Threats to sustainability in face of post-pandemic scenarios and the war in Ukraine.

As the World slowly emerged from the then-ongoing pandemic, War broke out in Europe with the invasion of Ukraine by Russia. The enduring military conflict in Ukraine has had sweeping consequences at the human, social, economic, and environmental levels, not only for the nations involved but across Europe and globally. Damaged infrastructures, severe disruption of economic activity, and forced migration have led to negative impacts on sustainability. The COVID-19 pandemic has added another layer of complexity to this already challenging situation, as the virus has further disrupted economic activity and strained healthcare systems. Herein, we examine how the intersection of war and COVID-19 affect the United Nations' 2030 Agenda for Sustainable Development. How these intersecting challenges have impacted efforts to build a more sustainable future, and how these impacts have a global reach are also assessed. The broader implications of this case for understanding the linkages between conflict, pandemics, and sustainability more generally are also considered, relating these with the United Nations' Sustainable Development Goals (SDG) Agenda for 2030.

Multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection and severe abdominal syndrome: the Lviv "OHMATDYT" (Western Ukraine) experience.

Multisystem inflammatory syndrome in children (MIS-C) associated with Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) usually develops 1-1.5 months after mild or asymptomatic COVID-19 in countries with high incidence. MIS-C has a polymorphism of clinical manifestations, which include prolonged fever, polymorphic rash, non-purulent conjunctivitis, pneumonia complicated by distress syndrome, myocarditis, coronary artery disease, toxic shock syndrome, limb edema, polyserositis, severe abdominal syndrome with diarrhea and others. Establishing this diagnosis requires significant efforts to rule out diseases of other etiology. The aim of our study was to analyze the clinical and laboratory features of children with MIS-C associated with SARS-CoV-2 and severe abdominal syndrome. Six children with MIS-C associated with SARS-CoV-2 and severe abdominal syndrome were hospitalized in Lviv Regional Children's Clinical Hospital "OHMATDYT", Ukraine, from April 2020 to September 2021. For differential diagnosis IgM, IgG to SARS-CoV-2 by ELISA, RNA to SARS-CoV-2 by PCR, bacteriological tests of blood, urine and feces were performed. Furthermore, the diagnostic work up included chest radiography, echocardiography, ultrasound of the lungs and abdominal organs. Laboratory findings revealed an increase in the normal value of inflammatory markers and high levels of IgG to SARS-CoV-2. Administration of intravenous immunoglobulin at a dose of 1 to 2 g/kg body weight per day prevented further coronary artery disease in patients and provided regression in already affected coronary arteries. At the same time, regression of abdominal syndrome was observed. Early diagnosis of MIS-C in patients with SARS-CoV-2 and severe abdominal syndrome allows to define the appropriate treatment strategy.

Nurses and global health responsibility: In light of the COVID-19 pandemic and the war in Ukraine.

AIM: The aim of this paper was to reflect on global ethical challenges for nurses in light of the COVID-19 pandemic and the war in Ukraine and to discuss 'Nurses and Global Health', a new element in the revised ICN Code of Ethics for Nurses, 2021, and its implications for nurses. BACKGROUND: The authors participated in the latest revision of the Code. When we were revising the ICN Code of Ethics, there was neither an ongoing pandemic nor a war in Europe. SOURCES OF EVIDENCE: Relevant scientific articles and other academic literature, documents from international organisations, and authors' views. DISCUSSION: The discussion emanated from our reflections on how to actually apply the ICN Code of Ethics, i.e., moving the words from the document itself into everyday practice, in light of the COVID-19 pandemic and the war in Ukraine. In the Code, the nurse's responsibility is highlighted, but there is little or no instruction on how to undertake it. CONCLUSION AND IMPLICATIONS FOR NURSES: The ICN Code of Ethics needs to be operationalised through ethical reflection and discussion in all contexts where nurses work, from policy level to the care environment.

Excess mortality in Ukraine during the course of COVID-19 pandemic in 2020-2021.

In this work, the COVID-19 pandemic burden in Ukraine is investigated retrospectively using the excess mortality measures during 2020-2021. In particular, the epidemic impact on the Ukrainian population is studied via the standardized both all-cause and cause-specific mortality scores before and during the epidemic. The excess mortality counts during the pandemic were predicted based on historic data using parametric and nonparametric modeling and then compared with the actual reported counts to quantify the excess. The corresponding standardized mortality P-score metrics were also compared with the neighboring countries. In summary, there were three "waves" of excess all-cause mortality in Ukraine in December 2020, April 2021 and November 2021 with excess of 32%, 43% and 83% above the expected mortality. Each new "wave" of the all-cause mortality was higher than the previous one and the mortality "peaks" corresponded in time to three "waves" of lab-confirmed COVID-19 mortality. The lab-confirmed COVID-19 mortality constituted 9% to 24% of the all-cause mortality during those three peak months. Overall, the mortality trends in Ukraine over time were similar to neighboring countries where vaccination coverage was similar to that in Ukraine. For cause-specific mortality, the excess observed was due to pneumonia as well as circulatory system disease categories that peaked at the same times as the all-cause and lab-confirmed COVID-19 mortality, which was expected. The pneumonias as well as circulatory system disease categories constituted the majority of all cases during those peak times. The seasonality in mortality due to the infectious and parasitic disease category became less pronounced during the pandemic. While the reported numbers were always relatively low, alcohol-related mortality also declined during the pandemic.

Not only COVID-19. Not only Ukraine. Under-reported hunger crises in the Horn of Africa and the politics around them.

Funding requirements for humanitarian needs have reached a record high, driven by Ukraine's war, other conflicts worldwide, the COVID-19 pandemic, climate change-related disasters, economic slowdown, and their combined global consequences. More people are in need of humanitarian assistance, and more are forcibly displaced than ever before, the majority of them from countries facing acute food insecurity. The largest global food crisis in modern history is unfolding. Particularly, in the Horn of Africa, levels of hunger are alarmingly high, with countries edging close to famine. This article discusses why and how famine, which had declined in frequency and lethality, is resurging, using Somalia and Ethiopia as 'mini case studies', emblematic as they are of a broader trend. Technical and political aspects of food crises and their consequences on health are analysed. The article examines some of the most contentious issues around famine: the data challenges for declaring it and the use of starvation as a weapon of war. The article concludes with the claim that the elimination of famine is possible, but only through political action. Humanitarians can warn of an impending crisis and mitigate some of its consequences, but they are powerless in the face of an ongoing famine, like those described in Somalia and Ethiopia.

Long COVID prevalence and physiology-centered risks: population-based study in Ukraine.

AIM: Multifaceted long COVID caused by SARS-COV-2 affects all populations in the World and takes priority over any other research topics for health care. The purpose of study is to identify physiology-centered risks, prevalence, symptoms and laboratory findings in patients with long COVID in Ukraine. METHODS: A prospective, cohort study was carried out on 332 patients with long COVID after 4 weeks and more after acute infection COVID-19 from Jul 1, 2021, to Jul 1, 2022. Physiology-centered risks related to age, gender, body mass index (BMI), marital status and educational capacity, smoking, lifestyle, physical activity, and laboratory findings (before disease), and symptom distribution were analyzed. RESULTS: The cohort for the study consisted of 166 females and 107 males (mean age = 42; including young 18 (5.4%) and middle- and old-aged adults 314 (96.4%)). Increased BMI was in 61%, and less physical activity-65%. There were 4 clusters of symptoms related to physical, neurocognitive, pulmonary, and pain conditions. 95% of participants had ≥ 3 symptoms. The most common symptoms were fatigue (90%), muscular pain (85%), anosmia (70%), hair loss (70%), sleep disorders (70%), dyspnea (30%), and brain fog (25%). Among laboratory finding increased CRP (92.6%) and fibrinogen (82.7%) dominated. There are no differences between hospitalized and non-hospitalized patients in distribution symptoms. CONCLUSIONS: The prevalence of long COVID is 23%, and its physiology-centered risk factors are related to age more 38 years, female sex, unhealthy lifestyle, increased BMI, and increased inflammatory markers during COVID-19. The most common symptoms are associated with neurocognitive and pain clusters.

CURRENT CHALLENGES FOR THE HEALTH CARE SYSTEM DUE TO THE LACK OF MEDICAL STAFF AND THE CONTINUOUS PROFESSIONAL DEVELOPMENT OF DOCTORS.

OBJECTIVE: The aim: Research of the ways of adequate solving of problems with understuffed healthcare system and problems with continuous professional development of doctors. PATIENTS AND METHODS: Materials and methods: We have used a official statistical data for the period from 2009-2020 years. This data was analyzed with usage of systemic approach and statistical epidemiological analysis. RESULTS: Results: According to the data from Ministry of Health of Ukraine during the first year of the pandemic (2020) the quantity of our doctors has diminished by 6.9 thousands, and quantity of nurses - by 22,5 thousands which is much bigger deficit then in period of 2018-2019 years. The insufficiency of pediatric doctors in Ukraine has reached 1000 vacancies, general physicians - 1700, family doctors - more than 3000 vacancies, surgeons - more than 950 vacancies. It is also important to involve medical experts and medical associations and unions in the process of accreditation and licensing of providers of continuous medical education. CONCLUSION: Conclusions: Existing deficit of medical personnel should be replenished by increasing of medical education of students in medical universities and colleges funded by government. Existing system of continuous professional development of doctors requires a lot of changes (additional activities, new technologies) which must be implied with the help of professional medical associations and unions.

Stressors related to the Covid-19 pandemic, climate change, and the Ukraine crisis, and their impact on stress symptoms in Germany: analysis of cross-sectional survey data.

BACKGROUND: Climate change, the Covid-19 pandemic, and the Ukraine crisis are considered unprecedented global stressors, potentially associated with serious health consequences. However, simultaneous effects of these stressors are not yet understood, making it difficult to evaluate their relative contribution to the population burden and potential future manifestations in clinically significant psychiatric disorders. This study aimed at disentangling the relative contribution of the three stressor groups on current sub-clinical stress symptoms. METHODS: A cross-sectional, representative survey study was conducted two months after the outbreak of the Ukraine war in Germany. Proportional quota sampling was applied for age, gender, income, and regional characteristics. Data were recruited by means of an online survey. 3094 data sets (1560 females) were included. Age ranged from 18-89 (M: 50.4 years; SD: 17.2). The Subclinical Stress Questionnaire (SSQ-25) served as main outcome measure. In collaboration with a professional media agency, 20 items were generated to capture salient population stressors. A three-factor exploratory structural equation model confirmed the appropriateness of this scale. RESULTS: (1) Differences in subjective rankings revealed that stressors related to the Ukraine crisis were rated as most worrying, followed by climate change, and the Covid-19 pandemic (Generalized-Linear-Model: Epsilon = .97; F(1.94, 6001.14) = 1026.12, p < .001; ηp2 = .25). (2) In a linear regression model (R2 = .39), Covid-19 pandemic stressors were the only meaningful predictors for current ill-health (standardized ß = .48). Ukraine crisis did not predict stress symptom profiles in the present sample. (3) Older and male individuals report less and/or less severe stress symptoms, although effect sizes were small (range: η2 .11-.21). An older age also reduced the impact of Covid-19 stressors. CONCLUSIONS: Researchers from the health sciences must consider overlapping effects from population stressors. Although the Ukraine crisis and climate change mark salient stressors, including economic threats, the Covid-19 pandemic still has a profound effect on ill-health and must be considered as a relevant factor in future manifestations of psychiatric and associated health consequences.

The war in Ukraine and diabetic foot care: Challenges, recommendations.

AIMS: A number of reports have illustrated the barriers that the war in Ukraine puts to diabetes care. While their recommendations are valuable for glycemic control and the prevention or early detection of life - threatening diabetes complications, such as hypoglycemia and ketoacidosis, the discourse on diabetic foot is limited. This letter emphasizes the implications of the war in diabetic foot care and discusses potential solutions. METHODS: The authors searched peer - reviewed and grey literature to identify records related to the prevalence of diabetic foot in Ukraine and the standards of care before and after the invasion of Ukraine. RESULTS: Thousands of people in Ukraine sustain diabetic foot ulcers and, thus, are at high risk for lower limb amputations due to the limited access to healthcare services in the country. If not addressed, disability associated with chronic ulcers and amputations can severely affect individual and public health in Ukraine. Strengthening primary and remote care, educating people on self - care and providing adequate supplies for the management of diabetic foot have a major potential to prevent amputations, disability and death. CONCLUSIONS: Providing adequate diabetic foot care in Ukraine and other regions tormented by armed conflicts is vital for the health of the local population and the potential of the affected countries to recover after the crisis.

The human toll and humanitarian crisis of the Russia-Ukraine war: the first 162 days.

BACKGROUND: We examined the human toll and subsequent humanitarian crisis resulting from the Russian invasion of Ukraine, which began on 24 February 2022. METHOD: We extracted and analysed data resulting from Russian military attacks on Ukrainians between 24 February and 4 August 2022. The data tracked direct deaths and injuries, damage to healthcare infrastructure and the impact on health, the destruction of residences, infrastructure, communication systems, and utility services - all of which disrupted the lives of Ukrainians. RESULTS: As of 4 August 2022, 5552 civilians were killed outright and 8513 injured in Ukraine as a result of Russian attacks. Local officials estimate as many as 24 328 people were also killed in mass atrocities, with Mariupol being the largest (n=22 000) such example. Aside from wide swaths of homes, schools, roads, and bridges destroyed, hospitals and health facilities from 21 cities across Ukraine came under attack. The disruption to water, gas, electricity, and internet services also extended to affect supplies of medications and other supplies owing to destroyed facilities or production that ceased due to the war. The data also show that Ukraine saw an increase in cases of HIV/AIDS, tuberculosis, and Coronavirus (COVID-19). CONCLUSIONS: The 2022 Russia-Ukraine War not only resulted in deaths and injuries but also impacted the lives and safety of Ukrainians through destruction of healthcare facilities and disrupted delivery of healthcare and supplies. The war is an ongoing humanitarian crisis given the continuing destruction of infrastructure and services that directly impact the well-being of human lives. The devastation, trauma and human cost of war will impact generations of Ukrainians to come.

What message appeal and messenger are most persuasive for COVID-19 vaccine uptake: Results from a 5-country survey in India, Indonesia, Kenya, Nigeria, and Ukraine.

Effective strategies to encourage COVID-19 vaccination should consider how health communication can be tailored to specific contexts. Our study aimed to evaluate the influence of three specific messaging appeals from two kinds of messengers on COVID-19 vaccine acceptance in diverse countries. We surveyed 953 online participants in five countries (India, Indonesia, Kenya, Nigeria, and Ukraine). We assessed participants' perceptions of three messaging appeals of vaccination-COVID-19 disease health outcomes, social norms related to COVID-19 vaccination, and economic impact of COVID-19-from two messengers, healthcare providers (HCP), and peers. We examined participants' ad preference and vaccine hesitancy using multivariable multinomial logistic regression. Participants expressed a high level of approval for all the ads. The healthcare outcome-healthcare provider ad was most preferred among participants from India, Indonesia, Nigeria, and Ukraine. Participants in Kenya reported a preference for the health outcome-peer ad. The majority of participants in each country expressed high levels of vaccine hesitancy. However, in a final logistic regression model participant characteristics were not significantly related to vaccine hesitancy. These findings suggest that appeals related to health outcomes, economic benefit, and social norms are all acceptable to diverse general populations, while specific audience segments (i.e., mothers, younger adults, etc.) may have preferences for specific appeals over others. Tailored approaches, or approaches that are developed with the target audience's concerns and preferences in mind, will be more effective than broad-based or mass appeals.

POST-COVID SUICIDE: FORENSIC SCIENCE ANALYSIS.

OBJECTIVE: The aim: The article draws attention to the raise of suicide incidents after COVID-19 and proposes special knowledge to use in some forensic examinations for patients with COVID-19 and after as a measure of suicide preventing. PATIENTS AND METHODS: Materials and methods: Scientific researches and comparative analyzes of criminal cases marked as a suicide were done based on statistics method. 415 suicide cases were fixed in Ukraine in 2020, and other persons' influence for suicide committing was revealed only in 61cases. In 2021, the tendency has increased, and only during the first four months (from January till April) there were 213 suicide cases. CONCLUSION: Conclusions: There are so many cases of suicide after COVID-19 caused by mental and neurological disorders due to the coronavirus effects on human brain and psyche, not only at hospitals but at home as well. The virus can disrupt nervous system work both directly and indirectly, activating the immune system excessively (the so-called cytokine storm). Complex forensic medical and psychological examination may be appointed to determine the mental state of persons after COVID-19. There are two ways to solve the problem with the help of special knowledge and forensic science. On the one hand, investigate person's predisposition for suicide after covid to prevent a suicide. On the other hand, if you had failed and the person committed a suicide use the information received to prevent other persons' suicides.