 11%-61%), with a peak value in the second half of 2020. The IHR, IIR, and IFR consistently decreased throughout the pandemic with 22-44-fold reductions between the initial phase and the Omicron period. At the end of the study period, we estimate an IHR of 0.24% (95%CI: 0.17-0.36), IIR of 0.015% (95%CI: 0.011-0.023), and IFR of 0.05% (95%CI: 0.04-0.08). Conclusions Since 2021, changes in the dominant SARS-CoV-2 variant, vaccination rollout, and the shift of infection to younger ages have reduced SARS-CoV-2 infection ascertainment. The same factors, combined with the improvement of patient management and care, contributed to a massive reduction in the severity and fatality of COVID-19.
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Affiliation(s)
| | - Giorgio Guzzetta
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Francesco Menegale
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
- Department of MathematicsUniversity of TrentoTrentoItaly
| | - Chiara Sacco
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Daniele Petrone
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | | | - Martina Del Manso
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Antonino Bella
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Massimo Fabiani
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | | | - Flavia Riccardo
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Piero Poletti
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Mattia Manica
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Agnese Zardini
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Valeria d'Andrea
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Filippo Trentini
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
- Dondena Centre for Research on Social Dynamics and Public PolicyBocconi UniversityMilanItaly
- COVID Crisis LabBocconi UniversityMilanItaly
| | - Paola Stefanelli
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Giovanni Rezza
- Health Prevention directorateMinistry of HealthRomeItaly
| | | | - Silvio Brusaferro
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and BiostatisticsIndiana University School of Public HealthBloomingtonIndianaUSA
| | - Patrizio Pezzotti
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Stefano Merler
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
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3
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Mantri N, Joshi NK, Bhardwaj P, Goel AD, Gupta MK, Singh K, Misra S. Barriers and facilitators to COVID-19 screening at Jaipur International Airport, India. J Family Med Prim Care 2022; 11:5969-5982. [PMID: 36618255 PMCID: PMC9810875 DOI: 10.4103/jfmpc.jfmpc_427_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/19/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022] Open
Abstract
Background Airports pose a possible threat in facilitating global disease transmission within the community which may be prevented by rigorous systematic entry-exit screening. This study captures the perception of stakeholders on barriers and facilitators of coronavirus disease 2019 (COVID-19) screening. Further, key outcomes viz. total passengers screened, suspected cases, and confirmed cases were assessed. Methods An inductive-deductive mix-method thematic analysis was conducted to capture qualitative data of key stakeholders on COVID-19 disease screening at Jaipur International Airport. Additionally, secondary data retrieved from Rajasthan Medical & Health Department team deployed for COVID-19 airport screening were analyzed. Results Jaipur International Airport screened 4565 passengers (Males = 4073 and Females = 492) with 23 suspected cases during an outlined period of declaration of Pandemic to Lockdown in India (11 to 24 March 2020). Total 65 passengers had travel history from China (3 from Wuhan). The mean average age of passengers was 40.95 ± 7.8 years. The average screening time per passenger was 2-3 min with a load of 25-90 passengers per team per flight. Fishbone analysis of screening challenges revealed poor cooperation of passengers, masking symptoms, apprehension, and stigma related to quarantine. Moreover, inadequate human resources and changing guidelines overburdened healthcare providers. But, perception of risk, and social responsibility of travelers together with supportive organization behavior act as facilitators. Overall, groundwork on airport screening was insightful to propose key action areas for screening. Conclusions Globally, COVID-19 has an impact on health infrastructure and international travel. International coordination with streamlined screening will go an extended way in virus containment.
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Affiliation(s)
- Neha Mantri
- School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nitin Kumar Joshi
- School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pankaj Bhardwaj
- School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,Address for correspondence: Dr. Pankaj Bhardwaj, Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan, India. E-mail:
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manoj Kumar Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kuldeep Singh
- Dean Academics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Director, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Chen LH, Petersen E, Blumberg L, Piyaphanee W, Steffen R. COVID-19 health passes: current status and prospects for a global approach. J Travel Med 2021; 28:6338088. [PMID: 34343308 PMCID: PMC8385839 DOI: 10.1093/jtm/taab118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA.,Faculty of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Eskild Petersen
- Faculty of Health Sciences, Institute for Clinical Medicine, University of Aarhus, Aarhus 8200, Denmark.,Emerging Infections Task Force, European Society for Clinical Microbiology and Infectious Diseases, Basel 4001, Switzerland
| | - Lucille Blumberg
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg 2131, South Africa
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Robert Steffen
- WHO Collaborating Center for Travellers' Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich 8001, Switzerland.,Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas, Houston, TX 77030, USA
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5
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Mouchtouri VA, Christoforidou EP, An der Heiden M, Menel Lemos C, Fanos M, Rexroth U, Grote U, Belfroid E, Swaan C, Hadjichristodoulou C. Exit and Entry Screening Practices for Infectious Diseases among Travelers at Points of Entry: Looking for Evidence on Public Health Impact. Int J Environ Res Public Health 2019; 16:E4638. [PMID: 31766548 DOI: 10.3390/ijerph16234638] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/22/2022]
Abstract
A scoping search and a systematic literature review were conducted to give an insight on entry and exit screening referring to travelers at points of entry, by analyzing published evidence on practices, guidelines, and experiences in the past 15 years worldwide. Grey literature, PubMed. and Scopus were searched using specific terms. Most of the available data identified through the systematic literature review concerned entry screening measures at airports. Little evidence is available about entry and exit screening measure implementation and effectiveness at ports and ground crossings. Exit screening was part of the World Health Organisation's (WHO) temporary recommendations for implementation in certain points of entry, for specific time periods. Exit screening measures for Ebola Virus Disease (EVD) in the three most affected West African countries did not identify any cases and showed zero sensitivity and very low specificity. The percentages of confirmed cases identified out of the total numbers of travelers that passed through entry screening measures in various countries worldwide for Influenza Pandemic (H1N1) and EVD in West Africa were zero or extremely low. Entry screening measures for Severe Acute Respiratory Syndrome (SARS) did not detect any confirmed SARS cases in Australia, Canada, and Singapore. Despite the ineffectiveness of entry and exit screening measures, authors reported several important concomitant positive effects that their impact is difficult to assess, including discouraging travel of ill persons, raising awareness, and educating the traveling public and maintaining operation of flights from/to the affected areas. Exit screening measures in affected areas are important and should be applied jointly with other measures including information strategies, epidemiological investigation, contact tracing, vaccination, and quarantine to achieve a comprehensive outbreak management response. Based on review results, an algorithm about decision-making for entry/exit screening was developed.
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Singh R, Sumit K, Hossain SS. Core Capacities for Public Health Emergencies of International Concern at Ground Crossings: A Case Study from North India. Disaster Med Public Health Prep 2020; 14:214-21. [PMID: 31507260 DOI: 10.1017/dmp.2019.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE International airports, ports, and ground crossings are required to have health units for undertaking public health measures during routine times and specific measures during the time of public health emergency of international concern (PHEIC). This study was conducted at a ground crossing of North India to assess the implementation status of International Health Regulations (IHR) (2005) at a ground crossing in the prevention and control of public health emergencies and to assess the risk of imported infections from a ground crossing. METHODS A qualitative study was conducted at the selected point of entry. The World Health Organization (WHO) core capacity assessment tool and in-depth interviews were used for data collection in the form of meetings and visits to isolation sites, and general observations were conducted regarding facilities on routine and other infrastructure and equipment that can be used during emergencies. Respondents were recruited using purposive methods. RESULTS The findings reveal that there is lack of awareness among the travelers, which increases the risks of spreading diseases. The overall implementation status at the ground crossing according to the assessment conducted using WHO Tool was 76%. It showed the need for further strengthening of the implementation at the site. Gaps were identified regarding the local capacity for handling chemical, radiological and nuclear hazards, and shortage of regular staff through stakeholders. CONCLUSION The findings from this study, as well as the suggestions and recommendations given by stakeholders, should help revise the current strategies of action. Hence, the gaps identified should be fulfilled to better respond to PHEIC at the ground crossings.
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7
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Adini B, Singer SR, Ringel R, Dickmann P. Earlier detection of public health risks - Health policy lessons for better compliance with the International Health Regulations ( IHR 2005): Insights from low-, mid- and high-income countries. Health Policy 2019; 123:941-946. [PMID: 31288952 PMCID: PMC7114645 DOI: 10.1016/j.healthpol.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 06/02/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
The International Health Regulations (IHR 2005) require all Member States to build and maintain the capacities to prevent, detect and respond to public health emergencies. Early detection of public health risks is one of the core functions. In order to improve surveillance and detection, a better understanding of the health system conditions and their influencing factors are needed. The Israeli Ministry of Health/IHR National Focal Point held a workshop to elucidate health system conditions and their influencing factors that enable earlier detection. The workshop methodology employed a stepwise, small working group analysis approach to elucidate the conditions and their influencing factors affecting each stage of recognition, assessment, and reporting of infectious disease outbreaks, at the local, regional and national levels. In order to detect public health risks earlier, the detection process needs to be moved closer to the local communities and start with building capacity within communities. Building capacity and engaging with local and diverse communities requires significant changes in the governance approach and include information sharing, multi-sectoral communication and coordination across various levels before, during and after public health emergencies. Across the regions, low-, mid- and high-income countries seem to struggle more with governance and information sharing rather than with technical capacities and capabilities.
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Affiliation(s)
- Bruria Adini
- Department of Emergency Management and Disaster Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shepherd Roee Singer
- Ministry of Health, Tel Aviv and Jerusalem, Israel; Hebrew University, Jerusalem, Israel
| | - Ronit Ringel
- Ministry of Health, Tel Aviv and Jerusalem, Israel
| | - Petra Dickmann
- Dickmann Risk Communication Drc
- , London, UK; Jena University Hospital, Department of Anaesthesiology and Intensive Care, Jena, Germany.
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Glynn RW, Boland M. Ebola, Zika and the International Health Regulations - implications for Port Health Preparedness. Global Health 2016; 12:74. [PMID: 27871327 PMCID: PMC5117607 DOI: 10.1186/s12992-016-0173-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background The outbreak of Ebola Virus Disease in West Africa in 2014-2015 was unprecedented in terms of its scale and consequence. This, together with the emergence of Zika virus as a Public Health Emergency of International Concern in 2016, has again highlighted the potential for disease to spread across international borders and provided an impetus for countries to review their Port Health preparedness. This report reviews the legislative framework and actions taken under this framework in advancing and improving Port Health preparedness in Ireland, in response to the declaration of the Public Health Emergency of International Concern for Ebola Virus Disease in August 2014. Findings Infectious disease Shipping and Aircraft Regulations were brought into force in Ireland in 2008 and 2009, respectively. Preparatory actions taken under these and the International Health Regulations necessitated significant levels of cross disciplinary working with other organisations, both within and beyond traditional healthcare settings. Information packs on Ebola Virus Disease were prepared and distributed to airports, airlines, port authorities and shipping agents, and practical exercises were held at relevant sites. Agreements were put in place for contact tracing of passenger and crew on affected conveyances and protocols were established for the management of Medical Declarations of Health from ships coming from West Africa. Conclusions The outbreak of Ebola Virus Disease in West Africa resulted in significant strengthening of Ireland’s Port Health preparedness, while also highlighting the extent to which preparedness requires ongoing and sustained commitment from all stakeholders, both nationally and internationally, in ensuring that countries are ready when the next threat presents at their borders.
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Affiliation(s)
- R W Glynn
- Department of Public Health East, Health Service Executive, Dr. Steevens' Hospital, Steevens' Lane, Dublin, 8, Ireland.
| | - M Boland
- Department of Public Health East, Health Service Executive, Dr. Steevens' Hospital, Steevens' Lane, Dublin, 8, Ireland
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Abstract
Middle East Respiratory Syndrome (MERS) coronavirus is the most recent among the Coronaviridae family to jump species and infect humans. Major healthcare associated MERS outbreaks have occurred in the Middle East and Korea that affected both patients and healthcare workers. These outbreaks were characterized by intra and inter-hospital spread and were exacerbated specifically by overcrowding, delayed diagnosis and appropriate use of personal protective equipment. Recent experience with this virus emphasizes the importance of compliance with infection control practices and with other interventions addressing patient triage, placement and flow within and between healthcare facilities. Our Achilles heel remains compliance with the best infection prevention practices and their harmonization with patient flow. Both infection prevention compliance and maintenance of patient flow are critical in preventing healthcare-associated transmission of many of these emerging infectious diseases, including MERS.
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Affiliation(s)
- Hanan H Balkhy
- Paediatric Infectious Diseases, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh 11426, Saudi Arabia; Infection Prevention and Control, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia; GCC Center for Infection Control, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia.
| | - Trish M Perl
- Johns Hopkins School of Medicine, United States; Bloomberg School of Public Health, United States; Johns Hopkins Medicine, United States.
| | - Yaseen M Arabi
- Intensive Care Department, MC 1425, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia.
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10
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Huang Y. China's position in negotiating the Framework Convention on Tobacco Control and the revised International Health Regulations. Public Health 2013; 128:161-6. [PMID: 24370173 PMCID: PMC7118741 DOI: 10.1016/j.puhe.2013.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/18/2013] [Accepted: 08/02/2013] [Indexed: 11/29/2022]
Abstract
This paper examines China's position in the negotiations of the Framework Convention on Tobacco Control and the revised International Health Regulations. In particular, it explores three sets of factors shaping China's attitudes and actions in the negotiations: the aspiration to be a responsible power; concerns about sovereignty; and domestic political economy. In both cases, China demonstrated strong incentives to participate in the negotiation of legally binding international rules. Still, the sovereignty issue was a major, if not the biggest, concern for China when engaging in global health rule making. The two cases also reveal domestic political economy as an important factor in shaping China's position in international health negotiations.
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Affiliation(s)
- Y Huang
- Seton Hall University and Council on Foreign Relations, USA.
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11
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Endlich PW, Claudio ERG, da Silva Gonçalves WL, Gouvêa SA, Moysés MR, de Abreu GR. Swimming training prevents fat deposition and decreases angiotensin II-induced coronary vasoconstriction in ovariectomized rats. Peptides 2013; 47:29-35. [PMID: 23792185 DOI: 10.1016/j.peptides.2013.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 05/31/2013] [Accepted: 06/03/2013] [Indexed: 11/20/2022]
Abstract
We investigated the effects of chronic swimming training (ST) on the deposition of abdominal fat and vasoconstriction in response to angiotensin II (ANG II) in the coronary arterial bed of estrogen deficient rats. Twenty-eight 3-month old Wistar female rats were divided into 4 groups: sedentary sham (SS), sedentary-ovariectomized (SO), swimming-trained sham (STS) and swimming-trained ovariectomized (STO). ST protocol consisted of a continuous 60-min session, with a 5% BW load attached to the tail, completed 5 days/week for 8-weeks. The retroperitoneal, parametrial, perirenal and inguinal fat pads were measured. The intrinsic heart rate (IHR), coronary perfusion pressure (CPP) and a concentration-response curve to ANG II in the coronary bed was constructed using the Langendorff preparation. Ovariectomy (OVX) significantly reduced 17-β-estradiol plasma levels in SO and STO groups (p<0.05). The STO group had a significantly reduced retroperitoneal and parametrial fat pad compared with the SO group (p<0.05). IHR values were similar in all groups; however, baseline CPP was significantly reduced in the SO, STS and STO groups compared with the SS group (p<0.05). ANG II caused vasoconstriction in the coronary bed in a concentration-dependent manner. The SO group had an increased response to ANG II when compared with all other experimental groups (p<0.05), which was prevented by 8-weeks of ST in the STO group (p<0.05). OVX increased ANG II-induced vasoconstriction in the coronary vascular bed and abdominal fat pad deposition. Eight weeks of swimming training improved these vasoconstrictor effects and decreased abdominal fat deposition in ovariectomized rats.
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Affiliation(s)
- Patrick Wander Endlich
- Department of Physiological Sciences, Health Sciences Center, Federal University of the Espírito Santo, Vitória, Espírito Santo, Brazil.
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Abstract
With growing concerns about international spread of disease and expanding use of early disease detection surveillance methods, the field of syndromic surveillance has received increased attention over the last decade. The purpose of this article is to clarify the various meanings that have been assigned to the term syndromic surveillance and to propose a refined categorization of the characteristics of these systems. Existing literature and conference proceedings were examined on syndromic surveillance from 1998 to 2010, focusing on low- and middle-income settings. Based on the 36 unique definitions of syndromic surveillance found in the literature, five commonly accepted principles of syndromic surveillance systems were identified, as well as two fundamental categories: specific and non-specific disease detection. Ultimately, the proposed categorization of syndromic surveillance distinguishes between systems that focus on detecting defined syndromes or outcomes of interest and those that aim to uncover non-specific trends that suggest an outbreak may be occurring. By providing an accurate and comprehensive picture of this field's capabilities, and differentiating among system types, a unified understanding of the syndromic surveillance field can be developed, encouraging the adoption, investment in, and implementation of these systems in settings that need bolstered surveillance capacity, particularly low- and middle-income countries.
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Affiliation(s)
- Rebecca Katz
- School of Public Health and Health Services, George Washington University, 2021 K Street, NW, Suite 800, Washington, DC 20006, USA
| | - Larissa May
- Department of Emergency Medicine, George Washington University, 2150 Pennsylvania Ave., NW, Suite 2B, Washington, DC 20037, USA
| | - Julia Baker
- School of Public Health and Health Services, George Washington University, 2021 K Street, NW, Suite 800, Washington, DC 20006, USA
| | - Elisa Test
- School of Public Health and Health Services, George Washington University, 2021 K Street, NW, Suite 800, Washington, DC 20006, USA
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