WHO Strategy Research Articles

Improving National and International Surveillance of Movement Behaviours in Childhood and Adolescence: An International Modified Delphi Study.

The actions required to achieve higher-quality and harmonised global surveillance of child and adolescent movement behaviours (physical activity, sedentary behaviour including screen time, sleep) are unclear. To identify how to improve surveillance of movement behaviours, from the perspective of experts. This Delphi Study involved 62 experts from the SUNRISE International Study of Movement Behaviours in the Early Years and Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: (1) funding, (2) capacity building, (3) methods, and (4) other issues (e.g., policymaker awareness of relevant WHO Guidelines and Strategies). Expert participants ranked 40 items on a five-point Likert scale from 'extremely' to 'not at all' important. Consensus was defined as > 70% rating of 'extremely' or 'very' important. We received 62 responses to round 1 of the survey and 59 to round 2. There was consensus for most items. The two highest rated round 2 items in each category were the following; for funding (1) it was greater funding for surveillance and public funding of surveillance; for capacity building (2) it was increased human capacity for surveillance (e.g. knowledge, skills) and regional or global partnerships to support national surveillance; for methods (3) it was standard protocols for surveillance measures and improved measurement method for screen time; and for other issues (4) it was greater awareness of physical activity guidelines and strategies from WHO and greater awareness of the importance of surveillance for NCD prevention. We generally found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30) or between SUNRISE (n = 20), AHKGA (n = 26) or both (n = 13) initiatives. There was a lack of agreement on using private funding for surveillance or surveillance research. This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally.

Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care

ObjectiveThis study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia.DesignSecondary data analysis of institution-based cross-sectional national survey data.SettingData...

Core outcome set for intervention research on snakebite envenomation in South Asia

BackgroundThe 2019 WHO strategy to reduce snakebite burden emphasises the need for fostering research on snakebite treatments. A core outcome set (COS) is a consensus minimal list of outcomes that...

WHO strategies to improve child and adolescents health in Europe

Across Europe, the health and wellbeing of children and adolescents requires attention. After the COVID-19 pandemic, the prevalence of mental health conditions has doubled, affecting 1 in 4 adolescents under the age of 18. Overweight and obesity are increasing: 1 in 3 primary school children are overweight or obese. Inequalities in weight and mental health are increasing in many countries, driven by socioeconomic circumstances. Reduction in child mortality, particularly of neonates, is stagnating in several countries, especially in Eastern Europe and Central Asia, and reversing in some.To rally member states to action, WHO is developing a new regional Child and Adolescent Health Strategy. The development commenced in 2019 with the identification of problem statements of issues affecting children and adolescents. These were then converted into actionable standards. They were updated considering the COVID-19 experience and the effects of regional crises on children. Children and adolescents were engaged in the development of the strategy, to identify and take their priorities into account, and stakeholders inside and outside WHO were consulted, including pediatricians and their societies. During a Member States consultation, European countries will have the opportunity to review and revise the draft strategy before it will be presented to the WHO Regional Committee for Europe for adoption.The main components of the strategy are: Early childhood development, school and adolescent health, strengthening health systems and improving quality of care, recognizing and acting on the needs of the most vulnerable and galvanizing societal action on the commercial, social, environmental and digital determinants of health affecting children and adolescents.The strategy forms the basis for monitoring regional progress. It will enable the development of national child and adolescent health and wellbeing strategies and monitoring frameworks. The implementation of the strategy will enable children and adolescents to realize their right to physical, social and mental health and well-being in healthy and enabling environments, so that they can fully participate in shaping prosperous and sustainable societies.

Impact of immunity loss on the optimal vaccination strategy for an age-structured epidemiological model.

The pursuit of effective vaccination strategies against COVID-19 remains a critical endeavour in global public health, particularly amidst challenges posed by immunity loss and evolving epidemiological dynamics. This study investigated optimal vaccination strategies by considering age structure, immunity dynamics, and varying maximal vaccination rates. To this end, we formulated an SEIR model stratified into $ n $ age classes, with the vaccination rate as an age-dependent control variable in an optimal control problem. We developed an objective function aimed at minimising critical infections while optimising vaccination efforts and then conducted rigorous mathematical analyses to ensure the existence and characterization of the optimal control. Using data from three countries with diverse age distributions, in expansive, constrictive, and stationary pyramids, we performed numerical simulations to evaluate the optimal age-dependent vaccination strategy, number of critical infections, and vaccination frequency. Our findings highlight the significant influence of maximal vaccination rates on shaping optimal vaccination strategies. Under constant maximal vaccination rates, prioritising age groups based on population demographics proves effective, with higher rates resulting in fewer critically infected individuals across all age distributions. Conversely, adopting age-dependent maximal vaccination rates, akin to the WHO strategy, may not always lead to the lowest critical infection peaks but offers a viable alternative in resource-constrained settings.

A review of the WHO strategy on traditional, complementary, and integrative medicine from the perspective of academic consortia for integrative medicine and health.

Despite important progress in modern medicine, widely regarded as an indispensable foundation of healthcare in all highly advanced nations and regions, not all patients respond well to available treatments in biomedicine alone. Additionally, there are concerns about side effects of many medications and interventions, the unsustainable cost of healthcare and the low resolution of chronic non-communicable diseases and mental disorders whose incidence has risen in the last decades. Besides, the chronic stress and burnout of many healthcare professionals impairs the therapeutic relationship. These circumstances call for a change in the current paradigm and practices of biomedicine healthcare. Most of the world population (80%) uses some form of traditional, complementary, and integrative medicine (T&CM), usually alongside biomedicine. Patients seem equally satisfied with biomedicine and T&CM, but in the field of T&CM there are also many challenges, such as unsupported claims for safety and/or efficacy, contamination of herbal medicines and problems with regulation and quality standards. As biomedicine and T&CM seem to have different strengths and weaknesses, integration of both approaches may be beneficial. Indeed, WHO has repeatedly called upon member states to work on the integration of T&CM into healthcare systems. Integrative medicine (IM) is an approach that offers a paradigm for doing so. It combines the best of both worlds (biomedicine and T&CM), based on evidence for efficacy and safety, adopting a holistic personalized approach, focused on health. In the last decades academic health centers are increasingly supportive of IM, as evidenced by the foundation of national academic consortia for integrative medicine in Brazil (2017), the Netherlands (2018), and Germany (2024) besides the pioneering American consortium (1998). However, the integration process is slow and sometimes met with criticism and even hostility. The WHO T&CM strategies (2002-2005 and 2014-2023) have provided incipient guidance on the integration process, but several challenges are yet to be addressed. This policy review proposes several possible solutions, including the establishment of a global matrix of academic consortia for IM, to update and extend the WHO T&CM strategy, that is currently under review.

Economic consequences of the implementation of primary DNA-HPV genotype testing in Bulgaria

There is a global call for action for cervical cancer elimination as a public health problem—WHO Strategy 90-70-90. One of the strategic pillars, alongside vaccination, is cervical cancer screening. This aims to assess the economic consequences and cost-effectiveness of primary DNA-HPV testing for cervical cancer screening in Bulgaria. Combined cost-effectiveness (CEA) and cost-benefit (CBA) analysis was performed to evaluate the net benefit of the HPV genotype testing program among women aged 30–54 in Bulgaria and to compare its cost-effectiveness with the current practice. ICER was presented separately for only direct costs and direct + indirect costs. The CBA analysis for the age group 30-54 shows that the benefit/cost ratio of DNA-HPV primary screening is 1.03 and the net present benefit accounts for 373,023 euro thus making the program beneficial for the healthcare system. CEA shows that HPV screening is cost-effective over the current practice of PAP testing with ICER 1634 euro/LYG when considering only direct costs and—8020 euro/LYG for direct and indirect costs. The ICER in terms of the sensitivity rate of the testing methods is 1316 euros. The LYG earned with the HPV testing account for 4989 for the observed women. Primary hrHPVDNA-based screening is an important scientific and clinical advance since it offers better reassurance of low cancer risk compared to cytology-only screening conducted at the same interval. Primary hrHPV screening can be considered as a dominant alternative to current cytology-based cervical cancer screening approaches including cytology alone and contesting and providing better benefit.

Tuberculosis in southern Morocco: Retrospective analysis from 2006 to 2012.

Tuberculosis, a global major concern, causes millions of deaths annually despite WHO strategies. A persistent gap in detection and treatment facilitates rapid spread in high-burden countries. Analyze the clinical-epidemiological profile of tuberculosis patients in Laayoune and Tarfaya, Morocco, emphasizing risk factors and evolution of the tuberculosis Methods: Retrospective analysis of 1332 tuberculosis cases at the Respiratory Diseases Diagnosis and Treatment Center in Laayoune (2006-2012). Variables with P < 0.10 in univariate analysis were included in multivariate analysis using multiple logistic regression to define the risk factors for tuberculosis, expressed as odds ratios (OR) with a 95% confidence interval (CI). The analysis revealed a pulmonary predominance (≈61%), with pleural (41.3%) and lymph node (31.5%) tuberculosis prevalent among extrapulmonary cases. Among 515 extrapulmonary tuberculosis cases, intestinal tuberculosis (14 cases) showed the highest mortality rate at 14.29%. The 15 to 64 age groups had a significantly higher risk of contracting pulmonary tuberculosis to children, and the 65 and over age group also had the highest risk of developing pulmonary tuberculosis (aOR=5.83 [2.43, 14.00]). Other risk factors included rural origin, personal history of tuberculosis, and smoking, all significantly associated with pulmonary tuberculosis (aOR=2.40 [1.001, 5.76]; aOR=2.00 [1.11, 3.61]; aOR=2.38 [1.40, 4.06]). Conversely, female gender was a protective factor (aOR=0.53 [0.40, 0.70]). Regarding recovery and loss to follow-up rates, they were higher in those with pulmonary tuberculosis (39.0% vs 2.1%; aOR=33.41 [17, 66.52]; 16.9% vs 10.3%; aOR=1.57 [1.02, 2.41], respectively). Holistic initiatives across various sectors will be essential to eliminate tuberculosis by 2030.

Cervical cancer prevention by vaccination: review.

Routine use of human papillomavirus (HPV) vaccines is recommended in adolescents under 15 years of age worldwide. Still, effective programs remain suboptimal for several factors, making the WHO strategy to eradicate cervical cancer public health with an uncertain future. To review the literature on the effectiveness, long-term protection, and safety of HPV vaccination programs and vaccination as adjuvant management. This review aims to describe the current state of vaccination programs and demonstrate the long-term protection and safety of vaccines implemented worldwide targeting adolescent girls, with the most recent published evidence of the three prophylactic HPV vaccines - bivalent (bHPV), quadrivalent (qHPV), and nonavalent (nHPV)-. We mainly focus on publications evaluating efficacy, dosing schemes, and HPV vaccination, as well as studies contributing to the mounting evidence for the real-life effectiveness of prophylactic HPV vaccines from several countries. Human Papillomavirus vaccination programs have made remarkable strides in preventing HPV-related diseases; countries with robust vaccination efforts have witnessed substantial reductions in HPV-related diseases with a decline in high-grade cervical abnormalities and genital warts (54%-83%). However, global coverage remains uneven, with disparities between high-income (HICs) and low-income countries (LMICs). The long-term efficacy of the available human papillomavirus (HPV) goes up to 9.4 years and continues to be immunogenic and well tolerated with an excellent safety profile. As these are crucial topics in HPV vaccination, it is essential to establish systems for continued monitoring of vaccine immunogenicity, efficacy, and safety over time.

CLINICAL DIAGNOSTIC ALGORITHMS OF ACTION IN THE PRACTICE OF A DOCTOR OF GENERAL PRACTICE – FAMILY MEDICINE DISEASES OF THE URINARY SYSTEM IN CHILDREN

Chronic kidney disease (CKD) is the presence of markers of pathological changes in the urinary system lasting more than 12 weeks, regardless of their cause. The number of cases in children with diseases of the urinary system has documented confi rmed chronic kidney disease according to the implemented regional registry of patients with CKD, but its signifi cant spread is observed. Early manifestations of CKD are often underestimated and not treated in time. CKD and chronic renal failure are not a narrowly defi ned nephrological problem. Nowadays, military aggression and the consequences of the 2019 coronavirus pandemic (COVID-19), which led to the destruction of standard ways (patient clinical routes) in the provision of medical care, the issue of providing medical care to children on the basis of evidence- based and personalized medicine is of particular relevance in Ukraine, which, according to the WHO strategy, should meet the needs and be safe,eff ective, timely and of appropriate quality. The introduction of innovations in pediatric practice in terms of standardization of medical care helps the physician to act eff ectively in specifi c clinical situations, avoiding ineff ective actions. Involvement of specialists of other specialties (general practitioners- family medicine, endocrinologists, urologists, cardiologists, pediatricians, ophthalmologists) in the management of CKD without coordination of cooperation to ensure the principle of continuity complicates the diagnostic and/or therapeutic support of the patient. Early diagnosis, proper management tactics of pediatric patients with diseases of the urinary system at the outpatient stage is an important component in the provision of integrated, patient- oriented medical care in the practice of a general practitioner- family medicine. The article highlights the clinical and diagnostic algorithms of action of a general practitioner- family medicine regarding the tactics ofmanagement of pediatric patients with the most common nephrological symptoms: leukocyturia (bacteriuria), proteinuria and erythrocyturia. The scientifi c research was carried out within the framework of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University. The research topics included: Research project on «Chronobiological and adaptive aspects and features of autonomic regulation in pathological conditions in children of diff erent age groups» (State registration number: 0122U002245, duration: 01.01.2022-31.12.2026).

Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review.

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.

Feasibility and acceptability of an HPV self-testing strategy: lessons from a research context to assess for ability to implement into primary care at a national level in Botswana.

The WHO strategy for cervical cancer elimination strives to achieve 70% coverage with high-performance cervical screening. While few low- and middle-income countries have achieved this, high-risk human papillomavirus (hrHPV) self-testing creates the possibility to rapidly upscale access to high-performance cervical screening across resource settings. However, effective hrHPV screening requires linkage to follow-up, which has been variable in prior studies. This study developed and tested an implementation strategy aimed at improving screening and linkage to follow-up care in South East District in Botswana. This study performed primary hrHPV self-testing; those with positive results were referred for a triage visit. Withdrawals for any reason, loss-to follow-up between hrHPV test and triage visit, and number of call attempts to give hrHPV results were also documented. Acceptability of the program to patients was measured as the proportion of patients who completed a triage visit when indicated, meeting the a priori threshold of 80%. Feasibility was defined as the proportion of participants receiving the results and attending follow-up. To assess the associations between participant characteristics and loss-to-follow-up we used log-binomial regressions to estimate risk ratios and 95% confidence intervals (CI). Enrollment of 3,000 women occurred from February 2021 to August 2022. In total, 10 participants withdrew and an additional 33 were determined ineligible after consent, leaving a final cohort of 2,957 participants who underwent self-swab hrHPV testing. Half (50%) of participants tested positive for hrHPV and nearly all (98%) of participants received their hrHPV results, primarily via telephone. Few calls to participants were required to communicate results: 2,397 (82%) required one call, 386 (13%) required 2 calls, and only 151 (5%) required 3-5 calls. The median time from specimen collection to participant receiving results was 44 days (IQR, 27-65). Of all hrHPV positive participants, 1,328 (90%) attended a triage visit. In a large cohort we had low loss-to-follow-up of 10%, indicating that the strategy is acceptable. Telephonic results reporting was associated with high screening completion, required few calls to participants, and supports the feasibility of hrHPV self-testing in primary care followed by interval triage.

Intestinal Helminth Infections and Their Association with QuantiFERON-TB Gold Plus Test Performance in an Endemic Setting, Northwest Ethiopia.

Timely detection and treatment of latent TB infection (LTBI) is part of WHO's strategy against tuberculosis (TB). Helminth infections can modulate immune responses, potentially impacting the performance of interferon-gamma release assays (IGRAs) such as the QuantiFERON-TB Gold Plus (QFT-Plus). This study evaluated the association between helminth infections and QFT-Plus results among participants from a TB-endemic region. A cross-sectional study was conducted from October 2022 to March 2023 in Bahir Dar, Ethiopia. Stool samples of 314 potential participants were examined for helminths using wet mount and Kato-Katz techniques. LTBI was assessed by QFT-Plus from a total of 100 gender-matched helminth-positive and -negative participants. The association between helminth infection status, egg count, and QFT-Plus positivity was analyzed, and p values <0.05 were considered significant. Overall, 53 of 314 screened participants were infected with helminths (16.9%), with A. lumbricoides (47.2%) and hookworm (30.2%) as most prevalent species. The overall QFT-Plus positivity rate was 30.0%, with similar rates observed between helminth-positive and helminth-negative participants. Although QFT-Plus positivity was slightly lower in hookworm carriers (25%) compared to those with A. lumbricoides (32%), a higher-than-median hookworm egg burden was significantly associated with reduced QFT-Plus positivity (P = 0.029). QFT-Plus positivity was significantly higher among male participants than females (P = 0.032). While overall helminth infection status did not significantly affect QFT-Plus positivity, higher hookworm burden was associated with reduced QFT-Plus reactivity. These findings suggest that the type of helminth and infection intensity, rather than its mere presence, may influence IGRA performance. Further studies with larger sample sizes are warranted to understand the species-specific effect of helminth infection on immune modulation of the host.

Utilization of cervical cancer screening and determinant factors among female nurses in selected public hospitals in Addis Ababa, Ethiopia

BackgroundCervical cancer is one of the top cause of death among childbearing women globally and public health issue for underdeveloped nations.It is the world's second most prevalent cancer among women. In 2018, 311,000 women died due to cervical cancer.Approximately 80 % of these deaths occurred in developing countries.However, there has been insufficient research on cervical cancer screening utilisation among Ethiopian nurses, despite the fact that nurses promote women's health and play a key role in cervical cancer education. As a result, evaluating utilization of cervical cancer screening among nurses is critical for program effectiveness. ObjectiveTo assess the magnitude of utilization of cervical cancer screening and determinant factors among female Nurses in selected public hospitals in Addis Ababa, Ethiopia. MethodologyAn institutional-based cross-sectional study design was employed from October 1 to November 30, 2022. Data was collected using an interviewer-administered questionnaire. The data was entered into Epi data version 3.1 and then exported to SPSS version 22 for data management and analysis. Bivariate and multi-variable logistic regressions were employed to identify the predictor variables. Statistical significance was considered at P < 0.05 with adjusted odds ratio calculated at 95 % CI. ResultThe magnitude of utilization of cervical cancer screening among nurses working in selected public hospitals in Addis Ababa was 18.5 % (95 % CI: 14.2, 23.1). Having work experience > 8 years (AOR = 16.78; 95 % CI: 4.82, 58.44), history of STI (AOR = 53.72; 95 % CI: 14.18, 203.45) and having multiple sexual partners (AOR = 12.74; 95 % CI: 4.15, 39.11) were significantly associated with utilization of cervical cancer screening among female nurses. ConclusionThe overall cervical cancer screening rate among female nurses was low compared to the WHO strategy for cervical cancer elimination, which asks for 70 % of women worldwide to be checked for cervical illnesses regularly by 2030. According to the study findings, respondents' work experience, STI history, and having multiple sexual partners influenced their utilization of cervical cancer screening among nurses. To boost the utilization of screening services, female nurses should place a strong emphasis on maintaining screening awareness through education and knowledge sharing.Finally, we recommend future researchers to do comparative study design to draw any scientific and credible conclusions.

Improving access to safe, quality surgical care for gynecologic cancers through capacity-building interventions in low- and middle-income countries: A scoping review.

Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low- and middle-income countries (LMICs). A well-integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task-sharing and training of gynecologic oncologists (GynOncs). This review aimed to explore existing literature on capacity-building for surgical management of early-stage gynecologic cancers. The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task-sharing, or outcomes following operation by subspecialists compared to specialists were included. Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non-subspecialized care, and task-shifting/-sharing. A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity-building and task-sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost-effectiveness.

Treatment seeking dilemma for tuberculosis as timed strategic prisoner’s dilemma game

Treatment seeking choices of individuals is one of the biggest hindrance in the global strategy to eliminate Tuberculosis (TB) by 2030. The individuals have a choice to take treatment under Directly Observed Treatment, short course (DOTS) which is the preferred strategy for curing and reducing the risk of TB cases. However, undergoing treatment under DOTS requires some changes in the routine behaviour of the infected individual which results in a ‘treatment seeking dilemma’. In this work, we explore the consequences of human choice of treatment on TB incidence by developing a compartmental model conjoined with timed strategic prisoner’s dilemma game. We classify the infected individuals into two categories, the individuals who cooperate (go directly to the DOTS for the treatment) and the individuals who defect (do not go directly to the DOTS for the treatment). We analyse the repercussion of this treatment seeking dilemma on the success of the ‘end TB strategy’. We also analyse the effectiveness of WHO strategy of public–private mixing (PPM) on TB incidence.

Commentary] The WHO strategies to reduce tobacco-related deaths are insufficient

The World Health Organization’s Framework Convention on Tobacco Control (FCTC) aims to combat global tobacco-related deaths. While it has reduced smoking in some regions, its overall effectiveness is debated, especially regarding alternative nicotine products like e-cigarettes and Swedish snus. Although the WHO views these as threats, evidence suggests they could aid harm reduction. With differing smoking trends in various countries and emerging evidence supporting alternatives, the upcoming 10th Conference of the Parties (COP10) in Panama represents a crucial juncture to reassess and potentially redefine global tobacco control strategies.

Analysis of Registered Cases of Acute Flaccid Paralysis in Stara Zagora District as a Part of Polio Eradication Strategy

Abstract Poliomyelitis is the infection that, after smallpox, is a “serious candidate” for eradication worldwide. In accordance with the WHO strategy for 2022-2026, epidemiological surveillance of acute flaccid paralysis (AFP) is carried out with the aim of poliomyelitis eradication. The aim of the study is to determine the risk factors for the occurrence of AFP in children up to 15 years of age and to analyze the effectiveness of the established system for epidemiological surveillance of AFP, in Bulgaria. Materials and methods. All cases of AFP for the monitoring period 2012-2021, in Stara Zagora district, were studied. A questionnaire (34 questions) for sociodemographic and lifestyle possible risk factors for developing of AFP was also completed. Retrospective, descriptive and analytic cross-sectional epidemiological methods were applied. The data were analyzed using SPSS Statistics, Version 25.0 (IBM Corp. Armonk, NY, USA) (with Fisher’s exact test). Results. There were 81 cases of Facial paralysis only, registered in the Web based system for surveillance of AFP, for Stara Zagora region, and 11 – AFP (without facial paralysis), for the period 2012-2021, in Stara Zagora district (92 in total). The protective factors for developing of AFP from our study were significantly associated to: having no history of paresis or paralysis in the past; absence of trauma; presence of central sewage near the home; absence of contact with animals; absence of consumption of unwashed fruits and vegetables. Conclusion. It is very important to carry out systematic surveillance of AFP, in children up to 15 years, with the aim of investigating all cases as part of the Global strategy for the eradication of poliomyelitis; monitoring of the immunization coverage with polio vaccine to maintain a high level; surveillance of the waste and sewage waters, twice during the year in 6 months.

The icope Intrinsic Capacity Screening Tool: Measurement Structure and Predictive Validity of Dependence and Hospitalization.

To evaluate the measurement structure of the ICOPE screening tool (IST) of intrinsic capacity and to find out whether the IST as a global measure adds explanatory power over and above its domains in isolation to predict the occurrence of adverse health outcomes such as dependence and hospitalization in community-dwelling older people. Secondary analysis of a cohort study, the Toledo Study of Healthy Ageing. Province of Toledo, Spain. Community-dwelling older people. Items equal or similar to those of the IST were introduced as a reflective-formative construct in a Structural Equation Model to evaluate its measurement structure and its association with dependence for basic and instrumental activities and hospitalization over a three-year period. A total of 1032 individuals were analyzed. Mean age was 73.5 years (sd 5.4). The least preserved indicators were ability to recall three words (18%) and to perform chair stands (54%). Vision and hearing items did not form a single sensory domain, so six domains were considered. Several cognition items did not show sufficiently strong and univocal associations with the domain. After pruning the ill-behaved items, the measurement model fit was excellent (Satorra-Bentler scaled chi-square: 10.3, degrees of freedom: 11, p=0.501; CFI: 1.000; RMSEA: 0.000, 90% CI: 0.000-0.031, p value RMSEA<=0.05: 1; SRMR: 0.055). In the structural model, the cognition domain items were not associated as expected with age (p values 0.158 and 0.293), education (p values 0.190 and 0.432) and dependence (p values 0.654 and 0.813). The IST included as a composite in a model with the individual domains showed no statistically significant associations with any of the outcomes (dependence for basic activities: 0.162, p=0.167; instrumental: -0.052, p=0.546; hospitalization: 0.145, p=0.167), while only the mobility domain did so for dependence (basic: -0.266, p=0.005; instrumental: -0.138, p=0.019). The model fit of the last version was good (Satorra-Bentler scaled chi-square: 52.1, degrees of freedom: 52, p=0.469; CFI: 1.000; TLI: 1.000; RMSEA: 0.01, 90% CI: 0.000-0.02, p value RMSEA<=0.05: 1; SRMR: 0.071). The IST operationalized as the sum of non-impaired domains was not associated after covariate adjustment (dependence for basic activities: -0.065, p=0.356; instrumental: -0.08, p=0.05; hospitalization: -0.003, p=0.949) either. The cognitive domain of the IST, and probably other of its items, may need a reformulation. A global measure of intrinsic capacity such as the IST does not add explanatory power to the individual domains that constitute it. So far, our results confirm the importance of checking the findings of the IST with a second confirmatory step, as described in the WHO's ICOPE strategy.

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