Adequate Treatment Research Articles (Page 1)

Stunting remains a major public health problem in developing countries, including Indonesia, due to its long-term impact on child growth and the quality of future human resources. One frequently cited risk factor associated with stunting is low birth weight (LBW), which reflects impaired fetal growth during pregnancy. This study aims to determine the relationship between birth weight and the incidence of stunting in children under five years of age. A cross-sectional method was applied to explore the relationship between the studied variables, and 763 toddler respondents were included from the working area of the Kintamani VI Community Health Center. The independent variable assessed was birth weight, categorized as normal (≥ 2,500 grams) and LBW (< 2,500 grams), while the dependent variable was stunting status, categorized as stunted or not stunted based on WHO standards. Data analysis was performed using Fisher's Exact Test, which showed a significant relationship between birth weight and stunting (p = 0.002), where toddlers with a history of LBW had a 4.45 times higher risk of experiencing stunting compared to toddlers with normal birth weight. These findings highlight the importance of preventing LBW through adequate maternal nutrition and health interventions during pregnancy as a strategic effort to reduce the incidence of stunting in the community.

Anti-osteoporosis medications (AOM) play a crucial role in the management of osteoporosis. This study investigates the patterns of consumption and expenditures of these agents in Iran. The wholesale data of the Iran Food and Drug Administration on the consumption and costs of AOM from 2001 to 2021 was investigated. Annual utilization of medications was converted to defined daily doses (DDDs) per 1000 individuals per day (DID). Adequacy of treatment was also calculated based on the proportion of post-menopausal patients who received a DDD per day of AOMs. Data were analyzed using descriptive statistics and Excel software. The consumption and expenditure of AOM exhibited a fluctuation pattern. AOM utilization increased from 0.2 to 3.68 DID in 2021, indicating a rise of 19 times. Alendronate was consistently the most widely used medication, maintaining a share of > 90% from 2005 to 2015. With the increasing share of zoledronic acid and denosumab, the share of alendronate reduced in the last 5 years. In 2021, the AOM expenditure amounted to US$ 42.72 million purchasing power parities (PPP). In recent years, denosumab and teriparatide accounted for the majority of the expenditure. Majority of patients (84.25-97.54%) did not receive adequate treatment in the study period. The utilization of AOM in Iran has shown an overall increasing trend over time, albeit with fluctuations. However, underutilization is a fundamental challenge. Given the impact of these medications on osteoporosis treatment and fracture reduction, it is imperative to identify patients and ensure timely and effective medication treatment.

Physical inactivity is highly prevalent in heart failure (HF) and chronic obstructive pulmonary disease (COPD) and is associated with poor outcomes, including worsened quality of life, increased hospitalizations, readmissions, and mortality. Accessible interventions that improve physical activity are needed. Mind-body strategies are well-suited for promoting physical activity; they show promise for targeting key health behavior change processes. The aim of this study was to examine the feasibility and acceptability of a web-based pedometer-mediated mind-body intervention (Mindful Steps) for promoting walking among individuals with HF and COPD. In this pilot randomized controlled trial, participants with chronic, stable HF and COPD were randomized to Mindful Steps or usual care in a 2:1 ratio. Mindful Steps is a 12-month multimodal intervention that includes a pedometer with individualized step-count goals, live mind-body exercise (MBE) classes, and a web platform with mind-body videos, motivation messages, and educational tips. Feasibility (recruitment rate, retention), intervention acceptability, and intervention adherence were the primary outcomes. Exploratory outcomes assessed at baseline, 3-, 6-, 9-, and 12-months included daily step counts, cognitive-behavioral/psychosocial measures, health-related quality of life, and self-reported physical function. Participants were enrolled in the study from April 2019 to July 2021. The study was converted to all-digital during the pandemic after March 2020. Forty-one participants were randomized to Mindful Steps (n=26) or usual care (n=15). The recruitment rate was 3% (43/178), and overall study retention was 76% (31/41). In the intervention group, over 12 months, 58% (15/26) met a predefined benchmark for MBE class adherence (attending >70% of classes). Participants engaged most consistently with the MBE classes, the pedometer, and mind-body videos. There was a positive signal regarding group differences in the change in daily step counts from baseline, favoring intervention at 3 months (estimate=2038.77 steps per day between groups, 95% CI 289.76-3788.77), 6 months (estimate=3031.45, 95% CI 1261.15-4801.74), and 9 months (estimate=2703.80, 95% CI 862.97-4544.62). There were also positive signals regarding group differences in the change from baseline favoring intervention in the following outcomes: emotional awareness (estimate=0.88, 95% CI 0.15-1.61) and body listening (estimate=1.16, 95% CI 0.25-2.07) at 3-months; internal motivation (estimate=1.03, 95% CI 0.01-2.04) and pressure/tension at 6-months (estimate=-1.59, 95% CI -2.55 to -0.63); and exercise self-efficacy at 12 months (estimate=1.77, 95% CI 0.20-3.33). Mindful Steps was largely feasible, acceptable, and had adequate intervention engagement. There were positive signals favoring the multimodal web intervention for daily step counts, interoceptive awareness, internal motivation, and exercise self-efficacy that will inform hypotheses in future studies. A pivot to fully remote conduct during the pandemic was successful. A larger trial examining the efficacy of Mindful Steps for promoting physical activity is warranted. ClinicalTrials.gov NCT03003780; https://clinicaltrials.gov/study/NCT03003780.

The indigenous community of Quisquinchir, in Saraguro (Loja, Ecuador), is facing a process of transformation of the rural Andean landscape associated with internal and external migration, as well as the influence of foreign architectural models. The new buildings symbolize, in the collective imagination, modernity and progress; however, they are alien to the natural environment characterized by the practice of agricultural and livestock activities. Although previous studies have described the loss of Andean vernacular architecture, its recent evolution in clear typologies has not been systematized. The objective of this study is to assess the current state of traditional dwellings and understand how migration reconfigures the landscape, collective memory, building traditions, and cultural identity of their inhabitants. Based on direct observation, photographic and stratigraphic analysis, and secondary sources, five typologies were identified: traditional one-story, traditional two-story, hybrid one-story, hybrid two-story, and eclectic. This classification indicates the replacement of earthen walls with cement blocks in 37% of the dwellings and of tile roofs with zinc roofs in 29%. However, 35% of the houses retain their traditional morphology and materials. These results and their classification are fundamental contributions to the design of local public policies that generate adequate interventions respectful of the environment.

BackgroundYouth in Germany are affected by various mental health challenges among which are relatively high prevalence and incidence rates of mental health conditions compared to other age groups and multi-faceted barriers to or lack of adequate mental health services and interventions. This qualitative study aims to explore the perceptions of youth mental health, the factors influencing perceptions, expectations, and preferences toward youth mental health interventions. It is conducted in the context of the EU-funded EARLY project.MethodsWe conducted three focus group discussions (FGDs) with youth, parents, and professionals with 15 participants in total. The sampling strategy was purposive sampling and guided by theoretical considerations. All FDGs were anonymized, transcribed, and coded using computer assistance. The data was analysed using thematic analysis with an inductive approach applying latent coding to develop a concept based on the data generated. We organized member checks to evaluate the findings.ResultsAll groups reported that mental health is associated with stigma that adds to the existing challenges of accessing mental health services such as lacking capacities and extensive waiting times. The most important protective factors for youth mental health were social connections such as supportive relationships with friends and family. Regarding risk factors, the youth’ and parents’ group stressed substance and social media use as well as the fast pace and pressure to perform they were experiencing, while the professionals pointed out the adverse effects of challenging family environments.ConclusionsThe FGDs’ results provide in-depth knowledge of youths’, parents’, and professionals’ perceptions of mental health, influencing factors, and intervention preferences. Future research should address the identified factors to design and implement interventions adapted to the specific needs of youth in Germany to promote their mental health.

ABSTRACTBackgroundSarcopenia and intervertebral disc degeneration (IDD) are both highly prevalent among the elderly and have a substantial impact on their quality of life. However, the association between sarcopenia and IDD remains unclear. This study aimed to investigate whether sarcopenia is independently associated with an increased risk of IDD in middle‐aged and older adults, using prospective data from the UK Biobank.MethodsA total of 378 773 participants from the UK Biobank were included and categorized into three groups based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria: normal, probable sarcopenia and confirmed sarcopenia. The association between sarcopenia and IDD was examined using Kaplan–Meier survival analysis and Cox proportional hazards models. Sensitivity analyses included subgroup analyses to assess the robustness of findings and interaction tests to explore potential effect modifiers.ResultsThe median age of participants was 59 years, with females accounting for 54.8% of the cohort. Over a median follow‐up duration of 171 months, 10 585 participants developed IDD. In unadjusted Cox regression analyses, compared to the normal group, the hazard ratios (HRs) for IDD were 1.51 (95% CI: 1.41–1.61) in the probable sarcopenia group and 1.47 (95% CI: 1.14–1.90) in the confirmed sarcopenia group. After adjusting for multiple covariates, the corresponding HRs were 1.35 (95% CI: 1.26–1.44) and 1.41 (95% CI: 1.10–1.80), respectively. These associations remained consistent across subgroup analyses. Notably, in BMI‐stratified analyses, individuals with sarcopenia and a BMI > 25 had a higher risk of IDD (HR: 1.88; 95% CI: 1.31–2.71) compared to those with BMI ≤ 25 (HR: 1.51; 95% CI: 1.06–2.16), with a significant interaction (p < 0.001).ConclusionsSarcopenia is associated with an increased risk of IDD, particularly in overweight or obese individuals. Regular assessment of muscle strength and mass, along with promoting physical activity and adequate nutritional interventions in ageing populations, may help prevent sarcopenia and delay the onset of IDD.

This paper presents typical damage observed during recent earthquakes in Türkiye and elsewhere, along with their qualitative interpretation revealing the main weaknesses of existing stone masonry buildings. Historical structural systems, having a stone masonry ground storey and upper storeys made of timber framed masonry are also included. Strengthening techniques, frequently applied to alleviate the inherent inadequacies of stone masonry buildings are commented on, while their rationale, their efficiency and the effect of their misuse are presented, based on field observations after recent earthquakes and/or experimental results. The paper focuses on good and ill practices with the purpose of opening the discussion on the selection of adequate intervention techniques that may ensure an improved seismic behaviour, thus protecting human lives and property and contributing to the preservation of the built cultural heritage.

Epilepsy is frequently accompanied by psychiatric symptoms, including mood disturbances such as depression, irritability and euphoria. Interictal dysphoric disorder (IDD), characterised by depressive and affective symptoms, is typically managed with psychiatric treatment. However, persistent symptoms, despite adequate psychiatric intervention, may indicate an underlying epileptogenic mechanism. To highlight the importance of recognising epileptogenic contributions to persistent psychiatric symptoms, even in patients with apparently well-controlled epilepsy. We present a case report of a Japanese woman in her 40s with well-controlled epilepsy; however, she developed enduring psychiatric symptoms. Clinical features, psychiatric treatments, neurological evaluation and therapeutic outcomes are described. The patient experienced anxiety, depression, irritability and fear, leading to an initial diagnosis of IDD. Treatment with escitalopram and olanzapine achieved only partial symptom relief. Residual symptoms prompted further investigation, which revealed symptoms suggestive of temporal lobe epilepsy auras. Adjustment of anti-seizure therapy with lacosamide resulted in complete resolution of psychiatric symptoms, marked functional recovery and a reduction in her Hamilton Depression Rating Scale (HAMD-17) score improved from 23 to 6. This case highlights that even in apparently well-controlled epilepsy persistent psychiatric symptoms may indicate an underlying epileptogenic mechanism rather than a primary psychiatric disorder. Careful evaluation and appropriate optimisation of anti-seizure medication can yield substantial psychiatric and functional improvements, underscoring the importance of multidisciplinary assessment in such presentations.

Perinatal mental health is a rising public health concern in the United States, with mental health conditions, including suicide and overdose, the leading cause of pregnancy-related deaths. Despite guidelines recommending that maternal healthcare providers screen all patients for perinatal mood and anxiety disorders (PMADs) and refer them to appropriate care, screening rates are low, and many perinatal people continue to experience symptoms of PMADs well after 1 year postpartum. Utilizing the conceptual framework of the treatment continuum- clinical recognition of treatment, adequate treatment, and engagement in effective treatment- this research highlights factors occurring within and outside the medical system that impact perinatal people’s recovery from PMADs. We conducted 39 semi-structured interviews with participants in a rural state who had experienced pregnancy within the past five years. The main themes of the results were: 1) Recognition of PMADs; 2) Initiation of Treatment; and 3) Adequacy of Treatment. Key barriers to PMAD identification and recovery were low capacity and support in the postpartum period, stigma, fear of CPS, inadequate screening, hesitancy to take medication, lack of follow-up, and limited access to mental health. Participants highlighted the crucial role of informal support from partners, families, friends, and community members in recognizing symptoms and encouraging treatment. The findings underscore the need for improved education and training for both providers and patients about PMADs, enhanced screening processes, and better access to mental healthcare.

Background: The number of students with Specific Learning Disorders (SLDs) in universities has recently increased. Thus, it is important to analyze their difficulties throughout their academic studies and propose adequate interventions to prevent emotional problems and dropout. Previous research has reported higher levels of internalizing problems (anxiety and depression) in students with SLDs compared to those with typical development. Surprisingly, academic burnout among students with SLDs remains a largely overlooked and under-researched issue. The present work is one of the first studies that seeks to address this critical gap by examining the levels of academic burnout, and exploring its relationship with depression and anxiety in university students both with and without SLDs. Methods: The sample included 120 university students (M = 42, F = 78; mean age = 21.16, SD = 2.26). Of these, 60 students had SLDs and 60 had typical development (TD). Students were asked to complete three questionnaires assessing burnout (BAT-C), depression (BDI-II), and anxiety (STAI-Y). Results: The comparison between groups revealed that students with SLDs reported significantly higher levels of total burnout (mean difference = −3.98, t[118] = −2.59, p = 0.011, d = 0.47) and trait anxiety (mean difference = −2.87, t[118] = −2.73, p = 0.007, d = 0.50), with a moderate effect size for both differences. They also exhibited greater cognitive impairment related to burnout (U = 2333.50, p = 0.006, r = 0.25). No group differences were found in depression. Path analyses showed that while trait anxiety mediated the burnout–depression link in both groups, state anxiety was a significant mediator only for students with SLDs (β = 0.22, p = 0.025). Conclusions: The findings provide new evidence of the importance of monitoring academic burnout and anxiety in students with SLDs. The results show that anxiety plays a crucial mediating role between burnout and depression in students with SLDs, reinforcing the need for specific psychological support programs in universities.

Teeth requiring endodontic treatment often present with loss of dental tissue due to caries and/or trauma. This loss compromises their strength and can lead to tooth fractures. The longer these teeth remain exposed and unprotected in the oral cavity, the greater the risk of contamination. Therefore, coronal reconstruction of structurally compromised teeth should be considered to reduce the risk of failure and ensure adequate endodontic intervention in cases of pulpal and/or periapical disease. This article presents a novel technique in which coronal reconstruction was performed prior to endodontic treatment in conjunction with immediate endodontic sealing (IES), allowing indirect restoration to be bonded to this reconstruction.

IntroductionDepression is a highly prevalent disease that severely impacts the life of patients. Inadequate response to at least two antidepressants despite adequacy of treatment and adherence is known as treatment-resistant depression (TRD), which entails a higher social and economic burden than non-resistant major depression. The lack of consensus on the definition of TRD and other aspects complicates management of the disease. Intranasal esketamine has a novel mechanism of action that differs from that of traditional antidepressants by improving neuroplasticity and synaptogenesis.Material and methodsA scientific committee comprising ten psychiatrists, experts in TRD in Spain, reviewed the literature (grey literature and articles or scientific communications published between January 2014 and January 2024 in PubMed) and developed statements on theoretical and conceptual aspects of TRD. Statements were developed in a first meeting following a discussion group approach, refined in a second meeting following a nominal group technique, and consensus was finally drafted in a third meeting.ResultsA series of statements and recommendations were developed. Definitions for TRD and clinical response were proposed. The impact of therapeutic inertia was highlighted, identifying its causes and consequences. The role of intranasal esketamine in the TRD therapeutic treatment landscape was reviewed, and a treatment algorithm was developed, including specifics on evaluation of response to avoid therapeutic inertia and ensure an adequate treatment.ConclusionsThis is the first consensus developed in Spain regarding theoretical aspects of TRD and the role of intranasal esketamine in TRD therapeutic approach. A definition of TRD was proposed, together with a treatment algorithm.

Prediabetes progression to type 2 diabetes mellitus (T2DM) can be effectively prevented by adequate dietary intervention via improved liver insulin resistance. Stevioside, as a natural and safe sweetener, has been shown to have antidiabetic properties. However, whether stevioside can enhance liver insulin resistance in prediabetes remains unclear. We therefore aimed to investigate the effect and molecular mechanisms of stevioside on liver insulin resistance in prediabetes. Prediabetic mice were induced using a high-fat diet and treated with stevioside for 8 weeks. The effects of stevioside on gene expression levels and signaling pathways in the mice liver were investigated by RNA-seq and gene enrichment analysis. We also treated the palmitic acid-induced insulin-resistance AML-12 cells with stevioside, and measured glucose uptake in insulin-stimulated cells with 2-NBDG. The expression levels of genes and proteins related to the insulin signaling pathway were detected using qRT-PCR and Western blotting. Stevioside improved glucose tolerance and plasma insulin levels in prediabetic mice with insulin resistance and enhanced liver function. Stevioside could improve liver insulin resistance via IRS1/PI3K/AKT signaling pathway in prediabetic mice. Similarly, stevioside decreased the level of p-IRS1 and increased the levels of p-PI3K p85α, AKT, and p-AKT in AML-12 cells. Stevioside could improve glucose tolerance in prediabetic mice with insulin resistance, and ameliorate liver insulin resistance by regulating the IRS1/PI3K/AKT signaling pathway. These results may support stevioside as a potential dietary approach for preventing prediabetes progression to T2DM.

Cancer treatment typically encompasses surgical intervention, chemotherapy, radiotherapy, and targeted therapies; however, the side effects that develop during treatment may adversely affect patients' general health status and quality of life. In this patient group, in addition to appropriate and adequate nutrition, supplementary nutrition and dietary interventions can enhance patients comfort and contribute positively to health. Studies have indicated that functional foods can be safely utilised in cancer patients because of their antioxidant, anti-inflammatory, antitoxic, antiallergic, anticarcinogenic, and immunomodulatory effects. Antioxidants, pre-probiotics, omega-3 fatty acids, and glutamine were the primary products recommended and used in this patient group. Knowledge and awareness of functional foods are crucial for cancer patients to benefit from these nutrients. This study aimed to evaluate the awareness of functional foods in patients with haematologic cancer. A total of 130 volutary patients diagnosed with haematologic cancer who were followed up at the Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Internal Medicine/ Department of Hematology were included. The "Consumers' attitudes scale toward functional foods" was used in the analysis. In our study, the scores of the group that responded positively to the question "should functional foods be purchased" were higher in the benefit and trust sub-dimensions of the scale, and the scores of the group that responded negatively in the necessity sub-dimension were significantly higher. The high scores in the benefit sub-dimension of the group that responded positively to the question "Would you like to be educated about functional foods" showed that the majority of patients believed that the products were beneficial.

ABSTRACT Telehealth, accelerated by the COVID-19 pandemic, has become essential in-home health care, particularly for individuals with spinal cord injury (SCI). However, traditional telehealth often lacks adequate remote intervention and monitoring for SCI patients. This study evaluated a novel telehealth trial using transcutaneous electrical stimulation (TES) with innovative approaches to improve bladder function in SCI patients. Fifteen participants completed daily 15-minute TES sessions over four weeks, supported by courier-delivered equipment, video conferencing, and online assessments with self-reported monitoring at home. The trial achieved 100% adherence, with 80% of participants expressing confidence in device use and 87% indicating willingness to continue TES. Most participants found the device user-friendly, and 66% reported symptom improvement. This study highlights the potential of telehealth trials to enhance access to care, improve patient outcomes, and promote health equity in home care settings, particularly during periods of restricted in-person healthcare delivery.

A microfluidic approach reveals ongoing disease activity in thrombotic thrombocytopenic purpura patients despite clinical remission.

INTRODUCTION. The prevalence of apical periodontitis among the adult population exceeds 60%. This disease also occurs in adolescents in permanent teeth, and it is often detected in a state where the growth zone has died, and it is not possible to treat with calcium hydroxide to achieve apexogenesis. Therefore, there is a need to find and apply the most optimal dental materials for the treatment of dental periodontitis in adolescents. AIM. Presentation of our own clinical case of endodontic treatment of a tooth with a wide apical opening. MATERIALS AND METHODS. The article presents the result of treatment of a 15-year-old girl with an established diagnosis according to ICD-10: tooth 2.6 – K04.5 Chronic apical periodontitis (chronic granulomatous periodontitis). The tactics of dental care were aimed at stimulating apexification with calcium hydroxide-based filling material Metapaste (Meta Biomed, South Korea). The functional parameters of the tooth have been restored. The stability of the obtained result was assessed 3 months after the treatment using CBCT of the causal tooth. CONCLUSIONS. The presented clinical case demonstrates the successful endodontic treatment of a tooth in a teenager, in which treatment tactics aimed at stimulating apexification were applied. Observation of the patient for 1.5 years confirmed the success of the therapy, which manifested itself in the formation of the dentinal bridge and the positive dynamics of the tooth condition. The use of the calcium hydroxide-based drug Metapaste (Meta Biomed, South Korea) played a key role in achieving a stable clinical result. This case highlights the importance of timely and adequate dental intervention to achieve optimal treatment outcomes. A pediatric dentist should have the skills to use modern methods of treating periodontitis of permanent teeth with a wide apical opening to choose the best approach to therapy.

Abstract Dermatological surgery training is an apprenticeship with techniques often passed down and rarely questioned. Aligning clinical practice with a robust evidence base is desirable for achieving optimal surgical outcomes. Four common dogmas in skin surgery were explored using evidence-based literature. (i) ‘Double and triple curettage and cautery is an effective treatment for basal cell carcinoma (BCC)’. Quality of evidence was low, and based mostly on historical practice using a spoon curette. Modern expert opinion is that should conservative surgical treatment be required, a one-piece tangential shave or saucerization with a flexible razor blade or scalpel is preferable. The biopsy details will influence adequacy of treatment and risk stratification. Furthermore, electrodesiccation (particularly if repeated) can lead to poor healing and increased scarring while exposing the surgeon to excessive surgical plume. Based on the evidence, we recommend that repeated curettage and electrodesiccation be abandoned for the treatment of BCC. (ii) ‘Excessive surgical garb and complete field sterility in dermatological surgery reduce surgical-site infection’. Quality of evidence was low: case series and case–control studies showed that the use of masks, head coverings, full-body drapes, theatre shoes and shoe covers did not prevent surgical-site infection. Dermatological surgery is classified as ‘clean’ where the contamination rate is low. Excessive surgical garb adds little to patient care and contributes to significant waste. (iii) ‘Mohs surgical excision of BCC leads to better cosmetic outcomes’. Quality of evidence was low and likely influenced by bias of Mohs surgeons. A prospective study comparing outcomes with standard excision showed no difference in cosmetic outcomes. Multiple different factors contribute to cosmetic outcome – both surgeon related and defect related. However, at certain sites such as the alar rim and the eyelid, tissue preservation by Mohs surgery may lead to a more straightforward reconstruction and a better cosmetic outcome. (iv) ‘A dressing should always be applied on sutured defects’. Quality of evidence was low (case series). This dogma is likely influenced by bias of specialty training. Potential benefits of postoperative dressings include reduced infection, protection from trauma, reduced bleeding, less staining of clothes and patient comfort. However, dressings can potentially cause ischaemia, dermatitis and increased infection risk. There is evidence that in clean, minimally invasive skin surgery, infection rates are similar with or without a dressing. Not using routine postoperative dressings simplifies postoperative care and reduces costs; we recommend a flexible approach including patient preference. We suggest further dermatological surgery dogma is critically appraised to balance opinion-driven practice and strive towards evidence-based dermatological surgery.

Background and Aim. Despite the efforts to eliminate brucellosis in the Pavlodar region, its local epizootics remain a huge concern. The aim of this work was to conduct epizootic surveillance and analyze the epizootiological situation with animal brucellosis in the Pavlodar region in 2019-2023. Materials and Methods. The materials used in this study include the official reports of the Committee for Veterinary Control and Supervision of the Ministry of Agriculture of the Republic of Kazakhstan (CVCS of MoA of RK), the Republican Anti-epizootic Unit (RSI RAU), the regional branch of the Republican Veterinary Laboratory (RVL), the Republican State Enterprise on the rights of economic management “Scientific and Practical Centre for Sanitary and Epidemiological Expertise and Monitoring” of the Ministry of Public Health of the Republic of Kazakhstan (RSE SPC SEEaM of MoPH of RK), and the results of our own epizootiological research. The research methods used in the study are in full compliance with the official guidelines for diagnosing brucellosis in animals. Results. We have established the leading role of cattle and small ruminants in the epizootiology of brucellosis, identified the most significant factors promoting brucellosis persistence in livestock and ascertained the occurrence of the infection in the human population in every district of the region. Using the epizootic surveillance data acquired over the past 5 years, we have identified areas with high, moderate and low incidence of animal brucellosis, as well as disease-free zones, and constructed an epizootic map that can be used to implement adequate interventions. Conclusion. Epizootic surveillance, coupled with the analysis of dynamics of brucellosis spread to new sites, its incidence in livestock and the results of screening tests, will facilitate epizootic control and help to elaborate a methodologically sound strategy for implementing adequate interventions.

Abstract ObjectivesChildren with eosinophilic esophagitis (EoE) may be at heightened risk for developing the eating disorder avoidant/restrictive food intake disorder (ARFID). However, relatively few studies have specifically looked at the prevalence of ARFID in children with EoE. The literature is plagued by varying diagnostic nomenclatures; existing studies have widely variable definitions of both ARFID and EoE. Finally, differentiating symptoms of EoE from those of ARFID can be challenging. The current study describes ARFID and its correlates in children ages 1–18 referred to a speciality EoE clinic.MethodsOne hundred and fifteen children participated in an observational, pilot study. All had confirmed diagnoses of EoE and were referred to a multidisciplinary EoE clinic for ongoing care. All completed questionnaires were collected at the time of the clinic visit.ResultsThirty‐seven percent of patients met criteria for ARFID based on the Eating Disorders in Youth‐Questionnaire and clinical interview. Seventy percent of children who were on food elimination only met criteria for ARFID, compared to 36% on medication only and 37% on combined food elimination and medication for EoE treatment. Children with food fussiness, a greater number of immunoglobulin E‐mediated food allergies, and low enjoyment of food were more likely to have a comorbid ARFID diagnosis. Youth with EoE and ARFID had a lower quality of life.ConclusionsA significant percentage of children with EoE referred to a multidisciplinary clinic struggle with the comorbid eating disorder ARFID. Routine screening and assessment should be considered to ensure adequate identification and intervention for this specific eating disorder.