The impact of the 2014 military conflict in the east of Ukraine and the Autonomous Republic of the Crimea among patients receiving opioid agonist therapies.

BACKGROUND: Opioid agonist therapies (OAT) for people with opioid use disorders (OUD) have been available in Ukraine since 2004. This study assessed the effect of 2014 Russian invasion of Ukraine on OAT re-enrollment and retention in conflict areas. METHODS: We analyzed the Ukraine national registry of OAT patients containing 1868 people with OUD receiving OAT as of January 2014 in conflict areas (Donetsk, Luhansk, and the Autonomous Republic [AR] of the Crimea). We developed logistic regression models to assess the correlates of re-enrollment of OAT patients in government-controlled areas (GCA) from conflict areas and retention on OAT at 12 months after re-enrollment. RESULTS: Overall, 377 (20.2 %) patients were re-enrolled at an OAT site in a GCA from confict areas, of whom 182 (48.3 %) were retained on OAT through 2021. Correlates of re-enrollment were residing in Donetsk (adjusted odds ratios (aOR) = 7.06; 95 % CI: 4.97-10.20) or Luhansk (aOR = 6.20; 95 % CI: 4.38-8.93) vs. AR Crimea; age 18-34 (aOR = 2.03; 95 % CI: 1.07-3.96) or 35-44 (aOR = 2.09; 95 % CI: 1.24-3.71) vs. ≥55 years, and being on optimal (aOR = 1.78; 95 % CI: 1.33-2.39) or high OAT dosing (aOR = 2.76; 95 % CI: 1.93-3.96) vs. low dosing. Correlates of retention were drug use experience 15-19 years (aOR = 3.69; 95 % CI: 1.47-9.49) vs. <14 years of drug use; take-home (aOR = 3.42; 95 % CI: 1.99-5.96) vs. daily on-site dosing, and optimal (aOR = 2.19; 95 % CI:1.05-4.72) vs. low OAT dosing. CONCLUSION: Our study showed that one-fifth of patients were re-enrolled at sites in GCA areas, less than half of re-enrolled patients were retained. Disruption of OAT has implications for drug-, HIV-, and HCV-related morbidity and mortality. FUNDING: AM was funded by NIH-funded grant D43TW010562; DCO was funded by the NIDA-funded Center for Drug Use and HIV|HCV Research (P30DA011041).

A Single Clinical Case of Leptospirosis in a 70-Year-Old Man During the Military Conflict in Ukraine.

Leptospirosis is a bacterial disease that affects both humans and animals worldwide. Clinical symptoms of leptospirosis in humans range widely, from mild to severe illness, with symptoms that can include severe jaundice, acute renal failure, hemorrhagic pneumonia, and meningitis. We present a detailed clinical description of a 70-year-old man with leptospirosis. This case presented without the typical prodromal period for leptospirosis, thus making diagnosis more difficult. This isolated case occurred in the Lviv region during the ongoing military conflict between Russia and Ukraine where Ukrainian citizens have been forced to hide in premises that are not properly adapted for their long-term stay, which result in conditions that can potentially lead to the emergence of many infectious diseases. This case highlights the need for heightened awareness into the symptoms of a variety of infectious diseases, including but not limited to leptospirosis.

Health Care Organization in Poland in Light of the Refugee Crisis Related to the Military Conflict in Ukraine.

BACKGROUND: Poland is witnessing a migration crisis caused by the ongoing military conflict in Ukraine. In addition to housing and necessities, 1.8 million Ukrainians that had taken refuge in Poland must have access to medical care. We aim to propose a strategy for implementing the changes in the Polish health care system in response to the Ukrainian refugee crisis. METHODS: A literature review on organizational changes in the functioning of health care systems during the migration crises worldwide in recent years and brainstorming in order to develop a strategy for implementing changes in the Polish health care system in response to the Ukrainian refugee crisis. RESULTS: The proposed strategy for implementing the changes in the Polish health care system is based on building health care resilience and adaptation to different crises. The operational objectives of organization-related activities are: (1) preparation of medical facilities to provide help for refugees, (2) development and implementation of the communication system, (3) implementation of available digital solutions, (4) organization of the diagnostic and medical services, (5) and implementation of changes in the management of medical facilities. CONCLUSIONS: Urgent reorganization is required to respond to an unavoidable increase in the demand for health care services.

The effect of military conflict zone in the Middle East on atmospheric persistent organic pollutant contamination in its north.

This study aimed to investigate long-range atmospheric transport of selected POPs released due to the effects of military conflicts in regions to the south of Turkey's borders. Ten locations were selected to deploy passive air samplers at varying distances to the border on a southeast-west transect of the country, proximity-grouped as close, middle, and far. Sampling campaign included winter and transition months when desert dust transport events occur. Hypothesis of the study was that a decreasing trend would be observed with increasing distance to the border. Group comparisons based on statistical testing showed that PBDE-183, Σ45PCB, and dieldrin in winter; PBDE-28, PBDE-99, PBDE-154, p,p'-DDE, Σ14PBDE, and Σ25OCP in the transition period; and PBDE-28, PBDE-85, PBDE-99, PBDE-154, PBDE-190, PCB-52, Σ45PCB, p,p'-DDE, and Σ25OCP over the whole campaign had a decreasing trend on the transect. An analysis of concentration ratio to the background showed that long-range atmospheric transport impacted the study sites, especially those of close group in comparison to the local sources. Back-trajectory analyses indicated that there was transport from the conflict areas to sites in the close-proximity group, while farther sampling locations mostly received air masses from Europe, Russia, and former Soviet Union countries, followed by North Africa, rather than the military conflict areas. In consequence, decrease in concentrations with distance and its relation to molecular weight through proportions, diagnostic ratios, analysis of concentration ratio to the background, and back-trajectory analyses support the effect of transport from the military-conflict area to its north.

Screening of legacy and emerging substances in surface water, sediment, biota and groundwater samples collected in the Siverskyi Donets River Basin employing wide-scope target and suspect screening.

Siverskyi Donets is the fourth longest river in Ukraine and its ecosystem is heavily affected by numerous agricultural and industrial activities. An impact of the on-going armed military conflicts in the Eastern Ukraine to the overall pollution by the chemicals has been studied. Considering the uncontrolled activities in the catchment due to the conflict, there is a high demand to assess the contamination status of the Siverskyi Donets basin. In this study, the occurrence of the EU Water Framework Directive priority substances, selected physicochemical parameters and wide-range emerging contaminants were investigated in surface water, groundwater, biota and river sediments samples from 13 sampling sites in the river basin. The study included metals, inorganic, non-polar and polar organic contaminants. The wide-scope target screening of 2316 substances and suspect screening of 2219 substances revealed occurrence of 83 compounds in the studied samples. A few industrial chemicals such as plasticizers bisphenol A and DEHP, as well as flame retardant brominated diphenylethers were found to be potentially hazardous to the ecosystem, exceeding the established legacy environmental quality standards (EQS) or the provisional no-effect concentration (PNEC) values. River sediment samples contained traces of long-term banned chemicals such as polychlorinated biphenyls (PCBs) and degradation products of DDT (p,p'-DDD and p,p'-DDE). A simplified risk assessment based on comparison of measured concentration of the detected compounds against their (eco)toxicity threshold values from the NORMAN Ecotoxicology Database has been performed to aid their prioritization in future monitoring and, eventually, establishing the list of Siverskyi Donets River Basin Specific Pollutants. A comparison with the recent similar studies in the Dniester and Dnieper river basins in Ukraine has shown that the overall pollution by chemicals in the Siverskyi Donets basin is significantly lower.

A randomized-controlled trial of community-based transdiagnostic psychotherapy for veterans and internally displaced persons in Ukraine.

BACKGROUND: There is limited research on community-based mental health interventions in former Soviet countries despite different contextual factors from where most research has been conducted. Ongoing military conflict has resulted in many displaced persons and veterans and their families with high burdens of mental health problems. Lack of community-based services and poor uptake of existing psychiatric services led to the current trial to determine the effectiveness of the common elements treatment approach (CETA) on anxiety, depression, and posttraumatic stress symptoms (PTS) among conflict affected adults in Ukraine. METHODS: We conducted a three-armed randomized-controlled trial of CETA delivered in its standard form (8-12 sessions), a brief form (five-sessions), and a wait-control condition. Eligible participants were displaced adults, army veterans and their adult family members with elevated depression and/or PTS and impaired functioning. Treatment was delivered by community-based providers trained in both standard and brief CETA. Outcome data were collected monthly. RESULTS: There were 302 trial participants (n = 117 brief CETA, n = 129 standard CETA, n = 56 wait-controls). Compared with wait-controls, participants in standard and brief CETA experienced clinically and statistically significant reductions in depression, anxiety, and PTS and dysfunction (effect sizes d = 0.46-1.0-6). Comparing those who received standard CETA with brief CETA, the former reported fewer symptoms and less dysfunction with small-to-medium effect sized (d = 0.20-0.55). CONCLUSIONS: Standard CETA is more effective than brief CETA, but brief CETA also had significant effects compared with wait-controls. Given demonstrated effectiveness, CETA could be scaled up as an effective community-based approach.

Extreme weather events and military conflict over seven centuries in ancient Korea.

We explore the causal connection between weather and war by constructing and analyzing a dataset featuring extreme weather events and military conflicts involving a set of stable political entities that existed side by side over several centuries, namely, the three ancient kingdoms of the Korean Peninsula between 18 Before the Common Era and 660 Common Era. Conflicts are classified as desperate if a state experiencing the shock invades a neighbor and opportunistic if a state experiencing the shock is invaded by a neighbor. We find that weather-induced conflict was significant, but largely opportunistic rather than desperate. That is, states experiencing an adverse shock were more likely to be invaded, but not more likely to initiate attack. We also provide evidence that the channel through which weather shocks gave rise to opportunistic invasions was food insecurity, which weakened the power of states to repel attack. Since climate change is projected to give rise to an increased frequency of extreme weather events, these historical findings have contemporary relevance.

Parenting among mothers exposed to ongoing military conflict in childhood: An exploratory study.

Mothers living in areas exposed to ongoing military conflict are at higher risk for psychological difficulties, such as posttraumatic stress disorder, than those not living in such areas. The aim of this two-part exploratory study was twofold. The first aim was to examine differences between mothers who grew up under ongoing military conflict in childhood and mothers who did not grow up in affected areas in terms of their levels of differentiation of self and parental self-efficacy (PSE). The second aim was to identify and describe the parenting experiences of mothers who were exposed to military conflict in childhood. In Part 1 of the study, the sample included 120 mothers (half of whom reported on being exposed to ongoing military conflict in childhood). Findings showed that mothers exposed to ongoing military conflict in childhood reported lower levels of differentiation of self and PSE than their counterparts. In Part 2, 10 mothers who were exposed to ongoing military conflict as children were interviewed about their experience as parents and their PSE. Results indicated that the mothers felt their childhood experiences affected their parenting and PSE negatively, resulting in anxiety, difficulty dealing with stress and sometimes posttraumatic symptoms as well as parental patterns of overprotectiveness, separation anxiety and intergenerational transmission of anxiety. The results highlight the consequences of exposure to ongoing military conflict during childhood on levels of differentiation of self and parenting practices.