The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0–4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.

The article presents the results of a dynamic study (spring, summer, and fall) of the residues of certain xenobiotics such as organochlorine pesticides (OCPs), synthetic surfactants (SSs) in surface water, soil, sludge, snow and phytotoxic activity in Ararat and Lori marzes of Armenia (2016–2017). A comparative analysis of the environmental status showed that all pollutants studied such as γ-hexachlorocyclohexane (γ-HCH), 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (4,4′-DDT), and p-p′-dichlorodiphenyldichloroethylene (4,4′-DDE) were identified in Ararat marz with the average concentrations and detection rates higher than in Lori marz. The prominent contaminant was γ-HCH. The findings indicated the concentrations of OCPs below of regulatory concern. In Ararat marz an increase in the number of sterile pollen grains of certain wild plants was revealed (14.8–26.0%), compared with Lori marz with the levels within the contingent standard of 5–11%. The phytotoxic activity of soil samples from the Ararat marz studied on Avena sativa seedlings was significantly higher in the summer-fall period. These data correlated with monitoring findings showed an increase in the levels of γ-HCH, 4,4′-DDT, SS in the soil and sludge sampled in summer-fall in Ararat marz. This difference in the environmental status can be considered as the result of active agriculture in Ararat marz, whose share of contribution to a relevant branch of the economy of Armenia is two times higher than in Lori marz, 15.4% and 7.9%, respectively. Mentioned rates of agricultural production may be one of the reasons for the environmental deterioration in Ararat marz. The detection of 4,4-DDT, γ-HCH residues testifies the circulation of these formulations in the environment indicating their use in recent past and confirming their persistence. Although since the 70s of the last century the application of OCPs in the Republic of Armenia has been prohibited. The current situation may be explained by low awareness of farmers on different issues related to the safe management of pesticides. To ensure safe working conditions and raise awareness among the farmers we have developed “Recommendations on Safety requirements when working with pesticides” that are approved by the State Service for Food Safety at the Ministry of Agriculture of RA and included in the reference booklets for farmers as guiding information. Our study shows the understanding of associations between the deterioration of the environmental status and share of agriculture contribution to the economy that provides the evidence for future research programs.

Background: Due to developing demographic changes, including an aging society and the increasing prevalence of non-communicable diseases, Palliative Care is increasingly highlighted as a universal healthcare need. The need for Palliative Care in Armenia is set against the context of an underdeveloped healthcare system. Further, the absence of palliative medicine within medical education, particularly undergraduate education in Armenia presents a major barrier to improving care. This research aimed to assess the perception of young Armenian physicians’ understanding of Palliative Care, its perceived status in Armenia and the experience and influence of any engaged Palliative Care education. Methods: Twenty Armenian first-year residents with different specializations were interviewed July and September 2016 regarding: understanding/knowledge, experiences, perceived competence, and expectations of Palliative Care and Palliative Care education. The transcripts from these semi-structured interviews were analyzed using Qualitative Content Analysis. Results: Participants perceived that Armenia’s health care system lacked sufficient Palliative Care and Palliative Care education. Although elements of Palliative Care were included in different specialty teaching, this provided just a partial understanding of typical Palliative Care patients/symptoms, approaches to holistic care, and crucially key communication skills. Challenges noted by participants in caring for Palliative Care patients included emotional difficulties, communication of diagnosis/prognosis, uninformed patients and concerns for patients, families, and physicians. Self-confidence in caring for patients with incurable illness varied. Participants hoped for increasing availability and accessibility of Palliative Care, and extension of clinical education in Palliative Care at all levels (undergraduate, postgraduate, specialization). Conclusions: Absence of training has resulted in misconceptions and ignorance of common concepts and practices in Palliative Care. Palliative Care education needs to be systematically developed and integrated into clinical training within Armenia. This research may provide a rallying call for changes within the core curricula in Armenia and may also encourage collaborative development in associated countries of the Caucasus region.

The awareness, practical approaches and attitude of health care professionals to drug hypersensitivity reactions in Armenia

Pediatric traumatic brain injury (TBI) is a major global cause of disability, yet its impact in low- and middle-income countries (LMICs) is poorly understood. This study assesses TBI incidence and health-related quality of life (HRQoL) among children in Armenia, Georgia, and Moldova. This cross-sectional study used a standardized pediatric TBI registry and the EQ-5D-Y-3L instrument (in Georgia and Moldova). A total of 745 pediatric TBI cases were recorded, with 273 children aged 4-18 completing the HRQoL assessment. Most TBIs were mild (93.7%). Despite mild severity, 30.6% reported pain/discomfort and 23.8% reported difficulty with usual activities. Older age was significantly associated with lower EQ-VAS scores (p = .007). Even mild pediatric TBIs can negatively affect HRQoL, particularly in older children. Incorporating HRQoL measures into TBI registries in LMICs can support evidence-based care, guide targeted interventions, and inform health policy in resource-limited settings.

The formation of the health of adolescent children is carried out under the influence of many risk factors, including non-medical determinants: lifestyle, socio-economic, household factors and living conditions. Conducting epidemiological studies to identify the leading risk factors for the lifestyle and quality of life of adolescents is currently consistent with the basic directions of development of preventive medicine. Aim. Analysis of literature data, leading factors, the impact of social determinants on the health and well-being of children and adolescents. Material and methods. The choice of publications was made according to keywords that reflected between the indicators of the health of children and adolescents and the factors that influence them. Assessment of the influence of social determinants on the health of children and adolescents made it possible to prepare comprehensive measures to improve the health and health of children and adolescents. Conclusions. In the literature review, the social conditions studied have a decisive influence on the formation of the lifestyle, health and well-being of children and adolescents. Keywords: сhildren, adolescents, social determinant.