Complementary feeding indicators from the World Health Organization and the Ministry of Health: agreement analysis and comparison of estimated prevalence in a cohort of children in southwestern Bahia, Brazil, 2018

OBJECTIVE

To assess the agreement between complementary feeding indicators established by the World Health Organization (WHO) and the Ministry of Health (MOH) and to compare the prevalence of these indicators in the first year of a child's life.

METHODS

: This was a cross-sectional study in a cohort of 286 children from Vitória da Conquista, state of Bahia, Brazil; agreement between indicators and comparison between prevalences were analyzed using the Kappa coefficient and McNemar's test; the prevalence of the indicators "introduction of complementary feeding" (ICF), "minimum dietary diversity" (MDD), "minimum meal frequency" (MMF) and "minimum acceptable diet" (MAD) were calculated.

RESULTS

: Three indicators showed poor agreement, with only one demonstrating moderate agreement; prevalence of WHO indicators was higher than that of the MOH (ICF, 94.3% vs. 20.7%; MDD, 75.2% vs. 50.7%; MMF, 97.2% vs. 44.8%; MAD, 96.8% vs. 26.9%).

CONCLUSION

The majority of indicators showed poor agreement and the prevalence of WHO indicators exceeded that of the Ministry of Health.

Turkish Translation and Cross-Cultural Validity of Whoqol-HIV Bref Tool

BACKGROUND

The assessment of health-related quality of life among people living with HIV (PLWH) has gained increasing importance as it assesses their overall well-being, guides treatment decisions, and addresses psychosocial challenges, improving their quality of life. This study focuses on adapting and validating the Turkish version of the WHOQOL-HIV Bref, a tool developed by the World Health Organization (WHO) to measure health-related quality of life in PLWH. This adaptation is based on the generic WHOQOL-Bref Turkish and WHOQOL-HIV Bref inventory.

METHODS

In line with WHO guidelines, the tool was translated and tested on 189 PLWH from İstanbul Şişli Hamidiye Etfal Training and Research Hospital's HIV outpatient clinic. A variety of statistical methods were employed to assess content, construct, concurrent, and known-group validity, as well as internal consistency and reliability.

RESULTS

Participants' median age was 35 years (IQR: 14), with 178(94%) being male. The Turkish WHOQOL-HIV Bref showed overall satisfactory psychometric properties. Despite limitations in the spirituality domain, it demonstrated good internal consistency (alpha coefficient: 0.93) and strong validity across several metrics, including test-retest reliability (ICC: 0.79).

CONCLUSION

The WHOQOL-HIV BREF in Turkish is a reliable and valid instrument for assessing the quality of life in Turkish PLWH.

Study of the Vertical Transmission of COVID-19 by Using the World Health Organisation Protocol in a Tertiary Care Hospital in Eastern India

BACKGROUND

The World Health Organisation (WHO) has established criteria to diagnose vertical transmission in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to determine the incidence of vertical transmission of SARS-CoV-2 using WHO criteria in a tertiary care centre in eastern India.

METHODS

A hospital-based prospective observational study was conducted from June 2021 to February 2022 on women admitted for delivery with a positive nasopharyngeal (NP) swab and a SARS-CoV-2 real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test. Following the delivery, the amniotic fluid (AF) and swab from the placenta were tested for SARS-CoV-2 by the Truenat test. The umbilical cord and maternal blood were analyzed to detect immunoglobulin M (IgM) and immunoglobulin G (IgG). The nasopharyngeal swabs of the newborns were tested for SARS-CoV-2 by RT-PCR.

RESULTS

Forty-eight SARS-CoV-2-positive asymptomatic women were included in the study. Twenty-eight (58.3%) were delivered via cesarean section. Preterm delivery occurred in 13 (27.1%) cases. In only one case, vertical transmission was confirmed as the neonate had a positive nasopharyngeal SARS-CoV-2 RT-PCR test and the cord blood was IgM positive (suggesting an immune response in the neonate). The placenta was positive in three cases, and amniotic fluid was positive in two. However, vertical transmission was deemed unlikely in these cases as there was no evidence of immune response or viral persistence according to the WHO criteria. There was one stillbirth, and it tested negative for SARS-CoV-2.

CONCLUSION

This study strengthens the evidence of vertical transmission in COVID-19-positive asymptomatic mothers. The data suggest a low transmission rate.

The Relationship Between Communicative Actions, Behavioral Intentions, and Corporate Reputation in the Framework of Situational Theory of Problem Solving in a Public Health Crisis

Objectives: This study aims to determine the individuals' communicative actions based on the basic assumptions of the situational theory of problem solving (STOPS) and the effect of these actions on people's willingness to follow WHO's instructions in the event of an epidemic. It also seeks to determine the impact of corporate reputation on people's communicative actions and intention to follow instructions. Methods: Data were collected digitally from 261 graduate students enrolled at a state university in the Eastern Anatolia Region of Turkey. A structural equation model (SEM) was employed for data analysis. Results: Perceptual antecedents affected situational motivation, and situational motivation affected communicative actions. Communicative actions were a determining factor in individuals' willingness to follow instructions. The perception of corporate reputation influenced both communicative actions and people's willingness to follow instructions. Conclusion: The study revealed that STOPS can provide an important theoretical framework for more effective risk communication practices in public health crises such as epidemics. It also displayed the relationship between the individuals' communicative actions and their willingness to follow instructions and the determining effect of corporate reputation on both of these factors.

Monitoring progress on Antimicrobial Resistance (AMR) response in the World Health Organization African region: Insights from the Tracking AMR Country Self-Assessment Survey (TrACSS) 2021 results for the human health sector

Antimicrobial resistance (AMR) is a major 21st century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan on AMR (GAP). The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. Fifteen 15(37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.

Advancing the World Health Assembly's landmark Resolution on Strengthening Rehabilitation in Health Systems: unlocking the Future of Rehabilitation

In May 2023, the historic Resolution on Strengthening Rehabilitation in Health Systems was adopted unanimously by the 194 Member States of the World Health Assembly (WHA), the highest health policy-setting body. The resolution aims to scale up and integrate rehabilitation into health systems as part of Universal Health Coverage (UHC) to address the growing rehabilitation needs due to the global ageing population, the increasing prevalence of non-communicable diseases, and the emergence of new infectious diseases such as COVID-19. Globally, data extracted from the Global Burden of Disease Study in 2019 showed that one out of three people could benefit from rehabilitation, while more than half of the population in many countries is not receiving essential rehabilitation services. This special article highlights the global challenges in meeting rehabilitation needs and emphasizes the importance of affordable, accessible, and quality rehabilitation services for vulnerable populations. The resolution's path, which started in 2017 with the "Rehabilitation 2030: a Call for Action" initiative by the World Health Organization (WHO), is outlined. We summarize the key aspects of the WHA resolution, including its requests for Member States, international organizations, and the WHO Director-General. Finally, we discuss the way forward towards implementation, involving advocacy and concrete actions by all stakeholders, with the support of the newly established World Rehabilitation Alliance. The goal is to integrate rehabilitation into health systems worldwide, thus improving the well-being and socio-economic participation of those in need.

Leave no one behind: why WHO's regional office for Europe should prioritise children and adolescents in their program of work. A position statement from the European academy of paediatrics

Children and adolescents are no longer a priority in the most recent European Programme of Work (EPW) 2020-2025 of the World Health Organization (WHO) Regional Office for Europe. In this position statement we provide arguments for why we think this population should be explicitly addressed in this important and influential document. We firstly emphasize the persistent health problems and inequalities in access to care for children and adolescents that are challenging to solve, and thus require a continuous focus. Secondly, we urge the WHO to prioritize children and adolescents in their EPW due to the new and emerging health problems related to global issues. Finally, we explain why permanent prioritization of children and adolescents is essential for the future of children and of society.

Old Wine in new Bottles: Silver Sulfadiazine Nanotherapeutics for Burn Wound Management

According to the World Health Organization (WHO), ∼180,000 casualties are recorded every year due to burns, majorly from low- and middle-income countries that require medical attention. For the last 5 decades, silver sulfadiazine (SSD) 1% cream has been the most widely used topical antimicrobial agent for managing burn wound infections. Although SSD is considered the gold standard therapy in burn wound management, however in the last 10 years, several studies have reported the negative impact of SSD on the wound healing process. The therapeutic potential of SSD is restricted by its poor solubility, and antimicrobial action appears only after the dissociation of SSD into silver ions (Ag⁺) and sulfadiazine (SD). Pharmaceutical researchers and industries are looking for alternative strategies to overcome the challenges and limitations of the available SSD formulation due to rising costs, extensive time commitment, and the high risk of failure associated with the de novo development of new antimicrobial drugs. Recent advances in drug delivery systems nanotechnology-based strategies have had a colossal impact on them, particularly in burn wound management. Nanoparticulate systems and nanotools could be considered as potential drug delivery approaches for burn management. This contemporary review provides an abridgment of the literature on advanced SSD nanotherapeutics and their importance in managing burns.

The Role of an Assistant Nurse in Implementing the WHO Surgical Safety Checklist: Perception and Perspectives

Introduction The World Health Organization (WHO) Surgical Safety Checklist is a tool developed by the WHO to promote safer surgical practices and reduce the incidence of surgical errors and complications. This study aims to describe the role of assistant nurses in the implementation of this checklist by surgical teams. Materials and methods This descriptive study utilized a questionnaire-based survey conducted between September 2018 and March 2019 among 196 healthcare professionals at two surgical units in a university hospital in Sweden. The questionnaire covered demographic information such as age, gender, and occupation, as well as details about their workplace, experience, education/training on using the WHO checklist, the adaptation of the checklist to their department, their responsibilities in implementing and using the checklist, the frequency of use in emergency situations, and the impact on patient safety. Results The results of the study showed that assistant nurses, despite having the lowest level of education among healthcare professionals, were highly trusted and valued by other members of the surgical team. Most healthcare professionals were unsure who was responsible for using the WHO checklist but believed it was the assistant nurse's responsibility to ensure its implementation. Assistant nurses reported little to no training on using the checklist but noted that it had been adapted to the department's needs. Almost half (48.8%) of assistant nurses believed that the checklist was often used in emergency surgery, and most believed that it improved patient safety. Conclusions Improved understanding of the significance of assistant nurses in implementing the WHO Surgical Safety Checklist may enhance adherence to the checklist and potentially improve patient safety, as they were the most valued and trusted healthcare professionals in the surgical team according to the study's findings.

The experience of Saudi respiratory therapists dealing with COVID-19 patients: A qualitative study

BACKGROUND

Healthcare professionals have fought hard to restrain the COVID-19 pandemic by providing high-quality care for their infected patients, but in doing so they have developed fears of becoming sick and feelings of isolation and loneliness. The lived experience of respiratory therapists (RTs) in Saudi Arabia who works with these infected patients needs further investigation. The study sought to describe the experiences and coping strategies of Saudi RT managing patients with COVID-19.

MATERIALS AND METHODS

The study utilized qualitative research methods, specifically employing a phenomenological research design. A total of 25 Saudi RT (RTs) who were in direct contact with COVID-19 patients were selected after they agreed to participate in this study. The study followed a one-on-one semi-structured interview process using the Zoom platform. This qualitative data collection technique focuses on the participants' lived experiences and feelings to discover shared patterns. The data were analyzed via an inductive approach.

RESULTS

Six themes were found in the RT perceptions including stress while treating COVID patients, managing the fear of catching of Covid 19, feelings towards COVID-19 patients, challenges faced by female RTs, workplace experiences, and excessive workload.

CONCLUSIONS

RTs feelings dramatically changed throughout the COVID-19 pandemic. All the RTs have developed a self-copying style that has helped them improve their psychosocial behavior to face the pandemic. During the outbreak, frontline RTs' positive and negative emotions intertwined and coexisted. Negative emotions predominated in the beginning, while good feelings emerged gradually. Self-coping methods and psychosocial development were significant factors in RTs mental health while caring for COVID-19 patients.

An analysis of COVID-19 and WHO global research roadmap: knowledge mapping and future research agenda

In this study, we review the publications on the COVID-19 pandemic indexed in the Scopus database from 1st January to 15th October 2020, using bibliometric analysis. In essence, we evaluate the publications against the global research roadmap outlined by the World Health Organization (WHO). We find that academic publications are contributed by researchers worldwide, with the USA and China being the top contributors in several parameters. We show that most publications are clustered around the issues related to the outbreak, diagnosis, candidate medicine, and disease treatment by analyzing publication keywords. Besides, considerable importance is given to unravel the connection between the present viral disease with its previous strains and the anxiety and stress-related problems that arise from the COVID-19. We further visualize the knowledge structure of the publication with thematic mapping and illustrate that mental health-related research denotes a specialized research theme besides public health issues being the basic theme. Our findings aid to comprehend how the scholarly publications have developed to address the prioritized research agendas by the WHO. Thus, our study can guide researchers to explore the less studied areas. Consequently, it will assist policymakers and governments in developing integrated and effective policies to fight the pandemic.

Donning Sterile Surgical Gloves - A Prospective Clinical Audit of Young Surgeons at a Tertiary Care Hospital of Lahore, Pakistan

Background Sterilization and aseptic surgical techniques are the most important keys to successful postoperative outcomes. The standard surgical gloving technique causes early wound healing and reduces morbidity and mortality. Objective To assess the standard technique of donning sterile surgical gloves while scrubbing among young surgeons. Material and Methods This two-week prospective audit involved 60 young residents and house officers after ensuring ethical implications. Participants were observed unannounced for donning sterile surgical gloves in the surgical operation theatre (OT) according to the standard criteria set by World Health Organization (WHO) before and after the relevant intervention. The intervention was made through a clinical lecture, live demonstration, and hands-on sessions. After a detailed literature study, a pro forma was generated to record participants' compliance with 14 steps of donning sterile surgical gloves. Data was sent to a statistician for descriptive analysis. Results About 72.14% of the participants followed the standard criteria of donning sterile surgical gloves before intervention. This percentage raised to 90.71% after the intervention, showing marked improvement. Conclusion Pre-intervention and post-intervention observations showed apparent differences in compliance rates for the standard criteria of donning sterile surgical gloves. This scientific study signifies the need for such clinical audits to boost standard surgical practices, especially among newcomers.

Osteoporosis Among Bahraini Women Based on Bone Mineral Density Measurements: A Retrospective Study

Objectives The objective is to estimate the prevalence of osteoporosis among women in Bahrain who are aged ≥18 years. Methods In this retrospective study conducted at Salmaniya Medical Complex, a total of 590 Bahraini women were enrolled. Their bone mineral density measurements were obtained through dual-energy x-ray absorptiometry (DEXA) performed between January 2017 and December 2017. Six sites were chosen as the measurement targets. Patients were diagnosed with osteoporosis if their T-score was > -2.5 according to the World Health Organization guidelines. Results Osteoporosis was diagnosed in 27.1% of the patients; 53.2% had osteopenia, 0.3% had severe osteoporosis, and 19.3% had normal bone conditions. The prevalence of osteopenia as well as osteoporosis increased with age. Conclusion Osteoporosis and osteopenia are common among Bahraini women. This study provides useful information on the prevalence of osteoporosis among Bahraini women. Major steps by health authorities in the country are needed to reduce morbidity and improve the quality of life.

Development Practices in Senior Nursing and Midwifery Leadership: Pathways to Improvement in South Pacific Health Policy

The Pacific Islands countries consist of thousands of isolated islands with a combined population of over 10 million people. It is a heterogeneous and diverse region culturally, linguistically economically and politically. Health challenges are considerable and healthcare systems are often overstretched. Framed in the context of the World Health Organisation's strategic directions and policy priorities, this paper describes an account of collaboration across these countries to develop leadership skills in the nursing and midwifery professions. It outlines lessons for nursing leadership, healthcare policy development and the valuable role of Government Chief Nursing and Midwifery Officers. The South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA) is a cooperative partnership, which was formed to improve the quality of healthcare in the region. It acts as an enabler to promote leadership skills and provide a safe space for learning, developing policy and the sharing of good practice. Through mentorship programs, international meetings and strong relationship-building, the SPCNMOA has strengthened partnerships within the region and improved community health services in even the most remote areas. By strengthening leadership and collaboration, these health professionals are now recognised by key policy makers as knowledgeable experts who have a legitimate role in guiding policy development, changing practice and delivering health policy improvements at local, country and international levels.

Perspectives d’élimination de la tuberculose : la stratégie OMS à l’épreuve de la pandémie de COVID-19

La tuberculose (TB) reste un problème majeur de santé publique au niveau mondial. En 2020, elle était la deuxième cause de décès due à un seul agent infectieux, après le COVID-19. La stratégie « Mettre fin à la TB » de l'Organisation Mondiale de la Santé vise à obtenir, d'ici à 2035, une réduction de 95 % de la mortalité et de 90 % de l'incidence de la tuberculose par rapport à 2015. Après 20 années de baisse régulière de l'incidence estimée dans le monde (2 %/an en moyenne), la situation mondiale de la tuberculose s'est heurtée aux effets de la pandémie de COVID-19. Pour la première fois depuis plus de dix ans, une augmentation nette des décès et une réaugmentation du nombre de nouveaux cas estimés a été constatée. La pandémie pourrait présenter une opportunité pour de nouvelles solutions technologiques et collaborations et le partage des ressources visant à renforcer l'ensemble des systèmes de santé.

A systematic review of Clinical Practice Guidelines for the management of fractures in children to develop the WHO's Package of Interventions for Rehabilitation

INTRODUCTION

Fractures have been identified as one of the 20 major health conditions for the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR) - that includes also the needs of children and youth. The identification of existing interventions for rehabilitation and related evidence is a crucial step along the development of the PIR. The methods for the identification have been developed by WHO Rehabilitation Program and Cochrane Rehabilitation under the guidance of WHO's Guideline Review Committee Secretariat.

EVIDENCE ACQUISITION

This paper is part of the "Best Evidence for Rehabilitation" (be4rehab) series, developed according to the methodology presented in the PIR introductory paper. It is a systematic review of the existing Clinical Practice Guidelines (CPGs) on fractures in pediatric population published between 2009 to 2019.

EVIDENCE SYNTHESIS

We identified seven relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria and after checking for quality, publication time, multidisciplinarity and comprehensiveness, we have been able to include two CPGs: one addresses the treatment of supracondylar humerus fractures and the other provides recommendations on the treatment of diaphyseal femur fractures.

CONCLUSIONS

The selected CPGs on the management of supracondylar humerus and diaphyseal femur fractures in pediatric population include few recommendations considered as interventions for rehabilitation, of low quality of evidence and weak strength. We found several gaps in specific rehabilitative topics. High quality studies are absolutely needed to upgrade the quality of available evidence to inform future development of guidelines.

Impact of surgical checklist and its completion on complications and mortality in urgent colorectal procedures

OBJECTIVE

to assess the impact of using a surgical checklist and its completion on complications such as surgical site infection (SSI), reoperation, readmission, and mortality in patients subjected to urgent colorectal procedures, as well as the reasons for non adherence to this instrument in this scenario, in a university hospital in Ottawa, Canada.

METHODS

this is a retrospective, epidemiological study. We collected data from an electronic database containing information on patients undergoing urgent colorectal operations, and analyzed the occurrence of SSI, reoperation, readmission, and death in a 30 day period, as well as the completion of the checklist. We conducted a descriptive statistical analysis and logistic regression.

RESULTS

we included 5,145 records, of which 5,083 (98.8%) had complete checklists. As for the outcomes evaluated, cases with complete checklists displayed higher SSI rate, 9.1% vs. 6.5% (p=0.466), lower reoperation rate, 5% vs.11.3% (p=0.023), lower readmission rates, 7.2% vs. 11.3% (p=0.209), and lower mortality, 3.0% vs. 6.5% (p=0.108) than cases with incomplete ones.

CONCLUSION

there was a high level of checklist completion and a larger number of the outcomes in the reduced percentage of incomplete checklists found, demonstrating the impact of its utilization on the safety of patients undergoing urgent operations.

Maternal Mortality in Brazil, 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019

INTRODUCTION

Maternal death continues to be one of the most challenging public health problems that needs to be addressed in low and middle-income countries. The objective of this study was to describe the problem of maternal death in Brazil, using estimates from the Global Burden of Disease Study (GBD).

METHODS

This study used data from the GBD 2019 to show the numbers of deaths and the Maternal Mortality Ratio (MMR) - number of deaths/100,000 live births - in Brazil and its 27 Federated Units (FU), for ages 10 to 54 years, from 1990 to 2019. The annual variation of the MMR was estimated in 1990, 2010, and 2019. The MMR were shown for specific causes as well as for five-year age groups. The estimates were presented with 95% uncertainty intervals (UI).

RESULTS

The number of maternal deaths, as well as the MMR showed a 49% reduction from 1990 to 2019. This reduction occurred heterogeneously throughout the country, and the profile of the MMR for specific causes changed between 1990 and 2019: from hypertensive gestation diseases, to indirect maternal deaths, followed by hypertensive gestation diseases. In the extreme age groups, the MMR is higher, with mortality increasing exponentially in direct proportion with age.

CONCLUSIONS

Maternal deaths in Brazil have decreased substantially since 1990; however, the numbers still fall short of what was established by the World Health Organization (WHO). Indirect causes are the greatest problem in more than 60% of the FU, especially for hypertensive pregnancy diseases.

SARS-CoV-2 Omicron (B.1.1.529) Variant: No Time to Wait!

On November 26th, a new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), B.1.1.529, was designated by the World Health Organization (WHO), named Omicron, and classified as a variant of concern (VOC). The news raised an international alarm about a new wave of coronavirus disease 2019 (Covid-19) outbreak, since Omicron has a large group of mutations which may affect the way it spread, cause disease, and escape from the immunity. Therefore, it is essential to take a closer look at how it has emerged, how it may sustain the pandemic, and how we can act correspondingly, both nationally and internationally, to help control the spreading of the disease.

Examining the Importance of Hand Hygiene Policy and Patient Safety Culture on Improving Healthcare Workers' Adherence to Hand Hygiene Practice in Critical Care Settings in the Sultanate of Oman: A Scoping Review

Several studies suggest that adherence to hand hygiene (HH) policy would be enhanced by improving the culture of safety in an organization. This could be achieved through continuous awareness programs about the dramatic effect of HH practice according to the HH policy on improving patient safety and quality care. Understanding the importance and purposes of HH policy by healthcare workers would allow them to prioritize HH policy in their planning. Therefore, healthcare leaders should be responsible and accountable for strengthening their healthcare system by improving infrastructure, providing adequate support and resources, providing comprehensive monitoring and evaluation of patient safety initiatives, monitoring adherence to the regional Gulf Cooperation Council (GCC) and local Oman HH policy and using World Health Organization (WHO) guidelines for patient safety and HH as a basis for providing safer care. This should involve HH policy as a basic and mandatory program during an internship or in new staff orientation programs, spending enough resources on conducting more research studies and benchmarking findings with other international countries or any other organization such as WHO or Centres for Disease Control (CDC). The development of an HH policy at three different levels, macro, meso, and micro, is discussed in this article. In this sense, patient safety and quality care are the most important issues when adopting any policy.

Contesting Legitimacy of Global Governance Institutions: The Case of the World Health Organization During the Coronavirus Pandemic

This article examines the (de)legitimation of a global governance institution (GGI) in the throes of a full-blown legitimacy crisis: the World Health Organization (WHO) during the coronavirus pandemic. Substantively, it fleshes out systematically the discursive (de)legitimating practices of six (types of) actors: the Trump administration, US allies, US quality press, global health-scientific community, the WHO, and the Chinese government. To that end, it synthesizes elements from the rich literature on legitimacy and elaborates a conceptual apparatus bolstered by operational sources of legitimacy. Empirically, it is grounded in a qualitative content analysis of a purpose-built data corpus of 458 texts that contain justifications for (de)legitimation. In so doing, this study not only presents a holistic and yet granular view of discursive (de)legitimation by some pivotal actors surrounding the WHO and its pandemic response, but offers general insights on legitimacy and (de)legitimation of GGIs during times of crisis.

Applying World Health Organization 2020 guidelines on physical activity and sedentary behavior to people with hemophilia

Introduction: The new World Health Organization (WHO) guidelines on physical activity incorporate new concepts, such as sedentary behavior, recommendations for specific age groups and for people living with chronic conditions and disability. This could be extrapolated for the first time to people with hemophilia (PWH) within the framework in which these recommendations are applicable. The benefits of physical activity for PWH include physical, psychological and social benefits.Areas covered: This is a narrative review of the literature. We searched the MEDLINE and the Cochrane Library for WHO guidelines and articles related to physical activity in PWH. For all population groups, the benefits of performing exercise outweigh the possible harms. In PWH, there is a perceived increased risk of bleeding associated with physical activity. However, research suggests that this risk is associated with trauma during activity rather than intensity of physical activity, which offers the most health benefits.Expert opinion: Given the hematological, physical and functional conditions of PWH are highly variable, individualized counseling is needed based on age, therapeutic strategy, degree of arthropathy and level of disability. In this article, we analyze the applicability of the WHO recommendations to PWH, which is important to further promote healthy lifestyle motivation.

Latin American forum on immunization services during the COVID-19 pandemic

Introduction: The Latin American Society of Pediatric Infectology (SLIPE for its acronym in Spanish) is working hard to contribute with strategic actions to prevent the recurrence of Vaccine-Preventable Diseases and to prevent the reduction of vaccine coverage in the region of the Americas.Areas covered: On Friday, September 25th, a Latin American forum of experts on immunization services during the COVID-19 pandemic was held through Webex platform. Issues such as: the imminent risk of occurrence and outbreaks of vaccine-preventable diseases, the importance of epidemiological surveillance and the vaccination campaign challenges, in the context of a pandemic were discussed.Expert opinion: Vaccination campaigns should no longer be postponed or delayed; instead, they must be reactivated; governments, scientific societies, and physicians must promote vaccination programs to avoid outbreaks of vaccine-preventable diseases. On the eve of a SARS-CoV-2 vaccine, it is necessary to insist on the availability of sufficient doses to avoid dose shortages in disadvantaged areas of the region.

Human Consequences of Multiple Nuclear Detonations in New Delhi (India): Interdisciplinary Requirements in Triage Management

The human casualties from simulated nuclear detonation scenarios in New Delhi, India are analyzed, with a focus on the distribution of casualties in urban environments and the theoretical application of a nuclear-specific triage system with significant innovation in interdisciplinary disaster management applicable generally to urban nuclear detonation medical response. Model estimates of nuclear war casualties employed ESRI’s ArcGIS 9.3, blast and prompt radiation were calculated using the Defense Nuclear Agency’s WE program, and fallout radiation was calculated using the Defense Threat Reduction Agency’s (DTRA’s) Hazard Prediction and Assessment Capability (HPAC) V404SP4, as well as custom GIS and database software applications. ESRI ArcGISTM programs were used to calculate affected populations from the Oak Ridge National Laboratory’s LandScan^TM 2007 Global Population Dataset for areas affected by thermal, blast and radiation data. Trauma, thermal burn, and radiation casualties were thus estimated on a geographic basis for New Delhi, India for single and multiple (six) 25 kt detonations and a single 1 mt (1000 kt) detonation. Major issues related to the emergency management of a nuclear incident are discussed with specific recommendations for improvement. The consequences for health management of thermal burn and radiation patients is the worst, as burn patients require enormous resources to treat, and there will be little to no familiarity with the treatment of radiation victims. Of particular importance is the interdisciplinary cooperation necessary for such a large-scale emergency response event, which would be exemplified by efforts such as the application of a Nuclear Global Health Workforce.

How about the quality and recommendation on prevention, diagnosis, and treatment of HIV/AIDS guidelines developed by WHO: A protocol for systematic review

BACKGROUND

Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has become a pandemic that has infected millions of people around the world and brings a tremendous economic burden. There are numerous guidelines for prevention, diagnosis, and treatment of HIV/AIDS published in recent years, but the quality of these guidelines is still unknown. Therefore, we conducted this study to evaluate the quality of prevention, diagnosis, and treatment of HIV/AIDS published by World Health Organization (WHO) as well as perform a comparison of recommendations between those guidelines. And we also hope our finding could provide suggestions to enhance the quality of future guidelines in this area.

METHODS

We obtained guidelines from WHO Guidelines approved by the Guidelines Review Committee (GRC). Two reviewers will independently select eligible guidelines. The quality of included guidelines will be appraised by at least four reviewers through AGREE II and RIGHT tools. The results will be checked for discrepancies. Differences between them than two reviewers will be considered as discrepant and the final discrepancies will be resolved by consensus. The results will be presented in tables and the descriptive statistics will be calculated for all domains of the AGREE II instrument as standard score and median (range) as the reporting quality result of eligible guidelines will also be evaluated through RIGHT criteria. In this study, we will also compare the differences and similarities of recommendations among different guidelines.

RESULTS

The results of this study will increase the knowledge about the development of recommendations guidelines for HIV/AIDS of high methodological rigor and reporting quality. This study may also identify potential limitations for future research in this area.

CONCLUSION

This study may guide health professionals, policy makers, and health policy managers in choosing the guidelines for recommendation to better to achieve the 90-90-90 targets.

INPLASY REGISTRATION NUMBER

INPLASY2020110010.

Interventional Study for Improving Health Information System in Khyber Pakhtunkhwa, Pakistan

Objective To assess the improvement in the health information system in the district Nowshera by integrating the data reporting of the Expanded Program on Immunization (EPI) and Lady Health Worker (LHW) programs in the existing system. Methodology The study was conducted at district Nowshera and Swabi, Pakistan between May 2015 and May 2016 for a duration of one year. The data collection instruments used in the study were adapted from the Performance of Routine Information System Management (PRISM) tool package. The study was conducted in three phases during a period of one year. The first three months were utilized for baseline assessment. The next six months were being used for implementing the integration of the EPI and LHW, and the next three months were being used for the post-intervention evaluation. Microsoft Excel software was used to enter and analyze the data. A p < 0.05 was considered as the cut-off value for significance. Results The results indicated that the integration of data from the EPI and LHW with that of the existing Health Information System (HIS) is possible and has the potential for improving the existing system. The least significant results were produced by the use of information, which depicts that the utilization of data in decision making or policy making is still needed to be improved. Moreover, we reported a lack of enforcement and regulation by the authorities in monitoring the feedback system in the HIS. Conclusion The current study revealed significant improvements in the use of information, data quality, and behavior of staff. It is essential to properly train the team on how to operate the District Health Information System (DHIS) to gain adequate and timely data on health status and determinants. Additionally, the integration would benefit in managing the data at not only the national level but at the district level too.

Highly selective sensor for the detection of Hg2+ ions using homocysteine functionalised quartz crystal microbalance with cross-linked pyridinedicarboxylic acid

This study reports an insightful portable vector network analyser (VNA)-based measurement technique for quick and selective detection of Hg2+ ions in nanomolar (nM) range using homocysteine (HCys)-functionalised quartz-crystal-microbalance (QCM) with cross-linked-pyridinedicarboxylic acid (PDCA). The excessive exposure to mercury can cause damage to many human organs, such as the brain, lungs, stomach, and kidneys, etc. Hence, the authors have proposed a portable experimental platform capable of achieving the detection in 20-30 min with a limit of detection (LOD) 0.1 ppb (0.498 nM) and a better dynamic range (0.498 nM-6.74 mM), which perfectly describes its excellent performance over other reported techniques. The detection time for various laboratory-based techniques is generally 12-24 h. The proposed method used the benefits of thin-film, nanoparticles (NPs), and QCM-based technology to overcome the limitation of NPs-based technique and have LOD of 0.1 ppb (0.1 μg/l) for selective Hg2+ ions detection which is many times less than the World Health Organization limit of 6 μg/l. The main advantage of the proposed QCM-based platform is its portability, excellent repeatability, millilitre sample volume requirement, and easy process flow, which makes it suitable as an early warning system for selective detection of mercury ions without any costly measuring instruments.

Evaluation of Safety in Horizontal Curves of Roads Using a Multi-Body Dynamic Simulation Process

Road transportation poses one of the significant public health risks. Several contributors and factors strongly link public health and road safety. The design and advancement of higher-quality roads can significantly contribute to safer roads and save lives. In this article, the safety aspect of the roads’ horizontal curves under the standard of the American Association of State Highway Transportation Officials (AASHTO) is evaluated. Several factors, including vehicle weight, vehicle dimensions, longitudinal grades, and vehicle speed in the geometric design of the horizontal curves, are investigated through a multi-body dynamic simulation process. According to the AASHTO, a combination of simple circular and clothoid transition curves with various longitudinal upgrades and downgrades was designed. Three vehicles were used in this simulation, including a sedan, a bus, and a 3-axle truck. The analysis was based on the lateral friction between the tire and the pavement and also the safety margin parameter. The results showed that designers must differentiate between light and heavy vehicles, especially in curves with a high radius. Evaluation of longitudinal grade impacts indicated that the safety margin decreases when the vehicle is entering the curve. Safety margin reduction on the clothoid curve takes place with a lower grade toward the simple circular curve. By increasing the speed, the difference between lateral friction demand obtained from simulation and lateral friction demand proposed by AASHTO grows. The proposed novel methodology can be used for evaluating road safety.

[Quarantine Alone or in Combination with Other Public Health Measures to Control COVID-19: A Rapid Review (Review)]

BACKGROUND

COVID-19 (coronavirus disease 2019) is a new, rapidly emerging zoonotic infectious disease, that was reported to the World Health Organization for the first time on 31 December 2019. Currently, no effective pharmacological interventions or vaccines are available to treat or prevent COVID-19, therefore nonpharmacological public health measures are more in focus.

OBJECTIVES

The aim was to assess the effects of quarantine - alone or in combination with other measures - during coronavirus outbreaks.

METHODS

Because of the current COVID-19 pandemic, WHO commissioned a rapid review. To save time, the method of systematic reviews was slightly and with caution modified. This publication is a summary of the most important aspects of the rapid review, translated into German by members of the WHO Collaborating Centre at the Danube University Krems (Austria).

RESULTS

Overall, 29 studies were included. Ten modeling studies focused on COVID-19, 4 observational studies and 15 modeling studies focused on SARS and MERS. The modeling studies consistently reported a benefit of the simulated quarantine measures. For example, the models estimated that quarantine of people exposed to confirmed or suspected cases of COVID-19 prevented between 44 and 81% of the cases that would otherwise have happened and 31 to 63% of the deaths, when compared to no such measures. In regard to costs, the earlier the quarantine measures are implemented, the greater the cost savings will be.

CONCLUSION

Our confidence in the evidence is very limited. This is mainly because the COVID-19 studies based their models on the limited data that have been available in the early weeks of the pandemic and made different assumptions about the virus. The studies of SARS and MERS are not completely generalizable to COVID-19. Despite only having limited evidence, all the studies found quarantine to be important for controlling the spread of severe coronavirus diseases. Looking to the coming months, in order to maintain the best possible balance of measures, decision makers must continue to constantly monitor the outbreak situation and the impact of the measures they implement.

The computation of case fatality rate for novel coronavirus (COVID-19) based on Bayes theorem: An observational study

BACKGROUND

When a new disease such starts to spread, the commonly asked questions are how deadly is it? and how many people are likely to die of this outbreak? The World Health Organization (WHO) announced in a press conference on January 29, 2020 that the death rate of COVID-19 was 2% on the case fatality rate (CFR). It was underestimated assuming no lag days from symptom onset to deaths while many CFR formulas have been proposed, the estimation on Bays theorem is worthy of interpretation. Hence, it is hypothesized that the over-loaded burdens of treating patients and capacities to contain the outbreak (LSBHRS) may increase the CFR.

METHODS

We downloaded COVID-19 outbreak numbers from January 21 to February 14, 2020, in countries/regions on a daily basis from Github that contains information on confirmed cases in >30 Chinese locations and other countries/regions. The pros and cons were compared among the 5 formula of CFR, including [A] deaths/confirmed; [B] deaths/(deaths + recovered); [C] deaths/(cases x days ago); [D] Bayes estimation based on [A] and the outbreak (LSBHRS) in each country/region; and [E] Bayes estimation based on [C] deaths/(cases x days ago). The coefficients of variance (CV = the ratio of the standard deviation to the mean) were applied to measure the relative variability for each CFR. A dashboard was developed for daily display of the CFR across each region.

RESULTS

The Bayes based on (A)[D] has the lowest CV (=0.10) followed by the deaths/confirmed (=0.11) [A], deaths/(deaths + recoveries) (=0.42) [B], Bayes based on (C) (=0.49) [E], and deaths/(cases x days ago) (=0.59) [C]. All final CFRs will be equal using the formula (from, A to E). A dashboard was developed for the daily reporting of the CFR. The CFR (3.7%) greater than the prior CFR of 2.2% was evident in LSBHRS, increasing the CFR. A dashboard was created to present the CFRs on COVID-19.

CONCLUSION

We suggest examining both trends of the Bayes based on both deaths/(cases 7 days ago) and deaths/confirmed cases as a reference to the final CFR. An app developed for displaying the provisional CFR with the 2 CFR trends can improve the underestimated CFR reported by WHO and media.

Impact of Surgical Checklist on Mortality, Reoperation, and Readmission Rates in Brazil, a Developing Country, and Canada, a Developed Country

PURPOSE

To compare the mortality, reoperation, and readmission rates before and after the implementation of a surgical checklist in Brazil and Canada.

DESIGN

An epidemiological, retrospective study was conducted.

METHODS

Preimplementation and postimplementation data were collected via patient chart reviews to determine mortality, reoperation, and readmission rates.

FINDINGS

In Brazil, a decrease in readmission rate from 2.9% to 1.7% (P = .518) was observed after the implementation of the checklist. In Canada, reoperation rate decreased from 5.6% to 4.8% (P = .649) and mortality from 1.7% to 0.9% (P = .407) after implementation. In the Brazilian institution, patients with incomplete checklists had increased rates of readmission, from 1.4% to 2.4% (P = .671), and reoperation, from 6.8% to 10.4% (P = .232).

CONCLUSIONS

The use of surgical checklist did not translate into improvements in the outcomes studied after its implementation in any of the scenarios evaluated. This result is possibly justified by the socioeconomic structure of each of these settings.

Evaluation of hand hygiene compliance over the years, in an intensive care unit of a north Delhi hospital preparing for accreditation: A 3-year study

Introduction:

World Health Organization (WHO) initiated a global movement to achieve universal health coverage (UHC). Hand hygiene (HH) is critical for achieving UHC as it is a practical and evidence-based approach with a gaugeable impact on the quality of care and patient safety in healthcare.

Material and Methods:

A cross-sectional observational study was conducted in an intensive care unit of a government hospital spanning a period of 3 years. WHO single-observer direct observation technique was used and HH compliance was noted. The results were compared over the years since the hospital was preparing to undergo a National Accreditation Board for Hospitals and Healthcare (NABH) assessment.

Results:

The overall compliance significantly increased over the years (P < 0.0001). HH compliance for hand rub (HR) and hand wash (HW) was compared among doctors, nurses, and ICU technicians, respectively. HR compliance remained more or less the same over the years (P = 0.4738) while HW compliance significantly improved (P < 0.0001).

Conclusions:

This is one of the first studies from our country evaluating HH compliance over the years in a healthcare setup undergoing accreditation. During the course of the study, we observed a significant increase in HH compliance. This can be attributed to the unflinching support of our hospital's administration and relentless efforts of our infection control team. This is our first step initiative towards improving HH and thus preventing healthcare-associated infections (HCAIs) in our setup.

An Ounce of Prevention: Coronavirus (COVID-19) and Mass Gatherings

Widespread, non-stop, and often sensational coverage of the coronavirus (COVID-19) has caught many governments flat-footed in efforts to protect the health and safety of their citizens. In response to the current global health event, the World Health Organization (WHO) declared COVID-19 a pandemic. Mass gatherings present a historic challenge in protecting the health and safety of attendees. The majority of the prominent mass gatherings are religious in nature. Global sporting events, such as the Olympics and the World Cup, pose unique health risks to attendees and host nations. Deferment or cancellation of such mass gatherings may exert an extraordinary economic loss to the host nation. Universal adoption of best practices for infection control is the surest way for governments to prepare for mass gatherings. In these uncertain times, it is up to intergovernmental organizations to be the voice of reason.

Psychopathological Symptoms and Gaming Motives in Disordered Gaming-A Psychometric Comparison between the WHO and APA Diagnostic Frameworks

BACKGROUND

'Gaming Disorder' (GD) has received increased medical attention and official recognition from both the American Psychiatric Association (APA) and the World Health Organization (WHO). Although these two medical organizations have independently developed promising clinical diagnostic frameworks to assess disordered gaming, little is known about how these frameworks compare at different psychometric levels in terms of producing consistent outcomes in the assessment of GD.

METHODS

A sample of 1429 German gamers (Meanage = 29.74 years; SD = 12.37 years) completed an online survey including measures on different psychopathological symptoms (depression, loneliness and attention problems), gaming motives and disordered gaming according to the WHO and APA frameworks.

RESULTS

The findings suggest the existence of minor discrepancies in the estimation of prevalence rates of GD according among the two frameworks. Nevertheless, both diagnostic frameworks are fairly consistent in the psychometric prediction of GD in relation to gaming motives and psychopathological symptoms. The findings underscore the role of key gaming motives as risk factors and protective factors across both diagnostic frameworks. Finally, the study provides support for the WHO diagnostic framework for GD and its measurement with the German Gaming Disorder Test (GDT). The findings and their implications are further discussed in terms of clinical relevance.

Developing and applying a 'living guidelines' approach to WHO recommendations on maternal and perinatal health

How should the WHO most efficiently keep its global recommendations up to date? In this article we describe how WHO developed and applied a ‘living guidelines’ approach to its maternal and perinatal health (MPH) recommendations, based on a systematic and continuous process of prioritisation and updating. Using this approach, 25 new or updated WHO MPH recommendations have been published in 2017–2018. The new approach helps WHO ensure its guidance is responsive to emerging evidence and remains up to date for end users.

Attention to childbirth and delivery in a university hospital: comparison of practices developed after Network Stork

OBJECTIVE

to compare, after four years of the implementation of the Stork Network, the obstetric practices developed in a university hospital according to the classification of the World Health Organization.

METHOD

cross-sectional study carried out in the year of adherence to the Stork Network (377 women) and replicated four years later (586 women). Data were obtained through medical records and a structured questionnaire. The Chi-square test was used in the analysis.

RESULTS

four years after the implementation of the Stork Network, in Category A practices (demonstrably useful practices/good practices), there was increased frequency of companions, non-pharmacological methods, skin-to-skin contact and breastfeeding stimulation, and decreased freedom of position/movement. In Category B (harmful practices), there was reduction of trichotomy and increased venoclysis. In Category C (practices with no sufficient evidence), there was increase of Kristeller's maneuver. In Category D (improperly used practices), the percentage of digital examinations above the recommended level increased, as well as of analgesics and analgesia, and there was decrease of episiotomy.

CONCLUSION

these findings indicate the maintenance of a technocratic and interventionist assistance and address the need for changes in the obstetric care model. A globally consolidated path is the incorporation of midwife nurses into childbirth for the appropriate use of technologies and the reduction of unnecessary interventions.

In the eye of the beholder: to make global health estimates useful, make them more socially robust

A plethora of new development goals and funding institutions have greatly increased the demand for internationally comparable health estimates in recent years, and have brought important new players into the field of health estimate production. These changes have rekindled debates about the validity and legitimacy of global health estimates. This paper draws on country case studies and personal experience to support our opinion that the production and use of estimates are deeply embedded in specific social, economic, political and ideational contexts, which differ at different levels of the global health architecture.

Broadly, most global health estimates tend to be made far from the local contexts in which the data upon which they are based are collected, and where the results of estimation processes must ultimately be used if they are to make a difference to the health of individuals. Internationally standardised indicators are necessary, but they are no substitute for data that meet local needs, and that fit with local ideas of what is credible and useful. In other words, data that are both technically and socially robust for those who make key decisions about health.

We suggest that greater engagement of local actors (and local data) in the formulation, communication and interpretation of health estimates would increase the likelihood that these data will be used by those most able to translate them into health gains for the longer term. Besides strengthening national information systems, this requires ongoing interaction, building trust and establishing a communicative infrastructure. Local capacities to use knowledge to improve health must be supported.

Physical Activity Is an Opportunity for the Health of Nations: What Should We Do Next?

Physical activity provides huge opportunities for the health of nations. Understanding this, the World Health Organization has published a Global Action Plan which aims to provide member states with a framework for action, namely to create active societies, people, environments and systems. The target is set at a 15 % reduction in physical inactivity levels by 2030. We explore in this paper some of the challenges and opportunities that come with it, and give the practitioner some real-world opportunities for relevant action at the local level, as well as for their patients, staying true to the Physician's Pledge (Declaration of Geneva): "I will attend to my own health, well-being, and abilities in order to provide care of the highest standard."

Review of the Global Solar UV Index 2015 Workshop Report

The Global Solar UV Index was developed as an easy-to-understand measure of the amount of biologically-effective ambient solar ultraviolet radiation (UVR) at different locations on the earth's surface. Over the past few years, questions have been raised about the global applicability of the UV Index, about the evidence base for exposure risk thresholds and related protective measures, and about whether the overall impact of the UV Index could be improved with modifications. An international workshop was organized by several organizations, including the World Health Organization, to assess if current evidence was sufficiently strong to modify the UV Index and to discuss different ways it might be improved in order to influence sun-protective behavior. While some animal research suggests there may be no threshold effect, the relative importance of sub-erythemal doses of sunlight in causing skin cancer in humans remains unknown. Evidence suggests that regular use of sunscreen can prevent skin cancer and that sunglasses are an effective method of protecting the eyes from solar UVR. The UV Index as a risk communication tool continues to be useful for raising awareness and to support sun-protection behavior. Although there was agreement that guidance on the use of the UV Index could be improved, the workshop participants identified that strong health outcome-based human evidence would be needed as the basis for a revision. For the UV Index to be relevant in as many countries as possible, it should continue to be adapted to suit local conditions.

Investigation of health promotion status in specialized hospitals associated with Hamadan University of Medical Sciences: health-promoting hospitals

OBJECTIVES

The prophecy of health promoting hospitals (HPH) is bringing about a change and transition from treatment-oriented to health-oriented attitudes. In Iran, hospitals usually play the traditional roles. The present study was aimed at the evaluation of the health promotion status in specialized hospitals associated with Hamadan University of Medical Sciences (HUMS).

METHODS

This applied study was conducted in two Hamadan specialized hospitals in the Hamadan city. The health promotion status was evaluated using a self-assessment checklist designed by the World Health Organization's HPH. The evaluation was done in five standards including management policy, patient assessment, patient information and intervention, promotion of a healthy workplace and continuity and cooperation.

RESULTS

The results showed that both the hospitals studied had a poor status in terms of promoting a healthy workplace (average = 31.24%) and management policy standards (average = 35.29%) in comparison with the other relevant standards: patient assessment (53.12%), patient information and intervention (62.5%), continuity and cooperation (65.78%)). The results of the standards and sub-standards status displayed better performance in the cardiovascular hospital (53.67%) compared to the women and parturition hospital (42.64%).

CONCLUSION

The findings indicated that HPH standards are very low in the studied hospitals. The reason behind this wide gap might be due to the fact that hospitals in Iran are more treatment-oriented and patient-oriented and they do not play an active part in health promoting. It was found that management policy and promoting healthy workplace standards had the worst status and must be improved.

Redefining Health: The Evolution of Health Ideas from Antiquity to the Era of Value-Based Care

The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country's chosen solution for its healthcare crisis. As the US transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understanding of what "health" actually means. To truly understand its meaning, one must have a thorough historical understanding of the changes in the concept of health and how it has evolved to reflect the beliefs and scientific understanding of each time period. Thus, this review summarizes the changes in the definition of health over time in order to provide a context for the definition needed today. We then propose a new definition of health that is specifically tailored to providers working in the era of value-based care.

A Closer Look at the Thresholds of Thermal Damage: Workshop Report by an ICNIRP Task Group

The International Commission on Non-Ionizing Radiation Protection issued guidelines in 1998 for limiting public and occupational exposure to radiofrequency electromagnetic fields (100 kHz to 300 GHz). As part of the process of updating this advice, a 2-d workshop titled "A closer look at the thresholds of thermal damage" was held from 26-28 May 2015 in Istanbul to re-examine the thermal basis of the guidelines and to provide further information on heat-related effects and thresholds of thermal damage. Overall, the workshop provided much useful information relevant to revision of the guidelines. Participants indicated that the effects of heating from radiofrequency fields are consistent with those from other sources, and that the information derived from those studies can be applied to radiofrequency-induced heating. Another conclusion was that absolute temperature of tissues was more important for thermal damage than temperature change. The discussion suggested that the 6-min averaging time used in international guidelines was valid for whole-body exposures but with a large uncertainty: 30 min may be a more appropriate averaging time for localized exposures, and less than 1 min for implanted medical devices. The duration of whole-body radiofrequency exposure is a critical parameter that often determines the effect threshold, but this will be affected by other, ongoing thermoregulation, which is dependant on many factors. The thresholds for localized radiofrequency exposure were difficult to determine because of the potential range of exposure conditions and the possibility of radiofrequency-induced local hotspots. Suggestions for future dose metrics and further research were discussed and are included in this report.

New Allergic and Hypersensitivity Conditions Section in the International Classification of Diseases-11

Allergy and hypersensitivity, originally perceived as rare and secondary disorders, are one of the fastest growing conditions worldwide, but not adequately tracked in international information systems, such as the International Classification of Diseases (ICD). Having allergic and hypersensitivity conditions classification able to capture conditions in health international information systems in a realistic manner is crucial to the identification of potential problems, and in a wider system, can identify contextually specific service deficiencies and provide the impetus for changes. Since 2013, an international collaboration of Allergy Academies has spent tremendous efforts to have a better and updated classification of allergies in the forthcoming International Classification of Diseases (ICD)-11 version, by providing scientific and technical evidences for the need for changes. The following bilateral discussions with the representatives of the ICD-11 revision, a simplification process was carried out. The new parented "Allergic and hypersensitivity conditions" section has been built under the "Disorders of the Immune System" chapter through the international collaboration of Allergy Academies and upon ICD WHO representatives support. The classification of allergic and hypersensitivity conditions has been updated through the ICD-11 revision and will allow the aggregation of reliable data to perform positive quality-improvements in health care systems worldwide.

Applying the WHO conceptual framework for the International Classification for Patient Safety to a surgical population

OBJECTIVE

Efforts to improve patient safety are challenged by the lack of universally agreed upon terms. The International Classification for Patient Safety (ICPS) was developed by the World Health Organization for this purpose. This study aimed to test the applicability of the ICPS to a surgical population.

DESIGN

A web-based safety debriefing was sent to clinicians involved in surgical care of abdominal organ transplant patients. A multidisciplinary team of patient safety experts, surgeons and researchers used the data to develop a system of classification based on the ICPS. Disagreements were reconciled via consensus, and a codebook was developed for future use by researchers.

RESULTS

A total of 320 debriefing responses were used for the initial review and codebook development. In total, the 320 debriefing responses contained 227 patient safety incidents (range: 0-7 per debriefing) and 156 contributing factors/hazards (0-5 per response). The most common severity classification was 'reportable circumstance,' followed by 'near miss.' The most common incident types were 'resources/organizational management,' followed by 'medical device/equipment.' Several aspects of surgical care were encompassed by more than one classification, including operating room scheduling, delays in care, trainee-related incidents, interruptions and handoffs.

CONCLUSIONS

This study demonstrates that a framework for patient safety can be applied to facilitate the organization and analysis of surgical safety data. Several unique aspects of surgical care require consideration, and by using a standardized framework for describing concepts, research findings can be compared and disseminated across surgical specialties. The codebook is intended for use as a framework for other specialties and institutions.

Tobacco is "our industry and we must support it": Exploring the potential implications of Zimbabwe's accession to the Framework Convention on Tobacco Control

BACKGROUND

Zimbabwe is the largest tobacco producer in Africa. Despite expressing opposition in the past, Zimbabwe recently acceded to the World Health Organization's Framework Convention on Tobacco Control (FCTC). We explored why Zimbabwe acceded to the FCTC and the potential implications for tobacco control within Zimbabwe and globally.

METHODS

We conducted a qualitative archival case study based on 542 documents collected from 1) the Truth Tobacco Industry Documents; 2) media indexed in the Lexis-Nexis media database; 3) the websites for tobacco growers' associations, tobacco control groups, and international agencies; 4) FCTC reports and Framework Convention Alliance newsletters; 5) Zimbabwe's legal codes; and 6) the peer reviewed scientific literature related to tobacco growing.

RESULTS

Zimbabwe has a long history of tobacco growing. There are currently over 90,000 tobacco farmers, and tobacco growing is prioritized, despite widespread food insecurity and environmental degradation. Zimbabwean government officials have been outspoken FCTC critics; but recently joined the accord to better protect Zimbabwe's tobacco growing interests. FCTC membership obligates nations to implement a variety of tobacco control measures; Zimbabwe has implemented several measures aimed at reducing tobacco demand, but fewer aimed at reducing tobacco supply or protecting the environment. Zimbabwe joins the FCTC amid increased efforts to protect FCTC proceedings from industry interference, to adopt recommendations for alternative crops and livelihoods and reduce environmental damage.

CONCLUSION

Zimbabwe's decision to accede to the FCTC does not appear to represent a softening of its historical opposition to the treaty. Thus, its status as a Party creates opportunities for it to undermine ongoing efforts to implement and strengthen the treaty. At the same time, however, Zimbabwe's accession could provide much needed international support for Zimbabwe's civic organizations and its Ministry of Health to develop stronger tobacco control measures. How Zimbabwe's participation impacts the work of the FCTC as a whole may ultimately depend on the allegiances of its delegates, and the effectiveness of FCTC measures to limit tobacco industry interference and enforce compliance with FCTC measures.

Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator

BACKGROUND

Two themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO's capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.

METHODS

This qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?

RESULTS

Analysis of the interviews and documents revealed three main themes: 1) WHO's role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO's cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO's cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.

CONCLUSION

There are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO's constitution, requires cultural and institutional changes for it to be fully implemented.