Effect of culture on acceptance of telemedicine in Middle Eastern countries: Case study of Jordan and Syria

© Mary Ann Liebert, INC.We investigated issues that affect the use and adoption of telemedicine in Middle Eastern countries, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as case studies. Our study is based on interviews with key stakeholders (including doctors, technicians, engineers, and decision makers) and questionnaires administered to key stakeholders (including patients), ensuring opinion was gained from people from a full range of backgrounds and roles in the healthcare system. We found doctor and patient resistance was a major issue preventing the adoption of telemedicine in both countries, followed by poor infrastructure, lack of funding, and lack of information technology training. Our research identifies that culture is a greater issue than technical matters for the adoption of telemedicine in Middle Eastern countries. Based on our preliminary results we developed a guideline framework for each country that might be applied to telemedicine projects at the pre-implementation phase. The proposed guideline framework was validated through a return visit to the stakeholders and seeking further opinion

Modelling the spead of Sphaerothecum destruens, a generalist fungal pathogen.

Humans have altered the global landscape with agriculture, urban development and international trade, and the incidence of emerging infectious diseases (EIDs) has increased as a result. Pathogens can emerge in new areas as a direct result of global transport trade or indirectly due to climate–mediated shifts in parasite geographic range. These pathogens can cause considerable ecological and economic damage, as they accelerate biodiversity loss and threaten global food security. Furthermore, the inherent characteristics of pathogens allow their rapid evolution, intensifying their potential threat. Fungi and fungal-like pathogens are an increasing component of EIDs with highly opportunistic features. One group of these pathogens on the animal-fungal boundary is the Mesomycetozoea, a group which has raised ecological concerns for a range of susceptible host species including birds, amphibians and mammals. To be able to mitigate the impacts of these pathogens effectively, their dynamics and drivers must be better understood. Using the only Mesomycetozoea fungal species that has been cultured to date, the generalist pathogen Sphaerothecum destruens, empirical data on infectivity and pathogen life cycle were used in several epidemiological models to explore how a fungal-like generalist is transmitted within different host communities. First, a single host system was created using the available empirical data. This demonstrated that multiple saturation functions were needed to parameterise the model accurately, and identified incubation and recovery rates as drivers of epidemics. The parameter values obtained from the single-host models enabled the characterisation of mathematical relationships between different parameters, a task which can be difficult in epidemiology. Following this, a multi-host model was used to examine pathogen establishment in different communities. The roles of community structure and composition were explored, including the influence of competitive interactions between host species. Host density, proximity between communities, the competitive interactions between species, and the persistence of free-living pathogen propagules were identified as important factors in disease emergence and community survival. Environmental transmission was a key pathway for pathogen establishment. Finally, the evolution of S. destruens’ virulence was explored in different conditions and for various transmission strategies. Direct contact and environmental uptake rates were key determinants of pathogen evolutionary stable strategy. Host eradication and selective restocking were evaluated as disease management techniques, examining the advantages and possible repercussions of each approach in light of the pathogen’s ecological and evolutionary dynamics. Mathematical models have been crucial in expanding ecological and epidemiological knowledge in other pathogens, allowing the exploration of diverse conditions and hypotheses about disease dynamics. The reliability of the results and their applicability were greatly enhanced by the inclusion of empirical data, giving this research substantial advantage in the robustness of model outputs. This work provided new insights on how fungal and fungal-like pathogens are transmitted and the risks of establishment in different populations, and can be applied to similar emerging pathogens, especially those that are fungi and fungal-like

Improving Healthcare Access through Digital Health: The Use of Information and Communication Technologies

Healthcare has been going through major digital transformations due to the extensive use of information and communication technologies (ICT) in the sector. Many patients lack access to healthcare services due to lack of knowledge of the exitance of the service, physical or mental disability, distance, siege, lockdown and other possible reasons. Access to healthcare services has been impacted by a number of innovations including electronic health record, artificial intelligence, sensors, wearable devices, Internet of (medical) things, Blockchain, big data and other applications. COVID-19 has created new realities in accessing healthcare services through telehealth and telemedicine services as many countries have imposed lockdown and physical distancing. Digital health has been used to empower people, in general and patients in particular, to enable them to access healthcare services at the point of care or remotely. Healthcare professionals have been using digital health to enhance their knowledge, skills and more important to enable them to reach to patients to provide guidance and assistance. Using digital health solutions has a number of challenges which can be legal, ethical, infrastructural, human and material resources, training, education, attitude, cultural, organizational and behavioral. A number of national, regional and international agencies have adopted resolutions and developed strategies to support digital health implementation in countries. This chapter provides few examples to demonstrate how access to healthcare services is being enabled and facilitated by information and communication technology (ICT) through proper national planning of digital health

The influence of predation on community resilience to disease

1. Outbreaks of generalist pathogens are influenced by host community structure, including population density and species diversity. Within host communities predation can influence pathogen transmission rates, prevalence and impacts. However, the influence of predation on community resilience to outbreaks of generalist pathogens are not fully understood. 2. The role of predation on host community resilience to disease was assessed using an epidemiological multi-host Susceptible-Exposed-Infectious-Recovered (SEIR) model. Sphaerothecum destruens, an emerging fungal-like generalist pathogen, was used as a model pathogen. Six cyprinid and salmonid fishes, including an asymptomatic carrier, were selected as model hosts that are known to be impacted by S. destruens, and they were used within a model host community. 3. Pathogen release into the host community was via introduction of the asymptomatic carrier. Mortality from infection, pathogen incubation rate, and host recovery rate were set to a range of evidence-based values in each species and were varied in secondary consumers to predict top-down effects of infection on the resilience of a host community. Predation pressure within the fish community was varied to test its effects on infection prevalence and host survival in the community. 4. Model predictions suggested that predation of the asymptomatic hosts by fishes in the host community was insufficient to eliminate S. destruens. S. destruens persisted in the community due to its rapid transmission from the asymptomatic host to susceptible host fishes. Following transmission, pathogen prevalence in the community was driven by transmission within and between susceptible host fishes, indicating low host community resilience. However, introducing low densities of a highly specific piscivorous fish into the community to predate asymptomatic hosts could limit pathogen prevalence in the host community, thus increasing resilience. 5. The model predictions indicate that whilst resilience to this generalist pathogen in the host community was low, this could be increased using management interventions. The results suggest that this model has high utility for predicting community resilience to disease and thus can be applied to other generalist parasites to determine risks of disease emergence

Stress and Professional – Counseling Self –Efficacy among Female Teachers of Pupils with Learning Disabilities in Muscat Governorate

The purpose of this study was to assess stress and professional counseling self–efficacy among female teachers of pupils with learning disabilities in Muscat governorate. The study attempted to answer the following questions: what is the extent to which female teachers of pupils with learning disabilities experience stress? What is the extent to which female teachers of pupils with learning disabilities have professional – counseling self–efficacy? Are there significant differences in stress due to female teachers' experience, qualification and marital status? Are there significant differences in professional counseling self–efficacy due to female teachers' experience, qualification and marital status? The sample consisted of female teachers of pupils with learning disabilities (n=96) in Muscat governorate. Two scales were designed to assess the dependent variables. To answer study questions; means, standard deviations, MANOVA, and Scheffe’s test were conducted. The findings revealed that there were significant differences in stress and professional counseling self–efficacy due to qualification, while there were no significant differences due to experience, and marital status

The alternate role of direct and environmental transmission in fungal infectious disease in wildlife: threats for biodiversity conservation.

Emerging fungal pathogens have substantial consequences for infected hosts, as revealed by the global decline of amphibian species from the chytrid fungus. According to the "curse of the Pharaoh" hypothesis, free-living infectious stages typical of fungal pathogens lengthen the timespan of transmission. Free-living infectious stages whose lifespan exceeds the infection time of their hosts are not constrained by virulence, enabling them to persist at high levels and continue transmitting to further sensitive hosts. Using the only Mesomycetozoea fungal species that can be cultured, Sphaerothecum destruens, we obtained tractable data on infectivity and pathogen life cycle for the first time. Here, based on the outcomes of a set of infectious trials and combined with an epidemiological model, we show a high level of dependence on direct transmission in crowded, confined environments and establish that incubation rate and length of infection dictate the epidemic dynamics of fungal disease. The spread of Mesomycetozoea in the wild raise ecological concerns for a range of susceptible species including birds, amphibians and mammals. Our results shed light on the risks associated with farming conditions and highlight the additional risk posed by invasive species that are highly abundant and can act as infectious reservoir hosts

Where There Is No Internet: Delivering Health Information via the Blue Trunk Libraries

There are many areas in the developing world that have neither computers nor a reliable electricity supply. In response to the need for printed health information, WHO librarians created the Blue Trunk Library Project

Discussion of "Evidence-based health informatics:how do we know what we know?"

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Evidence-based Health Informatics: How Do We Know What We Know?" written by Elske Ammenwerth [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Ammenwerth paper. In subsequent issues the discussion can continue through letters to the editor. With these comments on the paper "Evidence-based Health Informatics: How do we know what we know?", written by Elske Ammenwerth [1], the journal seeks to stimulate a broad discussion on the challenges of evaluating information processing and information technology in health care. An international group of experts has been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.11 page(s