Special Issue:
Challenges and Opportunities in Global Health
Irene Atuhairwe
Seed Global Health Inc, Kampala Uganda.
Prisca Kizito
Department of Emergency Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Bonaventure Ahaisibwe
Seed Global Health Inc, Boston, MA, United States of America.
Raymond Bernard Kihumuro
Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Tonny Luggya
Department of Anesthesia, School of Medicine, Makerere University, Kampala, Uganda.
Martin Msukwa
Seed Global Health Inc, Lilongwe, Malawi.
Helen Ewing
Seed Global Health Inc, Boston, MA, United States of America.
Randall Ellis
Seed Global Health Inc, Boston, MA, United States of America.
Vanessa Kerry
Seed Global Health Inc, Boston, MA, United States of America; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
Abstract
Introduction: Low- and middle-income countries (LMICs) face a disproportionate burden of diseases requiring emergency care. In Uganda, road traffic trauma in the context of rapid urbanization, particularly motorcycle accidents, accounts for 48% of medical emergencies. The burden of road traffic accidents, obstetric complications, and non-communicable diseases necessitate robust emergency care, yet Uganda faces systemic challenges in this sector. Following the 60th and 72nd sessions of the World Health Assembly that called for strengthened emergency, critical and operative care to achieve universal health coverage, Uganda committed to strengthening emergency medical services through taking key steps such as developing a national Emergency Medical Services (EMS) Policy. The EMS Policy outlined twelve key focus areas including development of human resources for emergency medical services, key among are emergency physicians. To support these efforts, Seed Global Health, the Ugandan Ministry of Health, Makerere University, and Mbarara University of Science and Technology partnered to strengthen the emergency medicine training between 2019 and 2024.
Methods: We conducted a desk review to evaluate the collaborative effort between Seed Global Health, Ministry of Health, Makerere University and Mbarara University of Science and Technology. We reviewed policy documents, health records, and program reports to assess initiatives by Seed Global Health that were focused on developing human resources for emergency medical services, including emergency physicians training, emergency nurses and the contributions of local and international faculty.
Results: The partnership between Seed Global Health, Ministry of Health, Mbarara University of Science and Technology and Makerere University successfully trained 21 new emergency physicians, with 43 more residents currently in training. It introduced essential clinical resources, enhancing diagnostic and treatment capacities for improved patient care while improving learning environments through skills laboratory support, simulation support and classroom equipment. Additionally, it supported the coordination of emergency services within emergency departments in hospitals as well as enhanced advocacy efforts to improving emergency care in Uganda. However, despite these tremendous milestones, challenges persist including a shortage of specialists relative to the high demand for services, a need for increased investment for emergency medical services and a need for better integration of emergency services within the healthcare system.
Conclusion: This article highlights the value of international collaborations, long term partnership and targeted training in addressing emergency care gaps in LMICs. We recommend expanding emergency medicine programs, increasing government investment in facilities and human resources, and strengthening interdisciplinary emergency response teams. These measures are essential for providing sustainable, quality emergency care to address Uganda’s growing needs.
Susan Garfield, Shannon Armstrong, Julie Nguyen
Christine Hildreth, Bianca Wu, Isabella James, Sylvie Babat, Malu Foley
Abstract
Health technology assessments are evaluation tools used by decision makers and governing bodies to evaluate the relative effectiveness, safety, and cost of new health technologies. Despite the significant access and reimbursement implications of the decisions informed by health technology assessments, health equity is not consistently included in these assessments. This review explores current health technology assessment approaches using global examples, examines how health technology assessments include health equity considerations, reviews how health equity is not optimally included in health technology assessments using a case study example, and discusses emerging practices to include more health equity related metrics using examples from sponsors and health technology assessment agencies. Results show that health technology assessments do not have a consistent, clearly defined measures of health equity impact or methods to include health equity-oriented measures in assessments. Additionally, most do not provide differentiated value assessments for health equity-oriented data or impact. However, innovators and health technology assessment organizations are presenting new approaches to evaluation. Some outside groups are advocating for change and investing in developing health equity checklists and frameworks for incorporation in health technology assessments. Moving forward, more research is needed to understand how to best incorporate heath equity-oriented measures into health technology assessments and how innovators can get more involved to inform both product development and evaluation efforts. If done well, health technology assessments can be developed to reward technologies and research programs that have a significant and measurable impact on delivering more equitable health outcomes.
Nikolaos Sapoutzis
Public Health Department Hochtaunuskreis, Bad Homburg vor der Höhe, Germany; Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
Laura Corazza
Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
Marjo Wijnen-Meijer
Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
Abstract
Public, Global, and One Health are individual approaches to health that partly influence each other and all are becoming increasingly important in medical education. ‘’Public Health’’ is an approach to protect and improve health of a population. Nevertheless, most health threats are transcended national boarders, so the “Global Health” approach is becoming increasingly relevant. The holistic approach “One Health” goes even further: in addition to human health, animal health and the environment must also be considered. All these approaches are influenced by globalization, the increasing immigration and the occurrence of pandemics. Accordingly, it is the responsibility of higher education institutes to integrate health approaches in their curriculum to train future physicians to meet the demands of their patients and the population.
This review reflects the current situation of the mentioned approaches in medical education in different countries from which data are available. The research shows that there exists a wide range of Public Health programms, but they are rarely assessed and only a small number of degrees programes is offered for physicians. In contrast to this, Global Health activities during medical education are more reported, and the main providers for Global Health education are medical schools. The necessity to implement One Health topics in medical curriculum is seen by many organizations, but there are just a few publications about the implementation in medical education available.
The main issue in educating health approaches is a missing standard; the dissent of competences, which are relevant to future practical use; the curriculums are oversaturated; and a lack of expertise to the topics. For the future there is a need to implement health approaches into the core curriculum of medical education. Therefore, it is a possibility to integrate the subjects into existing activities and to use didactic concepts, such as clinical rotation, problem-based learning, or case-based learning. In addition, interprofessional work and partnerships between medical and Public Health communities must be improved.
Public, Global, and One Health education requires a structured and comprehensive curriculum that ensures adequate training of medical students in an increasingly globalized world and diversified patient population.
Mushtaq Ahmed
Department of Surgery, The Aga Khan University. Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
Cameruddin W. Vellani
Department of Medicine, The Aga Khan University
Abstract
South Asia and Sub-Saharan Africa are facing rapid proliferation of medical schools especially in the private sector stimulated by demand for doctors in the mainly curative private health sector. Accreditation has failed to stem declining standards of basic medical education and its increasing irrelevance to national health care needs. Medical graduates tend to opt for careers in high paying specialties and frequently migrate to Western countries for career progression and a better organized lifestyle.
However, some recent developments hold promise for improvement and are potential solutions to the problem: (a) the trend towards decentralization of health systems favours strengthening of district health services that hold the key to serve populations equitably, with district hospitals as hubs for integrating clinical care and Primary Health Care; (b) the trend towards diversification of basic medical education to district health services is potentially beneficial for both as they are interdependent; and (c) the realization that accreditation of health professional education must influence health outcomes through practice provides the impetus to improve related health services.
The aim of the present review was to find evidence of successful implementation of these measures in South Asia and Sub-Saharan Africa.
Evidence of improvements in performance and health outcomes from decentralization of health systems and strengthening of district health services is forthcoming, although provision and management of human and financial resources are challenging. Similarly, there is growing evidence from Sub-Saharan Africa that improvement of health professional education and quality of health care occurs when experiential learning is based at district level hospitals and its related health services; albeit the evidence is presently limited to externally supported projects.
Accreditation based on successful integration of medical education and health services, is the weakest link. Although there is growing pressure for national accreditation agencies to implement global standards of basic medical education, without the context of professional development associated with coordinated improvement in related health services the notion that global standards will improve health care lacks credibility.
Eventually, effective convergence of these measures is required if the daunting health challenges in South Asia and Sub-Saharan Africa are to be addressed sustainably.
Kathryn M. Yount, PhD
Hubert Department of Global Health, Rollins School of Public Health and Department of Sociology, College of Arts and Sciences, Emory University
Alicia Macler
Department of Behavioral, Social, and Health Education Sciences, Emory University
Eun-Ok Im
University of Texas at Austin, School of Nursing
Joanne A. McGriff
Hubert Department of Global Health, Rollins School of Public Health, Emory University
Michael Sacks
Goizueta Business School, Emory University
Abstract
Background: Women are under-represented in global health leadership worldwide. Socio-ecological barriers may diminish women’s institutional belonging, career aspirations, and leadership pathways.
Aims: In this pilot study, we describe and evaluate EMERGE, Empowering Women for Leadership in Global Health, a theory-based, multicomponent leadership development program for diverse women graduate students.
Methods: Emory graduate students who self-identified as women and engaged in global health were eligible to participate in EMERGE. Socio-ecologically grounded program components included: a three-day leadership development workshop; nine-month mentored team-challenge projects; monthly seminars by women leaders; social-media outreach; and project presentations with peers, mentors, and university leadership. We conducted a mixed-methods, single-group pretest-posttest evaluation that included a) four quantitative self-assessments on leadership capabilities over the program period and b) three focus groups with mentored teams that explored fellows’ experiences applying leadership skills, managing team projects, and working with mentors.
Results: All 12 selected fellows self-identified as women from at least one other underrepresented group. Half originated from low- or middle-income countries. At baseline, completing the team project was a common short-term (12-month) aspiration. Managing and leading teams emphasizing equity, mentoring, and participatory problem solving were common longer-term (1-5-year) aspirations. At baseline, fellows were least confident about negotiating their interests and most confident about making ethical decisions. Overall, fellows expressed high satisfaction with instructors (mean 8.8 of 10) and content (mean 8.3 of 10) of the leadership development workshop as well as increased confidence and proficiency in most leadership, team-management, and mentor-related skills at month one. Reported confidence and proficiency in most skills declined by program midline and then increased and peaked at endline.
Conclusion: The EMERGE program supported sustained improvements in fellows’ leadership capabilities. The program’s multi-month and multi-component approach grounded in socio-ecological theory were key elements. EMERGE holds promise to train the next generation of women leaders in global health. Future work is needed to identify opportunities to support leadership pathways for women in global health in diverse work settings.
Holmes L Jr.
Global Epigenomic Research Analytics, Wilmington, DE 19802; Biological Sciences Department, University of Delaware, Newark, DE 19716
Deepika K
Global Epigenomic Research Analytics, Wilmington, DE 19802
Williams J
Global Epigenomic Research Analytics, Wilmington, DE 19802; SUNY Downstate Health Sciences University, Brooklyn, NY 11203
Chinaka C
Global Epigenomic Research Analytics, Wilmington, DE 19802
John V
Global Epigenomic Research Analytics, Wilmington, DE 19802
Ogundele B
Global Epigenomic Research Analytics, Wilmington, DE 19802
Okundaye O
Global Epigenomic Research Analytics, Wilmington, DE 19802
Philipcien G
Victoria Hospital, Castries, St. Lucia W.I
Poleon M
Global Epigenomic Research Analytics, Wilmington, DE 19802
Thompson J
Compliance Resources Network, Houston, TX 77449
Enwere M
Global Epigenomic Research Analytics, Wilmington, DE 19802
Ward D
Medical College of Wisconsin, CTSI, Milwaukee, WI
Picolli T
Global Epigenomic Research Analytics, Wilmington, DE 19802
Comeaux C R
Global Epigenomic Research Analytics, Wilmington, DE 19802; Florida A&M University, Tallahassee, FL 32307
Shikha Jain
MVJ Medical College, Hoskote, Karnataka, India
Naresh Dasari
Medicine and Longterm care Associates, Cranston, RI 02920
Ram Sanjiv Alur
Marion Veterans affairs medical center, IL
Ramesh Adhikari
Franciscan Health, Lafayette, IN 47909
Gbadebo O Ogungbade
Global Health Services Initiatives Inc, 1600 Nandina Dr, Arlington, TX 76014
Abstract
Background: Historically, populations with deprived optimal care, preventive health services, value-based care, and low socio-economic status with marginalized social hierarchy had been observed with poor health outcomes and excess mortality during pandemics. The current COVID-19 global pandemic mirrors the flu pandemic of 1918, where the social gradient predicted the disproportionate burden of mortality among blacks in the United States (US). The current study aimed to assess the racial differentials in SARS-Cov-2 case positivity, case fatality and mortality in Washington DC, US as well as the potential explanatory model therein.
Materials and Methods: A cross-sectional ecologic design was used to examine the COVID-19 data from the Washington DC Department of Health (https://coronavirus.dc.gov/data ) by race/ethnicity, sex, ward (geographic locale), and age. This predictive model examined the pre- (November, 2020) and post-thanksgiving (December, 2020) data for trends. While the variables examined were in aggregate data format, chi square statistic and binomial regression models were used for variable characterization by race and mortality risk race prediction respectively.
Results: During late November, the SARS-Cov-2 case positivity in Washington DC was higher among Blacks/AA (n=9,441(46.7%)) relative to Whites, 4603 (22.8%). With respect to Hispanics, the SARS-Cov-2 case positivity was 4,853 (24.1%) and 13,477 (66.9%) among non-Hispanics. With respect to COVID-19 mortality, this was lowest among non-Hispanic Whites (NHW), 1.50%, intermediate among Hispanics (1.81%), and highest among non-Hispanic Blacks (NHB), 5.30%. There was sex differential in mortality cumulative incidence (CmI), with males (57.0%) compared to females (43.0%) illustrating higher mortality. The mortality CmI by age was lowest among cases, 20-29 years (6.4%), intermediate among cases, 50-69 years (36.3%) and highest among individuals, 70 years and older, 58.7%. With respect to the geographic locale (DC-Ward), the mortality CmI was higher in DC- Wards 4-6 (39.3%) and wards DC-7-8 (35.4%) but lower in DC-Wards 1-3 (22.1%). The mortality risk from COVID-19 illustrated racial/ethnic differentials. Relative to NHW in Washington DC, NHB were almost 4 times as likely to die from COVID-19 in November 2020 prior to Thanksgiving, prevalence odds ratio, (pOR)=3.62, 95%CI, 2.78-4.73, Attributable fraction of exposed (AFE),72%, while Hispanics were 25% more likely to die, Hispanics, pOR=1.25, 95%CI, 1.0-1.74, AFE(18%).
During the first week in December, post –thanksgiving period, the SARS-Cov-2 case positivity was lower among Whites (n, 5719, (23.0%)) compared to Blacks/AA, 11,218 (47%). The CmI mortality was highest among NHB, n=521 (74%), intermediate among Hispanics, n=93 (13.2%) and lowest among NHW, n=72, (10.2%). Similarly, there was racial differential in mortality risk,with increased risk observed among Blacks/AA, relative to their White counterparts in DC. Compared to Whites, Blacks/AA were 4 times as likely to die from COVID-19, pOR=4.00, 95%CI, 2.87-4.80, AFE (73%).
Conclusions: There were racial/ethnic disparities in SARS-Cov-2 case positivity, COVID-19 mortality and mortality risk, which was higher among Blacks/AA relative to their White counterparts in Washington DC. Additionally, mortality was higher in male compared to female as well as DC-ward variation by mortality.
Elizabeth Armstrong-Mensah
Georgia State University School of Public Health, Atlanta, Georgia.
Maha Karim
Georgia State University School of Public Health, Atlanta, Georgia.
Oluwatoyosi Ogunmuyiwa
Georgia State University School of Public Health, Atlanta, Georgia.
Ernest Alema-Mensah
Morehouse School of Medicine, Department of Community Health and Preventive Medicine, Atlanta, Georgia.
Florence Darko
Georgia State University School of Public Health, Atlanta, Georgia.
Kritika Kolla
Georgia State University School of Public Health, Atlanta, Georgia.
Abstract
Objective: The study examined the mental health conditions experienced by working mothers as caregivers in Georgia, United States during the COVID-19 pandemic, the causes and outcomes of the mental health conditions experienced, and the coping mechanisms they employed.
Methods: A mixed methods cross-sectional study design was used to collect data from 132 working mothers in Georgia across six domains using Qualtrics. Quantitative data was analyzed using SPSS and SAS. Qualitative data was analyzed using a thematic approach.
Results: Working mothers experienced depression and anxiety while providing care during the pandemic. The lack of access to childcare and family support (12.5%), home schooling (18.1%), and juggling work and family (25.6%) contributed to the mental health conditions experienced, which led to anger (12.5%), aggression towards partners (11.3%), and the inability to sleep (18.8%). Coping mechanisms employed were drinking (1.3%), smoking (5.6%) and arguing with a spouse (8%).
Conclusion: While the pandemic affected the mental health of many adults in the US, working mothers providing care were among the population hardest hit. Although the immediate threat of COVID-19 has abated, its impact on mental health cannot be overlooked. By focusing primarily on the mental health of working mothers as caregivers during the pandemic, the study draws attention to, and underscores the need for targeted interventions and policies to be put in place to respond to the mental health needs of this population in the event of a future global health emergency.
Dan-Yu Lin, Ph.D.
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Yi Du, Ph.D.
Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA; Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Yangjianchen Xu, B.S.
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Sai Paritala, Pharm.D.
Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA; Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Matthew Donahue, M.D.
Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA.
Patrick Maloney, Ph.D.
Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA; Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Abstract
Background: The updated Moderna, Pfizer-BioNTech, and Novavax COVID-19 vaccines containing the SARS-CoV-2 omicron XBB.1.5 strain have replaced their predecessors in the United States and in other countries since the fall of 2023. The clinical impact of these vaccines on currently circulating variants was unknown.
Aims: We aimed to assess the effectiveness of the updated XBB.1.5 vaccines against currently circulating omicron subvariants.
Methods: We examined data on the administration of XBB.1.5 vaccines and the incidence of COVID-19 between September 11 and November 27, 2023 for approximately 2 million persons by linking records from the Nebraska Electronic Disease Surveillance System and the Nebraska State Immunization Information System. We used Cox regression to estimate the effects of XBB.1.5 vaccines on the risk of COVID-19, as a function of time elapsed since vaccination, while adjusting for demographic factors, previous infection history, and previous vaccination history.
Results: The effectiveness (i.e., proportionate reduction of risk) for XBB.1.5 vaccines against SARS-CoV-2 infection was 63.0% (95% confidence interval [CI], 48.6 to 73.4) 4 weeks after vaccination and 67.1% (95% CI, 49.9 to 78.4) 6 weeks after vaccination; vaccine effectiveness started to decline after 6 weeks. Vaccine effectiveness was broadly similar across subgroups defined by age, sex, race and ethnicity, socioeconomic status, and previous immunity status.
Conclusion: XBB.1.5 vaccines were effective against currently circulating variants, regardless of age, sex, race and ethnicity, socioeconomic status, or previous immunity status. These findings can be used to develop effective prevention strategies against COVID-19.
Laurens Holmes, Jr.
Global Epigenomic Research Analytics, Wilmington, DE 19802
Keerti Deepika
Global Epigenomic Research Analytics, Wilmington, DE 19802 ; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Janille Williams
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Benjamin Ogundele
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Glen Philipcien
Emergency Department, Victoria Hospital, Castries, St. Lucia
Michael Enwere
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA; Public Health Department, Walden University, Minneapolis, MN 55401, USA
Shikha Jain
MVJ Medical College, Hoskote, Karnataka, India
Naresh Dasari
Medicine and Long-term Care Associates, Cranston, RI 02920
Ram Sanjiv Alur
Marion Veterans Affairs Medical Center, IL
Ramesh Adhikari
Franciscan Health, Lafayette, IN 47909
Gbadebo O Ogungbade
Global Health Services Initiatives Incorporated, Arlington, TX 76014 USA
Abstract
Purpose: Historically until date, viral pathogens remain very challenging with respect to transmission, severity, mortality and survival with respect to sub-population variances. While racial disparities in cumulative incidence (CmI) and mortality from the influenza pandemics of 1918 and 2009 implicated Blacks with survival disadvantage relative to Whites in the United States, COVID-19 currently indicates comparable disparities. We aimed to: assess COVID-19 CmI by race, determine the Black–White case fatality (CF) and risk differentials, and apply explanatory model for mortality risk differentials.
Methods: COVID-19 data on confirmed cases and deaths by selective states health departments were assessed using a cross-sectional ecologic design. Chi-square was used for CF independence, while binomial regression model for the Black–White risk differentials.
Results: The COVID-19 mortality CmI was disproportionate among Blacks/AA with 34% of the total mortality in the United States, albeit their 13% population size. The COVID-19 CF was higher among Blacks/AA relative to Whites; Maryland, (2.7% vs. 2.5%), Wisconsin (7.4% vs. 4.8%), Illinois (4.8% vs. 4.2%), Chicago (5.9% vs. 3.2%), Detroit (Michigan), 7.2% and St. John the Baptist Parish (Louisiana), 7.9%. Blacks/AA compared to Whites in Michigan were 15% more likely to die, CmI risk ratio (CmIRR) = 1.15, 95% CI, 1.01–1.32. Blacks/AA relative to Whites in Illinois were 13% more likely to die, CmIRR = 1.13, 95% CI, 0.93–1.39, while Blacks/AA compared to Whites in Wisconsin were 51% more likely to die, CmIRR = 1.51, 95% CI, 1.10–2.10. In Chicago, Blacks/AA were more than twice as likely to die, CmIRR = 2.24, 95% CI, 1.36–3.88.
Luciana Pelosi
Departments of Neurology and Neurophysiology, Bay Of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand
Hannah P Blumhardt
Te Herenga Waka – Victoria University of Wellington, Wellington, New Zealand
Abstract
Climate change is the greatest global health threat of the 21st century. Urgent mitigating interventions are needed to stop the current trend and prevent catastrophic irreversible damage to human health.
Health practitioners and scientists have a special responsibility to reduce carbon emissions from all health sectors, and to lead by example by minimizing their own contribution. For the health academic community this contribution mainly comes from long-distance global travel to attend scientific and educational meetings.
The COVID-19 pandemic travel restrictions and social distancing requirements offered an invaluable opportunity to assess the feasibility and effectiveness of virtual conferences. This experience showed that the virtual approach was not only as feasible as in-person, but significantly more effective in reducing carbon emissions while also increasing accessibility and inclusion for attendees across the world.
However, once the restrictions were lifted, in-person attendance was rapidly reinstated as the sole method for most events or, in a hybrid format with virtual attendance. This could be due to lack of awareness or even misinformation amongst the health community about the connection between climate change and human health outcomes. Climate change and its impact on health should have greater consideration in the education of health professionals, and effective mitigating measures should receive more focus and normalisation through positive messaging in current affairs, medical publications and social media.
Laurens Holmes, Jr
Global Epigenomic Research Analytics, Wilmington, DE 19802
Kerti Deepika
Global Epigenomic Research Analytics, Wilmington, DE 19802; 2 Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Janille Williams
Global Epigenomic Research Analytics, Wilmington, DE 19802 ; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Benjamin Ogundele
Global Health Services Initiatives Inc, Arlington, TX, 76014; 2 Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Glen Philipcien
Emergency Department, Victoria Hospital, Castries, St. Lucia
Michael Enwere
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA; Public Health Department, Walden University, Minneapolis, MN 55401, USA
Shikha Jain
MVJ Medical College, Hoskote, Karnataka, India
Naresh Dasari
Medicine and Long-term care Associates, Cranston, RI 02920
Ram Sanjiv Alur
Marion Veterans affairs medical center, IL
Ramesh Adhikari
Franciscan Health, Lafayette, IN 47909
Gbadebo Ogungbade
Global Health Services Initiatives Incorporated, Arlington, TX 76014 USA
Abstract
Purpose: Viral infections had been historically observed in chronic disease development and complications including although not limited to hepatitis C, influenza A, cytomegalovirus (CMV), Epstein bar virus (EBV), HIV and herpes simplex. Epidemiologic data had implicated CMV, herpes simplex and hepatitis C in type II diabetes (T2D). With the observed increased incidence T2D in COVID-19 among children and adults, this review aimed to examine scientific literature on immune and endocrine systems dysregulation in T2D and pancreatic neoplasm.
Materials & Method: A qualitative systematic review (QSR) was utilized in assessing the immune system deregulation and endocrine system involvement in chronic disease development such as T2D. The PubMed was the main search engine in studies identification with several search terms such as “SARS-CoV-2 and T2D”, “COVID-19 and T2D”, SARS-CoV-2 and insulin resistant”, etc.
Results: Viral pathogens such as CMV, influenza A, and herpes simplex and hepatitis C infections have been implicated in decreased insulin sensitivity (IS) and increased insulin resistant (IR). Similarly, these pathogenic microbes increased the T2D incidence and complications. SARS-CoV-2 a COVID-19 causative pathogen had been observed in increased risk and incidence of T2D among children and adults. While data are not currently available on the precise mechanistic process, SARS-CoV-2 viral infection in T2D incidence may be explained by excess pro-inflammatory cytokines elaboration (cytokine storm) resulting in increased IR and decreased IS, leading to glucose intolerance and T2D. Further COVID-19 may increase pancreatic neoplasm in populations with increased incidence of COVID-19, due to pancreatic beta cells and insulin receptors dysregulation and cellular dysfunctionality as abnormal cellular proliferation.
Conclusions/Recommendation: SARS-CoV-2 a causative pathogen in COVID-19 morbidity is associated with increased incidence of T2D, which is explained in part by immune and endocrine system integration dysregulation, resulting in cytokine storm, decreased IS and increased IR, implying glucose intolerance and T2D. Additionally this pathogenic microbe may result in increasing incidence of pancreatic neoplasm, a malignant neoplasm with the worst prognosis and excess mortality due to late stage at diagnosis and marginalized biomarkers of susceptibility and morbidity.
Kenneth Blum
The Kenneth Blum Behavioral & Neurogenetic Institute, Austin, TX., USA.; Division of Addiction Research & Education, Center for Sports, Exercise & Psychiatry, Western University Health Sciences, Pomona, CA., USA.; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.; Department of Psychiatry, School of Medicine, University of Vermont, Burlington, VT.,USA.; Department of Psychiatry, Wright State University Boonshoft School of Medicine and Dayton VA Medical Centre, Dayton, OH, USA.; Division of Nutrigenomics Research, TranspliceGen Therapeutics, Inc., Austin, Tx., 78701, USA; Department of Nutrigenomic Research, Victory Nutrition International, Inc., Bonita Springs, FL, USA.; Division of Personalized Medicine, Cross-Cultural Research and Educational Institute, San Clemente, CA., USA; Sunder Foundation, Palm Springs, CA, USA; Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel.
Mark S Gold
Jean Lud Cadet
Molecular Neuropsychiatry Research Branch, National Insti-tute on Drug Abuse, National Institutes of Health, Bethesda, MD., USA
Marjorie C. Gondre-Lewis
Neuropsychopharmacology Laboratory, Department of Anatomy, Howard University College of Medicine, Washing-ton, DC., USA.
Thomas McLaughlin
Division of Nutrigenomics Re-search, TranspliceGen Thera-peutics, Inc., Austin, Tx., 78701, USA
Eric R Braverman
The Kenneth Blum Behavioral & Neurogenetic Institute, Austin, TX., USA.
Igor Elman
Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Chil-dren’s Hospital, Boston, MA., USA.
B. Paul Carney
Division Pediatric Neurology, University of Missouri ,School of Medicine, Columbia, MO., USA
Rene Cortese
Department of Child Health – Child Health Research Institute, & Department of Obstetrics, Gynecology and Women’s Health School of Medicine, Uni-versity of Missouri, MO., USA.
Tomilowo Abijo
Neuropsychopharmacology Laboratory, Department of Anatomy, Howard University College of Medicine, Washing-ton, DC., USA.
Debasis Bagchi
Department of Pharmaceutical Sciences, Texas Southern Uni-versity College of Pharmacy and Health Sciences, Houston, TX, USA
John Giordano
Division of Personalized Mental Illness Treatment & Research, Ketamine Infusion Clinics of South Florida, Pompano Beach, Fl., USA
Catherine A. Dennen
Department of Family Medi-cine, Jefferson Health North-east, Philadelphia, PA, USA.
David Baron
Institute of Psychology, ELTE Eötvös Loránd University, Bu-dapest, Hungary.
Panayotis K Thanos
Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY 14203, USA.; Department of Psychology, State University of New York at Buffalo, Buffalo, NY 14203, USA.
Diwanshu Soni
College of Osteopathic Medi-cine of the Pacific, Western University of Health Sciences, Pomona, CA., USA.
Milan T. Makale
Department of Radiation Medi-cine and Applied Sciences, UC San Diego, 3855 Health Sci-ences Drive, La Jolla, CA 92093-0819, USA.
Miles Makale
Department of Psychology, UC San Diego, Health Sciences Drive, La Jolla, CA, 92093, USA
Kevin T. Murphy
Peak Logic, San Diego, CA., USA
Nicole Jafari
Department of Human Devel-opment, California State Uni-versity at long Beach, Long Beach, CA., USA ; Division of Personalized Medi-cine, Cross-Cultural Research and Educational Institute, San Clemente, CA., USA
Keerthy Sunder
Department of Psychiatry, Me-nifee Global Medical Center, Palm Desert, CA., USA; Sunder Foundation, Palm Springs, CA, USA
Foojan Zeine
Awareness Integration Institute, San Clemente, CA., USA.; Department of Health Science, California State University at Long Beach, Long Beach, CA., USA.
Mauro Ceccanti
Società Italiana per il Tratta-mento dell’Alcolismo e le sue Complicanze (SITAC), ASL Ro-ma1, Sapienza University of Rome, Rome, Italy
Abdalla Bowirrat
Department of Molecular Biol-ogy and Adelson School of Medicine, Ariel University, Ariel, Israel.
Rajendra D. Badgaiyan
Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, Long School of Medicine, University of Texas Medical Center, San An
Abstract
Addiction, albeit some disbelievers like Mark Lewis [1], is a chronic, relapsing brain disease, resulting in unwanted loss of control over both substance and non- substance behavioral addictions leading to serious adverse consequences [2]. Addiction scientists and clinicians face an incredible challenge in combatting the current opioid and alcohol use disorder (AUD) pandemic throughout the world. Provisional data from the Centers for Disease Control and Prevention (CDC) shows that from July 2021-2022, over 100,000 individuals living in the United States (US) died from a drug overdose, and 77,237 of those deaths were related to opioid use [3]. This number is expected to rise, and according to the US Surgeon General it is highly conceivable that by 2025 approximately 165,000 Americans will die from an opioid overdose. Alcohol abuse, according to data from the World Health Organization (WHO), results in 3 million deaths worldwide every year, which represents 5.3% of all deaths globally [4].
Wamae PM
Climate and Human Health Research Unit, Centre for Global Health Research, Kenya Medical Research Institute (KEMRI). P.O Box 1578-40100 Kisumu, Kenya; Department of Community Health, School of Public Health, Kenyatta University. P.O Box 43844-00100 Nairobi, Kenya
Otieno GO
Department of Community Health, School of Public Health, Kenyatta University. P.O Box 43844-00100 Nairobi, Kenya
Kabiru EW
Department of Community Health, School of Public Health, Kenyatta University. P.O Box 43844-00100 Nairobi, Kenya
Munga S
Division of Malaria Control (DOMC), Ministry of Public Health and Sanitation, Kenya. P.O Box 19982-00202 Nairobi, Kenya
Kibet SJ
Division of Malaria Control (DOMC), Ministry of Public Health and Sanitation, Kenya. P.O Box 19982-00202 Nairobi, Kenya
Githeko AK
Climate and Human Health Research Unit, Centre for Global Health Research, Kenya Medical Research Institute (KEMRI). P.O Box 1578-40100 Kisumu, Kenya
Abstract
Malaria heterogeneity in the highlands is due to range of factors including seasonal weather changes, climate variability, land-use changes, topography, drug resistance, and malaria control programs. High coverage of long lasting insecticide treated nets is the basis of vector control in epidemic prone western Kenya highlands. Long lasting insecticide treated nets have effectively controlled malaria in the hypo-endemic zones, but not in meso-endemic and hyper-endemic zones where significant residue of transmission remains despite control efforts.
Inadequate policy on integrated vector management application for ecologically heterogeneous ecosystems hinders effective malaria control. Advances in ecological and epidemiological studies have improved our understanding on vector distribution determinants and malaria transmission enabling us to effectively integrate indoor residual spraying into the existing long lasting insecticide treated nets programme.
Data on malaria vector abundance and parasite prevalence for different malaria ecosystems within western Kenya highlands before and after mass insecticide treated bed-net distribution campaigns was gathered to assess the efficacy of the long lasting insecticide treated nets based control efforts. Field tests were carried out to determine the impact of combined indoor residual spray and long lasting insecticide treated nets on vector indoor resting densities in zones where insecticide treated nets alone had limited efficacy or zero efficacy was observed.
Female An. gambiae s.l resting densities of 0.1 mosquitoes/ house/night were associated with a plasmodium falciparum (pf) prevalence rate of 10% or below. This observation enabled the development of a framework for the inclusion of indoor residual spray in integrated vector management with the suggestion that IRS should be applied in malaria eco-epidemiological zones where An. gambiae s.l resting densities exceeds 0.1 females/ house/ night.
Similarly, only those houses with a resting density of 0.1 females An. gambiae s.l and above should be targeted during spraying. Such an approach would significantly reduce the cost associated with indoor residual spray and provides a rationale for judicious integration of indoor residual spray within existing long lasting insecticide treated nets control programmes.
