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Background: Basic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality. Aim: This joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor. Setting: Palliative Medicine programme leads and teachers from eight medical schools in South Africa. Methods: A survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers. Results: Responses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the pre-clinical and clinical components of the curriculum. Conclusion: Through mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC).

INTRODUCTION: Paper currency notes, exchangeable fomite, that is continuously contaminated because of the poor handling and storage practices. Objective: the general objective of the study was to determine the bacterial contamination of paper currency notes possessed by food vendors around Mulago National Referral Hospital Complex.

Abstract not available.

Introduction: the World Health Organization recommends TT surveys to be conducted in adults aged 15+ years (TT 15 survey) and certifies elimination of TT as a public health problem when there is less than 1 unknown case per 1,000 people of all ages. There is no standard survey method to accurately confirm this elimination prevalence threshold of 0.1% because rare conditions require large and expensive prevalence survey samples. The aim of this study was to develop an accurate operational research method to measure the total backlog of TT in people of all ages and detect when the elimination threshold is achieved. Methods: between July to October 2016, an innovative Community-based, Mapping, Mop-up and Follow-up (CMMF) approach to elimination of TT as a public health problem was developed and tested in Esoit, Siana, Megwara and Naikara sub-locations in Narok County namely in Kenya. The County had ongoing community-based TT surgical camps and case finders. TT case finders were recruited from existing pool of Community health volunteers (CHV) in the Community Health Strategy Initiative Programme of the Ministry of Health. They were trained, validated and supervised by experienced TT surgeons. A case finder was allocated a population unit with 2 to 3 villages to conduct a de jure pre-survey census, examine all people in the unit and register those with TT (TT all survey). Identified cases were confirmed by TT surgeons prior to surgery. Operated patients were reviewed at 1 day, 2 weeks and 3-6 months. The case finders will also be used to identify and refer new and recurrent cases. People with other eye and medical conditions were treated and referred accordingly. Standardised data collection and computer based data capture tools were used. Case finders kept registers with details of all persons with TT, those operated and those who refused to be operated (refusals). These details informed decision and actions on follow-up and counselling. Progress towards achievement of elimination threshold was assessed by dividing the number of TT cases diagnosed by total population in the population unit multiplied by 1,000. Results: Narok County Government adopted both the CMMF approach and TT all survey method. All persons in 4,784 households in the four sub-locations were enumerated and examined. The total population projection was 29,548 and pre-survey census 22,912 people. Fifty-three cases of TT were diagnosed. The prevalence of was 0.23% and this is equivalent to 2.3 cases per thousand population of all ages. Prior to this study, the project required to operate on at least 30 cases (excess cases) to achieve the elimination threshold of 1 case per 1000 population. Conclusions: the total backlog of TT was confirmed and the project is now justified to lay claim of having eliminated TT as a public health problem in the study area. Limitation: TTall method may not be appropriate in settings with high burden of TT. Nomadic migrations affect estimation of population size. Non-trachomatous TT could not be ruled-out.

Introduction. Influenza-like illness (ILI), Acute Respiratory Infections (ARI), and Severe Acute Respiratory Infections (SARI) are the most common infectious diseases globally, causing severe forms annually, especially in at-risk groups. The aim of this paper is to analyse the epidemiological and virological data on ILI, ARI, and SARI in the Republic of Moldova during the 2014/2015 to 2022/2023 epidemic seasons. Material and methods. The descriptive-retrospective epidemiological study analysed morbidity due to ILI, ARI, and SARI, as well as laboratory results for the presence of influenza viruses during the 2014/2015 to 2022/2023 epidemic seasons. Results. ILI has been of low to medium intensity except for two seasons, while ARI has been of very high intensity in one season. ILI, ARI, and SARI primarily affected children aged 0-14 years. During the nine seasons (except 2020/2021), influenza virus types A(H1N1) pdm09, A(H3N2), and B have been identified, with the percentage of positives decreasing considerably in the last two seasons. During the period under review, each influenza virus type dominated, and in three seasons, two to three virus types co-dominated. Genetic characterization of the identified strains demonstrated that influenza viruses fully fit the phylogenetic tree constructed for the nominated period, do not differ antigenically from strains identified in other regions of the northern hemisphere, and are susceptible to antivirals. Conclusions. The national surveillance system for ILI, ARI, and SARI makes it possible to monitor the evolution of the epidemic process in real-time and geographic space, facilitating prompt intervention with control and response measures.

Introduction. The transition from childhood to adulthood significantly impacts overall health and requires adequate nutrition to facilitate physical and cognitive development. Managing children’s weight and fostering an environment that promotes healthy eating habits are significantly influenced by parents’ knowledge, attitudes, and practices. Material and methods. In February – March 2023, a quantitative study was conducted, involving 472 parents of school-aged children. The questionnaire, developed according to the Knowledge, Attitudes, and Practices methodology, was completed both online, in electronic format, and on paper. Results. The results of the KAP study regarding the nutrition of school-aged children show that parents have a significant level of knowledge (76.9±19.07%) about their children’s nutrition. Regarding attitude, the score is moderate (59.99±10.7%), indicating that parents may not prioritize healthy eating habits for their children or may not be sufficiently motivated to act. However, there is a low level of practice: 45.43±16.6%. Statistical analysis indicates significant correlations between: gender and knowledge (τ=0.175, p

Workplace-based assessment has become increasingly crucial in the postgraduate training of specialists in South Africa, particularly for family physicians. The development of a Portfolio of Learning (PoL) has been a central focus within the discipline of family medicine for over a decade. Initially, a paper-based portfolio was adopted to collect evidence of learning for 50 out of 85 agreed exit-level outcomes. Stellenbosch University led the conversion of this portfolio into an electronic format, known as e-PoL, utilising Scorion software. The e-PoL was successfully implemented in the Western and Eastern Cape regions and was subsequently adopted nationally under the coordination of the South African Academy of Family Physicians. In 2023, the e-PoL underwent a redesign to gather evidence of learning for 22 entrustable professional activities (EPAs). Key insights from this development process underscore the importance of the PoL in supporting assessment-for-learning rather than merely assessment-of-learning. This necessitates features for feedback and interaction, ensuring that the PoL functions beyond a mere repository of forms. Additionally, the e-PoL should facilitate triangulation, aggregation, and saturation of data points to effectively measure EPAs. Furthermore, the PoL has not only documented learning but has also played a pivotal role in guiding the development of clinical training by explicitly outlining expectations for both registrars and supervisors. While the initial design and development costs are significant, operational costs become affordable when shared across all training programmes.

Workplace-based evaluation is one of the most important, but challenging aspects of medical education. The aim was to improve the assessment of the rural community-based clinical training for undergraduate 3rd and 4th year family medicine students at the University of Namibia (UNAM) and implement a paperless process. An online module was developed on the Moodle platform to include a study guide, an electronic portfolio, and electronic resources (e-books and apps) to replace the current paper version of the logbook. We explored local resources by engaging with students and clinical trainers on how to best conduct the initial implementation. Engagement also entailed motivating students to actively participate in the implementation process. All 3rd and 4th year community-based education end service (COBES) students are now submitting proof of clinical learning electronically with the use of their phones in their online portfolio and using online resources. In addition, students in the practical family medicine module that has been introduced in the 6th year since 2023 are now also using an electronic portfolio and these assessment tools. Contribution: Overall feedback from students and supervisors indicates a positive atmosphere of learning and constructive feedback on performance from all team members, hopefully improving work-based assessments and ultimately patient care. More members of the primary health care team were involved and the carbon footprint has also been decreased.

Introduction. Scalp tumours raise multiple problems regarding the radical excision of the neoplasm followed by reconstructive surgery. Prolonged sun exposure and administration of immunosuppressive medication are the main risk factors for the onset of this neoplasm. The paper presents the advantages and disadvantages of scalp reconstruction using rhomboid flaps, after surgical excision of the skin cancer. Case presentation. The paper presents the case of a 83-year-old patient admitted for the treatment of squamous cell carcinoma located on the scalp. The pathological history of the patient showed that there were multiple hospitalizations for the treatment of chronic heart failure and hypertension. The therapeutic protocol included excision of a squamous cell carcinoma located in the scalp, followed by immediate reconstruction with three rhomboid flaps advanced towards the midline. The local evolution of the patient was favorable, the flaps integrating without complications, obtaining in this context a very good result from an aesthetic point of view. Conclusions. The use of the reconstructive technique involving the transposition of three rhomboid flaps to cover the soft tissue defects located in the scalp region is a feasible solution that offers very good aesthetic results.

In sub-Saharan Africa, there is a significant unmet need for emergency care, with a shortage of trained providers. One model to increase the number of providers is to task-share: roles traditionally filled by clinicians are shared with lay workers who have received task-specific training. Separately, there has been much recent interest in the possible implications of artificial intelligence (AI) on healthcare. This paper proposes that, by combining the task-sharing model with AI, it is possible to design an Emergency Unit (EU) that shares the tasks currently undertaken by physicians and nurses with lay providers, with the activities of lay providers guided and supervised by AI. The proposed model would free emergency care clinicians to focus on higher-acuity and complex cases while AI-supervised routine care is provided by lay providers. The paper outlines the model for such an implementation and considers the potential benefits to patient care, as well as considering the risks, costs, effect on providers, and ethical questions. The paper concludes that, AI and healthcare workers can operate as a team, with significant potential to augment human resources for health in sub-Saharan Africa.

This paper discusses the results of a study that focuses on the human and financial costs of justice for those who are injured at or made ill by work. The results presented here are based on a qualitative field study which began in September 2018. Three elements that arose from the appeal process are discussed in light of the tangible and intangible costs of justice: the medicalization of the process and the delays and complexity of the judicial process. These elements are likely to influence the costs incurred by injured workers and pose specific challenges, particularly in terms of the quest for a medical expert and access to expert legal support. We end this paper with a discussion that highlights how the appeal process itself can be conceived as an additional layer of vulnerability that ultimately creates a form of precariousness.

The treatment paradigm for individuals living with human immunodeficiency virus (HIV) has evolved beyond solely focusing on viral load suppression to encompass a comprehensive approach that prioritizes health-related quality of life (HRQoL). Biktarvy (BIC/FTC/TAF) has emerged as a promising therapeutic option for achieving this treatment goal. During the 11th German-Austrian AIDS Congress (DÖAK), eight healthcare professionals from Germany, Austria, and Switzerland convened at a non-public, industry-sponsored meeting to discuss how treatment with BIC/FTC/TAF supports a holistic, long-term, and patient-centered treatment approach to optimize HRQoL for people living with HIV (PwH). The experts were invited to share their experience with BIC/FTC/TAF and examine relevant real-world data presented during the DÖAK congress. The industry-sponsored and expert-led meeting was initiated to provide valuable perceptions from the eight experts practicing in different clinical and practical settings. This paper highlights the key findings from the expert meeting discussion. The experts agreed that the BIC/FTC/TAF regimen is highly suitable for everyday use, showing efficacy and tolerability across various patient groups, including those with unclear prior therapies, hepatitis B virus status, low CD4 counts, opportunistic infections, and individuals engaged in chemsex. Moreover, adherence to the BIC/FTC/TAF regimen is crucial for successful therapy, requiring personalized patient care and a structured, regular questioning process. Various factors, such as substance abuse or changes in life circumstances, can affect adherence; hence, open discussions about the patient's life situations and needs are important. In conclusion, the BIC/FTC/TAF regimen supports the achievement of new therapeutic goals beyond virological suppression by effectively catering to different patient groups. It also fosters personalized patient care by leniency towards suboptimal adherence. The regimen's versatility and practicality make it an integral tool in achieving broader health objectives in HIV management. PEER REVIEWED ARTICLE Peer reviewers: Dr Rein Jan Piso, Kantonsspital Olten, Olten, Switzerland One anonymous peer reviewer Received: September 1, 2023; Accepted after peer review: January 15, 2024

Rhino-orbital-cerebral mucormycosis (ROCM) is a rare angioinvasive fungal infection known to be associated with high morbidity and mortality rates of over 50%. Its incidence has increased lately due to the increasing number of patients with predisposing immunocompromising conditions, as well as COVID-19. In addition to the common acute disease progression, chronic, less aggressive courses have rarely been described. In this paper, we report the case of a 39-year-old man with recurrent diabetic ketoacidosis who initially presented with acute sinonasal symptoms, was positive for SARS-COV-2 and was later diagnosed with acute ROCM. He had mutilating but not complete surgical removal of infected tissue and was given high-dose liposomal amphotericin B followed by long-term oral antifungal therapy. One year after being lost to follow-up because of repatriation to his home country he sent us a holiday picture of himself having recovered from the disease. Despite the incomplete and mutilating resection, coupled with long-term antifungal treatment, we conclude that survival is possible in cases of Rhino- orbito- cerebral Mucormycosis (ROCM). However, it is important to note that there is still a scientific gap in evidence regarding follow-up procedures and the optimal duration of therapy. PEER REVIEWED ARTICLE Peer reviewers: Three anonymous peer reviewers Received: December 6, 2023; Accepted after peer review: January 8, 2024

The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescence lends itself to the exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increase adolescents’ access to OMSRH care by leveraging on dental clinics as a template for integration. The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents´ access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel proposals are needed to enhance adolescents´ access to health care they are in dire need of. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.

The developing world is facing a serious problem of TB since ages. The condition is really profound in resource-constrained countries. The situation in some of the high TB burden countries is so grave that there are huge numbers of TB patients and deaths due to TB. TB control in most of the countries is done by the national TB control programs. In India, this is popularly known as the Revised National Tuberculosis Control Program (RNTCP). The RNTCP comes under the umbrella of the national health mission. The main components of RNTCP are Directly observed treatment, short-course (DOTS) and DOTS-Plus. The effective and adequate implementation of the RNTCP is the most effective solution to control the ever growing cases of TB. The present situation, as detailed in the WHO global annual TB report, with ever-rising cases of various categories of TB is really scary and demands prompt attention. In this paper, the authors highlight the important issues related to the RNTCP in India. The main motto of writing this paper was to address the challenges associated with the organizational structure of the national TB control program of India and to suggest solutions for the same. The authors believe that these challenges could pose a serious threat to the efforts aimed at TB elimination from India. Besides, this paper will serve as a tool to modify and/or to formulate new guidelines for the betterment of the program. Also, the challenges detailed here are usually common in the other high TB burden countries of the world and this will help the program managers worldwide.

In the context of addressing the pressing health needs for the global population, the World Health Organization has repeatedly called for universal health coverage (UHC) to be prioritised by its member countries. This is to be achieved through a high-quality primary health care (PHC) approach that provides comprehensive and integrated generalist care as close to where people live as well as links the clinical care to health promotion and disease prevention. In this paper, we argue for the introduction of family medicines as a critical player in the healthcare system of Tanzania to strengthen the strategies towards UHC. The paper reviews how PHC is understood, the context of family medicine in sub-Saharan Africa and makes a case for how family medicine can assist in addressing the current burden of disease in Tanzania.

Canadian nursing programs are required to provide Interprofessional Education (IPE) since formal inclusion in the undergraduate curricula in 2012. This multiple case study explored how four undergraduate university nursing programs in Northern Ontario integrated IPE into their curricula, including opportunities and challenges of meeting the new IPE requirements. Data collected and analyzed in the study were: interviews with program directors, focus groups and interviews with faculty members, program documentation and information on websites, and on-site program observations. This paper extends the findings of this study and the themes identified in it. These themes were as follows: 1) varied understandings of IPE, 2) diverse IPE learning activities within curricula, 3) the requirement for support and resources for IPE and research, 4) student participation and leadership in IPE, and 5) limited IPE evaluation (Author names removed for integrity of review process, 2019). In this paper, the themes are explored in further depth through extensive consideration of documentation provided by the involved universities. These resources complement the data derived through interviews and focus groups with faculty and directors. Exploration of these data is a valuable means of illuminating any congruencies and dissonances found in the director and faculty data.

Introduction. Intersectoral collaboration in public health represents a huge potential for optimizing the three fundamental public health actions: disease prevention, health protection, and healthcare awareness. The COVID-19 pandemic has significantly impacted the engagement of the parties particularly interested in disease prevention and control. Material and methods. A mixed qualitative and quantitative research (in-depth interviews/questionnaire survey) was carried out in this paper. Results. Most of the respondents assessed the intersectoral cooperation as unsatisfactory and consider that the latest reform of the Public Health Service had a negative impact on it. The pandemic alert caused by the COVID-19 infection served as a catalyst to improve cooperation. The main barriers to collaboration are considered the lack of staff and insufficient communication, various viewpoints and lack of public health knowledge, an overlying complex legal framework, and lack of motivation, which often requires central authority involvement. Conclusions. Some barriers to cooperation can be overcome without any systemic changes and centralized involvement, while more easily achievable measures such as joint training are sufficient. Thus, understanding these aspects can greatly improve the interaction between services.

In this paper, I try to demonstrate how critical empiricism and philosophical reasoning intertwine with each other and affected the development of medicine. It is a case study considering the problems of generation and semen in the writings of Aristotle and Galen via relationship between such concepts as matter, form, movement, change, causes and some others. The main question addressed in the paper is the reason of Galen’s return to Hippocratic paradigm of two-semina (male and female). I argue that the reason is two-fold: 1) Different philosophical reasoning and erroneous understanding of some aspects of Aristotle’s embryological model by Galen. 2) Empirical discoveries, which proved to be wrong. I demonstrate that Galen’s understanding of form/matter relationship, and his view on matter as an underling principle conditioned his understanding of the notion of physical change, that allowed him to speak about conception only as quantitative mixture between equal substrata. Finally, I show that Galen’s view on teleology and his limited understanding of formal/final vs efficient causes and their relationship forced him to claim the inadequacy of Aristotle’s biology and necessitated Galen to introduce emendations in definitions of seminal faculties of genders and reproductive fluids.

Background: Oral health-related quality of life (OHRQoL) is influenced by cultural and societal context. Existing OHRQoL children measurement tools have been conceptualised in high-income countries. Probing whether the factors influencing OHRQoL are context-reliant in the African setting is necessary and is the purpose of the current review. Aim: To investigate if the factors influencing OHRQoL are context-reliant. Methods: Seven databases were searched using search terms (‘oral health’; and ‘quality of life’, ‘health-related quality of life’, ‘patient-reported outcomes’, ‘well-being’; and ‘child*’, ‘adolescents’, ‘teen*’, ‘youth’; and ‘determinants’, ‘factors’, ‘predictors’; and ‘oral health quality of life tools/instruments/scales’; and ‘Africa*’). Abstracts identified were exported to a reference software manager. Three of the authors used specific selection criteria to review, firstly, 307 abstracts and, secondly, 30 full papers. Data were extracted from these papers using a pre-designed data extraction form, after which quantitative synthesis of data was performed. Results: Key factors influencing OHRQoL followed an existing conceptual framework where environmental and individual factors in the form of socio-economic status (SES), area of residence and children psyche status, and the presence of any oral condition other than dental caries were reported among child populations in Africa. Conclusion: There is preliminary evidence to suggest an association between individual factors such as children’s psyche and oral problems, excluding dental caries, and environmental determinants such as area of residence and SES in children’s OHRQoL in African children. The finding that dental caries was not a key factor in child-oral health is unexpected. There seemed to be a contextual viewpoint underpinning the current OHRQoL frameworks and OHRQoL was context-reliant.

INTRODUCTION: Research is essential in all areas of health development. However, medical students and residents frequently lack the time and training on performing research. This is especially prevalent in resource-limited settings. We aimed to compare the word counts of undergraduate and postgraduate dissertations with published projects in Rwanda, and to identify the proportion of postgraduate pediatric research projects that have been published since 2012. METHODS: retrospective, cross-sectional study of undergraduate and postgraduate research dissertations at the University of Rwanda. Dissertations were then compared to randomly selected published papers of Rwandan research. Each IMRaD (Introduction, Methodology, Results and Discussion) section word count was compared using Student's t-test. RESULTS: 19/190 (10%) undergraduate dissertations and 22/41 (54%) postgraduate dissertations, were available in electronic format for word-count analysis. The mean total word count for postgraduate dissertations (5163 words) was significantly longer (p=0.001) than the randomly selected peer-reviewed journal articles (2959 words). Each section of the IMRaD structure of postgraduate dissertations was significantly longer than those of the control group. Undergraduates used a similar number of words to published papers, but used significantly more tables and figures. Of the 41 postgraduate dissertations, only four (10%), were published in peer-reviewed journals. CONCLUSION: this is the first study to assess the writing style of Rwandan medical students and pediatric postgraduate residents. A simple step to increase dissemination of research findings would be for institutions to modify academic regulations so that students write-up in manuscript form rather than dissertation format.

Background: Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy. Aim: This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). Setting: The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu. Methods: A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin’s approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. Results: This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases. Conclusion: The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science.

INTRODUCTION: Historically, programs aimed at making communities abolish female genital mutilation or cutting (FGM/C) consisted mainly of awareness campaigns on sexual reproductive health and rights and the enforcement of newly implemented laws. These types of programs or interventions have proven to be only partially effective and sometimes yield unintended results, such as actually strenghtening commitment to FGM/C or transforming it into a secret practice. A newer approach to change that is intended to account for the cultural meanings ascribed to FGM/C are alternative rites of passage (ARP). Amref Health Africa started adopting this approach in 2007. Since then, by a trial-and-error process lessons have been learned, that will be reflected upon in this paper. METHODS: Desk research was conducted on organizational data regarding all Amref Health Africa's efforts to end FGM/C. Ninety-four in-depth formal interviews were held with members from Maasai and Samburu communities in Kenya targeted through maximum variation sampling. And participant observation of significative events as well as daily pastimes took place during school holiday season at the end of 2016. Furthermore extensive informal talks were held with project donors, activists, journalists, members of other non-governmental organizations, members of community services organizations, local government officials, high-ranking Dutch and US diplomats and senior members of the Anti-Female Genital Mutilation Board, which is part of the Kenyan Ministry of Public Service, Youth and Gender Affairs. On the basis of these data a framework on different positions on FGM/C was developed and published in early 2018. By reviewing the data again from a particular change management and public health perspective, by peer-debriefing within a multi-disciplinary research team and by explicating the lessons learned this paper adds to an overview that is of crucial importance to practitioners working to end FGM/C. RESULTS: Risk of exclusion, perceived loss of cultural identity, changing meanings ascribed to cultural practices, lack of precise knowledge about subjective (sexual) experience and negative stereotyping are reasons not to adhere to anti-FGM/C programs. Areas of concern are the role confusion with following-up on policing, perceived outsider interference and the intended prolonging of the transition phase not being explicated and embedded with ARP. Aspects to enhance to lever change more effectively are education and school curriculum development, male involvement, new stylization of love relationships, monitoring and evaluation and inclusive aspects of religion.

INTRODUCTION: As a response to challenges associated with adolescent reproductive and sexual health, policy makers in Rwanda have instituted preventive measures against risky sexual behaviours among adolescents. There is an ongoing debate on whether condoms should be made available in secondary schools to minimise risks related to unprotected sex in the context of a growing number of unplanned pregnancies among school girls. This paper aims to examine the proposal of condom provision in Rwandan secondary schools through the analysis of policy narratives and the claims-making process. METHODS: a narrative policy analysis was used to understand the claims and counter claims surrounding the debate on the provision of condoms in secondary schools. Documents that were consulted include: the national reproductive health policy, the girls' education policy, the national behaviour change and communication policy for the health sector, the Rwanda national policy on condoms, the adolescent sexual reproductive health and rights policy and the Rwanda family planning policy. RESULTS: social and cultural norms in the Rwandan context consider adolescent sexual practices as immoral and thus reject the idea of providing condoms in secondary schools. However, some stakeholders promoting reproductive health suggest that ignoring that some adolescents are sexually active will prevent them from accessing appropriate reproductive and sexual health protective programmes. Consequently, adolescents will be exposed to risky sexual behaviours, a situation which may be counter productive to the overarching goal of safeguarding adolescent sexual health which might impact their long-term education goals. CONCLUSION: making condoms available in secondary schools evokes different meanings among the debaters, underscoring the complex nature of the condom provision debate in Rwanda. This paper calls for a revision of policies related to adolescent reproductive and sexual health in order to answer to the issues of risky sexual behaviours among secondary school students.

# Purpose Flammer syndrome (FS), a clinical entity characterized by primary vascular dysregulation of blood flow together with various signs and symptoms, has been reported in both healthy individuals and those with certain diseases. Adequate management of FS requires personalized treatment and preventive measures. In the field of aesthetic medicine, proper regulation of blood flow is crucial for optimal wound healing. This study aims to investigate the prevalence of FS signs and symptoms among individuals seeking aesthetic intervention. # Methods A total of 207 patients seeking aesthetic intervention at the Beauty2Go clinic in Lucerne answered a standardized questionnaire consisting of 15 signs and symptoms of FS. # Results Overall, 189 (91.3%) patients were female and 18 (8.7%) were male. The mean age was 36.0 years (standard deviation \[SD\] 12.1) and the median age was 35.0 years (interquartile range \[IQR\]: 14.0−67.0). Several signs and symptoms of FS were present among patients undergoing aesthetic surgery. Compared to a control group patients showed a higher tendency towards cold hands (25.1% \[95% confidence interval \[CI\]: 19.5--31.7\]), feeling cold (21.7% \[95% CI: 16.4--28.1\]) and low blood pressure (27.3% \[95% CI: 21.0--34.7\]). Other signs and symptoms included Increased response to certain drugs (8.4% \[95% CI: 4.8--14.3\]) a low Body Mass Index (BMI) (58.0% \[95% CI: 50.9--64.7\]), Reversible skin blotches (7.2% \[95% CI: 4.3--11.9\]) and a tendency towards perfectionism (53.6% \[95% CI: 46.6--60.5\]). Accompanying symptoms of migraines were lower in the patient group (5.0% \[95% CI: 2.2--10.4\]) than in the control group. # Conclusions The prevalence of FS is notable among individuals seeking aesthetic interventions. Acknowledging this fact not only enables the treatment of FS in patients but also empowers the field of aesthetic medicine to devise proactive strategies for enhancing blood flow regulation through personalized treatment in this population. This research paper emphasizes the significance of identifying FS in the context of aesthetic procedures and highlights the potential benefits of personalized preventive treatments.

This paper presents some results concerning the Project Cultural and educational values in specialized metaphor: multiple images of the world economic crisis in print media, which is being developed under Capes-DGPU Program, a cooperation program established between Brazil and Spain in order to support exchange and research among researchers and post-graduate students from Brazilian and Spanish universities. Based on the corpus of journalistic texts constituted within this project, we emphasize, in this paper, the relations between Economics and Medicine. These relations, established through metaphors and other figures, show how these two sciences establish intersections, which are reflected in the terminology of the world economic crisis.

This paper aims to explain the main issues emerging from the research of Sergio Piro, not only a psychiatrist (or psychiatrist and much more) concerning the subject, otherwise defined in common sense terms and extensively intended as person, self, individual and so on. So, this paper presents the topic of the historical constitution of the singularity, its development, its relations to world and the topic of destinies too, questions concerning the structure of the unconscious and its relationship with Time.

The therapeutic role of theatre and drama has remained useful to health experts as a preventive measure and for patients as a fast recovery antidote. This paper examines the medical dimension of the play Cauldron of Death by Tracie Chima Utoh. The play denotatively invokes the dangers of HIV/AIDS and serves preventive and life-sustaining purposes for HIV/AIDS patients. Utilizing the artistic and content analysis approaches, the paper re-examines this one-act play as a preventive and healing template for HIV/AIDS disease both for those who read the play as text and for those who view it in performance. As an HIV/AIDS conscientization play, Cauldron of Death is not only a tool for the usual conventional theatre pedagogy but also an invaluable resource material/drug for pharmacists, doctors, patients and disease prevention NGOs.

This paper presents potential avenues for developing forms of interdisciplinarity able to identify the remaining blind spots between health and work. Based on examples discussed during an interdisciplinary seminar (2014-2015) and an international symposium (2016), the paper analyzes the consequences of the dependence of expertise on historically constructed knowledge and disciplines (in particular epidemiology). It also analyzes the impact of the lack of scientific research in certain themes on the capacity to develop a counter-expertise. It finally looks at how to make scientific knowledge more accessible and useful to people whose health is directly at stake. Far from definitively answering these questions, this article simply reports on how the problems were outlined and discussed by various categories of actors having participated in these meetings.

In institutions in the social and health sectors, divisions within teams are an almost inherent part of their makeup. The interdependent nature of the teams and their work focusing on caregiving relationships produce a defensive group mode with complex ramifications and detrimental effects. Such divisions fall into a scenario of exclusion and a logic of rivalry among colleagues. The human suffering generated by this phenomenon and the negative consequences for the people receiving aid remain understudied. In this regard, the present paper offers a clinical outlook based on team meetings and sessions where practices were analysed. These different work contexts among educational, paramedical, and management teams made it possible to interpret institutional divisions as boundaries and to develop a typology of stable/organised divisions versus unstable/disorganised divisions. The paper explores these different aspects, looking at the suffering and probable evolution of these kinds of organisations. Finally, the paper suggests possible avenues for breaking down these divisions, in the form of recommendations and institutional mechanisms.

Toxoplasmosis is a disease caused by a protozoal parasite: Toxoplasma gondii. This infection can cause severe illness when the organism is contracted congenitally or when it is reactivated in immunosuppressed people. In this paper we review for the first time the prevalence and risk factors of T. gondii among pregnant women and HIV-infected adults in Morocco. A systematic review methodology was used to consult three databases: Pub Med, Science Direct and Google Scholar dated until 2015, regarding prevalence data and risk factors of infection among pregnant women and people living with HIV. Data collection and eligibility criteria were established in this paper. No statistical method was employed in this study. Our review resulted in a total of 6 publications meeting the inclusion criteria of prevalence and risk factors of toxoplasmosis in Morocco. Seropositive rates of T. gondii infection reach up to 51% in pregnant women. Risk factors that were reported included contact with soil, lack of knowledge about toxoplasmosis, and a low educational level . For HIV-infected adults, the limited data show a 62.1% prevalence rate of T. gondii .According to our review, there is still very little information on toxoplasmosis disease in pregnant women and HIV infected patients in Morocco. Further research on toxoplasmosis is needed to better ascertain the human disease burden in Morocco.

An earlier paper in this journal reported on the perception and experience of 77 allopathic health practitioners (AHPs) and health managers about working together with South African traditional health practitioners (THPs). The paper stated that the abolishment of the Witchcraft Suppression Act of 1957 and the introduction of the Traditional Health Practitioners Act No. 22 of 2007 is a milestone in the development of traditional health knowledge, and for the eventual incorporation thereof into modern health care practices. The authors also comment that a decolonisation of mindset and a change of attitude is required to change one’s perception of traditional healer practices and to develop them parallel to allopathic health practice. This opinion paper is a response to the paper, to negate its claims about the Witchcraft Suppression Act of 1957 and to provide clarity on the Traditional Health Practitioners Act No. 22 of 2007 and related policies and regulations. Although this Act recognises THP, the Act and other regulations actually require THP to conform to practices analogous to those of AHP. It is rather a systematic and scientific ‘mindset’ that is required to develop THP parallel to AHP. The Traditional Health Practitioners Act of 2007 and the Draft Policy on African Traditional Medicine (TM) for South Africa dictate that a substantial THP sectoral transformation is required before there can be a parallel system. Legislation and regulations have excluded THP and African TM from operating (present and future) in the same space as AHP.

Introduction. Sugar consumed in reasonable quantities plays a beneficial role for the human body. In recent decades, however, it has been found that increased sugar consumption has negative effects on the health of the population. Material and methods. The paper presents a synthesis of official international and national documents and bibliographic sources on the occurrence of certain non-communicable diseases (NCDs) as a result of excessive sugar consumption. A focused search of literature sources was conducted using the Google Scholar search engine, PubMed, Research for Life, and Medline databases. The criteria for selecting the items included health problems caused by excessive sugar consumption. Results. Excessive sugar consumption contributes to the emergence of various NBTs such as circulatory system diseases, type 2 diabetes and a. Excessive sugar consumption has a major contribution to the phenomenon of overweight and obesity with its consequences. Excess sugar in the daily diet is one of the main causes of tooth decay. According to WHO recommendations, complex, multi-sectoral interventions are needed to reduce sugar consumption. Conclusions. In order to prevent NCDs associated with the nutritional factor, especially with excessive sugar consumption, in the Republic of Moldova, it is important to implement cost-effective interventions both socially and economically.

Introduction. The risk factors for multiple sclerosis (MS) and cancer overlap to a large extent. The objective of our study was to estimate the prevalence and risk ratios (RR) of cancers in patients with MS and to identify which types of cancer have the lowest frequency. Materials and methods. We carried out research of the literature in the PubMed, Medline, and Google Academic databases, with the aim of identifying large-scale studies addressing the link between different cancers and MS. From 411 relevant articles, we selected 13 scientific papers for further analysis, comprising 109,276 patients diagnosed with MS from different countries. Results. Of all MS patients, 5.1% were diagnosed with a certain type of cancer compared to 5.5% in the general population; the cancers with the lowest incidence were respiratory, digestive, and blood cancers. Conclusions. The results of our analysis suggested that MS patients are less exposed to respiratory, digestive, and blood cancers, but more research is needed to understand if some disease-modifying therapies play a role in this regard.

Introduction. Antimicrobial resistance (AMR) is a major problem with a negative impact on animal health and public health worldwide. Actions to reduce this phenomen are of major importance and require collective management in the context of "one health". Material and methods. The research material constituted the legislative acts that regulate the activity of the veterinary sanitary service within the National Agency for Food Safety, statistical data regarding the use of antimicrobial in the animal population from the republic. Results. The analysis of the data presented in the paper is focused on the legal acts of activity of the veterinary service in order to reduce the effect of RAM at the national level with the involvement of the authorities in the field of human and animal health, as well as environmental protection. Conclusions. The reduction of AMR at the national level can be achieved by creating an institutional framework responsible for intersectoral coordination and collaboration as well as the effective implementation of control of the release of animal medicaments only on the basis of veterinary prescriptions.

Background: Community health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes are integrated into respective health systems in sub-Saharan Africa (SSA) are missing. Aim: This review presents evidence on CHW programmes’ integration into National Health Systems for improved health outcomes in SSA. Setting: Sub-Saharan Africa. Method: Six CHW programmes representing three sub-Saharan regions (West, East, and Southern Africa) were purposively selected based on their deemed integration into respective National Health Systems. A database search of literature limited to the identified programmes was then conducted. Screening and literature selection was guided a scoping review framework. Abstracted data were synthesised and presented in a narrative form. Results: A total of 42 publications met the inclusion criteria. Reviewed papers had an even focus on all six CHW programmes integration components. Although some similarities were observed, evidence of integration on most CHW programme integration components varied across countries. The linkage of CHW programmes to respective health systems runs across all reviewed countries. Some CHW programme components such as CHW recruitment, education and certification, service delivery, supervision, information management, and equipment and supplies are integrated into the health systems differently across the region. Conclusion: Different approaches to the integration of all the components depict complexity in the field of CHW programme integration in the region. Contribution: The study presents synthesized evidence on CHW programmes integration into national health systems in SSA.

Background: In resource limited-settings, timely tuberculosis (TB) diagnosis depends upon referral of sputum samples from non-diagnostic to diagnostic facilities for examination. The TB programme data for 2018 suggested losses in Mpongwe District’s sputum referral cascade. Aim: This study aimed to identify the referral cascade stage where loss of sputum specimen occurred. Setting: Primary health care facilities in Mpongwe District, Copperbelt Province, Zambia. Methods: Data were retrospectively collected from one central laboratory and six referring health facilities between January and June 2019, using a paper-based tracking sheet. Descriptive statistics were generated in SPSS version 22. Results: Of the 328 presumptive pulmonary TB patients found in presumptive TB registers at referring facilities, 311 (94.8%) submitted sputum samples and were referred to the diagnostic facilities. Of these, 290 (93.2%) were received at the laboratory, and 275 (94.8%) were examined. The remaining 15 (5.2%) were rejected for reasons such as ‘insufficient sample’. Results for all examined samples were sent back and received at referring facilities. Referral cascade completion rate was 88.4%. Median turnaround time was six days (IQR = 1.8). Conclusion: Losses in the sputum referral cascade for Mpongwe District mainly occurred between dispatch of sputum samples and receipt at diagnostic facility. Mpongwe District Health Office needs to establish a system to monitor and evaluate the movement of sputum samples along the referral cascade to minimize losses and ensure timely TB diagnosis. Contribution: This study has highlighted, at primary health care level for resource limited settings, the stage in the sputum sample referral cascade where losses mainly occur.

Serious accidents, which occurred in road tunnels in the 2000’s, have revealed specific risks related to tunnels, along with safety management issues. The lessons learned analyses are one resource used by tunnel operators, supported by the French Tunnel Research Centre (CETU), to improve safety management. The question raised in this paper is how these processes are linked to the actual collective safety management. Based on careful analysis of shift handover of tunnel control station operators, we aim to show what makes them a means for sharing feedback, managing safety and building a collective structure. We will thus highlight the strength of communication dynamics to design innovative safety management tools within a high-risk industrial environment. Serious accidents that occurred in road tunnels in the 2000’s revealed specific risks related to tunnels as well as safety management issues. The question raised in this paper is how are shift handovers linked to the collective safety management. Based on a careful analysis of the shift handovers of a tunnel’s control station operators, we aim to show how they can be used to share feedback, manage safety, and build a collective structure.

Introduction. According to the European Association of Urology guidelines, flexible ureterorenoscopy is one of the treatment modalities for kidney stones less than 2 cm. Disposable flexible ureterorenoscopes are superior to reusable ones in terms of scope performance deterioration, damage repair costs and special gas-sterilization equipment. Despite the undeniable progress of disposable flexible ureterorenoscopes in everyday urological practice, the literature lacks a rich database on their technological design and clinical effectiveness. The objective of this paper is to present our experience in the management of kidney stones by a flexible disposable ureteroscope – WiScopeTM. Material and methods. Between the 1st of January 2020 –the 1st of January 2021, 76 patients with kidney stones were treated in our centre by flexible ureteroscopy and laser lithotripsy. The evaluation of demographics, efficacy and safety of the procedure was performed. Results. A successful procedure was recorded in 94.7% (72/76) of the patients. We evaluated the total stone-free rate 8 weeks after the intervention, which was 94.4% (70/72). The complications rate was 13.1% (10/76). No serious adverse events were observed. Conclusions. The use of flexible disposable ureteroscopes has proven a good efficacy and safety. WiScopeТМ is a comparable option among all available flexible disposable ureteroscopes, in terms of all basic characteristics.

Background: The family planning service requires a routine health information system (RHIS) that can produce quality data that will be used for making decisions. However, the quality of data generated is not always of a good standard. Its usefulness in making data-driven decisions in family planning service is questionable. Aim: The study intended to assess the quality of family planning data and determine healthcare providers’ (HCPs’) views on factors influencing data quality in Tshwane district. Setting: The study was carried out in 13 healthcare institutions in Tshwane district, Gauteng province, South Africa. Methods: This paper reports on the quantitative strand of a mixed methods study. A sample of 111 HCPs was selected through a stratified random sampling technique, and six months of monthly reports from 13 institutions were reviewed for data quality. A self-administered questionnaire and a tick sheet were utilised to collect data from the HCPs and to review monthly reports for data quality, respectively. The Statistical Package for the Social Sciences (SPSS) programme for Windows version 24.0.0 was used to analyse the data. Results: Data quality, mainly accuracy and timeliness, was a challenge. Many HCPs were not trained in the RHIS. They viewed several issues relating to organisational, behavioural and technical factors as barriers to data quality. Conclusion: The low quality of family planning data has a negative impact on policy development and decision-making. Contribution: There is a need for capacity building through training and supportive supervision, provision of adequate human and technical resources to enhance data quality and use of information for decision-making.

The ongoing pandemic of COVID-19 is causing more health, economic and social issues worldwide. As of July 5, 2021, the world registered more than 184 million cases across 222 countries; more than 4 million have died from the deadly infection. The SARS-CoV-2 continues spreading globally; new variants emerge randomly due to errors in the virus' gRNAs replication process. The present paper treats the new delta variant of concern, also known as B.1.617.2 lineage. The study highlights transmissibility, vaccine effectiveness, pathogenicity, and the likelihood of hospital admission related to delta variant infection based on a literature review of 10 indexed databases. The findings indicate high transmissibility of the B.1.617.2 lineage, approving it to be the dominant strain worldwide. Also, reduced vaccine effectiveness is confirmed. However, approved vaccines for emergency use remain valuable against COVID-19's delta variant. Finally, the risk of hospitalization seems to be twice in the case of delta variant infection. A combined approach of vaccination and nonpharmaceutical interventions is the leading way to contain the ongoing pandemic of COVID-19.

Background: The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane’s Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response. Aim: To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal. Setting: Three community-based COSUP sites in Mamelodi (Tshwane, South Africa). Methods: A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data. Results: Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants’ median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol. Conclusion: Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists. Contribution: This research contributes to the limited data around short-acting tramadol for opioid withdrawal management in the African context, with specific focus on the need for increased access to opioid agonists for those who need them, in primary care settings.

Background: Although there is evidence of the key role played by focusing on local knowledge in designing appropriate interventions regarding modifiable risk behaviours among patients living with diabetes and hypertension in Mangochi (and Malawi), little is known about local salient beliefs. Aim: With a focus on the theory of planned behaviour as a theoretical lens, this study aimed to identify salient beliefs about modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, south-eastern Malawi. Specifically, the objectives were to identify advantages and disadvantages (behavioural salient beliefs), people who approve or disapprove (normative salient beliefs) and enablers and barriers (control salient beliefs) for measures to change modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, Malawi. Setting: A hypertension diabetes clinic at Mangochi District Hospital, south-eastern Malawi. Methods: A formative qualitative study of a quasi-experimental trial was conducted among 25 patients, purposefully sampled, who were living with diabetes, hypertension or both at Mangochi District Hospital in February 2019. Researchers conducted in-depth interviews with patients using an interview guide informed by the theory of planned behaviour’s elicitation interview guide. Thematic content analysis was used to identify emerging themes. Results: A total of 25 participants were recruited, of which 12 (48%) were living with diabetes. Five thematic areas emerged from this analysis: physical and psychological fitness, social disconnection, perceived support systems, perceived enablers and perceived barriers to change. Conclusion: Appropriate words for each salient belief were identified. Future researchers should use the identified salient beliefs when designing interventions based on the theory of planned behaviour in diabetes and hypertension. Contribution: The paper adds to the body of knowledge informing the use of theory of planned behavior in addressing modifiable risk factors among practitioners, specialists and academics in primary care and Family Medicine in the field of noncommunicable diseases in Mangochi Malawi and beyond.

Introduction. Wiskott-Aldrich syndrome is a rare X-linked disorder characterized by microthrombocytopenia, eczema, and recurrent infections. It is caused by mutations of the WAS gene which encodes the WAS protein (WASp) – a key regulator of actin polymerization in hematopoietic cells. Mutations within the WASp gene result in a wide heterogeneity of clinical disease, ranging from ‘classical WAS’ to mild asymptomatic thrombocytopenia (X-linked thrombocytopenia [XLT]), or congenital neutropenia (X-lined neutropenia [XLN]). Case presentation. This present paper reports a phenotypical and laboratory description of two children diagnosed with WAS and one child diagnosed with XLT. The first case was a six months old male with septicemia, thrombocytopenia, eczema and petechial rash. The second case was a 2 years old boy presenting with complaints of recurrent infections, eczema and thrombocytopenia with small platelet size. The third case was a 16 years old boy who presented with thrombocytopenia and recurrent sinopulmonary infections. Conclusions. Due to a wide spectrum of clinical findings, the diagnosis of WAS/XLT should be considered in any male patient presenting with petechiae, bruises, and congenital or early-onset thrombocytopenia associated with small platelet size.

Abstract Oscar Nerval de Gouvêa was a scientist and teacher in Rio de Janeiro, Brazil, whose work spanned engineering, medicine, the social sciences, and law. This paper presents and discusses a manuscript entitled “Table of mineral classification,” which he appended to his dissertation Da receptividade mórbida , presented to the Faculty of Medicine in 1889. The foundations and features of the table provide a focus for understanding nineteenth-century mineralogy and its connections in Brazil at that time through this scientist. This text was Gouvêa’s contribution to the various mineral classification systems which have emerged from different parts of the world.

Nothing personal? Tension and mediation of Personalization in Medicine Personalized medicine aims to develop tailored treatments for individual patients, linking biological knowledge with personal responsibility towards health. The aim of this paper is to analyze the tension and the mediation between these polar opposites. Taking into account the mediation theory by philosophy of technology, we are going to prove the paradox of personalized medicine, turning into a statistical knowledge and a de-personalized practice. It appears to be a new social strategy to foster personal initiative, in order to have a healthy conduct, supported by analysis of objective data, on a personal and general basis.

Palaeopathology is a scientific tool which provides an integrated vision of diseases and lifestyle habits of ancient populations. This review paper aims to present an overview of the most common diseases of the Stone Age, their correlation with human habits and lifestyle, as well as their impact to health status of the prehistoric populations. Although the paleopathology of the Stone Age period is not well studied, we provide some indicative results of research works from Greek Neolithic archaeological sites. More paleopathological investigations are needed to have a satisfactory approach of the health status of prehistoric populations.

Global burden of diseases studies collected and analysed data from more than 195 countries, reflecting premature death and disability related to more than 350 diseases and injuries, by age and sex, since 1990 to the present. The national profile of each country in the studies contains comparative data for 2007 and 2019. The purpose of this paper was to analyse the differences in leading risk factors and causes of global burden of diseases between Balkan countries. The leading causes of years of life lost due to disability are mainly chronic non-communicable diseases, with the leading positions being low back pain, falls, headaches, diabetes, etc. The summary indicator for lost years of life due to premature death and disability-adjusted life years (DALYs) for 2017 again shows the leading role of ischemic heart disease and stroke. Preventable mortality in Bulgaria remains very high. Much of the overall burden of disease in Bulgaria can be attributed to behavioural risk factors, including smoking, alcohol consumption, dietary risks and low physical activity.

Though it had been one of the most studied pharmacological substances in the years 1950-1970, LSD, a potent psychedelic with numerous therapeutic indications, came to be neglected by the international scientific community in the early 1970s. Whereas factors that are external to medicine have had an impact on the decline of this drug, it is also necessary to ponder on the internal causes of such rejection. To do so, some Anglo-Saxon literature has been emerging in recent years in the field of psychedelic studies to be here enriched through a study highlighting the specificities of French sources on the subject. This paper is meant to show how the method of so-called “psychedelic” psychotherapy designed by some of the researchers using LSD, together with the questioning of their probity, as these therapists were deemed to be “overenthusiastic”, have both then been key factors in bringing this drug into disrepute.

Reports of women giving birth to a baby together with an animal (toad, mouse, bird, etc.), are documented in Europe from the 1100s onwards: the most important traditions of which are the frater Salernitanorum and the sooterkin. Throughout the centuries, authors have typically attempted to explain monstrous animal siblings in the light of contemporary medical knowledge. The present paper compares the medieval frater Salernitanorum with the later sooterkin and investigates both in historico-folklore terms. It argues that it is important to understand monstrous birth traditions not only in the light of medical history, but as beliefs and narratives actively shared through acts of communication. In so doing, this article is informed by both the history of medicine and folklore studies.