Vol 41 # 3 September 2009 - Kma.org.kw

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September 2009 KUWAIT MEDICAL JOURNAL 197 Fig. 1: Framework for improving population health genomics in the GCC countries a cost-effectiveness evaluation to determine its feasibility for wider use among target groups [26,29] . Pre-implantation diagnosis could help couples who do not take the recommendation of premarital counseling and proceed with marriage despite a high risk for single-gene and chromosomal disorders [30,122,123] . Medical education and training for health staff is a very important means of improving genetic health services in any country [25,43] . The
198 Population Health Genomics in Member Countries of the Cooperation Council for the Arab... September 2009 dissemination of information through health staff to the public is also crucial. Hence, the training of primary health care staff in the area of genetic health education is vital, since these workers represent the first line of contact with genetic services for the general public [25,27,30,43,44,112,115, 124-126] . There is no single perfect framework for providing genetic services, and differences in research results and in the methodological quality of studies make the development of such a framework even harder. Religious, ethical, cultural and social differences can mean that a solution that is suitable for one country cannot be implemented in another [127] . For the purpose of improving population health, an integrative genomic program should be adopted that involves all community levels. This program should be in close communication with policy-makers and decisionmakers in all of the GCC countries, and should undergo regular evaluation, with the sharing of knowledge between the different participating sectors. Fig. 1 represents a proposed framework for improving population health genomics across all levels of a community. As discussed earlier, GCC countries have implemented some of the proposed components and have achieved various degrees of success. Integrated into a national comprehensive program, these advances could be even more effective in improving population health. FRAMEWORK COMPONENTS To support the translation of currently available knowledge into action and thus reduce the gap between the current level of available services and actual need, the proposed framework was created after a review of the pertinent literature and discussion with experts in the field of population health genomics and public health. It is important to bear in mind that the implementation of each component of this framework is intended to be adjusted to the specific needs and expectations of the populations of the GCC countries. At the same time, it is hoped that in moving forward in population health genomics and facilitating the implementation of current knowledge, the experience gained in one country might be generalized to others. Although it is acknowledged that GCC countries have tried to improve services related to population health genomics, a more comprehensive and integrated approach is needed to optimize the effectiveness of these services. The guidelines proposed here are not intended to be adapted in a rigid manner; rather, they are meant to accommodate further suggestions and the integration of new services and to provide the necessary flexibility to implement each component according to the needs and expectations of each country. These guidelines are thus open to the kind of innovation and adaptation necessary for any health care system to continue to improve and to provide effective health care services [128-130] . • Stakeholder engagement and communication: Provision of support by the higher authorities is an important component of any successful program. Supportive policies, strategic planning, and legislation will improve the genomic health of the population. Another important role of stakeholders is to ensure accessibility and equity in the provision of services to all population subgroups. Religious, ethical, social, and cultural issues related to the implementation of genetic services should be taken into consideration in the appropriate application of genetic services. Communication between the different disciplines involved in implementing the framework is also important for programs to be run effectively and should be encouraged and reinforced by stakeholders in all of the GCC countries. The process of communication involves sharing evidence-based knowledge, addressing challenges, and applying possible solutions in different disciplines to enhance outcomes, while bearing in mind that each discipline has its own characteristics, such as target population and methods of operation and of communication [112,131] . • Community level: The promotion of genetic health in the general population is required to support all disciplines that provide genetic services. Such promotion can be divided into a general approach that focuses on improving the engagement of the public in regard to genetic health, diseases, associated burden and predisposing factors. For specific groups, a more detailed approach can be used to provide information about particular programs that are available, clarifying their purpose and encouraging the targeted group to participate [131] . It is important to frame the message carefully and to use channels of communication that are appropriate for the target group. Communitylevel interventions can also involve campaigns to promote the adequate intake of folic acid by women of child-bearing age, campaigns to provide immunization against rubella for girls before they reach puberty, and campaigns that involve the private sector, as for example in the fortification of salt to prevent iodine
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252 Neurosarcoidosis as a First Pre
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256 Urosepsis Simulating Congenital
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258 Rituximab in Severe Refractory
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260 Rituximab in Severe Refractory
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262 Selected Abstracts of Articles
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264 Selected Abstracts of Articles
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266 Forthcoming Conferences and Mee
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274 WHO-Facts Sheet September 2009
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Vol 41 # 3 September 2009 - Kma.org.kw

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