Health Protection Research Articles

Как обеспечить приоритет профилактических мероприятий в системе государственного контроля качества и безопасности медицинской деятельности: предложения.

In the article, based on the analysis of legislation, the authors formulated a number of proposals, the implementation of which will ensure the priority of preventive measures in the system of state control of the quality and safety of medical activities. It is noted that the priority of a preventive visit, as one of the most important preventive measures, in relation to control (supervision) measures, provided for by the Law on State Control No. 248-FZ, is primarily determined by the quality of the content of the preventive visit. The content of the preventive visit should allow the inspector of the supervisory authority in the field of health protection to identify during the preventive conversation the level of awareness of the controlled person about the mandatory requirements that this person is obliged to comply with. The step-by-step algorithm for carrying out a preventive visit in terms of monitoring the safety of medical devices presented in the article allows the inspector of the supervisory authority in the field of health protection to promptly and reliably obtain information about the level of awareness or lack of awareness of the supervised person about the established mandatory requirements for the activities carried out, and accordingly about their compliance or non-compliance by the supervised person.

Un/met: a mixed-methods study on primary healthcare needs of the poorest population in Khyber Pakhtunkhwa province, Pakistan

BackgroundAccess of all people to the healthcare they need, without financial hardship is the goal of Universal Health Coverage (UHC). As UHC initiatives expand, assessing the needs of vulnerable populations can reveal gaps in the system which may be covered by relevant policies. In this study we (i) identify the met and unmet primary healthcare needs of the poorest population of Khyber Pakhtunkhwa province (KP), Pakistan, and (ii) explore why the gaps exist.MethodsWe used Leveque’s Framework of Patient-centred Access to Healthcare to examine unmet primary healthcare (PHC) needs and their underlying causes for the poorest population in four districts of Khyber Pakhtunkhwa province, Pakistan. Using a triangulation mixed methods design, we analysed data from a quantitative household survey of744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers.ResultsOur results show that indicate that despite service utilization, PHC needs were not met, primarily due to prohibitively high costs at each stage of access. Furthermore, gaps in outreach and information (approachability), and varying availability of medicines and diagnostics at facilities (appropriateness) the supply side as well as difficulties in navigating the system (inability to perceive) and adhering to prescriptions (inability to engage) on the demand side, also led to unmet PHC needs. Going beyond utilization, our findings highlight that engagement with care is an important determinant of met needs for vulnerable populations.ConclusionSocial health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations.

The impact of wastewater treatment plants on the composition and toxicity of pollutants in urban rivers in Nanjing, China

Widespread wastewater pollution is one of the biggest challenges threatening the ecological health of rivers. It is crucial to identify the toxic changes of effluents after entering urban rivers as well as the toxic substances in the complex chemical mixtures found in these urban rivers. This study used HepG2 cell line for cytotoxicity test to evaluate the ecological impact of effluents on urban rivers. Water samples were collected from the Xingwu River and Yunliang River in Nanjing, China. The bacterial communities in the lower reaches of urban rivers were altered due to the differences in total nitrogen and nitrate nitrogen. The complex chemical mixtures collected in the urban rivers were divided into 10 fractions, >100 chemicals were screened in each fraction. The substances with LC50 < 1000 mg/L were listed as toxic substances, and the number of toxic substances dominated the toxicity of urban rivers. Our study highlights toxicity as a comprehensive indicator for assessing river pollutants and reveals relationship between the number of toxic substance and river toxicity. These findings have direct implications for the monitoring and management of environmental stressors and the protection of aquatic organisms and human health.

Candidate-Probiotic Lactobacilli and Their Postbiotics as Health-Benefit Promoters.

Lactobacillus species are widely recognized for their probiotic potential, focusing on their mechanisms of health benefits and protection. Here we conducted an in vitro investigation of the probiotic potential with a role in microbiome homeostasis of four strains: Lactiplantibacillus plantarum L6 and F53, Ligilactobacillus salivarius 1, and Lactobacillus helveticus 611. A broad spectrum of antibacterial and antifungal activity was determined. The strain-specific inhibition of Staphylococcus aureus, Streptococcus mutans, Escherichia coli, Pseudomonas aeruginosa, and saprophytic/toxigenic fungi makes them promising as protective cultures. DPPH (2,2-diphenyl-1-picrylhydrazyl) and ABTS (2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic) acid) measurements showed that tested samples had strain-specific capacity for scavenging of radicals. The molecular base for the antioxidant potential of two lyophilized forms of active strains was investigated by electron paramagnetic resonance spectroscopy. The MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, with fractions of the most active postbiotics obtained by SEC-FPLC (fast protein liquid chromatography) analysis, showed a wide variety of effects on the growth of a K562 myeloid leukemia cell line. The IC50 (half-maximal inhibitory concentration) of L. salivarius 1 was determined to be 46.15 mg/mL. The proven in vitro functionality of the selected lactobacilli make them suitable for development of target probiotics with specific beneficial effects expected in vivo. Further investigations on produced postbiotics and safety have to be completed before they can be considered as scientifically proven probiotic strains.

TÉCNICAS CIRÚRGICAS PARA ESTÉTICA GENGIVAL E PERFIL EMERGENTE EM IMPLANTODONTIA

Introduction: Implant dentistry seeks to improve the similarity of implants with natural teeth, focusing on soft tissue quality, authentic gingival shape and adequate crown. The emergence profile plays a vital role in implant esthetics, guiding the soft tissues and preventing food accumulation. Direct and indirect techniques manipulate tissue to create the emergence profile using grafts and temporary abutments. Connective grafts and PRF are options to improve the gingival phenotype, with standard CTG and PRF promising to treat peri-implant diseases. Choosing the right techniques is crucial to restoring the patient’s anatomical profile. This study explores the main surgical techniques for gingival aesthetics and the emerging profile in implant dentistry. Objectives: To address the main surgical techniques for gingival aesthetics and the emerging profile in implant dentistry. Results: 27 articles were obtained, 2 (by duplicity), 20 (by abstract) and 1 (by not meeting the eligibility criteria) were excluded. Finally, 4 articles were included in this review. Discussion: the appropriate surgical technique promotes an adequate emergency aesthetic profile that reduces the time of the clinical procedure and obtains the best osseointegration associated with a peri-implant tissue, stable, healthy, with ideal and safe extensions. Thus achieving longevity in protection and gingival health. Conclusion: The choice of surgical technique depends on the individual characteristics of each patient, and the anatomical and aesthetic aspects of the patient must be considered in order to create an emerging profile that is aesthetically healthy and functionally healthy.

Impact of Kitchen Natural Gas Use on Indoor NO2 Levels and Human Health: A Case Study in Two European Cities

Natural gas (NG) is commonly used in kitchens, powering stoves, ovens, and other appliances. While it is known for its efficiency and convenience, NG contributes to the release of nitrogen dioxide (NO2) and can have significant implications for human health. In this study, the importance of the use of NG in kitchens on human exposure to NO2 was analyzed. An extensive literature review in the field was conducted, and the NO2 levels were assessed in kitchens with NG cookers in Aveiro and electric cookers in Porto, both in Portugal. Higher levels of NO2 were found in kitchens in Aveiro, where NO2 levels outdoors are lower than in Porto. This pollutant can spread to other rooms, especially when ventilation is lacking, which is particularly concerning during colder seasons and at night. As around 70% of the time is spent at home, this can have a significant impact on human exposure to NO2. Therefore, although Aveiro has low levels of NO2 outdoors, its population may be exposed to much higher levels of this pollutant than the Porto population, a city with air quality issues, but predominantly using electric cookers. This finding emphasizes the need for the stricter regulation of NG use indoors to protect human health and also suggests a shift in human health protection policies from mere monitoring/control of outdoor air quality to a comprehensive assessment of human exposure, including exposure to indoor air quality.

Ergonomic optimization in forestry harvesting: analysis of indicators and workstation layout for machine operators

The planted tree sector in Brazil plays a significant role in the national economy, driven by technological advancements in forestry machines, especially in harvesting. The interaction between operators and machines has become essential for improving performance and ensuring occupational health. This study analyzed forest harvesting machine operators, focusing on anthropometric surveys and proposing indicators for ergonomic satisfaction and cabin layout. Conducted between May 2022 and July 2023 in a northeastern Brazilian forestry company, data were collected during mechanized harvesting of a six-year-old Eucalyptus spp. stand using the cut-to-length system. A questionnaire was applied to 111 employees to assess their ergonomic satisfaction and health. Two indices were created: the Ergonomic Satisfaction Coefficient and the Occupational Health Coefficient. The anthropometric analysis evaluated operators’ percentiles and BMI, revealing that 77.77% were overweight, highlighting the need for health protection measures. The ergonomic indices proved effective in assessing operator satisfaction. The study also determined an adequate workstation layout for the sample group. From the Ergonomic Work Analysis perspective, FW2 and HV3 machines received a good rating based on the adopted parameters.

Notes from the Field: Support for Wastewater Monitoring and Influence on Protective Behavioral Intentions Among Adults - United States, July 2024.

In 2020, during the COVID-19 pandemic, CDC established the National Wastewater Surveillance System and later expanded it to include mpox and influenza A data dashboards.† Wastewater utility partners have cited community health benefits as a motivating factor for participating in wastewater surveillance; a lack of public support for wastewater surveillance activities might lead utility partners to cease participation (1,2). However, little is known about public support for wastewater monitoring and its influence on protective health behaviors. As innovative surveillance strategies such as wastewater surveillance evolve, ethical considerations, including understanding public perceptions regarding support for these activities and potential risks to communities, are essential (3).

Estimated prevalence of obstructive sleep apnea by occupation and industry in England: a descriptive study.

Obstructive sleep apnea (OSA) can induce excessive sleepiness, causing work-related injuries and low productivity. Most individuals with OSA in the United Kingdom are undiagnosed, and thus, theoretically, workplace screening, might by identifying these individuals improve both their individual health and overall productivity. However, the prevalence of OSA in different workplaces is unclear. This study aimed to estimate the prevalence of OSA by industries and occupations in England. The Health Survey for England 2019 dataset was combined with Sleep Heart Health Study dataset. We applied multiple imputation for the combined dataset to estimate OSA in the English population aged 40-64. We estimated the pooled prevalence of OSA by both industry and occupation by separating samples by Standard Industry Classification and Standard Occupation Classification. The overall OSA prevalence estimated by imputation for ages 40-64 was 17.8% (95% CI=15.9% to 19.9%). Separating those samples into industrial/occupational groups, the estimated prevalence of OSA varied widely by industry/occupation. Descriptive analysis revealed that the estimated prevalence of OSA was relatively higher in the Accommodation and food, Public administration and defence; compulsory social security, Construction industries, and Protective service occupations, health and social care associate professionals, and skilled construction and building trades occupations. In England in 2019, Accommodation and food, Public administration and defence; compulsory social security, Construction industries, and Protective service occupations, health and social care associate professionals, and skilled construction and building trades occupations showed a relatively higher prevalence of OSA indicating that they may be target populations for workplace screening.

Uncovering the coronavirus outbreak: present understanding and future research paths.

The review discusses the pathophysiological mechanisms of SARS-CoV-2, the modes of transmission, and the long-term health consequences of COVID-19, emphasizing the importance of research and successful public health initiatives. COVID-19 taxonomy, pathophysiology, symptomatology, and epidemiological importance are the key objects of this research paper. This review explains how COVID-19 affects different systems of the body, including respiratory, cardiovascular, and reproductive systems of the human body. It describes the modes of entry of the virus into the cell; more precisely, ACE2 and TMPRSS2 in viral entry. In addition, the present study analyzes the situation of COVID-19 in India regarding vaccine development and the transmission rate related to socioeconomic factors. The manifestation of COVID-19 presents a lot of symptoms and post-acute problems, issues which are seriously impacting mental health and physical health as well. The present review summarizes current research into pathogenicity and the mode of virus transmission, together with immunological responses. Coupled with strong vaccination programs, public health initiatives should hold the key to fighting this pandemic. Long-term effects and the development of treatment methods will need further study, as ambiguities on COVID-19 remain. Multidisciplinary collaboration across healthcare sectors in this respect is of paramount importance for the prevention of further spread and protection of public health.

A parenting program delivered through existing community-based peer groups to improve early child development in Homabay and Busia Counties, Kenya: study protocol for a cluster-randomized controlled trial

BackgroundPoor early childhood development (ECD) is a major global health concern that is associated with various adverse outcomes over the lifecourse. Parenting interventions especially during the earliest years of life can benefit ECD. However, there is limited evidence from Kenya about the effectiveness of parenting interventions for improving ECD outcomes especially across rural disadvantaged communities. This paper describes the study protocol for an impact and implementation evaluation of a community-based group parenting program that aims to improve ECD in rural Kenya.MethodsWe will conduct a cluster-randomized controlled trial to determine the effectiveness of a parenting program for caregivers of young children in Homabay and Busia counties in Western Kenya. Sixty-four village clusters will be randomly assigned to either the parenting intervention arm or the waitlist control arm with stratification by county. In each village, 10 primary caregivers with a child aged 0–24 months will be enrolled. The parenting program will be delivered through existing peer groups within communities whereby caregivers will receive counseling and psychosocial support to enhance their parenting skills and wellbeing to in turn promote ECD. The intervention curriculum comprises 21 sessions targeting various nurturing care messages, including early learning, responsive caregiving, child nutrition, health, protection, and caregiver mental health. Group sessions are facilitated by a trained volunteer biweekly for a total of 11 months. The primary trial outcome is an overall measure of ECD using the Global Scales of Early Development long form version. Secondary outcomes include various caregiver outcomes (e.g., parenting practices, mental health) and other child outcomes (e.g., socioemotional development, dietary diversity). All outcomes will be assessed at baseline and endline. We will also conduct a qualitative implementation evaluation at endline and interview various stakeholders to assess program fidelity, quality, and sustainability.DiscussionThis trial will evaluate the effectiveness of a parenting intervention on ECD and caregiving outcomes and assess program implementation quality as delivered through existing community-based peer groups. This study will provide rigorous evidence that can be used to inform scale-up of this program model that leverages existing community social networks and resources for improving caregivers’ parenting skills and promoting ECD in rural Kenya and other similar settings across LMICs.Trial registrationClinicalTrials.gov #NCT06165315. Registered on December 11, 2023.

Uranium extraction from wastewater by heteroatom-doped carbon microspheres derived from polyphosphazene loading with zinc oxide

The effective management of uranium-contaminated wastewater is crucial for environmental protection and public health safety. In this context, a novel composite was synthesized involving the intergration of zinc oxide into heteroatom-doped polyphosphazene carbon microspheres (TAC/ZnO) by hydrothermal method. The incorporation of ZnO into TAC significantly enhanced the porosity, offering more adsorption sites and improving the uranium adsorption performance. The optimal adsorption experiment achieved a remarkable adsorption capacity of 513.9 mg.g−1 for U(VI) at a pH of 5.5 within just 80 min. Additionally, the adsorption process was found to be endothermic and spontaneous, following both the Langmuir isothermal adsorption model and the pseudo-second-order kinetic model. Moreover, the TAC/ZnO presented higher selectivity for U(VI) in the presence of other cations. Even after 8 cycles, TAC/ZnO maintained a good removal rate for U(VI), decreasing from 97.54 % to 81.95 %. Furthermore, the findings from X-ray photoelectron spectroscopy (XPS) and density functional theory (DFT) calculations indicated that the adsorption mechanism of U(VI) on TAC/ZnO may involve the coordinated interaction between oxygen atoms in Zn-O and nitrogen atoms in pyridinie-N-oxide with uranyl ions. Overall, this study presents an easily prepared, cost-effective, and highly efficient adsorbent that offers potential for large-scale production and practical application in purifying radioactive wastewater.

Heavy metal ions in polluted water removable by synthesising a new compounds for dithiocarbamate derivatives

Metal ion poisoning in water and industrial effluents threatens ecosystems and human health. The development of efficient metal ion removal technologies has garnered attention in recent years. This work synthesizes and characterizes dithiocarbamate complexes as metal ion scavengers. Used to make dithiocarbamate ligands. Different metal salts were added to carbon disulfide and the proper amines to initiate substitution reactions. The complexes were characterized using FTIR, UV-Vis, mass spectroscopy, 13C-, 1H-NMR, magnetic susceptibility, melting point, and electrical conductivity molar EC. Data from spectroscopy and analysis indicate the development of two-type macrocyclic complexes with the formula [M(L)]2, where M = FeII, CoII, and ZnII ions. Tetrahedral geometries around the metal core and the second general formula [M(L)(H2O)2]2, where M = MnII, NiII, CuII, suggested octahedral structures. Heavy water pollution has been removed using this essential ligand. Metal ion scavenging of 96–98% was possible with the produced dithiocarbamate complexes. This work developed unique and efficient strategies for metal contamination removal from aquatic settings, promising environmental remediation and human health protection. Optimizing synthesis conditions and scaling up operations are needed to fully use these compounds in real-world applications. KEY WORDS: Dithiocarbamate ligand, Transition metal complexes, Spectral characterization, Coordination chemistry, Dithiocarbamate complexes, Scavenger heavy metal ions Bull. Chem. Soc. Ethiop. 2024, 38(6), 1583-1593. DOI: https://dx.doi.org/10.4314/bcse.v38i6.7

Trihalomethanes in chlorinated drinking water: Seasonal variations and health risk assessment in southern Iran

Assessing the adverse impacts of trihalomethanes, the most hazardous disinfection by-products, is crucial for community health protection. This study evaluated physicochemical parameters, trihalomethane levels, their prediction, and risk assessment using probability and Sobol analysis. Results indicated that electrical conductivity, total dissolved solids, nitrate, sulfate, calcium, lithium, total organic carbon, and ammonium exceeded permissible limits. Tribromomethane (0.14–3.21 μg/L in winter; 0.06–0.17 μg/L in summer), trichloromethane (1.90–3.53 μg/L in winter; 3.19–5.44 μg/L in summer), bromodichloromethane (0.62–4.24 μg/L in winter; 3.27–6.41 μg/L in summer), and dibromochloromethane (0.82–2.41 μg/L in winter; 0.69–3.03 μg/L in summer) remained within safe limits. Random Forest analysis identified total organic carbon as the most significant factor in trihalomethane production, with a positive correlation between trihalomethanes and bromide. Per the World Health Organization's risk assessment, trihalomethane concentrations posed no harm to residents (IWHO<1). However, the United States Environmental Protection Agency's assessment indicated an acceptable low cancer risk (100% cumulative cancer risk for all groups). Additionally, nitrate and fluoride levels surpassed the standard limit, with hazard index above 1 in both seasons for residents. Monte Carlo simulations showed that the 95th percentile of residents faced non-carcinogenic (nitrate and fluoride). However, 100% of children and 99.98% of adults were exposed to an acceptable low carcinogenic risk for THMs. Factors like inhalation rate, body weight, and trihalomethane levels significantly impacted health risk. These findings highlight the necessity for continuous monitoring and effective water treatment to safeguard public health, promote clean water, and advance sustainable development, advocating for sustainable water management to tackle health risks from environmental pollutants like disinfection by-products.

Risk Perception, Cooperation, and Emotional Distress During the COVID-19 Pandemic: Exploring Adaptive Risk Perception

During the COVID-19 pandemic, while risk perception may promote public cooperation with pandemic prevention, it may also increase emotional distress and thus endanger mental health. This study aimed to examine whether there is an adaptive risk perception pattern that fits both needs of pandemic control and mental health protection. Two waves of Chinese participants (N sample 1 = 1633, N sample 2 = 1899) completed the Scale of Pandemic Risk Perception, the Scale of Public Cooperation with Pandemic Prevention, the Epidemic Worry Scale, and the Positive and Negative Affective Schedule during Feb 3rd to 5th, and during Feb 18th to 20th, 2021 respectively. Four risk perception profiles were identified by using latent profile analysis based on pandemic risk perception. Regression mixture models found that individuals in the perceived-controllable-high-perceived-risk profile were the most cooperative and reported the least worries and negative affect. The perceived-uncontrollable-high-perceived-risk profile demonstrated high cooperation but serious worry and negative affect. Individuals in the ignoring-risk profile reported the least levels of cooperation and worry but the highest levels of negative affect. Finally, the perceived-moderate-perceived-risk profile reported moderate levels of both cooperation and emotional distress. These results were well repeated in two samples. Present findings point towards an adaptive risk perception pattern (the controllable-high-perceived-risk profile) which may optimize cooperation while also avoid serious emotional distress.

Gig Workers: A Paradigm Shift in the Indian Workforce—A Bibliometric Analysis and Future Directions

Gig workers across India seem to be looming large. Though it is in its infancy stage, it has led to millions of jobs being created for workers. It can penetrate Indian urban towns and cities, connecting workers with consumers and clients. Currently, the gig-platform economy is aiming to unfold a paradigm shift. The gig-workers number is on the rise, but its nature happens to be temporary. Technology advancement linked to Industry 4.0, the global financial crisis of 2007–2009, and the Coronavirus-2019 abnormal emergency have led the gig economy to grow faster. The workforce is currently about 8 million in 2020–2021, found in India being employed, which which eventually increase. A bibliometric analysis is adopted in this study. Out of 247 documents retrieved, ranging from 2009 to 2022, 242 papers from Scopus were considered. Data visualization and quantitative analysis were done using VOSviewer and RStudio. Top cited countries, research contribution of countries, authors impact, most global cited documents, and journal impact are the analyses carried out using RStudio. Apart from this quantitative analysis, the findings of 11 articles were synthesized and tabulated. The overlay visualization of keywords revealed that a shift is taking place from digital platforms like information systems, information use, gamification, and crowdsourcing to COVID-19, workers, psychology, and human experiments. The keywords like “Employment”, “Workers”, “Human”, “Gig Economy”, and “HRM” have the highest frequency in the “word cloud”. Thus, human aspects like recognition, rewards, and health protections ought to be given importance for the work they are doing.

"Health is Just the Basic Requirement for Optimal Performance and Winning": Stakeholders' Perceptions on Testing and Training in Competitive Alpine Skiing, Snowboarding and Freestyle Skiing.

Competitive alpine skiing, snowboarding and freestyle skiing, all different in nature and risks, are known for their high injury and illness burden. Testing measures and training methods may be considered for athletes' preparation to support performance enhancement while safeguarding their health. We explored the perspectives and perceptions of competitive alpine skiing, snowboarding and freestyle skiing stakeholders regarding testing and training practices in their competitive snow sports. We conducted an exploratory qualitative study based on grounded theory principles through 13 semi-structured interviews about testing and training practices with athletes, on-snow and off-snow coaches, managers and healthcare providers from different national teams. The interviews were inductively analysed through a constant comparative data analysis. Participants described winning as the end goal of testing and training practices, which requires athletes to perform in their best condition. To do so, they mentioned two main targets: performance enhancement and health protection. Participants acknowledged health as a premise to perform optimally, considering testing and monitoring approaches, goal setting, and training to support and protect athlete performance. This continuous cyclic process is driven by communication and shared decision making among all stakeholders, using testing and monitoring outputs to inform goal setting, training (e.g. on-snow and off-snow) and injury prevention. Such an approach helps athletes achieve their goal of winning while being fit and healthy throughout their short-term and long-term athletic career development. The ultimate goal of testing measures and training methods in such competitive snow sports is winning. Performance enhancement and health protection act as pillars in systematic, tailored and flexible processes to guarantee athletes' best preparation to perform. Moreover, athletes' assessments, goal setting, monitoring tools, open communication and shared decision making strongly guide this cyclic process.

Research progress of piezoelectric materials in protecting oral health and treating oral diseases: a mini-review.

Piezoelectric materials, as a class of materials capable of generating electrical charges under mechanical vibration, have special piezoelectric effects and have been widely applied in various disease treatment fields. People generate vibrations in the oral cavity during daily activities such as brushing teeth, using electric toothbrushes, chewing, and speaking. These natural vibrations (or external ultrasound) provide ideal conditions for activating piezoelectric materials, leading to their high potential applications in protecting oral health and treating oral diseases. Based on this, this review reports on the research progress and trends of piezoelectric materials in the protection of oral health and the treatment of oral diseases in the past 5years, and discusses its treatment mechanism, challenges and shortcomings, aiming to provide theoretical basis and new ideas for the future application of piezoelectric materials in the field of oral cavity. Finally, a brief outlook is provided, suggesting that the potential of piezoelectric materials may enable them to quickly move towards real clinical applications.

Informing policy with health labour market analysis to improve availability of family doctors in Tajikistan

BackgroundTajikistan has embarked on health reforms to orient the health system towards primary health care (PHC). The health labour market analysis (HLMA) was initiated by the Ministry of Health with the World Health Organization (WHO) on policy questions related to the PHC workforce team. This article presents the results with focus on family doctors as a critical part of the PHC team, providing lessons for strengthening family medicine and PHC in the European Region and central Asia.MethodsThe HLMA framework was used to guide the analysis. The data for analysis were provided by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Descriptive means were used to analyse the data. A Technical Working Group guided the process.ResultsThere has been an increase in the number of health workers in the country over the last 7 years. However, there is a huge shortage of family doctors when compared with norms, with decreasing family doctor densities over the last 7 years. Family doctors have the highest vacancy rates among specialists and also constitute the highest proportion of specialists who migrate. There is inequitable distribution of doctors across the regions. Overall number of enrolments and graduates in family medicine are declining. Although salaries in PHC are higher than in hospitals, the overall health workforce salaries are lower than the national average. While there have been efforts to retain and attract doctors to PHC in rural and remote regions, challenges exist. The attraction of doctors to narrow specialties may be leading to undermining PHC and family medicine. While the optimal skill-mix and availability of nurses provide an opportunity to strengthen multi-disciplinary teams at the PHC level, shortages and unequal distribution of doctors are affecting health services coverage and health indicators.ConclusionsApplication of the HLMA framework has helped identify the bottlenecks in the health labour market flows and the possible explanations for them. The policy considerations emerging out of the HLMA have contributed to improving evidence-based planning for retention and recruitment of the PHC workforce, improvements in medical and nursing education, and higher investments in the PHC workforce and particularly in family doctors. Implementation of the Action Plan will require political commitment, financial resources, strong inter-sectoral collaboration, stakeholder management, and cross-country learning of best practices. Through this process, Tajikistan has shown the way forward in implementing the Central Roadmap for health and well-being in Central Asia and the Framework for Action on the Health and Care Workforce in the WHO European Region.

High-throughput single-cell sequencing of activated sludge microbiome

Wastewater treatment plants (WWTPs) represent one of biotechnology's largest and most critical applications, playing a pivotal role in environmental protection and public health. In WWTPs, activated sludge (AS) plays a major role in removing contaminants and pathogens from wastewater. While metagenomics has advanced our understanding of microbial communities, it still faces challenges in revealing the genomic heterogeneity of cells, uncovering the microbial dark matter, and establishing precise links between genetic elements and their host cells as a bulk method. These issues could be largely resolved by single-cell sequencing, which can offer unprecedented resolution to show the unique genetic information. Here we show the high-throughput single-cell sequencing to the AS microbiome. The single-amplified genomes (SAGs) of 15,110 individual cells were clustered into 2,454 SAG bins. We find that 27.5% of the genomes in the AS microbial community represent potential novel species, highlighting the presence of microbial dark matter. Furthermore, we identified 1,137 antibiotic resistance genes (ARGs), 10,450 plasmid fragments, and 1,343 phage contigs, with shared plasmid and phage groups broadly distributed among hosts, indicating a high frequency of horizontal gene transfer (HGT) within the AS microbiome. Complementary analysis using 1,529 metagenome-assembled genomes from the AS samples allowed for the taxonomic classification of 98 SAG bins, which were previously unclassified. Our study establishes the feasibility of single-cell sequencing in characterizing the AS microbiome, providing novel insights into its ecological dynamics, and deepening our understanding of HGT processes, particularly those involving ARGs. Additionally, this valuable tool could monitor the distribution, spread, and pathogenic hosts of ARGs both within AS environments and between AS and other environments, which will ultimately contribute to developing a health risk evaluation system for diverse environments within a One Health framework.