Introduction: Although there are several international cleft-care organizations, there are variations in how these organizations are structured. The purpose of this paper was to analyze international cleft-care organizations based out of the United States. We provided an analysis of each, with a specific focus on team structure, funding, location, and model of care. Methods: A systematized review was conducted using PubMed using specific MeSH terms and related keywords. Organizations screened had to have the following inclusion criteria: (1) be based out of the United States (2) have a valid web presence. Results: Nineteen unique international cleft-care organizations were identified in the database search. Most international cleft-care organizations included in this review had originally started with the vertical model and, over time, adopted a diagonal approach including a team-based structure, resulting in an increased need for volunteers. Most organizations reviewed in this paper also demonstrated expansion of care beyond cleft lip and/or palate treatment. The cost of trip per volunteer was variable. The number of trips per year ranged from a minimum of one trip per year to a maximum of 150 trips. Conclusion: Throughout the analysis of each international cleft-care organization, a common theme of sustainability and self-sufficiency was present. The data compiled in this manuscript enables critical appraisal of various cleft-care organizations, comparison of different models of care, and provides insight on engaging in international cleft-care initiatives.
Air pollution is responsible for one in eight deaths globally per year. The severity of air pollution and its effects on global health are frequently discussed in the literature but are poorly reflected in health policy and have not yet resulted in sufficient actionable change. Air pollution mitigation policies should embody the planetary health concept, which highlights the interdependence between the health of humans and the planet. There is an urgent need for the standardisation of air quality measurement and programmes on a global scale. A reduction in fine particulate matter has been shown to contribute to the greatest degree of public health benefits. Current efforts to improve urban air quality include a significant focus on the transition to sustainable energy and transportation through the electrification of transportation. There are two main fronts in the campaign against pollution, one being the reduction of anthropogenic emissions through public and government policy, and the other being the introduction of novel attempts to decrease pollution and other innovative research to develop new approaches that will ultimately improve global health.
Introduction: Employment is a major social determinant of health (SDoH) and core socioeconomic status (SES) indicator. This study used a nationally representative sample of American adults to test the association between employment and self-rated health (SRH) overall and by race. Methods: Using data from the Health Information National Trends Survey (HINTS 2020) Cycle 4, this analysis included 1403 individuals including 1109 (79%) non-Latinx White and 294 (21%) non-Latinx Black participants. The dependent variable was SRH, the independent variable was employment, and age, sex, marital status, education, and income were the covariates. Race was the moderator. Results: Employment was associated with better SRH overall. A significant statistical interaction reflected racial differences in the effect of employment (above and beyond education and income) on SRH by race. The protective health effects of employment on SRH were weaker for non-Latinx Black than non-Latinx White individuals. Conclusion: The association between employment and SRH varies across racial groups, and this difference can also be seen during the COVID-19 pandemic. Diminished health returns of SES indicators such as employment in non-Latinx Black individuals compared to non-Latinx White people may reflect some additional health risk for middle-class non-Latinx Black communities in the US. Sustainability of marginalization-related diminished returns (MDRs), defined as weaker effects of social determinants and resources such as employment on health outcomes for marginalized than privileged social groups, is another risk for underserved populations during pandemics. These MDRs that reflect systemic inequalities may hinder our efforts to secure equality during pandemics.
Introduction: Angiotensin-converting enzyme 2 (ACE2) is the central receptor of coronavirus disease 2019 (COVID-19) in host cells. Genetic polymorphisms in the ACE2 gene may promote cardiovascular disease and systemic inflammatory injury in a patient affected by COVID-19. Thus, the genetic background may account for the substantial inter-individual diversity in illness susceptibility or severity. Our study was conducted to find a significant relationship between ACE2 rs4646142 and rs2285666 polymorphisms and susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: In this study, we randomly selected 230 samples, including 76 patients with severe clinical symptoms and 154 patients with mild clinical symptoms (the positive case of COVID-19 was confirmed by real-time reverse transcriptase polymerase chain reaction [RT-PCR] assay). Then, we performed DNA extraction and investigated the polymorphisms of rs2285666 and rs4646142 by RFLP-PCR method with TaqI and Alu1 restriction enzymes. Results: The study population included 107 men and 123 women, and the mean (±SD) age of the participants was 42.66±10.2. First, the levels of IgM and IgG were examined, and a significant association was observed in the level of IgM between the two groups of COVID-19 patients with mild and severe symptoms, as opposed to IgG. Meanwhile, no significant difference was observed between ACE2 rs4646142 and rs2285666 polymorphisms and the severity of COVID-19. Conclusion: To better understand the genetic variations in people’s susceptibility to COVID-19, this study was designed to evaluate the association between various ACE2 polymorphisms and the infection risk of SARS-CoV-2. However, no statistical difference was discovered.
Introduction: The African Americans’ health paradox can be defined as better subjective health held of African American individuals compared to White individuals, despite their higher objective and medical adversities such as chronic medical conditions (CMCs). This phenomenon depicts African Americans’ relative resilience (advantage). However, most of the existing literature on this topic is limited to studies comparing African Americans and Whites. There is little research, if any, on this phenomenon among other ethnic groups. To fill this gap in the literature, this study tests the African Americans’ health paradox with consideration of Latinos as the control group. Methods: This cross-sectional study collected demographic data, socioeconomic status, CMCs, and subjective health of 734 African American and Latino older adults residing in south Los Angeles. Logistic regression was used for data analysis. Results: 118 Latino and 616 African Americans entered our study. Overall, a higher number of CMCs was associated with lower subjective health, however, a statistically significant interaction between ethnicity and the number of CMCs suggested that this association is weaker for African Americans than Latinos, which is the African American health paradox. Conclusion: African Americans with a higher number of CMCs report better subjective health compared to Latinos with the same number of CMCs. This finding is indicative of a relative advantage of African Americans compared to other ethnic groups.
Antibiotic resistance is primarily propagated by mobile genetic elements (MGEs) around the world. As a result, antibiotic resistance genes can be found in a wide spectrum of environmental microorganisms. Environmental bacteria are not resistant to all antibiotics now accessible, despite long histories of antibiotic development and exposure. As a result, obtaining a complete resistance arsenal will be challenging. The goal of this study is to look at how the mobility of resistance determinants influences antimicrobial resistance spread. The sources, distribution, and development of resistance mechanisms in various microorganisms and bacterial populations are mosaic features that act as barriers to the spread of bacterial pan-resistance. This is critical information for a better understanding of the genesis of resistance in hazardous bacteria, which could lead to improved antibiotic therapy and the creation of new medications.
Following the discovery and identification of Vibrio cholerae, cholera disease continues to be a burden on the global community, including Nigeria. In this article, we provide an inclusive review on antimicrobial resistance (AMR) in cholera and the need for its quick interventions. Cholera spread over Asia and other continents, majorly because of poor hygiene practises since 1817, and still exists. This agent secretes a toxin called cholera toxin (CT) after ingestion of contaminated water and/or food, which adheres to the cells in the intestinal epithelial, leading to symptoms such as watery diarrhea, fever, and even death if not treated. Many antimicrobials such as tetracycline, trimethoprim/sulfamethoxazole, and ampicillin, previously effective in cholera therapy, are now reported ineffective due to emerging and developing AMR strains of V. cholerae. AMR in cholera continues to be a major public health concern. Various outbreaks have been reported in Nigeria since the 1970s. This is as a result of the acquisition of resistance genes and/or mutation. Also, irrational usage of antibiotics by people. Promising approaches such as probiotics, vaccines, phage therapy, provision of safe water and proper hygiene are ways to avert the outbreak of cholera and resistant strains in Nigeria.
Introduction: Blastomycosis is an endemic granulomatous fungal infection involving multiple organ systems predominantly the lungs. The diverse clinical spectra of the pulmonary disease encompass a subclinical infection, an acute infection mimicking a bacterial pneumonia and a chronic variant masquerading as tuberculosis or malignancy. Case Presentation: Here we report a case of a middle-aged gentleman who was evaluated for a malignant pulmonary mass which was later identified as pulmonary blastomycosis. The diagnosis of blastomycosis was made through histopathology and was retrospectively corelated with a travel history to an endemic region. Conclusion: The endemicity of this infection contributes to the diagnostic dilemma in the non-endemic setup. This warrants a high clinical suspicion in patients with a chronic pulmonary syndrome with a travel history to an endemic area.
Brain drain is a term used to describe the migration of highly skilled or educated people from their home country to other locations across the world. One of the existing strategies to combat the brain drain of medical students and graduates from poorer countries is the practice of conditional or bonded scholarships. Conditional scholarships have been relatively successful in stemming brain drain and have been implemented all over the world, even in developed nations such as the USA, Kuwait, and Australia, although this perspective focuses on Nepal and Malaysia as developing countries. While bonding has proven to be effective in reducing the emigration of medical graduates from poorer to wealthier countries, it is not a perfect solution. In this policy review we argue on ethical grounds that it may not be truly justifiable to limit the freedom of movement of medical graduates. Another problem associated with bonding schemes is that they further widen the gap between rich and poor in developing nations. Most countries that implement this compulsory service following graduation allow a means to escape the bond through monetary payments, which may be equivalent to the cost of their undergraduate medical education. The problem arises when wealthier graduates can pay this cost and emigrate to countries with better resources, salaries, and opportunities, while poorer students remain in their home countries. An analysis of the factors that push medical graduates away from their home countries and pull them to countries abroad is provided.
Introduction: Points of entry (PoE) in Pakistan serve as key conduits for international travel, transport, and trade. Central Health Establishment (CHE) is a key stakeholder in the implementation of the International Health Regulations 2005 (IHR) core capacities at PoE and National Action Plan 2020 against COVID-19. A comprehensive screening plan for COVID-19 was carried out effectively despite limitations. Methods: A descriptive study on CDC guidelines for health screening at PoE was conducted from February 2020 to March 2021. Guidelines are based on 11 attributes to be implemented; these include legal and regulatory bodies to detain the travelers as suspect, isolate, and coordinate at PoEs, funds for screening, well-equipped quarantine facilities, referral health care facilities, protocols for primary and secondary screening, capacity building, supply of personal protective equipment and screening tools, and provision of basic facilities at isolation areas. Data were collected using both qualitative and quantitative methods from health officers and quarantine assistants of PoEs. The analysis of CHE’s information system was performed to assess the management of traveler surveillance. Results: Eleven attributes were addressed for health screening according to CDC guidelines and well implemented at PoE by CHE under the flagship of the MNHR&C. Primary health screening of 4,088,119 inbound travelers was conducted. Secondary health screening led to the referral of performed at airports for inbound travelers, with a positivity rate of 0.32. Conclusion: Preparedness and response for COVID-19 at PoE are in line with the National Action Plan of the Government of Pakistan and IHR (2005).
Introduction: Medical tourism is developing more rapidly, particularly in developing countries, as a tool to enhance economic growth and achieve a competitive position. The present study aims to investigate and identify contributory factors to the competitiveness of Iran’s medical tourism using importance-performance analysis. Methods: This is an applied study with a descriptive nature conducted using field studies and surveys. A conceptual model was adopted and contributory factors were extracted from previous studies. A questionnaire was designed based on extracted factors and opinions of experts who are specialists in the field of medical tourism. The statistical population consisted of tourism experts, health experts, physicians, and medical staff working in hospitals with international units. Data analysis was performed using SPSS. Results: The results showed that "medical services" were more important than the two components "special factors of tourism" and "characteristics of medical tourism destinations". It was also revealed that the current situation of "medical tourism destination characteristics" is unfavorable compared to the other two components. Conclusion: This study provided an insight into the importance and quality of performance of the factors affecting the competitiveness of medical tourism, which can be beneficial for managers and planners in Iran and other medical tourism destinations.
Soccer activities in Brazil are in the eminency of returning with the public. The fans’ return was the choice of 18 of the 20 clubs in the first division, even though high transmission rates are described between the athletes. Additionally, preventive measures are still not being taken considerably, both in relation to the athletes and the fans at stadium entrances. Although vaccination rates have been advancing, most lowincome countries are still not with desirable vaccination rates for herd immunity. The absence of preventive measures and the returning of soccer activities are a concerning issue for returning. The paper by Ruiz-Lozano et al, highlights this finding, that both deaths and cases of deaths by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have considerably increased during the European Soccer Championship.1 However, preventive measures alone may be quite interesting to avoid SARS-CoV-2 transmission, which justifies the public’s non-return. Considering only athletes, the paper by Krug et al,2 described that some preventive measures taken were able to reduce the spread of SARS-CoV-2 (ice hockey athletes), and resulted in zero cases of SARS-CoV-2 infection in the athletes, considering a total time bigger than 500 practices and games and at least 15. 858 athlete-hours. Krug et al, highlight that the transmission appears to be more likely in congested indoor areas involving adults than in the game space.2 Therefore, we highlight the importance of a protocol that considers fewer opportunities for crowded indoor areas (e.g., not using changing rooms in stadiums, but using bathrooms in hotel rooms that delegations have concentrated; transport in vehicles for small groups or even just with a driver; food in an individual environment, such as in the hotel room) should be a rule to be accomplished by athletes and organizers of these events. We highlight that if the transmission control with a few dozen athletes is difficult to control, we should increase transmission rates considering thousands of fans in the ten stadiums that host games in the Brazilian championship. Additionally, Krug et al reported that during the 18 weeks of follow-up of the ice hockey tournament, high stringency preventive measures protocols reduced to zero cases of SARS-CoV2 transmission. This finding supports how the need of preventive measures to avoid transmission.2 Especially in Brazil, this critical finding brought us to reflect regarding the need for strict preventive measures for sanitary safety of soccer championships that have gradually returned. In fact, a recent study revealed that the new infection rate of SARS-CoV2 in the state of São Paulo was 11.7% and 7.2% for athletes and staff, respectively, during soccer events, after the resuming of the championships.3 Brazil has recently held one of the main Latin American soccer championships, the Conmebol American Coup 2021, competing in around 10 nations. Some of them had a high incidence of SARS-CoV2 infection. Previously, Argentina and Colombia had declined to host the event because they were unable to fulfill their http://ijtmgh.com Int J Travel Med Glob Health. 2022 Feb;10(1):44-45 doi 10.34172/ijtmgh.2022.08 TMGH IInternational Journal of Travel Medicine and Global Health J
Introduction: While socioeconomic status (SES) indicators such as household income are known to be associated with larger cortical surface area, recent research on Marginalization-related Diminished Returns (MDRs) suggests that family SES indicators such as household income may have weaker effects on brain function and structure for non-White (marginalized) than White (privileged) families: a pattern that reflects structural and societal inequalities deeply intertwined into the United States social fabric. Methods: This is a cross-sectional study that used baseline data from the Adolescent Brain Cognitive Development (ABCD) study. Data was collected between 2016 and 2018. Overall, 6039 9–10-year-old children entered our analysis. The independent variable was household income. The moderator was race. The primary outcome was the overall cortical surface area. Age, sex, and family structure were the covariates. We used mixed effects regression models that adjusted for data analysis because ABCD data is nested into families, centers, and US states. Results: While high household income was associated with larger cortical surface area, this effect was weaker for Asian than non-Hispanic White children. This racial heterogeneity in the effects of household income on cortical surface area was documented by a statistically significant interaction between race and household income on cortical surface area. Conclusion: For American children, household income does not similarly correlate with cortical surface area of diverse racial groups. Brain development in the US is not solely a function of SES (availability of resources) but also how social groups are racialized and treated in the society. In the US, race, as a proxy of racism, limits how much SES can affect brain structures such as cerebral cortex. Due to racialization, segregation, discrimination, and marginalization, racial minority children may experience weaker effects of SES. Structural inequalities should be addressed to equalize the return of SES resources across racially diverse families.
Introduction: A cluster of novel coronavirus disease 2019 (COVID-19) linked to an international traveller was reported in Kedah, Malaysia in July 2020. This study aimed to report data of a local community cluster of COVID-19 with a view to document the lessons learnt and to identify key points for future containment strategy in response of the ongoing pandemic. Methods: Epidemiological and clinical data from individuals with confirmed cases of COVID-19 within this cluster were collected via interviews and in-patient medical records. All data were analysed, and socio-demographic and clinical characteristics of all cases were presented. Results: Total of 31 cases of COVID-19 were confirmed and linked epidemiologically in Kedah state. The index case was identified and reported to breach quarantine order for international traveller given by health authority. The virus transmission widely spread among family members, restaurant customers and later in the community. Conclusion: Non-adherence to the preventive measures is the driving factor for the widespread of this cluster infection. Active contact tracing, aggressive containment measures, and effective risk communication are important to control the virus transmission in this locality.
Introduction: Ill health and poor physical and mental conditioning adversely affects pilgrims’ ability to optimally perform the arduous physical rituals of Hajj. We postulate that a supervised, pre-departure exercise programme improves their health status and may reduce morbidity. Methods: Ninety-three accredited pilgrims completed a 6-12 weeks graduated, supervised walking programme designed to get the participants fit to do a 10 km walk. Assessments including a morbidity survey, a six-minute walk test, and a POMS (Profile of Mood States) were conducted before and immediately after the exercise programme. A morbidity questionnaire, the six-minute walk test, and POMS were completed post-Hajj (n=88). A group of 200 non-matched pilgrims who were not part of the exercise programme, were approached post-Hajj to fill in the morbidity questionnaire, with eight-two responding. Results: Results for 88 participants were available with 13.7% reporting medical events during the Hajj period, significantly less than the non-participants (62.2% of 82 respondents), and less when compared to other studies (up to 91%). The mean distance recorded in the six-minute walk test increased by 5% after the exercise programme (481.3 meters before to 506.3 m after) and 3% after Hajj (520.7 m). Similar positive changes in the POMS were noted across the three time periods. The resting heart rate did not show significant changes. Conclusion: This study shows that a supervised exercise programme for Hajj pilgrims has a positive effect on their physical and mental conditioning, which may reduce morbidity. Larger controlled trials are warranted to determine the optimum dose of exercise.
Introduction: The prevalence of anemia among patients with malaria is very common from subsequent erythrocytes destruction and should be managed most appropriately. This study aimed to explore the changes in hematological parameters and their underlying influence among people with uncomplicated Plasmodium falciparum infection. Methods: A cross-sectional study was conducted among uncomplicated malaria patients infected by P. falciparum on community-based active screening days in one of the highest malaria hot-spot areas of northwestern Cambodia. Descriptive statistics, and student t-tests were used to analyze the data. Results: Among 103 malaria blood samples, the results showed that most participants had thrombocytopenia (84.5%). More than onehalf of the participants presented normal levels of the following hematological parameters: red blood cells, hemoglobin, hematocrit, mean corpuscular volume (MCV) and red cell distribution width (RDW). A significant correlation was noted between parasite counts and three body mass index (BMI) groups (P=0.047). Next, a strong association was also seen between parasite counts and body temperature (P = 0.03). Statistically significant differences in parasite count were observed across three levels of neutrophil (P=0.005), lymphocyte (P=0.001), eosinophil (P<0.001), absolute lymphocyte (P=0.001) and absolute eosinophil (P<0.001) counts. Conclusion: The results of this study revealed the significant role of hematological parameters in predicting the presence of malaria infection, parasite density, and forecasting adverse consequences of malaria, together with the underlying risk factors.
Introduction: The COVID-19 pandemic has widely affected medical tourism on a global scale, thereby reducing the number and volume of medical services. Given the importance of this topic, the present study aimed to determine the challenges of medical tourism after the prevalence of COVID-19 in the field of neurosurgery. Methods: The present descriptive study was conducted by the neurosurgery department of Isfahan University of Medical Sciences, Isfahan, Iran in the first quarter of 2022. Using the convenience sampling method and based on Morgan’s table, 500 patients with neurosurgical diseases registered in Medical Tourism companies were identified and included in the study. The data were analyzed in SPSS. Results: 142 (28.4%) out of 500 patients with COVID-19 were willing to come to Iran for neurosurgical treatment. The most important non-medical reasons included natural attractions (4.37±0.44), cost-effective accommodation (4.03±0.23), and support from a country of destination (place of residence) (3.75±0.22). The most important medical reasons included the short waiting list, the fast treatment response (4.26±0.76), the availability of qualified doctors (3.96±0.27), and the low-cost treatment (3.87±0.53). Conclusion: The present study focused on the functions and potentials of medical tourism in neurosurgery. It can be more successful by providing the right conditions to improve the current situation.
Introduction: Kleine-Levin syndrome (KLS) is a rare disorder often associated with recurrent hypersomnia, first described by Klein in 1925 but named in 1942 by Critchley and Hoffman. KLS is more common in adolescence and is also more common in men than women. It must be distinguished from repetitive depressive disorder, or psychotic disorder. Case Presentation: In this report, we present a 27-year-old woman with KLS who showed symptoms such as overeating and mood changes, unwillingness to talk to anyone, and a sedentary lifestyle. Meanwhile, during these periods, other symptoms such as lack of speech, decreased energy, lethargy, and slowness of mental and mood movements were observed in the patient. Eventually, with lithium consumption, her symptoms improve significantly. However, the exact cause of this syndrome and its definitive treatment is still unknown and will require further reports and studies. Conclusion: According to the reported case, KLS may be triggered by travel and migration, and in such a situation, may respond well to lithium.
The coronavirus disease 2019 (COVID-19) has persisted as a pandemic for just over two years; vaccines have been developed to prevent the clinical disease and treatment regimens improved upon, but severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears to be up to the task, coming up with mutations resulting in multiple variants, alpha, beta, delta, Omicron and so much more. The most important and recent one, the omicron variant, with an amazing 50 genetic mutations, 37 of which are on the spike protein, has emerged as a massive public health problem, rapidly replacing the delta-variant and the predominant variant in many countries, and foretelling a new and likely more devastating wave of the pandemic. To deliver a comprehensive overview to global health authorities and prospective readers worldwide, we detailed in this review, the properties of the Omicron Variant, its infectiousness, and the perils it poses to the general public; we also discuss the situation in Nigerian and the rest of the world alike.
Introduction: COVID-19 is a novel infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). This study was a descriptive analysis the epidemiology of COVID-19 during the first and second waves in Kwara State, North-Central Nigeria. Methods: This study investigated COVID-19 cases and deaths in Kwara State between 2nd April 2020 when Kwara State recorded her index case till the 15th of September 2020 (first wave), and between 16th September 2020 till 15th March 2021 (second wave). Case definitions of COVID-19 as obtained from the Nigeria Centre for Disease Control (NCDC) was used. Data were extracted from the case notes of patients and the Surveillance Outbreak Response Management System, and on-site activities engaged in by the field investigation team were duly captured. Results: Overall, 3015 confirmed cases of COVID-19 have been identified in Kwara State as of 15th March 2021. The median age was 38 years and ranged between 24 days to 97 years. Also, 1056 (35%) were aged 25 – 39 years, 1695 (56.2%) were males. The case fatality rate was less than 2%. A total of 1064 (35.3%) symptomatic COVID-19 cases had been identified as of the reference date, among whom 696 (65.4%) were mild, 308 (28.9%) were moderate, and 60 (5.6%) were severe/critical cases. Conclusion: COVID-19 remains a public health problem. A scale-up of COVID-19 surveillance activities should be conducted by the Ministry of Health through active case search and regular refresher training for volunteers. In addition, active community engagement should be prioritized by stakeholders in the national COVID-19 outbreak response.
