Hydroclimatic changes on multiple timescales since 7800 y BP in the winter precipitation-dominated Central Asia.

Central Asia (CA) is one of the world's most significant arid regions, which is markedly impacted by global warming. A better understanding of the dynamical processes governing its Holocene climate variability is critical for a better understanding of possible future impacts of climate change in the region. To date, most of the existing CA paleoclimate records are from the summer precipitation-dominated eastern CA (ECA), with few records from the winter precipitation-dominated western CA (WCA). Here, we present a precisely dated (~6‰) and highly resolved (<4-y) record of hydroclimatic variations from the WCA covering the period between 7,774 and 656 y BP. Utilizing multiple proxies (δ18O, δ13C, and Sr/Ca) derived from a stalagmite from the Fergana Valley, Kyrgyzstan, we reveal a long-term drying trend in WCA, which is in contrast with the wetting trend in ECA. We propose that different responses of winter and summer westerly jets to seasonal solar insolation over the past 8,000 y may have resulted in an antiphased precipitation relationship between the WCA and ECA. Our data contain dominant quasiperiodicities of 1,400, 50 to 70, and 20 to 30 y, indicating close connections between the WCA climate and the North Atlantic. We further identified a series of droughts and pluvials on centennial-to-decadal timescales, which may have influenced regional societies and trans-Eurasian culture exchanges during historical and prehistorical times.

Drug-Resistant Tuberculosis, Georgia, Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, 2017-2022.

In 2021, the World Health Organization recommended new extensively drug-resistant (XDR) and pre-XDR tuberculosis (TB) definitions. In a recent cohort of TB patients in Eastern Europe, we show that XDR TB as currently defined is associated with exceptionally poor treatment outcomes, considerably worse than for the former definition (31% vs. 54% treatment success).

Typologies of Sex Work Practice and Associations with the HIV Risk Environment and Risk Behaviors in Kazakhstan.

Women engaged in sex work (WESW) who use drugs are a key population in Kazakhstan's HIV epidemic. Global research suggests susceptibility to HIV varies by sex work environment. This study aims to identify evidence-based typologies of WESW and examine their associations with HIV risk. We surveyed 400 WESW who use drugs in two Kazakhstani cities, including questions on sociodemographic characteristics, social, physical, and economic risk environments, and sexual risk behaviors. Latent class analysis identified four distinct typologies of sex work practice: occasional sex work (n = 61, 15%), professional sex work for money (n = 187, 47%), sex work in exchange for drugs, goods, or other services (n = 117, 29%), and managed sex work under a boss/pimp/madam (n = 35, 9%). We then used logistic regression to examine associations between typologies and risk behaviors. Compared to professional sex work, occasional sex work was associated with lower odds of multiple sexual partners (aOR:0.46[95%CI:0.24,0.90]), of multiple paid clients (aOR:0.25[0.13,0.49]), and of > 1 instance of unprotected sex with a paying partner (aOR:0.33[0.17,0.63]). Compared to professional sex work, sex work for nonmonetary items was associated with higher odds of multiple sexual partners (aOR:1.85[0.96,3.67]) and of > 1 instance of unprotected sex with a paying partner (aOR:1.71[1.01,2.93]). Results suggest heterogeneity among WESW who use drugs in Kazakhstan, and that typologies of sex work are associated with varying HIV risk environment factors and risk behaviors. Effective HIV prevention efforts must be tailored to address these varying risk environments and the resulting variety of needs.

A greater negative impact of future climate change on vegetation in Central Asia: Evidence from trajectory/pattern analysis.

In the context of global warming, vegetation changes exhibit various patterns, yet previous studies have focused primarily on monotonic changes, often overlooking the complexity and diversity of multiple change processes. Therefore, it is crucial to further explore vegetation dynamics and diverse change trajectories in this region under future climate scenarios to obtain a more comprehensive understanding of local ecosystem evolution. In this study, we established an integrated machine learning prediction framework and a vegetation change trajectory recognition framework to predict the dynamics of vegetation in Central Asia under future climate change scenarios and identify its change trajectories, thus revealing the potential impacts of future climate change on vegetation in the region. The findings suggest that various future climate scenarios will negatively affect most vegetation in Central Asia, with vegetation change intensity increasing with increasing emission trajectories. Analyses of different time scales and trend variations consistently revealed more pronounced downward trends. Vegetation change trajectory analysis revealed that most vegetation has undergone nonlinear and dramatic changes, with negative changes outnumbering positive changes and curve changes outnumbering abrupt changes. Under the highest emission scenario (SSP5-8.5), the abrupt vegetation changes and curve changes are 1.7 times and 1.3 times greater, respectively, than those under the SSP1-2.6 scenario. When transitioning from lower emission pathways (SSP1-2.6, SSP2-4.5) to higher emission pathways (SSP3-7.0, SSP5-8.5), the vegetation change trajectories shift from neutral and negative curve changes to abrupt negative changes. Across climate scenarios, the key climate factors influencing vegetation changes are mostly evapotranspiration and soil moisture, with temperature and relative humidity exerting relatively minor effects. Our study reveals the negative response of vegetation in Central Asia to climate change from the perspective of vegetation dynamics and change trajectories, providing a scientific basis for the development of effective ecological protection and climate adaptation strategies.

Informing policy with health labour market analysis to improve availability of family doctors in Tajikistan.

BACKGROUND: Tajikistan has embarked on health reforms to orient the health system towards primary health care (PHC). The health labour market analysis (HLMA) was initiated by the Ministry of Health with the World Health Organization (WHO) on policy questions related to the PHC workforce team. This article presents the results with focus on family doctors as a critical part of the PHC team, providing lessons for strengthening family medicine and PHC in the European Region and central Asia. METHODS: The HLMA framework was used to guide the analysis. The data for analysis were provided by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Descriptive means were used to analyse the data. A Technical Working Group guided the process. RESULTS: There has been an increase in the number of health workers in the country over the last 7 years. However, there is a huge shortage of family doctors when compared with norms, with decreasing family doctor densities over the last 7 years. Family doctors have the highest vacancy rates among specialists and also constitute the highest proportion of specialists who migrate. There is inequitable distribution of doctors across the regions. Overall number of enrolments and graduates in family medicine are declining. Although salaries in PHC are higher than in hospitals, the overall health workforce salaries are lower than the national average. While there have been efforts to retain and attract doctors to PHC in rural and remote regions, challenges exist. The attraction of doctors to narrow specialties may be leading to undermining PHC and family medicine. While the optimal skill-mix and availability of nurses provide an opportunity to strengthen multi-disciplinary teams at the PHC level, shortages and unequal distribution of doctors are affecting health services coverage and health indicators. CONCLUSIONS: Application of the HLMA framework has helped identify the bottlenecks in the health labour market flows and the possible explanations for them. The policy considerations emerging out of the HLMA have contributed to improving evidence-based planning for retention and recruitment of the PHC workforce, improvements in medical and nursing education, and higher investments in the PHC workforce and particularly in family doctors. Implementation of the Action Plan will require political commitment, financial resources, strong inter-sectoral collaboration, stakeholder management, and cross-country learning of best practices. Through this process, Tajikistan has shown the way forward in implementing the Central Roadmap for health and well-being in Central Asia and the Framework for Action on the Health and Care Workforce in the WHO European Region.

How likely are Eastern European and central Asian countries to achieve global NCD targets: multi-country analysis.

BACKGROUND: In Europe, mortality rates from noncommunicable diseases (NCDs) among persons 30-69 years of age ("NCD premature mortality rates") have declined significantly, except in twelve countries of Eastern Europe and Central Asia, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Data on long-term trends in NCD mortality in these countries are limited. We analyzed NCD premature mortality rates, identified change points in NCD mortality trends and forecasted how likely countries are to achieve the global NCD targets, stratified by gender and NCD type. METHODS: We used the 1990-2019 Global Burden of Disease database to analyze NCD trends and identified country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving the global targets for reducing NCD premature mortality rates among persons 30-69 years of age from four NCDs: cancers, diabetes, cardiovascular and chronic respiratory diseases. The global NCD targets are 25% reduction in mortality from 2010 to 2025 (WHO 25X25 target) and 33%-from 2015 to 2030 (SDG 3.4.1). We applied the analysis to both genders and four NCDs. RESULTS: Only Kazakhstan and Russia are likely to achieve the global NCD targets. For Kazakhstan, WHO 25X25 and SDG 3.4.1 global targets for mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1-461.1] and 245.1 [CI 113.4-376.8]. For Russia, WHO 25X25 and SDG 3.4.1 global targets were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3-585.1] and 311.0 [CI 102.8-519.1]. Achieving NCD global targets is less likely for Kyrgyzstan, while it is unlikely for the rest of countries. Most countries had higher mortality rates and slower progress among men compared with women. The likelihood of achieving overall global NCD targets was mainly explained by reduction in cardiovascular mortality. CONCLUSIONS: In most Eastern Europe and Central Asia countries, progress towards achieving NCD global targets is slow, or there's a reverse trend. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor trends for cancers, diabetes and chronic respiratory diseases.

Barriers and facilitators to viral hepatitis testing in Uzbekistan: scoping qualitative study among key stakeholders, healthcare workers, and the general population.

INTRODUCTION: In the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022-2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions. METHODS: This study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan. RESULTS: Following the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator. CONCLUSIONS: A multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.

Measuring sustainability of opioid agonist therapy programs in the context of transition from global fund support.

BACKGROUND: Programmatic and financial sustainability of health responses dependent on donor funding has risen as a major concern. In the HIV field in particular, it generated a number of instruments and assessments on sustainability and processes related to donor transition planning. The authors aimed to develop an instrument specific to opioid agonist therapy (OAT) programs as they were addressed only marginally by the HIV-specific assessments. METHODS: The development of the OAT sustainability instrument used desk review of existing HIV sustainability concepts and tools, an International Advisory Board, and piloting to validate the instrument. RESULTS: The new OAT sustainability instrument is comprised of the three parts: the conceptual framework, methodological guidelines and a practical implementation tool for assessing the degree of OAT sustainability at the country level. It measures sustainability in the three broad areas for sustainability measuring-Policy & Governance; Finance & Resources; and Services. The selection of indicators and their composites for the three sustainability areas extensively used the United Nations and World Health Organization's guidance on health system building blocks, on care and HIV and viral hepatitis prevention among people using opioids and for opioid dependence, and the definition of access to health framed by the United Nations Convent on Economic, Social and Cultural Rights. The instrument's methodological guidelines require the engagement of a national consultant to conduct desk review, key informant interviews and focus groups for measuring discrete milestones and adding qualitative information for interpretation of the data, progress and opportunities. The guidelines advise engaging a country-specific multi-stakeholder advisory group for planning, validation and follow-up of the assessment. The pilot of the instrument in 3 countries in 2020 validated it and required minor adjustments in the instrument. By mid-2023, the instrument has been successfully applied in 5 countries. CONCLUSIONS: The developed instrument enables a comprehensive review of the resilience of OAT programs and their ability to scale up and to inform a roadmap for improved sustainability. While developed in the context of Eastern Europe and Central Asia, it has been reviewed by a global advisory panel and could be easily adapted outside this regional context.

Molecular Genotyping Analysis Suggested High Clonality and Simple Marker Loci in Puccinia striiformis f. sp. tritici Population in Uzbekistan, Central Asian Region.

Puccinia striiformis f. sp. tritici (Pst) is a destructive pathogen that causes wheat stripe rust worldwide. Understanding the population structure and dynamic of pathogen spread is critical to fight against this disease. Limited information is available for the population genetic structure of Pst in Uzbekistan, Central Asia. In this study, we carried out surveillance from nine different regions (Andijan, Fergana, Jizzakh, Kashkadarya, Namangan, Samarkand, Sirdaryo, Surkhandarya, and Tashkent) of Uzbekistan to fill this gap. A total of 255 isolates were collected, which were genotyped using 17 polymorphic simple sequence repeat markers. The DAPC analysis results showed no population subdivision in these sample-collected regions except Surkhandarya. Multilocus genotype (MLG) analysis, FST, and Nei's genetic distance results indicated a clonal population (rBarD ≤ 0.12) and merely three MLGs accounting for 70% of the overall population. MLG-34 was predominant in all regions of Uzbekistan, followed by MLG-36 and MLG-42. Low genotypic diversity was observed in Andijan, Fergana, Jizzakh, Kashkadarya, Namangan, Sirdaryo, and Tashkent (0.56 to 0.76), compared with Samarkand (0.82) and Surkhandarya (0.97). No virulence against Yr5, Yr15, YrSp, and Yr26 was found, while resistance was overcome against Yr1, Yr2, Yr6, Yr9, Yr17, and Yr44 genes (virulence frequency ≥75%). Comparative study results of Uzbekistan with the previous Himalayan population showed divergence from China and Pakistan populations. Further studies need to be conducted in a worldwide context to understand migration patterns; for that purpose, collaborative work is essential because of the Pst long-distance migration capability.

The Genetic Echo of the Tarim Mummies in Modern Central Asians.

The diversity of Central Asians has been shaped by multiple migrations and cultural diffusion. Although ancient DNA studies have revealed the demographic changes of the Central Asian since the Bronze Age, the contribution of the ancient populations to the modern Central Asian remains opaque. Herein, we performed high-coverage sequencing of 131 whole genomes of Indo-European-speaking Tajik and Turkic-speaking Kyrgyz populations to explore their genomic diversity and admixture history. By integrating the ancient DNA data, we revealed more details of the origins and admixture history of Central Asians. We found that the major ancestry of present-day Tajik populations can be traced back to the admixture of the Bronze Age Bactria-Margiana Archaeological Complex and Andronovo-related populations. Highland Tajik populations further received additional gene flow from the Tarim mummies, an isolated ancient North Eurasian-related population. The West Eurasian ancestry of Kyrgyz is mainly derived from Historical Era populations in Xinjiang of China. Furthermore, the recent admixture signals detected in both Tajik and Kyrgyz are ascribed to the expansions of Eastern Steppe nomadic pastoralists during the Historical Era.

Revisiting epidemiology of leishmaniasis in central Asia: lessons learnt.

In this work we reviewed historical and recent data on Leishmania spp. infection combining data collected in Turkmenistan, Uzbekistan, Kazakhstan, Kyrgyzstan, Iran, China and Mongolia. We specifically focused on a complex of co-existing species (Leishmania major, Leishmania turanica and Leishmania gerbilli) sharing the same animal reservoirs and vectors. In addition, we analysed the presence of dsRNA viruses in these species and discussed future research directions to identify species-specific traits, which may determine susceptibility of different Leishmania spp. to viral infection.

Comparative Analysis of Central Asian Publication Activity Using SCImago Journal & Country Rank Data in 1996-2021.

BACKGROUND: Central Asian countries (CACs) are less visible in the global scientific environment, despite their solid scientific nature. The current article aimed to assess the publication productivity of CACs since 1996 using SCImago Journal & Country Rank (SJR). METHODS: This is a descriptive study. The SJR portal was used to retrieve the data. The Country Rankings section was viewed, and the Asiatic Region option was chosen. The most active countries and CACs' number of documents, number of citable documents, citations, self-citations, citations per document, and H index data were obtained. The number of documents from CACs was recorded annually to determine the ten-year trend (2012 to 2021). Scientific categories in which CACs were prolific were defined. RESULTS: Between 1996 and 2021, 18,336,647 documents with Asian region origins were produced. The most active countries in the Asiatic Region were China (1st), Japan (2nd), India (3rd), South Korea (4th), and Taiwan (5th). According to the number of documents, Kazakhstan ranked 15th, Uzbekistan 19th, Kyrgyzstan 24th, Tajikistan 27th, and Turkmenistan 31st among the Asiatic Region countries. The total number of documents originating from CACS, which was 1,616 in 2012, increased to 9,780 in 2021 with an upward trend (6.05 fold increase). CONCLUSION: Despite a rising number of articles, CACs are not at the forefront of scientific productivity in the Asiatic Region. Kazakhstan is the leading country in scientific productivity among CACs. Nonetheless, the increasing quantity of articles from CACs over the last ten years suggests that these countries have the infrastructure and human resources to enhance scientific research and production.

Melon diversity on the Silk Road by molecular phylogenetic analysis in Kazakhstan melons.

To uncover population structure, phylogenetic relationship, and diversity in melons along the famous Silk Road, a seed size measurement and a phylogenetic analysis using five chloroplast genome markers, 17 RAPD markers and 11 SSR markers were conducted for 87 Kazakh melon accessions with reference accessions. Kazakh melon accessions had large seed with exception of two accessions of weedy melon, Group Agrestis, and consisted of three cytoplasm types, of which Ib-1/-2 and Ib-3 were dominant in Kazakhstan and nearby areas such as northwestern China, Central Asia and Russia. Molecular phylogeny showed that two unique genetic groups, STIa-2 with Ib-1/-2 cytoplasm and STIa-1 with Ib-3 cytoplasm, and one admixed group, STIAD combined with STIa and STIb, were prevalent across all Kazakh melon groups. STIAD melons that phylogenetically overlapped with STIa-1 and STIa-2 melons were frequent in the eastern Silk Road region, including Kazakhstan. Evidently, a small population contributed to melon development and variation in the eastern Silk Road. Conscious preservation of fruit traits specific to Kazakh melon groups is thought to play a role in the conservation of Kazakh melon genetic variation during melon production, where hybrid progenies were generated through open pollination.

Effects of drought and climate factors on vegetation dynamics in Central Asia from 1982 to 2020.

Ecological security and ecosystem stability in Central Asia depend heavily on the local vegetation. Vegetation dynamics and the response and hysteresis relationships to climate factors and drought on multiple scales over long time series in the region still need to be further explored. Using the net primary productivity (NPP) values as the vegetation change index of interest, in this study, we analyzed vegetation dynamics in Central Asia from 1982 to 2020 and assessed the responses and time lags of vegetation to climate factors and drought. The results showed that NPP gradually decreased from north to south and from east to west. Vegetation was distributed along both sides of the mountains. The temperatures rose from northeast to southwest, while precipitation gradually increased from southwest to northeast. The proportion of dry and wet years was as follows: normal (56.41%) > slightly dry (28.2%) > slightly humid (15.39%). Precipitation and drought conditions were positively correlated with NPP during the growing season, while temperature was negatively correlated with NPP. Increased spring temperature, precipitation, and drought conditions positively affected vegetation, while sustained summer temperature resulted in suppressed vegetation growth. Autumn vegetation was positively affected by temperature and drought, and precipitation was negatively correlated with autumn vegetation. Increasing winter temperatures promoted vegetation growth. The time lag between NPP and temperature gradually increased from northeast to southwest, and the time lag between NPP and precipitation gradually increased from south to north. Spring temperatures had the greatest beneficial impact on forestlands; summer climatic factors and drought had little effect on shrublands; the autumn climate exhibited small differences in its influence of each plant type; and winter temperatures had the greatest positive effect on grasslands. No time lag effect was found between any of the four vegetation types and precipitation. A one-month lag was found between cultivated lands and temperature; a two-month lag was found between forestlands and temperature; and a one-month lag was found between forestlands and drought and between shrublands and drought. The results can provide a scientific foundation for the sustainable development and management of ecosystems.

Indicator-based assessments of the coupling coordination degree and correlations of water-energy-food-ecology nexus in Uzbekistan.

Grappling with the global ecological concern of the Aral Sea disaster, Uzbekistan exemplifies the urgent necessity of unravelling and addressing the complex Water-Energy-Food-Ecology (WEFE) nexus conflicts in arid regions, a critical task yet largely uncharted. Through the strategic process of 'Indicator Articulation - Weight Calibration - Nexus Coordination Quantification - Correlational Analysis', this work has developed a tailored framework that integrates a novel, context-specific indicator system, enabling an illumination of the intricate dynamics within the WEFE nexus in arid regions. During 2000-2018, the WEFE Nexus in Uzbekistan showed low-level coordination, indicating systemic imbalances. The Aral Sea crisis was the central disruptor, resulting in a moderately disordered ecological subsystem. Concurrently, disorder was observed in water resources, signaling inadequate management and potential overutilization. Furthermore, Coordination for energy and food were barely coordinated and under primary coordination respectively, underlining critical challenges in energy efficiency and food security. Over the last two decades, the WEFE Nexus has evolved towards a tighter interlinkage, yet the stability of this coupling coordination has experienced increased fluctuations, indicating that Uzbekistan's policies in the WEFE subsystems have been less stable in the last two decades and are in need of further adjustment and improvement. To address the challenges, we recommend a comprehensive approach that integrates technological, infrastructure, and policy solutions is needed. Specifically, promoting water-saving irrigation technology, renewing and maintaining outdated energy facilities, and raising public awareness of ecological protection are part of the essential measures. Furthermore, alleviating the contradiction between economic growth and ecological conservation remains a major challenge. Collectively, our constructed WEFE Nexus framework, with its extendable and context-specific indicators, holds significant potential for broad application in the analysis of multi-sectoral sustainability, particularly within arid regions globally, and forms a solid foundation for the formulation of effective, targeted policies and sustainable development strategies.

Digitalization and resilience during the COVID-19 pandemic.

The COVID-19 pandemic has resulted in an unprecedented shock to firms with adverse consequences for existing productive capacities. At the same time, digitalization has increasingly been touted as a key pathway for mitigating economic losses from the pandemic, and we expect firms facing digital constraints to be less resilient to supply shocks. This paper uses firm-level data to investigate whether digitally-enabled firms have been able to mitigate economic losses arising from the pandemic better than digitally-constrained firms in the Middle East and Central Asia region using a difference-in-differences approach. Controlling for demand conditions, we find that digitally-enabled firms faced a lower decline in sales by about 4 percentage points during the pandemic compared to digitally-constrained firms, suggesting that digitalization acted as a hedge during the pandemic. Against this backdrop, our results suggest that policymakers need to close the digital gap and accelerate firms' digital transformation. This will be essential for economies to bounce back from the pandemic, and build the foundations for future resilience.

Changing Well-Being in Central Asia: Evidence from Kazakhstan and Kyrgyzstan.

This article explains the puzzle why subjective well-being (SBW) declined in Kazakhstan and increased in Kyrgyzstan from 2011 to 2018. It examined the predictors of the change in SWB in two Central Asian states over this period. We found that freedom of choice and financial satisfaction are powerful factors that predict the change in SWB in the two states. In addition, we observed that SWB has changed differently for various social groups. In Kazakhstan SWB has increased for financially satisfied people and it has diminished for the financially dissatisfied people. In Kyrgyzstan, for both groups we observe the increase in life satisfaction. These results show that even within one state the change in SWB might vary from one group to another. As such, scholars should disaggregate various factors to understand a more nuanced dynamics of life satisfaction over time. In addition, the differences in economic and political contexts are important.

Competition and firm recovery post-COVID-19.

This paper examines the impact of the COVID-19 crisis on the reallocation of economic activity across firms and whether this reallocation depends on the competition environment. The paper uses the World Bank's Enterprise Surveys COVID-19 Follow-up Surveys for about 8000 firms, including both small and large firms, in 23 emerging and developing countries in Europe and Central Asia, matched with 2019 Enterprise Surveys data. It finds that during the COVID-19 crisis, smaller firms were hit harder, and economic activity was reallocated toward firms with higher pre-crisis labor productivity. Countries with a strong competition environment experienced more reallocation from less productive to more productive firms than countries with a weak competition environment. The evidence also suggests that reallocation from low- to high-productivity firms during the COVID-19 crisis was stronger compared with pre-crisis times. Finally, the analysis shows that government support measures implemented in response to the crisis may have adverse effects on competition and productivity growth since support went to less productive and larger firms, regardless of their pre-crisis innovation.

Epidemiology Helicobacter pylori infection in children in the Tyva Republic (Russia).

BACKGROUND: Tyva Republic is a small mountainous area at the geographical center of Asia in southern Siberia, with a high incidence of gastric cancer. AIM: We examined the prevalence of H. pylori and associated risk factors among children in Tyva. METHODS: Cross-sectional study was conducted among Tuvan children who had upper gastrointestinal symptoms and underwent upper gastroscopy with gastric biopsies. Informed consent was obtained from the parents and assent from the children. Demographic information, ethnicity, parents' education and employment status, and family size were collected. H. pylori infection was diagnosed by histologic examination. RESULTS: There were 270 children between the ages 7 and 17 years (mean 13.4 ± 2.7); 64% girls; 147e Tuvan and 123 Caucasians. The overall prevalence of H. pylori was high and similar between boys and girls (55 vs. 57%, respectively, p = 0.42). The infection was highest in Tuvan children (67%. vs. 43%, respectively (OR = 2.4; 95%CI = 1.9.4-3), p = 0.05. H. pylori prevalence increased with age from 44% among 7 to 10 years and 64% among those 14 to 17 (OR = 3.0; 95%CI = 1.6-5.8), p = 0.0.005; the pattern was consistent among both ethnic groups. The prevalence of the infection among Caucasian children was inversely correlated with the level of mother's education (44%, vs. 61%) (i.e., for with and without a college education the OR = 2.3; 95%CI = 1.2-3.7), p = 0.02. Neither the total number of children nor adults living in the same household correlated with H. pylori prevalence. CONCLUSIONS: Strategies to reduce the incidence of gastric cancer in Tyva will need to start in childhood.

Social network-based ethical analysis of COVID-19 vaccine supply policy in three Central Asian countries.

BACKGROUND: In the pandemic time, many low- and middle-income countries are experiencing restricted access to COVID-19 vaccines. Access to imported vaccines or ways to produce them locally became the principal source of hope for these countries. But developing a strategy for success in obtaining and allocating vaccines was not easy task. The governments in those countries have faced the difficult decision whether to accept or reject offers of vaccine diplomacy, weighing the price and availability of COVID-19 vaccines against the concerns over their efficacy and safety. We aimed to analyze public opinion regarding the governmental strategies to obtain COVID-19 vaccines in three Central Asian countries, focusing particularly on possible ethical issues. METHODS: We searched for opinions expressed either in Russian or in the respective national languages. We provided data on the debate within three countries, drawn from social media postings and other sources. The opinion data was not restricted by source and time. This allowed collecting a wide range of possible opinions that could be expressed regarding COVID-19 vaccine supply and human participation in the vaccine trial. We recognized ethical issues and possible questions concerning different ethical frameworks. We also considered scientific data and other information, in the process of reasoning. RESULTS: As a result, public views on their respective government policies on COVID-19 vaccine supply ranged from strongly negative to slightly positive. We extracted the most important issues from public debates, for our analysis. The first issue involved trade-offs between quantity, speed, price, freedom, efficacy, and safety in the vaccines. The second set of issues arose in connection with the request to site a randomized trial in one of the countries (Uzbekistan). After considering additional evidence, we weighed individual and public risks against the benefits to make specific judgements concerning every issue. CONCLUSIONS: We believe that our analysis would be a helpful example of solving ethical issues that can arise concerning COVID-19 vaccine supply around the world. The public view can be highly critical, helping to spot such issues. An ignoring this view can lead to major problems, which in turn, can become a serious obstacle for the vaccine coverage and epidemics' control in the countries and regions.