National COVID-19 preparedness and response plans: a global review from the perspective of services for maternal, newborn, child and adolescent health and older people

INTRODUCTION

Infectious disease outbreaks have historically led to widespread disruptions in routine essential health services. Disruptions due to COVID-19 responses led to excess deaths, including among women and children. This review builds on earlier reviews of essential health services in national COVID-19 response and preparedness plans, focusing specifically on maternal, newborn, child, adolescent and ageing health (MNCAAH) in the context of renewed global emphasis on monitoring, recovering and strengthening these services.

METHODS

Using Google searches, we identified publicly available COVID-19 response and preparedness plans authored by a national government body or Public Health Institute from any country, territory and/or area, published between January 2020 and December 2022. We assessed whether each plan considered maintenance of MNCAAH services with related activities, costing or monitoring plans, and whether these considerations were integrated into the national incident management system for COVID-19.

RESULTS

We identified plans from 110 countries, representing 56% of our sample, in 10 languages. Most plans came from low-income and middle-income countries. Three quarters of dated documents were published between February and April 2020. 22% of plans referenced the impact of COVID-19 on MNCAAH, but only 13% included a planned activity for monitoring or mitigating this impact and less than 5% included relevant indicators, costing or integration of services in the incident management system.

CONCLUSION

We propose that unless content specifically related to the services and needs of these populations is integrated, these services will suffer in a future disruptive event. The COVID-19 response demonstrated the need for an interdisciplinary response to address the unforeseen impacts that arose, yet plans continue to have a narrow focus and a generic approach which may be limiting.

Multisectoral action towards sustainable development goal 3.d and building health systems resilience during and beyond COVID-19: Findings from an INTOSAI development initiative and World Health Organization collaboration

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. As the world faces global health crises such as pandemics, epidemics, climate change and evolving disease burdens and population demographics, building strong and resilient public health systems is of critical importance. The need for an integrated approach to building health system resilience; the widening of inequalities; and fears of vulnerable populations being left behind are critical issues that require Supreme Audit Institutions (SAIs) enquiry as independent public oversight bodies. Each country has a Supreme Audit Institution with a remit to audit public funds as an effective, accountable, and inclusive institution. Government audits are key components of effective public financial management and Good Governance. SAIs contribute to the quality of government engagement and better state-society relations through their work. As SAIs provide independent external oversight and contribute to follow up and review of national targets linked to the Sustainable Development Goals (SDGs) in their respective countries, they can play an important role in national recovery efforts. WHO and INTOSAI Development Initiative (IDI) have been collaborating in facilitating SAIs' audits of strong and resilient national public health systems linked to the national target of SDG 3.d in 40 countries across Africa, Americas, Asia and Oceania between 2021 and 2022. This paper aims to convey key lessons learned from the joint multisectoral collaboration for facilitating the 3.d audits that can contribute to building health systems resilience in ongoing recovery efforts. The collaboration included facilitation of the audits through professional education and audit support using a health systems resilience framework. The 3.d audits are performance audits and follow IDI's SDG Audit Model (ISAM). Following the ISAM implies that the SAI should focus on a whole-of-government approach, policy coherence and integration, and assess both government efforts at 'leaving no one behind' and multi-stakeholder engagement in implementing the chosen national SDG target linked to 3.d. WHO's Health Systems Resilience team has supported IDI and SAIs by delivering training sessions and reviewing working papers and draft reports of the SAIs from a health systems resilience perspective. IDI has provided the technical expertise on performance audits through its technical team and through in-kind contributions from mentors from many SAIs in the regions participating in the audit. In the 3.d audit, SAIs can ask how governments are acting to enhance capacity in some or all of the following, depending on their own national context and risk: forecasting, preventing and preparing for public health emergencies (PHEs) and threatsadapting, absorbing and responding to PHEs and threatsmaintaining essential health services in all contexts (including during emergencies/crises). The audits are expected to highlight current capacities of health systems resilience; the extent to which a whole-of-government approach and policy coherence have been utilised; and government efforts related to multistakeholder engagement and leaving no one behind in building health systems resilience related to progressing towards achieving the national target linked to 3.d by 2030. An overall positive achievement noted was that undertaking a complex health audit in the middle of a pandemic is possible and can contribute to building health systems resilience and recovery efforts. In their review of audit plans, draft summaries, and other work by the SAIs, both WHO and IDI have observed that SAIs have used the training and supplementary materials and applied various parts of it in their audits. This collaboration also demonstrates key considerations needed for successful partnership across multisectoral partners at global, regional and national levels. Such considerations can be applied in different contexts, including socioeconomic and health system recovery, to ensure whole-of-society and whole-of-government action in building health systems resilience and monitoring and evaluation to maintain and accelerate progress towards the national target linked to SDG3.d, health security and universal health coverage (UHC), as well as broader socioeconomic development.

A synthesis of concepts of resilience to inform operationalization of health systems resilience in recovery from disruptive public health events including COVID-19

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict' Health systems resilience has become a ubiquitous concept as countries respond to and recover from crises such as the COVID-19 pandemic, war and conflict, natural disasters, and economic stressors inter alia. However, the operational scope and definition of health systems resilience to inform health systems recovery and the building back better agenda have not been elaborated in the literature and discourse to date. When widely used terms and their operational definitions appear nebulous or are not consistently used, it can perpetuate misalignment between stakeholders and investments. This can hinder progress in integrated approaches such as strengthening primary health care (PHC) and the essential public health functions (EPHFs) in health and allied sectors as well as hinder progress toward key global objectives such as recovering and sustaining progress toward universal health coverage (UHC), health security, healthier populations, and the Sustainable Development Goals (SDGs). This paper represents a conceptual synthesis based on 45 documents drawn from peer-reviewed papers and gray literature sources and supplemented by unpublished data drawn from the extensive operational experience of the co-authors in the application of health systems resilience at country level. The results present a synthesis of global understanding of the concept of resilience in the context of health systems. We report on different aspects of health systems resilience and conclude by proposing a clear operational definition of health systems resilience that can be readily applied by different stakeholders to inform current global recovery and beyond.

Corrigendum: A novel approach to utilizing the essential public health functions in Ireland's health system recovery and reform

[This corrects the article DOI: 10.3389/fpubh.2023.1074356.].

Developing technical support and strategic dialogue at the country level to achieve Primary Health Care-based health systems beyond the COVID-19 era

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Pursuing the objectives of the Declaration of Alma-Ata for Primary Health Care (PHC), the World Health Organization (WHO) and global health partners are supporting national authorities to improve governance to build resilient and integrated health systems, including recovery from public health stressors, through the long-term deployment of WHO country senior health policy advisers under the Universal Health Coverage Partnership (UHC Partnership). For over a decade, the UHC Partnership has progressively reinforced, via a flexible and bottom-up approach, the WHO's strategic and technical leadership on Universal Health Coverage, with more than 130 health policy advisers deployed in WHO Country and Regional Offices. This workforce has been described as a crucial asset by WHO Regional and Country Offices in the integration of health systems to enhance their resilience, enabling the WHO offices to strengthen their support of PHC and Universal Health Coverage to Ministries of Health and other national authorities as well as global health partners. Health policy advisers aim to build the technical capacities of national authorities, in order to lead health policy cycles and generate political commitment, evidence, and dialogue for policy-making processes, while creating synergies and harmonization between stakeholders. The policy dialogue at the country level has been instrumental in ensuring a whole-of-society and whole-of-government approach, beyond the health sector, through community engagement and multisectoral actions. Relying on the lessons learned during the 2014-2016 Ebola outbreak in West Africa and in fragile, conflict-affected, and vulnerable settings, health policy advisers played a key role during the COVID-19 pandemic to support countries in health systems response and early recovery. They brought together technical resources to contribute to the COVID-19 response and to ensure the continuity of essential health services, through a PHC approach in health emergencies. This policy and practice review, including from the following country experiences: Colombia, Islamic Republic of Iran, Lao PDR, South Sudan, Timor-Leste, and Ukraine, provides operational and inner perspectives on strategic and technical leadership provided by WHO to assist Member States in strengthening PHC and essential public health functions for resilient health systems. It aims to demonstrate and advise lessons and good practices for other countries in strengthening their health systems.

Building back better children's surgical services toward universal health coverage: Perspectives from Bangladesh and Zimbabwe

Introduction

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Children's surgical services are crucial, yet underappreciated, for children's health and must be sufficiently addressed to make and sustain progress toward universal health coverage (UHC). Despite their considerable burden and socioeconomic cost, surgical diseases have been relatively neglected in favor of communicable diseases living up to their inauspicious moniker: 'the neglected stepchild of global health'. This article aims to raise awareness around children's surgical diseases and offers perspectives from two prototypical LMICs on strengthening surgical services in the context of health systems recovery following the COVID-19 experience to make and sustain progress toward UHC.

Approach

We used a focused literature review supplemented by the perspectives of local experts and the 6-components framework for surgical systems planning to present two case studies of Bangladesh and Zimbabwe. The lived experiences of the authors are used to describe the impact of COVID-19 on respective surgical systems and offer perspectives on building back the health system and recovering essential health services for sustainability and resilience.

Findings

We found that limited high-level policy and planning instruments, an overburdened and under-resourced health and allied workforce, underdeveloped surgical infrastructure (from key utilities to essential medical products), lack of locally generated research, and the specter of prohibitively high out-of-pocket costs for children's surgery are common challenges in both countries that have been exacerbated by the COVID-19 pandemic.

Discussion

Continued chronic underinvestment and inattention to children's surgical diseases coupled with the devastating effect of the COVID-19 pandemic threaten progress toward key global health objectives. Urgent attention and investment in the context of health systems recovery is needed from policy to practice levels to improve infrastructure; attract, retain and train the surgical and allied health workforce; and improve service delivery access with equity considerations to meet the 2030 Lancet Commission goals, and make and sustain progress toward UHC and the SDGs.

Towards applying the essential public health functions for building health systems resilience: A renewed list and key enablers for operationalization

The COVID-19 pandemic, climate change-related events, protracted conflicts, economic stressors and other health challenges, call for strong public health orientation and leadership in health system strengthening and policies. Applying the essential public health functions (EPHFs) represents a holistic operational approach to public health, which is considered to be an integrated, sustainable, and cost-effective means for supporting universal health coverage, health security and improved population health and wellbeing. As a core component of the Primary Health Care (PHC) Operational Framework, EPHFs also support the continuum of health services from health promotion and protection, disease prevention to treatment, rehabilitation, and palliative services. Comprehensive delivery of EPHFs through PHC-oriented health systems with multisectoral participation is therefore vital to meet population health needs, tackle public health threats and build resilience. In this perspective, we present a renewed EPHF list consisting of twelve functions as a reference to foster country-level operationalisation, based on available authoritative lists and global practices. EPHFs are presented as a conceptual bridge between prevailing siloed efforts in health systems and allied sectors. We also highlight key enablers to support effective implementation of EPHFs, including high-level political commitment, clear national structures for institutional stewardship on EPHFs, multisectoral accountability and systematic assessment. As countries seek to transform health systems in the context of recovery from COVID-19 and other public health emergencies, the renewed EPHF list and enablers can inform public health reform, PHC strengthening, and more integrated recovery efforts to build resilient health systems capable of managing complex health challenges for all people.

A novel approach to utilizing the essential public health functions in Ireland's health system recovery and reform

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict.' The COVID-19 pandemic presented a challenge to health systems and exposed weaknesses in public health capacities globally. As Ireland looks to recovery, strengthening public health capacities to support health systems resilience has been identified as a priority. The Essential Public Health Functions (EPHFs) provide an integrated approach to health systems strengthening with allied sectors and their operationalization supports health systems and multi-sectoral engagement to meet population needs and anticipate evolving demands. The Health Systems Resilience team (World Health Organization, HQ) in collaboration with the Department of Health (Ireland) developed a novel approach to the assessment of the EPHFs in Ireland. The approach involved a strategic and focused review of the delivery and consideration of EPHFs in relation to policy and planning, infrastructure, service delivery, coordination and integration, monitoring and evaluation and learning. Informed by a literature review and key document search, key stakeholder mapping and key informant interviews, lessons learned from experience with COVID-19 nationally and internationally, strengths as well as potential areas of improvement to optimize delivery of EPHFs were identified. Mapping of the EPHFs in Ireland revealed that there is evidence of delivery of all 12 EPHFs to varying degrees; however a number of challenges were identified, as well as numerous strengths and opportunities. Recommendations to optimize the delivery of EPHFs in Ireland include to integrate and coordinate EPHFs, increase the visibility of the public health agenda, leverage existing mechanisms, recognize and develop the workforce, and address issues with the Health Information System. There is a public health reform process currently underway in Ireland, with some of these recommendations already being addressed. The findings of this process can help further inform and support the reform process. Given the current focus on strengthening public health capacities globally, the findings in Ireland have applicability and relevance in other WHO regions and member states for health systems recovery and building back better, fairer and more resilient health systems.

Applying Essential Public Health Functions in building health systems’ resilience globally

Background

The COVID-19 pandemic has exposed Public Health system weaknesses due to chronic underinvestment in Public Health. In this context, Essential Public Health Functions (EPHFs) have been revitalized as an integrated, cost effective and sustainable approach to operationalising Public Health. The World Health Organization's recent position paper on building health systems resilience towards universal health coverage and health security recommended investing in EPHFs as a key mean for countries’ health systems recovery and transformation during COVID-19 and beyond. There is a need for conceptual and operational clarity of EPHFs to support countries to build back better, fairer and more resilient health systems.

Methods

A rapid review of peer-reviewed and grey literature regarding the EPHFs was conducted to identify different actors’ understandings of EPHFs and key lessons of applying the EPHFs at the global, regional and national levels, in order to identify the added value and key enablers to operationalising EPHFs. A crosswalk analysis of different authoritative lists of EPHFs was conducted to develop a common list of EPHFs as a reference for countries in response to Public Health challenges.

Results

A consolidated list of 12 EPHFs derived from the crosswalk analysis of different authoritative lists is presented, underpinning the consideration of health systems components and pressing health challenges. Six key enablers are identified from evidence and experience. These enablers are fundamental for countries to build holistic and strong Public Health capacities.

Conclusions

The EPHFs provide a clear and integrated framing to operationalise Public Health in countries that can be adapted to country contexts to build resilience. Health authorities and other Public Health stakeholders must seize the opportunity brought by COVID-19 recovery to continue advocating for and strengthening Public Health as a priority in health systems’ reconstruction and reform.

Essential Public Health Functions in Ireland: Perspectives to strengthen capacities and stewardship

Background

COVID-19 has caused unprecedented disruptions to health, social and economic systems in countries worldwide including Ireland. Weaknesses in Public Health capacities have undermined health system resilience compounding the effects of the pandemic. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost-effective approach to operationalising public health and a means to build health systems resilience. As Ireland looks to recovery, the Department of Health engaged the World Health Organization (WHO) to undertake a mapping of the current state of delivery of EPHFs to identify opportunities for improvement and support wider health system strengthening towards resilience.

Methods

A strategic review of the delivery of EPHFs in Ireland was conducted with respect to policy, infrastructure, service provision and coordination and integration. Findings were reported in the context of international lessons identified through experience with COVID-19 and major health system challenges within the Irish context.

Results

There are significant capacities present within the Irish context to support the delivery of the EPHFs though they are limited in strategic cohesion, coordination and implementation. These include a high level of Public Health expertise, an agile and resourceful workforce, a strongly engaged community and significant evidence generation and synthesis capacities. Gaps recognised included ICT infrastructure and capacity, workforce resourcing and support, pandemic planning and public health governance, visibility, legislation, strategy and resourcing. COVID-19 has led to the development and strengthening of mechanisms to leverage a whole-of-government and -society approach to health that should be sustained to tackle ongoing and future stressors.

Conclusions

The use of the EPHFs within the Irish setting provides a comprehensive approach to strengthening capacities for public health and enhanced population health and wellbeing.

Investigation of roost composition of passerine birds in different environmental conditions

Abstract The majority of the birds in different habitats are stressed due to alteration in multiple climate factors contributing to their loss. The present study has been planned to find the roosts composition of passerine birds in different major and sub-habitats of Punjab, Pakistan. In Faisalabad, of the four species, the higher number of exits was almost comparable, while Passer domesticus and Pastor roseus were more abundant than Tachycinet bicolor and Lanius cristatus. For the three remaining birds, total exits and returns were 180 for P. roseus, 181 for T. bicolor, and 179 for L. cristatus, respectively. Considering the exits in morning hours, a total of 314, 256, 246 and 210, were recorded from Sheikhupura. In Khanewal, of the four species, the highest exits and returns were that of P. domesticus (407; 451), followed by that of the P. roseus (273; 336), T. bicolor (242; 319) and L. cristatus (220; 397). The temperature imposed serious effects on roost exits for the four birds. The varied P-values which were higher (< 0.001***, < 0.001***, 0.002 **, <0.001***) appeared to limit the roost exits for them. Nonetheless, the impact of relative humidity exerted a strong influence on the T. bicolor (0.003**). In roosts return, it was seen that roost returns were even likely in warm temperatures and precipitation did not impose seriously on returns, and even in light rainfall. Nonetheless, relative humidity (RH) strongly impacted the sparrow. The T. bicolor and L. cristatus were adversely affected with the slopes (1.37) and (2.06), indicated with each percentage increase of relative humidity, and slope variations became least.

Clearing the air about airborne transmission of SARS-CoV-2

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has created the current pandemic, has caused a worldwide worry. Different countries have since enforced varying levels of lockdowns and guidelines for their populations to follow in a serious effort to mitigate the spread. Up until recently, the majority of these regulations and policies were established on the assumption that the dominant routes of transmission of this virus are through droplets and fomite contact. However, there is now a substantial amount of research pointing towards the strong possibility that SARS-CoV-2 can spread through airborne means. The World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have recently recognized this, which poses the question of whether our collective methods of lessening transmission risk and keeping people safe have been sufficient. This paper is a comprehensive review of the evidence on SARS-CoV-2 being an airborne disease, through different epidemiological, experimental, and animal-model based published research. Studies opposing this evidence have also been discussed. The majority of these studies are favoring the high plausibility of SARS-CoV-2 aerosol transmission, and therefore the many implications of aerosol transmission have been discussed in this paper to suggest effective mitigation and control strategies.

Building resilience through integrated health systems strengthening: policy and planning analysis

 

Health system strengthening towards universal health coverage and health security are key objectives promoted by health policy actors. However, bringing together these agendas has presented challenges. Health investments are often reactive and siloed e.g. emergency and humanitarian response programmes. There has been disinvestment in public health and primary health care (PHC), and limited linkages with allied sectors (e.g. environmental and animal health). There is a need to better understand policies that promote integration and enable effective response to threats such as COVID-19 in tandem with maintaining routine health system functions (e.g. PHC and essential individual and population health services). We conducted document analysis of national health sector, security and public health policies and plans and drew on perspectives of key stakeholders to investigate integration using a health systems resilience framework. We examined the extent and manner in which policies are integrated to enable national and subnational systems to prepare for, prevent and adapt to shocks while maintaining routine and essential functions. While we identified a recognition of the need for better integration to promote health security within health systems strengthening efforts and vice versa including strengthening governance, accountability and capacity for stewardship within national and local health and allied authorities, evidence of such an approach was limited. National laws to support IHR (2005) implementation were often outdated and insufficient to produce the policy environment for multi-sectoral working. In 2020, only 47% of national COVID-19 plans from 106 countries considered the maintenance of non-COVID-19 essential health services - a key component of health systems resilience. Policies which strengthen PHC services and preventative interventions can be cost-effective and efficient whilst bridging pandemic response and other essential functions of the health system.

Key messages

COVID-19 is an opportunity to promote and sustain greater integration and inter- and multisectoral engagement.

Everyone can play a role to foster an integrated approach focussing on preventative, cost-effective health services to ensure health systems resilience.

1677 Integrating Venepuncture Training Within the Curriculum for Oral and Maxillofacial Dental Core Trainees Within A Hospital in South Wales, UK

Aim

The aim of this quality improvement project was to provide a solution to improve the confidence and skill of Oral and Maxillofacial Dental Core Trainees (DCTs) in venepuncture by attending phlebotomy training sessions. DCTs within the hospital where this project was undertaken are dentally qualified and are often not taught the principles of venepuncture during their undergraduate degree. Furthermore, they rarely gain hands-on experience to confidently apply these skills.

Method

Phlebotomy training sessions were held, each an hour and a half long and were completed within the first 4 weeks of the DCTs starting their job. A survey was completed by each of the DCTs prior to the training. The sessions consisted of a short introduction to phlebotomy and the different techniques, observing a phlebotomist taking blood, and then performing venepuncture on live patients attending the clinic who required blood investigations. The Vacutainer eclipse single needle was used with the single-use holder. Following the training, the DCTs completed a second survey.

Results

The mean confidence of the DCTs increased from 2.7 to 8.2 out of 10 following the phlebotomy training. 100% of the DCTs rated the quality of the workshop 10 out of 10, with 10 being excellent. The sessions had minimal disruption to the running of the phlebotomy and maxillofacial clinics.

Conclusions

This quality improvement project will have an overall benefit firstly to patients and also to the Health Board. The success of this programme lead to its permanent implementation within the curriculum for or each intake of new DCTs.

1662 Closure of Oro-Antral Fistulae in Conjunction with Functional Endoscopic Sinus Surgery: A Retrospective Analysis + Systematic Review

Aim

The aim of this study was to evaluate the surgical closure of OAFs created following dental extractions in conjunction with FESS in adult patients within a hospital in South Wales, UK, during a 5-year period, from 1st January 2014 to 31st December 2018, with a systematic review of the literature to investigate success rates.

Method

A manual search in the hospital’s theatre system for surgery between 2014 and 2018 containing codes for FESS, OAC or OAF was completed. These were screened for joint cases, and the patient’s hospital numbers entered into a Microsoft Excel spreadsheet. A retrospective analysis of their clinical records was performed. Success was measured as total closure and relief of sinusitis after 1 month. The PRISMA format was used to complete the systematic review.

Results

13 patients (mean age 51 ± 12.44, 7:6 male to female) met the inclusion criteria. The most common cause was extraction of the maxillary first molar. A 100% success rate was achieved, with no patients requiring revision surgery. The systematic review highlighted an average success rate of 98.7%. A protocol for the management of OACs was designed in both English and Welsh and distributed to Primary Care Dentists within South Wales.

Conclusions

OAF closure with FESS can be considered as a highly effective approach, leaving patients symptom free. It is important that protocols are in place for dentists suspecting an OAC in order to expedite patient management.

887 Suspected malignancy and unusual pathology in a severe case of Lemierre’s syndrome

Lemierre’s syndrome, although rare, is a potentially fatal condition, usually associated with the anaerobic bacterium, Fusobacterium necrophorum. This case describes a previously healthy 59-year-old female, who had a three-week history of pharyngitis and dysphagia. She presented to the emergency department with a left neck swelling and fever. A CT scan showed a 3 cm left level IV low-density suspected neck mass or necrotic node. There were multiple pulmonary nodules raising suspicion for metastases. Blood cultures were positive for Streptococcus constellatus and Dialister pneumosintes. The scan was further reviewed by a Head and Neck specialist radiologist and an Oral and Maxillofacial consultant, which highlighted a peritonsillar abscess and filling defect in the left internal jugular vein. A conclusive diagnosis of Lemierre’s syndrome with septic pulmonary emboli was established. She improved clinically with IV antibiotics in conjunction with daily enoxaparin injections. We believe that this is the first reported case of Lemierre’s syndrome associated with Dialister pneumosintes. A high index of suspicion is essential in cases of persistent pharyngitis and sepsis in an otherwise healthy individual, in order to promptly diagnose the condition and initiate treatment.

Gastrointestinal parasitic infections of buffaloes (Bubalus bubalis) in Sarawak Borneo: Prevalence, risk factors, and farming practices

The objectives of this study were to investigate the prevalence and associated risk factors for gastrointestinal (GI) parasites in buffaloes from various areas of Sarawak, and to assess current management practices of GI parasites among farmers. Faecal samples were collected from 15 farms and 129 animals, as well as data on farm and animal-based characteristics. A total of 129 faecal samples were examined for GI parasites using a modified McMaster and sedimentation. Association between potential risk factors and the prevalence of GI parasites was investigated using Chi-square statistic. The prevalence of Paramphistomum sp., strongyles, and coccidia were 75.2% (95% CI±7.5), 52.7% (95% CI±8.6) and 48.1% (95% CI±8.6), respectively. Farms which had a grazing area less than 50 acres in size had significantly higher prevalence of strongyles (70.5%, χ² = 8.34, P = 0.004) and paramphistomes (88.6%, χ² = 6.46, P = 0.01) relative to farms with a larger grazing area (43.5% and 68.2%, respectively). Prevalence of strongyles was lower in farms that did not implement a cut- and-carry system (45.6%, χ² = 4.17, P = 0.04) in comparison to those that did (64%). The prevalence of paramphistomes was higher on farms with more than 40 animals (80.6%, χ² = 3.18, P = 0.05) relative to farms with fewer animals. The majority of farmers surveyed (67.9%) showed awareness of GI parasite infection and reported that they recognized the associated symptoms. Most farmers practised deworming, and ivermectin was the most commonly used anthelminthic (60.4%); only 1.9% of farmers used albendazole. Overall this study revealed a high prevalence of GI parasites in buffalo in Sarawak. Although farmers report they are aware of parasitic diseases, further education is still required. This could include how they can successfully implement on-farm changes to reduce the prevalence of GI parasites in their herds.

Building the evidence base for global health policy: the need to strengthen institutional networks, geographical representation and global collaboration

National public health institutes and WHO collaborating centres, and their global networks, are a key resource to support public health system strengthening with essential public health functions and generate evidence for health policy central to national health and socioeconomic development. The COVID-19 pandemic has laid bare global inequities in public health capacities, made urgent the need to examine sources of global knowledge and understand how to better invest in and use public health institutes and their capacities. This analysis paper incorporates experiences and perspectives from the WHO and International Association of National Public Health Institutes including the ongoing pandemic and work conducted in the UK-WHO ‘Tackling Deadly Diseases in Africa Programme’. We acknowledge geographical disparities in public health capacities both within and across countries and regions, provide examples of novel ways of working for global health actors, and define the challenging environment in which public health authorities operate. We identify four incentives for all countries to invest in public health and strengthen institutions: (1) transparency and trust; (2) socioeconomic dividends; (3) collective health protection and (4) knowledge sharing and equity. By pursuing shared priorities; enabling voices from low-resource settings to be more equitably heard; facilitating collaboration and learning within and across regions, we articulate actionable next steps to develop and better harness public health institutes and international networks.

O-083 Non-invasive, label-free optical analysis to detect aneuploidy within the inner cell mass of the preimplantation embryo

Study question

Can we separate between control and reversine-treated cells within the inner cell mass (ICM) of the mouse preimplantation embryo by using label-free and non-invasive hyperspectral microscopy?

Summary answer

Hyperspectral microscopy is able to discern between control and reversine-treated cells using cellular autofluorescence in the complete absence of fluorescence tags.

What is known already

Embryo mosaicism (containing cells that are euploid (46 chromosomes) and aneuploid (deviation from the expected number of chromosomes)) affects up to 17.3% of human blastocyst embryos. Current diagnosis of aneuploidy in the IVF clinic involves a biopsy of trophectoderm (TE) cells or spent media followed by sequencing. In some blastocyst embryos these approaches will fail to diagnose of the proportion of aneuploid cells within the fetal lineage (ICM).

Study design, size, duration

The impact of aneuploidy on cellular metabolism was assessed by using cellular autofluoresence and hyperspectral microscopy (broad spectral profile). Two models were employed: (i) Primary human fibroblast cells with known karyotypes (4-6 independent replicates, euploid n = 467; aneuploid n = 969) and reversine induced aneuploidy in mouse embryos (5-8 independent replicates, 30-44 cells per group). Both models were subjected to hyperspectral imaging to quantify native cell fluorescence.

Participants/materials, setting, methods

The human model is comprised of euploid (male and female) and aneuploid (triploid and trisomies: 13, 18, 21, XXX, and XXY) primary human fibroblast cells. For the mouse model, we treated embryos with reversine, a reversible spindle assembly checkpoint inhibitor, during the 4- to 8-cell division. Individual blastomeres were dissociated from control and reversine treated 8-cell embryos. Blastomeres were either imaged directly or used to generate chimeric blastocysts with differing ratios of control:reversine-treated cells.

Main results and the role of chance

Following unsupervised linear unmixing, the relative abundance of metabolic cofactors was quantified: reduced nicotinamide adenine dinucleotide (NAD(P)H) and flavins with the subsequent calculation of the optical redox ratio (ORR: Flavins/[NAD(P)H + Flavins]). Primary human fibroblast cells displayed an increase in the relative abundance of NAD(P)H with a decrease in flavins, leading to a significant reduction in the ORR for aneuploid cells (P &lt; 0.05). The mouse embryos displayed an identical trend as the human model between control and reversine-treated embryos. Mathematical algorithms were applied and able to distinguish between (i) euploid and aneuploid primary human fibroblast cells, (ii) control and reversine-treated mouse blastomeres and (iii) chimeric blastocysts with differing ratios of control and reversine-treated cells. The accuracy of these separations was supported by receiver operating characteristic curves with areas under the curve. We also showed that hyperspectral imaging of the preimplantation embryo does not impact on embryo developmental competence, pregnancy outcome and offspring health in a mouse model. We believe the role of chance is low as both human somatic cells and mouse embryos showed a consistent shift in cellular metabolism in response to human fibroblast cells that are aneuploid and reversine treated mouse embryos.

Limitations, reasons for caution

Further validation of our approach could include sequencing of the ICM of individual blastocysts to determine the proportion of aneuploid cells in ICM and correlate this with the metabolic profile obtained through hyperspectral imaging.

Wider implications of the findings

With hyperspectral imaging able to discriminate between (i) euploid and aneuploid human fibroblast cells and (ii) control and reversine-treated mouse embryos, this could be an accurate, non-invasive and label-free optical imaging approach to assess mosaicism within the ICM of mouse embryos, potentially leading to a new diagnostic tool for embryos.

Trial registration number

Not applicable

COVID-19 Preparedness and Response Plans from 106 countries: a review from a health systems resilience perspective

Coronavirus disease (COVID-19) has exposed long-standing fragmentation in health systems strengthening efforts for health security and universal health coverage while these objectives are largely interdependent and complementary. In this prevailing background, we reviewed countries’ COVID-19 Preparedness and Response Plans (CPRPs) to assess the extent of integration of non-COVID-19 essential health service continuity considerations alongside emergency response activities. We searched for COVID-19 planning documents from governments and ministries of health, World Health Organization (WHO) country offices and United Nations (UN) country teams. We developed document review protocols using global guidance from the WHO and UN and the health systems resilience literature. After screening, we analysed 154 CPRPs from 106 countries. The majority of plans had a high degree of alignment with pillars of emergency response such as surveillance (99%), laboratory systems (96%) and COVID-19-specific case management (97%). Less than half considered maintaining essential health services (47%); 41% designated a mechanism for health system–wide participation in emergency planning; 34% considered subnational service delivery; 95% contained infection prevention and control (IPC) activities and 29% considered quality of care; and 24% were budgeted for and 7% contained monitoring and evaluation of essential health services. To improve, ongoing and future emergency planning should proactively include proportionate activities, resources and monitoring for essential health services to reduce excess mortality and morbidity. Specifically, this entails strengthening subnational health services with local stakeholder engagement in planning; ensuring a dedicated focus in emergency operations structures to maintain health systems resilience for non-emergency health services; considering all domains of quality in health services along with IPC; and building resilient monitoring capacity for timely and reliable tracking of health systems functionality including service utilization and health outcomes. An integrated approach to planning should be pursued as health systems recover from COVID-19 disruptions and take actions to build back better.

Suicidality measured by PHQ-9 in kosovo during the COVID-19 outbreak

Introduction

As a consequence of the impact of COVID-19 there are suggestions and projections that suicide rates will rise, although this is not inevitable. It is intriguing what impact it will have on Kosovo as a country with the lowest suicide rate in Europe.

Objectives

The objective of this study was to understand the level of suicidal thinking as a result of the COVID-19 situation and possible associations with sociodemographic variables.

Methods

It’s a comparative study. We examined data of two cross-sectional online surveys conducted during the one-month periods 20.03.20 until 23.04.20 and 27.04.2020 until 05.06.2020. The participants were online respondents, N = 194 (first period) and N = 155 (second period); who completed the Albanian version of PHQ-9. We used the statement number 9 of questionnaire indicative of suicide.

Results

Mean score of suicidal thinking resulted 0.58 (SD = .98) in the first period and 0.84 (SD = 1.16) in the second period. 10.1% of participants in March/April and 18.2% in May/June period scored that almost every day thoughts that would be better off dead, or of hurting yourself in some way. Significantly higher suicidal thinking resulted for females and for respondents who had previously had depression in both periods. Compared to two previous studies (2018 and 2019) in different settings only the results of the second period show an increase in suicidal thinking.

Conclusions

Further studies are needed to better scientifically elaborate these findings. It is important enhanced surveillance of COVID-19-related risk factors contributing to suicidal behaviors and timely preventive efforts.

Disclosure

No significant relationships.

Intravenous glycoprotein IIbIIIa inhibitor bridging for urgent coronary artery bypass graft after acute coronary syndrome

Background

Previous studies have shown the safety of intravenous glycoprotein (GP) IIbIIIa inhibitors used as a bridging after ADP receptor blocker withdrawal in patients with stable coronary artery disease and previous percutaneous coronary interventions (PCI) undergoing cardiac or non-cardiac surgeries. However, there are few data analyzing GP IIbIIIa inhibitor bridging among patients with acute coronary syndromes (ACS) scheduled for coronary artery bypass graft (CABG) during the same hospitalization.

Purpose

To evaluate the safety of tirofiban bridging after clopidogrel withdraw in post-ACS patients schedule for CABG during the same hospitalization.

Methods

Fifty-six patients who underwent CABG after tirofiban bridging post-ACS (bridge group - BG) were compared to 56 sex and age-matched controls also submitted to same-hospitalization CABG post-ACS without bridging (control group - CG). All patients received aspirin plus clopidogrel for ACS; clopidogrel was withdrawn 5 to 7 days before CABG and aspirin was maintained during the whole perioperative period. The primary endpoint was chest tube output in the first 24h after CABG (CTO24h). We hypothesized that BG would be non-inferior to CG, with a non-inferiority margin of 25% in excess of CTO24h in the BG compared to the CG, based on prior literature data. Other exploratory analyses were: blood transfusions, number of red blood cells/patient and re-thoracotomy 24h after surgery. A multivariable linear regression model was developed considering CTO24h as dependent variable and adjusted for other eight co-variates, described in the figure.

Results

From the 112 patients included (75% men; mean age 60.2±9.3 years), in comparison with CG, BG had higher proportion of STEMI (80.0% vs. 28.6%, p&lt;0.01), fibrinolytic utilization (25% vs. 7.1%, p&lt;0.05), PCI in the acute phase (92.9% vs. 0%, p&lt;0.01) and LMCA stenosis (30.4% vs. 7.1% p&lt;0.01). Tirofiban was utilized by clinician discretion due to PCI in the same hospitalization previously to CABG (n=52), previous PCI up to 3 months before index event (n=3) or severe LMCA stenosis (n=1). BG patients received tirofiban for a mean of 4.3±2.1 days and it was withdrawn at a mean of 6.6±4.3 hours before CABG. After adjustments, BG was non-inferior to CG regarding CTO24h (figure) There were no significant differences between BG and CG regarding need for blood transfusion (26.8% vs. 26.8%, p&gt;0.99), mean number of red blood cells/patient (0.3±0.8 vs 0.5±1.2, p=0.35) or re-thoracotomy due to bleeding (5.4% vs 0%, p=0.24).

Conclusion

Among ACS patients submitted to urgent CABG after clopidogrel withdrawal, tirofiban bridging, compared to no bridging, was not associated with higher risk of bleeding in the first 24 hours after surgery. Our study suggests that tirofiban may be a safe therapy to patients with high risk of thrombotic complication (such as stent thrombosis or re-infarction) after clopidogrel withdraw.

Figure 1

Funding Acknowledgement

Type of funding source: None

A survey on smartphone dependence and psychological effects among undergraduate students in a Malaysian University

OBJECTIVE

Problematic smartphone use (PSU) is the development of pathological dependence at the expense of performing activities of daily living, thus having negative health and psychological impact on the users. Previous PSU studies focused on medical students and little is known regarding its effect on students undergoing other courses. The objective of this study is to identify the pattern of smartphone usage and determine the psychological factors affecting PSU among undergraduate students in Malaysia and compare the pattern among students from different fields of study.

METHOD

A prospective cross-sectional study was conducted using the validated Smartphone Addiction Scale-Malay version (SAS-M) questionnaire. One-way ANOVA was used to determine the correlation between the PSU among the students categorised by their ethnicity, hand dominance and by their field of study. MLR analysis was applied to predict PSU based on socio-demographic data, usage patterns, psychological factors and fields of study.

RESULTS

A total of 1060 students completed the questionnaire. Most students had some degree of problematic usage of the smartphone. Students used smartphones predominantly to access SNAs, namely Instagram. Longer duration on the smartphone per day, younger age at first using a smartphone and underlying depression carried higher risk of developing PSU, whereas the field of study (science vs. humanities based) did not contribute to an increased risk of developing PSU.

CONCLUSION

Findings from this study can help better inform university administrators about at- risk groups of undergraduate students who may benefit from targeted intervention designed to reduce their addictive behaviour patterns.

[Zinc induces normoxic accumulation of transcriptionally active hypoxia-inducible factor 1-alpha in mammary epithelial cells]

Both zinc and the α-subunit of hypoxia-inducible factor (HIF-1α) play important roles in the remodelling of mammary gland tissues. In the present study, we examined the level and the transcriptional activity of HIF-1α in mammary cells upon zinc treatment. In MCF-7 mammary adenocarcinoma and MCF-10A mammary epithelial cell lines, the toxicity levels of zinc differ. Interestingly, both cell lines overexpress HIF-1α following zinc treatment. As it was evident from an up-regulation of its specific target gene CA9 that encodes carbonic anhydrase IX, the stabilized HIF-1α translocated to the nucleus and was transcriptionally active. Hence, we conclude that zinc causes normoxic accumulation of transcriptionally active HIF-1α by interfering with its post-translational regulation.

Perceptions and Attitudes Towards HIV/AIDS Patients among General Public in Bahrain

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Genetische Veränderungen des Protein-C-Systems

Das Protein-C-System umfaßt neben dem Protein C (PC) das Protein S (PS) sowie Thrombomodulin (TM). Obwohl das PC bereits im Jahr 1976 isoliert und charakterisiert wurde, wurde familiärer PC-Mangel erst im Jahr 1981 mit familiärer Thrombophilie in Zusammenhang gebracht. Heute wissen wir, daß PC einen der wichtigsten Inhibitoren der Gerinnung repräsentiert. Zur Umwandlung des Zymogens PC durch Thrombin in aktiviertes PC (APC) ist das TM von essentieller Bedeutung. Dieses Protein wurde 1981 entdeckt und danach intensiv in seiner biochemischen Funktion studiert. Die klinische Relevanz von TM-Defekten ist allerdings bis heute unklar. APC inaktiviert proteolytisch die aktivierten Gerinnungsfaktoren Faktor V (FVa) und Faktor VIII (FVIIIa). Zur Entfaltung der vollen Aktivität benötigt PC einen Kofaktor, das PS. Ein Mangel von PS führt zu erhöhter Thromboseneigung. Eine häufig vorkommende Mutante des Faktor V (FV), der FV-Leiden, kann durch APC nur unzureichend inaktiviert werden und ist ebenfalls mit erhöhter Thromboseneigung assoziiert. Der genaue Mechanismus über den FV-Leiden zu einem erhöhten Thromboserisiko beiträgt wird derzeit noch kontrovers diskutiert. Heute sind die biochemischen Interaktionen der Komponenten des PC-Systems recht genau untersucht und viele zugrundeliegende Mutationen aufgeklärt. Darüber hinaus gibt es recht umfangreiche Studien an großen Patientenkollektiven, in denen die Auswirkungen der Mutationen in den einzelnen Komponenten des PC-Systems auf das Thromboserisiko analysiert wurden. Die Ergebnisse mehrerer Evaluierungen werden in diesem Artikel zusammengefaßt.

Self-esteem links with anxiety and depression at one community adolescent sample

Introduction

Anxiety and depression is becoming an increasingly important public health issue. The adolescents’ population is among affected seriously.

Objectives

The objectives of the study was to investigate the level of anxiety, depression and self-esteem among adolescents and explore links between.

Methodology

Participants were 99 adolescents randomly selected in school, aged between 12 to 19 years (M = 14.88; SD = 2.09); in terms of gender composition, there were girls 41.1% and boys 58.9%. The measures used included the Albanian versions of depression self-rating scale for children, the revised children's manifest anxiety scale, and the rosenberg self-esteem scale. All data has been analysed by SPSS 21 and Excel 2007.

Results

Results showed that clinical significant levels reported 10.3% of participants for anxiety and 22.4% for depression. With low self-esteem scored 16.3% of participants. Self-esteem is significantly negatively correlated only with depression (r = -.433, P < .00). Mann-Whitney Test didn’t found significant differences in anxiety based on self-esteem levels. Mann-Whitney Test found significant differences in depression levels based on levels of self-esteem (Mdlowself-esteem = 15; n = 16; Mdnormalself-esteem = 10; n = 81) as adolescents with low self-esteem had significantly higher depression as compared to adolescents with normal self-esteem (z = -2.876, P < .004).

Conclusions

Findings suggested that self-esteem and depression links are present but not links self-esteem and anxiety. It is important to investigate these relationships in future research aimed identification/interventions programs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Cation-Exchange Properties of Aluminium(III) Phosphate

Potentiometric titrations of aluminium(III) phosphate have been performed in the presence of aqueous electrolyte solutions containing Cu2+, Zn2+, Ni2+ and K+ ions as a function of the concentration of the latter, the pH and the temperature. The sorption of Zn2+ ions has also been studied and the data for metal ion sorption shown to correlate with the Potentiometric titration data, indicating that the process responsible for metal ion uptake is ion exchange. The pKa value of the exchanger and its thermodynamic parameters have been evaluated.

Exchange of Some Divalent Metal Cations and Their Effect on the Dissociation of Iron(III) Phosphate

Potentiometric titrations of iron(III) phosphate have shown an apparently weak monobasic acid behaviour towards alkali, alkaline earth and divalent transition metal ions. The selectivity sequence and dissociation of the exchanger was found to increase in the order Cu2+ > Zn2+ > Ni2+ > Ca2+ > K+. The dissociation constants of iron(III) phosphate have been determined from Potentiometric titration data in the temperature range 303–323 K. In addition, the exchange of Cu2+, Zn2+ and Co2+ on iron(III) phosphate and the effect of these ions on dissociation were also studied as a function of concentration, temperature and solution pH value. The thermodynamic parameters ΔH0, ΔS0 and ΔG0 for the dissociation of iron(III) phosphate are also presented.

Temperature and pH Effect on the Sorption of Divalent Metal Ions by Silica Gel

The sorption of Zn2+, Ni2+ and Cd2+ ions by silica gel was studied as a function of ion concentration, pH and temperature. An increase in all three parameters led to an increase in the extent of sorption for all the metal cations studied. The selectivity of the solid was observed to be in the order Zn2+ > Ni2+ > Cd2+. Sorption of the metal cations was accompanied by the release of H+ ions into the bulk phase. On average two moles of H+ ions were released per mole of metal cation sorbed. The sorption data fitted the linear forms of both the Kurbatov and Langmuir adsorption equations. The values of the binding constants were used to estimate the apparent thermodynamic parameters, ΔH and ΔS, for the adsorption process. FT-IR spectroscopic studies also showed that the uptake of metal cations by the silica gel occurred via a cation-exchange process.

Sorption of Metal Ions on a Mixed Oxide [0.5 M SiO2:0.5 M Fe(OH)3]

The sorption of Zn2+, Ni2+, Cd2+, Ca2+ and Mg2+ ions on to a mixed oxide of iron and silicon was found to increase with increasing temperature, concentration and pH of the system. The selectivity of this mixed oxide was Cd2+ ≥ Zn2+ ≥ Ni2+ > Ca2+ > Mg2+, indicating that the mixed oxide was more selective as an exchanger towards Cd2+ ions relative to its components, SiO2 and Fe(OH)3. The sorption data fitted the linear forms of the Kurbatov and Langmuir adsorption equations. The sorption of metal cations was accompanied by the release of H+ ions to the bulk phase. On average 1 mol H+ was released for every cation sorbed. The values of the binding constants were used to estimate the apparent thermodynamic parameters, ΔH and ΔS. The phenomenon of enthalpy/entropy compensation showed that the adsorption of metal ions by the mixed oxide occurred typically through a cation-exchange mechanism.

Cation-Exchange Properties of CrPO4

Alkali metal ion exchange (Li+, Na+ and K+) on chromium phosphate (CrPO4) was studied potentiometrically as a function of temperature and metal ion concentration. The shift in the potentiometric titration curves corresponding to the exchange of alkali metal cations increased with increasing pH and concentration of the metal ions, while the opposite results were obtained by increasing the temperature of the system. The affinity of the exchanger for alkali metal ions was also found to be in the order Li+ > Na+ > K+. The data were employed to evaluate the apparent deprotonation constants of CrPO4 and the corresponding thermodynamic parameters ΔH0, ΔS0 and ΔG0.

Temperature Effect on the Surface Properties of ZnO(am)

The point of zero charge and surface acidity constants of zinc oxide were determined over the temperature range 293–323 K. Both the point of zero charge (pzc) and the surface acidity constants (pKa1 and pKa2) were found to decrease with increasing temperature. The values of the dissociation constants (pKa1 and pKa2) determined from the Henderson-Hasselbach equation agreed very well with those determined using the Gaines-Thomas equation. The thermodynamic parameters ΔH0 and ΔS0 for the processes were also evaluated.