Епідемічні реалії кору на Тернопільщині

The global pandemic caused by the SARS-CoV-2 virus has created unprecedented health, social and economic challenges, and has led to a sharp decline in official statistical reporting of many infectious diseases, including Lyme borreliosis (LB), especially in children, due to COVID-19-related health, anti-epidemic and quarantine measures. Purpose - to assess the completeness of statistical accounting of LB in children against the background of the COVID-19 situation in the context of the epidemic in the Ternopil region of Ukraine that began in the spring of 2020. Materials and methods. A PubMed search was conducted for analytical articles on LB and COVID-19 for the period from 2020 to February 2023. Epidemiological analysis and forecasting were performed using statistical methods. The search included 300 publications. After the selection process, 25 publications were included in the review. The results of long-term epidemiologic surveillance of tick-borne infectious diseases in the Ternopil region, including data from official statistics, epidemiologic investigations, and laboratory studies, were analyzed. To predict the incidence of LB in the first half of 2023 for the age group 0-17 years, over 17 years and all age groups, increasing polynomial trends of the second order with approximation coefficients equal to 1 were used. To predict the incidence of COVID-19 in the first half of 2023 for the age group 0-17 years, an increasing linear trend with an approximation coefficient equal to 0.8 was used. To predict the incidence of COVID-19 in the first half of 2023 for the age groups 18-29 years, 30-49 years, 50-65 years, over 65 years and all age groups, we used decreasing polynomial trends of the second order with approximation coefficients equal to 1. The vast majority of the highest values of the approximation coefficients confirm the high accuracy of predicting the incidence of VL and COVID-19 in the first half of 2023 in the Ternopil region. Results and conclusions. The officially registered number of cases of pulmonary disease, including among children, during the COVID-19 epidemic in Ternopil region is likely incomplete and does not reflect the actual incidence rate. This is due to the problem of identifying patients with pulmonary disease during the COVID-19 epidemic. After a sharp decline in reported cases of LB in 2020 compared to previous years, in 2021-2023, there was an improvement in its detection and diagnosis, but at levels lower than before the COVID-19 epidemic. However, the proportion of children is decreasing. No conflict of interests was declared by the authors.

Objective To explore the relative contribution of refractive status and stereopsis in a school population and to determine the associations between refractive status and stereoacuity,age,and axial length.Methods Subject data were sampled from the materials of a population-based cluster sampling of children in 8 primary schools in Shanghai in this cross-sectional investigation.According to the standards established for this study,a table was created based on a questionnaire and the examination of vision,stereopsis and axial length of the subjects.SPSS 20 software was used to analyze the data for the different ages (6,7,8,9 and 10 years of age) and refractive status (emmtropia,mild myopia,severe myopia,mild hyperopia and severe hyperopia).A x2 test was used to compare groups.An ANOVA was used to compare the normal distribution measurement data among groups.For non-normal distributions data,nonparametric tests were used throughout.Results ①The trend for the incidence of myopia increased and for the incidence of hyperopia decreased with an increase in age.There was a positive correlation between the prevalence of myopia and increased age (r=0.427,P＜0.01),and a negative correlation between the prevalence of hyperopia and increased age (r=0.269,P＜0.01).There was a significant difference in stereopsis with normal uncorrected vision (Kruskal Wallis,x2=88.867,P＜0.01).There was a statistically significant difference in stereopsis between ages 6 and 7 (Kolmogorov-Smirnov,Z=2.584,P＜0.01),but no difference between ages 7 and 8,8 and 9,and 9 and 10 (P＞0.05).The difference in the detection rate of anomalous stereopsis was statistically significant for different refractive states (x2=57.294,P＜0.01).Stereoacuity also differed significantly among different refractive groups (Kruskal Wallis,x2=67.428,P＜0.01).The differences were statistically significant between severe hyperopia (Z=2.584,P＜0.01),severe myopia (Z=2.138,P＜0.01),and mild hyperopia (Z=1.819,P＜0.01) and normal groups respectively.The mean value of axial length gradually increased with an increase in age and the differences were significant among age groups (F=115.248,P＜0.01).The differences were significant when all age groups were compared to each other (P＜0.01).Conclusion ①The results suggest that the prevalence of myopia increases with age,but the prevalence of hyperopia decreases with age in school-aged children.The eye in school-aged children goes from farsightedness to myopia.②Stereopsis reaches maturity at 7 to 8 years of age.③Mild and severe hypermetropia obviously influenced the development and establishment of stereopsis.④The mean axial length of the eye gradually increased with age. Key words: Refractive error; Depth perception; Child (6-12); Small-area analysis; Data collection; Cross-sectional studies

Purpose. To analyze the clinico-epidemiologic situation of Lyme disease in the Ternopil’ region.Materials and methods. The materials of the regional sani­tary and epidemiological station concerning the morbidity of Lyme disease in the Ternopil region during 2001-2011, cards of patients’ epidemiological examination (Form № 357/O), who had been treated in the regional infectious diseases hospitals, were analyzed for the first time. The diagnosis was made on the basis of relevant clinical and epidemiological data, and it was confirmed with determination of IgM and IgG to B. burgdorferi in the labo­ratory of transmissible infections in Lviv Research Institute of Epidemiology and Hygiene (laboratory SYNEVO).Results. Clinico-epidemiologic situation regarding the spread of systemic tick-borne Lyme in Ternopil’ region was gen­eralized in our work. The region was recognized as endemic one regarding Lyme-borreliosis. During the years of 2001-2011 en­zootic areas of LB in 80 localities of 15 districts of Ternopil’ re­gion and Ternopil’ city were revealed. Amount of districts, where new enzootic areas were revealed during the years 2005-2011, increased in comparison with those during the years of 2001­2004 in 3,8 times (from 4 to 15), amount of localities in 16 times (from 5 to 80). Most enzootic areas (13) were found in Kremenetsky district, in Terebovlyansky and Ternopilsky dis­tricts - 10 registered in each, in Berezhansky and Zborivsky dis­tricts - 8 in each. Taking into account endemicity of Ternopil’ region concerning Lyme-borreliosis, at the ticks’ bites serologic examination of victims and health education among the popula­tion in order to inform about the methods of Lyme disease pre­vention should be performed.

Relevance.Measles and rubella have been known to humanity for centuries. These two infections have a number of similarities. However, despite all the similarities and a single elimination program, it is not possible to achieve the same results by the level of the incidence of these infections. Goal. Identify common features and differences in the manifestations of the epidemic process of measles and rubella at the present stage and formulate a hypothesis on their explanation.Materials and methods. Methods of retrospective epidemiological analysis of morbidity were used: Evaluation of the statistical significance of the differences in indicators with the Student’s test. To compare the rate of decrease in the incidence of measles and rubella their exponential approximations using the method of least squares were used. To process the research data, the Microsoft Excel program was used.Results.In the pre-vaccination period, the incidence of measles was 4.6 times higher than rubella. For major infections in this period characterized by a pronounced cyclic morbidity, while the intervals between cyclical rises for measles are shorter, and the amplitude of cycles is higher. As the population was vaccinated, the incidence of these infections decreased, while the rate of decline in the incidence of rubella was higher than that of measles. Also, a faster decrease in morbidity and smoothing of the cyclicity, a transition to older age groups, a gradual exit from the incidence of younger age groups confirm that the rubella has a contact number less then measles.Conclusion.The current level of population immunity is sufficient to eliminate rubella in a relatively short time. For measles, which has greater contagiousness and a contact number, and is more demanding for population immunity, this level is not enough. As a consequence, rubella shows better «manageability» in immunization than measles.

An outbreak of measles that occurred in Anchorage, Alaska, in 1998 resulted in 33 diagnosed cases: 26 were laboratory confirmed and 7 were clinically confirmed. Twenty-nine (88%) of 33 cases occurred in individuals who had not been immunized with at least two measles-mumps-rubella (MMR) vaccinations; 25 (76%) of 33 occurred in school-age children, 0 to 19 years of age. This study identifies the difference in the incidence of measles between the civilian school-age population, who was not completely immunized (two MMR vaccinations given at least 30 days apart), and the military dependent population who had been completely immunized. All cases occurred among civilians, and most (25 of 33 confirmed cases) were associated with school attendance. The authors conclude that a two-dose regimen of MMR vaccine is required to adequately protect individuals against measles.

In 2012, the World Health Organisation (WHO) set out a roadmap for eliminating schistosomiasis as a public health problem by 2025. To achieve this target, preschool-aged children (PSAC; aged 6 years and below) will need to be included in schistosomiasis treatment programmes. As the global community discusses the tools and approaches for treating this group, one of the main questions that remains unanswered is how to quantify infection in this age group to inform treatment strategies. The aim of this study was thus to determine whether a relationship exists between levels of schistosome infection in PSAC and school-aged children (SAC), that can be used to determine unknown schistosome infection prevalence levels in PSAC. A systematic search of publications reporting schistosomiasis prevalence in African PSAC and SAC was conducted. The search strategy was formulated using the PRISMA guidelines and SPIDER search strategy tool. The published data was subjected to regression analysis to determine if a relationship exists between infection levels in PSAC and SAC. The interaction between SAC and community treatment history was also entered in the regression model to determine if treatment history significantly affected the relationship between PSAC and SAC prevalence. The results showed that a significant positive relationship exists between infection prevalence levels in PSAC and SAC for Schistosoma mansoni (r = 0.812, df (88, 1), p = <0.0001) and S. haematobium (r = 0.786, df (53, 1), p = <0.0001). The relationship was still significant after allowing for diagnostic method, treatment history, and the African sub-region where the study was conducted (S. mansoni: F = 25.63, df (88, 9), p = <0.0001; S. haematobium: F = 10.20, df (53, 10), p = <0.0001). Using the regression equation for PSAC and SAC prevalence, over 90% of the PSAC prevalence studies were placed in the correct WHO classifications category based on the SAC levels, regardless of treatment history. The study indicated that schistosome prevalence in SAC can be extended as a proxy for infection levels in PSAC, extending on its current use in the adult population. SAC prevalence data could identify where there is a need to accelerate and facilitate the treatment of PSAC for schistosomiasis in Africa.

Spain has been in a measles elimination phase since 2014. No evidence exists about the distribution of measles cases among the population born outside Spain. The aim of this study was thus to describe the epidemiological situation of measles, stratified by place of birth, during the post-elimination period in Spain. This is a retrospective study of confirmed measles cases reported to RENAVE between 2014 and 2022. A descriptive analysis of case characteristics (sex, age group, vaccination status, imported case) was performed, was well as an analysis of temporal trends and geographic distribution in measles incidence rate (IR; cases/million inhabitants). All analyses were stratified by place of origin (Spain born vs. born outside Spain). We then performed a sensitivity analysis of those born outside Spain, with the representation of Kaplan-Meier curves taking into account the year of arrival in the country until the onset of measles. Between 2014 and 2022, 951 measles cases were reported in Spain (overall IR: 2.3). Among these, 18.6% (177 cases, IR: 3.0) were born outside Spain. The IRs show differences (p < 0.001) in terms of distribution by age group and origin. By age group, children under 5 years had the highest IR, but adults aged 30 years and older reported the highest proportion of cases. The incidence rate ratio (IRR) was 5-fold higher among foreign-born children under 5 years than among native-born children. The measles time trend shows the highest peak in 2019 for foreign-born and native-born (IR: 8.6 and 5.4, respectively), consistent with the European-wide scenario, while only one case of measles was reported in 2022. Geographical variability in incidence rates by region was observed: Catalonia and the Valencian Community accumulated the highest proportion of cases throughout the study period. Among those born outside Spain, the median time from arrival to onset of rash was 6 years. The incidence of measles is 40% higher in Spain's foreign-born population than in its native-born population. Taking into account the increasing migrant population in Spain, we consider that public health efforts need to be directed towards susceptible groups of people. In this context of advanced elimination, specific interventions for identifying and attending the most vulnerable populations should be designed and implemented.

Relevance. The success of the global community in the fight against measles through vaccination at the beginning of the twentyfirst century allowed WHO to declare the goal of eliminating this infection by 2010. However, ten years later, the problem of the growing incidence of measles has become relevant again for all countries of the world. The pandemic of the new coronavirus infection (COVID-19) has affected all spheres of human life and has exacerbated the situation in the fight against other infections, including those managed with the help of specific prophylaxis. Since the measles contagiosity index and mortality rate are significantly higher than similar characteristics of COVID-19, the risk of increasing the incidence of this infection in the coming years is difficult to overestimate.Aim of the study: to assess the epidemic situation of measles in the context of the COVID-19 pandemic, as well as the prospects for its development; to propose preventive measures.Materials and methods. The article analyzes the statistical materials available on the official websites of the WHO (WHO). https://www.who.int/data/), the CDC US (https://www. cdc.gov) and the Federal Service of Rospotrebnadzor (https://www.rospotrebnadzor.ru/) on vaccination coverage and measles incidence in 13 countries in the WHO European Region and the United States. The epidemic situation on measles, as well as the level of population coverage with vaccination against its pathogen in the Russian Federation, were assessed according to the Federal State Statistical Observation forms 2010 – 2020: Form 2 «Information on infectious and parasitic diseases» and Form 6 «Information on the populations of children and adults vaccinated against infectious diseases».Results. It has been established that the increase in the measles incidence occurred in 2017–2019 worldwide, including European countries with a population coverage of two vaccine doses at the 97% level between 2010 and 2019. The prevalence of measles cases in children under the age of 10 is shown, as well as the wide range (from 56.9% to 10.9%) in the proportion of vaccinated persons among them. The results obtained indicate the existence of problems in the organization of modern vaccine prevention. The introduction of widespread restrictive and quarantine measures against the COVID-19 pandemic, on the one hand, has reduced the incidence of measles and, on the other hand, has exacerbated the difficulties in implementing measles prevention. Thus, the results indicate a possible increase in measles incidence in the population after the end of the COVID-19 pandemic.Conclusion. It is necessary to immediately develop an action plan to catch up on the coverage and increase the rate of routine vaccination, to improve the statistical record of persons subject to the introduction of the vaccine and vaccinated, as well as to overcome anti-vaccination attitude among the population.

The age at which children enter school represents a transitional period between early childhood and adolescence that involves increasing autonomy, interaction with peers, and exposure to environments outside the home. Although mortality is generally much lower in the 5 to 9 age group compared with infancy and early childhood, there are many preventable causes of mortality, morbidity, and disability that emerge in this age group, including injuries, noncommunicable diseases, and vaccine-preventable and highly treatable infections.1 Partly because of relatively low mortality rates and less frequent contacts with the health system, school-age children and younger adolescents ages 5 to 14 have been referred to as the “missing middle,” in that there is a dearth of robust data on key health indicators, morbidity burden, and cause-specific mortality in this group.2 Many health issues that have a high burden in early childhood can persist in older children, especially in low- and middle-income countries (LMIC), resource-constrained settings, and marginalized communities worldwide. Undernutrition and infections occurring in the context of poverty remain leading causes of morbidity and mortality in school-age children living in LMIC,3 whereas those children in higher-income settings are more likely to die due to injuries or noncommunicable disease (NCD). In addition, the prevalence of overweight and obesity in children and adolescents has increased steadily over the last few decades,4 though the rate of these increases varies widely among countries.5New risk factors relating to diet, lifestyle, mental health, injuries, and NCDs also become more prominent as children approach and enter adolescence, many of which can contribute to the development of chronic NCDs over the life course. Within this period, school-age children begin to establish healthy lifestyle habits (eg, diet, physical activity, avoidance of substance use), and are learning about sexual and reproductive health and rights, as well as the measures they can take to protect themselves and others. This represents a window of opportunity for educational interventions to support good health, optimal development, and well-being. A growing body of evidence suggests that school-based and digital platforms and delivery strategies are promising tools that aid in the delivery of health interventions to older children.The methodology and reviews described herein contributed to the portion of the upcoming 2022 Lancet Optimizing Child and Adolescent Health and Development Series6 related to school-age child and adolescent health interventions. This Lancet Series is the product of an ongoing academic collaboration involving global child health researchers worldwide, including many who are authors on articles within this supplement. The aim of the specific Lancet Series article citing this supplement is to provide a comprehensive overview of systematic reviews describing the most recent evidence for effective interventions to support maternal, newborn, child, and adolescent health and development from preconception through to 20 years of age.Figure 1 provides an overview of the key child health domains, and a breakdown of the intervention review topics addressing key risk factors covered by the articles included in this journal supplement. On the basis of work done in previous comprehensive overviews of interventions for child and adolescent health (eg, Disease Control Priorities, 3rd edition7; Lancet Adolescent Health Commission8), we identified a comprehensive set of key child health domains that represented priority areas for interventions to address modifiable risks for the major causes of child mortality and morbidity. The factors that informed which domains were covered in this supplement included: conditions with a high global burden of disease, conditions with disproportionate impacts on vulnerable and marginalized populations, potential to support improved human capital development across the life course, and pragmatic considerations including whether the topic had recently been covered elsewhere. In cases where the child health domain was deemed too broad in scope for a single review (eg, infectious diseases), the subtopics for individual reviews were also chosen on the basis of these factors. The age group of specific interest for these reviews was older school-age children (ages 5–9.9), though the period of early adolescence (ages 10–14.9) was also recognized as an important area of overlap and transition. The general outcomes of interest aligned with those chosen through consensus by the Lancet Series working group. These included, but were not limited to, mortality, severe morbidity, disability, growth and development, knowledge and behavior, and indicators of improved human capital development such as academic achievement.The methodological approaches taken, and child health domains covered in this supplement of reviews, was informed by a broad initial literature-scoping and evidence-mapping process to identify key health interventions and associated evidence for their effectiveness in the form of systematic reviews. This was done across all domains, from preconception and pregnancy to ages 0 to 20 to inform the 2022 Lancet Optimizing Child and Adolescent Health and Development Series.6 This involved leveraging existing large-scale intervention overviews (eg, Disease Control Priorities 3rd edition, Lancet Series) that had already highlighted existing effective interventions and the most recent systematic reviews detailing the evidence for their effectiveness. Additional targeted searches for newer interventions and systematic reviews in each domain were also conducted. Through this evidence-mapping process, we explored coverage and extent of LMIC-specific evidence across all child health domains to identify areas where school-age evidence was lacking and determined that there were significant gaps in existing evidence for intervention effectiveness in school-age children.We funneled the reviews identified during this initial scoping process that contained studies covering school-age children and adolescents into the individual reviews for each domain of child health covered in this supplement. We elected to conduct targeted overviews of systematic reviews if there was deemed to be a large body of existing evidence syntheses. In cases where there was a lack of evidence syntheses of intervention effectiveness for a given domain of school-age child health, conventional systematic reviews of primary literature (ie, experimental studies) were conducted. The general methodology for these 2 approaches are described below. See Table 1 and Fig 1 for a summary of the review methods used for each child health domain, and Fig 2 for a breakdown of the main methodology followed in each type of review.For those child health domains that encompassed a variety of intervention types addressing a wide range of risk factors and health conditions, and for which the initial scoping process identified a variety of existing systematic reviews of intervention effectiveness, an overview of systematic reviews was undertaken. This approach was taken to ensure comprehensiveness, reduce duplication of review efforts, and make the review process feasible.In addition to incorporating those relevant reviews previously identified in the initial literature-scoping and evidence-mapping exercise, tailored searches were executed in several databases (eg, Medline, Cochrane Database of Systematic Reviews, Campbell Library) to identify literature published up until the end of 2020. Evidence derived from Cochrane reviews and other high-quality systematic reviews that synthesized evidence from randomized controlled trials and quasi-experimental studies examining the effectiveness of interventions was prioritized for inclusion. A first pass of title and abstract screening for relevance was conducted, followed by a full text screening that was done by at least 2 reviewers against inclusion criteria. Two reviewers independently filled a standardized data abstraction form to capture review characteristics, the characteristics of included studies and interventions (eg, age coverage, country representation, delivery platform), and pooled-effect estimates (eg, risk ratios, odds ratios, mean differences, 95% confidence intervals) derived from meta-analyses where they were reported. The main outcomes of interest across the reviews included measures of child morbidity, mortality, development, academic achievement, and mental and physical well-being. The extracted data were then matched among reviewers to check for errors and ensure consistency, and then consolidated into a single table for inclusion in the article. The AMSTAR 2 tool12 was used for review quality assessment, and was also conducted in duplicate, with any disagreements in ratings resolved by consensus or the involvement of a third reviewer.If for a given domain the initial evidence-mapping exercise revealed that the existing evidence-synthesis literature was lacking for the school-age group, we proceeded with a conventional systematic review of primary literature. All systematic reviews were reported in accordance with the reporting guidance provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.13Search strategies were developed using the population, intervention, control, and outcomes methodology, relevant medical subject headings terms, and keywords derived from the scoping search. The search terms were adapted for use in other bibliographic databases in combination with database-specific filters for controlled trials, where these were available. Searches for the individual, domain-specific reviews were conducted in a variety of databases, including but not limited to: PubMed, Embase, Medline, PsycINFO, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, and the World Health Organization regional databases. Evidence derived from LMIC was prioritized for synthesis, though evidence from high-income countries (HIC) settings was leveraged to highlight whether effective interventions exist in cases where LMIC evidence was sparse. Gray literature searches and additional hand searching were conducted in Google Scholar and reference lists of relevant articles, book chapters, and reviews.After removal of duplicate studies, a multistage screening process was performed to select studies that met the eligibility criteria. Each title and abstract was assessed by at least 1 reviewer, who excluded those that were deemed irrelevant. At the full-text review stage, at least 2 reviewers assessed all full texts. Any disagreements in inclusion decisions were resolved by discussion and, where necessary, by consulting a third reviewer. At this stage, reasons for exclusion were documented. The methods section of each individual review in this supplement describes their selection and eligibility criteria, which differed depending on the child health domain being assessed. Data from included studies were independently extracted and coded by 2 review authors using standardized, previously piloted data extraction forms, which sought general study characteristics, details of the population, intervention, comparison groups, and quantitative outcome data. Data extraction forms were matched and checked, and if necessary, a third review author was consulted in the event of any disagreements to establish consensus.Assessment of risk of bias for included studies was conducted according to criteria and tools outlined in the Cochrane Effective Practice and Organization of Care guidelines14 for randomized trials, nonrandomized trials, controlled before–after, interrupted time series, and the Cochrane Handbook for Systematic Reviews of Interventions.15 Assessments were conducted independently by 2 review authors; scores were compared, and a final risk of bias judgement was reported for the included studies of each systematic review. Randomized trials were assessed using the Cochrane Risk of Bias tool15 across the following domains: randomization process, deviations from the intended interventions (blinding of personnel, participants, and outcome assessment), missing outcome data, outcome measurement, the selection of the reported result, disclosure of funding, and conflicts of interest. Studies were assigned an overall risk of bias judgement accordingly (low risk, high risk, or some concerns/medium risk). Quasi-experimental study designs were assessed using the Risk of Bias Tool for Nonrandomized Studies of Interventions (ROBINS-I) tool.15,16 Studies were assessed according to the following domains: bias because of confounding, bias in selection of study participants, bias in classification of interventions, bias because of deviations from intended interventions, bias because of missing data, bias in measurement of outcomes, and bias in selection of the reported result. Each study was assigned an overall risk of bias judgement (low, moderate, serious, and critical risk).Meta-analyses were conducted where possible using Review Manager 5.4 software.17 Randomized controlled trials and cluster-randomized controlled trials were analyzed separately from quasi-experimental study designs. To mitigate heterogeneity within included studies, a random-effects meta-analysis was used for pooled outcomes. For those situations where meta-analysis was not possible, data on the effect of interventions from individual studies was tabulated and reported, and a narrative synthesis was conducted for each key intervention domain.Where there were a sufficient quantity of comparable studies (in both interventions and outcome), a summary of the intervention effect and a measure of quality for key outcomes were produced using the Grading of Recommendations Assessment, Development and Evaluation approach.18 The Grading of Recommendations Assessment, Development and Evaluation approach considers 5 domains (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of the body of evidence for each outcome. The evidence was downgraded from “high quality” by 1 level for serious (or by 2 levels for very serious) limitations, depending on assessments for risk of bias, indirectness of evidence, serious inconsistency, imprecision of effect estimates, or potential publication bias.The aim of the authors of this supplement of reviews is to comprehensively assess the available evidence for the effectiveness of interventions to improve health and well-being in school-age children and adolescents. The initial literature-scoping and evidence-mapping process, followed by the different review approaches taken, has helped to maximize the scope covered across this set of reviews, and has allowed us to provide the most comprehensive assessment of the state of the published literature covering interventions for school-age children and adolescents. The individual reviews in this supplement have also highlighted child health domain-specific gaps in the evidence for both primary literature in the school-age group, and gaps in existing evidence syntheses.It is important to note that, for the reviews within this supplement, the descriptions of intervention effects are meant to provide an overview of what is currently known in terms of evidence for effectiveness, and do not imply that other interventions were ineffective simply because there was an evidence gap. Given the limited space and large scope, it was only possible to provide the highlights of specific comparisons and outcomes in each of the results sections. Comprehensive tables of study characteristics, outcomes, and effect estimates are provided in both the main articles and appendices.Although we were specifically interested in focusing on LMIC research, this was only feasible for a few review topics (eg, sexual and reproductive health and rights, neglected tropical diseases) because of a dearth of literature. Instead of being used to attempt to generalize their effectiveness to LMIC settings, evidence from intervention effectiveness in HIC settings are included and described to establish that effective interventions do indeed exist and may differ in their impact between settings. This approach has previously been used in the context of adolescent health interventions.19 This evidence from HIC could act as a starting point for future research and implementation in various LMIC settings, with program components tailored to local contexts.In the case of those reviews taking the overview of systematic reviews approach, we were limited to including only those primary studies already included in systematic reviews and could not cover each subdomain in depth. Thus, we were unable to identify and include those primary studies that may not have been included in systematic reviews because of studies not being identified in review authors’ database searches, not meeting their inclusion criteria, or falling out of the time frame of the review. Furthermore, some systematic reviews of primary literature were unable to perform meta-analyses because of high heterogeneity or a lack of high-quality evidence from randomized trials, which makes synthesizing the existing evidence more difficult.

Background: The growing obesity epidemic among Australian children points to the need to identify strategies that may have a positive impact on cardiovascular disease (CVD) risk in school-aged children. Our review of the literature suggests that a single strategy school-based intervention, taking into account the pervasive control that the environment has over behaviour (such as diet and lifestyle) has the potential to reduce CVD risk among children and young adults. Studies analysing the current status of CVD risk factor measures in these age groups, obtained at local school levels, would also give an indication of the need for preventative strategies and a comparative measure of the local population to the national. And in exploring these possible preventative strategies, reviewing current policies and practices in place in schools would help fill in the gaps for future direction and emphasis. Utilising the school community would also harness parental involvement, which could also lead to more favourable results in obesity prevention, as parent role modelling and children's accessibility to healthy food are important determinants of preference for and intake of such foods. These interventions and programs would need to be trialled for feasibility without it being a burden in terms of resources or impact on school learning time. Methods: To achieve this, we sought to explore and validate these potentials through the following reviews and studies: 1) Literature review of existing literature to identify the effectiveness of nutrition-based interventions in school communities to reduce CVD risk factors in children and adolescents. 2) 'Monitoring Cardiovascular Risk Factors' (MCVRF) - a crosssectional study of CVD risk factors in children and adolescents, including body mass index (BMI), blood pressure (BP), blood cholesterol and glucose levels, cardiovascular endurance, and dietary eating and lifestyle habits. This project was designed to establish a CVD risk factor surveillance program suitable for implementation at the individual school level, and monitor the status and any trends of CVD risk over a four-year period. 3) 'Fruit Intake STudy' (FIST) Pilot - a pilot study in one school to assess determining the feasibility of a school-based intervention of providing fruit daily in the classroom and its effects on risk factors of CVD, and dietary behaviour. Assessment measures were as for the risk factors listed in MCVRF (above). 4) Fruit Intake STudy (FIST)- a randomised controlled trial involving four schools and with survey instruments assessing determining the impact of a school-based intervention of providing fruit daily in the classroom and its effects on risk factors for CVD, and dietary behaviour. 5) Survey of school principals to examine the current state of environmental and policy approaches to providing healthy CVD prevention nutrition choices in Victorian schools and subsequently recommends opportunities for state and local health departments to initiate and participate in environmental and nutrition policy initiatives. Results: This collection of studies have shown evidence that a complex and pressing issue of CVD risk and associated complications among children and adolescents can be addressed positively through a monitoring system (MCVRF), and an accompanying preventative strategy involving the school community as a vehicle of implementation (FIST), with improvements seen in dietary choice behaviour in both participants and their parents in just over 2 months. The approach of nutrition-based strategies was evidently neglected as seen in the school audit, but with clear benefits as shown in the strategy of fruit provision in the FIST studies. Discussion: The FIST studies revealed that a simple intervention strategy can be easily implemented in local schools, without being a burden on the school community in resources or curriculum. There is also the potential to concurrently collect useful baseline data for monitoring CVD risk (MCVRF) in these age groups at a local school level, empowering the local school to be better informed in formulating relevant health-related policy and practice. Conclusion: In a school age population, prevention is undoubtedly an effective strategy against CVD risk through these demonstrated auditing, monitoring and intervention programs.

Epidemic of Childhood Obesity: Implications for Kidney Disease

Immunizations represent a critical component of contemporary preventive measures. Their primary function is to safeguard against the development of diseases and the ensuing complications. The objective of this study is to evaluate the effects of the measles, mumps, and rubella immunization program on the population of children in Poland from 2014 to 2021. The vaccination rate against measles, mumps and rubella in the population aged 1-19 years was calculated. The numerator was the number of children vaccinated in a given year and the denominator was the number of children born in a given year. The rate of missed vaccinations was calculated, where the numerator was the difference between the number of children born in a given year and the number of children vaccinated in a given year, and the denominator was the number of children born in a given year. The incidence rate was calculated for the vaccinated and unvaccinated populations (per 1 million population). The numerator constituted the number of reported cases in a given calendar year, whilst the denominator represented the number of individuals in the vaccinated or unvaccinated population in an age group. In the subsequent years a gradual decrease in vaccination coverage was observed among the youngest age groups: 1-year-olds (from 77.8% to 70.7%) and 2-year-olds (from 94.8% to 89.5%). In the population vaccinated against measles, the highest incidence of the disease was observed among 1-year-olds. A decline in the incidence of rubella can be observed in subsequent years, both in the vaccinated and unvaccinated populations. A lower incidence of diseases was observed in 2020 and 2021 in all age groups. A significant decrease in the incidence of measles, mumps and rubella has been observed between 2014-2021 in the vaccinated population in comparison to the unvaccinated population.

KeywordsAnterior cruciate ligament; Tear; Meniscus; Rupture; PatternsIntroductionAnterior cruciate ligament (ACL), as a primary stabilizing structure of knee is the most common disrupted ligament in acute trauma in the US every year [1,2]. On the other hand, the menisci play a crucial role in the dynamics of the knee. Their shape, attachment, and material properties contribute substantially to joint alignment and load transmission by distributing both tensile and compressive forces. Damage to the menisci can influence proprioception, stability, and mobility of the knee [3,4]. Risk factors for meniscal tears include prolonged or repeated deep knee bending, obesity, and sports [5]. Acute injury, as seen in alpine sports, involves complex dynamics, which can damage singular or multiple tissue structures of the knee [5,6]. Meniscal tears are typically thought to be initiated by coupled compression and twisting movements [7,8] which can accompany high-energy maneuvers such as cutting, jumping, and landing during sporting events [9].Meniscal injuries commonly occur in conjunction with ACL tears. A numerous studies have examined the occurrence of these injuries, with their presence being reported as 16% to 82% in knees with acute ligament tears and as high as 96% in knees with chronic ligament tears [10-14]. Magnetic resonance imaging (MRI) is valuable tool, preferred than diagnostic arthroscopy in most patients with ligamentous and meniscal tears because it avoids the surgical risks of arthroscopy, with better accuracy in medial and lateral meniscus and ACL [15].Lateral meniscal tears (LMTs) occur slightly more frequently than medial meniscal tears (MMTs) in knees with acute ACL injuries, 56% lateral versus 44% medial. [10,12]. MMTs however, are more common in chronic ACL deficiency [10,12,14]. This difference in tear occurrence is usually attributed to the anatomic and functional differences that exist between the two menisci, especially in the ACL deficient knee, the lateral meniscus relatively loosely attached to the tibial plateau which allows it to be quite mobile, whereas the medial meniscus, is firmly attached to the tibia, especially at the posterior horn [12,16,17]. This firm attachment allows the medial meniscus to act as a knee stabilizer, a significant restraint to anterior tibial translation in the ACL deficient knee [18-21]. The loss of ACL function increases tibial translation, allowing the meniscus to “engage” the femoral condyle and act as a wedge against the tibia [22,23], while others have suggested that mechanical trauma causes the MMTs in this setting [12,18,20]. Several studies have explored the relationship between ACL injury and meniscal tear [24-30]. Some showed preponderance of the LMTs in the acute setting and in osteoarthritis [24,25], others suggested the MMTs especially in acute reconstructions [26-29].This study was conducted to determine the patterns of meniscus damage associated with ACL rupture and identify the commonest type of meniscus damage in our population that is associated with ACL tear.MethodsMedical records of patients with ACL rupture covering a period of 16 years (January 1996 to December 2012) seen at the author’s institute were retrospectively reviewed. The collected data included the presence or absence of meniscal tear, the type of meniscal tear diagnosed by MRI or arthroscopy, the time of the initial ACL injury and the time of meniscal tear, the duration between ACL rupture and reconstruction surgery, age, gender, mode of injury and level of sports activity performed, height, weight.BMI is calculated according to the Patient’s height and weight, patient is considered obese if the BMI is above 30 according to the World Health Organization [31].Sports level was classified as: professional athletes: (practicing a sport activity as a job, e.g. member of a team), recreational Athlete (considered a person, who is practicing a sport activity that is involving running and pivotal movements at least once in a week not professionally), non athlete (a person who is not practicing any kind of sport), patients with no clear statement regarding their level of sport are considered as missing data.Mode of Injury is classified as direct (Injury was caused be a direct trauma to the patent, e.g. hit by another player, felt on his knees or road traffic accident) or non direct (Injury was caused without trauma, e.g. over rotating the knee while exercising).Patients who were diagnosed with ACL rupture using MRI within 3 months of the injury, underwent primary arthroscopic ACL reconstruction at our institution and found to have meniscal damage diagnosed by MRI or arthroscopy were included in the study. Patients who had a chronic ACL tear or had undergone prior ipsilateral knee arthroscopy or surgery, those with osteoarthritis, with rheumatoid arthritis and patients who had undergone ACL rupture revision were excluded from the study. All images were obtained by routine knee MRI.Types of Meniscal Tears were obtained from the reports of the MRI and Arthroscopy and were classified as (longitudinal, Degenerative, flap, radial, complex) as according to Tandogan et al. [32], De Smet [33].Data collected were entered and coded systematically into a Microsoft Excel worksheet and were imported to a Predictive analysis software (PASW) program version 18 (SPSS, IBM, Chicago, Illinois, USA). Oneway analysis of variation (ANOVA) was used to compare means between the three groups (LMTs, MMTs and both). Pearson correlation was conducted to determine the relationship between the outcome variables (age, gender and sport levels). Independent sample t -test was done to identify differences between the mean values of continuous variables. Chi square test was done to determine associations between categorical variables. A test result considered statistically significant if p< 0.05.ResultsA total of 294 patients satisfied the inclusion criteria of the current study from 1996 to 2012. Of these patients, 175 (59.5%) had MMTs, 91 (31%) had LMTs and 28 patients (9.5%) with both MMT and LMT (Table 1).Table 1: Demographic characteristics of all patients with ACL rupture with meniscus injury. Variables Age in years, mean (SD)27.98 (6.8)Weight in kg, mean (SD)80.80 (17.1)Height in cm, mean (SD)170.73 (7.7)BMI in kg/cm2, mean (SD)27.68 (5.6)Mode of injury Direct injury, n (%)125 (42.5)Non-direct injury, n (%)169 (57.4)Sports level Professional athletes, n (%)5 (1.7)Recreational athletes, n (%)196 (66.7)Non-athlete, n (%)28 (9.5)No available data, n (%)65 (22.1) Patients who had MMTs were significantly older (29.10 ± 7.0 years) compared to lateral (26.24 ± 5.9 years) and both (26.61 ± 6.7 years), p=0.002. There were no significant differences in the height, weight, and BMI, level of sport and mode of injury in between the three groups (MMTs, LMTs and both) (Table 2). Types of meniscal tears are shown in Table 3.Table 2: Comparison between MMT, LMT and both in 294 patients who hadACL tear. VariablesMMTn=175LMTn=91Bothn=28 p valuesAge in years, mean (SD)29.10 (7.0)26.24 (5.9)26.61 (6.7)0.002^Weight in kg. mean (SD)82.38 (17.5)79.14 (16.4)76.87 (16.3)0.165^Height in cm, mean (SD)170.40 (8.1)171.42 (6.6)170.49 (8.1)0.602^BMI, mean (SD)28.34 (5.6)26.83 (5.6)26.43 (5.2)0.062^Obesity, n (%)56 (32.0)22 (24.2)7 (25.0)0.294*Type of ACL tear Direct ACL tear, n (%)68 (38.9)32 (35.2)9 (32.1)0.425*Indirect ACL tear, n (%)65 (37.1)30 (33.0)8 (28.6)Level of sports Recreational athlete, n (%)105 (60.0)67 (73.6)22 (78.6)0.144*Professional athlete, n (%)3 (1.7)2 (2.2)1 (3.6)Note: ^ by ANOVA, * by Chi-square test Table 3: Types of meniscal tears by MRI & Arthroscopy. Types of Meniscal TearsMedialLateralTotalLongitudinal Tears152(75%)86(72%)238(74%)Degenerative Tears16(8%)10(8%)26(26%)Radical Tears8(4%)9(7%)17(5%)Complex Tears6(3%)2(2%)8(2.5%)FLAP6(3%)5(4%)11(3.5%)N/A15(7%)7(7%)22(7%)Total203119322DiscussionIn our study, the patients who had medial meniscal tearing were significantly older than those who had only lateral meniscal tear, and those who had both medial and lateral meniscal tears. No such relationship was significant between age and lateral meniscal tear. Our findings are in concordance with the findings of the study that was conducted in Turkey by Tandogan et al. [32], which showed preponderant injury to the medial meniscus than the lateral meniscus, they also found that the mean age of the patients with medial meniscal tears was 27.0 ± 7.6 years, significantly older than those who had no medial meniscal tearing (25.4 ± 6.7 years). Our patient’s mean age who had medial meniscal tearing was 29.10 ± 7.0 years, significantly older than 26.61 ± 6.7 years in those who did not have medial meniscal tearing. Sports level was not significantly correlated to the parameters we have studied or to the site of meniscal tear. This is probably because most of our patients (66.8%) were just recreational athletes.Our study was in contrast to the findings of Bellabarba et al. [10] ,Thompson et al. [12], Melissa [34] wherein they found that LMTs are more frequently encountered than MMTs, and that MMTs on the other hand are more common in chronic injuries. Our study showed more frequent MMTs than LMTs, of patients with acute ACL injuries. Again, this is probably due to the older age of our patients, which was significantly correlated with MMTs.Obesity, Mechanism of injury, Sport level as a risk factors of meniscal tear didn’t show any significance in determining a common pattern, which goes with the same results that was found in Kluczynski et al. [34] where different risk factors have been examined prospectively to see their effect on meniscal tears and chondral changes.The sensitivity of MRI in detecting meniscal pathology has been proven in several studies [10]. However, Oei in 2003 [35] pointed out the low sensitivity of MRI in detecting lateral meniscal pathology compared to detecting medial meniscal pathology with a sensitivity difference by as much as 14% (93.3% versus 79.3%), in an adult population, more so in the presence of ACL tears [36]. This window would probably explain the differences between the frequencies of LMTs and MMTs, more so in our findings, another point which could also explain our findings; is the common presentation of knee varus malalignment in Saudi population. In a comparison study between Saudi Arabian and Canadian cohorts by the same group, it was clearly found that in knee osteoarthritis patients Saudis had more varus alignment, showed by the Hip-Knee-Ankle angle parameter used to diagnose knee alignment disorders [37].A study addressing the Knee alignment in the Saudi Population Comparing the means of Tibiofemoral angle (TFA) of different age groups in Saudi population to those of corresponding age groups in Japanese and Australian Caucasians showed a statistically significant lower TFA difference in all age groups. Comparison of the means of TFA of different age groups in Saudi population to those of corresponding age groups in Japanese and Australian Caucasians showed a statistically significant difference in all age groups, also Comparison of the means of TFA of Saudi males and females to those of Europeans, Chinese and American Caucasians showed a significant difference from all of them [38].Genuvarus can result in added contact stresses on the medial compartment of the knee and possibly lead to accelerated wear and damage to the articular cartilage.Another explanation for the significant association of older age to MMTs is the association of the medial meniscus posterior horn with severity of the chondral lesion and arthritic changes according to the K-L radiographic score. There is usually accompanied chondral damage in MMTs [39].Secondary medial meniscal tears are considered as the main reason of osteoarthritis followed by ACL deficiency [40]. The aim of this study is to alert the surgeons about the existence of this common finding in order to decrease future osteoarthritis. There were a few limitations in the study mainly because of its retrospective nature; a lot of the Patient’s X-rays were not found in order to study the alignment of the knees. In addition we were not able to obtain detailed information about the chondral lesions in the MRI reports to augment our significant findings of MMTs among our older-aged population.ConclusionThe higher occurrence of medial meniscal tear in acute anterior cruciate tears could be attributed to the age related arthritic changes as well as to the common varus deformity in our population; this finding should be considered by the surgeons in order to decrease future osteoarthritis.ReferencesGriffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, et al. (2000) Noncontact anterior cruciate ligament injuries: Risk factors and prevention strategies. J Am Acad Orthop Surg 8: 141-150. Grindstaff TL, Hammill RR, Tuzson AE, Hertel J (2006) Neuromuscular control training programs and noncontact anterior cruciate ligament injury rates in female athletes: A numbers-needed to treat analysis. J Athl Train 41: 450-456. Aagaard H, Verdonk R (1999) Function of the normal meniscus and consequences of meniscal resection. Scand J Med Sci Sports 9: 134-140.Jerosch J, Prymka M, Castro W (1996) Proprioception of knee joints with a lesion of the medial meniscus. Acta Orthop Belg 62: 41-45.Baker P, Coggon D, Reading I, Barrett D, McLaren M, et al. (2002) Sports injury, occupational physical activity, joint laxity, and meniscal damage. J Rheumatol 29: 557-563.Renstrom P (1994) Clinical practice of sports injury prevention and care. Olympic encyclopedia of sports medicine. Oxford, London, Edinburgh, Boston, Melbourne, Berlin, Paris, Vienna: Blackwell Scientific Publications, LTD.Muellner T, Nikolic A, Vecsei V (1999) Recommendations for the diagnosis of traumatic meniscal injuries in athletes. Sports Med 27: 337-345. Slocum DB, Larson RL (1968) Rotatory instability of the knee: Its pathogenesis and a clinical test to demonstrate its presence. J Bone Joint Surg Am 50: 211-225.Muellner T, Weinstabl R, Schabus R, Vécsei V, Kainberger F, et al. (1997) The diagnosis of meniscal tears in athletes: A comparison of clinical and magnetic resonance imaging investigations. Am J Sports Med 25: 7-12. Bellabarba C, Bush-Joseph CA, Bach BR Jr (1997) Patterns of meniscal injury in the anterior cruciate-deficient knee: A review of the literature. Am J Orthop 26: 18-23.Yoon KH, Yoo JH, Kim KI (2011) Bone contusion and associated meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture. J Bone Joint Surg Am 93: 1510-1518.Thompson WO, Fu FH (1993) The meniscus in the cruciate-deficient knee. Clin Sports Med 12: 771-796. Panisset JC, Duraffour H, Vasconcelos W, Colombet P, Javois C, et al. (2008) Clinical, radiological and arthroscopic analysis of the ACL tear. A prospective study of 418 cases. Rev Chir Orthop Reparatrice Appar Mot 94: 362-368.Wickiewicz TL (1990) Meniscal injuries in the cruciate-deficient knee. Clin Sports Med 9: 681-694. Crawford R, Walley G, Bridgman S, Maffulli N (2007) Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 84: 5-23.Villegas DF, Hansen TA, Liu DF, Donahue TL (2008) A quantitative study of the microstructure and biochemistry of the medial meniscal horn attachments. Ann Biomed Eng 36: 123-131.Kan A, Oshida M, Oshida S, Imada M, Nakagawa T, et al. (2010) Anatomical significance of a posterior horn of medial meniscus: The relationship between its radial tear and cartilage degradation of joint surface. Sports Med Arthrosc Rehabil Ther Technol 2:1.Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, et al. (2000) Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res 18: 109-115. Hsieh H-H, Walker PS (1976) Stabilizing mechanisms of the loaded and unloaded knee joint. J Bone Joint Surg Am 58: 87-93. Indelicato PA, Bittar ES (1985) A perspective of lesions associated with ACL insufficiency of the knee: A review of 100 cases. Clin Orthop Relat Res 198: 77-80.Markolf KL, Kochan A, Amstutz HC (1984) Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament. J Bone Joint Surg Am 66: 242-252. Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 64: 883-888. Sullivan D, Levy IM, Sheskier S, Torzilli PA, Warren RF, et al. (1984) Medial restraints to anteriorposterior motion of the knee. J Bone Joint Surg Am 66: 930-936. Cipolla M, Scala A, Gianni E, Puddu G (1995) Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Classification, staging and timing of treatment. Knee Surg Sports Traumatol Arthrosc 3: 130-134.Nikolic DK (1998) Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc 6: 26-30. Cerabona F, Sherman MF, Bonamo JR, Sklar J (1988) Patterns of meniscal injury with acute anterior cruciate ligament tears. Am J Sports Med 16:603-609. Keene GC, Bickerstaff D, Rae PJ, Paterson RS (1993) The natural history of meniscal tears in anterior cruciate insufficiency. Am J Sports Med 21:672-679.Paletta GA, Levine DS, O’Brien SJ, Wickiewicz TL, Warren RF (1992) Patterns of meniscal injury associated with acute anterior cruciate ligament injury in skiers. Am J Sports Med 20: 542-547.Smith JP III, Barrett GR (2001) Medial and lateral meniscal tear patterns in anterior cruciate ligament deficient knees. Am J Sports Med 29: 415-419. Kaeding CC, Pedroza AD, Parker RD, Spindler KP, McCarty EC, et al. (2005) Intra-articular findings in the reconstructed multiligament injured knee. Arthroscopy 21: 424-430. WHO (2000) Obesity: Preventing and Managing the Global Epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. Tandogan RN, Taşer O, Kayaalp A, Taşkiran E, Pinar H, et al. (2004) Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time form injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 12: 262-270.De Smet AA (2012) How I diagnose meniscal tears on knee MRI. AJR Am J Roentgenol 199: 481-499. Kluczynski MA, Marzo JM, Bisson LJ (2013) Factors Associated With Meniscal Tears and Chondral Lesions in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Prospective Study Am J Sports Med 41: 2759-2765.Oei EH, Nikken JJ, Verstijnen AC, Ginai AZ, Myriam Hunink MG (2003) MR imaging of the menisci and cruciate ligaments: a systematic review. Radiology 226: 837-848.De Smet AA, Mukherjee R (2008) Clinical, MRI, and arthroscopic findings associated with failure to diagnose a lateral meniscal tear on knee MRI. AJR Am J Roentgenol 190: 22-26.Cooke TD, Harrison L, Khan B, Scudamore A, Chaudhary MA (2002) Analysis of limb alignment in the pathogenesis of osteoarthritis: a comparison of Saudi Arabian and Canadian cases. Rheumatol Int 22: 160-164.El Fouhil AF, Khoshhal KI, Al-Nakshabandi NA, Al-Boukai AA, Atteya M (2011) Normal knee angles in the adult Saudi population. Saudi Med J 32: 1143-1148.Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, et al. (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16: 849-854.Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: Osteoarthritis. Am J Sports Med 35: 1756-1769.

Background: Measles surveillance program plays an essential role in determining disease prevalence data and outbreaks as well as monitoring the preventive activities toward measles elimination. This study illustrates epidemiological measles indicators through the national measles surveillance program in Libya in the year 2018. Materials and Methods: Annual measles surveillance report in 2018 was analyzed to figure out the spread of measles disease. Case-based surveillance is being implemented to notify suspected measles cases (skin rash and fever) through the measles surveillance system. The program depends on immediate notification of suspected measles cases and blood sample collection by official measles surveillance officers covered most health facilities in the country. National measles laboratory is the only official institute authorized to confirm measles cases. The characteristics such as the number of confirmed measles cases, deaths, age group, measles trends, and vaccination status were analyzed to find the indicators, as well as the incidence rate of measles cases was calculated nationwide. Results: Total number of measles cases was 1059 confirmed from 1852 suspected measles cases. Of confirmed cases, 339 were laboratory confirmation and 720 were epi-linked, with limited deaths (2 cases) were registered in the year. Seven outbreaks were detected in several locations. The age group of most cases (86%) was below 3 years of age group. Measles incidence was 152 per million which higher than previous years and comparable to many neighboring countries. The measles vaccine was not reached to 47% of suspected cases. Seasonality of measles was not in normal trend as it was continued high even in the summer month. Conclusion: A significant measles burden was shown through the measles surveillance system even though high measles vaccination coverage rate was officially documented. Supplementary immunization activities should be an essential action point to mitigate measles morbidity.

An epidemiological study on measles was conducted among the under five children in slum areas of Kolkata to assess the incidence of measles. 20 cluster sampling technique was followed and in each cluster 250 under five children were covered. Paramedical workers identified children of the target of age group who had history of measles in past one year and the medical officer confirmed the diagnosis following standard case definition. Incidence of measles was found as 5.76%. Incidence was equal in both the sex groups, but found more among infants. The incidence of measles gradually declined with the increase of age strengthening the view in favor of early immunization. Amongst the measles cases only 19.7% were immunized with measles vaccine. 100% of measles cases gave history of rash, 98.9% had history of fever, 82.8% reported that the rash started from face and progressed downwards to abdomen and leg. Cough, redness of eye and discoloration of skin were reported by 97.5%, 83.8% and 65.2% measles cases respectively. Only 16.9% and 8.6% children received Vitamin A oil before and after the illness respectively. 49% gave history of exposure to measles cases and 46.6% cases had measles within 2 weeks incubation period. The study highlighted the necessity of timely measles vaccine coverage, additional dose at a higher age and Vitamin A supplementation through IEC activities.