Outcomes of surgical management of Ebstein anomaly and tricuspid valve dysplasia in critically ill neonates and infants.

Objective: To describe the surgical outcomes in neonates and infants who had surgery for Ebstein anomaly (EA) and tricuspid valve dysplasia (TVD). Methods: Retrospective chart review for all patients who underwent surgery for EA or TVD during the index hospitalization after birth at our institution from January 2005 to February 2023. Results: Fifteen symptomatic neonates and infants who had surgery for EA or TVD were included, 8 with EA and 7 with TVD. Eleven patients (73%) and 3 patients (20%) required preoperative inotropes and extracorporeal membrane oxygenation, respectively. Nine patients (60%) had a Starnes procedure and 6 patients (40%) had tricuspid valve repair (TVr). Mortality at last follow-up was 27% overall (n = 4/15), 22% after Starnes (n = 2/9) and 33% after TVr (n = 2/6), without a significant difference despite a greater-risk profile in the Starnes group. Postoperative day 1 lactate level was associated with mortality on Cox regression (hazard ratio, 1.45; P = .01). Three of 9 patients who had a Starnes procedure were or will be converted to a cone repair (1.5/2-ventricle repair). Conclusions: Mortality after surgery for EA or TVD during the index hospitalization after birth is still significant in the current era and is associated with a greater lactate level at postoperative day 1. The Starnes procedure and TVr had comparable outcomes despite a greater-risk profile in the Starnes group. An initial single-ventricle approach does not preclude conversion to biventricular or 1.5-ventricle repair.

The impact of COVID-19 and associated measures on health, police, and non-government organisation service utilisation related to violence against women and children.

BACKGROUND: Globally, concerns have been raised that the priority implementation of public health measures in response to COVID-19 may have unintended negative impacts on a variety of other health and wellbeing factors, including violence. This study examined the impact of COVID-19 response measures on changes in violence against women and children (VAWC) service utilisation across European countries. METHODS: A rapid assessment design was used to compile data including a survey distributed across WHO Europe Healthy Cities Networks and Violence Injury Prevention Focal Points in WHO European Region member states, and a scoping review of media reports, journal articles, and reports. Searches were conducted in English and Russian and covered the period between 1 January 2020 and 17 September 2020. Data extracted included: country; violence type; service sector; and change in service utilisation during COVID-19. All data pertained to the period during which COVID-19 related public health measures were implemented compared to a period before restrictions were in place. RESULTS: Overall, findings suggested that there was a median reported increase in VAWC service utilisation of approximately 20% during the COVID-19 pandemic. Crucially, however, change in service utilisation differed across sectors. After categorising each estimate as reflecting an increase or decrease in VAWC service utilisation, there was a significant association between sector and change in service utilisation; the majority of NGO estimates (95.1%) showed an increase in utilisation, compared to 58.2% of law enforcement estimates and 42.9% of health and social care estimates. CONCLUSIONS: The variation across sectors in changes in VAWC service utilisation has important implications for policymakers in the event of ongoing and future restrictions related to COVID-19, and more generally during other times of prolonged presence in the home. The increased global attention on VAWC during the pandemic should be used to drive forward the agenda on prevention, increase access to services, and implement better data collection mechanisms to ensure the momentum and increased focus on VAWC during the pandemic is not wasted.

Barriers and Facilitators of Physical Activity Participation in Adolescent Girls: A Systematic Review of Systematic Reviews.

Background: Persistent low physical activity (PA) levels among adolescent girls constitute a public health concern that calls for immediate and evidence-based policy action. This systematic review (SR) aimed to summarize evidence from SRs examining the barriers and facilitators of PA participation in adolescent girls. The objectives were to provide a synthesis of the available evidence and identify key areas for fostering gender-responsive action and policy implications. Methods: A comprehensive search of relevant SR and meta-analyses were performed in PubMed and Cochrane Library, until February 2021. Studies were included if they were SRs or meta-analyses, included adolescent girls aged between 10 and 19 years, and described barriers or facilitators of PA. Two independent authors performed the screening of potentially eligible studies and both assessed the methodological quality of included studies using the AMSTAR 2 tool. The barriers and facilitators were synthesized at environmental, interpersonal, and individual levels. Results: A total of eight SRs were included in the qualitative synthesis. The most frequent barriers identified were the lack of support from peers, family, and teachers, and the lack of time. The most reported facilitators were weight loss, and support from peers, family, and teachers. Key areas for action and policy implementation include an inclusive approach to curriculum development to address gender norms; adequate training of professionals so they have a range of skills to ensure inclusion of adolescent girls; environmental changes in and out of schools to stimulate participation, to allow adolescent girls to be active in a safe and attractive environment; multistakeholder support at local, regional, and national level in incorporating a gender-responsive approach toward PA participation. Conclusion: The results highlight a variety of factors that influences the PA participation of adolescent girls. For the attainment of effective policies that increase PA levels in adolescent girls, it is essential to engage several stakeholders at different levels in incorporating a gender-responsive approach toward PA participation. Systematic Review Registration: PROSPERO, identifier: CRD42020204023.

Effects of the coronavirus disease 2019 pandemic and the policy response on childhood obesity risk factors: Gender and sex differences and recommendations for research.

Childhood obesity is a public health concern globally, with generally higher prevalence rates in boys compared to girls. Although biological sex is an important determinant, gender roles and norms influence the exposure and vulnerability to risk factors for noncommunicable diseases. Norms and roles might be reinforced or change due to coronavirus disease 2019 (COVID-19) related measures as well as the exposure to risk factors for childhood obesity. COVID-19 related changes, such as home confinement, influence a child's risk of obesity. Using Dahlgren and Whitehead's model of the main determinants of health, this paper aims to provide a roadmap for future research on sex, gender, and childhood obesity during the time of COVID-19. It examines how COVID-19 has led to important changes in children's general socioeconomic, cultural, and environmental conditions, social and community networks, and individual lifestyle factors and how these may affect a child's risk for obesity. It focuses on the influence of gender and sex and outlines key considerations and indicators to examine in future studies concerned with promoting health and gender equity and equality. We need to understand the differential impact of COVID-19 related measures on girls' and boys' risk for obesity to adequately react with preventive measures, policies, and programs.

Emerging responses implemented to prevent and respond to violence against women and children in WHO European member states during the COVID-19 pandemic: a scoping review of online media reports.

OBJECTIVES: This study aims to explore the strategies that governments and civil society organisations implemented to prevent and respond to the anticipated rise in violence against women and/or children (VAWC) during the 2019 novel coronavirus (COVID-19) pandemic. DESIGN: A scoping review and content analysis of online media reports. SETTING: WHO European region. METHODS: A scoping review of media reports and publications and a search of other grey literature (published from 1 January to 17 September 2020). Primary and secondary outcome measures included measures implemented by governments, public services and non-governmental and civil organisations to prevent or respond to VAWC during the early months of the COVID-19 pandemic. RESULTS: Our study found that in 52 of the 53 member states there was at least one measure undertaken to prevent or respond to VAWC during the pandemic. Government-led or government-sponsored measures were the most common, reported in 50 member states. Non-governmental and other civil society-led prevention and response measures were reported in 40 member states. The most common measure was the use of media and social media to raise awareness of VAWC and to provide VAWC services through online platforms, followed by measures taken to expand and/or maintain helpline services for those exposed to violence. CONCLUSION: The potential increase in VAWC during COVID-19-imposed restrictions and lockdowns resulted in adaptations and/or increases in prevention and response strategies in nearly all member states. The strength of existing public health systems influenced the requirement and choice of strategies and highlights the need for sustaining and improving violence prevention and response services. Innovative strategies employed in several member states may offer opportunities for countries to strengthen prevention and responses in the near future and during similar emergencies.

Улучшение показателей по неинфекционным заболеваниям: барьеры и возможности систем здравоохранения: страновая оценка – Туркменистан

В Туркменистане высокий уровень преждевременной смертности от неинфекционных заболеваний (НИЗ). Вероятность преждевременной смерти (в возрасте 30–69 лет) от одного из основных НИЗ составляет 26,9%. Значительные социально-экономические последствия этой ситуации для развития страны обусловливают необходимость срочного укрепления потенциала системы здравоохранения для эффективного реагирования на растущее бремя НИЗ. В Туркменистане в этом направлении уже достигнут значительный прогресс, например, в решении проблемы распространенности поведенческих факторов риска и в модернизации инфраструктуры медицинских учреждений, имеется также политическая приверженность, однако показатели по контролю НИЗ все еще нуждаются в улучшении.В настоящем докладе приведен обзор проблем и возможностей системы здравоохранения Туркменистана применительно к наращиванию основных услуг профилактики, ранней диагностики и лечения НИЗ. Также освещены примеры передовой практики борьбы против табака. По результатам оценки сформулированы рекомендации для дальнейших действий.

Better noncommunicable disease outcomes: challenges and opportunities for health systems: Turkmenistan country assessment

Premature mortality due to noncommunicable diseases (NCDs) is high in Turkmenistan. The probability of dying prematurely (between the ages of 30 and 70 years) from one of the major NCDs is 26.9%. This has significant socioeconomic consequences for the development of the country and calls for immediate strengthening of the health system to respond to the growing burden of NCDs. Despite political commitment and significant progress, for example in reducing the prevalence of behavioural risk factors and in upgrading the health facility infrastructure, the outcomes of NCDs could still be improved.This report reviews the challenges and opportunities of the health system in Turkmenistan for scaling up core services for the prevention, early diagnosis and management of NCDs. The report also provides examples of good practice in tobacco control. Policy recommendations are made for further action, based on the assessment.

Укрепление здоровья мужчин в Ирландии: наращивание потенциала среди работников здравоохранения первой линии контакта для вовлечения мужчин в заботу о своем здоровье: информационный обзор по передовому опыту

Неинфекционные заболевания являются ведущей причиной смертности и инвалидности среди мужчин в Ирландии, и обусловливаются менее здоровым образом жизни мужчин и недостаточным использованием ими услуг здравоохранения. Национальная политика Ирландии в области здоровья мужчин (2008-2013) выделила наращивание потенциала среди поставщиков услуг первой линии в качестве крайне важного, но обделенного вниманием компонента разработки эффективных стратегий вовлечения мужчин в заботу о собственном здоровье. Для решения этого дефицита в области гендерно-чувствительного предоставления услуг мужчинам, была разработана программа ENGAGE (вовлечение, англ.), Ирландская национальная программа обучения в области здоровья мужчин. Этот комплексный однодневный тренинг основан на подходе эмпирического научения и рефлективной практики, в комбинации с механизмами для обратной связи и коллегиальной поддержки во время тренинга, и за его пределами. ENGAGE улучшил знания, навыки и потенциал поставщиков услуг в области вовлечения и работы с мужчинами и предоставления более гендерно-компетентных услуг и программ здравоохранения; усилил общественные кампании по охвату приоритетных групп мужчин; и повлиял на развитие гендерно-чувствительного предоставления услуг.

Improving men’s health in Ireland: building capacity among front-line health workers to engage men: good practice brief

Noncommunicable diseases are the leading cause of death and disability among men in Ireland and are underpinned by men’s poorer lifestyle behaviours and underutilization of health services. Ireland’s National Men’s Health Policy (2008–2013) identified building capacity among front-line service providers as an essential but neglected component of developing effective strategies for engaging men in self-care.In order to tackle this deficit in gender sensitive service provision for men, ENGAGE, Ireland’s National Men’s Health Training programme, was developed. The comprehensive one day training is based on an experiential learning and reflective practice approach, combined with mechanisms for feedback and peer support during and beyond training. ENGAGE has improved service providers’ knowledge, skills and capacity to engage and work with men and to deliver more gender-competent health services and programmes; boosted community outreach programmes to priority groups of men; and influenced the development of gender sensitive service provision.

Development of an Alternative Modified Live Influenza B Virus Vaccine.

Influenza B virus (IBV) is considered a major human pathogen, responsible for seasonal epidemics of acute respiratory illness. Two antigenically distinct IBV hemagglutinin (HA) lineages cocirculate worldwide with little cross-reactivity. Live attenuated influenza virus (LAIV) vaccines have been shown to provide better cross-protective immune responses than inactivated vaccines by eliciting local mucosal immunity and systemic B cell- and T cell-mediated memory responses. We have shown previously that incorporation of temperature-sensitive (ts) mutations into the PB1 and PB2 subunits along with a modified HA epitope tag in the C terminus of PB1 resulted in influenza A viruses (IAV) that are safe and effective as modified live attenuated (att) virus vaccines (IAV att). We explored whether analogous mutations in the IBV polymerase subunits would result in a stable virus with an att phenotype. The PB1 subunit of the influenza B/Brisbane/60/2008 strain was used to incorporate ts mutations and a C-terminal HA tag. Such modifications resulted in a B/Bris att strain with ts characteristics in vitro and an att phenotype in vivo Vaccination studies in mice showed that a single dose of the B/Bris att candidate stimulated sterilizing immunity against lethal homologous challenge and complete protection against heterologous challenge. These studies show the potential of an alternative LAIV platform for the development of IBV vaccines.IMPORTANCE A number of issues with regard to the effectiveness of the LAIV vaccine licensed in the United States (FluMist) have arisen over the past three seasons (2013-2014, 2014-2015, and 2015-2016). While the reasons for the limited robustness of the vaccine-elicited immune response remain controversial, this problem highlights the critical importance of continued investment in LAIV development and creates an opportunity to improve current strategies so as to develop more efficacious vaccines. Our laboratory has developed an alternative strategy, the incorporation of 2 amino acid mutations and a modified HA tag at the C terminus of PB1, which is sufficient to attenuate the IBV. As a LAIV, this novel vaccine provides complete protection against IBV strains. The availability of attenuated IAV and IBV backbones based on contemporary strains offers alternative platforms for the development of LAIVs that may overcome current limitations.

Proceso de erupción de los primeros molares permanentes / Eruption of the first permanent molars

Introducción: el proceso de erupción de la dentición permanente puede alterarse por causas sistémicas y/o locales, debido a que su periodo es largo. Objetivo: identificar la edad inicial de erupción de primeros molares permanentes y el momento de su oclusión en escolares al sur de la ciudad de México. Métodos: estudio longitudinal, descriptivo realizado en la escuela de educación básica Espartaco al sur de la ciudad de México. La muestra quedó conformada por 53 escolares (31 niñas / 22 niños) cuyos padres firmaron el consentimiento informado. Las variables estudiadas fueron sexo, edad cronológica y erupción de primeros molares permanentes. La muestra fue revisada cuatrimestralmente por dos examinadores calibrados, bajo buena iluminación y con espejo dental. En la identificación de erupción se usaron los criterios: no erupcionado, erupción inicial y oclusión funcional. Se realizaron revisiones posteriores hasta observar todos los molares ocluidos. Se calcularon medidas de tendencia central y dispersión por edad cronológica (inicio y oclusión funcional), así como el promedio que duró el proceso de erupción. Los datos fueron analizados con el paquete SPSS (versión 21). Resultados: la edad de erupción inicial de los primeros molares permanentes superiores derechos fue de 6,69 años, izquierdos de 6,68, inferiores derechos 6,67 años e izquierdos de 6,59. El primer molar que ocluyó fue el superior derecho (7,29 años) y los últimos ambos molares inferiores (7,56 años). La duración global promedio para llegar a oclusión del molar superior derecho fue 0,6 años, para el izquierdo 0,7 años, para el molar inferior derecho 1,1 años y para el izquierdo 1 año. Conclusiones: en la población estudiada la edad promedio del inicio de la erupción del primer molar permanente es a los 6,6 años. En los niños los primeros molares inferiores son los que inician la erupción y los últimos en llegar a oclusión(AU)

Introduction: due to its long duration, the process of eruption of permanent dentition may be affected by a number of systemic and/or local factors. Objective: identify the initial age for the eruption of the first permanent molars and the moment of their occlusion among students from a school located south of Mexico City. Methods: a longitudinal descriptive study was conducted at Espartaco elementary school south of Mexico City. The study sample consisted of 53 students (31 girls / 22 boys) whose parents granted their informed consent. The variables studied were sex, chronological age and eruption of the first permanent molars. The sample was checked every three months by two qualified examiners in a well-lit place using dental mirrors. The following criteria were applied: unerupted, initial eruption and functional occlusion. Further examination was performed to include all occluded molars. Estimation was made of central tendency and dispersion measures by chronological age (initial eruption and functional occlusion), as well as the average duration of the eruption process. Data were processed with the statistical software SPSS version 21. Results: initial eruption age was the following: 6.69 years for the first permanent upper right molars, 6.68 for the upper left, 6.67 for the lower right, and 6.59 for the lower left. The first molar to occlude was the upper right (7.29 years) and the last ones were the two lower molars (7.56). Overall average time to reach occlusion was 0.6 year for the upper right molar, 0.7 for the upper left, 1.1 for the lower right and 1 year for the lower left. Conclusions: in the population studied average age for the start of eruption of the first permanent molar was 6.6 years. Among boys the first lower molars are the ones that start eruption and the last to reach occlusion(AU)

Toll-like receptors are key participants in innate immune responses.

During an infection, one of the principal challenges for the host is to detect the pathogen and activate a rapid defensive response. The Toll-like family of receptors (TLRs), among other pattern recognition receptors (PRR), performs this detection process in vertebrate and invertebrate organisms. These type I transmembrane receptors identify microbial conserved structures or pathogen-associated molecular patterns (PAMPs). Recognition of microbial components by TLRs initiates signaling transduction pathways that induce gene expression. These gene products regulate innate immune responses and further develop an antigen-specific acquired immunity. TLR signaling pathways are regulated by intracellular adaptor molecules, such as MyD88, TIRAP/Mal, between others that provide specificity of individual TLR- mediated signaling pathways. TLR-mediated activation of innate immunity is involved not only in host defense against pathogens but also in immune disorders. The involvement of TLR-mediated pathways in auto-immune and inflammatory diseases is described in this review article.

Toll-like Receptors are Key Participants in Innate Immune Responses

During an infection, one of the principal challenges for the host is to detect the pathogen and activate a rapid defensive response. The Toll-like family of receptors (TLRs), among other pattern recognition receptors (PRR), performs this detection process in vertebrate and invertebrate organisms. These type I transmembrane receptors identify microbial conserved structures or pathogen-associated molecular patterns (PAMPs). Recognition of microbial components by TLRs initiates signaling transduction pathways that induce gene expression. These gene products regulate innate immune responses and further develop an antigen-specific acquired immunity. TLR signaling pathways are regulated by intracellular adaptor molecules, such as MyD88, TIRAP/Mal, between others that provide specificity of individual TLR- mediated signaling pathways. TLR-mediated activation of innate immunity is involved not only in host defense against pathogens but also in immune disorders. The involvement of TLR-mediated pathways in auto-immune and inflammatory diseases is described in this review article.