Priority Public Health Problem Research Articles

Aberrant microbiomes are associated with increased antibiotic resistance gene load in hybrid mice.

Antibiotic resistance is a priority public health problem resulting from eco-evolutionary dynamics within microbial communities and their interaction at a mammalian host interface or geographical scale. The links between mammalian host genetics, bacterial gut community, and antimicrobial resistance gene (ARG) content must be better understood in natural populations inhabiting heterogeneous environments. Hybridization, the interbreeding of genetically divergent populations, influences different components of the gut microbial communities. However, its impact on bacterial traits such as antibiotic resistance is unknown. Here, we present that hybridization might shape bacterial communities and ARG occurrence. We used amplicon sequencing to study the gut microbiome and to predict ARG composition in natural populations of house mice (Mus musculus). We compared gastrointestinal bacterial and ARG diversity, composition, and abundance across a gradient of pure and hybrid genotypes in the European House Mouse Hybrid Zone. We observed an increased overall predicted richness of ARG in hybrid mice. We found bacteria-ARG interactions by their co-abundance and detected phenotypes of extreme abundances in hybrid mice at the level of specific bacterial taxa and ARGs, mainly multidrug resistance genes. Our work suggests that mammalian host genetic variation impacts the gut microbiome and chromosomal ARGs. However, it raises further questions on how the mammalian host genetics impact ARGs via microbiome dynamics or environmental covariates.

Hyperglycemia and elevated C-reactive protein are independent predictors of hospital mortality in hospitalized COVID-19 patients in South-Kivu, eastern Democratic Republic of the Congo: A cross-sectional study.

The coronavirus disease 2019 (COVID-19) pandemic was a priority public health problem because of its high mortality rate. This study mainly aimed to determine factors associated with a poor outcome in COVID-19 hospitalized patients in South-Kivu, an eastern province of the Democratic Republic of the Congo (DRC). This observational study retrospectively evaluated medical records of patients consecutively admitted for probable or confirmed COVID-19 between May 01 and July 31, 2020 at the Hôpital Provincial Général de Référence de Bukavu (HPGRB), a tertiary hospital located in South-Kivu. A binary logistic regression model was performed to determine the predictors of mortality. A total of 157 hospitalized COVID-19 patients aged 57.7 (13.2) years were included in this study. Male gender (69.4%), older age (52.9%), medical history of diabetes (38.2%), and arterial hypertension (35.1%) were the most frequent risk factors. Most patients presented with fever (73.3%), cough (72.6%), and dyspnea (66.2%). Overall, 45.1% of patients died. Intrahospital mortality was significantly associated with advanced age [odds ratio, OR (95% confidence interval, CI) = 2.34 (1.06-5.38)], hypoxemia [OR (95% CI) = 4.67 (2.02-10.77)], hyperglycemia [OR (95% CI) = 2.14 (1.06-4.31)], kidney failure [OR (95% CI) = 2.82 (1.4-5.68)], hyperleukocytosis [OR (95% CI) = 3.33 (1.67-6.66)], and higher C-reactive protein (CRP) levels [OR (95% CI) = 3.93 (1.93-8.01)]. After adjustment for various covariates, only higher CRP levels [OR (95% CI) = 3.23 (1.23-8.5)] and hyperglycemia [OR (95% CI) = 2.5 (1.02-6.11)] at admission were independently associated with mortality. Hyperglycemia and marked inflammatory syndrome were the major predictors of poor outcomes in patients hospitalized for COVID-19 in South-Kivu. These two factors should be quantified at hospital admission to establish the patient's prognosis.

Revisiting the work-suicide link: renewed evidence and models of analysis in workplace contexts

Suicide is a priority public health problem for the World Health Organization. It is a multifactorial phenomenon, for which there is no effective strategy for prevention and reduction. The scientific knowledge generated has not paid much attention to the differentiating role of work and employment on the phenomenon of suicide. This article first presents Abrutyn’s recent conceptual model of suicide, which has a psychosocial, holistic and integrated approach. Based on this model, it examines the most recent and solid evidence and trends linking working conditions and phenomenon of suicide, identifying the most relevant findings in work stress theories. It concludes by pointing out avenues of development for a more holistic and ecological understanding of suicide.

Determinants of precancerous cervical lesion among HIV infected women on ART in Woldia comprehensive specialized hospital NorthEast Ethiopia

BackgroundPrecancerous cervical lesion is a priority public health problem that jeopardizes the life of enormous women. previous studies in Ethiopia were more focused on knowledge, attitude, and practices of Cervical cancer screening. studies on the risk factors of pre-cancerous cervical lesions among the risk population (HIV infected) relative to the general population were limited. This study aimed to identify the determinants of precancerous cervical lesions among HIV Infected Women in Woldia Comprehensive Specialized Hospital in Northeast Ethiopia, 2022.MethodsHospital-based unmatched case-control study was conducted in Woldia Comprehensive Specialized Hospital among HIV-infected women from June to August 2022. Data were collected from 104 cases and 208 controls using an interviewer-administered questionnaire and clinical data from the patient chart using Electronic Medical Record _ Anti-Retroviral Therapy Smart care database checklist. The binary logistic regression model was used to identify the determinants of the precancerous cervical lesion. An odds ratio with a 95% Confidence interval was used to measure the association and p-value < 0.05 were considered significant.ResultsWomen who have two or more lifetime sexual partners (AOR = 3.21,95% CI: 1.71–6.04), history of sexually transmitted infection (AOR = 4.97, 95% CI: 2.78–8.78), early age at first sexual intercourse (< 18 years) (AOR = 4.35,95% CI: 2.48–7.67) and baseline CD4 count < 200 cells/mm3 (AOR = 1.89, 95% CI: 1–3.57) had a higher odd of developing a precancerous cervical lesion.ConclusionThis study confirms that having a history of sexually transmitted infection, two or more lifetime sexual Partners, the initiation of sexual intercourse before the age of 18 years, and Baseline CD4 count < 200 cells/mm3 were determinants for precancerous cervical lesions. So it should be focused on prevention through early detection and treatment of sexually transmitted infections.

The 3'UTR VNTR SLC6A3 Genetic Variant and Major Depressive Disorder: A Systematic Review.

Major Depressive Disorder (MDD) is a disabling and particularly persistent mental disorder that is considered to be a priority public health problem. The active human dopamine transporter (DAT), which is encoded by the SLC6A3 gene, regulates the dopamine concentration in the synaptic cleft. In this sense, this neurotransmitter is primordial in modulating human emotions. This systematic review aims to verify the SLC6A3 (DAT1) 3'UTR VNTR (rs28363170) gene variant's SS (9R/9R) genotype and S (9R) allele frequency fluctuation and its influence on the modulation of pharmacotherapy in MDD. For this purpose, we searched different databases, and after applying the eligibility criteria, six articles were selected. Studies have shown an association between the SS (9R/9R) genotypic and S (9R) allelic presence with the risk of developing MDD, in addition to influencing the decrease in response to antidepressant therapy. However, despite the findings, disagreements were observed between other studies. For this reason, further studies with the SLC6A3 3'UTR VNTR (rs28363170) variant in different populations are necessary to understand this polymorphism's role in the onset of this disease.

Epidemiological and Clinical Aspects of Severe Acute Malnutrition in Children Aged 0 to 59 Months Hospitalized at the Reference Health Center of the Commune I of Bamako (Mali)

Severe acute malnutrition (SAM) is characterized by a weight/height (W/T) ratio below -3Zscore and/or nutritional edema and/or arm circumference (MUAC) below 115 mm. This is a priority public health problem in Mali, because the nutritional situation remains very worrying for years. During our study period, 159 children suffering from severe acute malnutrition (SAM) with medical complications were hospitalized in the pediatric department. Materials and method: This is a prospective and descriptive study of children aged 0 to 59 months hospitalized for severe acute malnutrition with medical complications at the pediatrics department of the commune I from June 1, 2018 to May 31, 2019. All children from 0 to 59 months hospitalized in pediatrics during the study period and having parameters in favor of SAM were included. Results: We have a hospital prevalence of 14.7%. The average age of the children was 18 months with extremes of 3 to 59 months. Children aged 12-24 months were in the majority 55% and children under 12 months accounted for 40%. Most of the children were male with a sex ratio of 1.17. The majority of children (61.6%) came from the health district of the commune I. The frequency of admissions was higher in July and August (15.7% and 19.5%). The reasons for consultation were: anorexia (lack of appetite) 32.7%, diarrhea 26.4%, cough 9.4%, edema 8.2%, fever 7.6%, vomiting 7.6%, weight loss 5%. Marasmus was the most noticed form of malnutrition with 83.6%. The average length of hospitalization was 8 days with extremes of 3 to 17 days. Lethality reached 6.9%. The state of shock was the most marked factor of death 54.5%, cases of false route (food inhalation) 27.3% and respiratory distress 18.2%.

Quality Mindset: The Missing Ingredient in Tuberculosis Care and Control in Togo

Quality has been mentioned as the missing ingredient in TB care and control. In Togo, TB is a priority public health problem. We hypothesize that "quality mindset" is the missing ingredient for excellence in TB care and control in Togo. We used statistical process control (SPC) tools to analyze cohort data from the National Tuberculosis Control Program. There was an unstable quarterly variation in smear-positive pulmonary TB (TBP+) treatment success rate from 2017 to 2022. The general trend since the first instability was a quarterly variation around a success rate of 86%. Results showed stability in the quarterly variation of TBP+ case fatality rate at 7% since 2017. The root cause analysis of the low performance of the program revealed that TB management and DOTS strategy standards were not well adhered to. Based on the Pareto chart prioritizing the most affected health systems building blocks, health services delivery and health workforce building blocks accounted for 70% of all the dysfunctions. This study revealed that quality mindset is the missing ingredient for TB control program to be a center of excellence in Togo. It is therefore timely for a national project to verify the real contribution of total quality care to TB program performance in Togo.

Gerakan Pencegahan Stunting melalui Peningkatan Pengetahuan Ibu dengan Metode Emotional Demonstration di Wilayah Kerja Puskesmas Mungo

Based on the analysis of the working area of the Mungo Health Center, namely Luak District, and 50 Kota District, it was found that there was a trend of increasing stunting cases every year. For this reason, stunting is a priority public health problem that must be resolved immediately. The cause of stunting is closely related to the lack of knowledge of mothers about parenting and balanced nutrition in children. One of the most effective efforts to increase mothers' knowledge is to provide education through the Emo-Demo counseling method (Emotional demonstration). Emo-Demo is a very participatory activity guide that aims to convey simple messages in a fun way. It is hoped that this activity will help increase mothers' knowledge, in an effort to prevent and reduce the prevalence of stunting in the working area of the Mungo Health Center. The target of counseling activities is mothers of toddlers with indications of stunting. Based on the results of the analysis (pre-test and post-test) there was an increase in mothers' knowledge and awareness regarding parenting and stunting prevention as indicated by an increase in the average knowledge before and after counseling. Thus this Emo-Demo activity is proven to be an innovative approach to educational communication because it can increase changes in mothers' knowledge related to parenting and balanced nutrition to toddlers.

Vitamin D2 versus vitamin D3 as a risk factor in compromised bone health

Background: Vitamin D plays an important role in the prevention of many diseases. More than 1 billion people worldwide suffer from vitamin D deficiency. Vitamin D deficiency can contribute to the development of 16 types of cancer (breast, colon, prostate, etc.), cardiovascular diseases, stroke, autoimmune diseases, periodontal pathologies, transplant failure in endo-alveolar surgery, etc. There are several risk factors that would prevent the achievement of treatment objectives. The national protocol for deficiency rickets prevention privileges vitamin D2 versus vitamin D3, which creates a medical risk factor compromising oral health in both children and adults. The article provides sufficient arguments in favour of vitamin D3 vs vitamin D2 prescription for prophylactic and treatment purposes. Conclusions: Considering that vitamin D deficiency is currently a global public health problem, it can be proposed to declare vitamin D deficit/deficiency a priority public health problem at the national level. Vitamin D3 should be elective in preventing deficit. Taking into account the multitude of acute and chronic diseases related to vitamin D deficiency, in order to improve the status of vitamin D in all population categories, it is necessary to include vitamin D3 in the list of molecules fully subsidized by the state and distributed free of charge at least to children under the age of 5 years and adolescents in the period of intensive growth.

Cross-mapping medical records to NANDA-I to identify nursing diagnoses in a vulnerable population.

To assess the association between vulnerable populations and nursing care needs, using NANDA-I diagnostics, in the population of the Canary Islands, Spain. Nursing social epidemiology study. Cross Mapping of Medical Records to NANDA-I to Identify Nursing Diagnoses in a Population usinga medical, epidemiological follow-up study of a cohort of 7,190 people. The level of vulnerability of the participants was assigned, among those who were also assigned nursing diagnoses, using the "ICE index" to calculate the expected associations. The most prevalent nursing diagnosis in our sample was Sedentary lifestyle (60.5%), followed by Ineffective health self-management (33.8%) and Risk-prone health behaviour (28.7%). Significant differences were found by sex, age group and social class, with the nursing diagnoses included in the study being more prevalent among the most socio-economically disadvantaged social class. The cross-mapping method is useful to generate diagnostic information in terms of care needs, using the NANDA-I classification. The expected associations between high social vulnerability and care needs have been verified in a comprehensive and representative sample of the Canarian population (Spain). From an epidemiological perspective, identifying nursing diagnoses at the population level allows us to find the most prevalent needs in the different community groups and to focus appropriate nursing interventions for their implementation and impact assessment.

Maternal and Child Health Implementation Research in Mozambique: Effective community interventions to promote sexual and reproductive health

Background: High maternal and neonatal mortality rates in Mozambique, are due to adolescent pregnancies, difficulties in accessing health services, traditional constraints, and gender inequalities. An implementation research project, Alert Community to Prepared Hospital in Natikiri, Nampula, Mozambique was developed to reduce maternal and newborn mortality. From 2016 to 2020, it implemented activities to improve population knowledge and function in sexual and reproductive health, and to enable community participation in maternal health services. In this paper, we assessed and discussed the impact of community participation on improving sexual and reproductive health. Methods: The “Alert Community to Prepared Hospital” was an implementation research program with community intervention and programmed mid-term evaluations. It used mixed methods research design such as descriptive quantitative surveys, qualitative focus group discussions, and interviews, applied from 2017 to 2020. Local health committees, traditional birth attendants, traditional healers, and local leaders all participated: trained in sexual and reproductive health and participated in radio discussion groups; community and hospital members of the co-management committee enabled local programming. Maternal and child health indicators were evaluated with the health unit’s statistical operational data. Quantitative data were captured in Microsoft Office Excel, analysed with SPSS21 to find the frequency, percentage, mean and standard deviation; qualitative data were registered in Microsoft Office Word and analysed with Nvivo software. This research received bioethical approvals from both the Mozambican and Canadian universities and followed all Helsinki Declaration recommendations. Results: Comparing changes from 2016 to 2019, the number of health committees operating in Natikiri rose from 7 to 20. Each committee integrated four Family Health Champions, who attained 24738 residents with health education interventions on reproductive health and rights. A theatre group developed dramas about the same key messages and presented the plays in local communities. Population access to contraceptives was facilitated, from 42% to 91% in women and from 65% to 90% in men. At Marrere Health Centre, women with four ante-natal visits rose by 185%, and children less than one year of age’ surveillance visits raised by 89%; at Marrere General Hospital’ maternity deliveries rose 60%. Conclusion: Community participation, at all levels of maternal and child health service care continuum, from families, health committees, and communities to health centres and hospitals, enhanced with complementary interventions well contextualized, sexual, and reproductive health and rights key messages broadcasted, discussed, and presented by local theatre groups, is effective in improving adolescent and adult sexual and reproductive health. Plain English summary An Alert Community to a Prepared Hospital Implementation Research Project was carried out in Natikiri, Nampula, Mozambique, from 2016 to 2020, aiming to reduce maternal and neonatal mortality rates, considered priority public health problem in this country. It deployed activities to improve population knowledge and behaviour in sexual and reproductive health and rights and enable community participation in maternal and newborn health services: classroom training, community radio discussion groups, and drama performances. Using mixed-methods research to evaluate results with local health committees, traditional birth attendants, traditional healers, and local leadership, we compared the evolution of maternal and child health indicators at health units. Comparing changes from 2016 to 2019, the number of local health committees rose, attaining 24738 residents with health education interventions, population access to contraceptives was facilitated, from 42% to 91% in women and from 65% to 90% in men, women with four antenatal visits rose by 185%, children less than one year of age’ surveillance visits rose by 89%; and hospitals’ maternity deliveries rose by 60%. Community participation in maternal and child health service care has been demonstrated to be effective in improving adolescent and adult sexual and reproductive health. Trial registration This maternal and child health study was approved by the Lúrio University Bioethics Committee (02/CBISUL/16) and the Behavioural Ethics Board at the University of Saskatchewan (BEH#15-112), and was not registered in any database. Keywords: Maternal and child health, community, family planning, health services, implementation research, Mozambique, participation, pregnancy, reproductive and sexual health.

PEMETAAN PERSEBARAN KASUS DEMAM BERDARAH DENGUE DI DESA WEDARIJAKSA, KECAMATAN WEDARIJAKSA, KABUPATEN PATI

DHF is a contagious disease that has become a priority public health problem in Indonesia. DHF is transmitted through female Aedes spp. Carrying the dengue virus in her body. There were 107 cases and one death in Pati Regency, the purpose of this study was to map the distribution of dengue cases and conduct a survey of Aedes spp larvae and determine the type of Aedes spp mosquito vector in the area of dengue cases that died in Wedarijaksa District. This study used a descriptive observational method with a cross sectional research design and was carried out in August - November 2020. The samples of this study were all dengue fever incidence houses in Wedarijaksa Village and houses potentially affected by dengue. From the results obtained, cases have a group pattern and the average larvae are found in the bathtub in the residents' houses. The risk of transmission in Wedarijaksa Village is classified as moderate because DF&gt; 1 (DF = 3,3), HI&gt; 1, BI &lt;50%. All of the mosquito larvae found were Aedes aegypti.

Linking to and addressing the determinants of health: a review of the Innovation Strategy experience.

This review focuses on the work of the Equipping Canadians: Mental Health throughout Life and Achieving Healthier Weights in Canada's Communities projects funded under the Public Health Agency of Canada Innovation Strategy (PHAC-IS) during the latter half of phase 2 (2013/14). The PHAC-IS was a national strategic grantmaking program that funded the testing and delivery of evidence-based population health interventions between 2009 and 2020. A key objective of the PHAC-IS was to support work to address underlying determinants of health for priority public health problems. Overall, PHAC-IS funded projects most frequently linked to culture, social environment, and personal health practices and coping skills when phase 2 performance reports were reviewed against identified determinants of health. While the same pattern of prominent linkages was seen in the mental health funding stream, projects funded under the healthy weights stream differed slightly, most frequently linking to the social environment, followed by personal health practices and coping skills, as well as the physical environment. Population health programming funded by the PHAC-IS has reported cursory links with the determinants of health. This corresponds with the PHAC-IS program's original intent to address these determinants that crosscut jurisdictions, sectors, and ecological levels, and underscores the need for more sustained capture of work around health equity and the determinants of health at the systems level.

Состояние проблемы остеопороза в странах Евразийского региона

The public health burden of osteoporosis estimated by the results of clinical and population-based researches in most of the former USSR is uncertain for today. The objective of this audit (Audit-2020) was the epidemiological, medico-social and economic analyse of current and future osteoporosis challenges for the future years for eight countries of the Eurasian region. Methods. We did a search and critical analysis of the publications, including of regional in English, Russian or national languages, did organize a structured survey among national osteoporosis societies members in Armenia, Belarus, Georgia, Kazakhstan, Moldova, Uzbekistan, Kyrgyz Republic, Russia, as well as explored the demographic trends in these countries. Results. Scientific researches including the wide population-based EVA project discovered that the expected number of patients with osteoporosis varies from 240,000 in Armenia to 16 million in Russia. All the countries should be categorized as a moderate risk of hip fractures for women (200–300 cases /100,000 per year). Belarus, Moldova, Armenia, Georgia and Kyrgyzstan have moderate risk for men (100–150/100,000), as well as Russia, Uzbekistan and Kazakhstan are distinguished by a high risk for men (over 150 cases/100,000). Population aging trends are predicting the future growth in the osteoporosis-associated health challenges throughout the region. It is likely the number of osteoporotic fractures to rise in Uzbekistan, Kazakhstan and Kyrgyzstan the most: 2.5–3.5 times by 2050. However current hospitalization rates for hip fracture persons are low in most countries (33–80%), the diagnostic equipment is insufficient (0.2–1.3 per million), DXA testing are expensive. Although modern treatments are available, the cure expenses remain high. Hereby, immediate action is required in each country of audit, including admit osteoporosis is a priority public health problem. Conclusion. Osteoporosis is a challenge for the countries of the Eurasian region. Its burden is about to get worse due to the expected demographic changes.

Validación al castellano del cuestionario revised Patients’ Attitudes Towards Deprescribing (rPATD) para evaluar las actitudes de los pacientes hacia la deprescripción. Protocolo de investigación

Introduction and objectivePolypharmacy has become a priority public health problem in developed countries. In response to its approach, deprescription stands out. Its success will depend largely on the attitudes and beliefs of patients towards the number of drugs they are taking and their willingness to initiate a process of deprescription. To explore these factors, researchers have developed the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire, originally in English. The objective of this study is the validation into Spanish of rPATD questionnaire, both older adults and caregivers versions. Material and methodsA first qualitative validation phase and a second phase of analysis of its psychometric characteristics will be carried out through an observational descriptive study of validation of a measurement instrument. One hundred and twenty subjects (polymedicated older adults and caregivers) from three health centers will be selected by consecutive sampling. The questionnaire will be provided and clinical and sociodemographic data will be collected. Feasibility, reliability (through internal consistency and intraobserver reliability) and validity (apparent, construct and criterion) of the questionnaire will be evaluated. Expected resultsIt is expected to obtain a questionnaire that will serve as a tool for the clinician to identify patients with a favorable predisposition to deprescription and that will allow to contribute the patient's perspective to this process. ConclusionThe use of the rPATD questionnaire, alone or integrated into other more complex interventions, may lead to an improvement in the quality of care for the polymedicated patients.

Correlation of neuropsychological indicators of child development with speech: Empirical research underpinning the National Children’s Health Prevention Programme

Background/Aim. Psychophysiological disorders and speech pathology is one of the priority public health problems in the Republic of Serbia. A child?s growth and development proceed in a particular sequence and course, depending on individual physiological capacities, quality of neuromuscular structures, and stimuli, which can be significantly affected by the environment. The development of speech from birth to the adult age is a result of the interaction of neurocognitive factors that contribute to the gradual attainment of phonological presentation and motor control abilities. The aim of the study was to examine the connection between manipulative manual dexterity, oral praxis, and lateralization with the development and speech in children and their potential for the development of prevention programs. Methods. The sample included 60 children from Belgrade of both sexes, aged between 5.5 and 7 years. Of these, 30 made up the experimental group ? children with deviations in speech development (articulation disorders), and 30 made up the control group ? typically developing children from the general population. The instruments used were the Manipulative Manual Dexterity Test (Lafayette), Oral Praxis Test, and part of the Test for assessing lateralization (auditory, visual, and functional). Results. The hand grip development level was statistically significantly different between the experimental and the control group (?2 = 21.40, df = 3, p &lt; 0.01). The presence of associated involuntary movements statistically significantly differed between the experimental and the control group examinees (?2 = 10.58, df = 1, p &lt; 0.01). Oral praxis statistically significantly differed between the experimental and the control group (t = 2.01, p &lt; 0.05). Visual laterality statistically significantly differed (?2 = 7.56, p &lt; 0.05) between the observed groups. When all predictors were taken into account, significant contribution to the explanation of the existence of speech pathology (articulation disorders) was given by the variables: Visual lateralization [odd ratio (OR) = 0.38; 95% confidence interval (CI) = 0.179?0.832; p = 0.015] and the level of hand grip development (OR = 0.23; 95% CI = 0.082?0.699; p = 0.009). Conclusion. The hand grip development level and visual laterality are worse in children with speech (articulation) impairment and developmental deviations. These indicators of child development should be used as a guide in designing the national programs for developmental assessment and prevention in the child healthcare system.

Параметры физического развития детей с особыми возможностями здоровья с различными типами исходного вегетативного тонуса

At present, the deterioration in the health status of children is a priority public health problem. Special (limited) health abilities are understood as insufficiency of physical and / or mental development, which, among other things, negatively affects the adaptive and adaptive abilities of the body of children. The study of physical development coupled with indicators of autonomic regulation allows us to evaluate the general biological development of the body and adaptive mechanisms. The aim of the study was to analyze the state of physical development in children with special health abilities associated with impaired intellectual development, depending on the initial type of autonomic regulation. 168 children of primary school age were examined. Of these, 54 are children with special health abilities (SHA) associated with intellectual disabilities (F70, F71), and 114 mentally healthy children as control group. It was found that in children with disabilities, sympathicotonic (33%) and hypersympathicotonic (24%) types of initial tone dominate. At the same time, the number of children with an eutonic type of IVT in the group with SHA is 2 times lower (26%) compared with the control group (47%). In the analysis of physical development, depending on the initial vegetative tone in children with SHA, the minimum values of anthropometric parameters were established with vagotonia. As sympathetic modulations increase, an increase in all anthropometric indicators is recorded. Also, in the group of children with SHA, the lag of anthropometric parameters in vagotonia and the predominance of the sympathicotonic type of IVT compared with the control group were revealed. Identified features can be taken into account when selecting an individual correctional program for children with special health abilities associated with intellectual developmental disorders.

The burden of cardiovascular diseases in Ethiopia from 1990 to 2017: evidence from the Global Burden of Disease Study.

In Ethiopia, evidence on the national burden of cardiovascular diseases (CVDs) is limited. To address this gap, this systematic analysis estimated the burden of CVDs in Ethiopia using the Global Burden of Disease (GBD) 2017 study data. The age-standardized CVD prevalence, disability-adjusted life years (DALYs) and mortality rates in Ethiopia were 5534 (95% uncertainty interval [UI] 5310.09 - 5774.0), 3549.6 (95% UI 3229.0 - 3911.9) and 182.63 (95% UI 165.49 - 203.9) per 100 000 population, respectively. Compared with 1990, the age-standardized CVD prevalence rate in 2017 showed no change. But significant reductions were observed in CVD mortality (54.7%), CVD DALYs (57.7%) and all-cause mortality (53.4%). The top three prevalent CVDs were ischaemic heart disease, rheumatic heart disease and stroke in descending order. The reduction in the mortality rate due to CVDs is slower than for communicable, maternal, neonatal and nutritional disease mortalities. As a result, CVDs are the leading cause of mortality in Ethiopia. These findings urge Ethiopia to consider CVDs as a priority public health problem.

Typical Aspects of the "Mastic Kidney" Suggestive of Renal Tuberculosis

Tuberculosis remains a priority public health problem for the World Health Organization (WHO), The difficulty of often late diagnosis and the seriousness of lesions caused by BK even after anti-bacillary treatment, explains the seriousness of the disease with a high number of nephrectomies. The clinical pictures can be misleading, hence the advantage of making this diagnosis before any recurring urological symptom. In our observation, the diagnosis was mentioned in the face of the appearance of the "mastic kidney" indicates an already advanced stage of the pathology, after the anti bacillary treatment, the ablative surgical treatment takes place for the treatment sometimes serious consequences.

ИММУНОПРОФИЛАКТИКА ВИРУСНОГО ГЕПАТИТА «В» В РЕСПУБЛИКЕ КАЗАХСТАН

In article presented effectiveness of conducted vaccine prevention of viral hepatitis “B” in Republic of Kazakhstan, decreasing of level of morbidity by viral hepatitis, disability because of viral hepatitis against the background of vaccination. Vaccination against hepatitis “B” is known to be an effective preventive measure. According to the program of preventive vaccination in our republic the practical use of hepatitis “B” vaccine allowed us to achieve significant in the fight against this infection.Hepatitis “B” is a priority public health problem worldwide, which is associated with a highinfection of the population with the virus, leading to dire consequencesю.