Autonomous Province Research Articles

Diagnostic significance of immunophenotyping of peripheral blood lymphocytes in pediatric patients from the Autonomous Province of Vojvodina, Republic of Serbia

Introduction/Objective. Although lymphocyte immunophenotyping based on flow cytometry is a powerful tool in the diagnosis of many primary immunodeficiences (PID), there has been an increasing awareness of associated costs and the need for its reassessment as a screening tool. We present the results and diagnostic impact of immunophenotyping performed by flow cytometry in the University Children?s Hospital, Belgrade, in a series of patients referred from the Institute for Child and Youth Health Care of Vojvodina from July 2008 to July 2018. Methods. We reviewed the laboratory reports on numbers of B lymphocytes (CD19+), T lymphocytes (CD3+), natural killer cells (CD3?CD16/CD56+) and activated T cells (CD3+HLA-DR+), as well as CD4+ and CD8+ T cells in 198 children. Results. Patients were grouped by stated indication into the following eight categories: hypogammaglobulinemia (34), selective IgA deficiency and/or IgG subclass deficiency (43), various infections with no immunoglobulin deficiencies (67), asthma and/or allergies with no immunoglobulin deficiencies or infections (23), known or suspected autoimmune disorders (24), and miscellaneous diagnoses not accompanied by infections (7). In total, 159 (80.3%) findings were either completely within the respective reference range or exhibited only minimal aberrations. Four patients were diagnosed with Bruton?s disease and one with Artemis immunodeficiency. Nineteen patients were given immunoglobulin substitution to control infections and/or maintain immunoglobulin G levels. Conclusion. Lymphocyte immunophenotyping aids the diagnosis of PID in selected patients. We venture some thoughts on how the usefulness of this laboratory method could be improved in real-life tertiary care pediatric hospital settings.

Ispravka: Uloga socijalne podrške u relaciji između različitih strategija prevladavanja gubitka i emocionalnog distresa kod tugujućih starih osoba (2023, vol. 26, br. 1, str. 93-1133, DOI: 10.5937/PSISTRA26-39172)

In the paper entitled "The role of social support in the relationship between different coping strategies and emotional distress in the bereaved elderly ", published in No. 1, Volume 26, p. 93 of the journal Psihološka istraživanja (https://scindeks-clanci.ceon.rs/data/pdf/0352-7379/2023/0352-73792301093L.pdf), the information was inadvertently omitted that the paper was written as part of the project "The elderly in Vojvodina: factors of successful ageing", funded by the Provincial Secretariat for Higher Education and Scientific Research of the Autonomous Province of Vojvodina, Republic of Serbia (project number 142-451-2665/2021-01). At the request of the authors, we are supplementing the information on the funding of the project. The authors apologise to the funder and the readers for the omission and especially thank the funder for the institutional support.

Finansiranje kao instrument kulturne politike u oblasti amaterskog stvaralaštva na primeru kulturno-umetničkih društava

Amateur creativity in various areas of arts and culture is of great importance for cultural development. Amateur associations enable citizens living in both urban and rural areas to actively participate in the creation of cultural content and encourage them to actively participate in reception of various cultural content created by professional artists. In addition, it is important that amateur associations stay open for all generations (from junior to senior participants), and that they cherish cultural expressions of national minorities. The importance of amateurism is acknowledged in the Law on Culture as the key act for implementation of cultural policy in Serbia. This is important for financial support, as another key instrument of cultural policy implementation. Based on results of a research conducted among amateur associations in Serbia at the turn of the 2020s, this paper will analyse the financial support for amateurism from public funds (Republic of Serbia, Autonomous Province of Vojvodina and local self-governments) in the period 2019 - 2021. The case study covers amateur associations active in traditional dance and folklore as the most numerous amateur associations in Serbia.

Kraljevo tokom epidemije variole vere 1972. godine

In the spring of 1972, the infectious disease smallpox appeared in Yugoslavia, which was characterized by high mortality. Today, it is known for certain that the epidemic was brought by Ibrahim Hoti, a pilgrim who went on a trip to Saudi Arabia and Iraq. Most of the sick and deceased were from the area of the then Socialist Autonomous Province of Kosovo, followed by those from Belgrade. On the territory of the municipality of Kraljevo during the smallpox epidemic, there were no cases of infection, although the areas where the infections appeared are geographically very close. Nikola Nakaradić, a student of the Forestry High School and a resident of the boarding school in Kraljevo, was one of those infected and successfully cured. He got the symptoms and the diagnosis when he was not in Kraljevo, and then he was treated and taken care of in a quarantine in Belgrade, which is why he was listed as a patient from Belgrade in the records. Getting out of the epidemic situation without a single case of illness in the area of the then municipality of Kraljevo is considered a success, especially considering the poor state of healthcare, both in terms of material and technical conditions, and in terms of unpreparedness for the challenge of a sudden epidemic. The municipal headquarters for quarantine diseases carried out combat measures by organizing quarantines, and mass vaccination of the population was carried out. The quick formation of the quarantine, immediately after learning that the resident of the boarding school was infected, as well as the quick and successful action to locate the fugitives from the quarantine, represent the merit of the internal affairs authorities, while the greatest merit certainly belongs to the health care workers, on whose shoulders fell the main burden of responsibility and who engaged in preventing the virus outbreak in Kraljevo The fact that Nikola Nakaradić from Morović, a sick student of the Forestry School and a resident of the boarding school in Kraljevo, did not infect anyone in the territory of Kraljevo can certainly be considered an extremely fortunate set of circumstances. Unfortunately, material conditions in the health institutions in Kraljevo did not significantly improve even several years after the epidemic. The experience of smallpox has led to the fact that in the next draft of the health care program, measures for the detection, prevention, control and treatment of infectious diseases will be outlined in the first point. The formal legal basis has been laid, but experience after smallpox has shown that the action in the first moments of the epidemic is the most important. Knowledge, conscientiousness, responsibility, courage and dedication of health workers and other employees in competent institutions are the first and most important frontline for preventing epidemics at their very beginnings.

EPIDEMIOLOGICAL CHARACTERISTICS OF HUMAN LISTERIOSIS IN VOJVODINA, SERBIA, IN THE PERIOD 2005-2020

In the Autonomous Province of Vojvodina, listeriosis has been reported to health authorities since 2005. In this study, we retrospectively analysed the data of listeriosis collected from January 1, 2005 to December 31, 2020. Descriptive method was applied. Demographic, chronological and topographical distribution of the disease in Autonomous Province of Vojvodina was reviewed. In the study period, a total of 52 cases of listeriosis were registered. The average annual incidence rate of reported cases was 0.16/100,000. The largest annual number of cases (n = 10) was reported in 2020. The highest incidence rate registered in youngest age group < 1 year was (5.4/100,000). Gender distribution of the infected population showed no difference with respect to number of infected males and females. Listeriosis was registered throughout the year, but most frequently in October (21.15%). Topographical distribution revealed that listeriosis was more frequently reported in South Bačka county (2.4/100,000 inhabitants). The overall case fatality rate of reported Listeria monocytogenes infection was 23.08%. The highest case fatality rate was in the age group 19 - 59 years (29.41%), and fatal outcome in males was twofold the fatality rate in females. Our data analysis suggests that our practitioners, gynaecologists, paediatricians, oncologists and other clinicians should take listeriosis into consideration much more often in differential diagnosis in order to improve the diagnosis of the disease and further on epidemiological investigation on source of infection.

Prevalence of gestational diabetes and recourse to postpartum oral glucose tolerance test in the Autonomous Province of Trento (Italy)

ObjectiveThe occurrence of gestational diabetes (GDM) is increasing worldwide, and such a diagnosis is important for women's health beyond pregnancy. Therefore, many guidelines suggest the re-evaluation of glucose tolerance with a postpartum oral glucose tolerance test (OGTT) in women with GDM. This study reports the prevalence of GDM and the use of a postpartum OGTT in women assisted at maternity units in the Autonomous Province of Trento in the years 2017–2018, investigating the socio-demographic and health-care variables that can facilitate access to the test. Study designFor the diagnosis of GDM, the International Association of Diabetes and Pregnancy Study Group criteria were used. The Birth Assistance Certificate and the Hospital Information System were used to retrieve clinical and socio-demographic data. Univariate and multivariate analyses were performed to evaluate the stratification of the use of a postpartum OGTT. ResultsIn total, 8,308 pregnant women were assisted at the maternity units in Trento. There were 532 recorded cases of GDM (266 cases per year) and the overall average prevalence was 6.4 % (95 % CI, 5.90–6.90), 4.9 % of whom were Italian (95 % CI, 4.38–5.42) and 10.4 %, foreigners (95 % CI, 9.13–11.67).135 women diagnosed with GDM and residing in Trento out of 513 were evaluated using a postpartum OGTT (26.3%, CI 95% 22.50–30.10), with pathological results in 61 cases (45.2%). In the multivariate analyses, insulin therapy during pregnancy, delivery at a third-level birth point, and a discharge letter informing of the presence of GDM and of the need for a postpartum OGTT were independent factors associated with the probability of carrying out a postpartum OGTT. ConclusionsThe prevalence of GDM in our study is lower than in previous Italian studies; however, it is consistent with European data. The proportion of women who were assessed using the postpartum OGTT is lower than that reported by previous studies. The health-care factors seem predominant among the socio-demographic characteristics of the cases in influencing access to the test. The awareness of women, the sharing of guidelines among the different sectors of the health system, and an optimal management of the discharge from the birth point are critical in ensuring an optimal follow-up in women with GDM.

Seroepidemiology of SARS-CoV-2 Virus in Healthcare Workers before Circulation of the Omicron Sublineages BA.4/BA.5 in Vojvodina, Serbia.

Healthcare workers (HCWs) are a vulnerable and critical population in the ongoing response to the SARS-CoV-2 pandemic. We aimed to estimate the seroprevalence in HCWs considering all of their previous contacts with the SARS-CoV-2 virus and/or the immunity acquired through their immunization against COVID-19 before the advent of the Omicron variants BA.4/BA.5. Serum samples were collected from 28 March to 10 June 2022. We covered 25% out of all the people who worked in some of the government healthcare centers (primary, secondary, and tertiary level) across the entire Autonomous Province of Vojvodina (Northern Serbia). Two serological tests (Anti-SARS-CoV-2 QuantiVac ELISA and LIAISON® SARS-CoV-2 TrimericS) were used to detect anti-spike IgG antibodies. The overall prevalence of the SARS-CoV-2 antibody among the 6936 HCWs was 92.96% [95% CI 92.33-93.55]. Regarding the type of serological test, there was a statistically significant (p = 0.0079) difference of the seropositivity obtained by the LIAISON® SARS-CoV-2 TrimericS (93.87%, 95% CI 92.97-94.69) and Anti-SARS-CoV-2 QuantiVac ELISA (92.23%, 95% CI 91.34-93.06) tests. Seropositivity to SARS-CoV-2 significantly (p < 0.0001) increased with the number of SARS-CoV-2 infections combined with the number of doses of the SARS-CoV-2 vaccines received. A vast majority of the HCWs in Vojvodina had detectable levels of antibodies to the spike protein of SARS-CoV-2, but despite this high seropositivity, it is unknown whether this herd immunity among HCWs is protective against the new variants of concern. Further research should evaluate the rates of reinfections and the associated severity of COVID-19 caused by the Omicron sublineages and/or new variants of SARS-CoV-2 among HCWs.

Agricoltura di montagna in divenire: Approcci alle sfide agroalimentari in Trentino

The current paper belongs to a set of ongoing multi-scalar and trans-disciplinary research studies investigating potential approaches for regenerating rural areas in the Alpine areas of Italy, which have been suffering for years from underused phenomena (Balducci, 2019; Gretter et al., 2018a).The paper focuses mainly on the territory of the Autonomous Province of Trento to investigate how farmers face the current challenges in different ways while looking for sustainable and viable systems from the ecological and socio-economic perspectives (Bender & Haller, 2017). Trentino’s cultural context reflects a long tradition of specific law rules, which have granted a degree of self-government capabilities in various sectors such as territorial planning and land use policies, culture and school system, or social services (Gretter et al., 2018b).Rather than present specific results based on deep quantity-qualitative analysis, the goal of the manuscript is to overview the peculiar features of this alpine territory, opening a series of inputs of reflection and discussions. Some have already been locally activated, but most must be addressed in a broader and systemic approach, involving a more comprehensive series of stakeholders, moving from public authorities to citizens.In this manuscript, we highlight ongoing experiences that the Trentino Agro-food value chain faces today and how this impact the territory and its cultural landscapes’ preservation.

Mountain Farming in the Making: Approaches to Alpine Rural Agro-food Challenges in Trentino

The current paper belongs to a set of ongoing multi-scalar and trans-disciplinary research studies investigating potential approaches for regenerating rural areas in the Alpine areas of Italy, which have been suffering for years from underused phenomena (Balducci, 2019; Gretter et al., 2018a).The paper focuses mainly on the territory of the Autonomous Province of Trento to investigate how farmers face the current challenges in different ways while looking for sustainable and viable systems from the ecological and socio-economic perspectives (Bender & Haller, 2017). Trentino’s cultural context reflects a long tradition of specific law rules, which have granted a degree of self-government capabilities in various sectors such as territorial planning and land use policies, culture and school system, or social services (Gretter et al., 2018b).Rather than present specific results based on deep quantity-qualitative analysis, the goal of the manuscript is to overview the peculiar features of this alpine territory, opening a series of inputs of reflection and discussions. Some have already been locally activated, but most must be addressed in a broader and systemic approach, involving a more comprehensive series of stakeholders, moving from public authorities to citizens.In this manuscript, we highlight ongoing experiences that the Trentino Agro-food value chain faces today and how this impact the territory and its cultural landscapes’ preservation.

Mass transfer rate and osmotic treatment efficiency of peaches

Abstract The highest-quality peaches [Prunus persica (L.) Batsch] are cultivated in areas with sunny summers, therefore the territory of the Autonomous Province of Vojvodina is a favourable region for their production. Peaches are usually consumed fresh, canned, or dried and represent a great source of the essential nutrients. Osmotic dehydration is a well-known preservation method that relies on mild temperatures and requires low energy. Research conducted at the Faculty of Technology Novi Sad has introduced sugar beet molasses as an efficient osmotic solution for drying various food samples. In this research, peach samples were osmotically treated in sugar beet molasses, and the goal was to investigate the impact of different solution concentrations, temperatures, and immersion time on the mass transfer rate and the efficiency of treatment. The results have shown that the mass transfer rate during the osmotic treatment of peach samples in sugar beet molasses was the most intensive at the beginning of the process, at the highest solution concertation, and at the highest temperature. In accordance with the results, diffusion occurred most rapidly during the first three hours of the process; therefore, processing time can be reduced.

신규식과 대종교(Ⅰ)

This study This article intends to examine Shin, Kyu-sik's thoughts on the Daejonggyo by focusing on the poems 'Amokru' and contents of 'Korean Soul' in his collection of works. Shin, Kyu-sik wrote poetry about Na, Cheol's deeds when he majored in Daejonggyo, when he left for Manchuria for missionary work, when he built a church in Manchuria, when he performed a miracle, and when he committed suicide at Samseongsa Temple in Guwolsan. To him, Na, Cheol was regarded as a life saver and the embodiment of Dangun. Na, Cheol's self-determination was compared to Jesus' crucifixion, and Na, Cheol's missionary difficulties were compared to Shakya's difficult realization. He believed that the three gods, the doctrine of Daejonggyo, were one and that it was Dangun, and he built a heavenly palace that enshrined Dangun and prayed every day. He studied cultivating to become a rookie unity through strikeout, and revealed that he had no original guilt in Christianity. Shin, Kyu-sik thought that a new country should be established with the identity standard of Dangun. This was also reflected in the Provisional Government. In addition, one can understand the new ritual only by understanding Daejonggyo. Building a nation-state centered on Dangun was the historical task of this period and the aspirations of independence activists. Shin, Kyu-sik reaffirmed Na, Cheol's missionary work on Daejonggyo by extending the identity of the Korean people not only to the Korean Peninsula, but also to the Gando region. The restoration of the Korean national identity in the Gando region served as a base for the independence movement during the anti-Japanese struggle and was a great story that laid a solid foundation for the establishment of the Korean-Chinese Autonomous Region after the establishment of the People's Republic of China in 1948. The significance of Daejonggyo's mission to the Gando region is that it was achieved in the Goryeo and Joseon dynasties, even though efforts were made to restore the Goguryeo homeland, but did not achieve great results. The current identity of the Korean people (政体, government) became an opportunity to form three autonomous provinces: South Korea, North Korea, and Josen ethnicity. Shin Kyu-sik has historically had the perception that Manchuria has been our territory since Dangun.

The Role of the Ministry of the Interior of the Republic of Serbia in the Conduct of Ethnic Cleansing of the Albanian Population in Kosovo and Metohija From 1998 to 1999

The paper presents a short chronology of the political conflict in the Autonomous Province of Kosovo and Metohija (Socialist Autonomous Province of Kosovo, until the constitutional changes of 1989), which in the 1990s turned into an armed conflict in which the security forces of the Republic of Serbia from October 1998 to June 1999, carried out a planned action of ethnic cleansing of Kosovo Albanians. In the action, several thousand Albanian civilians were executed extrajudicially and between 800,000 and 850,000 Albanians were forcefully expelled to Macedonia, Montenegro, Albania and Bosnia and Herzegovina. This paper is based on the final judgments of the International Criminal Tribunal for the former Yugoslavia (ICTY) by which the highest state officials and military and police generals in the Federal Republic of Yugoslavia and the Republic of Serbia were convicted of joint criminal enterprise aimed at altering the ethnic structure in at least 13 Kosovo municipalities, especially in the period of the NATO alliance campaign from March 24 to June 12, 1999. The role of the Ministry of Interior in the joint criminal enterprise (JCE), as established by the ICTY judgments to the then Ministry of Interior leaders: Vlastimir Đordđević, head of the Public Security Department, Sreten Lukić, head of the Ministry of Interior Staff for Kosovo, (Vlajko Stojiljković, the Minister of Interior, was also accused, but he committed suicide in 2002) - is undoubted. Therefore, it calls for a public analysis and presentation of the role of this part of the repressive apparatus of the state of Serbia in the ethnic cleansing of Kosovo Albanians, as well as its role in the planned and systematic concealment of crimes. The concealment of the crime was conducted from March to June 1999 by the Ministry of Interior forces through secret operations of transfer of bodies of Kosovo Albanians from primary graves in Kosovo and their burial in mass graves at secret locations in Serbia. Three graves were discovered in 2001 and one in 2013, with the assumption that there are more because they are looking for another 1,086 Albanian victims and 562 victims of Serbs, Roma, Bosniaks, Egyptians, Ashkali and others.

A participative methodology for prioritising intervention logic in the design of the Italian CAP Strategic Plan

The new CAP implementation model requires each Member State to design a CAP Strategic Plan (CSP) to deliver operational actions under the two CAP pillars. Each CSP must be built from an evidence-based needs assessment that undergoes rigorous prioritisation to plan comprehensive and achievable interventions. In Italy, the institutional context requires all the Regions and Autonomous Provinces to express their preferences and to discuss the CSP collectively, both as regards identifying territorial needs and their prioritisation. In this framework, it became pertinent to introduce a specific instrument to facilitate participation in this process. The Italian Ministry, in collaboration with the National Rural Network, developed a participatory route to assess the prioritisation of the identified needs, to support the decision-making process in CSP drafting process. The process is primarily based on a voting aggregation technique called the Constrained Cumulative Voting method. The process identified makes it possible, on the one hand, to formulate a shared consensus on the level of importance of each need; on the other one, via the definition of natural breaks, to determine homogeneous groups of needs by importance of intervention. This process is in line with the European Commission’s legislative proposals requiring a sound and well-founded logic of intervention.

Indian intervention in ethnic movement of Nepal: Did Madheshi lose or gain?

This paper examines the impact of Indian intervention on the Madheshi parties’ claim to self-determination in Nepal. In 2007, the Madheshi parties launched mass protests, demanding the recognition of their self-determination through an autonomous Madheshi province. Mainstream political parties became hesitant to incorporate this demand. The Nepalese government signed agreements with the agitating Madheshis but did not intend to implement its commitments. The Indian government was monitoring these developments; it stood on the Madheshi side and urged the Nepalese government to recognize self-determination and autonomy in the new Constitution. It increased pressure through press releases, parliamentary statements, bilateral visits, and an undeclared economic sanction. Against this background, this paper examines the following question: What is the impact of the Indian intervention on the Madheshi claims for self-determination in Nepal? It identifies that the Indian intervention obstructed the recognition of Madheshi self-determination as a constitutional right and the agenda of the nationalist movement. The mainstream political parties perceived the Indian intervention as unwanted interference in a sovereign state’s internal affairs and responded to this pressure by adopting the Constitution without including self-determination. The Indian government continued to pressure through economic sanctions, but the latter just increased anti-Indian sentiments in Nepal. As a result, the Nepalese government re-strengthened its ties with the Chinese government and concluded trade and transit agreements. The Indian government perceived that Nepal-China ties would affect its national interests in Nepal and stayed silent about the Madheshi parties. This silence constructed a permissive environment for the Nepalese government to ignore the nationalist demands and forced the Madheshi parties to concede their self-determination as the ethnonational agenda.

COVID-19 Breakthrough Infections among Patients Aged ≥65 Years in Serbia: Morbidity and Mortality Overview.

BACKGROUND: Vaccines against severe acute respiratory syndrome coronavirus 2 have shown effectiveness in the prevention of COVID-19. Breakthrough infections occur, and age has been shown to be one of the dominant risk factors for poorer outcome. This research focuses on characteristics of breakthrough infections in older adults. METHODS: This retrospective study was conducted for four months (March−June 2021) in the autonomous province of Vojvodina in Serbia on 11,372 patients using reverse-transcription polymerase chain reaction or antigen-detection rapid diagnostic tests verifying COVID-19 in those aged ≥65 years. Demographics, comorbidities, disease severity, and final outcomes were evaluated in fully vaccinated compared to unvaccinated individuals. Individuals were divided into younger-old (65−74 years) and older-old (≥75 years) age groups and differences between those groups were further evaluated. Binary logistic regression was performed to identify independent predictors of poor outcome. RESULTS: By the end of the research, 51.3% of the population of APV 65−74 years, as well as 46.2% of those older than 74 years, were vaccinated. From the acquired sample, 17.4% had breakthrough infection. Asymptomatic forms were higher in both age groups of vaccinated vs. unvaccinated (3.9%—younger-old, 6.3%—older-old vs. 2.9%—younger-old, 3.9%—older-old). The same results were registered with mild symptoms (82.1%—younger-old, 68.1%—older-old vs. 76.3%—younger-old, 57.5%—older-old) (p < 0.001). The case fatality ratio of the vaccinated population was smaller than the unvaccinated population in both groups (3.1% vs. 7.9%—younger-old; 11.4% vs. 22.5%—older-old) (p < 0.001). The odds ratio for poor outcome in unvaccinated individuals was 2.3 (95% confidence interval, p < 0.001) for the total sample. CONCLUSIONS: An increase in asymptomatic and mild forms, as well as decrease in severe or critical forms and poor outcomes, were noted in the vaccinated population. Choosing to avoid vaccination against SARS-CoV-2 may increase the chance of poor outcome in older individuals.

Rural–Urban Metabolism: A Methodological Approach for Carbon-Positive and Circular Territories

Cities are responsible for about 75% of the global greenhouse gas emissions. Various materials and energy sources, which are mostly produced by the rural areas rather than the cities, are consumed by the cities, and their waste is released back into the rural areas, thereby causing evident environmental damages. The Rural–Urban Metabolism approach can offer a comprehensive tool to understand the flux of resources that cross the urban environments and plan for more sustainable cities. Considering the strength of the relationship between the urban and rural areas, this paper offers a new perspective regarding the Rural–Urban Metabolism and its application in the Autonomous Province of Trento is discussed. The methodological approach consists of four main steps: data collection and management to support strategic territorial/urban plans; data assessment to critically evaluate the existing context; data mapping to visualize the data and territorial dynamics; and finally, the definition of the strategic and integrated development plan and actions. The Rural–Urban Metabolism proved to be a strategic approach for urban planning and design to monitor the flow of it, assess the impacts of it and promote more sustainable and circular urban policies.

A novel stream of collaborative National portals to enhance preparedness and informed choices

Abstract Issue/problem AGENAS supports the implementation of health policies in direct collaboration with Italian Regions and Autonomous Provinces. To improve public reporting, we aimed to complement the production of technical reports with new forms of timely communication, using National Portals. Description of the problem Between October-December 2020, we designed and implemented the Covid-19 National Portal, including a suite of targeted indicators, fully automated via ad hoc scripts written in php and R on top of a relational database using internal and external data sources. Targeted information was widely communicated and continuously updated. Dedicated sections on forecasting and resilience were delivered in collaboration with specialised academic institutions. In 2021, we deployed the Portal for the Transparency of Health Services, broadly oriented towards health issues, the location of services and performance indicators. Results Pre-post comparisons of web analytics for Jan-Apr 2020-2022 showed clear advantages of Covid-19 Portal. By Apr 2020, Italy had introduced national lockdown, while AGENAS covered the topic traditionally, recording 48,122 users overall, with daily peaks below 5,000 sessions. In 2021-2022, the number of users skyrocketed at 436,280, with daily peaks of 100,000 sessions, and 421,123 respectively, with daily peaks of 150,000 sessions. Visits to the Transparency Portal were considerably more limited. Lessons To be widely used, public health information needs to be relevant (responding to personal need close to home), understandable, accurate and timely. National Portals can gain efficiency through the mediation of search engines, enhanced by: targeted naming (url), coherent semantic perimeter (third level domain in a highly referenced institutional website), continuous updating, and impact factor (linked by authoritative websites). The Transparency Portal will take stock of these lessons to succeed in a new funded program of NextGenerationEU. Key messages • Relevant, understandable, accurate and timely dissemination for different types of audience may be effectively organised through National Portals. • Productive collaboration between health specialists and communication experts can enhance usability and actionability of National Portals for public health.

A novel plot for the early alert of epidemic growth using regional targets: the doubling plot

Abstract Background During the pandemic, restrictions set by the Italian Government were primarily based on the regional level of key parameters including hospitalization and incidence rates. We aimed to build a specific plot to monitor trends and trigger early alerts, with daily updates publicly available on a National Portal. Methods A multidisciplinary team conceived and implemented a new composite plot, developing ad hoc R scripts on top of a specialised database, built in collaboration with the Ministry of Health. We calculated the doubling time Td as log(2)/log(1+r/100), where r is the daily change of target parameters and Td ranges between (0,+-infinity), and not determined for constant or missing values. We calculated Td daily, as either doubling (growth) or halving (decrease) time. To visualize trends, we assembled two different types of graphs: a bivariate plot showing the path of each point (Td, target parameter) over time, and a line plot of Td over time. The Y axis was inverted for doubling times, as lower Td indicate higher alert in this case. The two graphs were arranged in lines, using cutoffs for excessive high values for doubling times and low values for halving times. A third line was included to display trends of the target parameter over time. Results The plot was successfully realized and published on the Portal for all regions in February 2021 (https://www.agenas.gov.it/covid19/web/index.php?r=english%2Fdoubling&amp;q=ITA&amp;t=0). Since July 2021, we used the doubling plot to monitor the three main parameters adopted to set restrictions for Covid-19: a) occupancy rates in intensive care; b) occupancy rates in medical wards; c) weekly incidence rates. The plot highlighted growth trends and early alerts, particularly in the initial phases of growth. Conclusions The doubling plot can provide useful information to trigger early responses for pandemic control in decentralised governance. R code is available open source from AGENAS for free use. Key messages • The doubling plot was conceived and implemented on a National Portal to trigger early alerts of Covid-19 progression in Italian Regions and Autonomous Provinces. • The plot could be rapidly adapted to legislative parameters and can be useful in different situations to monitor epidemic growth and support public health policies.

The community pharmacy model for colorectal cancer screening: policy insights from Italy

Abstract Background Despite its effectiveness, compliance to colorectal cancer (CRC) screening remains low. Different strategies to improve the adherence were identified, such as the involvement of new stakeholders as the community pharmacists. In Italy a recent national project fuelled the development of this strategy, scaling-up the collaboration between screening programmes and pharmacies formerly at the local level up to the national level. Methods The regional representatives of the CRC screening programmes provided to the National Screening Monitoring Centre the agreements arranged between the Regions/Autonomous provinces and their respective pharmacy owners representatives. The agreement decrees were analysed describing the fecal occult blood test pathway (e.g. kit supply and delivery) and supplementary activities provided by the pharmacies together with the CRC screening kit delivery, such as health promotion ones. Results Information was received from 18 Regions and Autonomous provinces (86% of the total). Regarding the economic compensation, the amount of money paid for each kit varies a lot, with a range from 0 to 18 EUR. The number of process phases covered by the agreements ranged from a maximum of 16 (out of 18) to a minimum of 0. The processes that were included most often were the supply of the kit, the delivery of the kit, and education/awareness of CRC screening (68.8%), followed by sample transfer to the laboratory, test tube tracing and counselling (62.5%). Among the processes less covered there were the warehouse management and awareness of other healthcare initiatives (12.5%), and only in one case a supplementary agreement on delivery of preparation for intestinal cleansing was included. Conclusions The arrangements between pharmacies and CRC screening programmes in Italy are very diverse and unique model is missing. Collaboration between programs and pharmacies is promising and quality standards of the service should be set at international level. Key messages

Dying Dreams in Tajikistan’s Global Borderland

Twenty-five years since the end of Tajikistan’s civil war in 1997, dreams and aspirations of international development and cross-border mobility in the country’s Gorno-Badakhshan Autonomous Province, colloquially called “the Pamirs,” have evaporated. Once the mountainous region was envisaged to have a prosperous postwar future ahead of it, with emerging trade links to China and Afghanistan, substantial funding from international nongovernmental organizations, and support from wealthy Muslim institutions. Today, as the Tajik government mounts a violent campaign to eradicate opposition, people in the Pamirs are surrounded by closed international borders and an ever-shrinking space in which to participate in Tajikistan’s politics and economy.