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Eaton J, Baingana F, Abdulaziz M, Obindo T, Skuse D, Jenkins R. The negative impact of global health worker migration, and how it can be addressed. Public Health 2023; 225:254-257. [PMID: 37949017 DOI: 10.1016/j.puhe.2023.09.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 11/12/2023]
Abstract
International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.
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Affiliation(s)
- J Eaton
- London School of Hygiene and Tropical Medicine, UK.
| | - F Baingana
- World Health Organization, African Regional Office, People's Republic of Congo
| | - M Abdulaziz
- Africa Centres for Disease Control and Prevention, Ethiopia
| | - T Obindo
- Association of Psychiatrists in Nigeria and University of Jos, Nigeria
| | - D Skuse
- University College London, UK
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Alkasaby MA, Baingana F, Bosu WK, Abdulaziz M, Mwaisaka R, Kakunze A, Keita N, Saeed K, Eaton J, Walker I. Integrating mental health into emergency preparedness and response: lessons learned from Covid-19. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The COVID-19 crisis has disrupted health systems all over the world. In a survey by the WHO, 93% of the countries reported disruption in their mental health services. This research assessed the extent to which mental health was included in the national response to the COVID-19 pandemic in African countries. It also explored barriers and enablers to mental health integration into the COVID-19 response. Lessons learned from COVID-19 can help improve the response to future public health emergencies.
Methods
A web-based survey was sent to mental health focal points in 55 African countries. The survey assessed the perceived degree of implementation of the Inter-Agency Standing Committee (IASC) “14 Globally Recommended Activities” for mental health response to COVID-19. This was followed by in-depth interviews to explore barriers and enablers to mental health integration into the COVID-19 response.
Results
Responses were received from 28 countries. Lack of political will, poor funding, limited human resources, and weak pre-existing mental health systems were the key challenges in addressing mental health needs during COVID-19. Participants highlighted the need to capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the longer term. They have also stressed the importance of sustaining and strengthening the new partnerships and service delivery models that emerged during the COVID-19 pandemic.
Conclusions
The number of recommended mental health activities implemented during the COVID-19 pandemic varied considerably across African countries. Several factors limit mental health integration into emergency response. However, there are signs of optimism, as mental health gained some attention during COVID-19, which can be built on to integrate mental health into emergency response and strengthen health systems in the long term.
Key messages
• Capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the long term.
• Sustain and strengthen the new partnerships and service delivery models that emerged during the COVID-19 pandemic.
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Affiliation(s)
- MA Alkasaby
- UK Public Health Rapid Support Team, UK Health Security Agency, LSHTM , London, UK
- Centre for Global Mental Health, LSHTM , London, UK
| | - F Baingana
- Regional Advisor for Mental Health, WHO Regional Office for Africa , Brazzaville, Congo (Brazzaville)
| | - WK Bosu
- West African Health Organisation , Bobo-Dioulasso, Burkina Faso
| | - M Abdulaziz
- Africa Centres for Disease Control and Prevention , Addis Ababa, Ethiopia
| | - R Mwaisaka
- East, Central and Southern African Health Community , Arusha, Tanzania
| | - A Kakunze
- Africa Centres for Disease Control and Prevention , Addis Ababa, Ethiopia
| | - N Keita
- West African Health Organisation , Bobo-Dioulasso, Burkina Faso
| | - K Saeed
- Regional Advisor for Mental Health, WHO Regional Office for Eastern Mediterranean , Cairo, Egypt
| | - J Eaton
- Centre for Global Mental Health, LSHTM , London, UK
- CBM Global Disability and Inclusion , Amstelveen, Netherlands
| | - I Walker
- Office for Health Improvement and Disparities, Department of Health and Social Care , London, UK
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Quiñonez F, Abdulaziz M, Abd-Alhameed R. UHF Radio Channel Measurements and Prediction for Maritime Communications. Proceedings of 2nd International Multi-Disciplinary Conference Theme: Integrated Sciences and Technologies, IMDC-IST 2021, 7-9 September 2021, Sakarya, Turkey 2022. [DOI: 10.4108/eai.7-9-2021.2314956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Stothers L, Locke JA, Abdulaziz M, Lazare D, Kavanagh A, Macnab A. Standing open magnetic resonance imaging improves detection and staging of pelvic organ prolapse. Can Urol Assoc J 2021; 16:E20-E24. [PMID: 34464248 DOI: 10.5489/cuaj.7244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The role of imaging in pelvic organ prolapse (POP) assessment is unclear. Open magnetic resonance imaging (MRI) systems have a configuration that allows for imaging women with POP in different positions. Herein, we use a 0.5 Tesla open MRI to obtain supine, seated, and standing images. We then compare these images to evaluate the impact of posture on detection and staging of POP. METHODS Women presenting with symptoms of POP at a tertiary care university hospital were asked to participate in this prospective cohort study. Symptom scores, POP-Q staging and three-position MRI imaging of the pelvis data were collected. The pubococcygeal line (PCL) was used to quantify within-patient changes in pelvic organ position as defined by: no displacement, <1 cm inferior to the PCL, mild (1-3 cm), moderate (3.1-6 cm), and severe (>6 cm) in the axial and sagittal T2-weighted images. Statistical analysis was completed (T-test; p<0.05 significant). RESULTS A total of 42 women, age range 40-78 years, participated. There was a significant difference in the mean values associated with anterior prolapse in the supine (0.7±1.8), seated (2.4±3.4), and upright (4.2±1.6) positions (p=0.015). There was a significant difference in the mean values associated with apical prolapse in the supine (0.5±1.5), seated (1.5±1.4), and upright (2.1±1.5) positions (p=0.036). CONCLUSIONS Our findings suggest that POP is more readily detected and upstaged with standing MRI images as compared to supine and seated positions. The developed two-minute standing MRI protocol may enable clinicians to better assess the extent of POP.
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Affiliation(s)
- Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD).,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer A Locke
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Marwa Abdulaziz
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Darren Lazare
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD)
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, South Africa
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Abdulaziz M, Kavanagh A, Stothers L, Macnab AJ. Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women. Can Urol Assoc J 2018; 12:E453-E460. [PMID: 29989885 DOI: 10.5489/cuaj.5186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In pelvic organ prolapse (POP), posture and gravity impact organ position and symptom severity. The advanced magnet configuration in open magnetic resonance imaging (MRO) allows patients to be imaged when sitting and standing, as well in a conventional supine position. This study evaluated if sitting and standing MRO images are relevant as a means of improving quantification of POP because they allow differences in organ position not seen on supine imaging to be identified. METHODS Forty women recruited from a university urogynecology clinic had MRO imaging (0.5 T scanner) with axial and sagittal T2-weighted pelvic scans obtained when sitting, standing, and supine. Pelvic reference lines were used to quantify the degree of POP, and the relevance of imaging position on the detection of POP compared. RESULTS Images from 40 participants were evaluated (20 with POP and 20 asymptomatic controls). Our results indicate that the maximal extent of prolapse is best evaluated in the standing position using H line, M line, mid-pubic line, and perineal line as reference lines to determine POP. CONCLUSIONS MRO imaging of symptomatic patients in a standing position is relevant in the quantification of POP. Compared with supine images, standing imaging identifies that greater levels of downward movement in the anterior and posterior compartments occur, presumably under the influence of posture and gravity. In contrast, no appreciable benefit was afforded by imaging in the sitting position, which precluded use of some reference lines due to upward movement of the anorectal junction.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine, Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Lynn Stothers
- Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Andrew J Macnab
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
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Abdulaziz M, Stothers L, Macnab A. MP63-09 A CLINICAL PROTOCOL FOR 3D IMAGE RECONSTRUCTION OF THE FEMALE PELVIS AND LEVATOR ANI DEFECTS SEEN WITH UPRIGHT POSTURE USING UPRIGHT OPEN MRI (MRO) IMAGING. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abdulaziz M, Deegan EG, Kavanagh A, Stothers L, Pugash D, Macnab A. Advances in basic science methodologies for clinical diagnosis in female stress urinary incontinence. Can Urol Assoc J 2017; 11:S117-S120. [PMID: 28616108 DOI: 10.5489/cuaj.4583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We provide an overview of advanced imaging techniques currently being explored to gain greater understanding of the complexity of stress urinary incontinence (SUI) through better definition of structural anatomic data. Two methods of imaging and analysis are detailed for SUI with or without prolapse: 1) open magnetic resonance imaging (MRI) with or without the use of reference lines; and 2) 3D reconstruction of the pelvis using MRI. An additional innovative method of assessment includes the use of near infrared spectroscopy (NIRS), which uses non-invasive photonics in a vaginal speculum to objectively evaluate pelvic floor muscle (PFM) function as it relates to SUI pathology. Advantages and disadvantages of these techniques are described. The recent innovation of open-configuration magnetic resonance imaging (MRO) allows images to be captured in sitting and standing positions, which better simulates states that correlate with urinary leakage and can be further enhanced with 3D reconstruction. By detecting direct changes in oxygenated muscle tissue, the NIRS vaginal speculum is able to provide insight into how the oxidative capacity of the PFM influences SUI. The small number of units able to provide patient evaluation using these techniques and their cost and relative complexity are major considerations, but if such imaging can optimize diagnosis, treatment allocation, and selection for surgery enhanced imaging techniques may prove to be a worthwhile and cost-effective strategy for assessing and treating SUI.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine; University of British Columbia, Vancouver, BC, Canada
| | - Emily G Deegan
- Masters Candidate, Department of Experimental Medicine; University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences; University of British Columbia, Vancouver, BC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences; University of British Columbia, Vancouver, BC, Canada
| | - Denise Pugash
- Department of Radiology, BC Women's Hospital; University of British Columbia, Vancouver, BC, Canada
| | - Andrew Macnab
- Department of Urologic Sciences; University of British Columbia, Vancouver, BC, Canada
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Abdulaziz M, Deegan EG, Stothers L, Pugash D, Macnab A. Advances in basic science methodologies for clinical diagnosis in female stress urinary incontinence. Can Urol Assoc J 2017. [DOI: 10.5489/cuaj.4582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We provide an overview of advanced imaging techniques currently being explored to gain greater understanding of the complexity of stress urinary incontinence (SUI) through better definition of structural anatomic data. Two methods of imaging and analysis are detailed for SUI with or without prolapse: (1) open magnetic resonance imaging with or without the use of reference lines, and (2) 3D reconstruction of the pelvis using MRI. An additional innovative method of assessment includes the use of near infrared spectroscopy (NIRS), which uses noninvasive photonics in a vaginal speculum to objectively evaluate pelvic floor muscle (PFM) function as it relates to SUI pathology. Advantages and disadvantages of these techniques are described. The recent innovation of open-configuration magnetic resonance imaging allows images to be captured in sitting and standing positions, which better simulates states that correlate with urinary leakage and can be further enhanced with 3D reconstruction. By detecting direct changes in oxygenated muscle tissue, the NIRS vaginal speculum is able to provide insight into how the oxidative capacity of the PFM influences SUI. The small number of units able to provide patient evaluation using these techniques and their cost and relative complexity are major considerations, but if such imaging can optimize diagnosis, treatment allocation, and selection for surgery enhanced imaging techniques may prove to be a worthwhile and cost-effective strategy for assessing and treating SUI.
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Abdulaziz M, Stothers L, Lazare D, Macnab A. An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse. Can Urol Assoc J 2015. [PMID: 26225188 DOI: 10.5489/cuaj.2783] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pessary use is the preferred non-surgical treatment option for female pelvic organ prolapse. As pessaries can be used chronically to alter pelvic floor anatomy, consideration of short-and long-term complications is important in patient management. We systematically reviewed articles describing the complications of pessary use to determine frequency and severity. METHODS A systematic search via MEDLINE and PubMed using the key terms "complications," "pessary," "pelvic organ prolapse," "side effects" was conducted for the years 1952 to 2014 inclusively. Selected articles cited in the publications identified were also considered. Only full-text material published in English was reviewed. All pessary-related complications described were collated; overall frequency within case reports and case series were calculated and severity was graded using the Clavien-Dindo classification. RESULTS In total, 61 articles met the inclusion criteria. The most common complications reported were vaginal discharge/vaginitis, erosion, and bleeding. Complications were related to pessary shape and material, and duration in situ. Clavien-Dindo classification of complication severity found that all 5 grade levels were attributed to pessary use; serious grade 4 and 5 complications included cancer, adjacent organ fistula and death. CONCLUSION There are few detailed reports of complications of pessary use relative to the estimated frequency of pessary use worldwide. Prospective studies documenting complications by shape, material, and size, and objectively classifying complication severity are required. As serious grade 4 and 5 complications of pessary use occur, further development of clinical follow-up guidelines for long-term pessary users is justified.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine, University of British Columbia, Vancouver, BC
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Darren Lazare
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Tadesse N, Bheemalingeswara K, Abdulaziz M. Hydrogeological Investigation and Groundwater Potential Assessment in Haromaya Watershed, Eastern Ethiopia. mejs 2010. [DOI: 10.4314/mejs.v2i1.49649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Priori R, Paroli MP, Luan FL, Abdulaziz M, Pivetti Pezzi P, Valesini G. Cyclosporin A in the treatment of relapsing polychondritis with severe recurrent eye involvement. Br J Rheumatol 1993; 32:352. [PMID: 8461940 DOI: 10.1093/rheumatology/32.4.352] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Pivetti-Pezzi P, Priori R, Catarinelli G, Meroni PL, Federici AB, Abdulaziz M, Falco M, Valesini G. Markers of vascular injury in Behçet's disease associated with retinal vasculitis. Ann Ophthalmol 1992; 24:411-4. [PMID: 1476395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The pathogenesis of vascular damage in Behçet's disease (BD) is still unknown. We investigated anticardiolipin antibodies (AC) in a genetically homogeneous group of Italian patients with BD and retinal vasculitis. In a subset, we examined the level of factor VIII-related antigen and antiendothelial cell antibodies (AECA). We found a high prevalence of AC; AECA were not found in most of our patients. Only three patients had raised levels of factor VIII-related antigen, all of whom had systemic involvement. We believe BD may be considered as a vasculitis of unknown origin in which several and different pathogenetic factors may play a role.
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Affiliation(s)
- P Pivetti-Pezzi
- Istituto di Oftalmologia, Universita La Sapienza di Roma, Italy
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