Tuberculosis Co-Infection Is Common in Patients Requiring Hospitalization for COVID-19 in Belarus: Mixed-Methods Study

A significant drop in tuberculosis (TB) case-finding has been widely reported during the period of the COVID-19 pandemic. To address a decrease in TB notification, Belarus introduced laboratory TB testing in patients with the laboratory-confirmed coronavirus disease 2019 (COVID-19). We conducted a secondary analysis of health records among 844 patients with laboratory-confirmed COVID-19 diagnosis who were admitted to repurposed departments at TB hospitals and who were tested by Xpert MTB/RIF (Cepheid Inc., Sunnyvale, CA, USA) in five Belarus regions between April and October 2021. Quantitative analysis followed by 13 individual interviews with health managers, physicians, and nurses participating in the intervention. Most patients were male (64%) and mean age was 43.5 ± 16 years. One in twenty (n = 47, 5.6%) patients were co-infected with active pulmonary TB, and over one-third of them (n = 18) had rifampicin resistance. In-hospital mortality was comparable in patients with and without TB co-infection (2.1% and 2.3% respectively, p > 0.99). Laboratory TB testing among patients with COVID-19 at repurposed departments of TB hospitals is feasible in Belarus and may improve TB case-finding.

Environmental differences explain subtle yet detectable genetic structure in a widespread pollinator

BACKGROUND

The environment is a strong driver of genetic structure in many natural populations, yet often neglected in population genetic studies. This may be a particular problem in vagile species, where subtle structure cannot be explained by limitations to dispersal. Consequently, these species might falsely be considered quasi-panmictic and hence potentially mismanaged. A species this might apply to, is the buff-tailed bumble bee (Bombus terrestris), an economically important and widespread pollinator, which is considered to be quasi-panmictic at mainland continental scales. Here we aimed to (i) quantify genetic structure in 21+ populations of the buff-tailed bumble bee, sampled throughout two Eastern European countries, and (ii) analyse the degree to which structure is explained by environmental differences, habitat permeability and geographic distance. Using 12 microsatellite loci, we characterised populations of this species with Fst analyses, complemented by discriminant analysis of principal components and Bayesian clustering approaches. We then applied generalized dissimilarity modelling to simultaneously assess the informativeness of geographic distance, habitat permeability and environmental differences among populations in explaining divergence.

RESULTS

Genetic structure of the buff-tailed bumble bee quantified by means of Fst was subtle and not detected by Bayesian clustering. Discriminant analysis of principal components suggested insignificant but still noticeable structure that slightly exceeded estimates obtained through Fst analyses. As expected, geographic distance and habitat permeability were not informative in explaining the spatial pattern of genetic divergence. Yet, environmental variables related to temperature, vegetation and topography were highly informative, explaining between 33 and 39% of the genetic variation observed.

CONCLUSIONS

In contrast to previous studies reporting quasi-panmixia in continental populations of this species, we demonstrated the presence of subtle population structure related to environmental heterogeneity. Environmental data proved to be highly useful in unravelling the drivers of genetic structure in this vagile and opportunistic species. We highlight the potential of including these data to obtain a better understanding of population structure and the processes driving it in species considered to be quasi-panmictic.

Biodiversity of macrophyte communities and associated aquatic organisms in lakes of the Vologda Region (north-western Russia)

BACKGROUND

This paper provides current data on the biodiversity of boreal lakes of the Vologda Region (north-western Russia), including macrophytes (vascular plants and macroscopic algae) and macrophyte inhabitants (invertebrates and microalgae). The raw data, given in two datasets (Sampling event dataset and an Occurrence dataset) and presented in the form of GBIF-mediated data, were collected from 139 lakes (macrophytes between 2005 and 2021, macrophyte inhabitants between 2014 and 2020). The dataset contains materials on the diversity of vascular plants (Tracheophyta, 3225 occurrences; Bryophyta, 155; Marchantiophyta, 16), macro- and microalgae (Ochrophyta, 546 occurrences; Chlorophyta, 193; Charophyta, 153; Cyanobacteria, 139; Cryptophyta, 86; Myzozoa, 33; Euglenozoa, 27; Rhodophyta, 8; Bigyra, 1) and aquatic invertebrates (Arthropoda, 1408 occurrences; Annelida, 487; Mollusca, 263; Platyhelminthes, 36; Cnidaria, 11). This paper summarises previously unpublished materials in a standardised form.

NEW INFORMATION

The paper summarises the data collected during the long-term phytodiversity studies in a series of lakes of different types (Vologda Region, north-western Russia). Data on algae and invertebrates diversity were obtained in 60 different plant communities of aquatic, semi-aquatic and coastal plants or their combinations. A total of 6787 occurrences were included in the dataset, published in the global biodiversity database (GBIF) for the first time. According to the GBIF taxonomic backbone, the dataset comprised 837 taxa, including 711 lower-rank taxa (species, subspecies, varieties, forms). New records of 47 species rare and protected in the Vologda Region are given: 43 species of plants, three species of animals and one species of Cyanobacteria.

Integrating citizen engagement into evidence-informed health policy-making in eastern Europe and central Asia: scoping study and future research priorities

BACKGROUND

The perspectives of citizens are an important and often overlooked source of evidence for informing health policy. Despite growing encouragement for its adoption, little is known regarding how citizen engagement may be integrated into evidence-informed health policy-making in low- and middle-income counties (LMICs) and newly democratic states (NDSs). We aimed to identify the factors and variables affecting the potential integration of citizen engagement into evidence-informed health policy-making in LMICs and NDSs and understand whether its implementation may require a different approach outside of high-income western democracies. Further, we assessed the context-specific considerations for the practical implementation of citizen engagement in one focus region-eastern Europe and central Asia.

METHODS

First, adopting a scoping review methodology, we conducted and updated searches of six electronic databases, as well as a comprehensive grey literature search, on citizen engagement in LMICs and NDSs, published before December 2019. We extracted insights about the approaches to citizen engagement, as well as implementation considerations (facilitators and barriers) and additional political factors, in developing an analysis framework. Second, we undertook exploratory methods to identify relevant literature on the socio-political environment of the focus region, before subjecting these sources to the same analysis framework.

RESULTS

Our searches identified 479 unique sources, of which 28 were adjudged to be relevant. The effective integration of citizen engagement within policy-making processes in LMICs and NDSs was found to be predominantly dependent upon the willingness and capacity of citizens and policy-makers. In the focus region, the implementation of citizen engagement within evidence-informed health policy-making is constrained by a lack of mutual trust between citizens and policy-makers. This is exacerbated by inadequate incentives and capacity for either side to engage.

CONCLUSIONS

This research found no reason why citizen engagement could not adopt the same form in LMICs and NDSs as it does in high-income western democracies. However, it is recognized that certain political contexts may require additional support in developing and implementing citizen engagement, such as through trialling mechanisms at subnational scales. While specifically outlining the potential for citizen engagement, this study highlights the need for further research on its practical implementation.

Hepatitis E - epidemiology and clinical course in the largest cohort in the Czech Republic

INTRODUCTION

The majority of hepatitis E (HE) reports come from Western Europe. The aim of the study was to describe the typical epidemiological and clinical characteristics of HE in the Czech Republic.

METHODS

A retrospective analysis of 173 patients with HE.

RESULTS

At least 90% of cases were autochthonous (HEV-3 genotype). Seventeen patients were treated with ribavirin. Five underwent liver transplants because of fulminant HE. We noted neurological symptomatology in 9 cases. Six patients developed chronic HE.

CONCLUSIONS

There is a possibility of severe health complications caused by the hepatitis E virus in the Czech Republic.

Rapid antiretroviral treatment start seems as vital and cost-effective strategy in Central and Eastern Europe

BACKGROUND

It is essential to deliver specialist human immunodeficiency virus (HIV) care with maximum effectiveness, but also minimum time delay. Therefore, we aimed to determine whether rapid linkage to care defined as starting combined antiretroviral therapy (cART) on the day of the first visit at the HIV clinic is a costeffective approach.

METHODS

In the analysis, Markov's lifetime model presented in our previous study was implemented. The inputs used in the model were updated in the terms of costs, life expectancy, and patient characteristics. For the analysis we used information from the previous model about the additional costs of treatment and qualityadjusted life years (QALYs) lost in the life horizon for people newly infected with HIV. The number of newly infected persons was estimated based on available data.

RESULTS

Input data was available for 344 men having sex with men (MSM) who registered in the HIV specialist care between 2016 and 2017. The estimated QALY loss due to lack of rapid treatment initiation, where the viral load is not (was) taken into account, equals 0·018 (0·022), 0·039 (0·047), 0·131 (0·158) respectively in low, medium and high risk transmission groups. Rapid cART initiation was dominant regardless of the chosen scenarios.

CONCLUSIONS

Cost-effectiveness analysis considering the HIV transmission indicates that the rapid initiation of HIV treatment is a cost-effective and potentially cost-saving approach to improve HIV care and reduce HIV transmission in Central and Eastern Europe.

Macrophyte diversity in rivers and streams of the Vologda Region and several other regions of Russia

BACKGROUND

The data paper contains the authors' materials on the diversity of macrophytes, macroscopic plants regardless of their taxonomic position, in rivers and streams of East European Russia and Western Siberia. These data, collected on 247 rivers and 32 streams in 13 administrative regions of the Russian Federation, were provided as an occurrence dataset presented in the form of GBIF-mediated data. The main portion of the data was obtained in water objects of the Vologda Region (5201 occurrences). In addition, occurrences from the Arkhangelsk Region (347 occurrences), Khanty-Mansi Autonomous Okrug (159), Yaroslavl Region (132), Novgorod Region (97), Kostroma Region (41), Republic of Karelia (31), Sverdlovsk Region (29), Komi Republic (28), Orenburg Region (26), Chelyabinsk Region (22), Voronezh Region (22) and Tyumen Region (18) were given. The studies were carried out mainly in the southern and middle taiga and, to a lesser extent, in the northern taiga and the forest-steppe. The analysed watercourses belong to five drainage basins: the Azov Sea, the Baltic Sea, the White Sea, the Caspian Sea and the Kara Sea. The dataset contains materials on the diversity of Plantae (6094 occurrences) and Chromista (59 occurrences). This paper, in a standardised form, summarises mostly unpublished materials on the biodiversity of lotic ecosystems.

NEW INFORMATION

The paper summarises the data obtained in long-term studies of phytodiversity in a range of rivers and streams of East European Russia and, fragmentarily, Western Siberia. A total of 6153 occurrences were included in the dataset. According to the GBIF taxonomic backbone, the dataset comprises 292 taxa, including 280 lower-rank taxa (species, subspecies, varieties) and 12 taxa identified to the genus level. All the occurrences are published openly through the Global Biodiversity Information Facility (GBIF) for the first time. Most of the data were stored in field diaries and, thus, by adding the data in GBIF, we believe that other researchers could benefit from it.

Biodiversity of a boreal mire, including its hydrographic network (Shichengskoe mire, north-western Russia)

BACKGROUND

The paper is based on the dataset whose purpose was to deliver, in the form of GBIF-mediated data, diverse materials on the biodiversity of a large mire, Shichengskoe mire (Vologda Region, north-western Russia), including its various mire sites and intra-mire water bodies. The dataset was based on our materials collected for two decades (from 2000 to 2021) in different parts and biotopes of the Shichengskoe mire and complemented by scarce data obtained previously by other researchers. The data contain materials on the diversity of Animalia (2886 occurrences), Bacteria (22), Chromista (256), Fungi (111), Plantae (2463) and Protozoa (131). Within the study period, the most detailed and long-term biodiversity studies were carried out for higher plants and invertebrates. On the other hand, the data on the composition of lichens, protozoa, algae, basidiomycetes, some groups of invertebrates and, to a lesser extent, lichens and vertebrates are far less comprehensive and require further substantial research efforts. The list includes occurrences from both the peatland (mire sites and mire margins different in typology) and the objects of the mire hydrographic network. In a standardised form, this article summarises both already published (mainly in Russian) and unpublished materials.

NEW INFORMATION

The paper summarises the results of long-term research on the biodiversity of a boreal mire, including its hydrographic network. A total of 5869 occurrences were included in the dataset published in the Global Biodiversity Information Facility (GBIF, gbif.org) for the first time. According to the GBIF taxonomic backbone, the dataset covers 1358 taxa, including 1250 lower-rank taxa (species, subspecies, varieties, forms) and 108 taxa identified to the genus level. Several species found in the Shichengskoe mire, mainly belonging to Bacteria, Chromista and Protozoa, have never been listed in GBIF for the territory of Russia before. The overwhelming majority of occurrences and identified species came from the territory of Shichengskiy Landscape Reserve. Due to our work, this Reserve is now the most studied regional reserve in the Vologda Region with respect to biodiversity. By the number of revealed species, it is close to two federal protected areas: Darwinskiy State Nature Biospheric Reserve and National Park "Russkiy Sever".

Mental health care in Eastern Europe and Central Asia: An analysis of needs and a call for greater investment

Over the past decade, there has been increased attention to global mental health, which emphasizes improving access to quality mental health care in order to reduce the worldwide treatment gap. However, Eastern European and Central Asian countries and their specific mental health needs have largely been under-emphasized, evidenced by a dearth in literature and funding. Here, we provide an overview of the mental health needs in Ukraine and its challenges with quality care provision as a key example in highlighting these gaps, then broaden our discussion to include parallels with other countries in the Eastern European and Central Asian region. We describe the unique strengths relative to mental health care provision that are present in Eastern Europe and Central Asia and suggest the importance of post-graduate training, regional collaboration, and capacity building specific to research management as strategies to address the current challenges. We stress that greater investment from funders, government, and the global mental health community are needed to improve the current mental health situation in Ukraine, specifically, and Eastern Europe and Central Asia, broadly. We argue that greater attention to Eastern Europe and Central Asia is needed to fully advance the agenda of the global mental health field.

Nutritional Content of Street Food and Takeaway Food Purchased in Urban Bosnia and Herzegovina

Street food (SF) and takeaway food (TAF) are important sources of out-of-home meals in urban Bosnia and Herzegovina, where diet-related non-communicable diseases are growing rapidly. This study aimed to characterise SF and TAF purchased in urban areas of Bosnia and Herzegovina, regarding customers' characteristics and the nutritional composition of the foods and beverages. A cross-sectional study was conducted in Sarajevo and Banja Luka in 2017. SF (n = 194) and TAF vending sites (n = 154) were selected through random and systematic sampling. Data on the food items purchased and customers' characteristics were collected by direct observation. Nutritional composition was estimated using data from chemical analyses of the foods most commonly available. Two-thirds of the customers observed (n = 755) were aged ≥35 years, half were women and 27.7% were overweight/obese. A total of 929 food items were purchased. The most commonly bought SFs were confectionery (30.5%), water (27.9%) and soft drinks/juices (22.2%). TAF customers purchased mostly savoury pastries (39.8%), breads (27.1%) and main dishes (21.4%). Almost half of customers purchased industrial food (i.e., pre-packaged foods and beverages produced by the food industry). The purchases presented median contents of 18.7 g of fat (39.6% saturated, 32.3% monounsaturated, 22.1% polyunsaturated, 1.5% trans), 838 mg of sodium and 285 mg of potassium. Saturated-fat contribution was higher in SF purchases (60.4% vs. 30.2%, p < 0.001), whereas TAF purchases presented higher trans-fat proportion (1.8% vs. 0.6%, p < 0.001), sodium (1241 vs. 89 mg, p < 0.001) and sodium-potassium ratio (6.1 vs. 0.6, p < 0.001). Generally, SF and TAF bought in Sarajevo and Banja Luka were rich in saturated and trans fatty-acids and sodium, and poor in potassium. Nutrition policies promoting use of healthier fats and salt reduction in SF and TAF may contribute to the prevention of diet-related diseases in these settings.

Corrigendum: Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014-2018: Findings and Implications From ESAC-Net and WHO Europe

[This corrects the article DOI: 10.3389/fphar.2021.639207.].

Time trends in consumption of sugar-sweetened beverages and related socioeconomic differences among adolescents in Eastern Europe: signs of a nutrition transition?

BACKGROUND

High intake of sugar-sweetened beverages (SSBs) contributes to detrimental cardio-metabolic indicators in youth. Monitoring of SSB consumption is lacking in Eastern Europe.

OBJECTIVES

We assessed trends in the prevalence of adolescent daily consumption of SSBs in 14 Eastern European countries between 2002 and 2018, both overall and according to family material affluence.

METHODS

We used 2002, 2006, 2010, 2014, and 2018 data of the Health Behaviour in School-Aged Children school-based study (repeated cross-sectional). Nationally representative samples of adolescents aged 11, 13, and 15 years were included (n = 325,184; 51.2% girls). Adolescents completed a standardized questionnaire, including a question on SSB consumption frequency. We categorized adolescents into 3 socioeconomic groups based on the relative Family Affluence Scale (FAS). Adjusted prevalences of daily SSB consumption by survey year, as well as country-level time trends between 2002 and 2018, were computed using multilevel logistic models (overall and by FAS groups).

RESULTS

In 2018, the prevalence of adolescents consuming SSBs every day varied considerably between countries (range, 5.1%-28.1%). Between 2002 and 2018, the prevalence of daily SSB consumption declined in 10/14 countries (P for linear trends ≤ 0.004). The largest reductions were observed in Slovenia (OR, 0.48; 95% CI: 0.45-0.50) and the Russian Federation (OR, 0.67; 95% CI: 0.64-0.70). Daily SSB consumption was reduced at faster rates among the most affluent adolescents (who were larger consumers in 2002) than in the least affluent adolescents in 11/14 countries (P for linear trends ≤ 0.004). Thus, differences between FAS groups narrowed over time or even reversed, leading to larger proportions of daily consumers in the least affluent adolescents in 2018 in 5/14 countries (P ≤ 0.05).

CONCLUSIONS

Adolescent daily consumption of SSBs decreased between 2002 and 2018 in most Eastern European countries. Declines were larger among higher-affluence adolescents. These results are useful to evaluate and plan interventions promoting healthy childhood diets.

The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine

Low- and middle-income countries are home to 80% of older people with HIV (OPWH). Ukrainian OPWH experience higher mortality and decreased antiretroviral therapy (ART) initiation than younger patients, but there is little data examining OPWH's perspectives around new diagnosis and impact on care. In this study, we examined accounts of 30 newly diagnosed OPWH in Ukraine, exploring challenges faced in the peri-diagnosis period. Themes emerged representing the longitudinal coping process: OPWH (1) viewed themselves as low risk before diagnosis; (2) experienced HIV diagnosis as a traumatic event challenging their self-image; (3) used disclosure to seek support among a small circle of family, friends, or health care providers; (4) avoided disclosure to outsiders including primary care providers for fears of stigma and breaches in confidentiality; (5) viewed age as an asset; and (6) used HIV diagnosis as starting point for growth. These findings highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning.

Highlights from the IOB Conference on Cancer, 20-22 May 2021 and the new research vision of The Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania

The latest edition of the Bucharest Institute of Oncology (IOB) Conference was held between 20 and 22 May 2021, in the capital of Romania. The conference was a hybrid event, with live and virtual participation and was attended by more than 1000 participants. The central theme was the value added by the tumor boards, underlining the significance of teamwork and collaboration between the different disciplines and oncology centers in the country. The opening session was attended by representatives from national and international cancer associations and societies, the mayor of Bucharest, the Vice-chancellor of the University of Medicine and Pharmacy, C. Davila, the health advisor of the President of Romania, as well other dignitaries and health experts in oncology in Romania. The conference sections covered all major types of cancer, education, research, health policies and new updates in guidelines and therapeutics. Since it is a yearly event of the institute, the current situation of the institute was presented in the context of the full COVID-19 pandemic as well as the ways of managing and overcoming the negative impact on the access to care for cancer patients.

Establishing Stroke Services in the Republic of Georgia

INTRODUCTION

This article summarizes the medical experience in establishing stroke units and systemic thrombolysis in Georgia, which, like many other post-Soviet countries, still faces problems in organizing stroke care even after 30 years of independence.

PATIENTS AND METHODS

We created an example of treating acute stroke with systemic thrombolysis and introduced stroke units in several hospitals in the country, including standardization of the diagnostic and treatment process, consistent evaluation, and monthly feedback to the stroke unit staff.

RESULTS

Systemic thrombolysis has become a clinical routine in some large hospitals and is meanwhile reimbursed by the state insurance. The data of consecutive 1,707 stroke patients in 4 major cities demonstrated significant time lost at the prehospital level, due to failure in identifying stroke symptoms, delay in notification, or transportation. The consequent quality reports resulted in a dramatic increase in adherence to the European and national guidelines. A mandatory dysphagia screening and subsequent treatment led to a decrease in pneumonia rates.

DISCUSSION

We discuss our experience and suggestions on how to overcome clinical, financial, and ethical problems in establishing a stroke services in a developing country.

CONCLUSION

The Georgian example might be useful for doctors in other post-Soviet countries or other parts of the world.

Access to Prenatal Testing and Ethically Informed Counselling in Germany, Poland and Russia

The development of new methods in the field of prenatal testing leads to an expansion of information that needs to be provided to expectant mothers. The aim of this research is to explore opinions and attitudes of gynecologists in Germany, Poland and Russia towards access to prenatal testing and diagnostics in these countries. Semi-structured interviews were conducted with n = 18 gynecologists in Germany, Poland and Russia. The interviews were analyzed using the methods of content analysis and thematic analysis. Visible in all three countries is a connection of prenatal medicine with the politically and socially contentious issue of pregnancy termination. Respondents in Poland and Russia concentrated on the topic of inadequate resources. Quality of information for expectant mothers is an important point in all three countries. Only in Germany was the issue of language barriers in communication raised. With regard to non-invasive prenatal testing (NIPT) respondents in Germany focused on the ethical issues of routinization of testing; in Poland and Russia they concentrated on fair access to NIPT. Challenges in all three countries arise from structural factors such as imprecise and prohibitive regulations, lack of resources or organization of healthcare services. These should be addressed on a political and medico-ethical level.

Oral and Written Language Abilities of School-Age Internationally Adopted Children from Eastern Europe

PURPOSE

Children adopted from Eastern Europe were assessed at ages 6 to 7 years and results were compared to the same children when they were 8 years. Patterns of relative strengths and weaknesses in language, verbal memory and literacy were analyzed. Variables that predicted reading and writing were determined.

METHOD

Children adopted from Eastern Europe between 1;0 and 4;11 years of age were assessed at ages 6 to 7 years and age 8 years on a variety of tests that measured language, verbal memory and literacy. Results were compared across ages, and language, verbal memory and literacy domains.

RESULTS

Group means for all measures fell within the average range at both ages. The children's scores were not significantly different from test norms except for measures of rapid naming and number repetition. However, a larger than expected percentage of children scored -1SD below the mean on decontextualized measures of verbal working memory and reading fluency. At age 8 years 24% of children received speech language therapy services and 26% had repeated a grade level. Vocabulary, expressive syntax, verbal short-term memory and writing were areas of relative strength. Higher level vocabulary knowledge was strongly correlated with all literacy measures.

CONCLUSION

As a group, Eastern European adoptees scored average on measures of language and literacy at 6 or 7 years and again at age 8 years. However, 26% of the children had repeated a grade and 24% were still receiving speech and language services. Vocabulary was an area of strength reflecting the children's enriched adopted home environments. In-depth knowledge of vocabulary was the best predictor of reading and writing. Some aspects of working memory were a strength but others were not. Rapid naming was also a weakness.

Spatial distribution of legacy pesticides in river sediment from the Republic of Moldova

Historical use of organochlorine pesticides (OCPs) in the Republic of Moldova could pose a potential risk for the aquatic environment due to the persistence, bioaccumulation and toxic properties of these environmental pollutants. However, knowledge on environmental concentrations of legacy OCPs in Moldova is limited. In this study, surface sediment from the two main rivers; Dniester (8 sites, n = 15) and Prut (6 sites, n = 12), and two tributary rivers; Bîc (11 sites, n = 11) and Răut (6 sites, n = 6), were collected during 2017-2018 and analyzed for hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs) and their transformation products (DDDs and DDEs) using gas chromatography coupled to mass spectrometry (GC-MS/MS). Sediment concentrations of Ʃ₆DDX (1.9-140 ng g^-1 dry weight (dw)) and Ʃ₄HCHs (n.d-2.5 ng g^-1 dw) were found. In the big rivers, the average Ʃ₆DDX concentration (18 ng g^-1 dw) were 35 times higher than Ʃ₄HCHs (0.51 ng g^-1 dw). Whereas, in the small rivers the average Ʃ₆DDX concentration (32 ng g^-1 dw) was approximately 41 times higher than Ʃ₄HCHs (0.77 ng g^-1 dw). Compared to previous studies from Eastern Europe, the sediment levels were generally similar as found in Moldova's neighboring countries (Romania and Ukraine). Overall, the contamination profile indicates long-term ageing of OCPs used in the past in the agricultural sector. Less than half of the sites (45%) had levels that pose a potential risk for benthic organisms. Hence, further work is needed to determine the bioaccumulation of OCPs in the aquatic food web in this region and the associated risks to ecosystems and human health.

The Price of Homemade Street Food in Central Asia and Eastern Europe: Is There a Relation with Its Nutritional Value?

The aim was to describe the price of homemade street foods in four cities of Central Asia and Eastern Europe and to analyze its association with energy density, macronutrients, sodium and potassium contents. Cross-sectional evaluations of street food vending sites were conducted in Dushanbe, Tajikistan (n = 562), Bishkek, Kyrgyzstan (n = 384), Almaty, Kazakhstan (n = 236) and Chișinău, Moldova (n = 89) in 2016-2017. Information on the homemade street foods available, including price, was systematically collected; the most commonly available foods (n = 64) were sampled for chemical analysis. Prices were converted to international dollars ($) and expressed as $/serving, $/100 g and $/100 kcal. The median street food price was $1.00/serving, $0.85/100 g and $0.33/100 kcal. Traditional foods were cheaper per 100 g than the westernized ($0.77 vs. $1.00, p = 0.011). For each unit increase in energy density (kcal/g), the homemade street foods were $0.12 cheaper per 100 kcal and $0.11 more expensive per 100 g. The carbohydrate content was negatively associated with price per 100 kcal, while total fat, monounsaturated, saturated and trans-fatty acids content were positively associated with price per 100 g. Energy-dense homemade street foods were the cheapest. Further insight on food preparation might clarify the association between carbohydrates and monounsaturated fatty acids content and street food price.

Dynamics of hepatitis C epidemic among people living with HIV in Estonia based on Estonian HIV cohort study

Background

Estonia has a typical Eastern European HIV epidemic where the most frequent co-infection is chronic hepatitis C (HCV). We aimed to describe the changes in HCV prevalence, the distribution of HCV genotypes (GT), and HCV treatment in Estonian people living with HIV over 15 years.

Methods

We used data of subjects included to the Estonian HIV Cohort Study (E-HIV) before 31st of December 2015. We compared two time periods—first, 1st of January 2000 to 31st of December 2008 when the HIV epidemic was mostly spreading among people who inject drugs (PWID) and second, 1st of January 2009 to 31st of December 2015 when HIV started to emerge to the general population.

Results

Of 4422 HIV positives 3708 (84%) had information about their HCV serostatus; 2706 (61%) were HCV seropositive, of latter 1625 (60%) were HCV RNA positive, 239 (9%) had their HCV GT determined, and 141 (5%) received treatment for HCV. The dominating subtypes were 1b (42%) and 3a (37%) followed by 1a (16%), and the few cases of 2 (1.5%). HCV prevalence was 1.5 times (95% CI 1.4–1.6) higher in subjects diagnosed with HIV in first as compared to those diagnosed in second period (84% vs 56%, respectively). There were more men and the median age at HIV diagnosis was lower in HIV/HCV co-infected than in HIV mono-infected patients (70% vs 47% and 24 years vs. 30 years, respectively; both p < 0.001).

Conclusion

There is a decrease in HCV prevalence but it remains high among HIV positive PWID, suggesting that there is need for improvement of harm reduction programs among PWID.

The Effect of COVID-19 on Herding Behavior in Eastern European Stock Markets

Unlike past health crises that were more localized, the highly contagious coronavirus disease 2019 (COVID-19) crisis is impacting the world to an unprecedented extent. This is the first study examining how and whether the COVID-19 pandemic affects herding behavior in the Eastern European stock markets. Using samples from the stock markets of Russia, Poland, the Czech Republic, Hungary, Croatia, and Slovenia from January 1, 2010 to March 10, 2021, we demonstrate that the COVID-19 pandemic has increased herding behavior in all the sample stock markets. Our results show that the COVID-19 crisis reinforces the impact of global market returns on herding behavior in these specific stock markets. We find that COVID-19 strengthens the spillover effect of regional herding on herding behavior. Thus, financial authorities should monitor investors in the stock market to avoid the increase in herding behavior as well as the reinforcement of the global market returns and regional return dispersion on herding during the period of pandemic.

Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014-2018: Findings and Implications from ESAC-Net and WHO Europe

Background: Surveillance of antimicrobial consumption (AMC) is important to address inappropriate use. AMC data for countries in the European Union (EU) and European Economic Area (EEA) and Eastern European and Central Asian countries were compared to provide future guidance. Methods: Analyses of 2014-2018 data from 30 EU/EEA countries of the European Surveillance of Antibiotic Consumption network (ESAC-Net) and 15 countries of the WHO Regional Office for Europe (WHO Europe) AMC Network were conducted using the Anatomical Therapeutic Chemical (ATC) classification and Defined Daily Dose (DDD) methodology. Total consumption (DDD per 1000 inhabitants per day) of antibacterials for systemic use (ATC group J01), relative use (percentages), trends over time, alignment with the WHO Access, Watch, Reserve (AWaRe) classification, concordance with the WHO global indicator (60% of total consumption should be Access agents), and composition of the drug utilization 75% (DU75%) were calculated. Findings: In 2018, total consumption of antibacterials for systemic use (ATC J01) ranged from 8.9 to 34.1 DDD per 1000 inhabitants per day (population-weighted mean for ESAC-Net 20.0, WHO Europe AMC Network 19.6, ESAC-Net Study Group, and WHO Europe AMC Network Study Group). ESAC-Net countries consumed more penicillins (J01C; 8.7 versus 6.3 DDD per 1000 inhabitants per day), more tetracyclines (J01A; 2.2 versus 1.2), less cephalosporins (J01D; 2.3 versus 3.8) and less quinolones (J01M; 1.7 versus 3.4) than WHO Europe AMC Network countries. Between 2014 and 2018, there were statistically significant reductions in total consumption in eight ESAC-Net countries. In 2018, the relative population-weighted mean consumption of Access agents was 57.9% for ESAC-Net and 47.4% for the WHO Europe AMC Network. For each year during 2014-2018, 14 ESAC-Net and one WHO Europe AMC Network countries met the WHO global monitoring target of 60% of total consumption being Access agents. DU75% analyses showed differences in the choices of agents in the two networks. Interpretation: Although total consumption of antibacterials for systemic use was similar in the two networks, the composition of agents varied substantially. The greater consumption of Watch group agents in WHO Europe AMC Network countries suggests opportunities for improved prescribing. Significant decreases in consumption in several ESAC-Net countries illustrate the value of sustained actions to address antimicrobial resistance.

Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009-2019

Background

Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea.

Methods

N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009–2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified β-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher’s exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance.

Results

In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018–2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment.

Conclusions

The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

Is elimination of hepatitis C virus realistic by 2030: Eastern Europe

The WHO elimination goals (diagnosis of 90% of the cases of hepatitis C virus (HCV), treatment coverage in 80% and a 65% reduction in deaths from HCV) are set to be reached by 2030. Although these elimination programmes are extremely important in the Eastern European countries (Russia, Ukraine, Belarus and Moldova) with a high prevalence of HCV, limited economic resources prevent their development and implementation. Regardless of the decrease in the incidence HCV in all Eastern European countries, low diagnosis and treatment access, especially in high-risk populations, will not allow to achieve HCV elimination or even to control the infection by 2030.

Geographic Shifts in Antibacterial Drug Clinical Trial Enrollment: Implications for Generalizability

BACKGROUND

As drug development has globalized, trials have increasingly enrolled participants from all parts of the world rather than just the United States and Western Europe. For antibacterial drug trials, understanding enrollment trends and regional differences is important for generalizability considerations.

METHODS

We retrospectively analyzed 42 phase 3 trials submitted to the US Food and Drug Administration after 2001 for complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), community-acquired bacterial pneumonia (CABP), and acute bacterial skin and skin structure infection (ABSSSI) (n = 29 282 participants). Enrollment numbers, demographics, clinical characteristics, and microbiological data were compared to identify temporal and geographic trends.

RESULTS

For cUTI, cIAI, and CABP trials, Eastern European enrollment greatly increased over the study period. For ABSSSI trials, North American enrollment increased. Demographic characteristics and regional microbiology among regions were broadly similar with several exceptions. For cIAI trials, Eastern European participants had the lowest proportion of participants with prior antibacterial drug therapy. For ABSSSI trials, North American participants more commonly reported intravenous drug use. Microbiological differences relative to North America included a greater proportion of Klebsiella pneumoniae among Asian cIAI isolates (17.8% vs 9.0%, P = .0057), a higher proportion of cephalosporin resistance in South American Enterobacteriaceae cUTI isolates (26.8% vs 15.7%, P = .044), and a lower proportion of Staphylococcus aureus in Eastern European ABSSSI isolates (43.7% vs 61.9%, P < .0001).

CONCLUSIONS

Geographic trends in recruitment for recent antibacterial clinical trials differ by indication. Regional similarities in demographic characteristics and microbiology across regions lessen concerns regarding generalizability due to shifting enrollment trends.