WHO Global Research Articles

Myocarditis in SARS-CoV-2 infection vs. COVID-19 vaccination: A systematic review and meta-analysis.

BackgroundThis study aimed to compare the incidence of myocarditis in COVID-19 vaccines and in severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection groups.MethodsElectronic databases (MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the WHO Global Literature on Coronavirus Disease) and trial registries were searched up to May 2022, for randomized controlled trials and observational cohort studies reporting the risk of myocarditis associated with the COVID-19 vaccines and the risk associated with SARS-CoV-2 infection. We estimated the effect of COVID-19 infection and vaccines on rates of myocarditis by random-effects meta-analyses using the generic inverse variance method. Meta-regression analyses were conducted to assess the effect of sex and age on the incidence of myocarditis.ResultsWe identified 22 eligible studies consisting of 55.5 million vaccinated cohorts and 2.5 million in the infection cohort. The median age was 49 years (interquartile range (IQR): 38–56), and 49% (IQR: 43 to 52%) were men. Of patients diagnosed with myocarditis (in both vaccination and COVID-19 cohort) 1.07% were hospitalized and 0.015% died. The relative risk (RR) for myocarditis was more than seven times higher in the infection group than in the vaccination group [RR: 15 (95% CI: 11.09–19.81, infection group] and RR: 2 (95% CI: 1.44-2.65, vaccine group). Of patients who developed myocarditis after receiving the vaccine or having the infection, 61% (IQR: 39–87%) were men. Meta-regression analysis indicated that men and younger populations had a higher risk of myocarditis. A slow decline in the rates of myocarditis was observed as a function of time from vaccination. The risk of bias was low.ConclusionIn this systematic review and meta-analysis, we found that the risk of myocarditis is more than seven fold higher in persons who were infected with the SARS-CoV-2 than in those who received the vaccine. These findings support the continued use of mRNA COVID-19 vaccines among all eligible persons per CDC and WHO recommendations.

O1-5 Digital tools for physical activity assessment and brief counselling in Primary Health Care: The Portuguese model

Issue/problemImplementation of national systems for patients' physical activity (PA) assessment and counselling is a cost-effective strategy recommended in the WHO Global Action Plan for PA 2018-2030. Although Primary Health Care (PHC) professionals are recognized as key agents for PA promotion, challenges remain on how to develop feasible and scalable tools to support them in promoting patients' PA. The Portuguese model could help other countries improve PA assessment and brief counselling in PHC settings. This study aims to describe the tools' development and usage.Description of the problemThe Portuguese Directorate-General of Health developed two evidence-based digital tools to support PA promotion by healthcare professionals: a) PA brief assessment tool; and b) brief counselling tool. The assessment tool was incorporated within the electronic medical health record software ?SClínico? in September 2017. It includes three questions: 1) how many days per week the patient performs any kind of PA (work, commuting or leisure-time); 2) how much time per day; and 3) how many hours per day the patient spends in sedentary behaviours. The PA brief counselling tool is available through the electronic medical prescription software ?PEM? since December 2017 and consists of five inter-related self-explanatory guides that can be delivered to patients (printed or by email), according to their motivation and PA levels. They facilitate person-centered and autonomy-supportive PA counselling, targeting specific behaviour change mediators, and using validated techniques.ResultsFrom September 2017 to December 2021, 159,179 patients had their PA assessed (2235 per 100,000 users of the National Health Service) and, from these, 16133 received PA brief counselling guides (177 per 100000 residents in Portugal, ≥ 15 years old), with a six-fold and three-fold increases, respectively, between 2018 and 2019 (previous to the COVID-19 pandemic). Future actions will address cost-effectiveness of this policy.LessonsThe brief assessment and brief counselling tools were well-accepted and are increasingly being used, with potential for generalized adoption within the Portuguese Health Care System.Main messagesPortugal has taken a decisive action to promote PA using PHC as a priority setting. PA tools usage is increasing considerably, highlighting the importance of making available easy-to-use PA promotion tools.

Measurement of symphysis fundal height for gestational age estimation in low-to-middle-income countries: A systematic review and meta-analysis.

In low- and middle-income countries (LMIC), measurement of symphysis fundal height (SFH) is often the only available method of estimating gestational age (GA) in pregnancy. This systematic review aims to summarize methods of SFH measurement and assess the accuracy of SFH for the purpose of GA estimation. We searched PubMed, EMBASE, Cochrane, Web of Science, POPLINE, and WHO Global Health Libraries from January 1980 through November 2021. For SFH accuracy, we pooled the variance of the mean difference between GA confirmed by ultrasound versus SFH. Of 1,003 studies identified, 37 studies were included. Nineteen different SFH measurement techniques and 13 SFH-to-GA conversion methods were identified. In pooled analysis of five studies (n = 5838 pregnancies), 71% (95% CI: 66-77%) of pregnancies dated by SFH were within ±14 days of ultrasound confirmed dating. Using the 1 cm SFH = 1wk assumption, SFH underestimated GA compared with ultrasound-confirmed GA (mean bias: -14.0 days) with poor accuracy (95% limits of agreement [LOA]: ±42.8 days; n = 3 studies, 2447 pregnancies). Statistical modeling of three serial SFH measurements performed better, but accuracy was still poor (95% LOA ±33 days; n = 4 studies, 4391 pregnancies). In conclusion, there is wide variation in SFH measurement and SFH-to-GA conversion techniques. SFH is inaccurate for estimating GA and should not be used for GA dating. Increasing access to quality ultrasonography early in pregnancy should be prioritized to improve gestational age assessment in LMIC.

Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19)-authors' response.

Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19)-authors' response.

Preconception and periconception interventions to prevent low birth weight, small for gestational age and preterm birth: a systematic review and meta-analysis

BackgroundLow birth weight (LBW), including preterm birth (PTB) and small for gestational age (SGA), contributes a significant global health burden. We aimed to summarise current evidence on the effect of...

Disease Burden, Risk Factors, and Trends of Leukaemia: A Global Analysis.

Leukaemia accounted for approximately 2.5% of all new cancer incidence and 3.1% of cancer-related mortality. The investigation of its risk factors and epidemiologic trends could help describe the geographical distribution and identify high-risk population groups. This study aimed to evaluate the global incidence, mortality, associated risk factors, and temporal trends of leukaemia by sex, age, and country. We extracted incidence and mortality of leukaemia from GLOBOCAN, CI5, WHO mortality database, NORDCAN, and SEER. We searched the WHO Global Health Observatory data repository for the age-standardised prevalence of lifestyle and metabolic risk factors. We tested the trends by calculating Average Annual Percentage Change (AAPC) from Joinpoint regression. The age-standardized rate of incidence and mortality were 5.4 and 3.3 per 100,000 globally. The incidence and mortality of leukaemia were associated with Human Development Index, Gross Domestics Products per capita, prevalence of smoking, physical activity, overweight, obesity, and hypercholesterolaemia at the country level. Overall, more countries were showing decreasing trends than increasing trends in incidence and mortality. However, an increasing trend of leukaemia incidence was found in Germany, Korea, Japan, Canada and the United Kingdom (AAPC, 2.32-0.98) while its mortality increased in the Philippines, Ecuador, Belarus, and Thailand (AAPC, 2.49-1.23). There was a decreasing trend of leukaemia for the past decade while an increase in incidence and mortality was observed in some populations. More intensive lifestyle modifications should be implemented to control the increasing trends of leukaemia in regions with these trends. Future studies may explore the reasons behind these epidemiological transitions.

The impact of preoperative oral nutrition supplementation on outcomes in patients undergoing gastrointestinal surgery for cancer in low- and middle-income countries: a systematic review and meta-analysis

Malnutrition is an independent predictor for postoperative complications in low- and middle-income countries (LMICs). We systematically reviewed evidence on the impact of preoperative oral nutrition supplementation (ONS) on patients undergoing gastrointestinal cancer surgery in LMICs. We searched EMBASE, Cochrane Library, Web of Science, Scopus, WHO Global Index Medicus, SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) databases from inception to March 21, 2022 for randomised controlled trials evaluating preoperative ONS in gastrointestinal cancer within LMICs. We evaluated the impact of ONS on all postoperative outcomes using random-effects meta-analysis. Seven studies reported on 891 patients (446 ONS group, 445 control group) undergoing surgery for gastrointestinal cancer. Preoperative ONS reduced all cause postoperative surgical complications (risk ratio (RR) 0.53, 95% CI 0.46–0.60, P < 0.001, I2 = 0%, n = 891), infection (0.52, 0.40–0.67, P = 0.008, I2 = 0%, n = 570) and all-cause mortality (0.35, 0.26–0.47, P = 0.014, I2 = 0%, n = 588). Despite heterogeneous populations and baseline rates, absolute risk ratio (ARR) was reduced for all cause (pooled effect −0.14, −0.22 to −0.06, P = 0.006; number needed to treat (NNT) 7) and infectious complications (−0.13, −0.22 to −0.06, P < 0.001; NNT 8). Preoperative nutrition in patients undergoing gastrointestinal cancer surgery in LMICs demonstrated consistently strong and robust treatment effects across measured outcomes. However additional higher quality research, with particular focus within African populations, are urgently required.

Supporting physical activity in an ageing world: a call for action

Supporting physical activity in an ageing world: a call for action

The epidemiological landscape of multiple myeloma: a global cancer registry estimate of disease burden, risk factors, and temporal trends

Multiple myeloma accounted for 176 404 (14%) of 1 278 362 the incidence cases leukaemia, lymphoma, and multiple myeloma in 2020. Identifying its geographical distribution, risk factors, and epidemiological trends could help identify high-risk population groups. We aimed to examine the worldwide incidence, mortality, associated risk factors, and temporal trends of multiple myeloma by sex, age, and geographical region. The incidence and mortality of multiple myeloma were extracted from Global Cancer Observatory (2020), Cancer Incidence in Five Continents, WHO mortality database, Nordic Cancer Registries, and Surveillance, Epidemiology, and End Results Program (1980-2019). The WHO Global Health Observatory data repository was searched for the age-standardised prevalence of lifestyle and metabolic risk factors (2010). Associations with risk factors were examined by multivariable regression. The temporal trends were evaluated by average annual percentage change (AAPC) using joinpoint regression. The age-standardised rate (ASR) of multiple myeloma incidence was 1·78 (95% UI 1·69-1·87) per 100 000 people globally and mortality was 1·14 (95% UI 1·07-1·21) per 100 000 people globally in 2020. Increased incidence and mortality were associated with higher human development index, gross domestics product, prevalence of physical inactivity, overweight, obesity, and diabetes. Australia and New Zealand (ASR 4·86 [4·66-5·07]), northern America (4·74 [4·69-4·79]), and northern Europe (3·82 [3·71-3·93]) reported the highest incidence. The lowest incidences were observed in western Africa (0·81 [0·39-1·66]), Melanesia (0·87 [0·55-1·37]), and southeastern Asia (0·96 [0·73-1·27]). Overall, more countries had an increase in incidence, especially in men aged 50 years or older. The countries with the highest incidence increase in men older than 50 years were Germany (AAPC 6·71 [95% CI 0·75-13·02] p=0·027), Denmark (3·93 [2·44-5·45] p=0·00027), and South Korea (3·25 [0·69-5·88] p=0·019). For women aged 50 years or older, Faroe Islands (21·01 [2·15-43·34] p=0·032), Denmark (4·70 [1·68-7·82], p=0·0068), and Israel (2·57 [0·74-4·43] p=0·012) reported the greatest increases. Overall, there was a decreasing trend for multiple myeloma mortality. The highest mortality was observed in Polynesia (ASR 2·69 [0·74-9·81]), followed by Australia and New Zealand (1·84 [1·73-1·96]) and northern Europe (1·80 [1·73-1·88]). The lowest mortalities were reported in southeastern Asia (ASR 0·82 [0·62-1·09]), eastern Asia (0·76 [0·71-0·81]), and Melanesia (0·73 [0·61-0·87]). Men (1·41 [1·29-1·53]) were found to have mortality higher than women (0·93 [0·85-1·02]). There was an increasing trend of multiple myeloma incidence globally, particularly in men, people aged 50 years or older, and those from high-income countries. The overall decreasing global trend of multiple myeloma mortality was more evident in women. Lifestyle habits, diagnosis capacity, and treatment availability should be improved to control the increasing trends of multiple myeloma in high-risk populations. Future studies should explore the reasons behind these epidemiological transitions. None.

Burn wound healing activity of ethanol extract gel of Green Algae (Ulva lactuca L) in mice

Recently, burn injuries have become a major cause of morbidity and mortality in low-middle-income countries. Burn injuries are tissue loss caused by contact with heat sources such as hot water, fire, chemicals, electricity, and radiation. According to the WHO Global Burden Disease, in 2017 an estimated 180.000 people died from burn injuries. Ethanol extract of green algae (EEGA) contains compounds that potentially heal burn injuries. The research was conducted to obtain a gel formulation from EEGA and test its burn wound healing properties in mice ( Mus musculus ). Forty-five mice were divided into five groups: I (negative control), II (treated with gel base), III (positive control, Bioplacenton gel), IV (5% EEGA gel), and V (10% EEGA gel). Wound diameters and description scores were observed every fourth, seventh, and fourteenth day, and the derived data were analyzed in the SPSS program with the one-way analysis of variance (ANOVA) and least significance difference (LSD) test. The results indicate that EEGA can be formulated into gels with physical properties compliant with the requirements of the dosage form. Further, it was found that Groups IV and V showed significant reductions in wound description scores and diameters (p&lt;0.05). In conclusion, gels containing 5% and 10% EEGA possess burn wound healing properties.

Availability of essential medicines for children with cancer in Sri Lanka: a prospective cohort study

The WHO Model List of Essential Medicines for children (2019 version) contains 39 antineoplastic and supportive medicines deemed essential for the successful treatment of children with cancer. The availability of these medicines varies across countries, but most reports are retrospective or short term. This study tracked the availability of these medicines in Sri Lanka's only treatment centre for childhood cancer, the National Cancer Institute of Sri Lanka, over 1 year, and examined initial mitigation strategies and implications. We prospectively tracked the availability of essential medicines at the National Cancer Institute of Sri Lanka in a customised database from April 1, 2019, to March 31, 2020. Consumption volumes and unit prices were extracted from the Sri Lankan Ministry of Health's Medical Supplies Management Information System. Availability was mapped against regimens used to treat childhood cancers, including WHO Global Initiative for Childhood Cancer index cancers, in Sri Lanka and by the International Society of Paediatric Oncology. Descriptive analyses and linear regression were used to assess factors associated with the unavailability of medicines. 31 (79%) of 39 medicines listed in the WHO Model List of Essential Medicines for children are in the Sri Lankan Essential Medicine List and 36 (92%) of 39 (48 formulations) are registered for use. Thioguanine, arsenic, and realgar-Indigo naturalis were the unregistered medicines. Over the study period, less than half (17 [44%]) of medicines were consistently available for 100% of the study period, 14 (36%) were available 75-100% of the study period, three (8%) between 50-75% of the study period, and two (5%) for less than 50% of the duration of the study period. The least available drug was procarbazine (available only on 212 [58%] of 366 days in the total study period). The availability of medicines did not reach 100% on any day in the study period. No substantial monthly variability was noted, but the best availability was in August, 2019, and the worst in January, 2020. Applying regimen-based analyses for acute lymphoblastic leukaemia, 12 stockout episodes affected seven (18%) medicines (median 37·5 consecutive days, IQR 12·0-62·0), whereas stockout mitigation strategies (low stock periods not resulting in stockout) were effective in 11 instances; only three (8%) medicines did not have alternate formulations or substitutions during stockouts (vincristine, cytarabine, and mercaptopurine). Of the WHO Global Initiative for Childhood Cancer index cancers, Hodgkin lymphoma was the most affected by stockouts, and retinoblastoma was the least affected. Annual consumption volumes (p=0·13), unit cost (p=0·5), and annual costs per medicine (p=0·091) were not significantly associated with medicine unavailability. Non-availability of essential medicines is an important problem to be addressed for children with cancer in Sri Lanka. This study showed the feasibility of prospective essential medicines tracking at the point-of-care, and how data visibility can inform stock and inventory management and help to identify mitigation strategies for stockouts. None.

Defining availability of 100 essential diagnostic items for children with cancer and gaps in implementing WHO recommendations: Global CEDx Working Group survey

WHO has established recommendations to guide governments' prioritisation of essential diagnostic tests, technologies, and priority medical devices for patients with cancer. Despite many countries committing to expanding resources for children with cancer since the WHO Global Initiative for Childhood Cancer was launched in 2018, data on the availability of essential diagnostics and on local awareness and adoption of WHO recommendations in low-income and middle-income countries are scarce. A purposive group of providers and policy makers was invited to review national interventions for access to diagnostics as part of their national cancer control plan or involvement in the WHO Global Initiative for Childhood Cancer. More than 800 diagnostic items (ie, diagnostic tests and diagnostic devices or equipment) from WHO recommendations for priority medical devices for cancer and essential in-vitro diagnostics list were iteratively summarised into 100 items relevant for children with cancer. A survey (in English, Spanish, French, and Russian) was developed to assess diagnostics availability and COVID-19 impact on access; out-of-pocket needs, or financial burden on families to pay for diagnostics; perception of the WHO recommendations with respect to completeness and relevance, use and usefulness for children with cancer; and factors affecting recommendation adoption and implementation. 380 participants from 16 low-income and middle-income countries in six WHO regions (Costa Rica, Dominican Republic, El Salvador, Ghana, Guatemala, Haiti, Honduras, Morocco, Myanmar, Nicaragua, Panama, Peru, Philippines, Sri Lanka, Ukraine, and Zambia), were invited. The median response rate across the 16 countries was 80%. 231 (80%) of 289 eligible respondents were multidisciplinary clinicians (including 101 paediatric haematologist-oncologists), and 58 (20%) self-identified primarily as administrators, non-governmental organisation representatives, and policy makers. Although some diagnostic items were not available in all settings, disparities were evident. Diagnostic items were significantly more available in the private than in the public setting across all three categories of laboratory and pathology (+25%), surgery and anaesthesia (+19%), and imaging (+43%; p<0·0015 for all categories). Most respondents indicated that at least one in four patients were affected by varying availability of diagnostic items, and that families paid out-of-pocket for essential diagnostic items. Top-ranked priorities by respondents included addressing access to advanced and basic diagnostics, delays in tests, and families' need to pay out-of-pocket. 119 (85%) of 140 eligible respondents considered that the 100 distilled core items reflected a complete list for laboratory and pathology, surgery and anaesthesia, and imaging. Although 69 (87%) of 79 respondents and 155 (90%) of 172 respondents found WHO recommendations useful and relevant, 228 (83%) of 276 had little previous familiarity with the recommendations, and only 82 (29%) of 278 had previously used them, mainly as personal references. Top factors affecting adoption and implementation of WHO recommendations included awareness and ease of extracting and applying recommendations to childhood cancer and to local contexts. This study established the availability of a core set of 100 essential diagnostic items recommended by WHO in low-income and middle-income countries in different phases of expanding access to care for children with cancer. A scarcity of essential laboratory and pathology, surgery and anaesthesia, and imaging diagnostics in all settings were identified, as well as a disproportionate lack of access for patients in the public setting, further disrupted by the COVID-19 pandemic. This study explored local awareness and factors affecting adoption and implementation of WHO recommendations and priorities for policy action. Our findings point to the utility of an essential diagnostics list for children analogous to WHO's essential medicines list. American Lebanese Syrian Associated Charities and St Jude Children's Research Hospital.

Measuring anti-transgender stigma in low-income and middle-income countries: a scoping review protocol

IntroductionGlobally, transgender and other gender diverse (trans) people face pervasive stigma, which contributes to health inequities across multiple health outcomes. Stigma is a fundamental cause of health inequities because it...

Effect of Music Therapy on Oxygen Saturation Level: A Literature Review

Music therapy as a non-invasive therapeutic modality is gaining prominence worldwide both in hospital settings as an adjunct therapy as well as for community wellbeing. Music therapy offers encouraging evidence-based outcomes for stabilising vital parameters to improve symptoms associated with complex illnesses such as autism spectrum disorder or major depressive disorders. The purpose of this review is to 1) identify scientific literatures that offer insights on the effect of music therapy on oxygen saturation levels of patients undergoing treatments for diverse conditions; 2) compare the effects of music therapy based on identified parameters 3) analyse the critical reviews of the researchers of studies included in this literature scan and 4) synthesise the review findings for the benefit of future scientific researches on the effect of music therapy on oxygen saturation levels. In this review, an analysis of relevant scientific papers published in the last 80 years from 1940 to 2020 (as available) was done by searching databases such as PubMed, Cochrane Library, Wiley Online Library, Gray Literature sources such as Google Scholar, Worldcat; DOAJ, and WHO Global Index Medicus. Eighteen relevant papers describing music therapy’s effect on the patient’s oxygen saturation levels (under different conditions) were included in the review. The results and discussions respectively compare and analyse characteristics of included studies, music therapy administered, measuring device used, the effectiveness of music therapy on oxygen saturation levels, and critical reviews of authors of the scanned literature.

Applying ‘cultural humility’ to occupational therapy practice: a scoping review protocol

IntroductionCultural humility is becoming increasingly important in healthcare delivery. Recognition of power imbalances between clients and healthcare providers is critical to enhancing cross-cultural interactions in healthcare delivery. While cultural humility...

Safety of an inactivated, whole-virion COVID-19 vaccine (CoronaVac) in people aged 60 years or older in Hong Kong: a modified self-controlled case series

BackgroundBecause evidence on the safety of COVID-19 vaccines in older adults is scarce, we aimed to evaluate the incidence and risk of adverse events after CoronaVac (Sinovac Biotech) vaccination in adults aged 60 years or older.MethodsIn this modified self-controlled case series, we enrolled adults aged 60 years or older who had received at least one dose of CoronaVac in Hong Kong between Feb 23, 2021, and Jan 31, 2022. We extracted population-based, electronic health record data from the clinical management system of the Hospital Authority on adverse events of special interest (from Jan 1, 2005, to Feb 23, 2022) and patients' demographic information (from Jan 1, 2018, to Jan 31, 2022), previous diagnoses (from Jan 1, 2018, to Jan 31, 2022), medication history (from Jan 1, 2018, to Jan 31, 2022), and laboratory tests, including those for SARS-CoV-2 infection (from Jan 1, 2018, to Jan 31, 2022). Details of vaccination status were provided by the Department of Health of the Hong Kong Government and were linked to data from the Hospital Authority with identity card numbers or passport numbers. Our outcomes were the overall incidence of any adverse event of special interest and the incidence rates of 30 adverse events of special interest, as suggested by the WHO Global Advisory Committee on Vaccine Safety, in the inpatient setting within 21 days (2 days for anaphylaxis) of either the first, second, or third CoronaVac dose compared with a baseline period. Individuals who had a history of a particular event between Jan 1, 2005, and Feb 23, 2021, were excluded from the corresponding analysis. We evaluated the risk of an adverse event of special interest using conditional Poisson regression, adjusting for seasonal effects.FindingsOf 1 253 497 individuals who received at least one dose of CoronaVac during the study period, 622 317 (49·6%) were aged at least 60 years and were included in the analysis. Our analysis sample received 1 229 423 doses of CoronaVac and had a mean age of 70·40 years (SD 8·10). 293 086 (47·1%) of 622 317 participants were men and 329 231 (52·9%) were women. The incidence of individual adverse events of interest ranged from 0·00 per 100 000 people to 57·49 per 100 000 people (thromboembolism). The first and third doses of CoronaVac were not associated with a significant excess risk of an adverse event of special interest within 21 days (or 2 days for anaphylaxis) of vaccination. After the second dose, the only significantly increased risk was for anaphylaxis (adjusted incidence rate ratio 2·61, 95% CI 1·08–6·31; risk difference per 100 000 people 0·61, 95% CI 0·03–1·81).InterpretationBecause older age is associated with poor outcomes after SARS-CoV-2 infection, the benefits of CoronaVac vaccination in older adults outweigh the risks in regions where COVID-19 is prevalent. Ongoing monitoring of vaccine safety is warranted.FundingThe Food and Health Bureau of the Government, Hong Kong Special Administrative Region, China and AIR@InnoHK, administered by the Innovation and Technology Commission.TranslationFor the Chinese translation of the abstract see Supplementary Materials section.

Survey on national practices regarding iodine thyroid blocking in 2016-2017.

Severe nuclear accidents may lead to a release of radioactivity, including radioactive iodine, into the environment. The thyroid gland in the human body needs natural or stable iodine to function properly and this iodine is normally absorbed in small quantities from food. Following a release of radioactive iodine from a nuclear or radiological accident, the body will absorb and accumulate the radioactive iodine in the thyroid gland. This increases the risk of thyroid cancer, especially in children. Since the thyroid gland cannot distinguish between radioactive and stable iodine, stable iodine can be taken to prevent the absorption of radioiodine by the thyroid in the event of a nuclear emergency. This is referred to as Iodine Thyroid Blocking (ITB). In 2017, the World Health Organization published revised guidelines entitled ‘Iodine Thyroid Blocking: guidelines for use in planning for and responding to radiological and nuclear emergencies’. The purpose of these guidelines is to support Member States in planning for and implementation of ITB before and during a radiation emergency. To enable the monitoring and measurement of the impact of a specific recommended intervention, a baseline should be established against which the impact will be measured over a certain period of time. With that in mind, a global WHO survey of national policies on ITB was carried out in 2016-2017. Here, an overview of some core findings of this survey is provided.

Depressive Symptoms Among Adolescents in Bangladesh

Adolescent mental well-being hardly took precedence in Bangladesh, which is reflected in both policies and literature. This study assessed the common symptoms of depression among school-going adolescents (aged 10–19 years) in Bangladesh. Primary data were collected during October–November 2019 from 289 participants in four schools using a questionnaire based on the WHO global school-based student health survey and WHO stepwise approach to NCD (Tools version 9.5). Sadness (45.3%) and aggression (40.5%) were the most common depressive symptoms found in the study, followed by confusion (27.7%), worthlessness (21.8%), fatigue (21.5%), and insomnia (18.0%). The sex of the student, grade of study, and duration of daily sleep showed differential associations with these symptoms. These findings indicate a crucial stage of adolescence, where the different societal pressures often ignored by primary carers, could have detrimental effect on children. There is an urgent need to address the growing adolescent mental health issue in Bangladesh and a need for health system to recognize its precedence.

Predisposing Factors of Tuberculosis Infection in Systemic Lupus Erythematosus Patients: A Single-Center Case-Control Study.

Introduction: Indonesia has the second-highest tuberculosis cases in the world, according to the global WHO tuberculosis report, amounting to approximately 10% of the world's tuberculosis cases. Systemic lupus erythematosus (SLE) patients are at an increased risk for tuberculosis infection. This research aims to analyze the association between corticosteroid pulse dose, corticosteroid cumulative dose, SLE disease duration, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and lupus nephritis status with the development of tuberculosis in SLE patients.Methods: This research was a matched case-control study to identify risk factors of tuberculosis infection in SLE patients. Data were taken from medical records of Cipto Mangunkusumo National General Hospital, a national tertiary hospital. Inclusion criteria were patients who meet the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria of SLE in the period of 2012-2016 or patients who meet the SLICC 2012 SLE criteria and developed tuberculosis between 2012 and 2016. Statistical analyses used were bivariate analysis and correlation analysis. All statistical analyses were conducted using SPSS software (IBM Corp., Armonk, NY). All statistical analyses were defined as statistically significant when the p-value was less than 0.05.Results: A total of 48 SLE patients were included from medical records consisting of 24 SLE patients with tuberculosis infection and controls of 24 SLE patients without tuberculosis infection. In this study, it was observed that the presence of lupus nephritis (p = 0.001), administration of pulse corticosteroids (p = 0.048), high corticosteroid cumulative dose (p = 0.001), and high SLEDAI score (p = 0.003) were associated with tuberculosis infection. Correlation analysis showed that all of these variables had a weak positive correlation with tuberculosis infection in SLE patients.Conclusion: SLE patients with lupus nephritis, administration of pulse corticosteroids, high cumulative corticosteroid dose, and high SLEDAI score have a higher risk of tuberculosis infection. Clinicians and patients should be aware of these risk factors in SLE patients to prevent tuberculosis infection. Corticosteroid pulse dose should be avoided in SLE patients and if it is needed, tuberculosis prophylaxis may be considered.

Decriminalizing suicide attempt in the 21st century: an examination of suicide rates in countries that penalize suicide, a critical review

BackgroundDecriminalizing suicide may decrease overall suicide rates because then individuals who are at risk of suicide would be more willing to seek help from the community and from mental health professionals, therefore enabling early interventions for preventing suicidality. We aimed to examine the suicide trends over the last 20 years in 20 countries that still criminalize attempted suicide, and to compare the suicide rates of these 20 countries against the global average suicide rate and to a comparison sample of 20 countries that do not criminalize suicide, matched according to region and majority religion.MethodsAge-standardized suicide rates were extracted from the WHO Global Health Estimates, available for the period 2000-2019. Population data were extracted from the World Bank. We analyzed only countries which criminalize attempted suicide under its criminal justice system. Countries were further categorized according to their membership in the Commonwealth of Nations and countries in Africa. Countries from the same region and with the same majority religion were chosen as a matching group. Joinpoint analysis was used to compare the trends of the two groups with the global average.ResultsBased on the 2019 WHO Global Health Estimates data, there is a large range in the suicide rates of the countries that criminalize attempted suicide, from 2.5 (Brunei) to 40.9 (Guyana) per 100,000 population. The mean suicide rate was 8.3 (Standard Deviation = 10.6). Out of the 20 countries, seven have suicide rates higher than the global average, covering a total population of about 387.3 million. Of these seven countries, five are in the African region. The other thirteen countries have suicide rates between 2.5 to 8.2. Mean scores of the countries which criminalized attempted suicide was lower than the global average and 20 comparison countries over the 20 years, but average annual percentage in the decrease of suicide was greater for countries in which attempted suicide was not criminalized.ConclusionsBased on our review, there was no substantial evidence here to indicate that countries which criminalized attempted suicide had consistently lower suicide rates compared to the global average. There is a need to acknowledge that the currently available evidence is inadequate to definitively claim that criminalizing suicide is beneficial or harmful for the reduction of suicide rate for the entire populations. Future studies should continue to evaluate the unique effects of decriminalizing attempted suicide while controlling for other key associated factors.