BACKGROUND: It is uncertain what could be the best training methods for infection prevention and control when an infectious disease threat is active or imminent in especially vulnerable or resource-scarce settings.
METHODS: A scoping review was undertaken to find and summarise relevant information about training modalities, replicability and effectiveness of IPC training programmes for clinical staff as reported in multiple study designs. Eligible settings were conflict-affected or in countries classified as low-income or lower-middle income (World Bank 2022 classifications). Search terms for LILACS and Scopus were developed with input of an expert working group. Initially found articles were dual-screened independently, data were extracted especially about infection threat, training outcomes, needs assessment and teaching modalities. Backwards and forwards citation searches were done to find additional studies. Narrative summary describes outcomes and aspects of the training programmes. A customised quality assessment tool was developed to describe whether each study could be informative for developing specific future training programmes in relevant vulnerable settings, based on six questions about replicability and eight questions about other biases.
RESULTS: Included studies numbered 29, almost all (n = 27) were pre-post design, two were trials. Information within the included studies to enable replicability was low (average score 3.7/6). Nearly all studies reported significant improvement in outcomes suggesting that the predominant study design (pre-post) is inadequate to assess improvement with low bias, that any and all such training is beneficial, or that publication bias prevented reporting of less successful interventions and thus a informative overview.
CONCLUSIONS: It seems likely that many possible training formats and methods can lead to improved worker knowledge, skills and / or practice in infection prevention and control. Definitive evidence in favour of any specific training format or method is hard to demonstrate due to incomplete descriptions, lack of documentation about unsuccessful training, and few least-biased study designs (experimental trials). Our results suggest that there is a significant opportunity to design experiments that could give insights in favour of or against specific training methods. \"Sleeping\" protocols for randomised controlled trials could be developed and then applied quickly when relevant future events arise, with evaluation for outcomes such as knowledge, practices, skills, confidence, and awareness.

Stroke is an extensive health problem in Ukraine, the prominence and effects of which are aggravated by the burden of the ongoing Russo-Ukrainian War. In this study, we aimed to holistically examine the overall stroke epidemiology in Ivano-Frankivsk using data from a secondary healthcare center in the city. We determine an increasing trend in stroke admissions since 2020, with a notable 22.4% increase in 2023, mainly due to ischemic stroke occurrence. In the same year, a significant non-linear relationship between stroke incidence and frequency of news about attacks was observed. Ordinal regression analysis of general sociodemographic, clinical, and healthcare-related factors influencing outcomes for intravenous thrombolysis-treated patients, revealed the significance of the 24-h National Institutes of Health Stroke Scale score (0.32 ± 0.03) and interaction of age and Door-to-Needle Time (- 0.28 ± 0.08). However, the extension of the latter independently is not significantly correlated with patient outcomes. In conclusion, war-induced stress, intranational migrations, and lack of adequate chronic cardiovascular disease management are primarily responsible for these results. Modulations and improvements to the current healthcare system, including managing chronic diseases and early stroke symptom recognition, are necessary to optimize patient outcomes.

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Early exposure to food scarcity in Ukraine increases diabetes risk in later life.

The current war in Ukraine has drawn public attention to the treatment of war injuries. Follow-up treatment in Germany is portrayed the clover leaf of the TraumaNetzwerke DGU, is largely based on the demands of the Federal Ministries for Defence and Health and is intended to enhance resilience in war.The present article presents the special features of the care of severely injured patients during hostilities and should provide insights into the expected results of treatment and the actual procedures. We emphasise the unpredictability of the care of the severely injured during hostilities.On the basis of a search of the literature for the deployment of the German Army in Afghanistan and for the current war in Ukraine, we present the challenges and the typical patterns of injuries. We discuss the factors that can influence the procedures and the quality of the results during hostilities and how these may differ from civil polytrauma care in Germany - which is well established and standardised.Even during deployment of the Federal Army or (as planned) NATO, care of the severely injured is under standardised conditions, as based on the algorithmic ATLS care and which is concentrated on bleeding control. The corresponding equipment and personnel are well established, well prepared and well trained.However, there may be special local conditions or special deployments that make it inevitable that emergency medical care will be more delayed than in the civil system in Germany and can only take place after protracted transport. The objective is always that soldiers in combat should be able to receive medical care that is equivalent to that received by all accident victims in Germany, whatever the time and site of the accident.
Durch den aktuellen Krieg in der Ukraine steht die Behandlung von Kriegsverletzungen in der öffentlichen Diskussion. Die hierzulande stattfindende Weiterversorgung von Verletzten aus der Ukraine nach Verteilung im Kleeblatt in die TraumaNetzwerke DGU steht nicht zuletzt durch die Forderung des Bundesverteidigungsministeriums und des Bundesgesundheitsministeriums, die Bundeswehr und das deutsche Gesundheitssystem gegenüber potenziellen Belastungen aus kriegerischen Auseinandersetzungen resilienter (kriegstüchtig) zu machen, im Fokus.Um ein Verständnis für die erwartbaren Behandlungsergebnisse, die Vorgehensweisen im Einsatz, aber auch die Unwägbarkeiten der Schwerstverletztenversorgung unter Einsatzbedingungen zu etablieren, ist es das Ziel des vorliegenden Artikels, die Besonderheiten der Schwerstverletztenversorgung in kriegerischen Auseinandersetzungen darzustellen.Durch eine Literaturrecherche werden die Herausforderungen und typischen Verletzungsmuster am Beispiel des Einsatzes der Bundeswehr in Afghanistan und des aktuellen Krieges in der Ukraine dargestellt. Es wird ein Überblick über die Faktoren gegeben, die abweichend von der gut etablierten und standardisierten, zivilen Polytraumaversorgung in Deutschland die Vorgehensweisen und die Ergebnisqualität unter Einsatzbedingungen beeinflussen können.Die Schwerstverletztenversorgung erfolgt auch im Einsatz der Bundeswehr oder wie aktuell konzipiert für den Einsatz der NATO unter standardisierten Bedingungen, die sich an der algorithmenbasierten Versorgung des ATLS mit Fokus auf Blutungskontrolle orientiert. Dies ist materiell und personell gut etabliert, vorbereitet und geschult.Einzelne Ländergegebenheiten bzw. Einsatzerfordernisse können aber dazu führen, dass die erste ärztliche notfallmedizinische Versorgung abweichend vom zivilen System in Deutschland erst zeitverzögert und nach längerem Transport erfolgen kann. Ziel ist es hierbei immer, für die eingesetzten Soldaten eine im Ergebnis gleichwertige Versorgung abzubilden, wie sie hier in Deutschland jedem Unfallopfer, unabhängig von Zeit und Ort des Unfalles, potenziell zur Verfügung steht.

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The Russo-Ukrainian war caused significant humanitarian and healthcare issues in the Russo-Ukrainian region, which were further aggravated by the escalation of the conflict on February 2022. Because of this ongoing confrontation between the two nations, which has its roots in geopolitical conflicts and historical events, there have been nearly 4 million refugees in only the first month, and 906 healthcare institutions have sustained significant damage. Consequently, the demand for medical services has increased, adding onto the burden of the pre-existing problems within the region\'s healthcare system, such as inequities, budget shortages, and corruption. With nearly 500,000 military deaths and an estimated 27,1499 civilian casualties, the war\'s immediate health effects are devastating. Due to inadequate disease surveillance and difficulties with immunization, the risk of infectious illnesses, particularly HIV/AIDS and tuberculosis, increased. Although there were originally few mental health problems, the long-term effects are yet unknown. Some of the indirect effects are the severe refugee situation, the burden on public infrastructure, and problems with the security of food and water. Unprecedented obstacles confronted neurosurgery in the Russo-Ukrainian region, including increased patient loads from war-related cases, resource limitations, and facility devastation. Many countries stepped up to aid in managing neurosurgeries however, the some of the problems still persisted, such as insufficient sterility and power outages. Strengthened security standards, financial incentives, telemedicine services, and cooperation with international medical organizations are the main points of recovery recommendations. Rebuilding the region\'s healthcare system and guaranteeing ongoing foreign support after the conflict require a comprehensive strategy that addresses both short- and long-term issues.