Health Systems Strengthening to Tackle the Global Burden of Pediatric and Congenital Heart Disease: A Diagonal Approach

1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].

Implementation of an international medical student pen-pal club:survey outcomes of perceptions in cultural competency and global health

Background:Pen-pal clubs(PPC)are used worldwide for students to learn about different cultures and other skillsets without the need for travel.Many medical students are interested in global health opportunities abroad but costs,scheduling,and other barriers allow few to participate in such experiences.It is important that medical students have nuanced global medical perspectives and can contribute to the global medical community.Objective:The purpose of this study is to demonstrate that an international medical student PPC improves medical students'perspectives of cultural competency and global health engagement.Methods:In 2021,a novel medical student PPC was established that began between an American and Japanese medical school.Following a shareholders meeting,it was decided that the number of medical schools involved globally be expanded through previous institutional affiliations and online presences.In total,the club connected 50 American medical students and 52 medical students from 17 high-and middle-income countries.The primary form of communication was online;pen-pals were encouraged to communicate monthly using provided topics,although frequency and way of communication was their discretion.In February 2022,American PPC members were emailed a qualitative survey to assess the PPC's impact.Results:The survey was completed by 42%of American PPC members,95%of which were 22-26 years.Participants were preclinical medical students,60%whom were female and the majority either white(47%)or Asian(43%).Overall,the PPC positively influenced American medical students'perception of global medicine,medical education,and their cultural competency after joining the PPC compared to prior(P=0.004).Conclusion:PPCs encourage medical students to think from a global perspective and foster open-mindedness within varying social and cultural contexts.Having a global communication platform for students during medical school education may be an additional way to train aspiring global leaders.

Shaping global health promotion:a comprehensive analysis of the 10 Global Conferences on Health Promotion Conferences(1986-2021)

Objective This study analyzed how the 10 Global Conferences on Health Promotion have played a significant role in shaping and promoting a worldwide consensus and actions on health promotion,effectively addressing diverse health challenges that evolved over different periods.Methods The textual analysis method was used in this study and text encoding was conducted to systematically examine the declarations and reports presented by the 10 Global Conferences on Health Promotion held during 1986-2021.We summarized the themes and key achievements,and key vocabulary in the conference declarations was extracted and analyzed to construct the global health promotion consensus and actions.Results The fundamental principles of the conferences are to foster consensus and initiate actions in the realm of health promotion on a global scale.The primary purpose and goal are to promote health from regional to global.Significantly,our findings highlight a transition in the primary actors driving health promotion.It underscores a shift in health promotion from being driven primarily by organizations like the World Health Organization,governments,and international bodies,to a more inclusive approach involving non-governmental organizations and the general public.This development implies that health promotion has evolved into a collective global endeavor,demanding the proactive involvement of various stakeholders,and forging new alliances in public health.Meanwhile,the coronavirus disease 2019(COVID-19)pandemic has further shaped the landscape of health promotion,underscoring the need for intensified focus on areas including disease prevention,health education,and the integration of digital health technologies,and emphasizing the importance of a multidimensional,responsive approach in public health initiatives.Conclusions Sustained collaboration and innovative strategies are pivotal to advancing health promotion globally.Countries,together with public and private entities,should intensify cooperation.Multisectoral collaboration among partners such as healthcare,education,social security,and the industry is vital for health promotion and achieving global health goals.

Artificial Intelligence for Global Health: Difficulties and Challenges: A Narrative Review

Global health (GH) aims to improve healthcare for all people on the planet and eradicate all avoidable diseases and deaths. The inception of Artificial Intelligence (AI) is innovating healthcare practices and improving patient outcomes by shuffling enormous volumes of health data—from health records and clinical studies to genetic information analyzing it much faster than humans. AI also helps in the improvement of medical imaging and medical diagnosis. There is an increased optimism regarding the use of applications of AI locally but can these facets be translated globally in the advancement and delivery of healthcare with the help of AI. At present majority of AI developments and applications in health care provide to the needs of developed countries and there is little effort to develop programs which could help to improve healthcare delivery globally. We performed this narrative review to assess the difficulties and discrepancies in implementing AI in global health delivery and find ways to improve.

Monkeypox outbreak in the age of COVID‑19:a new global health emergency

Dear Editor,The World Health Organization recently declared monkeypox as a global emergency after reporting more than 57,000 new cases worldwide[1].Monkeypox is an orthopoxvirus similar in nature to the Variola virus,which is a causative agent for smallpox[2].Monkeypox virus presents as a unique challenge for global health and should be regarded with grave concern as the vast majority of cases are occurring in countries where the disease is not considered endemic.Furthermore,the spread of this pathogen is occurring concomitantly as the world is still engaged in a battle with the coronavirus disease 2019(COVID-19)pandemic,which has caused substantial damage to global healthcare infrastructure.If monkeypox continues its rapid spread,hospitals could be quickly overwhelmed by both COVID-19 and monkeypox cases.Now more than ever,early symptom recognition and use of all available treatments to contain monkeypox outbreaks are vital.Early precautions including early recognition of symptoms by physicians,use of currently available treatments,and promoting precautionary measures in at-risk populations may be vital in preventing hospital burden and further physician burnout.

Chromoblastomycosis:a tropical-subtropical fungal disease with pathognomonic features not to be neglected in a global health scenario

Chromoblastomycosis(CBM)is a fungal disease,distributed in tropical and subtropical regions,affecting mainly rural workers.It is characterized by chronic skin lesions that may vary from nodular,tumorous,verrucous or plaque type.Associated constitutional symptoms are rarely found.The histological presentation may yield a pathognomonic feature,the Medlar(sclerotic)bodies,in which a typical brown to black pigment is depicted,explaining“copper pennies”as its alias.In this article,the case of a 56-year-old woman in the countryside of Brazil is reported,whose main complaint was a chronic leg ulcer for the past 8 years.The left leg had a large,partially ulcerated plaque lesion was found.Microbiological cultures were positive for the pathogen.Histological analysis demonstrated pseudoepitheliomatous hyperplasia,lymphohistiocytic infiltrate and sclerotic bodies(“copper pennies”).CBM’s epidemiological panorama,once established uniquely by geographical distribution,is transitioning to a global health issue,influenced by immunosuppressive conditions,global warming and migration.This scenario demands CBM to be widely considered as a differential diagnosis and may represent a clinical challenge in regions whose professionals have little expertise in infectious tropical diseases.

Link between childhood obesity and gut microbiota

Childhood obesity is a critical global health concern with rising prevalence and significant long-term health implications.Recent studies have implicated gut microbiota in the development and progression of obesity.This editorial analyzes the research conducted by Li et al,who utilized 16S rRNA gene sequencing to compare the gut microbiome of overweight and healthy-weight children.The study found significant differences in microbial diversity and composition between the two groups,with potential implications for understanding and managing childhood obesity.We analyzed the study’s advantages and drawbacks,proposing potential areas for future research to better understand the connection between gut microbiota and obesity.

Global prevalence and gender inequalities in at least 60 min of self-reported moderate-to-vigorous physical activity 1 or more days per week:An analysis with 707,616 adolescents

Background:Guidelines recommend that adolescents should accumulate an average of 60 min per day of moderate-to-vigorous physical activity(MVPA).However,using only this cut-off could hide important information.For instance,from a population-level point of view,increasing physical activity for those with no or low physical activity could provide more health benefits than increasing physical activity for those with intermediate levels.Also,including a more sensitive cut-point of≥1 days per week could be an additional strategy for identifying those with low access/opportunities for physical activity practice.Thus,the current study aims to estimate the prevalence of≥60 min of MVPA≥1 days per week among adolescents globally,and to describe any relevant gender inequalities.Methods:We used representative datasets from 146 countries/territories collected between 2003 and 2019.MVPA was self-reported.Participants were grouped into younger(≤14 years old)and older(>14 years old)adolescents.Crude Poisson regression models were used to identify the relative differences in≥60 min of MVPA≥1 days per week between boys and girls,and random-effects meta-analysis models were used to identify the pooled estimates.Analyses were stratified by country and region.Results:Approximately 80%of both younger and older adolescents reported≥60 min of MVPA≥1 days per week.This prevalence was≥94%in Europe and Central Asia and North America,while the estimates for the other regions were<77%.The prevalence of≥60 min of MVPA≥1 days per week was higher among boys than girls,with the largest differences occurring among the oldest adolescents(Prevalence ratio_(≤14y)=1.04(95%confidence interval(95%CI)):1.03-1.04)vs.Prevalence ratio_(>14y)=1.09(95%CI:1.08-1.10)).Conclusion:Approximately 8 out of 10 adolescents reported accumulating≥60 min of MVPA≥1 days per week,with notable differences between regions.Gender differences were observed in several countries,especially among the oldest adolescents.Priorities for physical activity promotion among adolescents should include increasing access/opportunities for physical activity among those who do not achieve≥60 min of MVPA≥1 days per week and reducing gender inequalities.

Reflections on Studying Huang Di Nei Jing in the West

Huang Di Nei Jing(《黄帝内经》The Yellow Emperor’s Inner Classic) has been the source text of Chinese medicine knowledge and innovation for over two thousand years. Despite this key relevance, many of its ideas and practices have proven difficult to understand and implement fully into clinical practice. Cultural and language differences can be compounded with these challenges but may also present new opportunities for advancement and insight when studied by researchers outside of the originating culture. This article introduces the method of Classical-Text Archaeology and delves into the author’s two-decade journey of researching this text, with a discussion on cultural differences and issues of medical scholarship.

Coronavirus disease 2019 (COVID-19) pandemic: how countries shouldbuild more resilient health systems for preparedness and response

Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto public health emergencies under the International Health Regulations (2005), the actions of most countriesto combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This crosssectionalstudy aimed to examine the health system resilience of selected countries and analyze their strategiesand measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K.,and the U.S., based on the severity of the national epidemic, the geographical location, and the developmentlevel. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure theseverity of the impact of the pandemic in each country;WHO State Parties Self-Assessment Annual Reporting (SPAR)Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience;and research articles and press materials were summarized to identify the strategies and measures adopted bycountries during response to COVID-19. This study applied the resilient health systems framework to analyzehealth system resilience in the selected countries from five dimensions, including awareness, diversity, selfregulation,integration and adaptation.Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and theU.S. were above the global and regional averages;the SPAR Scores of Iran were above the global average whilethe GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. investedmore health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategyof extensive testing and identification of suspected patients. In terms of specific measures, all the five countriesadopted measures such as restrictions on entry and international travel, closure of schools and industries,lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied acrosscountries, based on the response strategies.Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparednessand response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries stilldo not build resilient health systems in response to public health emergencies. Health system strengtheningand health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach todeveloping resilient health systems.

Global health education in Chinese universities and potential for collaboration with schools of nursing: A qualitative study

Background: The Chinese Consortium of Universities for Global Health (CCUGH) was established within schools of public health in 2013 with the goal of enhancing global health in China.Expanding nursing students' exposure to global health curricula is important as nurses are essential actors in the health care system.However,information related to existing global health education within CCUGH-affiliated universities and the current engagement of Chinese schools of nursing in global health remains extremely limited.Objective: To identify and describe the current definitions and conceptualizations of global health education in Chinese universities,with a focus on schools of nursing,in order to explore potential opportunities for strengthened collaboration between global health initiative and schools of nursing in China.Methods: Purposive sampling with snowballing was used to recruit 19 key informants who were critical stakeholders in global health and nursing in China.Key informant interviews were conducted from July 2014 to February 2015,and data were updated in June 2016.Content analysis was used to analyze data via Atlas.ti 7.Results: There was a rapid growth in global health education within and beyond CCUGH-affiliated universities with nine universities establishing global health institutes.Translation and definition of global health lacked consistency in Chinese language.Though no course directly related to global health was offered,schools of nursing were gradually participating in global health education and research.Nursing was a critical component of global health,and global health and nursing mutually advanced each other.Nursing education should include global health contents,but at present independent global health curriculum in schools of nursing was not appropriate.Conclusion: Increasingly Chinese universities are promoting global health education through the platform of CCUGH.It is an ideal moment to promote and expand work across the fields of global health and nursing,specifically to highlight opportunities for collaboration across education,research and practice.

Global health governance for travel health: lessons learned from thecoronavirus disease 2019 (COVID-19) outbreaks in large cruise ships

Background: The outbreak and global pandemic of coronavirus disease 2019 (COVID-19) attracts a great deal ofattentions to the problem of travel health. Cruise tourism is increasingly popular, with an estimated 30 millionpassengers transported on cruise ships worldwide each year. Safeguarding the health of cruise travelers duringthe entire travel is of ultimate importance for both the industry and global public health.Objective: This study aimed to explore the challenges and opportunities in travel health from the perspective ofglobal health governance.Methods: The global governance framework including problems, values, tools or regulations, and actors relatedto travel health were used to analyze the issues involved.Results: Up to April 2020, nearly thirty cruise ship voyages reported COVID-19 cases. The Diamond Princess,Grand Princess and Ruby Princess cruise ship had over 1,400 total reported COVID-19 cases, and more than 30deaths. A community with a common future in travel health is the core value of global health governance fortravel health. The travel-related international regulations, including the International Health Regulation (IHR[2005]), United Nations Convention on the Law of the Sea (UNCLOS) and the International Maritime Organization(IMO) conventions should be further updated to deal with the travel health problems. The roles andresponsibilities and the cooperation mechanisms of different actors are not clear in relation to the public healthemergencies during the travel.Conclusion: Travel health transcends national borders and involves multilevel actors, thus needs globalcooperation and governance. Regulations and legislation at global and country level are required to preventlarge-scale humanitarian crisis on travel health. Multilateral coordination, cooperation and collaborationmechanisms between governments, intergovernmental organizations, non-governmental organizations andindustry are needed to build a better community of common destiny for travel health.

Genomics and world health: hopes and realities

Due to lack of appreciation of the complexities of the interactions between nature and nurture, claims for the rapid improvements in medical care following the human genome project have been exaggerated. Although some progress has been made in certain fields, the full scope of genomic medicine may not be realised for many years.

《中国医科大学学报》入选2008年英国《公共健康研究数据库》(Global Health)收录中国期刊名单

据中国高校自然科学学报研究会网站2009年3月30日报道,《中国医科大学学报》入选2008年英国《公共健康研究数据库》(Glbobal Health)收录中国期刊名单。Global

Missed Opportunities for Vaccination and Associated Factors among Children Aged 12 - 23 Months in Cameroon: Further Analyses of 2018 Cameroon Demographic and Health Survey

Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data from the 2018 Demographic and Health Survey (DHS) was analyzed for children with at least one vaccination date in the home-based record (HBR). Immunization performances such as accessibility, drop-out, and timeliness, were assessed. Service quality was assessed using MOV. Multiple logistic regression examined the effect of DHS variables on MOV outcomes, and a decision tree approach was used to study their interaction. Results: Overall, 1824 children aged 12 to 23 months were surveyed;1285 (70.45%) had cards seen with vaccination dates leading to 85.03% of immunization activities. A proportion of 46.5% of children were not completely vaccinated. There was 27% of drop-out between BCG and MCV1, and less than 10% with the specific antigens. Vaccination timeliness proportions ranged from 42.18% for BGC to less than 70% for PENTA1-3. The national prevalence of MOV for simultaneous vaccines was 75.1% (95% confidence interval (CI) = 72;79). Among those who experienced MOV, 67.4% (95% CI = 60 - 73) were uncorrected MOV. MOV was an issue in all regions and comparable in rural areas that urban areas (p = 0.2). Dose-specific MOV ranged from 2.66% (for the third dose of the pneumococcal conjugate vaccine) to 91.12 (for the yellow fever vaccine). Second birth order children experienced more MOV than first born children (adjusted odds ratio (aOR) = 1.67, 95% CI: 1.11 - 2.47). Children born to non-educated/primary level mothers had increased odds of experiencing a MOV than those born to educated mothers (aOR = 1.48, 95% CI = 1.007 - 2.19/aOR = 1.55, 95% CI = 1.12 - 2.09). Children from poorest households were at high risk of experiencing MOV for any vaccine than richest households (aOR = 2.04, 95% CI = 1.11 - 3.76). Conclusion: There is a burden of MOV and under immunized children in the population. Direct interventions that target rural poor and focus on equity gaps that relate to maternal education, socio-economic status, and family planning, should be implemented. Such strategies should aim at reducing MOV for the achievement of the immunization agenda 2030 goals.

Disciplinary development of global health academic degree programs in China

This study aims to provide a brief overview of the history and development of global health education(GHE)as academic degree programs worldwide,and to identify GHE’s development opportunities and obstacles in China.This is a state-of-the-art review of published and unpublished information that described and evaluated disciplinary development of global health degree programs worldwide,written in English,and published or shared between 1990 and 2020.Data were derived from official websites of leading global health institutions,like“Google Scholar”,“PubMed”,and unpublished information such as presentation files and unpublished manuscripts collected from knowledgeable leaders in the field.We retrieved and reviewed a total of 35 articles and a large amount of unpublished information or sources on the internet.Global Health emerged as a new discipline around the end of the last millennium and proliferated in the last two decades in developed nations,especially the United States and the United Kingdom.The development of China’s GHE programs was built on China’s increasing engagement in global health affairs and research.In 2012,Wuhan University established the first official global health department in China.Several universities such as Peking University and Duke Kunshan University subsequently set up departments or programs to offer undergraduate and postgraduate majors and degrees.The first school-level global health unit was established in Shanghai in 2019.The Consortium of Chinese Universities for Global Health(CCUGH)grew from 10 founding members in 2013 to 25 in 2020.Major desirable attributes“unique”to students majoring in global health include global-mindedness,health interests,compassion,intercultural sensitivity,and adventurous spirit.Graduates from GHE programs have a diverse set of career choices spanning research,government,not-for-profit,and private sector occupations.We identified a number of strengths,weaknesses,opportunities,and threats to the future development of GHE in China.To ensure sustainable future growth,we advocate addressing the following key aspects:(1)clearer disciplinary distinctions;(2)multidisciplinary collaborations;(3)public-sector investments;and(4)non-public sectors participation.Amidst China’s increasing engagement in health affairs globally and the proliferation of GHE programs in developed nations,China has experienced fast growth in GHE degree programs since 2012 while a number of challenges remain for its future development.

Health Staff Ready to Work without Borders

Introducing courses on global health in Italian University curricula is essential to improve public health in Italy and to raise awareness in health professionals about global health challenges and inequalities. CCM （Comitato Collaborazione Medica） has developed a structured strategy to provide medical and nursing students and health professionals eager to work/volunteer in low- and middle-income countries with the necessary skills and knowledge to carry out sustainable health-care interventions, that require not only clinical expertise, but also foremost the understanding of local contexts and approaches to care. The comprehensive understanding of the variety of health-care systems at a global level can also help Western health professionals to properly address global migration challenges and the continuously evolving health needs in their own countries. Since 2004, CCM has been organizing training courses for a wide range of Italian health staff （e.g. physicians, nurses, midwives, laboratory technicians, psychologists, social workers） to transfer knowledge, skills and tools that may help them to address health needs in a globalized world. These courses aim to provide participants with soft skills meant at improving the doctor-patient relationship in a variety of contexts and to address health needs holistically; an additional goal is to raise awareness of global health inequities and inequalities and the determinants of health.

Cultivating global health professionals: evaluation of a training course to develop international consulting service competence in China

Background:China’s accelerating development and increasingly important role in global health engagement create a great demand for global health professionals including international consulting experts.This study reported the detailed development and evaluation of an international consulting training for global health workforce.Methods:Based on Kirkpatrick’s model,a mixed-methods approach was used to evaluate the effectiveness of the training.Quantitative and qualitative data on participants’reaction,learning,and application of the learned knowledge and skills were collected by a training evaluation survey at the ending of training and a follow-up interview in three months after the training.Results:Thirty-six participants attended the training and 34 of them completed quantitative investigation.The training satisfaction evaluations were positive,for which participants rated the training program highly and over 90%of them agreed with the usefulness of the training.About knowledge and skills change,participants showed improved consulting knowledge and skills from pre-to post-training(P<0.001).A total of 23 participants accepted follow-up interview,and most participants applied knowledge and skills learned from the training in their daily work or study.However,only 30.4%of participants applied their learning in the consulting program.The largest barrier of application was the lack of consulting opportunities.In addition,almost all the participants reported that they would be glad to attend more training courses in the future.Conclusion:The international consulting training program was well-received,and was feasible to improve the consulting service competence of global health professionals.According to participants’feedback,it is essential to develop and expand consulting training in the field of global health.

Global health education in U.K. universities

Background:The coronavirus disease 2019(COVID-19)pandemic has led to a paradigm shift in global health,casting a previously niche academic discipline into a headline dominating field of research.However,accurate information on the delivery of global health education(GHE)at a university level is lacking.This study aims to assess current GIIE practices in U.K.universities,by identifying the availability of dedicated global health qualifications,as well as the breadth of inclusion of GHE topics across university course content.Methods:Universities selected were the top 25 recipients of MRC funding in 2015-2016,as well as universi­ties who were included in previous iterations of the“Global Health League Table”.We used the Consortium of Universities for Global Health“GHE Competencies Toolkit”to identify the presence of global health content across university global health and other course offerings.Universities were additionally judged on opportunities available in global health and on the presence of sustainable partnerships.Results:Our results showed that 20 universities(74%)offer a post-graduate global health related course,with 9(33%)offering an undergraduate global health related course.13(48%)were identified as centers of global health excellence.Just 12(44%)universities had registered sustainable partnerships with Tropical Health and Education Trust.The London School of Hygiene and Tropical Medicine was identified as the top deliverer of GHE,with the Universities of Leicester and the Universities of Exeter joint bottom.We were unable to standardize quality assessments in this iteration of the project,but the release of student feedback to future assessors would help to improve the reliability of this study methodology.Additionally,much of our data was based on information available online,and thus some aspects of degree courses not published publicly may not have been accounted for in our scoring.Conclusion:Those institutions wishing to improve their delivery of GHE should consider the establishment of a postgraduate or undergraduate degree course.Breadth of global health content across curricular was a major discriminating factor between institutions,and we would advise universities to consider including more global health topics across their curricular-especially in light of the intersectional impacts of the COVID-19 pandemic.

Paths and Challenges of Chinese NGOs Participate in Global Public Health Governance——The Case Study of Chinese Red Cross Foundation

With the development of the world’s politics and economic,the participants in the global governance system have also undergone profound changes;among them,non-governmental organizations(NGOs)as an essential role of the sub-national actors have an important impact on today’s global public health governance.From the case of the Chinese Red Cross Foundation,we can see that Chinese NGOs have their own unique way to participate in global public health governance.Good project design,professional implementation plans,and diversified partners are powerful guarantees for successful governance participation.At the same time,financial issues,institutional guarantees,and further improvement of professionalism are areas that need to be improved in the future.