Infection science is a discipline of healthcare which includes clinical microbiology, public health microbiology, mechanisms of microbial disease, and antimicrobial countermeasures. The importance of infection science has become more apparent in recent years during the SARS-CoV-2 (COVID-19) pandemic and subsequent highlighting of critical operational domains within infection science including the hospital, clinical laboratory, and public health environments to prevent, manage, and treat infectious diseases. However, as the global community transitions beyond the pandemic, the importance of infection science remains, with emerging infectious diseases, bloodstream infections, sepsis, and antimicrobial resistance becoming increasingly significant contributions to the burden of global disease. Machine learning (ML) is frequently applied in healthcare and medical domains, with growing interest in the application of ML techniques to problems in infection science. This has the potential to address several key aspects including improving patient outcomes, optimising workflows in the clinical laboratory, and supporting the management of public health. However, despite promising results, the implementation of ML into clinical practice and workflows is limited. Enabling the migration of ML models from the research to real world environment requires the development of trustworthy ML systems that support the requirements of users, stakeholders, and regulatory agencies. This paper will provide readers with a brief introduction to infection science, outline the principles of trustworthy ML systems, provide examples of the application of these principles in infection science, and propose future directions for moving towards the development of trustworthy ML systems in infection science. Particularly, the use of ML continues to increase in high-stake environments where data is being used to support humans in decision-making scenarios and in some cases, completely removing human involvement. In healthcare, data driven processes are becoming more prominent along with the application of ML. This is evident by the growing application of ML in many areas of healthcare including radiology, cardiology, neurology, and general hospital use . This is2.ML is a type of artificial intelligence (AI), described as a set of methods/algorithms that learn patterns from data, utilising these patterns to produce predictions . ML tech3.Recently, the principles associated with trustworthy AI have become more of a focus in the research community as ML becomes increasingly applied in high-stakes environments such as finance, defence, and healthcare. This includes identifying the requirements for the development of trustworthy ML systems, and establish pathways to adoption for ML systems in practice.•Human agency and oversight•Technical robustness and safety•Privacy and data governance•Transparency•Diversity, non-discrimination and fairness•Societal and environmental well-being•AccountabilityThe implementation, relevance, and specific interpretations of the trustworthy AI requirements ultimately depends on the specific domain and context in which the ML system is being developed and deployed , established by the European Commission . They crdeployed . The guideployed , and do  purpose .In healthcare, it is the responsibility of the stakeholders in each of the unique domains to develop their own specific set of best practices that are appropriate for their own context. When developing ML systems worthy of trust, it is important to consider the entire lifecycle of the ML system. This involves data collection and processing, ML model development, and subsequent deployment and monitoring of the model. ML model development involves training, testing, and validation of the model, and deployment requires taking the model from the research, to the real world environment. This is often achieved by providing an interface to enable users to interact with the ML system, through a client-side application such as a web or mobile application, or through the use of an application programming interface (API) deployed through the use of cloud computing resources or on premise infrastructure. The principles of trustworthy ML systems need to be integrated at each of the stages in this ML system development and deployment lifecycle. This has been previously identified by Li et al. , where tThe recent attempts at establishing the principles, and guidelines for trustworthy AI systems has also prompted the requirement for methods to assess the overall trustworthiness of a system. An assessment of the trustworthiness of a ML system is necessary to deploy these systems into real world environments. Z-Inspection, introduced by Zicari et al. , is one 4.As previously identified, there have been a number of reviews highlighting the application of ML to problems in IS. However, far fewer ML applications implement the principles for developing ML systems that are worthy of trust. The google scholar database was searched to identify research articles that explore and implement the principles and practices of trustworthy machine learning systems for IS. Exact searches for “trustworthy machine learning for infection” did not produce any articles. Articles containing “trustworthy machine learning infection” and “machine learning infection” were searched for. Articles were then manually examined. Examples of studies which have implemented some of these principles based on this search have been included in this section and shown in 5.ML based approaches have been producing promising results in IS, providing insight into the utility of ML applications for addressing problems relating to patient management, clinical laboratory workflows, and surveillance and monitoring of public health. The increasing interest in the application of ML in the IS context presents additional opportunities to address the regulatory and system stakeholder concerns regarding the trustworthiness of ML based approaches in practice. The importance of implementing trustworthy ML principles along the entire ML lifecycle, from collection of data through to the deployment, monitoring, and continuous improvement of ML systems is critical to ensuring the success and adoption of these systems in practice. Whilst there has been a significant increase in the number of ML applications in IS, this is not reflected in the real world integration of the models into practice. A significant amount of the work regarding the development of ML systems in healthcare has been directed towards a small number of domains, which is evident by the number of approved AI based systems/devices in the United States of America (US) and Europe (EU). Between 2015 and 2020, 222 and 240 AI/ML devices have been approved in the US and EU respectively . These f6.There has been an increased focus on IS as a result of the COVID-19 pandemic and the significant impact on the global community. As the world moves beyond the pandemic, IS and the problems within the domain remain significant, with the growing threat of emerging infectious diseases, the global burden of sepsis, and the continual rise of AMR. The recent growth in the development of ML applications in the different areas of IS including the hospital, clinical laboratory, and public health setting has shown promising results. These applications have targeted a wide range of problems including the treatment and management of patients, the improvement of laboratory workflows, and predicting infection trends. However, there is a significant gap between the number of ML applications in research, and the effective implementation of ML systems. This paper has provided readers with an introduction to infection science, outlined the principles of trustworthy ML systems, presented an overview of the ML applications in IS that implement some of the principles of trustworthy AI, and identified the need for a change in focus towards implementing the practices of trustworthy ML systems to promote adoption of these systems in practice. Further work is required to ensure a more systematic view of trustworthiness is integrated into ML approaches in IS. In the future, we encourage researchers, engineers, and ML practitioners to address all areas of the ML system lifecycle, moving beyond model training and testing, and take a focused, end-to-end view of implementing trustworthy ML system principles in the IS domain to promote adherence to the regulatory requirements, stakeholder acceptance, and adoption of ML systems in practice within IS.


Stress Biology. Stress Biology was launched this year as an open access journal published by Springer Nature in partnership with Northwest A&F University of China. We plan to have the journal indexed by SCIE in 2024 and aim to obtain its first impact factor of no less than 5.0 in 2024.We are pleased to invite you to join us in celebrating the birth of a new life sciences academic journal, Stress Biology journal is to promote stress biology research for the sake of agricultural sustainability and human well-being.All organisms in nature, including plants, animals and microbes, have to struggle with a variety of biotic (pathogens and pests) and abiotic  stresses in order to survive and propagate. During the long history of evolution, these organisms have developed various strategies and mechanisms to cope with environmental stresses. Nevertheless, severe stresses are still the main challenges limiting the growth, health and productivity of plants and animals. Plants, animals, and microbes and their interactions are the vital parts of the ecology we depend on, and some of them such as crop plants, livestock and poultry provide the food, fiber and shelter for us. Global climate change brings with it more frequent extreme weathers, leading to outbreaks of diseases and pests, and severe drought and floods, heat waves and bitter cold, and causing great threats to agricultural production and food security. Therefore, understanding the mechanisms of stress resistance and developing technologies for improving the stress resistance of plants, animals and useful microbes is critical for sustainable agriculture. The mission of the Stress Biology aims to be a leading international journal that is vigorously peer-reviewed and publishes important results of stress biology research. The journal publishes original, high quality research of all aspects of stress biology, including but not limited to work that (1) provides fundamental insights into the understanding of responses of plants, microorganisms and animals to abiotic and biotic stresses; (2) elucidates the mechanisms underlying the adaptation and resistance of plants, microorganisms and animals to biotic and abiotic stresses; and (3) uses biotechnological and other strategies to improve the resistance of plants, microorganisms and animals to abiotic and biotic stresses. Topics covered by the journal include: physiology, molecular biology, cell biology, microbiology, pathology, ecology, genomics, epigenetics, gene editing, stress resistance breeding, biotechnology, and so on. Article types include: original paper, short communications, reviews, highlights, letters to the editor, editorials.Stress Biology will have all the good characteristics of a Springer Nature journal, including straightforward initial submission, fast and fair review with constructive comments, rapid online publishing prior to copyediting and typesetting, high-quality production, etc. Furthermore, as an open access journal, all contents will be freely available to researchers worldwide through the Springer Nature platform. The journal will cover article processing charge for authors during the period from 2021 to 2023.Stress Biology cover a wide range of research topics in the field of stress biology and showcase the goals and scope of our journal: a high-quality open access journal with a broad scope for communicating various discoveries in stress biology that contribute to the development of sustainable agriculture worldwide.The high-quality reviews and research articles published in this inaugural issue of Stress Biology!We sincerely thank all of the authors who have contributed papers to this inaugural issue. We also would like to thank all of our editorial board members and the reviewers, as well as members of our editorial and production teams, for their support. Our joint efforts have now culminated in the successful launch of this new journal of our own research community! We look forward to working together with you all to grow this promising journal so that your important research discovery can have the great impact and benefits to society it deserves. Come and publish in Editors-in-ChiefZhen-Sheng Kang: Academician of the Chinese Academy of Engineering, and Director of the State Key Laboratory of Crop Stress Biology for Arid Areas of ChinaJian-Kang Zhu: Member of the US National Academy of Sciences, and Director of the Shanghai Center for Plant Stress Biology, Chinese Academy of SciencesAssociate EditorsJin-Rong Xu: Professor of Purdue University, USAHuazhong Shi: Associate professor of Texas Tech University, USAExecutive editorQiao-Chun Wang: Professor of Northwest A&F University, China


First experience of the sub-national process of certification of elimination of mother-to-child transmission (MTCT) of HIV and/or syphilis at a global level. In 2022, 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants.The experience of sub-national certification of the EMTCT was important in mobilizing the municipalities that engaged in its initiatives, worked to improve the quality of care and surveillance and emerging as the main proponents in the process.Through this ongoing and dynamic initiative, there is an anticipation of over 100 municipalities and states joining in 2023. Sub-national certification aims to enhance comprehensive care for pregnant women, in order to achieve national certification of EMTCT.  to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission. Several recommendations and guidelines have been published, and a plan has been proposed for the Member States to promote the elimination of mother-to-child transmission (EMTCT) of HIV and syphilis in the Americas, with targets set to be met by 2015.Following PAHO’s initiative, the World Health Organization (WHO), in 2014, released the Global guidance on the criteria and processes for certification: EMTCT of HIV and/or syphilis. These criteria were expanded in 2017, when it was established the possibility for countries with a high prevalence of HIV and/or syphilis to be certified for the bronze, silver or gold tiers in “the path to elimination”, encouraging gradual reduction in MTCT rates.), and dual certification, in addition to providing for certification for gold, silver and bronze tiers on the Path to Elimination of MTCT of HIV and/or syphilis, in order to encompass places that have not achieved the elimination targets but show indicators that are closer to .8 Nati),,,,1,(1), The years evaluated were 2019 and 2020.The certification process of EMTCT of HIV and/or syphilis occurred in municipalities with ≥100,000 inhabitants during 2022, as a partnership strategy involving the Ministry of Health, states and municipalities, aiming to improve actions for reducing MTCT of HIV and syphilis, infections still considered a public health problem in the country.The steps for implementing the certification were as follows: (i) the establishment of the National Validation Committee for MTCT; (ii) definition of criteria and process and impact indicators; (iii) development of a list of cities with ≥ 100,000 inhabitants and eligible states, meeting the recommended indicators; (iv) proposal presentation to states and municipalities; (v) standardized development process of the certification report, based on the supplement to the Guide for Certification of Elimination of Mother-to-child Transmission of HIV and/or Syphilis, by the candidate municipality or state; (vi) analysis of municipal reports by the Ministry of Health; (vii) establishment and training of the National Validation Team (NVT), comprised of experts from each thematic axis; (viii) development of the field manual for the NVT; (ix) planning and performance of on-site visits by the NVT, based on the supplement to the Guide;In the Guide for Certification of Elimination of Mother-to-child Transmission of HIV and/or Syphilis, the subnational certification strategy acknowledges the development of actions distributed in four thematic axes, according to PAHO/WHO recommendations:a) programs and services;b)epidemiological surveillance and data quality;c) diagnostic capacity and test quality; andd)human rights, gender equality and community participation.These four axes were structured to induce organization and improvement of care based on the best evidence, according to the logistical and technological resources available.This spans from early prenatal care with timely access to testing and appropriate treatment, to surveillance, through case monitoring and control.The requirements and minimum criteria for municipality certification included (i) prior achievement of impact and process indicators, established in the Guide for Certification of EMTCT , (ii) thOf the total of 326 Brazilian municipalities with ≥ 100 thousand inhabitants, 85 were initially considered eligible based on the analysis of impact and process indicators and targets available in the national information systems; with the exception of testing, whose source is local. State administrators, contacted by the Ministry of Health via e-mail and phone calls, were asked to participate in the certification process by crafting strategies to support municipal administrators and health professionals of the network, aiming at epidemiological analysis of the data and development of the descriptive report.The main stage of the process was the on-site visit to the municipalities, carried out by the NVT, whose members should come from different states than those of the municipalities visited. The purpose of these visits was to validate and enhance the information provided in the report submitted by the municipality. This activity was divided into two segments: first, a technical and political meeting with state and municipal administrators, health professionals and local non-governmental organizations (NGOs) involved in the process; and secondly, the visit to the health services that comprise the maternal and child health care network . The primary care centers visited should preferably be located in regions of higher social vulnerability.In order to standardize the visits, (i) a list of evaluation points was developed for each type of request , according to the four axes previously described, and (ii) a structured framework was developed for generating reports during technical visits, including the evaluated points and observations.Conselho Nacional de Secretários de Saúde - CONASS), the National Council of Municipal Health Secretaries , professional councils , scientific societies, PAHO, UNICEF, UNAIDS and the National Regulatory Agency for Private Health Insurance and Plans . The visit report was also sent to the municipalities, as part of an ongoing process of improvement and qualification.A report was drafted for each visit in order to support the National Validation Committee in making the final judgment on the granting of certification. This Committee is comprised of representatives of the Ministry of Health, the National Council of Health Secretaries , followed by the Northeast region (n = 64). These regions encompass 71.5% of the Brazilian population living in municipalities of this size .In total, 45 certification requests were received from municipalities, across the country’s five macro-regions, and 43 received certification and/or tiers of progress toward elimination. The process involved visits to 337 health services within the maternal and child health care network. Services located in areas of greater social and individual vulnerability, as well as maternity hospitals and specialized care services (SCS) were given priority. Local specificities and schedule compliance represented challenges experienced by the NVT.At the end of the process, in 2022, of the 43 certifications awarded, 38 were for HIV and 22 for syphilis. One municipality achieved dual elimination of both HIV and syphilis. The highest number of certifications occurred in the Southeast and South regions of the country. The total number of municipalities that were certified encompassed 24.6 million inhabitants. Regarding the categories, 28 municipalities achieved elimination of HIV, while 10 received silver tiers. As for syphilis, there was one elimination, 4 gold, 13 silver and 4 bronze tiers A and 3B.The subnational certification process of EMTCT of HIV and/or syphilis in Brazil was the first experience in this regard, and can serve as a model for other countries. Implemented in 2022 for both health conditions, the initiative showed the importance of collaborating with states and municipalities in organizing service networks and surveillance of these infections.Some barriers and challenges emerged during the process, but the joint work involving the three levels of government enabled the identification of solutions and adaptations within the outlined dynamics. The primary required adjustment was the use of the guidance for certification proposed by the WHO,One barrier found in the experience was the challenge of measuring the indicator of coverage for pregnant women who underwent at least one HIV and/or syphilis test during prenatal care, given that there is no single national data source for its verification. It could be seen that adherence to the Ministry of Health’s electronic medical record system, which allows this information to be recorded, is heterogeneous across the country. It was also noted that a significant number of the candidate municipalities performed rapid testing, but did not systematically record this procedure. In addition, there was a gap in collecting this data within the private healthcare network. Therefore, the alternative found was to allow the systematic analysis of medical records, based on a representative random sample of live birth population in the years evaluated, namely: the medical records from the last full year for impact targets; and the last two full years for process targets. This measure was important and further motivated the municipalities to participate in the certification process for the elimination of MTCT of HIV and/or syphilis.),,,17,,(An opportunity in conducting this process was the face-to-face visits to the municipalities, which provided the exchange of experiences and knowledge, mobilization of local teams, identification of strengths and weaknesses in the processes developed in the locations, as well as encouraging the use of national information systems and the electronic medical record in primary health care. The certification process is a strategy for mobilization and continuous education. The indicators are monitored across the three levels of management annually, encouraging empowerment through recognition of the joint effort made. The stages of the process have strengthened the integration between surveillance and health care, intersectoral collaboration, intergovernmental management and social control in tackling EMTCT. All of these elements contribute to a continuous learning methodology and local improvement, operating as a potent mechanism for inducing the achievement of process and impact targets, towards the EMTCT of HIV and syphilis.By including the axis of “human rights, gender equality and community participation”, the certification process has promoted the recognition of municipal experiences in prevention, diagnosis and treatment, in the context of populations facing vulnerability and inequity in access to these services. Furthermore, it highlighted the need to promote community participation in instances of social control, such as health councils and ombudsman offices.The experience with the certification process of EMTCT of HIV and/or syphilis in 2022 was important in mobilizing the municipalities that engaged in its initiatives, worked to improve the quality of care and emerging as the principal proponents in the process. The participation of the three levels of government - federal, state and municipal - civil society and the scientific community showed the strength of tripartite governance, especially in a country with continental dimensions such as Brazil. For 2023, the whole process is being repeated with the anticipation of over 100 municipalities joining. The experience of the subnational certification of the elimination of MTCT of HIV and/or syphilis showed that, beyond the outcomes achieved, the methodologies employed were of paramount significance, providing change in service routines and better integration of surveillance with health care.


The process of ovulation involves multiple and iterrelated genetic, biochemical, and morphological events: cessation of the proliferation of granulosa cells, resumption of oocyte meiosis, expansion of cumulus cell-oocyte complexes, digestion of the follicle wall, and extrusion of the metaphase-II oocyte. The present narrative review examines these interrelated steps in detail. The combined or isolated roles of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are highlighted. Genes indiced by the FSH genes are relevant in the cumulus expansion, and LH-induced genes are critical for the resumption of meiosis and digestion of the follicle wall. A non-human model for follicle-wall digestion and oocyte release was provided. Ovulation is the term used to define the ovarian release of the female mature gamete that is ready to be fertilized. The process of ovulation includes a series of morphological and biochemical events within the preovulatory follicle. Several genes are activated in the ovarian environment, leading to enzymatic and structural transformations under the influence of gonadotropins and sex steroids that are modulated by several growth factors. All of these events ensure that the oocyte becomes likely to be fertilized and extruded on the ovarian surface to form the corpus luteum.menstrual cycle,menstrual cycle physiology,folliculogenesis,theca cells,granulosa cells,oocyte,oocyte-cumulus complex,follicular wall digestion,cumulus-oocyte-complex expansion,oocyte maturation,gene expression,FSH,LH, andprogesterone receptor. We expanded the search to the references of the retrieved articles.We searched for articles published in English in the PubMed and Google Scholar databases. The keywords were as follows:The more advanced stages of follicle development are characterized by the appearance of intercellular space filled by antral fluid. At this stage, the granulosa cells are differentiated into two distinct populations: cumulus cells, which are those closely linked to the oocyte, and wall or mural granulosa cells, which internally line the follicular wall. Although these two cell types share a common origin, there are differences in the production of transcribers and proteins.Folliculogenesis begins with the formation of the primordial follicle, and ends with the preovulatory follicle.The ovulation process occurs in a coordinated and interrelated way in five complex steps: interruption of granulosa cell proliferation, resumption of meiosis, expansion of the cumulus with oocyte release inside the antrum, lysis of the follicular wall, and oocyte extrusion at the metaphase II (MII) stage. In mammals, oocytes are stationed in meiosis I at prophase I. The resumption of meiosis I occurs during puberty as a result of the gonadotropic stimulus in follicles in the preovulatory stage, culminating in the rupture of the germ vesicle.Periovulatory gene expression induced by the FSH in cumulus cells plays a minor but necessary role in the mediation of ovulation . The ocThe role the LH in the ovulation process is complex and fundamental for the resumption of meiosis, loosening of the cumulus cells, and rupture of the follicle.The genetic and biochemical events responsible for cumulus mucification are summarized inThe oocyte maturation process aims to empower the female gamete and ensure its subsequent development until the activation of the embryonic genome occurs. Therefore, chromatin condensation is relevant in the continuity of meiosis, redistribution of organelles in the cytoplasm, and alterations in the cytoskeleton; all of these modifications are precisely regulated and coordinated .28ForThe functions of the OSFs include growth stimulation, prevention of apoptosis, inhibition of luteinization, regulation of energy metabolism, cholesterol biosynthesis, and regulation of cumulus expansion.In general, the properties of lacunar junctions enable the direct and bidirectional transport of small molecules between the oocyte and the granulosa cells. High intraoocyte levels of cAMP maintain the oocyte in the stage of germ vesicle, through suppression of the activity of the maturation-proimoting factor (MPF).In a recent studyThe meiotic spindles are responsible for the continuity of the meiotic division and extrusion of the two polar corpuscles. Initially, the mitochondrial groups are in a central position in the oocyte. As the maturation progresses, they migrate to the edges of the oocyte, close to the extruding regions of the polar body.Morphological and biochemical changes that result in rupture of the follicular wall and oocyte extrusion occur basically by the action of the LH, because it induces the synthesis and secretion of various enzymes . The roCAATenhancer-binding protein β (C/EBPβ), PR, and other activator protein-1 family members , all involved in the functional activity of the granulosa cells of the ovulating follicle.The ADAMTS 16, present in luteinized granulosa cells, responds to FSH stimulation and actively participates in the process of structural follicle remodeling at the time of ovulation. The role of the LH on PR is mimicked by cAMP-inducing agonists . Targets of PR appear to control the rupture of the follicle, mainly ADAMTS-1  and cathepsin L. Among the proteases involved, thrombospondins 1 and 4 (ADAMTS1/4) promote the breakdown of the proteoglycan family structures, such as versican, through granulosa activation by PRs,The proteoglycan  components of the ECM induced by the LH peak, on either granulosa or theca cells, serve as substrates preferably for ADAMTS 1, culminating in follicular rupture.After the rupture of the follicular wall, there is tissue reorganization by the activation of promatrix factors, which, in an organized and vascularized way, causes granulosa cell differentiation into luteal cells, thereby originating the corpus luteum. The corpus luteum is composed of functional cells for the synthesis of progesterone, the main regulator of the pituitary secretion of gonadotropins, the principal factors involved in the maintenance of the corpus luteum until initial gestation.


The “One Health” concept considers that human and animal health, and ecosystems are closely related and aims to make a link between ecology and human and veterinary medicine. Due to the explosion in population growth along with the geographic and climatic conditions , Africa is becoming a major hotspot for various socio-health issues associated with infectious diseases, including arboviruses. The incontestable advantages of a One Health approach in Africa lie in the fight against pathogens, such as arboviruses, and in the preservation of environmental, animal, and human health to ensure that the increasing high needs of this population are met as well as their protection against potential epidemics. The One Health strategy gives us a glimpse of the difficulties and challenges that the African continent faces. The importance of this approach in Africa is to establish guidelines and strategies for effective solutions and changes in behavior and harmful activities. Overall, the establishment of high-quality global health policies in the framework of the global health standards program would provide healthy and sustainable human–animal–environmental interactions for the welfare of all. The changes in our environment, mainly caused by human activities and the evolution of interactions between humans and animals, are, and will undoubtedly be, responsible for sanitary crises ,2,3. TheThe risk of the emergence and/or re-emergence of infectious diseases with active human-to-human transmission increases the risk of rapid and direct development of the diseases, leading to an epidemic and in some cases a pandemic. Likewise, the increase in interactions between wildlife, domestic animals, vectors for human and animal pathogens, and humans inevitably increases the risk of transmission and dissemination of zoonoses within the human population, leading to increased risk of epidemics. In addition to the challenges from the epidemics of Dengue in Burkina Faso, Ivory Coast, Nigeria, Ghana, Mali, Democratic Republic of Congo (DRC), Angola, Gabon, Sudan, and Ethiopia and the current management of the COVID-19 pandemic, there are the issues of antimicrobial resistance and environmental sanitation policies in Africa ,12,13. MAmong these emerging diseases, the term arbovirus refers to a group of viral diseases transmitted by arthropods, such as mosquitoes, ticks, and sandflies. Vector-borne diseases are a growing burden according to the World Health Organization (WHO), sometimes causing epidemic outbreaks in various tropical regions . These dThe impact of arboviral diseases in Africa is significant, particularly in low-resource settings where access to healthcare is limited ,30. The Arbovirosis in Africa is a complex problem that is influenced by a variety of factors, including the high prevalence of mosquito vectors that are the primary vectors. Many parts of the continent have a warm and humid climate that provides an ideal breeding ground for mosquitoes. Additionally, deforestation and urbanization create new habitats for disease-carrying mosquitoes, leading to an increase in their population ,31. The Overall, the combination of these factors makes arboviral diseases a significant economic burden to African countries, particularly in terms of healthcare costs, lost productivity, and reduced tourism revenue. Arboviruses are, unfortunately, not a priority for research and surveillance in Africa due to other health, security, and political issues. Thus, they are among the neglected diseases in many African countries, even though there is a great risk of emergence of new variants and/or re-emergence of existing variants. Many people in Africa are unaware of the risks associated with arboviral diseases and the measures they can take to protect themselves. This can lead to a lack of preparedness and a delay in seeking medical attention, which can exacerbate the impact of these diseases. The burden of these diseases is expected to increase in the future due to population growth, urbanization, and climate change, making it a major public health challenge for Africa.The One Health approach is of great importance in the management of current and future emerging and re-emerging diseases in Africa. Tight collaboration between various actors from different disciplines is very important in the prevention, surveillance, diagnosis, and discovery of therapeutic solutions necessary for the control and/or eradication of infectious diseases. Indeed, integrated surveillance lies in the surveillance, control, and diagnosis of infectious diseases , in the research for molecules of therapeutic interest, in the training of health professionals, in connecting actors from different fields, and in establishing policies to fight against endemic and neglected zoonoses. Human behaviors and activities also show the need for this strategy. For example, deforestation by humans forces changes in wild-animal behaviors. Indeed, the animals affected have to adapt to their new environments, for example, by changing their feeding grounds and settling increasingly close to livestock breeding areas ,31. In tArboviruses are, unfortunately, not often a research or surveillance priority in Africa. In this sense, they are among the neglected diseases, although they represent an increasing risk of epidemics and the appearance of new more virulent or contagious strains. Arboviruses are a major health risk in Africa because of its climate, and the different interactions between humans, animals, and vectors. African countries must therefore adopt comprehensive policies for surveillance of and research into arboviruses.Different methods can be used to better characterize the risk associated with arboviruses and understand their biological basis in order to better guide public health interventions. These methods include studies of biology at the environmental, vector, animal, and human level, with a trans/interdisciplinary interaction. In general, the transmission of arboviruses is influenced by a large number of factors related to the biology of hosts, vectors, and viruses, which are inter-related within dynamic natural environments and influenced by abiotic factors, such as climate or hydrography . A comprConsequently, the need to understand the emergence of a disease in humans through an approach that integrates a large number of environmental parameters, described as global, has been reinforced ,34. HencTight collaboration between animal, environmental, and human health institutions is important to find solutions and effective control approaches at both local and international levels. These efforts must include Africa, especially given its climate, rapid population growth, and slow economic growth, making Africa at risk for the emergence and/or re-emergence of epidemics. For the moment, no African country has taken the lead for the continent, but instead, individual countries are organizing themselves for carrying out studies with a One Health aim, sometimes with local funds and very often with foreign funds. This is particularly the case today for common North–South diseases  ,37. The The effectiveness of the One Health approach has been demonstrated with zoonoses responsible for emerging and/or re-emerging diseases linked to epidemics in certain regions of Africa  ,40,42,43We analyzed several reports on the One Health concept and highlight the relevance of using this approach in the control of arboviruses in Africa, while at the same time addressing the challenges and difficulties related to its implementation. A systematic literature search related to the topic was first performed in electronic databases . We also searched data on the WHO and the Institute of Research for Development (IRD) websites. All collected data were then used to discuss: (1) the relevance of the One Health concept in the control of arboviruses in Africa and (2) the challenges and difficulties of implementing this concept on the African continent. The search included research articles (in English and French) and news articles published between January 2009 and April 2023 (that last 14 years). A total of 863 articles were reviewed and all articles identified as irrelevant were excluded. Exclusion criteria included type of study, language of publication, nature of the pathogens addressed, and incomplete technical and/or clinical data. The articles were analyzed first on the basis of the title, then the abstract, and then, finally, the full text. A total of 71 articles were included for study. We combined the following search terms: “One Health and Africa” and “human health” or “environmental health” or “animal health” or “arbovirus and emerging diseases” or “re-emerging diseases” and “Africa climate”. Figure 2 was generated using the online software Datawrapper and Figures 1, 3–5 were generated using PowerPoint 2019 software.In regard of various epidemics in Africa , the health authorities of certain countries have thought of a multidisciplinary strategy to fight against these epidemics ,48,49,50The relationship between a pathogen , and its host is rather dynamic and the environment plays also an important role in the nature and dynamics of an epidemic . This maPhlebovirus of the Phenuiviridae family. RVF is endemic in Africa and affects domestic ruminants, such as cattle, sheep, goats, and camels [Aedes-type mosquitoes that transmit the virus during blood meals both in animals (domestic or wild) and humans, with contact between infected animals also allowing for virus spread ) and annual rainfall totals over 150 mm ,47. ThesNairoviridae, genus Orthonairovirus. It is a zoonosis that also has a high rate of human-to-human transmission and produces epidemic outbreaks in humans [CCHF is a viral hemorrhagic fever caused by a virus from the family n humans ,55,56. Tn humans . The morn humans . The modn humans . Farmersn humans .Considered the second most common arbovirus in the world due to its geographical distribution, CCHFV is endemic in several African countries, such as DRC, Nigeria, Namibia, Mali, Burkina Faso, Central Africa Republic, Senegal, Uganda, South Soudan, Ethiopia, Tanzania, Madagascar, Mauritania, South Africa, Kenya, and Senegal, as well as in Asia , South-Eastern Europe, and the Middle East  ,60,61,62Due to this very complex cycle, in which hosts and vectors are themselves strongly influenced by environmental parameters, a One Health approach is required for the prevention and control of this disease . The intIn Africa, improvement in technical platforms for the detection of CCHF is required. Indeed, the 451 antigenic cross-reactivities with nairoviruses prevents serological analyses due to the high rate of false positives. In this sense the One Health approach will make it possible to pool funds and direct funding towards the most appropriate strategies for all, and an appropriate screening strategy . AlthougThe One Health approach to CCHF surveillance also involves promoting awareness and education about the disease, particularly in areas where CCHFV is endemic. This includes educating communities about the importance of tick control, proper animal husbandry, and safe food-handling practices.Flaviviridae family, genus Flavivirus. There are four serotypes of DENV: DENV-1, DENV-2, DENV-3, and DENV-4 [Aedes. Like all arboviruses, transmission is either sylvatic, where the virus circulates between wild animals, such as Simian species , and mosquitoes  without human contact; or urban, where the virus circulates between mosquitoes  and humans through constant contact with the bite occurring preferentially during the day  helps in the early detection of cases and outbreaks, and facilitates a rapid response to control the spread of the disease. In addition, early detection of circulating DENV serotypes could identify potential new emerging strains. Then, by integrating data from human, animal, and environmental sources, public health officials may identify potential outbreaks early and take proactive measures to prevent their spread. This approach can lead to the development of more effective and sustainable strategies for disease prevention and control, as well as contribute to the overall health and well-being of communities.Prevention and control efforts are crucial to reduce the impact of the disease on humans. The interest in DEN surveillance by the One Health approach lies in its ability to provide a more comprehensive understanding of the disease and its transmission dynamics. Dengue involves multiple hosts and vectors, including humans, mosquitoes, and non-human primates, although dengue epidemics are currently linked to an urban transmission cycle. A One Health approach to DEN surveillance can provide a comprehensive understanding of the disease and help in developing effective prevention and control strategies. Surveillance of DENV circulation in mosquitoes . Most African countries are poor and located in areas at high risk of disease emergence due to their climate, proximity to risk areas, and human activities. Therefore, the pooling of funds and One-Health-type policies would be very useful, both in the reduction of unnecessary expenditure and in the establishment of priority policies related to the surveillance and control of emerging or re-emerging diseases . The chaAnalysis of the flaws in the management of the COVID-19 crisis has shown that the One Health strategy is indeed rarely used in many countries . The strAn integrated health strategy has indeed operational consequences that disrupt the existing methods of study, surveillance, prevention, and action—giving rise to resistance to implementation. Implementation of One Health requires a change in the understanding of risks and practices . The varThe centralization of data is important for an overall quality analysis based on the economic and geographical networks in place. It is also important to establish shared regulations between the different sectors involved, standardized operating protocols, effective control instruments, the creation of health structures for rapid treatment, and laboratories sufficiently equipped to maintain health and surveillance systems during crises. It is also important to improve staff training in One Health strategies by introducing the importance of this notion into the training paths of students from the various disciplines concerned.The recent outbreaks of arboviruses , and the COVID-19 pandemic have demonstrated the need for an integrated health strategy and have encouraged us to plan for the prevention and management of future crises. Africa is particularly exposed to the risks of the emergence of new pathogens given its environment of high demographic growth with a favorable climate to emerging/re-emerging diseases. A special effort must be made in Africa to ensure a trans/interdisciplinary approach for safer health and more effective management of future epidemics. This management involves coordinated multi-sector actions at different scales, from local to international. The One Health concept should be considered as an approach that goes far beyond the prevention of health crises; it is indeed a holistic vision of health that considers the close links between health, environment, climate, food, and agriculture. Implementing the One Health concept requires political commitment and adherence to a number of core principles, including socio-political and multi-cultural parity, inclusion, and community involvement, defined by the One Health high-level interdisciplinary expert group.


Cameroon has two main educational systems: English and French, which have a colonial heritage. The controversy is that each educational sub-system has its own curriculum. In the French-speaking part of the country, sports and physical education are mandatory for obtaining the CEPE, Baccalaureate, and any other public examination. In the English-speaking part, sports and physical education are yet to be included in the curriculum. The goal of this policy paper is to change the narrative of the curriculum of public examinations in Cameroon's anglophone educational sub-system by following the example of the country's French part. This policy paper targets curriculum developers, the General Certificate of Education Board, and the Ministries of Education. What will be innovative is that students from English-speaking Cameroon will also be included in sports activities at an early age.Development: We used the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) to collect data at the ministries of education, the Ministry of Sports and Physical Education, 197 public schools, and 204 health care facilities. Content analysis, ethnographic studies, and Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis are used to assess why average French-speaking Cameroonians have a longer life span, are physically active, and participate in more high-level sports than their English-speaking counterparts.The Cameroon Government Certificate (GCE) of Education Board is in charge of putting this project into action. Sports and physical education should be required courses for both the ordinary and advanced levels of the GCE.We will implement the process and conduct an impact assessment. With the process evaluation, we will monitor if the program is meeting the intended goals. The impact evaluation will give a broader view of the outcome of the program.When this policy is put into place, the English-speaking part of Cameroon will have HEPA and be pushed to be as healthy and fit as the French-speaking part.


Dear Editor,Tegumentary leishmaniasis (TL) in Brazil is the New World tegumentary leishmaniasis (NWTL), with distinct protozoan species, vectors, reservoirs and presentation when compared to the Old World tegumentary leishmaniasis (OWTL), which occurs in European, African and Middle Eastern countries. The authors report the fourth case of TL in Brazil caused by an Old World species, which is not native to Latin America, and discuss the introduction of this species in the country.L. amazonensis and L. major through the anatomopathological analysis, although the literature reports differences in the size of the parasitophorous vacuoles of these species .Leishmania spp. This genetic target was chosen due to the presence of multiple copies per cell and due to the size of the DNA fragment amplified from the employed primers ,Leishmania major species complex .L. major infection.In the Middle East, the most often reported etiological agents are In 1991 the cases decreased in Syria, where this disease is endemic, due to the fight against mosquitoes. However, in the late 1990s, an increase was observed, which was attributed to intense rural-urban migration and the deterioration of services, such as garbage collection and basic sanitation.The refugees were settled in border towns, mainly in Turkey, without medical care and living in an environment favorable for the spreading of epidemics. New cases of TL were observed in refugee camps. In Lebanon, there was an increase from six cases between 2000‒2012 to 1,033 cases in 2013 alone, 97% of which were Syrian refugees.In Brazil, Syrians constitute the predominant group of refugees.Leishmania. In Turkey, non-endemic strains have been detected, even in a patient with no history of travelling, suggesting the introduction of this species.Anopheles sergentii as a vector was verified,L. majorL. major-like strains, possibly L. major,Hence, it is possible to discuss the autochthonous transmission of new species of The authors emphasize the importance of this diagnosis in patients from endemic areas, considering the potential for deformities. Moreover, they emphasize the relevance of this report for the epidemiological investigation of the possibility of autochthonous transmission of Old World species in our country.None declared.Cindy Tiemi Matsumoto: Data collection, or analysis and interpretation of data; writing of the manuscript or critical review of important intellectual content; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.Milvia Maria Simões and Silva Enokihara: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.Marília Marufuji Ogawa: Data collection, or analysis and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.Samira Yarak: Data collection, or analysis and interpretation of data; writing of the manuscript or critical review of important intellectual content; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.None declared.


The WHO emphasizes lifelong management of hearing diseases such as hearing loss and advocates for prevention. The Ear and Hearing Care Situation Analysis (EHCSA) tool was designed by the WHO for assessment and quality improvement of state-led management of hearing loss prevention and management programs. The purpose of this study was to use the EHCSA to assess the ear and hearing management program in Korea and to establish goals consistent with best practices for improving policies and services related to ear and hearing care.The EHCSA was used as a need assessment of the ear and hearing management services in the country. The EHCSA consists of two sections. Section 1 consists of 41 questions to evaluate health policies and support services. Section 2 consists of 203 questions to evaluate human resources and services of the ear and hearing management sector.There are an estimated 800,000 people with hearing loss in Korea. Policies such as hearing aid support are in place, and outreach services such as free hearing tests are also being actively conducted. In all medical institutions, ear and hearing management treatment and medication prescriptions could be received without barriers. Workers in the fields of ear and hearing management, such as audiologists, language therapists, special education teachers, and sign language interpreters, are specialized and have well-established guidelines for training.Overall, the domestic ear and hearing management sector has confirmed that policies and services are well-prepared in comparison with advanced countries such as the United States, Iran, and China. The use of the EHCSA was functional in collecting data on the current state of domestic ear and hearing management policies and services in Korea, can be used for continuous quality improvement and expansion of medical services, and can be used as a reporting mechanism to the WHO. Hearing is one of the five senses and refers to a mechanical sense that detects the frequency and intensity of sound waves transmitted through a medium, such as air or water. The ear is a sensory organ that causes brain activity, which leads to thoughts and emotions, and it has a proportion equivalent to vision in perceiving the surrounding environment . By 2050Accordingly, since 2005, China has been implementing a national project called the Hearing the Future-China National Hearing Care Program, which includes the early diagnosis, prevention, treatment, and rehabilitation of hearing loss. India has also continued to implement a state-led policy called NPPCD since 2008, and Australia is operating a government-led program to manage and supervise hearing screening, diagnosis, hearing loss prevention, and rehabilitation services from newborns to the older adult. The United States is striving to reduce the occurrence of social problems caused by hearing loss through the national “Healthy People 2020”  is a method for situation analysis developed by the WHO and includes the conditions of situation analysis . SituatiThe “WHO EHCSA” was distributed to collect, evaluate, and report on ear and hearing management policies, services, and human resources and for the assessment of national health systems in the context of ear and hearing management. This can help to understand the dynamics of hearing loss and the systems and policies that support ear and hearing management, including available personnel, infrastructure, and services, and to establish an improved healthcare system that can help with hearing management. The tool has a total of two sections: Section 1 and Section 2 with a total of 41 and 203 questions, respectively. Section 1 provides information on overall health policies and services, such as total population, age distribution, gender distribution, illiteracy rate, Internet penetration rate, life expectancy, fertility rate, vaccination status, deaf patient distribution, infant health policy, youth health policy, and disease management protocol. Section 2 provides detailed information on human resources, such as departments and representatives dealing with ear and hearing care issues in the Ministry of Health and Welfare, ear and hearing care-related institutions, policies, and programs. Questionnaires for assessment are also available .The emphasis was on collecting indicators in line with the context of the questions in the WHO ear and hearing care situation analysis tool. Information, such as country profiles and holidays, was collected using documents from national institutions, such as WHO statistics, the Ministry of Health and Welfare, and the National Statistical Office. First, the indicators of the National Statistical Portal (KOSIS) serviced by the National Statistical Office were confirmed. In addition, to confirm the specific information, documents, such as project reports and academic publications of national institutions that calculated the indicators, were checked. Finally, if the index was not secured through the search, consultations were conducted with experts.To answer the questions, open materials distributed by the state and materials from the conference were used. Data from the National Statistical Office, 2021 population and housing census, 2021 future population estimation, 2020 death cause statistics, and 2017 and 2021 birth statistics press releases were used. In the data from the Korea Centers for Disease Control and Prevention, the 2021 tuberculosis patient report status, 2020 HIV/AIDS report status year, and tuberculosis treatment guidelines were used. In the data from the Ministry of Health and Welfare, clinical guidelines for screening genetic testing for newborns, criteria for determining the grade of disablement, disaster crisis management measures for infectious diseases, and the classification of medical institutions were used. In addition, the World Population Review's literacy rate by the country in 2022, the Ministry of Science and ICTs 2021 wireless communication service subscriber statistics, the 2021 Internet usage survey, the Ministry of Education's school health inspection guidelines and integrated education guidebook, the National Health Insurance Service and Health Insurance Review and Assessment Service's health insurance statistics year, and hospital inquiry services were included. To use data from National Health Insurance, approval of the institutional review board is required. This study was approved by the Institutional Review Board of Yonsei University Wonju Severance Christian Hospital  (CR323326). The National Statistical Portal (KOSIS) provided by the National Statistical Office, Population and Housing Survey, and Disability Statistical Yearbook published by the Korea Disabled Development Institute were mainly used.The Korean Statistical Information Service (KOSIS) is a statistical service provided by the National Statistical Office for users to find the statistics they want at once by collecting major domestic and international statistics. Currently, it contains more than 1,000 types of state-approved statistics on the economy, society, and environment prepared by more than 300 institutions and provides the latest statistics on international finance, the IMF, the World Bank, and the OECD. Most national distribution data, such as the population and housing census and disability statistical yearbook, are uploaded on the portal .The population and housing general survey is a basic national statistical survey conducted by the National Statistical Office to understand the size and characteristics of all people and houses in Korea and is released annually. It is a national basic statistical survey conducted on people and residences in the national territory at a certain time and period and is used as basic data in various fields, including policymaking, planning, research, and evaluation by national institutions, private companies, academic organizations, and the public. It is used to prepare secondary processing statistics, such as the Ministry of Employment and Labor's labor supply plan, the Ministry of Health and Welfare's premium rate and national pension fiscal estimate, the low birth rate and aging index, and the Ministry of Land, Infrastructure, and Transport's housing supply rate . The disThe main priority was whether the criteria for determining the data were calculated by national ministries. As most of the data produced by national ministries are targeted at the entire nation and collected at the national level, it can be inferred that these data have been verified in terms of representation and reliability. If there were no data, the data of the academic society or association in the field were used; if there were no data in the institution, the engineer or expert was consulted. The year of the data to be used was set as 2021, as the data from the major national ministries for the year 2022 would be distributed the following year, and the most recent data were used if there were no data for the year 2021.The results of the population profile are shown in The results of the sociopolitical profile are shown in The results of the health status indicators are shown in The results of the hearing loss are shown in The results of the healthcare strategies are shown in The results of the EHC policies implemented by the Ministry of Health and Welfare and other institutions are shown in The results of the existence of primary medical care and the presence or absence of EHC are shown in The results of the overall state of the primary medical institutions are shown in The results of the overall state of the secondary medical institutions are shown in The results of the overall state of the tertiary medical institutions are shown in Section 2.3 concerns people employed in the EHC field. The results of the overall state of ENT specialists are shown in The results of the overall state of audiologists are shown in The results of the overall state of speech and audio-verbal therapists are shown in The results of the overall state of hearing aid and earmold technicians are shown in The results of the overall state of teachers of the deaf are shown in The results of the overall state of sign language interpreters are shown in The results of the overall state of general physicians are shown in Health workers, excluding medical personnel  specified in the Medical Act, include emergency medical technicians, caregivers, health education specialists, and practical nurses.The results of the overall state of emergency medical technicians are shown in The results of the overall state of health education specialists are shown in The results of the overall state of caregivers are shown in The results of the overall state of practical nurses are shown in The results of the overall state of hearing aids are shown in Cochlear implants are available in both public health systems and the private sector, similar to hearing aids. This was confirmed in the hospital inquiry service of the Health Insurance Review and Assessment Service, and the guidelines are publicly distributed by Snail of Love, a non-profit organization .The results of the overall state of other assistive devices are shown in The results of the overall state of medicines are shown in The results of the overall state of enactment of the hearing care service are shown in The results of the overall state of health insurance are shown in The results of the overall state of health-related data are shown in The results of the overall state of EHC research are shown in This study aimed to identify the current status of EHC in Korea using EHCSA distributed by the WHO in 2015, compare it with other countries, and establish and improve policies related to medical services and hearing diseases. To this end, we would like to examine various areas, such as domestic health policies, the status of patients with hearing-impairment, and the status of medical personnel, and report to WHO on the state of EHC in Korea.In Iran, a situation analysis was conducted on the domestic ear and hearing care program based on the EHCSA. Through this, inadequate health literacy, weak intra-sectoral and intersectoral cooperation, inadequacy of policy responses, non-integration of the EHC in the primary healthcare system, poor standard processes and resources of EHC, and lack of an EHC surveillance system were identified as major problems . In BangIn contrast, Russia supplemented its nationwide implant and hearing aid programs by introducing a cochlear implant in 1991. Therefore, infants born with hearing impairments could receive hearing aids or cochlear implants and rehabilitation services as needed, and up to 1,100 infants receive cochlear implants each year. In addition, people of all ages can receive hearing tests and hearing aid fitting services at audiological centers, which are paid through the national budget . In the Comparing policies and workforce status in other countries, data, such as Korea's EHC program and workforce status, are at the level of advanced countries. The Ministry of Health and Welfare publishes a health and welfare white paper every year to understand major policies and achievements in the health and welfare sector and to help the government achieve new national goals and tasks. The policies implemented by the Ministry of Health and Welfare, the current status of projects, and plans for implementing new policies are specified. There are child welfare policies, older adult welfare policies, low birth rate measures, disability welfare policies, oral health policies, mental health policies, and herbal medicine policies; however, EHC policies are not implemented or planned, except for innate hearing tests and hearing aid support policies .The Korea Health Industry Promotion Agency's “Hearing Aid Market Analysis” published in 2015 reported that the average growth rate of hearing aids worldwide is 6.9%. Looking at the ranking, Korea showed the fourth-highest growth rate of 8.5% after 18.3% in China, 10.3% in Germany, and 9.1% in France . There aA survey was conducted to investigate the current status of the domestic hearing aid market, and 61.6 and 71.7% of the respondents said they needed an obscure certificate to sell hearing aids in the category of factors that hinder the development of the domestic hearing aid market and need education as a hearing expert, respectively .The above data are not updated continuously, so it is difficult to state that it represents the current situation because it is not the latest data and the survey was conducted with a limited number of people. Therefore, this study is meaningful, and the information on the latest status of the EHC programs was collected. Overall, both the Health workforce and EHC programs are well-prepared, but incidences of hearing diseases, such as hearing loss, are continuously increasing, so various support measures need to be prepared to convert hearing aid-related certificates into national certificates or rehabilitation and support. In addition, domestic health policy improvements and medical service expansion should be achieved through the continuous collection of data on EHC.The original contributions presented in the study are included in the article/The studies involving humans were approved by the Institutional Review Board of Yonsei University Wonju Severance Christian Hospital (CR323326). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants' legal guardians/next of kin in accordance with the national legislation and institutional requirements.Conceptualization: YS. Data curation: JuhL and JunL. Formal analysis, methodology, and visualization: CY and JuhL. Project administration, writing—reviewing, and editing: CY, YS, SO, and TK. Writing—original draft: JuhL. All authors contributed to the article and approved the submitted version.


In order for the results to be tangible and have an impact, it is essential to be attentive and agile in attracting resources.Knowing one’s own budget and that of other entities that may become a source of resources, understanding the ecosystem that surrounds it is extremely timely for the search for better investments.Although there is no regulation for the profession of fundraiser, being created according to the needs of the entities, it is important to notice that the search for complementary resources is a method of identifying opportunities and partners to explore and test new business initiatives, enabling the best use, optimizing efforts, and obtaining better results.fundraising points exclusively to the financial understanding, the concept is much broader and also covers those resources related to technical, technological, material, immaterial, and human capacity, both for creation and implementation,Although the term Actions involving these activities can be applied to collaborate specifically with an institution (whether public or private), municipalities, states and/or priority projects and programs,The scarcity of capital directly affects entities, generating the most diverse limitations, from the provision of basic services, infrastructure, updates, and the implementation of continuous improvements through research and academic studiesAn example is the current crisis caused by the coronavirus, which has required a large volume of investments in health in a short period of time. In order to reduce the health crisis, public resources were redirected to the Brazilian Unified Health System (SUS) in the three spheres of government. Although the private sector has supported the SUS, it has not received the same opportunities and benefits.The private sector suddenly had to cope with an increase in demand for COVID-19 care, a rise in the price of supplies, and the suspension of elective surgeries and examinations, sharply reducing the revenues of private hospitals.,In the third sector, the pandemic has affected the budget of entities. According to Luis Donadio, coordinator of Fundraising Office of Fundação Oswaldo Cruz (Fiocruz), with the COVID-19 pandemic, it was found that of the R$ 7 billion received by Fiocruz during the pandemic, from the various entities of society, 80% had been operated by public institutions,The pandemic itself was one of the main recent factors that demonstrated how fragile and limited the budgets of institutions and governments are, sensitizing them on the importance of structuring areas and sectors focused on fundraising activitiesOther challenges that make resources more constrained are the economic, legal, and political scenarios in Brazil.However, it is not enough just to raise funds, with the structuring of areas and sectors focused on these actions. It is essential to qualify the human resources involved, training the teams to prepare plans based on priorities and feasibility of implementation, considering all the perspectives that the project requires, monitoring the technical and financial execution until completion, aiming at efficient and effective management.When drafting, the adequacy of real targets, objective and up-to-date value estimates, the assessment of deadlines and their follow-up forms help to implement feasible projects.Setting feasible targets, acapacity building, monitoring indicators, investing in institutional relationships, and monitoring project implementation are essential for achieving favorable results.Aware of the competing demands on their own resources, external fundraising alternatives are sought.,There are several formats of resource transfers from public entities to other spheres, widely served in other areas as essential as health, briefly explained here only to add knowledge to the reader, since the focus of this work is the health areaConstitutional transfers: the portions of resources collected by the Union and transferred according to the Federal Constitution;Legal transfers: regulated by representative laws that determine the qualification, application, and accountability. They may or may not be linked to a specific purpose. They are presented in automatic transfers, which consist of financial transfers without the use of covenants, adjustments, agreements, or contracts, occurring through deposit in a specific account of the beneficiary, used for the decentralization of resources in certain programs in the area of education;Direct transfer to citizen: provides monthly financial benefits to the target audience of the program;Voluntary transfers: for costing or investment, as cooperation, aid or financial assistance not related to constitutional or legal determinations.The main financial provider for health care, public resources can be obtained by governmental and non-governmental (non-profit) entities.Constitutional Amendment No. 29 of 2000 ensures the financing of public health actions and services, proposing that the three spheres of government annually contribute minimum resources from percentages of revenues. Expenses for public health actions and services are considered to be those with active personnel and other costing and capital expenses, related to finalistic and support programs, including administrative ones, which are aimed at actions and services of universal, equal and free access and which are in accordance with the objectives and goals of the health plans of each federative entity,Ordinance GM/MS No. 204 of January 29, 2007, regulates the financing and transfer of resources for health actions and services, monitoring and controllingCurrently, the distribution of public resources, mainly from the Union, is guided by the Federative Pact, established by the Federal Constitution of 1988. This pact determines the financial obligations, laws, collection of resources, fields of action and the definition of the competencies of each entity of the federation–Union, states, and municipalities.The Constitution provides that each sphere of government must apply a minimum share of tax revenues to health, with 12% of revenues for states and 15% for municipalities.,,The National Health Fund, established by Decree No. 64,867 of 1969, acts at the federal level as the financial manager of SUS resources, financing capital and current expenses, in accordance with the policies and programs managed by the final secretariats of the Ministry of Health, in addition to managing the transfers of these resources to states, municipalities and the Federal DistrictThe budget allocations that make up the general budget of the Union, intended for the transfer of resources, are:Program Resources: programs previously listed by the grantor, available for public and private entities to register project proposals;Parliamentary Amendment Resources: these are resources granted to parliamentarians of the Legislative Branch, inserted in the General Budget of the Union, with a view to participating and influencing the distribution of the proposals of the Executive Branch. The distribution by the ministry occurs through current legislation and adapting to the technical character of execution,After the publication of Ordinance No. 3,992/2017, federal funds for public health actions and services began to be transferred in the fund-to-fund modality, through two blocksPublic Health Actions and Services Costing Block: resources intended for public health actions and services already implemented and the functioning of the responsible bodies and establishments.Investment Block in the Public Health Services Network: resources for the structuring and expansion of public health actions and services.,The Investment classification (GND 4) is used for budget expenses with the execution of expansion works and new constructions or with the acquisition and installation of equipment and permanent material. The transfer occurs via fund to fund, agreement or transfer contract, taking into account the structuring of specialized health care units or the structuring of the primary health care services networkIt is noteworthy that only the acquisition of equipment and permanent materials that are part of the National List of Equipment and Permanent Materials that can be financed for SUS is allowedThe classification of Other Current Expenses (GND 3) is used for budget expenses for the acquisition of consumables, renovations, training, in addition to other current expenses of the other nature groups. The transfer occurs via fund to fund, considering the temporary increment of the medium and high complexity ceiling or the temporary increment to the costing of primary health care servicesBefore sending the resource, it is recommended to consult the primary health care services and medium and high complexity ceilings of each state, the Federal District, and each municipality to be indicated as beneficiary. If the ceiling is already exceeded, it is not possible to receive new resources within the current year.–No counterpart is required from states, municipalities or the Federal District for transfers of resources to SUS, as well as for private non-profit entities that work in health and comply with art. 76 of Law No. 13,242/2015The instruments for the transfer of resources from the Ministry of Health to the states and municipalities are carried out by:Fund-to-fund transfers;Agreements;Onlending contracts;Decentralized execution term;Public consortia, created by Law No. 11.107/2005, establish the joining of two or more federation entities with legal personality to establish cooperation relations and the achievement of common objectives. Art. 9 of Interministerial Ordinance No. 127/2008 determines that public consortia have preference to voluntary transfers from bodies and entities of the federal public administration.These transfers of resources from the Union to the other spheres of public administration or to private non-profit entities are carried out through the conclusion of instruments between the parties, for the execution of activities of reciprocal interest, highlighted in the general budget of the Union in budget appropriations for specific purposes.Prioritizing the capture of public resources in health, according to the classifications already mentioned, the following describes in detail the transfer instruments.Fund-to-fund transfers decentralize resources by dispensing with the formalization of agreements. Guided by Law No. 8,142/1990 and regulated by Decree No. 1,232/1994, they are transfers that are developed within the scope of the Brazilian SUS, through the National Health Fund, under the management of the Basic Operational Standard of the Brazilian SUS 01/1996Intended to cover health actions and services that are implemented by the states, Federal District, and municipalities, these actions and services correspond to investments in the service network, outpatient and hospital coverage and other health actions.The decentralization process was improved by the Ministry of Health in 2006, with the release of the Health Pact (Ordinance No. 399/2006). Thus, the transfers became part of six resource blocks: basic care (primary care), medium and high complexity care, health surveillance, pharmaceutical assistance, SUS management, and unregulated blockTransfers occur directly from the National Health Fund to state, Federal District, and municipal health funds. The application must be carried out as provided for in the health plan of the respective government sphere. It should reflect, at the end of each year:The link with the purpose of each work program of the general budget of the Union that gave rise to the transfer;The established in the health plan and in the annual health programming of each federative entity;The object and commitment agreed in the normative acts of the SUS.When directing resources to municipalities, according to Law No. 8,142/1990, the municipality must meet the minimum criteria, which include the existence of a health fund, health council, health plan, management report, counterpart of resources in the respective budgets, and a commission for the elaboration of the career, positions and salaries plan, with a two-year deadline for its implementation. Failure to comply with these criteria will result in the State being responsible for administering the funds,With regard to accountability, Consolidation Ordinance No. 1/GM/MS of 2017 regulates the management report by consolidating the rules on the rights and duties of health users, the organization and functioning of the Brazilian SUSThis management report must be sent to the Ministry of Health annually and submitted to the respective health council for approval, proving the conformity in the application of the transferred resources (adequacy with the purpose of the budget action), and compliance with the agreed object.,Interministerial Ordinance 424, of December 30, 2016, establishes: Agreement is an instrument that regulates the transfer of financial resources from bodies or entities of the Federal Public Administration, direct or indirect, to bodies or entities of the State, District or Municipal Public Administration, direct or indirect, public consortia, or private non-profit entities, for the purpose of executing a project or activity of reciprocal interest and in mutual cooperation,Decree No. 6,170, of July 25, 2007, establishes that the on-lending contract is the administrative instrument in which the transfer of financial resources is carried out through a federal public financial institution or agent, as agent of the UnionThe rules apply to agreements and, when applicable, to transfer contracts.The decentralized execution term is the decentralization of credit between bodies and / or entities that are part of the Union’s fiscal and social security budgets, to carry out actions of interest to the decentralizing budget unit and the object provided for in the work program, faithfully respecting the functional programmatic classification.The health sector in Brazil has faced numerous difficulties, which has required an urgency on the part of institutions and organizations in diversifying to contribute resources to their projects. The professionalization of project management has become increasingly necessary and resolutive in view of the prospects and projections for the economic scenario in the country.In order to finance investments, alternatives are emerging in the private sector that can help to complement public resources, which are currently insufficient for health maintenance.,Although the search for resources in the private sector provides a wider range of options, these follow fiscal obligations are disciplined by legislation and in particular by the fiscal responsibility law–Complementary Law No. 101,Interestingly, before Complementary Law No. 101, there was no legislation that guided public indebtedness, spending limits and contracting of credit operations, which provided a real chaos in the budgets of government entities, causing the accumulation of immense, poorly planned debts that went from mandate to mandateThe absence of legislation such as this one was and has been up to nowadays the biggest cause of the existence of unfinished works and indebted public entities.The fiscal responsibility law came to establish parameters related to the public spending of each federative entity. The implementation of budget restrictions proposes the fiscal preservation of entities, in accordance with their annual balance sheets, ensuring the financial health of states and municipalitiesThe main source of private funding, financing is the most common alternative for supplementing budgets and making major investments.In Brazil, the main financiers are the development banks, which are used for both public and private projects of long term and high value.Briefly, development banks are financial institutions, usually set up by governments, and provide adequate supply of medium and long-term financing for economic and social development programs and projects.,Currently, the main lenders, which account for 50% of the Brazilian banking system, are Caixa Econômica Federal, Banco do Brasil and Banco Nacional de Desenvolvimento Econômico e Social. In addition to these, some national banks also act as capital providers for long-term financingFor the most part, financing is desired to expand and/or modernize the physical structures of health institutions, to improve and increase the capacity of care and the provision of health services, but it still meets demands for modernization of management, governance, operational efficiency, and certification, aiming at economic and financial sustainability.Inserted in the national scenario by Federal Law No. 11,079/2003, public private partnerships are commonly presented as the union of a group of actors with a common goal of improving health, with mutually agreed roles and principlesAt least one private non-profit organization and one for-profit organization;Sharing of efforts and benefits;Creating social values to improve health.Subject to the rules imposed by government regulators, they can come up with breakthroughs and innovative solutions to provide additional resources for public health research.The expression of interest procedure allows individuals or legal entities to present feasibility studies for a specific project, subsidizing with information suitable for the opening of a concession or public private partnership process.The winning study that will be used for the implementation of the project will have the reimbursement of the expenses of the elaboration of the project, while the other ones do not have any valid reimbursement.Expression of interest procedure can be applied in public private partnership projects, concession, permission and lease of services and public goods, concession of real right of use, privatization of companies and partnership contracts.Public notices are public calls opened by legal entities, which, through the proposed criteria, select normative Manager procedures to receive resources or awards provided for in the notice.It is a very important source of fundraising, being recommended for all types of organization, as in 2019 the number of calls for proposals moved more than R$ 3 billionThey are extremely democratic and are made available throughout the year, for the most diverse causes, for the most diverse stakeholders, and at flexible values adaptable to demands and projects.The competition is broad and requires that the projects are well prepared and planned, meeting the proposed needs, and the criteria required in the notices. Upon approval, the resource must be used exclusively for the purpose for which it was registered and estimated in the work planFinally, fundraising, regardless of whether it is public or private, is an important step and should be discussed by the researchers involved. It is important that this fundraising is strategic, structured, with clear objectives and that it considers all the financial needs involved, such as administrative expenses, human resources, and maintenance of the physical structure.


Medical education is an important and ever-changing profession that determines the future of healthcare and public health in any nation. It is also a complicated and difficult process that needs ongoing adaptation and innovation in order to satisfy the changing demands and expectations of health systems and communities. However, several challenges and limits impede the growth and quality of medical education in the Arab world, preventing it from reaching its full potential. In this article, we will highlight some of the major difficulties affecting medical education in the Arab world from our own experience as a medical student in one of the Arab nations. The puzzle and the answerThe Educational SubjectsIn the Arab world, there is a misalignment between the curriculum and the demands of local health systems and communities. Many medical schools in the area confront this difficulty, since they frequently follow outmoded or imported curricula that do not represent the epidemiological, cultural, and socioeconomic realities of the region . This crThis gap is caused by a number of factors, including the rapid changes in the health landscape caused by the increasing burden of chronic diseases, aging, and environmental issues, the limited involvement of stakeholders in the design and evaluation of curricula, such as health professionals, policymakers, patients, and communities, the lack of integration of scientific research skills and evidence-based practice into curricula, and the insufficient use of innovative teaching methods .Despite the challenges, the Arab world has seen some achievements and opportunities for improvement, such as the establishment of prestigious and reputable universities that provide medical education in accordance with the most recent and advanced educational curricula, the attraction of international partnerships and collaborations that enhance the exchange of expertise and resources, and the adoption of continuing medical education as a principle ,3.Faculty MembersOne of the primary issues that medical education faces in the Arab world is a lack of skilled and competent faculty members and mentors who can provide high-quality education and training to medical students. This scarcity has an adverse effect on the quality and outcomes of medical education, as well as on the healthcare system and society as a whole. There are several reasons for this shortage, including the low attractiveness and retention of medical faculty members, a lack of incentives and recognition for teaching excellence and innovation among faculty members, a lack of training and development opportunities for faculty members to improve their teaching skills and knowledge in line with current advances and standards in their fields, and the high workload and stress that faculty members face in their academic and clinical roles, which often leads to burnout and dissatisfaction .There are various viable remedies that might be applied by medical schools, hospitals, and policymakers throughout the Arab world to solve this dilemma. Some of these solutions include: increasing faculty recruitment and retention in the medical field by offering competitive salaries, benefits, and career opportunities that match their qualifications and competencies, rewarding and recognizing faculty members who demonstrate teaching excellence and innovation in their fields through awards, grants, promotions, and other forms of recognition, providing regular and effective training and development , and lowLimited Opportunities for Scientific Research and InnovationScientific research and innovation are critical in every civilization for expanding knowledge and improving health outcomes. However, the Arab world's medical education confronts several problems that hinder its ability to conduct high-quality research and create an innovative culture. Lack of finance, inadequate infrastructure, insufficient human resources, low academic standards, poor cooperation, and restricted dissemination of research findings are some of the obstacles .Despite these obstacles, there are some possibilities and initiatives throughout the Arab world to improve research and innovation in medical education. Some institutions, for example, have developed centers for entrepreneurial studies, social innovation, and technology transfer to encourage faculty and student innovation and entrepreneurship . To suppInfrastructure and ResourcesMedical education in the Arab world is suffering from a significant lack of facilities and teaching and learning tools. The physical buildings, equipment, technology, and communication systems that enable the delivery of medical education are referred to as infrastructure. The human, financial, and material inputs that enable the execution of medical education programs are referred to as resources. According to a recent assessment, many Arab medical schools lack enough facilities and resources to achieve quality and accrediting criteria .In the Arab world, limited facilities and resources have a detrimental influence on the quality and results of medical education. Inadequate infrastructure, for example, may limit the availability and accessibility of clinical training facilities, simulation labs, libraries, and research institutes . InadequSeveral solutions have been suggested and executed by various parties to solve the Arab world's poor infrastructure and resources for medical education. Increased governmental and corporate investments in medical schools, hospitals, clinics, labs, libraries, and research institutes are among them. Enhancing collaboration and coordination among medical education institutions, health authorities, professional groups, and international organizations to exchange best practices, standards, curriculum, professors, and students is another approach ,10. A thConclusionMedical education in the Arab world has several problems, particularly in light of social, political, and economic developments. The coronavirus disease 2019 (COVID-19) epidemic has highlighted both the region's strengths and inadequacies in medical education. As a medical student in the Arab world, I wanted to express some of my thoughts on the present situation and potential solutions.Despite these challenges, there are several possibilities and strengths that may be used to improve medical education in the Arab world. One of them is the availability of technology and digital platforms that may help with information access, communication, cooperation, and creativity. The COVID-19 pandemic has hastened the adoption of online learning and telemedicine, which have the potential to improve the quality and efficiency of medical education and practice. However, it is critical to guarantee that these technologies are used correctly, ethically, and successfully.Medical education in the Arab world is facing a critical era of development that will need collaborative efforts from every group involved to solve problems and capitalize on possibilities. As a regional medical student, I hope that this article has thrown some light on some of the challenges that impact our education and future professions. I also hope that it has sparked some conversation and action among educators, politicians, practitioners, and students in our region to enhance medical education.