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1.
Int J Tuberc Lung Dis ; 26(10): 963-969, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36163669

RESUMO

BACKGROUND Diagnosing drug resistance is critical for choosing effective TB treatment regimens. Next-generation sequencing (NGS) represents an alternative approach to conventional phenotypic drug susceptibility testing (pDST) for diagnosing TB drug resistance.METHODS We undertook a budget impact analysis estimating the costs of introduction and routine use of NGS in the Moldovan National TB Programme. We conducted an empirical costing study and collated price and operating characteristics for NGS platforms. We examined multiple NGS scenarios in comparison to the current approach (pDST) for pre-treatment drug resistance testing over 2021-2025.RESULTS Annual testing volume ranged from 912 to 1,926 patients. For the pDST scenario, we estimated total costs of US$362,000 (2021 USD) over the 5-year study period. Total costs for NGS scenarios ranged from US$475,000 to US$1,486,000. Lowest cost NGS options involved targeted sequencing as a replacement for pDST, and excluded individuals diagnosed as RIF-susceptible on Xpert® MTB/RIF. For all NGS scenarios, the majority (55-80%) of costs were devoted to reagent kits. Start-up costs of NGS were small relative to routine costs borne each year.CONCLUSION NGS adoption will require expanded resources compared to conventional pDST. Further work is required to better understand the feasibility of NGS in settings such as Moldova.


Assuntos
Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Resistência a Medicamentos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Testes de Sensibilidade Microbiana , Moldávia , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
2.
Clin Lymphoma Myeloma Leuk ; 22 Suppl 2: S333, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36164001

RESUMO

CONTEXT: Over the last several decades, we have observed an increase in the number of young patients with myeloproliferative neoplasms. The lack of information about clinic-hematological manifestations and outcomes requires a boost of common efforts between specialists. OBJECTIVE: Determination of clinical hallmarks of primary myelofibrosis (PM) in patients under 40 years of age. DESIGN: We performed this retrospective, clinico-analytical study and evaluated the data of 46 patients with PM, registered at the Department of Hematology of the Institute of Oncology in the Republic of Moldova. SETTING: In Moldova, all patients with the diagnosis of hematological malignancies are followed up by the doctors from the Department of Hematology of the Institute of Oncology. These patients are managed at the Consultative Diagnostic Center outpatient and inpatient wards. PATIENTS OR OTHER PARTICIPANTS: At the moment, there are 450 patients with PM, including 46 young persons. These are the newest data that enroll all patients and newly diagnosed young patients with PM. We divided them into three groups according to age: 18-20, 21-30, and 31-40 years. MAIN OUTCOME MEASURES: The data analysis allowed us to formulate the hypothesis, which indicated a correlation between changes in the complete blood count (CBC) and splenomegaly, hepatomegaly, and long-term outcomes. RESULTS: There were 11 male and 35 female patients. The major features of the first group were massive splenomegaly dominating in all 5 (10.9%) patients and mostly normal CBC values. In the third group, we observed elevated hemoglobin levels in 6 cases (13.0%) and frequent thrombocytosis in 24 (52.1%) cases. Massive splenomegaly was detected in 9 (19.6%) cases and normal spleen size in 3 (6.5%) cases. Two patients underwent splenectomy. Histological investigations revealed fibrosis MF 1-2 and hypercellular bone marrow in almost all cases. Thrombocytosis and splenomegaly of various sizes were found in the entire group of patients aged 21-30 years. CONCLUSIONS: This analysis did not reveal a correlation between the proliferative syndrome and the degree of leukocytosis and thrombocytosis. The disease may start with initial changes in the CBC, which should alert any specialist. All these patients remain under observation in our department.


Assuntos
Mielofibrose Primária , Trombocitose , Adolescente , Adulto , Feminino , Hemoglobinas , Humanos , Masculino , Moldávia , Mielofibrose Primária/diagnóstico , Mielofibrose Primária/patologia , Estudos Retrospectivos , Esplenomegalia/etiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-36011864

RESUMO

In Middle Ages, in Moldavia and Wallachia, the healthcare system was almost non-existent, medical practice being the attribute of old women, midwives, charmers, and later monastic personnel. The first elements of medical ethics are identifiable in written texts from the 17th century, associated with a process of laicization of medicine and the appearance of the first combined civil and penal codes (Vasile Lupu's Law from 1646 and Matei Basarab's Law from 1652). In the next 150 years, elements of medical ethics were rarely identified, usually in legal regulations, personal letters, or literary works. Starting with the end of the 18th century, associated with the emergence of the position of public physician, detailed regulations regarding the healthcare system associated with an increased number of ethical norms began to emerge. The purpose of this article is to increase awareness to an international audience about the history of Romanian medical deontology and the roots of concepts appertaining to medical ethics in the territories of Moldavia and Wallachia.


Assuntos
Ética Médica , Médicos , Beneficência , Feminino , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , Moldávia
4.
Int J Drug Policy ; 104: 103683, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35417790

RESUMO

BACKGROUND: Eastern Europe and Central Asia have intertwined HIV and incarceration epidemics, concentrated in people who inject drugs. Moldova is one of the few countries in this region that offers methadone within prisons, but uptake and post-release retention remains suboptimal. Screening, brief intervention, and referral to treatment (SBIRT) procedures are a potential implementation strategy to address this problem. METHODS: From June 1, 2017 to March 3, 2018, we conducted a 2-stage SBIRT strategy in nine prisons and four pre-trial detention facilities in Moldova among incarcerated persons with opioid use disorder (OUD; N = 121) and within 90 days of release. Survey results were analyzed to evaluate the effect of the SBIRT strategy on the uptake of and post-release retention on methadone maintenance treatment (MMT). RESULTS: Among the 121 screened with OUD, 27 were on MMT at baseline within the prison and this number increased to 41 after the two-step SBIRT intervention, reflecting a 51.9% increase over baseline. Eleven (78.6%) of the 14 participants that newly started MMT did so only after completing both SBIRT sessions. The brief intervention did not significantly improve knowledge about methadone but did improve attitudes towards it. Among the 41 participants who received methadone during this trial, 40 (97.6%) were retained 6 months after release; the one participant not retained was on methadone at the time of the intervention and had planned to taper off. CONCLUSION: The SBIRT strategy significantly improved participant attitudes, but treatment initiation mostly occurred after completing both sessions, including soon after release, but remained low overall. Work within the Moldovan prison subculture to dispel negative myths and misinformation is needed to further scale-up OAT in Moldova.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Prisioneiros , Humanos , Metadona/uso terapêutico , Moldávia , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/epidemiologia
5.
PLoS Med ; 19(2): e1003933, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35192619

RESUMO

BACKGROUND: The incidence of multidrug-resistant tuberculosis (MDR-TB) remains critically high in countries of the former Soviet Union, where >20% of new cases and >50% of previously treated cases have resistance to rifampin and isoniazid. Transmission of resistant strains, as opposed to resistance selected through inadequate treatment of drug-susceptible tuberculosis (TB), is the main driver of incident MDR-TB in these countries. METHODS AND FINDINGS: We conducted a prospective, genomic analysis of all culture-positive TB cases diagnosed in 2018 and 2019 in the Republic of Moldova. We used phylogenetic methods to identify putative transmission clusters; spatial and demographic data were analyzed to further describe local transmission of Mycobacterium tuberculosis. Of 2,236 participants, 779 (36%) had MDR-TB, of whom 386 (50%) had never been treated previously for TB. Moreover, 92% of multidrug-resistant M. tuberculosis strains belonged to putative transmission clusters. Phylogenetic reconstruction identified 3 large clades that were comprised nearly uniformly of MDR-TB: 2 of these clades were of Beijing lineage, and 1 of Ural lineage, and each had additional distinct clade-specific second-line drug resistance mutations and geographic distributions. Spatial and temporal proximity between pairs of cases within a cluster was associated with greater genomic similarity. Our study lasted for only 2 years, a relatively short duration compared with the natural history of TB, and, thus, the ability to infer the full extent of transmission is limited. CONCLUSIONS: The MDR-TB epidemic in Moldova is associated with the local transmission of multiple M. tuberculosis strains, including distinct clades of highly drug-resistant M. tuberculosis with varying geographic distributions and drug resistance profiles. This study demonstrates the role of comprehensive genomic surveillance for understanding the transmission of M. tuberculosis and highlights the urgency of interventions to interrupt transmission of highly drug-resistant M. tuberculosis.


Assuntos
Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Genótipo , Humanos , Moldávia/epidemiologia , Mycobacterium tuberculosis/genética , Filogenia , Filogeografia , Estudos Prospectivos , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
6.
PLoS One ; 17(1): e0261509, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34990459

RESUMO

The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning.


Assuntos
COVID-19/psicologia , Fertilidade/fisiologia , Comportamento Reprodutivo/psicologia , Adulto , COVID-19/metabolismo , Preservativos/tendências , Anticoncepção/tendências , Comportamento Contraceptivo/tendências , Características da Família , Serviços de Planejamento Familiar/provisão & distribuição , Serviços de Planejamento Familiar/tendências , Feminino , Humanos , Renda , Dispositivos Intrauterinos/tendências , Masculino , Moldávia/epidemiologia , SARS-CoV-2/patogenicidade , Inquéritos e Questionários
7.
J Radiol Prot ; 42(1)2022 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-34492638

RESUMO

The long-term condition and potential radiological consequences of legacy radioactive waste stored in a RADON-type of near-surface disposal facility outside the city of Chisinau is of concern to the central government and health protection authorities of the Republic of Moldova. A 'zero alternative scenario' risk assessment has been undertaken in order to evaluate the potential radiological impact on humans and the environment of the facility, were it to be left in its current state with no remediation. The results have been used as a basis for regulatory decision making regarding remediation and decommissioning of the legacy radioactive waste facility. The aim of this study was two-fold: first to demonstrate a complete radiological risk assessment of a real site using a combination of methodologies developed by the IAEA (ISAM and BIOMASS), the second to illustrate the current state-of-the-art in respect of extracting site-specific information from site-descriptive material. We illustrate the practicality of employing geographic information systems techniques on site-specific topographic data to identify relevant biosphere dose objects, thereby allowing customisation of the generic ISAM model framework to site-specific conditions. As a result, a simple method is suggested to bound activity concentrations in well water based on an understanding of water balance in the local catchment area in which the biosphere dose object is embedded. With conservative assumptions, estimated doses from the calculation cases of the design scenario remain lower than the IAEA's dose criteria and environmental screening values. However, the results also indicate that human intrusion activities after the institutional control period could lead to radiological exposures above the IAEA's criteria for a period up to 100 000 years. The long-lived radionuclide239Pu dominates doses for the on-site residence scenario. Remediation measures should be implemented were the waste to remain at its present place of disposal.


Assuntos
Resíduos Radioativos , Eliminação de Resíduos , Humanos , Moldávia , Resíduos Radioativos/análise , Medição de Risco , Instalações de Eliminação de Resíduos
8.
Arch Environ Contam Toxicol ; 82(3): 355-366, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35266044

RESUMO

The moss biomonitoring technique was used for the assessment of air pollution in the Republic of Moldova, in the framework of the UNECE ICP Vegetation Programme. The content of 11 chemical elements (Al, V, Cr, Fe, Ni, Zn, As, Sb, Cd, Cu, and Pb) was determined by neutron activation analysis and atomic absorption spectrometry in samples collected in spring 2020. Distribution maps were built to identify the most polluted sites. The highest concentrations of elements in mosses were determined in the north-eastern, central, and western parts of the country. The main element associations were identified using factor analysis. Three factors were determined, of which one of mixed geogenic-anthropogenic origin and two of anthropogenic origin. A comparison of the data obtained in 2020 and 2015 showed a significant decrease in the concentrations of Cr, As, Sb, Cd, Pb, and Cu in 2020. The state of the environment was assessed using Contamination Factor and Pollution Load Index values, which characterized it as unpolluted to moderately polluted. Possible air pollution sources in the Republic of Moldova are resuspension of soil particles, agricultural practices, vehicles, industry, and thermal power plants.


Assuntos
Poluentes Atmosféricos , Briófitas , Metais Pesados , Oligoelementos , Poluentes Atmosféricos/análise , Monitoramento Biológico , Monitoramento Ambiental/métodos , Metais Pesados/análise , Moldávia , Oligoelementos/análise
9.
BMC Oral Health ; 21(1): 652, 2021 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-34922498

RESUMO

INTRODUCTION: Moldova, Belarus, and Armenia are post-Soviet countries with a high rate of heavy smokers and a relatively high age-standardized incidence of oral cancer. However, to our knowledge, there is lack of available information on dentists' knowledge on prevention of oral cancer in the countries in question. Accordingly, this study aimed to assess the knowledge, opinions, and practices related to oral cancer prevention and oral mucosal examination among dentists in Moldova, Belarus, and Armenia. METHODS: This was a multi-country, cross-sectional study based on a self-administered questionnaire. A structured questionnaire was distributed to 3534 dentists (797 in Chisinau, Moldova, 1349 in Minsk, Belarus, and 1388 in Yerevan, Armenia). Dentists' knowledge about risk factors for oral cancer development and its clinical picture, current practices and opinions with regard to oral mucosal screening and oral cancer prevention, and their consistency to perform oral mucosal examination were assessed. A knowledge score ranging from 0 to 14 points was generated based on each dentist's answer to the questionnaire. RESULTS: A total of 1316 dentists responded, achieving an overall response rate of 37.2% (34.5% in Moldova; 52.3% in Belarus; 24.2% in Armenia). Most dentists in the three countries correctly identified tobacco (83.8-98.2%) and prior oral cancer lesions (84.0-96.3%) as risk factors for oral cancer. Most dentists correctly identified leukoplakia as a lesion with malignant potential (68.7% in Moldova; 88.5% in Belarus; 69.9% in Armenia), while erythroplakia was identified by much fewer in all three countries. Less than 52% of dentists identified the tongue, rim of tongue, and floor of mouth as the most common sites for oral cancer. The mean knowledge score for all countries combined was 7.5 ± 2.7. The most commonly reported barriers to perform oral mucosal examination were lack of training, knowledge, and experience. CONCLUSIONS: This study highlights the need for improved oral cancer-related education and training on oral mucosal examination for dentists in Moldova, Belarus, and Armenia. Such skills are essential to enhance oral cancer prevention and to improve the prognostic outcome by early detection.


Assuntos
Detecção Precoce de Câncer , Neoplasias Bucais , Armênia , Atitude do Pessoal de Saúde , Estudos Transversais , Odontólogos , Humanos , Moldávia , Neoplasias Bucais/prevenção & controle , Padrões de Prática Odontológica , República de Belarus , Inquéritos e Questionários
10.
Parasit Vectors ; 14(1): 565, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732241

RESUMO

BACKGROUND: In Europe, Aedes albopictus is an important vector of chikungunya virus and Dirofilaria nematodes and has been involved in local autochthonous circulation of dengue and Zika viruses. Due to the ongoing spread, targeted field surveillance at potential points of entry of invasive Aedes mosquitoes was initiated by the Republic of Moldova in 2020 as part of the transboundary "Invasive Aedes Mosquitoes COST-Action project." METHODS: In 2020, ovitraps were positioned at each of three locations: the border crossing to Romania in Leuseni (Hancesti region), Chisinӑu International Airport and Chisinӑu Botanical Garden. RESULTS: A total of 188 Aedes spp. eggs were collected at the Chisinӑu International Airport between August and September 2020. Twenty-three adults reared in the laboratory were identified morphologically as Ae. albopictus (Skuse, 1895), and 12 selected specimens were confirmed by molecular barcoding of the cytochrome oxidase subunit I gene region. In addition, one adult Ae. albopictus female at the same site was caught with a manual aspirator. CONCLUSIONS: This is the first documented report of Ae. albopictus in the Republic of Moldova. The presence of immature and adult stages indicates the local reproduction of the species in the country. Therefore, it is crucial to extend and strengthen surveillance of the invasive Aedes mosquitoes to prevent Ae. albopictus and other exotic mosquito species from becoming established in the Republic of Moldova.


Assuntos
Aedes/classificação , Mosquitos Vetores/classificação , Aedes/genética , Aedes/crescimento & desenvolvimento , Aedes/fisiologia , Animais , Código de Barras de DNA Taxonômico , Complexo IV da Cadeia de Transporte de Elétrons/genética , Feminino , Proteínas de Insetos/genética , Espécies Introduzidas , Masculino , Moldávia , Mosquitos Vetores/genética , Mosquitos Vetores/crescimento & desenvolvimento , Mosquitos Vetores/fisiologia
11.
J Infect Dev Ctries ; 15(9.1): 17S-24S, 2021 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-34609956

RESUMO

INTRODUCTION: The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe. This study compared adherence and short and long-term TB treatment outcomes for TB patients who experienced asynchronous Video Observed Treatment (aVOT) during three months of outpatient treatment versus Directly Observed Treatment (DOT) in operational conditions in 2016-2017 in Chisinau. METHODOLOGY: We used secondary data from the 2016-2017 Randomized Clinical Trial (RCT) that piloted the aVOT Strategy in Chisinau and data from the national TB register. Relative risk was selected as a measure of association in analysis of treatment strategies (aVOT and DOT under operational conditions) and short and long-term treatment outcomes. RESULTS: From 647 TB patients included in the study, 169 followed the treatment strategy in the RCT (83 in aVOT and 86 in DOT) and 478 were on DOT in operational conditions. Those in aVOT were more likely to have favourable short-term outcome than patients with DOT in operational conditions (RR 0.07; p < 0.001). TB recurrence as an indicator for the long-term outcome, was observed in group with DOT in operational conditions (40 cases, p = 0.006). CONCLUSIONS: This study demonstrated that the aVOT treatment strategy was associated with better adherence and both short and long-term TB treatment favourable outcomes. aVOT as a new patient-centred approach supporting TB patients on improving treatment adherence and outcomes might be recommended as an alternative to DOT strategy in the Republic of Moldova.


Assuntos
Antituberculosos/uso terapêutico , Adesão à Medicação , Tuberculose/tratamento farmacológico , Adulto , Terapia Diretamente Observada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moldávia , Resultado do Tratamento
12.
Microb Genom ; 7(8)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34431762

RESUMO

The evolution and emergence of drug-resistant tuberculosis (TB) has been studied extensively in some contexts, but the ecological drivers of these two processes remain poorly understood. This study sought to describe the joint evolutionary and epidemiological histories of a novel multidrug-resistant Mycobacterium tuberculosis strain recently identified in the capital city of the Republic of Moldova (MDR Ural/4.2), where genomic surveillance of drug-resistant M. tuberculosis has been limited thus far. Using whole genome sequence data and Bayesian phylogenomic methods, we reconstruct the stepwise acquisition of drug resistance mutations in the MDR Ural/4.2 strain, estimate its historical bacterial population size over time, and infer the migration history of this strain between Eastern European countries. We infer that MDR Ural/4.2 likely evolved (via acquisition of rpoB S450L, which confers resistance to rifampin) in the early 1990s, during a period of social turmoil following Moldovan independence from the Soviet Union. This strain subsequently underwent substantial population size expansion in the early 2000s, at a time when national guidelines encouraged inpatient treatment of TB patients. We infer exportation of this strain and its isoniazid-resistant ancestral precursor from Moldova to neighbouring countries starting as early as 1985. Our findings suggest temporal and ecological associations between specific public health practices, including inpatient hospitalization of drug-resistant TB cases from the early 2000s until 2013, and the evolution of drug-resistant M. tuberculosis in Moldova. These findings underscore the need for regional coordination in TB control and expanded genomic surveillance efforts across Eastern Europe.


Assuntos
Evolução Molecular , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/classificação , Tuberculose Resistente a Múltiplos Medicamentos/genética , Teorema de Bayes , Farmacorresistência Bacteriana Múltipla/genética , Feminino , Genômica , Humanos , Masculino , Moldávia/epidemiologia , Epidemiologia Molecular , Mutação , Mycobacterium tuberculosis/classificação , Filogenia , Prevalência , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Sequenciamento Completo do Genoma
13.
Parasit Vectors ; 14(1): 390, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362416

RESUMO

BACKGROUND: During the last decades, filarial infections caused by Dirofilaria spp. have spread rapidly within dog populations of several European countries. Increasing scientific interest in filariasis, and the availability of new diagnostic tools, has led to improved knowledge of the biology, morphology, and epidemiology of different species of filarial worms. However, data are still scarce for a number of countries, including the Republic of Moldova. Thus, we assessed the epidemiological status of canine filariasis in the Republic of Moldova to address part of this knowledge gap. METHODS: A total of 120 blood samples were collected between June 2018 and July 2019 from dogs originating from the cities of Cahul and Chisinau. The samples were examined microscopically, and multiplex polymerase chain reaction was performed to evaluate filarioid species diversity. RESULTS: Microscopic examination revealed that 12 dogs (10.0%) were positive for circulating microfilariae. The molecular test showed that one dog was positive for Acanthocheilonema reconditum (0.8%), one for Dirofilaria immitis (0.8%), six for Dirofilaria repens (5.0%), and four (3.3%) harboured a co-infection with D. immitis and D. repens. Prevalence was significantly higher in dogs aged ≥ 2 years. CONCLUSIONS: The epidemiological survey presented here for the Republic of Moldova confirmed the presence D. immitis, D. repens and A. reconditum in dogs that had not received any heartworm preventive.


Assuntos
Acanthocheilonema/genética , Acantoqueilonemíase/veterinária , Dirofilaria/genética , Doenças do Cão/epidemiologia , Filariose/epidemiologia , Filariose/veterinária , Acanthocheilonema/classificação , Acantoqueilonemíase/epidemiologia , Animais , Dirofilaria/classificação , Dirofilaria immitis/genética , Dirofilaria repens/genética , Doenças do Cão/parasitologia , Cães , Feminino , Filariose/sangue , Masculino , Moldávia , Prevalência
14.
BMC Public Health ; 21(1): 1469, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34320985

RESUMO

BACKGROUND: Brief behavioral interventions are seen as an efficient way to improve knowledge, change behavior, and reduce provider stigma regarding sexual health. When grounded in evidence-based behavioral change techniques and delivered using Brief Sexuality-related Communication (BSC) tools, brief behavioral interventions can address client-driven sexual health goals in a single session with their provider. Evidence for the efficacy of brief interventions for creating gains in sexual health comes largely from resource rich settings, and there is a lack of knowledge of how brief interventions can be implemented in the more resource constrained environments of low- and middle-income countries. As a first step in developing a brief intervention to address sexual health issues in Moldova, this paper reports on qualitative data collected from Moldovan providers to understand their attitudes, willingness and perceived barriers to the brief intervention and its implementation. METHODS: Thirty-nine in-depth interviews (IDI) were conducted between February and March 2020, with health providers recruited from three primary health care institutions, two Youth Friendly Health Centers and counselors from three NGOs who work with key populations in Moldova, including health centers selected from two cites - the capital city, Chisinau and from the Comrat Region. The IDI addressed four domains of provider attitudes: 1) attitudes towards the intervention; 2) willingness and motivation to implement the intervention; 3) logistics of providing the intervention and 4) ability to implement the intervention. A coding analysis approach was applied to all interview transcripts. RESULTS: Providers largely reported being willing to be trained in and implement the brief intervention. Willingness to implement the intervention stemmed from two perceptions: that it would improve the ability of providers to talk with their clients about sex, and that vulnerable groups would benefit from these conversations. However, while there were generally positive attitudes towards the intervention, providers consistently reported structural barriers to their perceived ability to implement the intervention. CONCLUSIONS: While providers reported high levels of initial acceptance of a brief behavioral intervention, care is needed to ensure that brief interventions, and the training of providers on brief interventions, incorporate cultural attitudes and norms around sex, particularly in highly patriarchal settings, and provide opportunities for providers to practice the intervention in ways that address their assumptions and implicit biases.


Assuntos
Intervenção na Crise , Saúde Sexual , Adolescente , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Moldávia , Comportamento Sexual
15.
J Nurs Educ ; 60(7): 377-385, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34232814

RESUMO

BACKGROUND: Nurse identity in the Republic of Moldova is undergoing change to achieve recognition as a profession. This article describes a faculty development program designed to help articulate the professional nurse role and scope of practice through enhanced teaching pedagogies used in basic nursing education. METHOD: Experiential learning strategies such as high-fidelity simulation, unfolding geriatric case study, role-play, task trainers, moulage, and teach-back were used to demonstrate the nursing process and scope of practice. RESULTS: Fifteen faculty from five technical colleges of nursing participated in the Geriatric Nursing Institute (GNI). Debriefings yielded positive responses on using experiential learning strategies to augment didactic methods to facilitate student competencies, nurse identity, and scope of practice. CONCLUSION: The GNI contributed to the professional development of faculty with potential impact on nursing students to achieve enhanced preparedness in global nurse competencies. Although the pedagogical innovations were welcomed, future initiatives building on the GNI are needed. [J Nurs Educ. 2021;60(7):377-385.].


Assuntos
Enfermeiras e Enfermeiros , Estudantes de Enfermagem , Idoso , Competência Clínica , Docentes de Enfermagem , Humanos , Moldávia , Âmbito da Prática
16.
Artigo em Inglês | MEDLINE | ID: mdl-34199564

RESUMO

BACKGROUND: Timely initiation of breastfeeding is the first step towards achieving recommended breastfeeding behaviours. Delayed breastfeeding initiation harms neonatal health and survival, including infection associated neonatal mortality. Eighty percent of neonatal deaths occur in the low-and middle-income countries (LMICs), where delayed breastfeeding initiation is the highest. Place and mode of childbirth are important factors determining the time of initiation of breastfeeding. In this study, we report the prevalence of delayed breastfeeding initiation from 58 LMICs and investigate the relationship between place and mode of childbirth and delayed breastfeeding initiation in each country. METHODS: We analysed data from the most recent Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) collected between 2012 and 2017 and reported by 2019. The study sample comprised all women who had a live birth in the 24 months preceding the survey. 'Delayed' initiation of breastfeeding was defined using WHO recommendations as starting breastfeeding after one hour of birth. We coded the stratifying variable for the place and mode of childbirth as "vaginal birth at a facility (VBF)", "caesarean section birth (CSB) ", and "vaginal birth at home (VBH)". We used respondent-level sampling weights to account for individual surveys and de-normalised the standard survey weights to ensure the appropriate contribution of data from each country. We report the prevalence and population attributable fractions with robust standard errors. The population attributable risk identifies the proportion of delayed initiation that we could avert among VBH and CSB if everyone had the same risk of delaying breastfeeding as in VBF. RESULTS: The overall prevalence of delayed initiation of breastfeeding was 53.8% (95% CI 53.3, 54.3), ranging from 15.0% (95% CI 13.8, 16.2) in Burundi to 83.4% (95% CI 80.6, 86.0) in Guinea. The prevalence of delayed initiation of breastfeeding was consistently high among women who experienced caesarean section births; however, there was no direct association with each country's national caesarean section rates. The prevalence of delayed initiation among women who experienced VBF was high in Sub-Saharan Africa and South Asia, even though the CSB rates were low. In some countries, women who give birth vaginally in health facilities were more likely to delay breastfeeding initiation than women who did not. In many places, women who give birth by caesarean section were less likely to delay breastfeeding initiation. Population attributable risk percent for VBH ranged from -28.5% in Ukraine to 22.9% in Moldova, and for CSB, from 10.3% in Guinea to 54.8% in Burundi. On average, across all 58 countries, 24.4% of delayed initiation could be prevented if all women had the same risk of delaying breastfeeding initiation as in VBF. DISCUSSION: In general, women who give birth in a health facility were less likely to experience delayed initiation of breastfeeding. Programs could avert much of the delayed breastfeeding initiation in LMICs if the prevalence of delayed initiation amongst women who experience CSB were the same as amongst women who experience VBF. Crucial reforms of health facilities are required to ensure early breastfeeding practices and to create pro-breastfeeding supportive environments as recommended in intervention packages like the Baby-friendly hospital initiative and Early essential newborn care. The findings from this study will guide program managers to identify countries at varying levels of preparedness to establish and maintain a breastfeeding-friendly environment at health facilities. Thus, governments should prioritise intervention strategies to improve coverage and settings surrounding early initiation of breastfeeding while considering the complex role of place and mode of childbirth.


Assuntos
Aleitamento Materno , Cesárea , África ao Sul do Saara , Ásia , Burundi , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Moldávia , Parto , Gravidez , Inquéritos e Questionários , Ucrânia
17.
Innate Immun ; 27(5): 365-376, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34275341

RESUMO

Polymorphisms in genes that control immune function and regulation may influence susceptibility to pulmonary tuberculosis (TB). In this study, 14 polymorphisms in 12 key genes involved in the immune response (VDR, MR1, TLR1, TLR2, TLR10, SLC11A1, IL1B, IL10, IFNG, TNF, IRAK1, and FOXP3) were tested for their association with pulmonary TB in 271 patients with TB and 251 community-matched controls from the Republic of Moldova. In addition, gene-gene interactions involved in TB susceptibility were analyzed for a total of 43 genetic loci. Single nucleotide polymorphism (SNP) analysis revealed a nominal association between TNF rs1800629 and pulmonary TB (Fisher exact test P = 0.01843). In the pairwise interaction analysis, the combination of the genotypes TLR6 rs5743810 GA and TLR10 rs11096957 GT was significantly associated with an increased genetic risk of pulmonary TB (OR = 2.48, 95% CI = 1.62-3.85; Fisher exact test P value = 1.5 × 10-5, significant after Bonferroni correction). In conclusion, the TLR6 rs5743810 and TLR10 rs11096957 two-locus interaction confers a significantly higher risk for pulmonary TB; due to its high frequency in the population, this SNP combination may serve as a novel biomarker for predicting TB susceptibility.


Assuntos
Genótipo , Mycobacterium tuberculosis/fisiologia , Receptor 10 Toll-Like/genética , Receptor 6 Toll-Like/genética , Tuberculose Pulmonar/genética , Adulto , Feminino , Frequência do Gene , Estudos de Associação Genética , Loci Gênicos , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Moldávia , Polimorfismo de Nucleotídeo Único , Grupos Populacionais , Risco
18.
Parasit Vectors ; 14(1): 371, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289883

RESUMO

BACKGROUND: Phlebotomine sand flies (Diptera: Psychodiae) in the Republic of Moldova have been understudied for decades. Our study provides a first update on their occurrence, species composition and bloodmeal sources after 50 years. METHODS: During 5 seasons (2013-2017), 58 localities from 20 regions were surveyed for presence of sand flies using CDC light traps and manual aspirators. Species identification was done by a combination of morphological and molecular approaches (DNA barcoding, MALDI-TOF MS protein profiling). In engorged females, host blood was identified by three molecular techniques (RFLP, cytb sequencing and MALDI-TOF peptide mass mapping). Population structure of most abundant species was studied by cox1 haplotyping; phylogenetic analyses of ITS2 and cox1 genetic markers were used to resolve relationships of other detected species. RESULTS: In total, 793 sand flies were collected at 30 (51.7%) localities from 12 regions of Moldova. Three species were identified by an integrative morphological and molecular approach: Phlebotomus papatasi, P. perfiliewi and Phlebotomus sp. (Adlerius), the first being the most abundant and widespread, markedly anthropophilic based on bloodmeal analyses, occurring also indoors and showing low population structure with only five haplotypes of cox1 detected. Distinct morphological and molecular characters of Phlebotomus sp. (Adlerius) specimens suggest the presence of a yet undescribed species. CONCLUSIONS: Our study revealed the presence of stable sand fly populations of three species in Moldova that represent a biting nuisance as well as a potential threat of pathogen transmission and shall be further studied.


Assuntos
Insetos Vetores/classificação , Leishmaniose/transmissão , Psychodidae/classificação , Animais , Feminino , Haplótipos , Especificidade de Hospedeiro , Humanos , Insetos Vetores/genética , Insetos Vetores/parasitologia , Masculino , Moldávia/epidemiologia , Phlebotomus/classificação , Phlebotomus/genética , Phlebotomus/fisiologia , Filogenia , Psychodidae/genética , Psychodidae/fisiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
19.
Arch Osteoporos ; 16(1): 87, 2021 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-34089424

RESUMO

Age-specific intervention and assessment thresholds based on FRAX® were developed for eight Eurasian countries participating in the EVA study (Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan). The intervention thresholds (major osteoporotic fracture) ranged from 3.6 (Armenia and Georgia) to 12.3% (Uzbekistan) for people at age 50 years, and from 16 (Armenia) to 27% (Belarus) at the age of 90 years. These thresholds enable a substantial advance in the ease of detection of individuals at high fracture risk. INTRODUCTION: The purpose of this study was to derive and compare FRAX-based intervention and BMD assessment thresholds for 8 Eurasian countries in the EVA study. METHODS: The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF), calculated without BMD, equivalent to a woman with a prior fragility fracture but no other clinical risk factors, and a body mass index (BMI) of 25.0 kg/m2. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI of 25.0 kg/m2, without previous fracture or other clinical risk factors. The upper assessment threshold was set at 1.2 times the IT. RESULTS: The age-specific intervention thresholds ranged from 3.6 (Armenia and Georgia) to 12.3% (Uzbekistan) for men and women at the age of 50 years and from 16 (Armenia) to 27% (Belarus) at the age of 90 years. The difference between countries was most evident at younger ages and become progressively less with advancing age. CONCLUSIONS: For the 8 Eurasian countries, the newly established FRAX-based intervention thresholds provide an opportunity to improve the clinical detection of both men and women with a high risk of fracture and improve treatment rates.


Assuntos
Densidade Óssea , Fraturas por Osteoporose , Idoso de 80 Anos ou mais , Armênia , Pré-Escolar , Feminino , Georgia , Humanos , Cazaquistão , Quirguistão , Masculino , Pessoa de Meia-Idade , Moldávia , República de Belarus , Medição de Risco , Fatores de Risco , Federação Russa , Uzbequistão
20.
Chemosphere ; 279: 130923, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34134442

RESUMO

Historical use of organochlorine pesticides (OCPs) in the Republic of Moldova could pose a potential risk for the aquatic environment due to the persistence, bioaccumulation and toxic properties of these environmental pollutants. However, knowledge on environmental concentrations of legacy OCPs in Moldova is limited. In this study, surface sediment from the two main rivers; Dniester (8 sites, n = 15) and Prut (6 sites, n = 12), and two tributary rivers; Bîc (11 sites, n = 11) and Raut (6 sites, n = 6), were collected during 2017-2018 and analyzed for hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs) and their transformation products (DDDs and DDEs) using gas chromatography coupled to mass spectrometry (GC-MS/MS). Sediment concentrations of Æ©6DDX (1.9-140 ng g-1 dry weight (dw)) and Æ©4HCHs (n.d-2.5 ng g-1 dw) were found. In the big rivers, the average Æ©6DDX concentration (18 ng g-1 dw) were 35 times higher than Æ©4HCHs (0.51 ng g-1 dw). Whereas, in the small rivers the average Æ©6DDX concentration (32 ng g-1 dw) was approximately 41 times higher than Æ©4HCHs (0.77 ng g-1 dw). Compared to previous studies from Eastern Europe, the sediment levels were generally similar as found in Moldova's neighboring countries (Romania and Ukraine). Overall, the contamination profile indicates long-term ageing of OCPs used in the past in the agricultural sector. Less than half of the sites (45%) had levels that pose a potential risk for benthic organisms. Hence, further work is needed to determine the bioaccumulation of OCPs in the aquatic food web in this region and the associated risks to ecosystems and human health.


Assuntos
Hidrocarbonetos Clorados , Praguicidas , Poluentes Químicos da Água , China , Ecossistema , Monitoramento Ambiental , Europa Oriental , Cromatografia Gasosa-Espectrometria de Massas , Sedimentos Geológicos , Humanos , Hidrocarbonetos Clorados/análise , Moldávia , Praguicidas/análise , Rios , Romênia , Espectrometria de Massas em Tandem , Ucrânia , Poluentes Químicos da Água/análise
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