Vitamin D and Cognitive Function: Descriptive Review of the Scientific Evidence

Introduction

The functions of vitamin D in relation with calcium absorption, its integration in bone and the regulation of the calciumphosphorus metabolism, have been known since the beginning of the last century. Numerous other functions have been discovered over time both in relation to health and disease. Its extra-bone effects are being explored on cardiovascular, endocrine, and neurological level, among others, including its implications in cognitive function [1,2]. In the current COVID-19 pandemic, its relationship with the function of immune system regulation is being investigated. In this regard, the Spanish Society of Geriatrics and Gerontology has prepared a document that states its position on vitamin D supplementation in this context and points out several recommendations [3]. Vitamin D is found in nature in two physiological forms: ergocalciferol (vitamin D2), from mainly vegetal origin, and cholecalciferol (vitamin D3) from animal origin. Most vitamin D in the form of vitamin D3 is synthesized in the skin by ultraviolet rays from 7-dehydrocholesterol; only a small part is obtained from food. The major circulating form of vitamin D is 25(OH)D (calcidiol or calcifediol), which is the metabolite tested in plasma to assess vitamin D status, although the most active form is 1,25(OH)D (calcitriol or hormone D). The most recommended form of supplementation is cholecalciferol or vitamin D3 [1].

In recent years, concern about vitamin D in relation to the elderly is growing in our society; the study of its blood concentration levels has been incorporated into many routine tests and vitamin D prescription is growing significantly, given the high detected prevalence of insufficiency or clear deficiency. There are also studies connecting hypovitaminosis D to cognitive impairment, particularly of neuro-degenerative type. Because of these facts we have considered performing a review of vitamin D and its implications on cognitive performance and its impairment. Since there are updated systematic reviews on the subject, cited in the text, we carried out a descriptive review whose objectives were to answer several relevant questions: Is there any data that would allow us to conclude that vitamin D has cognitive effects? Is hypovitaminosis D associated with cognitive impairment? Does vitamin D supplementation have any effect on cognitive impairment or dementia?

Development

Materials and Methods

The review conducted on the role of vitamin D in the management of cognitive impairment is descriptive, not systematic. We have used the PubMed/MEDLINE, EMBASE and Psych INFO databases to identify the most relevant study publications, establishing as search criteria the terms: vitamin D, cholecalciferol, calcifediol and vitamin D3, and crossing them with cognitive function, cognitive decline, cognitive impairment, dementia, and Alzheimer’ s disease. The following inclusion criteria have been considered for article selection: studies published from 2010 up to August 2021 in Spanish or English; epidemiological studies (both prospective, retrospective, or cross-sectional) and interventional clinical trials with vitamin D (open-label or controlled); variable (but mentioned) follow-up time; young and elderly population; diagnosis of healthy ageing, mild cognitive impairment and/or dementia; clinical trials which specific vitamin D supplementation dosage. The exclusion criteria were articles outside the specified period of time or that not mentioning relevant parameters to be compared (sample size, follow-up, assessment tests, or dose of vitamin D supplemented).

Results

Rationale of Vitamin D in Cognitive Impairment:

Vitamin D and Brain: Considerable amounts of vitamin D are in the brain since vitamin D can cross the blood-brain barrier, passively diffusing and binding to Vitamin D Receptor (VDR). VDR is widely spread in neurons, astrocytes, microglia of the hippocampus, orbitofrontal cortex, cingulate area, amygdala, and thalamus. These brain areas are all well-known for their relevant role in learning, memory, and other cognitive functions. It is known 1,25(OH)D-VDR coupling modulates the gene expression of neurons, astrocytes, and microglia [4]. In these cells, there are hydroxylases that can synthesize and catabolize both 25(OH)D (or calcidiol) and 1,25(OH) D (calcitriol or hormone D). Both calcidiol and calcitriol can act in a paracrine and autocrine manner by regulating different functions of these brain cells through gene modulation [5].

Vitamin D exerts its effect through genomic and non-genomic pathways. Genomics is performed through the VDR receptor which is a member of the nuclear transcription factor family, thus influencing gene transcription and regulating the expression of more than 900 genes [6]. Due to positioning in DNA, it is also involved in the expression of numerous protein complexes throughout the body, including the brain. Its effects through nongenomic pathways are like the ones of other steroid hormones. It has fast actions mainly through VDR and also through an associated protein (the disulfide isomerase of A-Pdia3 family). In this way it influences the modulation of adenylate cyclase, phospholipase C, protein kinases (among others, calmodulin) and participates in the phosphorylation of cellular proteins. It also promotes the intracellular release of calcium, and it is known that high levels of calcium produce neurotoxicity associated to cognitive impairment; several calcium-binding proteins are regulated by vitamin D: calbindin, parvalbumin and calretinin [7]. In this sense, Eyles, et al. [8] have mapped out the presence of metabolites of vitamin D in the brain, as well as its enzymes and VDR, indicating that vitamin D acts as a neurosteroid in processes related to learning and memory. These genomic and non-genomic actions are the basis for their effects on neurocognition (see Figure 1).

Vitamin D and Neurotransmission: In in vitro and preclinical research models, vitamin D has been shown to be involved in the gene expression of neurotransmitters such as acetylcholine, dopamine, serotonin, and gamma butyric acid, and may reduce the hyperphosphorylation of the tau protein, attenuating the neuronal death process [9]. Vitamin D has neuroprotective effects by decreasing the neurotoxic glutamatergic hyperactivity and the positive regulation of the expression of genes involved in the formation of new synapses in the hippocampus [10], as well as genes involved in neuronal myelination [11].

Figure 1: Actions on the Vitamin D Receptor (VDR) in the brain.

Vitamin D promotes the synthesis of Nerve Growth Factor (NGF), which acts on neurons in the fronto-basal area of the cholinergic system protecting it from glutamate toxicity, and also on Glial Cell Line-Derived Neurotrophic Factor (GDNF), which performs maintenance and repair functions of dopaminergic and noradrenergic neurons. It likewise promotes the synthesis of several neurotrophins which are involved in growth and differentiation of neurons, and in attenuation of programmed neuronal death [10]. Vitamin D is involved in synaptic plasticity, maintenance of the cytoskeleton and cell transport of cell organelles through regulation of numerous proteins involved including tubulin, drebrin, GAP43 and Dynactin [12]. It has anti-inflammatory effects on the brain, and reduces the activation of cytokines by activated microglia, decreasing the synthesis of nitric oxide, an enzyme that is also boosted in degenerative diseases, and regulates the expression of gamma glutamyl transpeptidase enzyme, so it has an important role on antioxidant mechanisms in the brain [9].

Vitamin D and Cognitive Impairment: Vitamin D deficiency is associated with psychiatric and neurological diseases in which cognitive disorders are involved, such as schizophrenia, autism spectrum disorders, attention deficit hyperactivity disorder, Parkinson’s disease and dementia. In patients with Alzheimer’stype dementia (AD) there is often a vitamin D insufficiency or even deficiency. However, it is not clear whether hypovitaminosis D is a factor involved in their aetiology or a consequence of dementia lifestyle involving lower sun exposure. There are several mechanisms on which its effects on neurocognition are based, mainly induction of neuroprotection, oxidative stress modulation, calcium regulation and inflammation reduction [12]. Furthermore, some polymorphisms of the VDR gene have been found to increase the risk of AD, specifically the haplotype of the TaqI, ApaI, Tru9I, BsmI and FokI alleles. Several studies consider that these haplotypes can be risk factors for AD [13]. Some research indicates that vitamin D might ease the clearance of amyloid plaques in the brain. This can be performed by at least two mechanisms: to increase the transportation of β-amyloid through brain-blood barrier by regulating the expression of transporters (P-glycoprotein or P-gp, and low-density protein receptor related to protein 1 or LRP-1) via VDR; and to stimulate macrophages to allow phagocytosis of the β-amyloid [14]. Based on these positive findings, Łukaszyk, et al. [15] and Patel, et al. [16] raised the consideration of vitamin D as a marker of cognitive dysfunction and possible treatment option. Nevertheless, vitamin D supplementation studies in patients with cognitive impairment in dementias have yielded contradictory results, as we will see below. It has been found that low 25(OH)D levels may increase the risk of cardiovascular disease. Therefore, vitamin D would decrease risk of cognitive impairment and dementia through beneficial vascular-type actions in hypertension, diabetes, atherosclerosis, and subsequent strokes [10]. In conclusion, there is sufficient neurophysiological rationale that supports a potential positive effect of vitamin D on cognitive functions.

Prevalence of Low Vitamin D Levels in Individuals with Cognitive Impairment: is there a Relationship Between Hypovitaminosis D and Poorer Cognitive Function?: 25(OH) D serum levels are considered to show objective deficiency when they are < 20 nanograms per millilitre (ng/ml) or < 50 nanomoles/ litre (< 50 nmol/l) [conversion factor x 2.5]; 20 - 30 ng/ml (50 nmol/l – 75 nmol/l) vitamin D deficiency; and optimum level above 30 ng/ml (75 nmol/l). In our country, most studies find vitamin D deficiency in a percentage of older adults greater than 50% [17].

Observational Association Studies and Mendelian Randomization Studies: In this section we raise several questions, among others: is there a relationship between the level of vitamin D and global cognitive functions, especially in areas such as memory, executive function, or language? Is hypovitaminosis D associated with cognitive impairment or dementia? Is there an association indicating a risk, or is it one of the direct causes of cognitive impairment? Can hypovitaminosis D be an effect -more than a cause- of the lifestyle of people with cognitive impairment or dementia? There are studies that have shown associations between low vitamin D levels and cognitive impairment; however, there are others that did not find such an association. Characteristics of these studies can be found in Table 1 [18-29].

Table 1: Epidemiological studies of association between 25(OH)D levels and cognitive impairment.

Note: 25(OH)D (25-hydroxy-vitamin D), 3MS (Modified Mini-Mental State examination), AD (Alzheimer’s type Dementia), CERAD-K (Korean version of the consortium to establish a registry for Alzheimer disease), FCSRT (Free and Cued Selective Reminding Test), HR (Hazard Ratio), MCI (Mild Cognitive Impairment), MMSE (Mini-Mental State Examination), MMSE-J (Japanese version of the Mini-Mental State Examination), TMT (Trail Making Test).

In the North American longitudinal population study (US Cardiovascular Health Study), 1,658 older adults without dementia were followed for more than 5 years. Hazard Ratio (HR) of risk of occurrence of dementia of any type was statistically significantly higher in individuals with severe vitamin D deficiency (<10 ng/ml, HR 2.25; 95% CI - 95% confidence interval- 1.23 - 4.13) or more moderate vitamin D deficiency (between 10 and 20 ng/ml, HR 1.53; 95% CI 1.06 – 2.21) [18]. In 2016, based on data from individuals who participated in the Framingham Heart Study, the relationship between vitamin D and cognitive impairment was studied based on 9-year follow-up data. Epidemiological information was analyzed from two cohorts of individuals: on the one hand, those with a diagnosis of dementia diagnosed throughout the follow-up (n = 1,663, mean age 72 years, mean baseline levels of 25(OH)D 25 ng/ ml or insufficiency); and those who, although without development of dementia, were performed with systematic cognitive tests, as well as brain imaging techniques by magnetic resonance (n = 1,139, mean age 60 years, mean baseline levels of 25(OH)D 20 ng/ ml or deficiency). In the first cohort, it was observed that 16.1% developed dementia; in this group, no association was found between vitamin D deficiency and increased risk of progression to dementia. However, in the cohort of individuals undergoing cognitive and imaging tests, an association was observed between low 25(OH)D levels and lower hippocampal volumes, as well as poorer performance in some neuropsychological function tests [20].

In the Rotterdam prospective study, covering more than 13 years of follow-up, it was observed that, in patients with initial dementia, no statistically significant difference in vitamin D levels was found, compared to the rest of the patients. However, when the incidence of dementia was analyzed in the 6,087 patients without a previous diagnosis (795 participants developed it, 641 with AD), an association was observed between lower baseline levels of 25(OH)D and higher risk of dementia incidence [23].These results from white North American and European individuals have also been replicated in other populations: in the Asian population, a cross-sectional epidemiological study [24] showed about a threefold risk of cognitive impairment in people with low vitamin D concentrations [OR -odds ratio- 2.70 (95% CI 1.38 – 5.28; p = 0.011)]. Similarly, in another cross-sectional study in 2,990 Koreans of 73 years mean age, an association was found between cognitive performance, measured by MMSE -Mini-Mental State Examination-, TMT -Trail Making Test- and digit scales, and the different levels of 25(OH)D, although losing the statistically significant association in an adjusted logistic regression model where sociological items were introduced [29]. Epidemiological studies carried out with Mendelian Randomization (MR) methodology have shown conflicting results and conclusions.

The first relevant study of this type was published in 2016 and was conducted by choosing 4 Single Nucleotide Polymorphisms (SNP) previously related to vitamin D deficiency from the genome of 33,996 patients, weighting the actual influence of each of the 4 SNPs on cognitive impairment from data from 2,347 individuals; thus, the corresponding risk estimates of developing AD could be obtained. The decrease of a standard deviation in 25(OH)D levels increased the risk of AD diagnosis (OR 1.25; 95% CI 1.03 – 1.51; p = 0.021) and, consequently, the authors concluded that vitamin D deficiency may represent a risk factor for AD [30]. Two years later another MR study was published with similar positive conclusions. In this case, researchers were able to identify 7 SNPs related to vitamin D deficiency and mutations in the 7 alleles were associated with an increased risk of diagnosis of AD [31]. However, other MR studies have been published not confirming these association findings. In 2017, a study was published without any finding of correlation between low 25(OH)D levels and risk of onset of dementia or cognitive impairment using data from Swedish men from the Uppsala Longitudinal Study of Adult men (12-year followup of a cohort of 1,182 elderly individuals) [32]. Also in 2017, the possible relationship between hypovitaminosis D and cognitive impairment was assessed based on data from 172,349 individuals from 17 cohorts with records of 2 polymorphisms (DHDR7- rs12785878 and CYP2R1-rs12794714). The authors found no associations between global or memory-related cognitive function and either of the two polymorphisms [33].

In addition to the above, systematic literature reviews and meta-analyses started to be published from the early 2010s, revealing a possible relationship between low vitamin D levels and poor cognitive functioning. Some concluded that there was an inverse association between cognitive performance and vitamin D levels [34-37], but others were considered negative [38-40]. If we try to answer the questions raised at the beginning of this section by summarizing the published evidence, most authors conclude that hypovitaminosis D is associated with cognitive impairment or dementia, although there are also relevant studies that did not find this association. Regarding the question of whether low 25(OH) D level a risk factor is or not, we have seen that several studies showed that people with vitamin D deficiency or insufficiency have a higher risk of cognitive impairment, in comparison with those with normal values. However, no study has clearly ascertained the vitamin D deficiency causality for cognitive impairment or dementia, although genetic studies results may point in that direction. Current research still cannot rule out the hypothesis that hypovitaminosis D could be a consequence of lifestyle of people with cognitive impairment or dementia including poorer sun exposure and nutrition, as well as even lower sociability. This latter approach would have to be demonstrated through the execution of appropriately designed prospective clinical trials. These studies should compare interventions with vitamin D supplementation versus placebo in patients with different stages of cognitive impairment. We will analyze this point in detail in the following section, according to the available evidence.

Effect of Vitamin D (Cholecalciferol) Supplementation on Cognitive Function: What Do Recent Clinical Trials Indicate Us?: Most vitamin D supplementation studies were conducted using vitamin D3/cholecalciferol (see Table 2); however, several questions could be raised in relation to vitamin D supplementation and cognitive functions: when cognitive impairment or dementia, especially AD, is already present, can supplementation reverse the damage or slow progression of disease? Does supplementation produce beneficial effects in healthy individuals without cognitive impairment? Is this cognitive improvement, if occurring, dependent or not on normal, deficient or insufficient vitamin D plasma levels? Which are the convenient or necessary doses? To investigate the results of vitamin D supplementation on cognitive function, studies have been carried out with healthy elderly people or with patients suffering from cognitive impairment or dementia, mainly AD. Since the effects in both groups could be different and this difference would be of utmost importance, we analyzed separately the studies conducted with each of these two groups (Table 2) [41-55].

Table 2: Clinical trials of supplementation on the effect of vitamin D3 (cholecalciferol) on cognitive function.

Note: AD (Alzheimer’s type Dementia), ADAS-COG (Alzheimer Disease Assessment Scale-COGnitive), ADL (Activity of Daily Living scale), BADL (Basic Activities of Daily Living), BDI (Beck Depression Inventory), CAB (Cognitive Assessment Battery), CANTAB (Cambridge Neurological Test Automated Battery), CAQ (Cognitive Ability Questionnaire), CDRS (Clinical Dementia Rating Scale), FAB (Frontal Assessment Battery), FSIQ (Full Scale Intelligence Quotient), IADL (Instrumental Activities of Daily Living), MCI (Mild Cognitive Impairment), IU (International units of vitamin D), MMSE (Mini-Mental State Examination), mRNA (messenger RiboNucleic Acid), MOCA (Montreal Cognitive Assessment), OP (Open Prospective), OR (Open Retrospective), PAL (Paired Associates Learning Task) / PRM (Pattern Recognition Memory task), PDI-21 (Peters Delusion Inventory - 21 Items), PIQ (Performance Intelligence Quotient), RCT (Randomized, double-blind, placebo-controlled Clinical Trial), TMT (Trail Making Test), VIQ (Verbal Intelligence Quotient), WAIS-RC (Wechsler Adult Intelligence Scale-Revised).

Studies in Elderly People Without Cognitive Impairment: In 2011, a RCT (Randomized, double-blind, placebo-controlled Clinical Trial) was conducted for six weeks with 128 young adults receiving vitamin D with average normal 25(OH)D levels without finding changes in the cognitive functions assessed [41]. If the treatment and assessment time could be considered insufficient in this study, the same cannot be said of another study published in 2012, when another RCT was carried out in 4,143 women over the age of 65 followed for about 8 years, probably the longest follow-up time of a study of these characteristics. There were no differences between the group with calcium supplementation and 400 IU of vitamin D3 and the one with placebo on the incidence of MCI or dementia, nor in other cognitive tests evaluating memory, language, or executive functions [42]. Pettersen, et al. [44] assessed the effect of high doses versus low doses of vitamin D3 in a single-blinded RCT by supplementing 82 healthy individuals with low (400 IU/day) or high (4,000 IU/day) doses for 16 weeks. Significant improvement was observed with high doses in non-verbal visual memory, an effect that was more pronounced in those who had lower 25(OH) D levels. No differences were detected in other cognitive domains [36]. Balbaloglu, et al. [48] also tested if there was an effect with high doses (starting dose: 50,000 IU per week). They selected 90 healthy women between 25 and 45 years of age with deficient levels of vitamin D and supplemented them for up to 3 months, finding improvements with respect to the baseline score in the MOCA (Montreal Cognitive Assessment) score, especially in the items of language and delayed recall [48].Unlike previous studies, another RCT compared supplementation at different doses (800 IU/day and 2000 IU/day) in individuals over 60 years old; they supplemented 273 subjects but found no differences after 24 months [47].

We found only one study that analyzed genetic variability and vitamin D supplementation in subjects without cognitive impairment; they studied 319 healthy adolescents who were supplemented with high doses of vitamin D3 (50,000 IU/week) for 9 weeks and observed that those who had the CYP2R1- rs10766197 genotype GG and AG alleles performed better than the ones with AA alleles in various cognitive functions assessed with the cognitive skills questionnaire: global cognitive function, memory, and executive functions. The authors concluded that some individual genotypes could particularly benefit from high doses of cholecalciferol [49].

Studies in Patients with Cognitive Impairment: Annweiller C et al. carried out an open retrospective study in patients with AD; they studied 43 patients supplemented with vitamin D at variable doses. At the six-month evaluation, they found that those who had been treated with memantine plus vitamin D had significantly improved in MMSE, averaging 4 points, while those who had taken memantine only or vitamin D only remained stable. They concluded that the objective cognitive improvement in this series of patients suggested some type of possible synergy or enhancement of effects of the memantine-vitamin D combination [51]. In 2018, an RCT was published with patients suffering from MCI and vitamin D deficiency. For 12 months, 93 patients received a supplement of 400 IU/day of vitamin D3 and 88 received placebo. The authors found statistically significant improvements attributed to cholecalciferol, compared to placebo, in 5 cognitive subdomains (information, digit span, vocabulary, block design, and visual organization) [52]. In the same year, another RCT of 105 patients with AD was published testing 800 IU/day intervention with cholecalciferol for 12 months. The treated group improved in several cognitive functions (vocabulary, block design, digit span, figure organization and other functions), and decreased in terms of some biomarkers related to the β-amyloid protein (β-amyloid 42, amyloid precursor protein, BACE-1 -β-secretase type 1- and others), compared to placebo [54]. This positive assessment on biochemical and cognitive functions may confirm the previous research that had found a relationship between β-amyloid protein and vitamin D. It is an admitted fact that in AD the amyloid production increases with a decrease in its clearance; in a pilot study with 14 healthy subjects over 50 years of age with vitamin D deficiency who were supplemented, an increase in plasma amyloid was observed, suggesting an increase in cerebral amyloid clearance by increasing its peripheral transportation. This occurred with greater intensity in individuals over the age of 60 [56].

Recently, a RCT was performed in 183 patients with MCI (mean age 67 years; mean 25(OH)D less than 20 ng/ml) who were administered 800 IU daily of vitamin D3 (n=93) or placebo (n=90) for 12 months. Statistically significant differences were found favorable to supplementation with cholecalciferol in terms of the FSIQ (Full Scale Intelligence Quotient) score and several other cognitive tests; among them, digit span, block design and vocabulary. This work also has the interest that the researchers observed that supplementation with cholecalciferol significantly reduced biological markers of oxidative stress regulated by telomere length [55]. Conversely, a systematic review and metaanalysis was published, including 2,345 participants from 9 clinical trials on vitamin D supplementation for the prevention of AD. The authors concluded that, in their opinion, the current evidence does not support a beneficial effect of vitamin D supplementation to prevent AD [57]. In short, vitamin D supplementation has generally led to increases in 25(OH)D levels to an optimal level. Both in healthy subjects and cognitive impairment or dementia patients, there are studies that have detected positive cognitive changes due to vitamin D cholecalciferol supplementation, while others have not detected them. This difference in results cannot be attributed to the doses used, the time used for supplementation, or to the quality of the work. We cannot, therefore, answer with certainty the questions raised about the effect of vitamin D supplementation on cognition, nor the effect of different doses or the duration of supplementation.

Nevertheless, and given the reasonably favorable findings, some authors consider vitamin D as a potential therapeutic target [16] or even a “new paradigm for therapy in the prevention and treatment of dementia and AD.” [2]. However, scientific evidence available to date regarding the possible efficacy of cholecalciferol in healthy or cognitively impaired individuals is insufficient to affirm that there is a robust and consistent effect.

Conclusion

Though, traditionally, science and statistics have been used and abused by politicians for the attainment of hegemony and personal advantages, an evidence-based approach is a necessity for every person, whether as a specialist or as an average person; otherwise the outcome can be messy and unfavorable. So, no direct or indirect relationship can be assumed to exist between politics and immunization; two non-combinable objects. Though conspiracy theory can be a hypothesis that needs acceptable proof and investigation, the current pandemic is a real threat that demands instant and proper response. Disregard to lack of information or anxiety, as the main causes of hesitation for refusal or deferring vaccination, politicization of immunization drives mostly from subjective judgment, which can be pushed by leader’s, cult’s, kin’s, or media’s standpoints, as plausible sources of data for hoi polloi, in comparison with scientific texts or bulletins, as authentic resources for professionals. On the other hand, neither pro-vaccine groups nor anti-vaccine crowds have unconditional aficionados. Both of them consist of different people with unlike viewpoints. Presently, vaccination is the best approach for decreasing natural vulnerability and augmenting bodily defense. Though it is not a perfect approach with unbreakable protection, at the moment immunization is the most reliable method for management of the present pandemic. Survival is everybody’s right and its increase is a blessed objective and duty in public health and medical practice.

Limitations of the Review

This conducted review is not a systematic review. We have not scored the studies, either with statistics, or qualitatively or with any systematic review usual methodology. All the studies shown in the tables are from the last decade when interest in this topic has relevantly increased, and particularly until mid-2021. The great heterogeneity of studies and vitamin D supplementation doses and treatment duration makes it difficult to draw consistent conclusions. Well-designed clinical trials, predominantly RCTs -more appropriate for establishing causality- with sufficient sample size to counteract usual attrition, adequate follow-up periods -preferably several years-, and targeting specific populations in relation to cognitive impairment are needed.

Conclusion

Although the available scientific evidence is inconclusive, there are sufficient clinical data to consider that supplementation with cholecalciferol in elderly patients with cognitive impairment and vitamin D insufficiency or deficiency may have beneficial effects on cognitive function. Hence, vitamin D status should be monitored in these patients and hypovitaminosis D corrected with cholecalciferol dosage regimens that achieve serum 25(OH)D levels preferably above 30 ng/ml. In any case, if such monitoring is not easily accessible for economic or administrative reasons, the high prevalence of vitamin D deficiency in these patients may warrant supplementation with cholecalciferol, even without the availability of 25(OH)D serum levels.

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Politicization of Immunization: Radicalism in the Field of Science

Introduction

Currently, the COVID-19 pandemic has forced all domestic administrations to enact major limitations on personal liberty to break the spread of the infection. These limitations have not only generated severe complaints by groups of inhabitants, but moreover have resulted in the reinforcement of some populist activities and their radical representatives, who are in general cynical of strategies that help to stop the spread of the COVID-19 pandemic - a phenomenon that is termed ‘medical populism’ [3]. While even before the occurrence of COVID-19 inoculation was a conflicting topic, a number of surveys have emphasized and revealed empirically that the sociopolitical orientation of people has a direct effect on outlooks toward injections [1]. No doubt, vaccinations are among the greatest successes of contemporary medicine, and there is optimism that they can generate a solution to break the ongoing COVID-19 disease. But the anti-vaccination effort is presently on the rise and is spreading online propaganda about vaccine side effects and has caused a distressing decline in immunization rates. So, it is necessary to comprehend the causes of vaccine uncertainty, and to find working policies to undo the hoopla of anti-vaccination admirers [2]. Though the dilemma of vaccine antagonism [4] and mask non-adherence [5] had been talked over before [4,5], in the present article, politicization or party-political polarization of immunization, as an astonishing integration of two unlike subjects in the contemporary epoch, has been looked over concisely to analyze the interrelated dynamics of vaccine resistance and the made-up relationship between politics and vaccination, which has been one of the most important outcomes of science and systematic method in the recent epochs.

Background

Immunization and Public Attitude: Inoculations are among the greatest medical successes of the last century, due to their essential aid in dropping the incidence of infectious diseases and in decreasing mortality. In spite of the existing proof and the scientific agreement on the safety and the requirement of inoculations, an anti-vaccination activity has been developing over the past years [6], with an ensuing drop in immunization proportions and the likely resurrection of infections such as measles [7]. The said movement, which has added energy after the notorious publication of Andrew Wakefield’s study, which linked inoculations to autism [8], has been, recently, increasing its power, by misusing social media as communication networks [9,10]. Till now, it has been presented that immunization selection is influenced by morality, religion and personal ideology, the belief in conspiracy theories, emotive appeals or the lack of trust in authorities, the confidence in alternative medicine, in addition to the readability of pro- vs. anti-vaccination literature [11,12]. Most surveys principally focus on two aspects, the role of the internet and particularly social media, and the psychological approach connected to immunization [13,14].

While it seems that the majority of persons don’t consider the reliability of the source of data [15], anti-vaccination accusations are based mainly on personal practices and attitudes and provaccination supporters have the tendency to quote professionals and refer to scientific works when sharing their opinions online [16,17]. It is shocking that while some activists believe that their sperm is unpolluted by the vaccine, they express themselves as ‘purebloods’ [18]. Besides, some Far-right political figures and societies have taken advantage of fast alteration and experiences of financial disaster during the COVID-19 epidemic to endorse dogmas about protecting traditional family principles and Western values. In this regard, anti-vaccination movements have proven especially pleasing to white people who feel disadvantaged by rapid alterations in Western society, which have undermined their monetary and social dominant situation [19]. So, some recognized adherents of pro-fascist, white supremacist and neo-Nazi groups have been existent at anti-vaccination meetings [18]. Furthermore, the essential doctrine of the anti-vaccine philosophy is that vaccines cause autism and other evil health effects, and that regimes and the pharmacological commerce perceptively suppress this info. Besides, according to their “natural immunity theory”, barricades to microbes, like physical distancing and masks, deteriorate our immune system, and vaccines are just one more artificial loaded weapon that has targeted our immune system [19]. Nonetheless, while the emergent political polarization on scientific matters has caused the COVID-19 vaccine-related feeling to be separated across sociopolitical lines [20], COVID-19 continues to contaminate and kill; so, extensive immunization becomes indispensable for combating the virus [21]. Alternatively, using inoculation to battle the COVID-19 illness will not work effectively unless the majority of the people get immunized [22], whose hesitancy may derive from specific concerns about side effects, distrust of medical professions, conspiratorial beliefs [23-25], low levels of trust in political institutions, a low degree of education, and a feeling of alienation [1].

Vaccination and Party-political Schism: Despite the fact renowned parts of the anti-vaccine effort are on the political lefthand, anti-vaccine feeling is more manifest on the right [19]. By and large, it seems that “the more ideologically extreme, the more negative toward injections and immunization” [1]. Politically inspired rejection of COVID-19 vaccine usefulness is driven from a melodramatic politicization of confidence in science, doubt in public organizations and supposed threats to one’s sociocultural characteristics, and it seems that maybe political philosophy, like sentiment to right-wing absolutism, or social power orientation with “superior” groups controlling “inferior” groups, is now the main predictor of anti-science outlooks [26]. While political polarity is explicitly and implicitly influencing daily lives of people around the world [27], preceding studies have indicated that conservative persons, compared to liberal people, are, in general, less positive about immunization, and have a tendency to find higher levels of vaccine side effects and lower levels of its usefulness [28]. There are a number of motives for conservatives’ predisposition to experience less favorable feelings toward immunization.

First, investigation has delivered proof of conservative-liberal psychological dissimilarities, with traditionalists having sturdier cynicism toward systematic confirmation [29]. Conservatives also tend to favor more instinctual, heuristic-driven processing methods over methodical, purposeful manners of thinking [30]. In various means, the COVID-19 infection has become more politicized, with bigotry affecting persons’ outlooks toward preventive measures and trust in the soundness of COVID-19 data [31]. Likewise, inquiry has exhibited that those who are more conformist are less likely to have confidence in medical professionals [32,33], and are more expected to confirm conspiracy schemes such as vaccine threats are being censored by pharmaceutical corporations [34]. Also, analysis has shown that while liberal people seem to emphasize vaccine development and its role in termination of contagion, conservative persons discuss the probable wrongdoing in vaccine studies and related broadcasts [20].

Conspiracy Theory, Sketchily: According to a survey, antivaccination enthusiasts, in comparison with pro-vaccination groups, have more faith in conspiracy theories [2]. Based on the insecurity and absence of coping plans at the primary stage of the contagion, it is likely that conspiracy thinking provides a mechanism for keeping a sense of security, control and meaning during an ambiguous period [35]. It seems that intriguing concepts of various types, along with anti-vaccination dogmas and political radicalism tend to be linked with each other [36,37]. While the particulars of the conspiracy theories from the left and the right are markedly dissimilar, all of them see malevolent or hidden motives in diverse groups of persons and administrations behind immunization progression and distribution [20]. A common allegation is that the vaccination programs and lockdown measures are part of a great plot to establish an innovative universal totalitarian system [New World Order], which is going to be shaped by a secret group of influential elites. So, many anti-vaccine devotees believe they are fighting back immoral globalist powers who want to corrupt them and their children by tracking devices, microchips and other stealthy technology supposedly concealed in COVID-19 shots, to protect civil liberties [18]. Thus, while its appearance is medical, its core intention is political hegemony, all over the world, and citizens’ control, on a national scale. But the attainment of such an aspiring plot is not effortlessly. As a result, it demands a series of changes in the thinking and manners of citizens. For example, while digitalization, the internet and social media can prepare the background for enhancement of interaction and communication, it can arrange for monitoring of individuals’ beliefs and their social network, too.

The relationship between a virus, which does not seem to be natural or to act aimlessly, and earlier suspicious backups or doubtful forecasts by recognized globalist figures, is mysterious enough to endorse the actuality of a deceitful arrangement. Anyhow, the result of such a pandemic could be nothing except guaranteeing the physical separateness of citizens and further individualization, which may cut structured political protest and increase social amenability, via digitalized apparatuses and networks that can edify persons, individually and repetitively. On the other hand and consistent with the said egoistic intrigue, while the covid-19 virus and its changeable variants could reduce surplus and impractical inhabitants, new invented vaccines, too, could exterminate other leftover crowds and change masses by their side effects. Moreover, while in the last decades scientists were practically unsuccessful with respect to provision of an effective vaccine against human immune deficiency virus (HIV), the manufacturing of multiple registered vaccines against the greatest pandemic of recent century in less than a year can not be without question; vaccines with indeterminate doses. Furthermore, a new vaccine permit, along with a representative identification number and classic domestic passport, can be the inauguration of newer social and political IDs. The outcome of such an unpleasant recording of decisions and doings is nothing except superfluous monitoring of inhabitants and further restriction of civil liberties. Consequently, refusal of vaccinations may neutralize or interrupt the said unfair plot, which tries to retract, sooner or later, others’ belongings and authorities. Since the skeptics are not from the same national, religious or ethnic group, their faith in the above-mentioned assumed treachery or plot, as well, is erratic and their outlooks are not automatically alike. For instance, there are skeptics, who see globalization as an immoral conspiracy but don’t resist immunization. Even some of the pessimists who introduce themselves as anti-globalists don’t have a precise understanding of principles of contemporary globalization and ascribe that to Marxian thinkers, who are innately the antagonist to neoliberal policies of globalization and declare that as a shambolic and worldwide renewal of capitalism. Thus, there are diverse doubters with diverse worries, though their share point is typically vaccine antipathy. According to a survey, persons who recounted more conspiratorial views tended to be more antivaccine [19].

Discussion

The COVID-19 virus has forced states to execute major social limitations to stop the spread of infection. At this time, because of the production of effective vaccines, these limitations are expected to become obsolete if people get immunized. But some people have uncertainty about inoculation. Though this is not a new occurrence, it can be a serious one with respect to management of COVID-19 contagion. Therefore, the task of planning suitable policies for achievement of high levels of immunization asks for better attention [1]. Anyway, as has been mentioned earlier [4], an adequate number of fans for promotion of stunning or conflicting philosophies are always existent in every society, whether in developed or developing countries, thanks to adequate prevalence of personality disorders (schizotypal (3% of the population), paranoid personality (1-2.5% of the population), dependent personality (2.5% of personality disorders), avoidant personality (1-10% of the population), histrionic personality disorders (2-3%), and antisocial personality disorder (1% in women, 3% in men)) and traits, which are very more prevalent than disorders per se, cognitive deficiencies ((borderline intellectual functioning = 6% of the population, mild mental retardation (1% of the population)), depression (5% of the population), and delusional disorder (0.025 – 0.03% of the population). So, disregard to metaphysical, theoretical or cultural explanations, psychopathology can, directly or indirectly, play an important role in the spreading of gossip or unreasoned, but fascinating, ideas.

For example, a depressed person with nihilistic ideas and conscious or unconscious self-harm impulses may reject immunization with no trouble. Similarly, a delusional person with paranoid distrust may ascribe erratic attributions to the vaccine, which could be imagined as a secret armament that has been invented by his recognized or anonymous and interminable antagonists. Also, it seems that supernatural interest in schizotypal traits provides an ample framework for the proliferation of antivaccine propaganda, which can be boosted impressively by illiteracy. On the other hand, though knowledge is an important buffer against unscientific proposals, it cannot guarantee nonstop logical thinking when it is challenged by inner emotional preferences. For instance, the antipathy of anti-vaccine protagonists against physicians and medical authorities may be driven mostly from their inner resentment, not insightful perspectives or scientific evidence. Similarly, while the usefulness of the automobile cannot be denied due to accidents or mechanical impairment, the helpfulness of vaccines, science or the medical profession, as well, cannot be denied due to exposed deficiencies or existent forensic files. No sensible mind can deny the essential role of medical science in the prolongation of human survival, due to its methodical discoveries and researches during the last epochs. Vaccine-antagonists have forgotten that most of them have been inoculated by a series of vaccines during their childhood, which has let them be alive and healthy at the moment. Maybe they don’t know anything about smallpox, which has been eradicated in the last century by wideranging immunizations. Having faith in the fallaciousness of press releases and data about CID-19 for deception of the masses is another shocking belief that shows that anti-vaccine supporters don’t want to see the real mess, due to COVID-19, in hospitals and medical facilities during the last months; maybe, till their own septicity and decease.

Such an obvious divergence between ability to see realities and sightlessness drives from lack of objective perspective, which is not scarce among lay people. On the other hand, though evidence-based inquiry is the usual method of approach among specialists and researchers, objectiveness is not always the preferred method of rationalization among sophisticated people, because a remarkable number of cultivated people, even medics, can be found among anti-vaccine supporters. This shows that insight is not always dependent on existing proofs, if inner wishes or antagonisms challenge peripheral actualities, and unconscious emotions subjugate conscious pondering. The same pattern can be seen in denial (or distortion), which is a narcissistic defense mechanism in psychoses, passive-aggressive (negativistic) behavior, which is an immature defense mechanism and can be found in unspecified personality disorder, and oppositional-defiant disorder, which is a disruptive condition in children and adolescents. Also, there are some cults or fundamental groups, which are typically characterized by conservatism, idealism, dependence on destiny [38], unwavering attachment to a set of irreducible beliefs, a strong sense of importance of maintaining in-group and out-group peculiarities [39], emphasis on purity and the wish to return to a former model from which sponsors believe followers have drifted [40], and refusal of multiplicity of opinion and rejection of criticism about their established standpoints and interpretations within the group [41]. So, due to secretive or incomprehensible reasons, disavowal of inoculation, as well, can be one of their inflexible and indubitable dogmas. Also, some of the supporters of the antivaccine movement refer to the likely relationship between autism and immunization. In this regard, while considerable controversies have arisen over the question of whether exposure to the measles– mumps–rubella (MMR) immunization might be a causative factor for autism, this assumption rests largely on case reports that link the onset of autism with the immunization; however, it has long been known that a small number of children with autism present with a developmental regression, and the bulk of the available evidence does not support a causative association with immunization.

On the other hand, the potential danger and negative effect of an increase in children not immune to measles, mumps and rubella is considerable [42]. Though malleability of public opinion is always one of the wishes of every administration, public opinion commonly acts upon inner and cultural consent that are different from civil laws, which are typically based on rational and peripheral determining factors. So, since the said conflict is not, at all times, solvable with no trouble, it may demand force or cost. Regarding the conspiracy theory, it is interesting that while the present data is not enough for approval of the aforementioned schemes, the current state of affairs, as well, doesn’t permit governments to wait for more documents or surveys with respect to the political intentions of unnationalistic philosophers and the rightness or wrongness of globalization. Management of existing pandemics and mess demands urgent endeavors for protecting innocent people, who have suffered, so far, many discomforts. Approval of the above accusations can be an extra step that demands systematic and legal inquiry for finding proper and convincing evidence; a process that needs more patience, time and effort. On the other hand, the presence of the mafia is clear in some anti-vaccine activities, which condemns vaccination, by highlighting its side effects or underperformance, but then admires unsanctioned remedies, which don’t have any value more than placebo, on behalf of private profits. Illiteracy, holiness, or magical tendencies of hoi polloi, which is explicit for the said mafia, forms the necessary milieu for such a nasty business or misuse. Moreover, uncertainties about the aptness of the existent administrative systems can support, reflexively, the mafia’s tricks.

Protagonists of alternative medicine, as well, may take advantage of the present condition for aggrandizement of their own attitudes, though many of them don’t condemn usage of standard medical approaches, and recommend their followers to use routine therapeutic tactics together with nonstandard alternative approaches. While vaccine antagonism is not a new phenomenon, its politicization seems to be an innovative tactic that is theorized discordantly. Though politics is an all-inclusive subject, politicization of non-political issues, like immunization, seems to be more a byproduct of dogmatism, and not political mindfulness. No politician, whether conformist or open-minded, can endanger people due to party-political challenges, and no admirer is obliged to yield to irrational recommendations. Evidence-based perspectives is not limited to medical sciences and no field in the modern era can survive without rational attitudes. The current civilization, competencies, healthiness and relief cannot be constructed by illusions or recklessness. It demanded sound reality-testing and scientific rationalization. So, no reasonable correlation can exist between political affairs and immunization, except in biased conditions. If decision makers, as well, cannot polish up their strategies in line with external realities and are unable to take evidence-based decisions, then they cannot master challenges realistically and may use fascistic tactics [43]. Though policymakers may use or abuse science for gaining hegemony, they are not merited to falsify facts. If they misrepresent proof, knowingly or insentiently, then they are not politicians and they are charlatan or ill-informed, respectively.

For sure, no selfless political figure advises their fans and folks to act ridiculously and generally let them decide knowingly and liberally; otherwise it cannot be recognized as a party-political participation and it seems to represent a sectarian atmosphere [44], which may, sooner or later, jeopardize civil liberties. Therefore, policymakers must depoliticize immunization in order to increase trust in and public support for the vaccines in general and for vaccines against COVID-19 in particular [1]. So, it is important for officials who are planning an immunization policy against infections like COVID-19 or ones that might appear in the future to discern the dynamics of cynicism and resistance against inoculation [1]. Also, some intellectuals have described participatory community engagement as vital for successful COVID-19 immunization, which consists of working with communities and their leaders to help with bottom-up approaches [45]. They proposed that COVID-19 has drawn attention to the basic violence that is implanted within society, with the pandemic fostering the marginalization of traditionally excluded and oppressed groups. So, people who might have been neglected by the system and suffered disproportionate monetary and health costs from COVID-19 are now being asked “to trust the same structures” [45]that could not give suitable incomes and social protection during the pandemic. Failure to address these issues can worsen distrust and vaccine antagonism. Anyhow, participatory community engagement may engage more people with vaccine hesitancy, than persons with anti-vaccine beliefs [46]. Enlightening people about real threats and serious health care complications, proper use of the media, intelligible advertising billboards, healthful conferences, scientific criticism of unprincipled strategies by specialists and supporting community participation in the said discourses, encouragement of nongovernmental organizations and social activists to act reasonably in response to anti-vaccine agitators, are useful policies for strengthening immunization programs [47,48].

Conclusion

Though, traditionally, science and statistics have been used and abused by politicians for the attainment of hegemony and personal advantages, an evidence-based approach is a necessity for every person, whether as a specialist or as an average person; otherwise the outcome can be messy and unfavorable. So, no direct or indirect relationship can be assumed to exist between politics and immunization; two non-combinable objects. Though conspiracy theory can be a hypothesis that needs acceptable proof and investigation, the current pandemic is a real threat that demands instant and proper response. Disregard to lack of information or anxiety, as the main causes of hesitation for refusal or deferring vaccination, politicization of immunization drives mostly from subjective judgment, which can be pushed by leader’s, cult’s, kin’s, or media’s standpoints, as plausible sources of data for hoi polloi, in comparison with scientific texts or bulletins, as authentic resources for professionals. On the other hand, neither pro-vaccine groups nor anti-vaccine crowds have unconditional aficionados. Both of them consist of different people with unlike viewpoints. Presently, vaccination is the best approach for decreasing natural vulnerability and augmenting bodily defense. Though it is not a perfect approach with unbreakable protection, at the moment immunization is the most reliable method for management of the present pandemic. Survival is everybody’s right and its increase is a blessed objective and duty in public health and medical practice.

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Development of Specialized Maps Based on the Analysis of the Medical Geographical Situation of Uzbekistan (on the Example of Jizzakh and Siyrdarya Regions)

Proposed Method and Scientific Approaches to Provide a Scientific Solution to the Problem

At the same time, medical geographical atlases created by MSU scientists are taken as a sample, maps are used conditional symbols, colors selected in accordance with the essence of the content, cartographic methods reflecting diseases. Geoinformation technologies (ArcGIS, QGIS, Mapinfo) were used. Through the constant complementarity of databases based on GAT technologies, the work of creating maps, plans, their processing and data integration was considered, and databases were rapidly formed using new cost-effective methods. The proposed medical geographical atlas was considered cost-effective, not inferior to foreign analogues. The research process also used methods such as field research and aerospace, cartographic, mathematical modeling, statistical analysis, geographic information systems.

Keywords: Total Mortality; Maternal and Infant Mortality; Life Expectancy, Morbidity; Medical Geographic Map; Medical Geographical Atlas; Ecological Situation; Geography; Cartography; Natural-Economic Zones; Desert-Pastoral Livestock; Mountain-Pastoral Livestock; Sociological Survey

Introduction

Humanity has struggled with many diseases throughout its history. Infectious diseases, in particular, have become more prevalent among the population. According to its scope, such infectious diseases are called pandemics, epidemics. Among the peoples of Central Asia, a number of diseases, such as plague, malaria, tuberculosis, and rickets, have caused partial or mass extermination. The characteristics of the geographical distribution of these diseases depended largely on the natural and social geographical conditions of the regions, the lifestyle and traditions of the population [1]. The effects of the Spanish flu pandemic, which has killed nearly 100 million people in the last hundred years among a wide range of diseases, have had an impact on the nosogeographic situation, especially in Europe and the America. Analyzes show that the deterioration of the environment, the endless domination of man over nature, the deterioration of the ecological situation, as well as the spread of related diseases on earth, pose new challenges to medical geography, which studies the causes and patterns.

The rapid development of science and technology, the continuous increase of human impact on nature, and a number of negative changes in the natural environment have a significant impact on human health. Accelerated urbanization is causing problems such as air, water and soil pollution [2,3]. The spread of the 2019 novel coronavirus disease (COVID-19) has engulfed the world with a rapid, unexpected, and far-reaching global crisis. In the study of COVID-19, Geographic Information Systems (GIS) and Remote Sensing (RS) have played an important role in many aspects, especially in the fight against COVID-19 [3]. The development of geographical maps that meet modern requirements and their application in production is of great importance, both theoretically and practically. In this regard, the creation of medical-geographical maps that assess the health of the population and reflect the naturalecological, socio-economic and demographic factors affecting it is an urgent problem [4]. Today, along with the rapid growth of the world’s population, the need to reduce the incidence of disease, especially some of the diseases of its civilization, indicates the need to study not only at the international level, but also at the regional level. The resolution adopted at the 70th session of the United Nations General Assembly reads: It is necessary. ” Therefore, the reduction of mortality, including the reduction of the incidence of diseases, requires the strengthening of related research, further improvement of the regional organization of health care, optimization of the tanatogeographic and nosoecological situation [2].

The Main Purpose of the Study

Based on the analysis and assessment of regional differences in the medical geographical conditions of Jizzakh and Syrdarya regions, the development of a series of maps of the nosodemographic and nosoecological situation, determining the level of negative environmental impact on public health, as well as substantiation of recommendations for sustainable development.

The Task of the Study

Study of the main factors influencing the nosoecological situation in the cities of the region, identification and assessment of the nosogeographic situation related to the health of the population in the regions; based on the analysis of the regional composition of the population, the development of scientific and practical recommendations to improve the medical geographical location of the regions. assessment of natural, socio-economic geographical factors affecting the health of the population; Analysis of changes in mortality and morbidity within the districts of Jizzakh and Syrdarya regions; to identify the main problems in the nosogeographic situation of the region and to predict the disease groups and types present in the population.

The Degree to which the Research Problem has been Studied

Medical geographic studies, including morbidity rates and the regional composition of diseases, have been studied by scientists from the former Soviet Union and the current CIS countries. Among them are, first of all, D.K.Zabolotny, E.N.Pavlovsky, A.A.Shoshin, A.V.Chaklin, A.P.Avtsyn, E.I.Ignatev, B.B.Prokhorov, E.L. Reich, V.P.Podolyan, A.A.Keller, A.G.Voronov can be included. Each of the above-mentioned scientists has contributed to the development of this or that branch of medical geography. In particular, on theoretical issues of medical geography AA Shoshin, D.K. Zabolotny, E.L. Reich; Scientific research on medical geographical zoning was carried out by B.B. Prokhorov, V.P. Podolyan, E.I. Ignatev, A.G. Voronov. As the founder of oncogeography, A.V. Chaklin, A.P. EN Pavlovsky laid the foundation for the doctrine of foci of infectious diseases that occur in certain landscapes. Geographers of Moscow State University have created many works on medical cartography, medical geography, cartographic developments, geographical atlases. In one of these atlases [5]:

a. Determine the spectrum of the most diagnosed natural focal diseases observed over the past 15 years at the level of the subjects of the Russian Federation and the country as a whole;

b. Quantify disease morbidity in both absolute and relative terms;

c. Forecast incidence based on the types of dynamics of disease incidence using mathematical-cartographic modeling for the current natural focal diseases;

d. Identify the most visual ways of cartographic representation of the dynamics of disease incidence;

e. Carry out medical and geographic analysis of the territory for the spread of the basic nosoforms of natural focal diseases in the regions of the Russian Federation and in the territory of Russia as a whole.

Taken together, the maps allow assessing the persistence in the manifestation of the diseases and the degree of specific diseases spread risk of the territories. The results of analysis can be used for the purposes of health monitoring and targeted preventive measures, especially in the areas of new development and the areas affected by the recreational load. Among foreign scientists, J. May and others also played an important role in the development of medical geography [6]. It was noted that the main purpose of the proposed project is to develop a series of maps of the nosodemographic and nosoecological situation based on the analysis and assessment of regional differences in the medical geography of Uzbekistan, to determine the impact of environmental factors on public health, as well as recommendations for sustainable development. Scientists from Russia, the United States, Britain, Japan, Ukraine and other countries have made significant progress in this area. Research on the creation, study and application of medical maps is being carried out at Moscow State University (Russia), the University of California (USA), Oxford University (England) and the University of Tokyo (Japan).

In many countries around the world, a lot of attention is paid to a number of priority areas of medical geography, including research to determine the impact of climatic and geographical conditions on public health and the creation of medical and geographical maps. including: developed methods for monitoring the impact of climate on human health, developed nosogeographic maps of natural foci of the world’s leading diseases (University of North Carolina); theoretical issues of medical ecology and human ecology were identified (Harvard University); alternative options for improving the quality of the health care system have been developed. The main purpose of the work is to develop a series of maps on the nosodemographic and nosoecological situation based on the analysis and assessment of regional differences in the nosoecological conditions of Jizzakh and Syrdarya regions, to determine the level of impact of environmental factors on public health, as well as recommendations for sustainable development. To do this, it is necessary to solve the following pressing problems: Collect data not only on administrative units, but also on altitude zones, specific natural geographical objects with special natural conditions.

In addition to statistical materials specific to the regions, the results of analysis of water, soil samples, field research, sociological surveys were used. Based on the results, nosogeographic maps of regions, districts, as well as individual settlements were developed. At the end of the study, a medical geographical atlas of Jizzakh and Syrdarya regions is planned. Also, based on the assessment of natural, socio-economic factors affecting the nosogeographic situation in the region, problems related to public health were studied and recommendations for their solution were developed; epidemiological foci of some infectious diseases related to farm specialization and epizootic conditions were identified; regions were assessed for mortality and divided into tanotogeographic groups; the forecast of the dynamics of mortality and life expectancy and the future state of their indicators were analyzed; Differences in mortality and morbidity by age groups in different natural and economic zones of the region, i.e., in areas specializing in irrigated agriculture, desert-pastoral livestock, mountain-pastoral livestock, were identified [7].

The Final Result Obtaine

Taking into account the non-climatic features of the region, as well as a guide reflecting the seasonal changes in the atmosphere. A medical geographical atlas of Jizzakh and Syrdarya regions and an electronic platform have been created. This development is different from its analogues. Because it contains about 50 special medical cards, developed in sequence on specific topics. In addition to the maps of a complex nature, the Atlas provided by us includes maps dedicated to the types and groups of natural-ecological, social diseases, as well as maps of the history of diseases.

Conclusion

The study carried out natural-geographical monitoring based on the analysis and assessment of the natural-ecological and socio-economic-social geographical conditions of Jizzakh and Syrdarya regions in terms of public health. In order to study the geo-ecological and epidemiological situation in the districts, as well as recreational resources, especially balneological resources in the selected medical geographical areas were assessed; seasonal aspects of diseases, non-climatic changes in connection with the change of seasons, some types of diseases in relation to the location of the population in the highlands, differences in life expectancy, morbidity of certain disease groups (cardiovascular, respiratory, allergic) medium- and long-term forecasts have been developed to identify cases.

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