Conducting health research in conflict-affected areas and other complex environments is difficult, yet vital. However, the capacity to undertake such research is often limited and with little ...translation into practice, particularly in poorer countries. There is therefore a need to strengthen health research capacity in conflict-affected countries and regions.In this narrative review, we draw together evidence from low and middle-income countries to highlight challenges to research capacity strengthening in conflict, as well as examples of good practice. We find that authorship trends in health research indicate global imbalances in research capacity, with implications for the type and priorities of research produced, equity within epistemic communities and the development of sustainable research capacity in low and middle-income countries. Yet, there is little evidence on what constitutes effective health research capacity strengthening in conflict-affected areas. There is more evidence on health research capacity strengthening in general, from which several key enablers emerge: adequate and sustained financing; effective stewardship and equitable research partnerships; mentorship of researchers of all levels; and effective linkages of research to policy and practice.Strengthening health research capacity in conflict-affected areas needs to occur at multiple levels to ensure sustainability and equity. Capacity strengthening interventions need to take into consideration the dynamics of conflict, power dynamics within research collaborations, the potential impact of technology, and the wider political environment in which they take place.
Despite the rising risk factor exposure and non-communicable disease (NCD) mortality across the Middle East and the North African (MENA) region, public health policy responses have been slow and ...appear discordant with the social, economic and political circumstances in each country. Good health policy and outcomes are intimately linked to a research-active culture, particularly in NCD. In this study we present the results of a comprehensive analysis of NCD research with particular a focus on cancer, diabetes and cardiovascular disease in 10 key countries that represent a spectrum across MENA between 1991 and 2018.
The study uses a well validated bibliometric approach to undertake a quantitative analysis of research output in the ten leading countries in biomedical research in the MENA region on the basis of articles and reviews in the Web of Science database. We used filters for each of the three NCDs and biomedical research to identify relevant papers in the WoS. The countries selected for the analyses were based on the volume of research outputs during the period of analysis and stability, included Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Turkey and the United Arab Emirates.
A total of 495,108 biomedical papers were found in 12,341 journals for the ten MENA countries (here we consider Turkey in the context of MENA). For all three NCDs, Turkey's output is consistently the highest. Iran has had considerable growth in research output to occupy second place across all three NCDs. It appears that, relative to their wealth (measured by GDP), some MENA countries, particularly Oman, Qatar, Kuwait and the United Arab Emirates, are substantially under-investing in biomedical research. In terms of investment on particular NCDs, we note the relatively greater commitment on cancer research compared with diabetes or cardiovascular disease in most MENA countries, despite cardiovascular disease causing the greatest health-related burden. When considering the citation impact of research outputs, there have been marked rises in citation scores in Qatar, Lebanon, United Arab Emirates and Oman. However, Turkey, which has the largest biomedical research output in the Middle East has the lowest citation scores overall. The level of intra-regional collaboration in NCD research is highly variable. Saudi Arabia and Egypt are the dominant research collaborators across the MENA region. However, Turkey and Iran, which are amongst the leading research-active countries in the area, show little evidence of collaboration. With respect to international collaboration, the United States and United Kingdom are the dominant research partners across the region followed by Germany and France.
The increase in research activity in NCDs across the MENA region countries during the time period of analysis may signal both an increasing focus on NCDs which reflects general global trends, and greater investment in research in some countries. However, there are several risks to the sustainability of these improvements that have been identified in particular countries within the region. For example, a lack of suitably trained researchers, low political commitment and poor financial support, and minimal international collaboration which is essential for wider global impact.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader ...macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building.
The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict.
The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes.
Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.
Background
The World Health Organization (WHO) announced the COVID-19 occurrence as a global pandemic in March 2020. The treatment of SARS-CoV-2 patients is based on the experience gained from ...SARS-CoV and MERS-CoV infection during 2003. There is no clinically accepted therapeutic drug(s) accessible yet for the treatment of COVID-19.
Main body
Corticosteroids, i.e., dexamethasone, methylprednisolone, hydrocortisone and prednisone are used alone or in combination for the treatment of moderate, severe and critically infected COVID-19 patients who are hospitalized and require supplemental oxygen as per current management strategies and guidelines for COVID-19 published by the National Institutes of Health. Corticosteroids are recorded in the WHO model list of essential medicines and are easily accessible worldwide at a cheaper cost in multiple formulations and various dosage forms. Corticosteroid can be used in all age group of patients, i.e., children, adult, elderly and during pregnancy or breastfeeding women. Corticosteroids have potent anti-inflammatory and immunosuppressive effects in both primary and secondary immune cells, thereby reducing the generation of proinflammatory cytokines and chemokines and lowering the activation of T cells, monocytes and macrophages. The corticosteroids should not be used in the treatment of non-severe COVID-19 patients because corticosteroids suppress the immune response and reduce the symptoms and associated side effects such as slow recovery, bacterial infections, hypokalemia, mucormycosis and finally increase the chances of death.
Conclusion
Intensive research on corticosteroid therapy in COVID-19 treatment is urgently needed to elucidate their mechanisms and importance in contributing toward successful prevention and treatment approaches. Hence, this review emphasizes on recent advancement on corticosteroid therapy for defining their importance in overcoming SARS-CoV-2 pandemic, their mechanism, efficacy and extent of corticosteroids in the treatment of COVID-19 patients.
In conflict settings, COVID-19 is a multidimensional and existential crisis for many: a pandemic colliding with poor governance, insecurity, instability, other disease outbreaks (eg, cholera), ...disintegrated health and education systems, and food insecurity.3 These have dire consequences for vulnerable populations in conflict settings, including women and girls.4 Pandemics are a gendered vulnerability, with their socioeconomic impact disproportionately higher among women.5 6 In this article, we argue that cultivating and harnessing the advancements of women’s leadership globally and implementing a gender inclusive lens in pandemic preparedness and responses by including the experiences and voices of women in conflict settings is paramount. Women and girls are especially vulnerable to COVID-19 in conflict-affected settings Women and girls are disproportionately affected by armed conflict and humanitarian emergencies.7 This disproportionality has been exacerbated during COVID-19, where in conflict settings one of the most affected and at-risk population groups include women and girls who lack decision-making power.8 Analysis from UN Women identifies five critical areas that leave women and girls most vulnerable during COVID-19, including: increased risks for sexual and gender-based violence (SGBV) in the context of pandemic response policies; unemployment; economic and livelihood impacts for the poorest women and girls; unequal distribution of care and domestic work; and women and girls’ voices not being included for an informed and effective response.9 Women’s and girls’ predominant role in caregiving, and as health and social welfare responders, also makes them particularly exposed to potential contamination.10 In conflict settings, conflict itself promotes conditions during which existing gender inequalities and inequities are amplified; community structures, access to healthcare and human rights are all compromised resulting in worsening conditions for women.11 During a pandemic, resources for and access to adequate health services can be further complicated by armed conflict.12 13 Of particular concern, resources to deal with the pandemic, as evidenced during Ebola and Zika, are often diverted from essential health services for women and girls, namely sexual and reproductive health, with lasting effects for themselves, their children, their families and their economies.14 Previous public health emergencies have shown that the impact of an epidemic on sexual and reproductive health often goes unrecognised, because the effects are often not the direct result of the infection but instead the indirect consequences of strained healthcare systems, disruptions in care and redirected resources.15 A study modelling three scenarios on the indirect effects of COVID-19 on maternal and child mortality in low-income and middle-income countries in which the coverage of essential maternal and child health interventions is reduced by 9.8%–51.9%, and the prevalence of wasting is increased by 10%–50% over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths.16 The most severe scenario—coverage reductions of 39.3%–51.9% and wasting increase of 50%—over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths.17 Furthermore, the pandemic is also impacting family planning, due to closure of health facilities or their inability to provide these services, disrupted supply chains and community outreach efforts (eg, via mobile clinics), and women and girls not being able to attend these clinics or facilities. SGBV also increases during humanitarian crises, and access to support services are frequently halted or disrupted.19 While it has been extensively reported that SGBV against women increases in non-conflict settings, it is challenging to obtain SGBV data in conflict settings during COVID-19, and it is widely under-reported.20 Research shows that an increase in SGBV was observed during the 2013–2015 Ebola outbreak in West Africa, as response efforts focused on containing the disease.21 The International Rescue Committee has found through an analysis of its gender-based violence (GBV) case management data that the suspension of these protection services for women, restrictions on mobility, lack of information and increased isolation and fear have resulted in a dramatic drop in the number of reported cases of violence against women and girls in conflict settings, including Syria, Iraq and Burkina Faso.22 23 Modelling from UNFPA predicts that COVID-19 is likely to cause a one-third reduction in progress towards ending GBV by 2030, including 31 million additional GBV cases expected as a result of 6-month lockdowns.18 Furthermore, the UNFPA analysis reports that a 2-year delay in initiating prevention programmes is projected to lead to an additional 13 million child marriages, as well as 2 million female genital mutilation cases over the next decade that otherwise would have been averted, that is, a 33% reduction in progress. Various recommendations have been suggested since the emergence of COVID-19 to create gender-inclusive responses, including engaging women frontline workers, women’s groups and networks in all decision making and policy spaces to improve health security surveillance, detection and prevention mechanisms.9 In 2019, the Global Preparedness Monitoring Board called for the involvement of more women in planning and decision making as a vital part of sustainable outbreak preparedness efforts.27 Yet analysis of recent emergencies clearly demonstrates little has been done to ensure that women’s voices are included in decision-making responses.
Abstract
Background
Syria has been in continuous conflict since 2011, resulting in more than 874,000 deaths and 13.7 million internally displaced people (IDPs) and refugees. The health and ...humanitarian sectors have been severely affected by the protracted, complex conflict and have relied heavily on donor aid in the last decade. This study examines the extent and implications of health aid displacement in Syria during acute humanitarian health crises from 2011 to 2019.
Methods
We conducted a trend analysis on data related to humanitarian and health aid for Syria between 2011 and 2019 from the OECD’s Creditor Reporting System. We linked the data obtained for health aid displacement to four key dimensions of the Syrian conflict. The data were compared with other fragile states. We conducted a workshop in Turkey and key informants with experts, policy makers and aid practitioners involved in the humanitarian and health response in Syria between August and October 2021 to corroborate the quantitative data obtained by analysing aid repository data.
Results
The findings suggest that there was health aid displacement in Syria during key periods of crisis by a few key donors, such as the EU, Germany, Norway and Canada supporting responses to certain humanitarian crises. However, considering that the value of humanitarian aid is 50 times that of health aid, this displacement cannot be considered as critical. Also, there was insufficient evidence of health displacement across all donors.
The results also showed that the value of health aid as a proportion of aggregate health and humanitarian aid is only 2% in Syria, compared to 22% for the combined average of fragile states, which further indicates the predominance of humanitarian aid over health aid in the Syrian crisis context.
Conclusion
This study highlights that in very complex conflict-affected contexts such as Syria, it is difficult to suggest the use of health aid displacement as an effective tool for aid-effectiveness for donors as it does not reflect domestic needs and priorities. Yet there seems to be evidence of slight displacement for individual donors. However, we can suggest that donors vastly prefer to focus their investment in the humanitarian sector rather than the health sector in conflict-affected areas. There is an urgent need to increase donors’ focus on Syria’s health development aid and adopt the humanitarian-development-peace nexus to improve aid effectiveness that aligns with the increasing health needs of local communities, including IDPs, in this protracted conflict.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To provide an overview of the holistic impact of the armed conflict on medical education and health professionals' training (MEHPT) in Syria.
Syria is a country which underwent an armed conflict for ...10 years and suffered from the weaponisation of health.
A mixed-methods systematic review including quantitative, qualitative, mixed-methods and textual literature between 2011 and 2021 including papers on the Syrian MEHPT undergraduate and postgraduate education and training personnel (including medicine, dentistry, pharmacy, nursing, midwifery and allied health professionals). The electronic search was conducted in October 2018 in Embase, Global Health, Medline, PsycINFO, Web of Science, PubMed, Scopus, CINAHL and grey literature. And an update to the search was conducted in August 2021 in PubMed, Google Scholar and Trip database.
The impact of conflict on the MEHPT system, personnel, experiences, challenges and channels of support.
Of the 5710 citations screened, 70 met the inclusion criteria (34 quantitative, 3 qualitative, 1 mixed-method, and 32 reports and opinion papers). The two major cross-cutting themes were attacks on MEHPT and innovations (present in 41% and 44% of the papers, respectively), followed by challenges facing the MEHPT sector and attitudes and knowledge of trainees and students, and lastly health system and policy issues, and narrating experiences.
Conflict in Syria has politicised all aspects of MEHPT. Influenced by political control, the MEHPT system has been divided into two distinguished geopolitical contexts; government-controlled areas (GCAs) and non-GCAs (NGCAs), each having its characteristics and level of war impact. International and regional academic institutes collaboration and coordination efforts are needed to formulate educational platforms using innovative approaches (such as online/blended/store-and-forward/peer-training/online tutoring) to strengthen and build the capacity of the health workforce in conflict-affected areas.
New drugs being established in the market every year produce specified structures for selective biological targeting. With medicinal insights into molecular recognition, these begot molecules open ...new rooms for designing potential new drug molecules. In this review, we report the compilation and analysis of a total of 56 drugs including 33 organic small molecules (Mobocertinib, Infigratinib, Sotorasib, Trilaciclib, Umbralisib, Tepotinib, Relugolix, Pralsetinib, Decitabine, Ripretinib, Selpercatinib, Capmatinib, Pemigatinib, Tucatinib, Selumetinib, Tazemetostat, Avapritinib, Zanubrutinib, Entrectinib, Pexidartinib, Darolutamide, Selinexor, Alpelisib, Erdafitinib, Gilteritinib, Larotrectinib, Glasdegib, Lorlatinib, Talazoparib, Dacomitinib, Duvelisib, Ivosidenib, Apalutamide), 6 metal complexes (Edotreotide Gallium Ga-68, fluoroestradiol F-18, Cu 64 dotatate, Gallium 68 PSMA-11, Piflufolastat F-18, 177Lu (lutetium)), 16 macromolecules as monoclonal antibody conjugates (Brentuximabvedotin, Amivantamab-vmjw, Loncastuximabtesirine, Dostarlimab, Margetuximab, Naxitamab, Belantamabmafodotin, Tafasitamab, Inebilizumab, SacituzumabGovitecan, Isatuximab, Trastuzumab, Enfortumabvedotin, Polatuzumab, Cemiplimab, Mogamulizumab) and 1 peptide enzyme (
-derived asparaginase) approved by the U.S. FDA between 2018 to 2021. These drugs act as anticancer agents against various cancer types, especially non-small cell lung, lymphoma, breast, prostate, multiple myeloma, neuroendocrine tumor, cervical, bladder, cholangiocarcinoma, myeloid leukemia, gastrointestinal, neuroblastoma, thyroid, epithelioid and cutaneous squamous cell carcinoma. The review comprises the key structural features, approval times, target selectivity, mechanisms of action, therapeutic indication, formulations, and possible synthetic approaches of these approved drugs. These crucial details will benefit the scientific community for futuristic new developments in this arena.
The Sphere Handbook (Humanitarian Charter) includes guidelines for integrating NCD management and prevention in the programming systems of humanitarian actors, although the costs of tackling these ...diseases and the long-term commitment required to tackle them ha ve still not been achieved.4 Challenges in continuity of care and medication access after the start of the conflict in several countries such as Libya, Sudan, Yemen, Syria, Central African Republic, Burkina Faso, Democratic Republic of Congo and many others were frequently reported, suggesting a need for integration of NCD programming (including mental health services) into primary healthcare and targeted intervention planning in future response efforts.6 Programmes to address the high cost of both healthcare and medication need to be developed and aligned with the government’s declaration of free healthcare and medications for displaced populations.7 Strengthening the primary care workforce to deliver high-quality care for NCDs in refugee settings is also important as lessons learnt from a UNHCR (The UN Refugee Agency) partnership with Primary Care International to implement NCD trainings for front-line health workers shows. Additionally, international and non-governmental organisations should consider seeking diversified funding, aiding in prioritisation for equitable policy change and preventative interventions for NCDs.4 In order to address NCDs in a comprehensive way in humanitarian emergencies, a multistakeholder approach that includes healthcare providers, governments, humanitarian agencies and academic institutions as well as voices of people living with NCDs is required.5 Fifth, closer collaboration with non-health sectors such as food security, nutrition, shelter and site planning would support advocacy for preventive behaviour through healthier lifestyles.6 Provision of healthy food is a particularly relevant example, as affected populations are often dependent on food distribution and choice/control of their diet therefore relies on humanitarian agencies. The most critical dimension of the prevention strategy is lifestyle management at the individual level, with a focus on policy actions, such innovations, which can help society to increase the awareness of risk factors management, to take health policy decisions at a country level and to develop a health strategy at the global level.9 The ability to make healthy lifestyle choices is even more complicated in humanitarian and fragile settings with commercial determinants of NCDs, corporate behaviour and policy influence in humanitarian contexts. The inaugural International Strategic Dialogue on NCDs and the Sustainable Development Goals, held in Accra, Ghana, where a new Global Compact on NCDs was launched, co-hosted by WHO, together with Ghana and Norway did not mention of humanitarian or conflict in this new compact.11 This is despite the Global Action Plan for the prevention and control of NCDs, and the 2030 Agenda for Sustainable Development Goals are strongly committed to leaving no one including the growing numbers of IDPs and refugees around the world.4 Data availability statement There are no data in this work.
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