Immunisation status of children and adolescents with a new diagnosis of inflammatory bowel disease

Background Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines. Methods Paediatric patients (0–18 years) seen at the tertiary Royal Children’s Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available. Results Sixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC. Conclusions Children with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.

Assessment of Chainsaw Operators Training in Andalusia (Spain)

The chainsaw, as a work equipment, is considered one of the most dangerous in the field of occupational health and safety. The chainsaw is especially used in the forestry sector, although it is also used in other different sectors such as agriculture, construction or gardening. This study was carried out using an ad-hoc questionnaire as a research tool in order to assess the weaknesses in the training received by workers who use chainsaws in Andalusia, Spain, since it has never been addressed before. To achieve the objective set, the questionnaire was completed by 378 operators working with chainsaw and their responses were analysed. The results of this study show that there are obvious shortcomings related to work with chainsaws in very significant aspects for the occupational health and safety. Of special importance is the lack of training detected on rescue techniques and work at height, since these are aspects of special risk for workers’ health that could cause accidents with severe injuries. Also, a common denominator in all aspects studied was the lack of safety inspections and the state of the equipment to be used. These results evidence that there is a need to regulate chainsaw operator training.

Immunosuppressant Management in Renal Transplant Patients with COVID-19

The coronavirus disease 2019 (COVID-19) pandemic poses a special risk for both immunosuppressed patients, especially transplant recipients. Although the knowledge about this infection is growing, many uncertainties remain, particularly regarding the kidney. Kidney transplant recipients (KDRs) should be considered immunocompromised hosts since a potential risk for infection, comorbidity, and immunosuppression exposure exists. Additionally, the management of immunosuppressive agents in KDRs remains challenging. Potential drug interactions with immunosuppressive treatment escalated the risk of unwanted side effects. In this review, we aimed to attain an augmented awareness and improved management immunosuppressant for COVID-19 KDRs.

Tobacco use among transgender and gender non-binary youth in Brazil

Transgender and gender non-binary youth are particularly vulnerable to tobacco smoking and susceptible to smoking adverse health outcomes. That is, they are in special risk to start smoking and, after starting, they may face worse outcomes when comparing to their cisgender peers. Therefore, the present study aims to evaluate factors associated with tobacco use among transgender and gender non-binary youth. Brazilian youth aged 16 to 25 who identify as transgender or gender non-binary answered an online questionnaire. Poisson regression with robust variance was run to predict smoking cigarettes based on individual and environmental factors. 14.1% of 206 youth reported smoking cigarettes daily, whereas 9.3% of participants reported smoking e-cigarettes occasionally. Drug use, lack of social support, deprivation, discrimination, the wait for medical gender-affirming procedures and being outside school were associated with smoking cigarettes. Contextual and individual factors should be further explored in causal analysis and taken into consideration when planning smoking prevention and cessation interventions for transgender and gender non-binary youth.

TRANSFORMATION OF THE SOCIO-ECONOMIC FRAME OF THE REPUBLIC OF BASHKORTOSTAN

The author has analyzed the transformation of industrial, agricultural, tourist and recreational frameworks and the framework of settlement of the Republic of Bashkortostan over the past 10 years. The analysis showed that the major urban districts the core of the region's agglomerations are the supporting framework of the region. Agglomerations concentrate the bulk of industrial production, investments, and jobs in the region. At the same time, the formation of agglomerations is an objective trend in the transformation of the settlement system of the Republic of Bashkortostan, associated with intraregional and interregional flows of the population “village administrative center - city”. In four agglomerations of the republic (Ufa, South Bashkortostan, OktyabrskoTuimazinskaya and Neftekamskaya), almost 2/3 of the region's population lives in 2019 (62.1% (in 2006 - 57.9%)), including The Ufa agglomeration is 36.5% (in 2006 - 32.7%). In addition, agglomeration processes led to a change in the volume of construction in three municipal districts, on the territories of which the four largest urban districts of the region are located: Ufa, Sterlitamak, Salavat, Oktyabrsky. In total, the share of these three districts in the total volume of housing commissioned in the municipal districts of the region has grown from 20% to 30% over the past 10 years. The agricultural framework of the region is also moving towards agglomerations, forming an agricultural zone around them. Peripheral and depressive zones, despite the implementation of development programs in them, do not get out of the crisis, but gradually use additional development opportunities (for example, the activation of the tourism potential of the Trans-Urals republic). At the same time, in any case, these territories remain areas of special risk as a result of the pulling together of human and other resources both to the center of the region and to neighboring subjects of the federation.

Pressure ulcers

Pressure ulcers are a problem worldwide with social and cost implications. Patients at special risk are paraplegics, those in intensive care units who are critically sick, and older patients having prolonged bed rest for whatever reason. The important extrinsic factors are pressure, shear, and friction. There are a number of charts, which endeavour to identify patients at risk, and institute appropriate preventative measures thereby avoiding the long-term sequelae and burden of pressure ulcers. In patients with established pressure ulcers, an accurate patient and wound evaluation is vitally important. The long-term success of management of these ulcers is dependent on good patient rehabilitation and optimization of the wound. Reconstructive success is improved by following surgical guidelines. Use of fasciocutaneous flaps, designed in a V–Y configuration, is the preferred method of reconstruction with muscle flaps reserved as a back-up option. Conscientious postoperative care is equally important at ensuring a successful surgical outcome and minimizing complications

Peculiarities of micronutrient metabolism in obese pregnant women (literature review)

Here we summarize uptodate data on the influence of the most significant micro, macroelements, and vitamins, such as magnesium, vitamin D, iron, and folic acid, on the course of pregnancy and childbirth in obese women. The paper considers both domestic and foreign recommendations for correcting nutritional deficiencies to prevent the development of complications from the pregravid stage to the end of lactation. Nowadays, the deficiency of micro-, macroelements and vitamins is an extremely urgent problem, especially in a group of special risk, i.e. overweight and obese women, whose number is steadily growing simultaneously with an increase of the number of pregnant women of 35+ years of age. It is important to consider a woman's body mass index to prescribe the minimum effective dose of the necessary drugs. Timely preventive personalized correction of the micronutrient state can reduce the risks of such major obstetric syndromes as preeclampsia, premature birth, fetal growth retardation, miscarriage, and placental dysfunction.

Patients with CKD-5D and COVID infection. Individual organizational and clinical issues of therapy

New coronavirus infection (COVID-19) – a serious medical and social problem. Despite the achievement of certain successes in the treatment of patients with COVID-19, there is a need to develop special clinical and organizational approaches in patients with CKD who are on renal replacement therapy and are at special risk due to the course of the underlying disease and concomitant pathology. The article presents the experience of the Samara Regional Center of Nephrology and Dialysis of the Samara Regional Clinical Hospital named after V.D. Seredavin during the pandemic, as well as the features of the management of patients with stage 5 chronic kidney disease undergoing renal replacement therapy in the infectious department to provide MP to patients with COVID-19. Patients with CKD require increased attention, treatment of coronavirus infection (both specific and concomitant) should be carried out in full, while observing the regimens and dosage regimens of drugs and their combinations.