WHO Global Research Articles

6.H. Round table: How can the public health community contribute to better alcohol policies through trade law?

Abstract Alcohol is a causal factor in more than 200 disorders, communicable and injuries. Harms results at even relatively low levels of consumption, and it is estimated that alcohol use causes 3 million deaths globally each year. In parallel to the ever-growing evidence on alcohol-related harm, evidence also continues to accumulate on the effectiveness of policy interventions which tackle the commercial determinants of alcohol consumption, not least on labelling, marketing, pricing and availability. While it is imperative that States introduce national measures to tackle alcohol harms, alcohol is not merely an issue of national policy as it is manufactured, marketed, bought and sold across borders. The WHO Global Alcohol Strategy illustrates the importance of regulation in contributing to the development of robust, comprehensive interventions to tackle alcohol use. However, what States can do at the national level is constrained by international rules. In particular, international trade law under the World Trade Organization is often invoked in opposing national rules. This litigation can result in expensive, time-consuming and distracting disputes with no certainty of winning. Even before policies are challenged, ‘regulatory chill’ often results in preventing, watering down and delaying policies. This is unfortunate not least because many policies, if framed correctly, could be defended successfully. The objectives of this roundtable workshop are to: 1. To understand the relationship which trade law has with national and regional alcohol policies. 2. To explore how various stakeholders can contribute to the development rules which are not constrained by international trade law. Five short 5-minute presentations will be mixed with discussions. The first presentation sets the scene through giving an overview of the existing developments of alcohol policies in Europe and the context States find themselves in. The second presentation explores the role of WHO and the work it is undertaking, as well as the interventions envisaged by the WHO Global strategy, Global action plan and the European framework. The third presentation will discuss the various policies which have been discussed in international trade law forums by States, and the roles some States have played in promoting or challenging proposals by other States. The fourth presentation will continue the discussions on trade law by showing how policies can progress through increased recognition on the right to know and efforts to grant this right through standardising alcohol labelling internationally. The fifth presentation will reflects on the work by civil society in promoting more effective policies and the barriers faced from the alcohol industry in particular. The workshop will be moderated by the chair, who will draw on links and common themes and facilitate discussions between panellists, and between the panel and members of the public health community in the audience. Key messages • Trade law has a significant impact on national alcohol policies. • Trade law barriers can be overcome through effective strategies.

Suicidality among university students in the Eastern Mediterranean region: A systematic review.

The prevalence of suicide attempts and suicidal ideation among university students is a global concern. Cultural values, social determinants, religion, and especially growing stress all play an important role in this. This systematic review aimed to identify potential protective and risk factors thought to be associated with suicidal ideation among students in the Eastern Mediterranean region and highlight the importance of developing an effective health care response. MEDLINE, CINAHL, Embase, PsycINFO, WHO Global Health Library, IMEMR, Web of Science Core Collections and Farsi and Arabic databases were searched for papers in English, Farsi, and Arabic. A combination of validated filters, free text keywords, and Mesh and Non-Mesh terms were used to retrieve relevant literature. A total of 2774 papers were found after the search, 257 selected for full-text review, and 72 papers included in the final review. Family and peer support play a potential protective role in the development of suicidal ideation among university students, while adverse life events, bullying, depression, anxiety, and other mental health conditions were identified as risk factors. Suicidality was likely under-reported due to stigma around social and cultural factors. Factors involving religion and culture may act as both protective and risk factors and require more in-depth investigation. The student population in the Eastern Mediterranean region face many challenges. The common theme of suicidality emerged as an indicator of an imbalance of resources and stress, which needs to be addressed proactively, given a most likely underreporting of suicidal ideation and attempts due to stigma.

Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS).

Enhanced recovery after surgery (ERAS) protocols have largely been incorporated into practice in high-income settings due to proven improvement in perioperative outcomes. We aimed to review the implementation of ERAS protocols and other perioperative optimisation strategies in low- and middle-income countries (LMICs) and their impact on length of hospital stay (LOS). We searched MEDLINE, PubMed, Global Health (CABI), WHO Global Index Medicus, Index Medicus, and Latin American and Caribbean Health Sciences Literature (LILACS) for studies incorporating ERAS or other prehabilitation approaches in LMICs. We conducted a pooled analysis of LOS using a random-effects model to evaluate the impact of such programs. This systematic review was pre-registered on PROSPERO. We screened 1205 studies and included 70 for a full-text review; six were eligible for inclusion and five for quantitative analysis, two of which were randomised controlled trials. ERAS was compared to routine practice in all included studies, while none implemented prehabilitation or other preoperative optimisation strategies. Pooled analysis of 290 patients showed reduced LOS in the ERAS group with a standardised mean difference of -2.18 (95% confidence interval (CI) = -4.13, -.0.05, P < 0.01). The prediction interval was wide (95% CI = -7.85, 3.48) with substantial heterogeneity (I2 = 94%). Perioperative optimisation is feasible in LMICs and appears to reduce LOS, despite high levels of between-study heterogeneity. There is a need for high-quality data on perioperative practice in LMICs and supplementary qualitative analysis to further understand barriers to perioperative optimisation implementation. PROSPERO: CRD42021279053.

A glimpse into the future: modelling global prevalence of hypertension

BackgroundHypertension is a major risk factor for cardiovascular diseases. Insights and foresights on trends of hypertension prevalence are crucial to informing health policymaking. We examined and projected the patterns of hypertension prevalence among sexes.MethodsUsing annual hypertension prevalence (18 + years) data sourced from WHO Global Health Observatory data repository from 1975 to 2015, Prophet models were developed to forecast the 2040 prevalence of hypertension in males, females, and both sexes. We used k-means clustering and self-organising maps to determine the clusters of hypertension prevalence concerning both sexes among 176 countries.ResultsWorldwide, Croatia is estimated to have the highest prevalence of hypertension in males by 2040, while that of females is in Niger. Among the world’s most populated countries, Pakistan and India are likely to increase by 7.7% and 4.0% respectively in both sexes. South-East Asia is projected to experience the largest hypertension prevalence in males, whereas Africa is estimated to have the highest prevalence of hypertension in females. Low-income countries are projected to have the highest prevalence of hypertension in both sexes. By 2040, the prevalence of hypertension worldwide is expected to be higher in the male population than in female. Globally, the prevalence of hypertension is projected to decrease from 22.1% in 2015 to 20.3% (20.2 – 20.4%) in 2040. We also identified three patterns of hypertension prevalence in 2040, cluster one countries are estimated to have the highest prevalence of hypertension in males (29.6%, 22.2 – 41.1%) and females (29.6%, 19.4 – 38.7%).ConclusionThese findings emphasise the need for new and effective approaches toward the prevention and control of hypertension in Africa, South-East Asia, and Low-income countries.

Association between spinal and non-spinal health conditions reported in epidemiological studies: a scoping review protocol

IntroductionThe increasing prevalence of coexisting health conditions poses a challenge to healthcare providers and healthcare systems. Spinal pain (eg, neck and back pain) and spinal pathologies (eg, osteoporotic fractures and...

The Use of Facial Fillers in Clinical Practice: The Level of Patient Satisfaction and an Overview of Common Clinical Complications

BackgroundPatient esthetic satisfaction following facial fillers is an essential topic that should be studied as the number of individuals seeking treatment increases. The face is an essential component of the human body that is frequently associated with beauty, youthfulness, and health. Individuals may seek facial augmentation with fillers for a variety of reasons, such as congenital, acquired by means of aging or disease, or current aesthetic trends. ObjectiveThe aim is to assess patient's aesthetic satisfaction and description of common clinical complications in relation to the facial filler injections. MethodA cross sectional survey using a questionnaire derived from the global aesthetic improvement scale and WHO quality of life scale, convenience sampling was used to recruit patients attending cosmetic clinics, descriptive analysis and Chi-square methods were used to analyze the data. ResultsIn the study, 500 female participants, with an average age of 28.48 years, were included. Over 90% reported improvement after filler treatment, ranging from improved to very much improved. A statistically significant correlation was observed between patient satisfaction and the number of filler treatments and the anatomical injection site. However, no statistically significant correlation was found when considering age groups. Local side effects, such as swelling and redness at the injection site, were common but generally mild and of short duration. ConclusionAlthough the satisfaction level is currently high, practitioners in the field need to pay more attention to this important outcome, since understanding the patient's motivation and expectation before proceeding with the procedure is very important and can contribute significantly in determining patient satisfaction with the result.

The effectiveness of nurse-led interventions to manage frailty in community-dwelling older people: a systematic review

BackgroundThe global increase in the number of frail older people and the accompanying increase in chronic conditions underline the need to develop effective health promotion and preventive interventions for these population groups. Wide ranging of physical, psychological, and social health factors influence frailty in older people and leads to increased vulnerability to many adverse outcomes. To reverse or reduce the progression of frailty, nurses play a pivotal role in delivering health promotion and preventive interventions. The purpose of the review is to determine the effectiveness of nurse-led interventions in reducing frailty in community-dwelling older people.MethodsThe following electronic databases: PubMed, MEDLINE, Web of Science, SCOPUS, CINAHL, PsychInfo, and WHO Global Index Medicus were searched until June 2022. Nurse-led, "nurse led", education, training, intervention, program, teaching, frail*, fragile*, "frailty syndrome", debility, infirmity, elder*, aged*, old*, geriatric, "community based settings", "community-based", "community setting", community were the search terms. Before data extraction, eligible articles were assessed for their methodological quality. The JBI critical appraisal checklist for reporting experimental studies was utilised to appraise the methodological quality of the studies. Data were systematically examined using a narrative review to determine the effectiveness of the intervention.ResultsOf the 156 studies identified, from the search, six studies with samples ranging from 40 to 1387 older people were eligible for inclusion in the review. Two quasi-experimental studies and one Randomised Controlled Trial (RCT) showed a moderate risk of bias. The Nurse-led frailty interventions used a multi-component intervention approach across the studies. The interventions reversed frailty progression, improve physical functioning, nutritional status, and quality of life, enhance perceptions of social support, improve mental health, and reduce depression.ConclusionsFew studies have explored the effectiveness of a nurse-led intervention to decrease frailty in older people. Evaluating physical functioning, nutritional status, mental health, and quality of life in community-dwelling frail older people can contribute to developing appropriate interventions.Systematic review registrationPROSPERO ID of CRD42022348064.

Current challenges and potential solutions to the use of digital health technologies in evidence generation: a narrative review.

Digital health is a field that aims to improve patient care through the use of technology, such as telemedicine, mobile health, electronic health records, and artificial intelligence. The aim of this review is to examine the challenges and potential solutions for the implementation and evaluation of digital health technologies. Digital tools are used across the world in different settings. In Australia, the Digital Health Translation and Implementation Program (DHTI) emphasizes the importance of involving stakeholders and addressing infrastructure and training issues for healthcare workers. The WHO's Global Task Force on Digital Health for TB aims to address tuberculosis through digital health innovations. Digital tools are also used in mental health care, but their effectiveness must be evaluated during development. Oncology supportive care uses digital tools for cancer patient intervention and surveillance, but evaluating their effectiveness can be challenging. In the COVID and post-COVID era, digital health solutions must be evaluated based on their technological maturity and size of deployment, as well as the quality of data they provide. To safely and effectively use digital healthcare technology, it is essential to prioritize evaluation using complex systems and evidence-based medical frameworks. To address the challenges of digital health implementation, it is important to prioritize ethical research addressing issues of user consent and addressing socioeconomic disparities in access and effectiveness. It is also important to consider the impact of digital health on health outcomes and the cost-effectiveness of service delivery.

Strengthening public health policies for childhood cancer: Peru's achievements through the WHO Global Initiative for Childhood Cancer.

To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.

Updating national physical activity guidelines based on the global WHO guidelines: experiences and challenges from Switzerland

Physical activity guidelines are recognized as an important element of a national approach to promote physical activity. This publication summarizes the approach and process taken to update the Swiss Guidelines, presents a summary of the updated guidelines and discusses experiences and identifies challenges. The multistage project involved: 1) to summarize the scientific evidence underpinning the 2020-edition of the WHO guidelines; 2) to systematically analyze the existing Swiss guidelines for different target groups and to develop proposals for updates 3) a participatory process to gain consensus with the main interested groups 4) to finalize the guidelines. Updated guidelines were adopted for infants, pre-school children, children and young people, adults, older adults and pregnant and postpartum women, in most cases following the WHO guidelines. Children, young people and adults living with disability and adults and older adults with chronic conditions are specifically addressed in each of the general guidelines for healthy populations, rather than developing separate guidelines for each of these groups as done by the WHO. The systematic approach in identifying aspects to update, the participatory approach and a scientific consortium and project coordination group with different thematic backgrounds were key strengths in the process. Challenges included the large amount of feedback and finding scientifically sound compromises. The updated versions of the Swiss national guidelines provide an excellent basis to further promote physical activity in Switzerland. A remaining key task is to develop a range of communication tools and materials for different target groups beyond the circle of experts and interested groups, considering available evidence on optimal messaging and best outlet tools and channels. To track population prevalence, inform policy and evaluate physical activity promotion at national and sub-national level in a timely fashion, strengthening existing physical activity monitoring will be important.

S8-5 INTERACT capacity building framework for sport for all among sports federations

Abstract Purpose International Sports Organisations (ISOs) have increasing interest in investing on sport for all and have been called by policy-makers through different policies (e.g. WHO Global Action Plan for physical activity, UN Sustainable Development Goals) to leverage their health and physical activity potential towards the society. This presentation showcase a training (in-person, informal education workshop) that aims to empower the staff and volunteers of ISOs promote Sport for All and physical activity and act as multipliers to train their national federations and grassroot sport organisations. Project The INTERACT Capacity-Building Framework which was designed by INTERACT Erasmus+ project partners (TAFISA and 8 International Sports Organisation) through different meetings and a co-construction approach, addresses key elements, identified as part of the INTERACT project, to support ISOs and continental/national sport federations in developing their own Sport for All and physical activity initiatives and engage with their members in the field. It provides exchange of knowledge and training to empower ISOs, their staff and volunteers in Sport for All and place physical activity promotion at the core of their activities. This will in turn increase participation in sport and physical activity. By using different sensory channels (e.g. visual, acoustic, tactile), our approach satisfies the participant’s different learning types and primary ways of absorbing and processing information. Composed of three steps (advocacy, diagnostic, training), it alternates theory and practice as well as tension and relaxation, movement and rest. Participant-oriented educational work includes the conscious handling of diversity and diversity of people (e.g. in relation to sex/gender, nationality, ethnicity, religious belief, disability, sexual orientation etc.). A first pilot has been launched among 12 ISOs, and evaluation framework will be created this spring, based on a litterature review. Conclusion The INTERACT Capacity-building programme is developed to become a full-fetched service that is offered in the coming years to any ISO willing to step up its promotion of Sport for All activity.

O.2.2-11 Adapting national physical activity guidelines based on the global WHO guidelines: experiences and challenges from the case of Switzerland

Abstract Physical activity guidelines are recognized as an important element of a national approach to promote physical activity. This publication summarizes the approach and process taken to update the Swiss Guidelines, discusses experiences and identifies challenges. The multistage project involved to: 1) summarize the scientific evidence underpinning the 2020-edition of the WHO guidelines; 2) to systematically analyze the existing Swiss guidelines for different target groups and to develop proposals for updates 3) a participatory process to gain consensus with the main interested groups 4) to finalize the guidelines. Updated guidelines were adopted for infants, pre-school children, children and young people, adults, older adults and pregnant and postpartum women, in most cases adopting the WHO guidelines. Children, young people and adults living with disability and adults and older adults with chronic conditions are specifically addressed in each of the general guidelines, rather than adopting separate guidelines for each of these groups as done by the WHO. The systematic approach in identifying aspects to update, the participatory approach and a strong scientific consortium with different thematic backgrounds were key strengths in the process. Challenges included the large amount of feedback and finding scientifically sound compromises. The updated versions of the Swiss national guidelines for small children, young people, adults and women during and after pregnancy provide an excellent basis to further promote physical activity in Switzerland. A remaining key task is to develop a range of communication tools and materials for different target groups beyond the circle of experts and interested groups, considering available evidence on optimal messaging and best outlet tools and channels.

Development and Implementation of Educational Material by Nurses for Parents/Caregivers of Children With Cancer: A Peruvian National Study.

Background: Education for parents and caregivers of children with cancer is one of the fundamental roles of nurses to avoid complications, provide quality care, promote adherence to treatment and maintain basic standards of care. This study aimed to design educational material for parents and caregivers of children with cancer in Peru on general information about childhood cancer and its care. Method: Within the framework of the WHO Global Initiative for Childhood Cancer in Peru, a multicenter working group was convened by the Peruvian Ministry of Health. A comprehensive needs assessment of parents and caregivers of children with cancer was performed through a survey in June and July 2020. The survey was conducted online (via Google Forms) and in person at nine hospitals to examine the preferred method of delivery and content of information. Results: Based on the findings from the parent needs assessment, a national nursing working group developed Spanish-language audiovisual materials (i.e., diagnosis and treatment videos for nurses to educate parents and caregivers). A total of 365 parents and caregivers were included. Most respondents (56.9%) were parents of children receiving treatment. Main topics were childhood cancer overview and side effects (85%), food and nutrition (75%), and palliative care (67%); most (70.9%) preferred information through talks and videos (64.7%). Twenty-three videos were developed with support by the Pan American Health Organization and the Ministry of Health. Discussion: Assessing the educational needs of parents and caregivers of children with cancer provides a starting point in the design of targeted strategies.

Priority strategic directions in adolescent health in Iran based on the WHO's Global Accelerated Action for the Health of Adolescents.

In line with the World Health Organization's Global Accelerated Action for the Health of Adolescents (AA-HA!) guidance, the goal of the current research was to identify critical strategies for adolescents' health and to determine the role and distribution of responsibilities among the leading players in the field of adolescent health in Iran. The current qualitative and applied study is partof the Ministry of Health and Medical Education's "Adolescent, Youth and School Health" plan to develop the "National Adolescent Health Plan Document" in 2020. First, stakeholder analysis was done, then a pool of nationally appropriate strategies was selected from the list of priority strategies recommended by the WHO in the AA-HA! through several group sessions. After that, the experts selected priority strategies based on the criteria of feasibility, acceptability, effectiveness, guaranteed resources, coordination with other plans and temporal priority, scoring, and executive priorities. Eventually, the priority strategies wereassigned to different players/stakeholders in the field over several sessions bearing in mind the methods of implementation and the target groups. The experts identified 58 priority strategies/actions for adolescent health under the seven priority areas of positive development, sexual protection, reproductive health,mental health, substance abuse, self-harm, violence, unintentional injury, communicable and non-communicable diseases, nutrition, and physical activity. The highest identified priority areas were in the areas of vaccination; special health care package forservice providers; training and education to promote health literacy and self-care, life skills, sexual awareness, and prevention/protection against violence; community-based mental health services, planning for adolescents' spare time, substance use prevention.

Cancer Burden Variations and Convergences in Globalization: A Comparative Study on the Tracheal, Bronchus, and Lung (TBL) and Liver Cancer Burdens Among WHO Regions from 1990 to 2019

Lung cancer and liver cancer are the leading and third causes of cancer death, respectively. Both lung and liver cancer are with clear major risk factors. A thorough understanding of their burdens in the context of globalization, especially the convergences and variations among WHO regions, is useful in precision cancer prevention worldwide and understanding the changing epidemiological trends with the expanding globalization. The Global Burden of Disease (GBD) and WHO Global Health Observatory (GHO) database were analyzed to evaluate the burden metrics and risk factors of trachea, bronchus, and lung (TBL) cancer and liver cancer. Western Pacific Region (WPR) had the highest age-standardized incidence rate (ASIR) for both liver cancer (11.02 [9.62–12.61] per 100,000 population) and TBL cancer (38.82 [33.63–44.04] per 100,000 population) in 2019. Disability-adjusted life years (DALYs) for liver and TBL cancer elevated with the increasing sociodemographic index (SDI) level, except for liver cancer in WPR and TBL cancer in European Region (EUR). Region of the Americas (AMR) showed the biggest upward trends of liver cancer age-standardized rates (ASRs), as well as the biggest downward trends of TBL cancer ASRs, followed by Eastern Mediterranean Region (EMR). Alcohol use and smoking were the leading cause of liver and TBL cancer death in most WHO regions. Variances of ASRs for liver and TBL cancer among WHO memberships have been decreasing during the past decade. The homogenization and convergence of cancer burdens were also demonstrated in different agegroups and sexes and in the evolution of associated risk factors and etiology. In conclusion, our study reflects the variations and convergences in the liver and lung cancer burdens among the WHO regions with the developing globalization, which suggests that we need to be acutely aware of the global homogeneity of the disease burden that accompanies increasing globalization, including the global convergences in various populations, risk factors, and burden metrics.Graphical

Effect of Physical Exercise-Based Rehabilitation on Long COVID: A Systematic Review and Meta-analysis.

The number of persons living with post-coronavirus disease 2019 (COVID-19) conditions or long COVID continues to rise worldwide; however, the etiology and treatment of long COVID remain nebulous. Therefore, efficient, feasible, and cost-effective therapeutic strategies for a large population with long COVID remain warranted. Physical exercise-based rehabilitation is a promising strategy for long COVID, although its therapeutic effects remain to be determined. This systematic review and meta-analysis aimed to examine the effects of physical exercise-based rehabilitation on long COVID. The electronic databases Medline, Embase, Global Health (Ovid), CINAHL (EBSCO), Web of Science, WHO Global Research Database on COVID-19, LitCovid, and Google Scholar were searched from their inception to November 2022. The identified articles were independently screened by three reviewers, and a random-effects model was utilized to determine the mean differences in the meta-analysis. Twenty-three studies involving 1,579 individuals who had COVID-19 (752 women) were included. Physical exercise-based rehabilitation showed beneficial effects on long COVID-related symptoms characterized by dyspnea, fatigue, and depression, as well as on the 6-minute walk test, forced expiratory volume in 1 second/forced vital capacity, and quality of life in people who had COVID-19. Physical exercise-based rehabilitation is a potential therapeutic strategy against long COVID and can be applied as a routine clinical practice in people who have recovered from COVID-19. However, customized physical exercise-based rehabilitation programs and their effects on specific types of long COVID require future large-scale studies.

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance.

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.

Urban–rural disparity in global estimation of PM2·5 household air pollution and its attributable health burden

Polluting fuels and inefficient stove technologies are still a leading cause of premature deaths worldwide, particularly in low-income and middle-income countries. Previous studies of global household air pollution (HAP) have neither considered the estimation of PM2·5 at national level nor the corresponding attributable mortality burden. Additionally, the effects of climate and ambient air pollution on the global estimation of HAP-PM2·5 exposure for different urban and rural settings remain largely unknown. In this study, we include climatic effects to estimate the HAP-PM2·5 exposure from different fuel types and stove technologies in rural and urban settings separately and the related attributable global mortality burden. Bayesian hierarchical models were developed to estimate an annual average HAP-PM2·5 personal exposure and HAP-PM2·5 indoor concentration (including both outdoor and indoor sources). Model variables were selected from sample data in 282 peer-reviewed studies drawn and updated from the WHO Global HAP dataset. The PM2·5 exposure coefficients from the developed model were applied to the external datasets to predict the HAP-PM2·5 exposure globally (personal exposure in 62 countries and indoor concentration in 69 countries). Attributable mortality rate was estimated using a comparative risk assessment approach. Using weighted averages, the national level 24 h average HAP-PM2·5 exposure due to polluting and clean fuels and related death rate per 100 000 population were estimated. In 2020, household use of polluting solid fuels for cooking and heating led to a national-level average personal exposure of 151 μg/m3 (95% CI 133-169), with rural households having an average of 171 μg/m3 (153-189) and urban households an average of 92 μg/m3 (77-106). Use of clean fuels gave rise to a national-level average personal exposure of 69 μg/m3 (62-76), with a rural average of 76 μg/m3 (69-83) and an urban average of 49 μg/m3 (46-53). Personal exposure-attributable premature mortality (per 100 000 population) from the use of polluting solid fuels at national level was on average 78 (95% CI 69-87), with a rural average of 82 (73-90) and an urban average of 66 (57-75). The average attributable premature mortality (per 100 000 population) from the use of clean fuels at the national level is 62 (54-70), with a rural average of 66 (58-74) and an urban average of 52 (47-57). The estimated HAP-PM2·5 indoor concentration shows that the use of polluting solid fuels resulted in a national-level average of 412 μg/m3 (95% CI 353-471), with a rural average of 514 μg/m3 (446-582) and an urban average of 149 μg/m3 (126-173). The use of clean fuels (gas and electricity) led to an average PM2·5 indoor concentration of 135 μg/m3 (117-153), with a rural average of 174 μg/m3 (154-195) and an urban average of 71 μg/m3 (63-80). Using time-weighted HAP-PM2·5 indoor concentrations, the attributable premature death rate (per 100 000 population) from the use of polluting solid fuels at the national level is on average 78 (95% CI 72-84), the rural average being 84 (78-91) and the urban average 60 (54-66). From the use of clean fuels, the average attributable premature death rate (per 100 000 population) at the national level is 59 (53-64), the rural average being 68 (62-74) and the urban average 45 (41-50). A shift from polluting to clean fuels can reduce the average PM2·5 personal exposure by 53% and thereby lower the death rate. For all fuel types, the estimated average HAP-PM2·5 personal exposure and indoor concentrations exceed the WHO's Interim Target-1 average annual threshold. Policy interventions are urgently needed to greatly increase the use of clean fuels and stove technologies by 2030 to achieve the goal of affordable clean energy access, as set by the UN in 2015, and address health inequities in urban-rural settings. Wellcome Trust, The Lancet Countdown, the Engineering and Physical Sciences Research Council, and the Natural Environment Research Council.

Modern technologies for studying the genome of mycobacteria

Molecular technologies play a leading role in the laboratory diagnosis of tuberculosis and mycobacteriosis. The successes in studying the genome of Mycobacterium have contributed to significant progress in understanding the evolution, variability, and genetic diversity of pathogens, as well as the development of diagnostic technologies, including research into resistance to anti-tuberculosis drugs.&#x0D; The aim of this research is to conduct a comparative study of the spectrum of modern technologies for studying the genomes of mycobacteria and their impact on the efficiency of the laboratory diagnosis of tuberculosis.&#x0D; Materials and methods: a search for sources of information was carried out in the PubMed, Medline, Web of Science, and Google Scholar databases. Materials related to the technology of molecular diagnosis of tuberculosis and mycobacteriosis and for determining the susceptibility of pathogens to anti-tuberculosis drugs were selected.&#x0D; Results: it was determined that the modern methods for studying the genome of mycobacteria include amplification technologies (PCR analysis), hybridization, restriction, spoligotyping, sequencing, and their various combinations. The main methods are standard and modified protocols of PCR (RAPD-PCR, AP-PCR, rep-PCR, Real-time PCR, Inverse PCR, TB-LAMP, HIP, LM-PCR). Genomic Restriction Analysis can be used in studies of MTBC and NTM strains (RFLP, AFLP analysis, MIRU-VNTR genotyping). The most effective method for genome analysis is WGS. Complex methods that utilize a combination of molecular technologies allow for the direct detection of mycobacteria in clinical samples.&#x0D; Conclusions: the widespread application of genomic technologies in the study of mycobacteria will contribute to the effective implementation of the global WHO strategy for the prevention, treatment, and control of tuberculosis and mycobacteriosis

Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis

Approximately 90% of children with cancer live in low-income and middle-income countries (LMICs), where 5-year survival is lower than 20%. Treatment-related mortality in high-income countries is approximately 3-5%; however, in LMICs, treatment-related mortality has been reported in up to 45% of children with cancer. This study aimed to systematically explore the burden of treatment-related mortality in children with cancer in LMICs and to explore the association between country income level and treatment-related mortality. For this systematic review and meta-analysis we identified articles published between Jan 1, 2010, and June 22, 2021, describing treatment-related mortality in paediatric patients (aged 0-21 years) with cancer in LMICs. We searched PubMed, Trip, Web of Science, Embase, and the WHO Global Metric Index databases. The search was limited to full-text articles and excluded case reports (<10 patients) and haematopoietic stem-cell transplantation recipients. Two reviewers independently screened studies for eligibility, extracted data from included publications, and evaluated data quality. Random and mixed-effects models were used to estimate treatment-related mortality burden and trends. The Cochran-Q statistic was used to assess heterogeneity between studies. This study is registered on PROSPERO (CRD42021264849). Of 13 269 identified abstracts, 501 studies representing 68 351 paediatric patients with cancer were included. The treatment-related mortality estimate was 6·82% (95% CI 5·99-7·64), accounting for 30·9% of overall mortality (4437 of 14 358 deaths). Treatment-related mortality was inversely related to country income. Treatment-related mortality was 14·19% (95% CI 9·65-18·73) in low-income countries, 9·21% (7·93-10·49) in lower-middle-income countries, and 4·47% (3·42-5·53) in upper-middle-income countries (Cochran-Q 42·39, p<0·0001). In upper-middle-income countries, the incidence of treatment-related mortality decreased over time (slope -0·002, p=0·0028); however, outcomes remained unchanged in low-income (p=0·21) and lower-middle-income countries (p=0·16). Approximately one in 15 children receiving cancer treatment in LMICs die from treatment-related complications. Although treatment-related mortality has decreased in upper-middle-income countries over time, it remains unchanged in LMICs. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival. American Lebanese Syrian Associated Charities and National Cancer Institute.