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Haque U, Bukhari MH, Fiedler N, Wang S, Korzh O, Espinoza J, Ahmad M, Holovanova I, Chumachenko T, Marchak O, Chumachenko D, Ulvi O, Sikder I, Hubenko H, Barrett ES. A Comparison of Ukrainian Hospital Services and Functions Before and During the Russia-Ukraine War. JAMA HEALTH FORUM 2024; 5:e240901. [PMID: 38758566 PMCID: PMC11102023 DOI: 10.1001/jamahealthforum.2024.0901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/14/2024] [Indexed: 05/18/2024] Open
Abstract
Importance Since the full-scale Russian invasion, hospitals in Ukraine have been compelled to close or operate at reduced capacity due to inadequate supplies, damage, or destruction caused by war. Objective To analyze hospital services in Ukraine during the period before and after the Russian invasion. Design, Setting, and Participants Of the 450 hospitals currently functioning in Ukraine, a cross-sectional survey was carried out with the participation of 74 hospitals from 12 oblasts. Hospital administrators responded to an online survey with questions on the use of hospital services. Data were abstracted from hospital databases for the prewar period (before February 23, 2022) and during the war (February 23, 2022, to May 30, 2023). Main Outcomes and Measures Hospital services (including emergency services, preventive services, screenings, laboratory tests, obstetrics, telehealth, pharmacy, and rehabilitation services) were compared during the prewar and war periods. Results Of 450 Ukrainian hospitals in operation, 74 hospitals (16.0%) across 12 oblasts provided data for the current analyses. During the war, daily emergency admissions increased to 2830, compared with 2773 before the war. At the same time, hospitals reported reduced laboratory testing (72 [97%] vs 63 [85%]), tobacco education (52 [70%] vs 36 [49%]), cancer screening (49 [66%] vs 37 [50%]), gynecological services (43 [58%] vs 32 [43%]), rehabilitation services (37 [50%] vs 27 [36%]), pharmacy services (36 [49%] vs 27 [36%]), and telehealth programs (33 [45%] vs 21 [28%]). Hospitals reported additional difficulties during the war, including disruptions in the supply chain for essential equipment and pharmaceuticals, shortages of laboratory test kits, delays in the delivery of crucial medications, and problems around appropriate medication storage due to power outages. Conclusions and Relevance The ongoing war has inflicted profound devastation on Ukraine's hospitals. The findings of this cross-sectional survey offer valuable insights into the formidable challenges that hospitals confront in war-affected regions and underscore the pressing necessity for bolstering support to sustain and enhance hospital services during wartime.
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Affiliation(s)
- Ubydul Haque
- Rutgers Global Health Institute, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, New Jersey
| | | | - Nancy Fiedler
- Department of Environmental and Occupational Health and Justice, School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Shanshan Wang
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth
| | - Oleksii Korzh
- Department of General Practice—Family Medicine, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Juan Espinoza
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Miraj Ahmad
- Cell Biology & Neuroscience, School of Arts and Sciences, Rutgers University, Piscataway, New Jersey
| | | | - Tetyana Chumachenko
- Epidemiology Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Olga Marchak
- Overseas Council–United World Mission, Rivne, Ukraine
| | - Dmytro Chumachenko
- Mathematical Modelling and Artificial Intelligence Department, National Aerospace University, Kharkiv Aviation Institute, Kharkiv, Ukraine
| | | | - Ifthekar Sikder
- Department of Information System, Cleveland State University, Cleveland, Ohio
| | - Hanna Hubenko
- Department of Public Health, Sumy State University, Sumy, Ukraine
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, New Jersey
- Department of Environmental and Occupational Health and Justice, School of Public Health, Rutgers University, Piscataway, New Jersey
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Deac AA, Zaviryukha I, Zeziulin O, Peycheva A, Solórzano de Souza R, Skipper H, Abubakar A, Gustilo VB, Shenoi SV, Thornicroft G, Rozanova J. Ukrainian healthcare providers under siege during the first year of war: challenges and adaptations. BJPsych Int 2024; 21:35-37. [PMID: 38693956 PMCID: PMC11035963 DOI: 10.1192/bji.2023.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/05/2023] [Accepted: 12/18/2023] [Indexed: 05/03/2024] Open
Abstract
The overlapping COVID-19 crisis and the war starting in 2022 threaten front-line healthcare workers' mental health, well-being and job retention in Ukraine. This paper provides a synopsis of a panel discussion held by the Global Mental Health Humanitarian Coalition in May 2022 and expert consultations with clinicians between December 2022 and February 2023 on these challenges. The crises created new problems and exacerbated many pre-existing difficulties. We found that healthcare workers had needed to mobilise previously untapped strengths, including portable emergency medical documents and bespoke local psychosocial support services, amid the costs and pressures of ongoing healthcare reforms.
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Affiliation(s)
- Alexandra A Deac
- MSc, Research Affiliate, Department of Health Service and Population Research Department, King's College London, London, UK
| | - Irina Zaviryukha
- MD, Researcher, European Institute of Public Health Policy, Kyiv, Ukraine
| | - Oleksandr Zeziulin
- MPhil, Senior Researcher, European Institute of Public Health Policy, Kyiv, Ukraine
| | - Anna Peycheva
- MSc, Research Affiliate, Department of Health Service and Population Research Department, King's College London, London, UK
| | - Renata Solórzano de Souza
- MSc, Student, Department of Health Service and Population Research Department, King's College London, London, UK
| | - Harry Skipper
- MSc, Student, Department of Psychological Medicine, King's College London, London, UK
| | - Asmau Abubakar
- MSc, Student, Department of Health Service and Population Research Department, King's College London, London, UK
| | - V Benjamin Gustilo
- MSc, Student, Department of Psychological Medicine, King's College London, London, UK
| | - Sheela V Shenoi
- MPH, Associate Professor of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Graham Thornicroft
- PhD, Professor of Community Psychiatry, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Julia Rozanova
- PhD, Lecturer in Global Mental Health, Department of Health Service and Population Research Department, King's College London, London, UK. Email
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Dmitrieva A, Stepanov V, Titar I. (e)Managing the uncertainty of tuberculosis in the post-Soviet limbo: Tracking prisoners' coerced mobility for treatment in Ukrainian prisons. Soc Sci Med 2024; 349:116894. [PMID: 38648708 DOI: 10.1016/j.socscimed.2024.116894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
The collapse of the Soviet Union triggered an escalation of the tuberculosis (TB) epidemic in many post-Soviet countries, including Ukraine. The main reasons for this situation include both the approach to TB care and the concentration of TB cases in prisons. The neoliberal approach to TB care system reform promises the optimization of treatment terms, "dehospitalization" and "despecialization" of the system of care, and a different type of control, established through digital technologies. One such technology is the "e-TB Manager", which was designated as a national TB registry, including in the prison system in 2012. In prison, where everyone "is to be fixed" and isolated, the uncertainty of patients' movements seems to be avoided by pre-existing conditions. In practice, however, the vertically aligned, centralized organizational structure of the post-Soviet prison implies a constant need to link its elements together through "coerced" mobility carried out in secrecy. Treatment in exile may not be the primary goal of such a practice, but it becomes the result when prisoners from numerous prison facilities are sent to a limited number of prison TB hospitals. The integration of the e-TB Manager as a tool to enable the tracking of patient movements and, consequently, improve the efficiency of diagnostic and treatment processes in prison, can be seen as both a purely technical measure and a "magic bullet". In this article, we argue that, in the case of Ukrainian prisons, the neoliberal approach and the Soviet socialist approach to gaining control over TB indeed adapt and reinforce each other but fail to compete meaningfully. The fragmented implementation of one is absorbed by the fundamental and resilient nature of the other to produce and reproduce the state of "post-Soviet limbo". We use the "post-Soviet limbo" as an overall framework aimed at conceptualizing the post-Soviet transformation as a combination of efforts to avoid and manage the uncertainty of TB treatment, especially in prison. We examine the empirical case of coerced mobility of prisoners who require TB treatment, seeking to trace how this process is reflected in the e-TB Manager. We provide a more in-depth picture of this journey with details gathered from qualitative research materials to situate numbers and variables in their contexts, deconstructing the way the data are recorded according to the logic of the system in which they are produced.
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Affiliation(s)
- Alexandra Dmitrieva
- University of Haifa, Faculty of Law, 199 Aba Khoushy Ave, Haifa, 3448620, Israel; Support, Research and Development Center, Institutskaya Street 13/4, Kyiv, 01021, Ukraine.
| | - Vladimir Stepanov
- Support, Research and Development Center, Institutskaya Street 13/4, Kyiv, 01021, Ukraine; National University Kyiv-Mohyla Academy, Skovorody Street 2, Kyiv, 04655, Ukraine; Ben-Gurion University of the Negev, Beer Sheva blvd 1, Beer Sheva, 84105, Israel.
| | - Ivan Titar
- Public Health Center of the Ministry of Health of Ukraine, Yaroslavska St, 41, Kyiv, 04071, Ukraine.
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4
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Fel S, Jurek K, Lenart-Kłoś K. The relationship between socio-demographic factors and depression: a cross sectional study among civilian participants in hostilities in Ukraine. Sci Rep 2023; 13:21897. [PMID: 38082045 PMCID: PMC10713780 DOI: 10.1038/s41598-023-49289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
There is still a gap in scientific knowledge in relation to civilian participants in hostilities. This is despite the fact that there is an extensive body of literature on major depressive disorder (MDD) in individuals who have experienced armed conflict. The purpose of this article is to identify socio-demographic factors which are related to levels of depression among civilian participants in the war in Ukraine, based on a cross-sectional study that was conducted in 2019 from a convenience sample of 314 Ukrainian adults (235 males). Depression was assessed via the Beck Depression Inventory. Multiple regression analyses were conducted to identify possible predictors of depression. Significant predictors were: loss of a loved one, place of residence, age, health insurance, financial situation, and marital status (F (6, 224) = 10.515, p < 0.001, R2 = 0.21; Adjusted R2 = 0.19). They also show that symptoms of depression resulting from the loss of a loved one due to war can be reduced through participation in an educational system. Having children is associated with a risk of more severe depression. Specialists are encouraged to engage in face-to-face interviews and to maintain a supportive and safe environment for participants in hostilities, e.g., in the area of education.
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Affiliation(s)
- Stanisław Fel
- The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Krzysztof Jurek
- The John Paul II Catholic University of Lublin, Lublin, Poland.
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5
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Anufriyeva V, Pavlova M, Chernysh Stepurko T, Groot W. Satisfaction with primary health care in Ukraine in 2016-2020: A difference-in-differences analysis on repeated cross-sectional data. Health Policy 2023; 137:104916. [PMID: 37734208 DOI: 10.1016/j.healthpol.2023.104916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
The aim of this study is to examine the general satisfaction with primary health care services in Ukraine among service users and nonusers before and after the implementation of the capitation reform in 2017-2020. Data from a repeated cross-sectional household survey 'Health Index. Ukraine' in 2016-2020 were used. The survey had a sample size of over 10 000 participants per survey round. Effects were estimated using difference-in-differences methods based on matched samples. Our findings show that in general, respondents are 'rather satisfied' with the services of district/family doctors and pediatricians. Satisfaction with family doctors comprised 72.1 % (users) and 69.2 % (nonusers) in 2016; and 75.3 % and 71.9 % in 2020. For pediatrician services, these shares were 73.6 % (users) and 71.1 % (nonusers) in 2016; 74.7 % and 70.2 % in 2020. Our study also revealed an increase in satisfaction with the district/family doctor over time. However, this does not seem to be due to the reform. The results for pediatrician services were mixed. Why satisfaction with primary care is fairly high and slightly increasing over time is unclear. However, we offer several possible explanations, such as low expectations of primary health care, subjective perception of quality of health care services, improved access and affordability, and general improvements in primary health care settings not directly linked to the reform.
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Affiliation(s)
- Valentyna Anufriyeva
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. P.O. Box 616, 6200 MD Maastricht, the Netherlands; Ukrainian-Swiss project 'Medical Education Development', Swiss Tropical and Public Health Institute, Ukraine, Liuteranska street 6-b, apt. 43, Kyiv, 01001, Ukraine.
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Tetiana Chernysh Stepurko
- Ukrainian-Swiss project 'Medical Education Development', Swiss Tropical and Public Health Institute, Ukraine, Liuteranska street 6-b, apt. 43, Kyiv, 01001, Ukraine; Department of sociology, National University of Kyiv-Mohyla Academy, Ukraine, Skovorody 2, Kyiv, 04655, Ukraine
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. P.O. Box 616, 6200 MD Maastricht, the Netherlands; Top Institute Evidence-Based Education Research (TIER), Maastricht University, the Netherlands, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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6
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Deac AA, Zaviryukha I, Rozanova J, Zeziulin O, Kiriazova T, Shenoi S, Peycheva A, de Souza RS, Skipper H, Abubakar AA, Gustilo VB, Thornicroft G, Dellamura P, Rich KM, Earnshaw V, Bromberg DJ, Mamedova E, Yariy V. Treatment System Adaptations during War: Lessons from Ukrainian Addiction Treatment Providers. Subst Use Misuse 2023; 58:1447-1450. [PMID: 37317994 PMCID: PMC10527686 DOI: 10.1080/10826084.2023.2212377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: The war in Ukraine has posed significant challenges to the healthcare system. This paper draws upon expert consultations, held between December 2022 and February 2023, focused on HIV/AIDS, addiction, and mental health service delivery during the first year of this war, and following the Global Mental Health Humanitarian Coalition panel discussion in May 2022. Objectives: This commentary presents the experiences of frontline healthcare workers in Ukraine, challenges, and local adaptations to meet the increased mental health needs of healthcare providers. We aimed to document the adaptations made in the addiction healthcare system and to acknowledge the changes in vulnerabilities and lessons learned. Results: Burnout among healthcare providers delivering addiction, HIV/AIDS and mental health services became more visible after the second half of 2022. Challenges included increased workload, contextual threats, lack of job relocation strategies, and money-follow-the-patient policies. Recommendations: The lessons from the first year of war in Ukraine hold significant generalizability to other contexts. These include enabling bottom-up approaches to tailoring services and allowing healthcare providers to respond to the dynamics of war in an effective and active manner. Other recommendations include departmental-specific resources and strategies, particularly as vulnerable groups and challenges are unstable in humanitarian contexts. Conclusions: Globally and in Ukraine, healthcare workers need more than applause. Along with monetary incentives, other strategies to prevent burnout, ensure sustainable capacity building, job relocation opportunities, and bespoke adaptations are imperative to protect healthcare providers' wellbeing and overall public health.
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Affiliation(s)
- Alexandra A. Deac
- Department of Health Service and Population Research, King’s College London, London SE5 8AF, UK
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA
| | | | - Julia Rozanova
- Department of Health Service and Population Research, King’s College London, London SE5 8AF, UK
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA
- Centre for Interdisciplinary Research on AIDS (CIRA), Yale University School of Public Health, New Haven, CT 06510, USA
| | | | | | - Sheela Shenoi
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA
- Centre for Interdisciplinary Research on AIDS (CIRA), Yale University School of Public Health, New Haven, CT 06510, USA
| | - Anna Peycheva
- Department of Health Service and Population Research, King’s College London, London SE5 8AF, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Renata Solórzano de Souza
- Department of Health Service and Population Research, King’s College London, London SE5 8AF, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Harry Skipper
- Department of Psychological Medicine, King’s College London, London SE5 8AF, UK
| | - Asmau A. Abubakar
- Department of Health Service and Population Research, King’s College London, London SE5 8AF, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - V. Benjamin Gustilo
- Department of Psychological Medicine, King’s College London, London SE5 8AF, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Paula Dellamura
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA
| | | | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Daniel J. Bromberg
- Centre for Interdisciplinary Research on AIDS (CIRA), Yale University School of Public Health, New Haven, CT 06510, USA
| | | | - Volodymyr Yariy
- Kyiv City Addiction Treatment Clinic “Sociotherapy”, Kyiv, Ukraine
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7
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Niven AS, Skomro RP, Dziuba D, Gajic O. Supporting Health Care Workers During the Armed Conflict in Ukraine. Chest 2023; 163:1365-1367. [PMID: 37295880 DOI: 10.1016/j.chest.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 06/12/2023] Open
Affiliation(s)
- Alexander S Niven
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Robert P Skomro
- Department of Medicine, Division of Respiratory, Critical Care, and Sleep Medicine, RUH, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dmytro Dziuba
- Department of Anesthesiology and Intensive Care, Shupyk University of Public Health of Ukraine, Kyiv, Ukraine
| | - Ognjen Gajic
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Erickson TB, Harvin D, Schmid A, Loevinsohn G, Poriechna A, Martyshyn O, Kliukach K, Sydlowski M, Strong J, Kivlehan SM. Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War. Disaster Med Public Health Prep 2023; 17:e387. [PMID: 37157855 PMCID: PMC10171778 DOI: 10.1017/dmp.2023.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the change in knowledge and skill confidence after implementation of a chemical, biological, radiological, nuclear, and explosive (CBRNE) training course during the Russia-Ukraine War. METHODS Pre/post-test study in the Ukrainian cities of Kyiv, Dnipro, Zaporizhzhia, and Odesa. Fifteen CBRNE courses were conducted over a 3-mo period, August to October 2022. Change in knowledge and skills confidence were evaluated with pre/post-course written exams and practical skill assessments that were observed during the training exercises. Changes were analyzed based on nonparametric Wilcoxon matched-pairs signed-rank testing. Pre/post self-efficacy surveys were analyzed with McNemar's test for paired data. Course evaluations were conducted with standardized questions which assessed instruction quality, teaching relevance, knowledge gained, and post-course skills confidence. RESULTS A total of 523 participants registered and completed 1 of the 15 courses. Overall mean pre-course test score: 57.8% (SD 20.7%); mean post-course test score: 81.4% (SD 11.3%); participants with increasing test scores: 90.7%; mean difference in score (95% confidence interval) 23.6% (21.2%-25.9%), P < 0.0001. Pre/post self-efficacy surveys (4-point Likert scale) noted participants recognized signs and symptoms of a CBRNE incident, and necessary skills to manage CBRNE exposures, P < 0.0001. CONCLUSIONS The implementation of this CBRNE course for front-line providers in Ukraine was successful. To our knowledge, it was the first implementation of a field course during the current Russian-Ukraine war. Future research should evaluate knowledge retention and impact of our innovative Train-the-Trainer model. Further iterations should emphasize expanding the quantity of training equipment and practical skill sessions.
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Affiliation(s)
- Timothy B. Erickson
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
| | - Donell Harvin
- Rand Corporation, Homeland Security Operational Analysis Center and Georgetown University, Applied Intelligence and Emergency and Disaster Management Program, Washington, D.C
| | - Alexis Schmid
- Boston Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Global Health Program, Boston, MA
| | - Gideon Loevinsohn
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Jonathan Strong
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
| | - Sean M. Kivlehan
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
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Nigussie K, Tesfaye D, Bete T, Asfaw H. Perceived stigma, common mental disorders and associated factors among primary caregivers of adult patients with mental illness attending at public hospitals, Harari regional state, Eastern Ethiopia: A multicenter cross-sectional study. Front Public Health 2023; 11:1024228. [PMID: 36935723 PMCID: PMC10017855 DOI: 10.3389/fpubh.2023.1024228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Background Giving care to someone who is experiencing mental distress is a difficult and challenging task that could be detrimental to the caregiver's overall quality of life. Numerous studies show that caregivers frequently experience mental distress and feel stigmatized. However, there is limited study done on this topic in our country. Objective To determine the magnitude and associated factors of perceived stigma and common mental disorder among primary caregivers of adults with mental illness in public hospitals at Harari regional state, Eastern Ethiopia, 2022. Methods A cross-sectional study design was conducted. A total of 419 participants were recruited by a systematic random sampling technique. The data was collected by using a face-to-face interview and by reviewing patients' charts. Perceived stigma and common mental disorder were assessed by Family Interview Schedule and Self-Reporting Questionnaire, respectively. Epi-data version 4.6.2 was used to enter data, and SPSS version 20 was used to analyze. Bivariable and multivariable logistic regression were performed. P-values < 0.05 were considered statistically significant. Result The magnitude of perceived stigma and common mental disorder were 42.5% (95% CI, 37.7-47.3) and 39.4% (95% CI, 34.8-44.0) respectively. Age of caregiver between 26 and 33 [AOR = 3.13, 95% CI: (1.71-8.93)], no formal education [AOR = 3.85, 95% CI: (1.81-8.15)], illness duration ≥7 years [AOR = 1.93, 95% CI: (1.04-3.57)], family history of mental illness [AOR = 1.92, 95% CI: (1.09-3.39)] and poor social support [AOR = 4.87, 95% CI: (3.74-12.71)] were significantly associated with perceived stigma. Being female [AOR = 1.92, 95% CI: (1.31-3.34)], having no formal education [AOR = 4.04, 95% CI: (2.15-10.01)], having a family history of mental illness [AOR = 2.26, 95% CI: (1.29-4.00)], having comorbid other illness [AOR = 2.13, 95% CI: (1.15-3.94)], and having poor social support [AOR = 4.58, 95% CI: (2.53-8.28)] were significantly associated with common mental disorder. Conclusion The magnitude of perceived stigma and common mental disorder was high among primary caregivers of patients with mental illness compared with other studies. Age of caregiver between 26 and 33, no formal education, duration of illness ≥7 years, family history of mental illness and poor social support were associated with perceived stigma and being female, no formal education, family history of mental illness, comorbid other illness and poor social support were associated with common mental disorder.
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Affiliation(s)
- Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | | | | | - Henock Asfaw
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Jiang A, Ulrich R, Van De Griend K, Tintle N, McCarthy M, Beckelhymer DA. Mental health service-seeking behavior in post-Soviet Ukraine. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2023. [DOI: 10.1080/00207411.2023.2177464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Amanda Jiang
- Department of Psychology, Smith College, Northampton, Massachusetts, USA
| | - Rachel Ulrich
- Department of Mathematical Sciences, Montana State University, Bozeman, Montana, USA
| | - Kristin Van De Griend
- Department of Social Work, Dordt University, Sioux Center, Iowa, USA
- Department of Community and Public Health, Idaho State University, Pocatello, USA
| | - Nathan Tintle
- Department of Population Health Nursing Science, College of Nursing, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Mark McCarthy
- Department of History, Dordt University, Sioux Center, Iowa, USA
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11
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Osborne J, Goncharova M, Germanovich M, Koshalko O, Kutalek R, Dückers M, Rodyna R. Locating vaccine uptake and public participation in Ukraine: An exploratory qualitative study on attitudes and barriers to early childhood vaccination. Glob Public Health 2023; 18:2267643. [PMID: 37820044 DOI: 10.1080/17441692.2023.2267643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
A growing body of literature on vaccine hesitancy considers context and the intersecting factors affecting vaccine uptake. This study attempts to add focus to the conversation of vaccines in Ukraine by exploring how vaccines are perceived and how local stakeholders envision solutions to the problems surrounding vaccine uptake. Twenty-five in-depth interviews were carried out among parents of children under 6 years of age as well as health practitioners and other experts in Ukraine. Results were presented to stakeholders during a dialogue session to discuss the implications for policy recommendations. The Roma parents interviewed faced structural barriers to vaccine access, while other groups received vaccine information from others in their communities, such as family members or religious organisations. Mistrust of the health system and lack of access to reliable information preceded many doubts parents expressed surrounding vaccines. Stakeholders agreed that better, more targeted communication strategies are needed, as well as increased engagement with and training of medical practitioners. Qualitative methods allowed for a deeper, more nuanced understanding of the factors contributing to low vaccine uptake, of which vaccine hesitancy is only one part. The vulnerability-informed approach used may have broader applications for community engagement and responding to infectious diseases and crises.
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Affiliation(s)
- Jacob Osborne
- Nivel - Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Faculty of Social and Behavioural Sciences, University of Groningen, Groningen, The Netherlands
| | - Maria Goncharova
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | | | - Oksana Koshalko
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Michel Dückers
- Nivel - Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Faculty of Social and Behavioural Sciences, University of Groningen, Groningen, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
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12
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Anufriyeva V, Pavlova M, Stepurko T, Groot W. The perception of outpatient care quality by healthcare users in Ukraine. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2141685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Valentyna Anufriyeva
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Ukrainian-Swiss Project ‘Medical Education Development’, Swiss Tropical and Public Health Institute, Ukraine
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tetiana Stepurko
- Ukrainian-Swiss Project ‘Medical Education Development’, Swiss Tropical and Public Health Institute, Ukraine
- Department of Sociology, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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13
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Haque U, Naeem A, Wang S, Espinoza J, Holovanova I, Gutor T, Bazyka D, Galindo R, Sharma S, Kaidashev IP, Chumachenko D, Linnikov S, Annan E, Lubinda J, Korol N, Bazyka K, Zhyvotovska L, Zimenkovsky A, Nguyen USDT. The human toll and humanitarian crisis of the Russia-Ukraine war: the first 162 days. BMJ Glob Health 2022; 7:bmjgh-2022-009550. [PMID: 36167408 PMCID: PMC9511605 DOI: 10.1136/bmjgh-2022-009550] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We examined the human toll and subsequent humanitarian crisis resulting from the Russian invasion of Ukraine, which began on 24 February 2022. METHOD We extracted and analysed data resulting from Russian military attacks on Ukrainians between 24 February and 4 August 2022. The data tracked direct deaths and injuries, damage to healthcare infrastructure and the impact on health, the destruction of residences, infrastructure, communication systems, and utility services - all of which disrupted the lives of Ukrainians. RESULTS As of 4 August 2022, 5552 civilians were killed outright and 8513 injured in Ukraine as a result of Russian attacks. Local officials estimate as many as 24 328 people were also killed in mass atrocities, with Mariupol being the largest (n=22 000) such example. Aside from wide swaths of homes, schools, roads, and bridges destroyed, hospitals and health facilities from 21 cities across Ukraine came under attack. The disruption to water, gas, electricity, and internet services also extended to affect supplies of medications and other supplies owing to destroyed facilities or production that ceased due to the war. The data also show that Ukraine saw an increase in cases of HIV/AIDS, tuberculosis, and Coronavirus (COVID-19). CONCLUSIONS The 2022 Russia-Ukraine War not only resulted in deaths and injuries but also impacted the lives and safety of Ukrainians through destruction of healthcare facilities and disrupted delivery of healthcare and supplies. The war is an ongoing humanitarian crisis given the continuing destruction of infrastructure and services that directly impact the well-being of human lives. The devastation, trauma and human cost of war will impact generations of Ukrainians to come.
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Affiliation(s)
- Ubydul Haque
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Amna Naeem
- Department of Statistics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shanshan Wang
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Juan Espinoza
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Taras Gutor
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Dimitry Bazyka
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Rebeca Galindo
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sadikshya Sharma
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MA, USA
| | | | - Dmytro Chumachenko
- Department of mathematical modeling and artificial intelligence, National Aerospace University, Kharkiv, Ukraine
| | - Svyatoslav Linnikov
- Department of health promotion, Odesa Regional Center for Public Health, Odesa, Ukraine
| | - Esther Annan
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | - Natalya Korol
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | | | - Liliia Zhyvotovska
- Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University, Poltava, Ukraine
| | | | - Uyen-Sa D T Nguyen
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
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14
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Welten VM, Dabekaussen KFAA, Melnitchouk N. Global Health 101. Clin Colon Rectal Surg 2022; 35:355-361. [PMID: 36111085 PMCID: PMC9470279 DOI: 10.1055/s-0042-1746184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Global health is an evolving field that has been broadly defined as the promotion of health for all through transnational collaboration and research. It centers on the concepts of equity and collaboration. The focus of global health has recently undergone a major shift toward emphasizing the importance of a systems-based approach to healthcare delivery, which considers not only the target disease but also the many contextual factors, influencing the ability to deliver care equitably to a population to reduce the burden of any particular disease. Thus, an important global health delivery framework has been established to outline this inter- and multi-disciplinary systems-based to address major global health issues and improve health for all globally. The practice of global health, whether in research or in active intervention, necessitates guiding principles to ensure ethical conduct in the transnational partnerships and efforts to advance the field. With the introduction of the United Nations' Sustainable Development Goals in 2015, there has been a major shift in response to epidemiologic transition to focus on reducing the burden of noncommunicable diseases, including cancer, which disproportionately impact low-to-middle income countries. This is true for colorectal cancer, with care challenged by significant gaps in screening, early detection, and referral systems.
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Affiliation(s)
- Vanessa M. Welten
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Nelya Melnitchouk
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Caglevic C, Rolfo C, Gil-Bazo I, Cardona A, Sapunar J, Hirsch FR, Gandara DR, Morgan G, Novello S, Garassino MC, Mountzios G, Leighl NB, Bretel D, Arrieta O, Addeo A, Liu SV, Corrales L, Subbiah V, Aboitiz F, Villarroel-Espindola F, Reyes-Cosmelli F, Morales R, Mahave M, Raez L, Alatorre J, Santos E, Ubillos L, Tan DS, Zielinski C. The Armed Conflict and the Impact on Patients With Cancer in Ukraine: Urgent Considerations. JCO Glob Oncol 2022; 8:e2200123. [PMID: 35994695 PMCID: PMC9470147 DOI: 10.1200/go.22.00123] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
On February 24, 2022, a war began within the Ukrainian borders. At least 3.0 million Ukrainian inhabitants have already fled the country. Critical infrastructure, including hospitals, has been damaged. Children with cancer were urgently transported to foreign countries, in an effort to minimize interruption of their life-saving treatments. Most adults did not have that option. War breeds cancer—delaying diagnosis, preventing treatment, and increasing risk. We project that a modest delay in care of only 4 months for five prevalent types of cancer will lead to an excess of over 3,600 cancer deaths in the subsequent years. It is critical that we establish plans to mitigate that risk as soon as possible. Ukraine conflict may cost 3600 lives or more because of a delay and lack of access for patients with cancer.![]()
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Affiliation(s)
- Christian Caglevic
- Cancer Research Department, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
- Clinical Trials Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Christian Rolfo
- Clinical Research Center for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Andrés Cardona
- Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center—CTIC, ONCOLGroup/FICMAC, Bogota, Colombia
| | - Jorge Sapunar
- Cancer Research Department, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Fred R. Hirsch
- Center for Thoracic Oncology. Mount Sinai Cancer, Mount Sinai Health System, Icahn School of Medicine, Joe Lowe and Louis Price Professor of Medicine, Tisch Cancer Institute, New York, NY
| | - David R. Gandara
- Center for Experimental Therapeutics in Cancer, UC Davis Comprehensive Cancer Center, Translational and Clinical Research Program, University of Hawaii Cancer Center, International Society of Liquid Biopsy, Sacramento, CA
| | - Gilberto Morgan
- Skåne University Hospital, Department of Oncology, Lund, Sweden
| | - Silvia Novello
- Oncology Department, AOU San Luigi, University of Turin, Turin, Italy
| | | | - Giannis Mountzios
- 4th Oncology Department and Clinical Trials Unit Henry Dunant Hospital Center, Athens, Greece
| | - Natasha B. Leighl
- Medical Oncology Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, IHPME, Dalla Lana School of Public Health, Toronto, Canada
| | | | - Oscar Arrieta
- Toracic Oncology Unit, Instituto Nacional de Cancerologia de Mexico, Mexico City, Mexico
| | - Alfredo Addeo
- Oncology department, University Hospital Geneva, Geneva, Switzerland
| | - Stephen V. Liu
- Lombardi Comprehensive Cancer Center of Georgetown University, Washington, DC
| | - Luis Corrales
- Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, Medical Oncology Research, MD Anderson Cancer Network, Clinical Center For Targeted Therapy, Division of Pediatrics UT MD Anderson Cancer Center, Houston, TX
| | - Francisco Aboitiz
- Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | | | - Felipe Reyes-Cosmelli
- Clinical Trials Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Ricardo Morales
- Cancer Research Department, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
- Clinical Trials Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Mauricio Mahave
- Cancer Research Department, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
- Clinical Trials Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Luis Raez
- Memorial Cancer Institute/Memorial Health Care System, MCIFAU Florida Cancer Center of Excellence, Florida International University, Miami, FL
| | - Jorge Alatorre
- Instituto Nacional de Enfermedades Respiratorias (INER) Clínica de Oncología Torácica, México D.F., Mexico
| | - Edgardo Santos
- Florida Precision Oncology/a Division of Genesis Care USA, Research Services Thoracic and Head/Neck Cancer Programs Clinical, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Luis Ubillos
- Instituto Nacional del Cancer, Montevideo, Uruguay
| | - Daniel S.W. Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Christoph Zielinski
- Central European Cancer Center, Wiener Privatklinik, Vienna, and Central European Cooperative Oncology Group, HQ, Vienna, Austria
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16
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Welten VM, Wanis KN, Semeniv S, Shabat G, Dabekaussen KFAA, Davids JS, Beznosenko A, Suprun U, Soeteman DI, Melnitchouk N. Colonoscopy Needs for Implementation of a Colorectal Cancer Screening Program in Ukraine. World J Surg 2022; 46:2476-2486. [PMID: 35835863 DOI: 10.1007/s00268-022-06656-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Ukraine, there is no established colorectal cancer screening program. We aimed to project the number of screening colonoscopies needed for implementation of various CRC screening strategies in Ukraine. METHODS We modified a previously developed Markov microsimulation model to reflect the natural history of adenoma and CRC progression among average-risk 50-74-year-olds. We simulated colonoscopies needed for the following screening strategies: no screening, fecal occult blood test yearly, FOBT yearly with flexible sigmoidoscopy every 5 years, FS every 5 years, fecal immunohistochemistry test (FIT) yearly, or colonoscopy every 10 years. Assuming 80% screening adherence, we estimated colonoscopies required at 1 and 5 years depending on the implementation rate. In one-way sensitivity analyses, we varied implementation rate, screening adherence, sensitivity, and specificity. RESULTS Assuming an 80% screening adherence and complete implementation (100%), besides a no screening strategy, the fewest screening colonoscopies are needed with an FOBT program, requiring on average 6,600 and 26,800 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. The most screening colonoscopies are required with a colonoscopy program, requiring on average 76,600 and 101,000 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. In sensitivity analyses, the biggest driver of number of colonoscopies needed was screening adherence. CONCLUSIONS The number of colonoscopies needed and therefore the potential strain on the healthcare system vary substantially by screening test. These findings can provide valuable information for stakeholders on equipment needs when implementing a national screening program in Ukraine.
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Affiliation(s)
- Vanessa M Welten
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Kerollos Nashat Wanis
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Galyna Shabat
- Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Kirsten F A A Dabekaussen
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jennifer S Davids
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | | | | | - Djøra I Soeteman
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nelya Melnitchouk
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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17
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Anufriyeva V, Pavlova M, Stepurko T, Groot W. The perception of health care quality by primary health care managers in Ukraine. BMC Health Serv Res 2022; 22:895. [PMID: 35810293 PMCID: PMC9271244 DOI: 10.1186/s12913-022-08300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Ukraine is reforming its health care system to improve quality of health care. Insight into how primary health care managers perceive quality is important for the ongoing reform as well as for the improvement of medical services. Methods An online survey was conducted as part of the Ukrainian-Swiss project “Medical Educational Development” in April–May 2019 based on the contact list of USAID project “Health Reform Support”, and additionally on the database of the National Health Service of Ukraine and other channels. Data were analyzed using descriptive statistics and qualitative data analysis. Results In total, 302 health care managers took part in the study. The majority of primary health care managers perceive quality in health care as process quality. They associate quality mostly with compliance to standards. At the same time, primary health care managers prefer to assess outcome quality via a system of indicators and feedback. There appears to be a lack of consensus about health care quality. This may be due to a lack of awareness of the national strategy for better quality of health care service. Conclusions Our study provides new insights into primary care managers' perceptions of health care quality in Ukraine. The absence of a clear consensus about quality complicates the discussion about quality and how to measure quality in health care. This appears to be one of the obstacles to system-wide quality improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08300-y.
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Affiliation(s)
- Valentyna Anufriyeva
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. .,Ukrainian-Swiss Project "Medical Education Development", Swiss Tropical and Public Health Institute, Kyiv, Ukraine.
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tetiana Stepurko
- Ukrainian-Swiss Project "Medical Education Development", Swiss Tropical and Public Health Institute, Kyiv, Ukraine.,Department of Sociology, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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18
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Ludvigsson JF, Loboda A. Systematic review of health and disease in Ukrainian children highlights poor child health and challenges for those treating refugees. Acta Paediatr 2022; 111:1341-1353. [PMID: 35466444 PMCID: PMC9324783 DOI: 10.1111/apa.16370] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 12/24/2022]
Abstract
Aim Millions of Ukrainian children have been internally displaced or fled to other countries because of the Russian war. This systematic review focused on their health needs and future challenges for clinicians. Methods A systematic literature search of the Medline, Embase and MedRxiv databases from 1 January 2010 to 31 March 2022 identified 1628 papers on the health of Ukrainian children and 112 were relevant to this review. Results In 2019, under‐5 mortality was 8 per 1000 live births in Ukraine. Underweight and adverse childhood experiences, including child abuse, were frequent compared to other European countries, while childhood obesity seemed less common. Alcohol consumption was common in women of reproductive age, including during pregnancy, risking foetal alcohol syndrome. Neonatal screening programmes provided low coverage. Vaccine hesitancy was common and vaccination rates were low. Other concerns were measles, HIV, antibiotic resistance and multi‐resistant tuberculosis. Many children are expected to suffer from psychological and physical trauma due to the war. Other healthcare challenges include low COVID‐19 vaccination rates and a preference for secondary and tertiary care, rather than primary care. Many people cannot afford medication. Conclusion Ukrainian children often have poor health and host countries need to be aware of their needs.
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Affiliation(s)
- Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
- Department of Paediatrics Orebro University Hospital Orebro Sweden
- Department of Medicine Columbia University College of Physicians and Surgeons New York New York USA
| | - Andrii Loboda
- Department of Paediatrics, Academic and Research Medical Institute Sumy State University Sumy Ukraine
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19
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Armitage R. War in Ukraine and the inverse care law. THE LANCET REGIONAL HEALTH. EUROPE 2022; 17:100401. [PMID: 35721695 PMCID: PMC9198836 DOI: 10.1016/j.lanepe.2022.100401] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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20
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Affiliation(s)
- Richard Armitage
- Richard is a GP and Public Health Specialty Registrar, and Honorary Assistant Professor at the University of Nottingham's Academic Unit of Population and Lifespan Sciences. He is currently providing primary care to internally displaced people in the east of Ukraine. @drricharmitage
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21
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Vojtek I, Larson H, Plotkin S, Van Damme P. Evolving measles status and immunization policy development in six European countries. Hum Vaccin Immunother 2022; 18:2031776. [PMID: 35180372 PMCID: PMC9009904 DOI: 10.1080/21645515.2022.2031776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Developing and implementing new immunization policies in response to shifting epidemiology is a critical public health component. We adopted a mixed-methods approach (via narrative literature review [101 articles] and 9 semi-structured interviews) to evaluate policy development in response to shifting measles epidemiology in six European countries (Italy, Belgium, Germany, Romania, UK, and Ukraine); where policies and strategies have evolved in response to country-specific disease and vaccination patterns. Periodic outbreaks have occurred in all countries against a background of declining measles-containing-vaccine (MCV) uptake and increasing public vaccine hesitancy (with substantial regional or social differences in measles burden and vaccine uptake). Health-care worker (HCW) vaccine skepticism is also seen. While many outbreaks arise or involve specific susceptible populations (e.g., minority/migrant communities), the broader pattern is spread to the wider (and generally older) population; often among incompletely/non-vaccinated individuals as a legacy of previous low uptake. Immunization policy and strategic responses are influenced by political and social factors, where public mistrust contributes to vaccine hesitancy. A strong centralized immunization framework (allied with effective regional implementation and coherent political commitment) can effectively increase uptake. Mandatory vaccination has increased childhood MCV uptake in Italy, and similar benefits could be anticipated for other countries considering vaccine mandates. Although possible elsewhere, socio-political considerations render mandating impractical in other countries, where targeted immunization activities to bolster routine uptake are more important. Addressing HCW skepticism, knowledge gaps, improving access and increasing public/community engagement and education to address vaccine hesitancy/mistrust (especially in communities with specific unmet needs) is critical.
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Affiliation(s)
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Stanley Plotkin
- University of Pennsylvania School of Medicine, Doylestown, PA, USA.,Vaxconsult, Doylestown, PA, USA
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
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22
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Abstract
UNLABELLED Russian invasion of Ukraine has led to one of the largest refugee crises in recent history. Many internally displaced Ukrainians and refugees will need care for PTSD, anxiety, and depression. Here I will suggest practical steps to reduce long-term impact of trauma and stress on refugees' mental and physical health, and functioning. These include mental health first aid in acute phase of arrival, education of mental health and navigating healthcare system in the host countries. As well, training of manualized trauma-focused therapy and intervention methods in the host countries, focused education for physicians on psychopharmacological interventions for common mental health issues among refugees (PTSD, depression, anxiety), and utilization of videoconferencing for treatment, and consultation and supervision for providers. HIGHLIGHTS Many internally displaced Ukrainians and refugees will need care for PTSD, anxiety, and depression to prevent long-term disability and health consequences.There are challenges in receiving the needed care including stigma, lack of awareness by patients and providers, lack of resources, and lack of skills in trauma-focused treatments.In this article, suggestions are made on how to overcome these obstacles, that include mental health first aid upon arrival, education for refugees and those serving them, training providers at different layers, and remote treatment and counselling/supervision services.
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Affiliation(s)
- Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic (STARC), Wayne State University School of Medicine, Detroit, MI, USA
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23
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Hook K, Bogdanov S. Mental health care in Eastern Europe and Central Asia: An analysis of needs and a call for greater investment. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100182. [PMID: 34806062 PMCID: PMC8589706 DOI: 10.1016/j.lanepe.2021.100182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Over the past decade, there has been increased attention to global mental health, which emphasizes improving access to quality mental health care in order to reduce the worldwide treatment gap. However, Eastern European and Central Asian countries and their specific mental health needs have largely been under-emphasized, evidenced by a dearth in literature and funding. Here, we provide an overview of the mental health needs in Ukraine and its challenges with quality care provision as a key example in highlighting these gaps, then broaden our discussion to include parallels with other countries in the Eastern European and Central Asian region. We describe the unique strengths relative to mental health care provision that are present in Eastern Europe and Central Asia and suggest the importance of post-graduate training, regional collaboration, and capacity building specific to research management as strategies to address the current challenges. We stress that greater investment from funders, government, and the global mental health community are needed to improve the current mental health situation in Ukraine, specifically, and Eastern Europe and Central Asia, broadly. We argue that greater attention to Eastern Europe and Central Asia is needed to fully advance the agenda of the global mental health field.
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Affiliation(s)
- Kimberly Hook
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Corresponding author: Kimberly Hook, 720 Harrison Avenue, Doctors Office Building, Suite 915, Boston, MA 02118, 617.414.1955
| | - Sergiy Bogdanov
- National University of Kyiv-Mohyla Academy, Center for Mental Health and Psychosocial Support, Kyiv, Ukraine
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Allen A, Zaviryukha I, Kiriazova T, Shenoi S, Rozanova J. The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine. QUALITATIVE HEALTH RESEARCH 2021; 31:2290-2303. [PMID: 34414837 PMCID: PMC8930274 DOI: 10.1177/10497323211026914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low- and middle-income countries are home to 80% of older people with HIV (OPWH). Ukrainian OPWH experience higher mortality and decreased antiretroviral therapy (ART) initiation than younger patients, but there is little data examining OPWH's perspectives around new diagnosis and impact on care. In this study, we examined accounts of 30 newly diagnosed OPWH in Ukraine, exploring challenges faced in the peri-diagnosis period. Themes emerged representing the longitudinal coping process: OPWH (1) viewed themselves as low risk before diagnosis; (2) experienced HIV diagnosis as a traumatic event challenging their self-image; (3) used disclosure to seek support among a small circle of family, friends, or health care providers; (4) avoided disclosure to outsiders including primary care providers for fears of stigma and breaches in confidentiality; (5) viewed age as an asset; and (6) used HIV diagnosis as starting point for growth. These findings highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning.
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Affiliation(s)
- Amy Allen
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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Kolesnyk P, Bayen S, Shushman I, Kolesnyk A, Kuodza G, Klemenc-Ketiš Z, Frese T. Identification and Ranking of Core Values in Family Medicine: A Mixed Methods Study From Ukraine. Front Med (Lausanne) 2021; 8:646276. [PMID: 33829026 PMCID: PMC8019795 DOI: 10.3389/fmed.2021.646276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/17/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction/Context: The term core value (CV) can be defined as fundamental beliefs or principles, guiding one's behavior in a social context. Though core competencies of family medicine (FM) have been clearly defined by WONCA, there has been an ongoing debate on what the CVs are for family doctors (FDs). Ukraine is a developing country in the middle of Europe with a population of 43 million inhabitants, gained independence from the Soviet Union in 1991. Ukraine is a low-income country, developing a modern European healthcare system, especially regarding FM. To implement WONCA standards, it is mandatory to assess the ongoing understanding of CVs in clinical daily practice among active FDs, working in different countries of Europe including Ukraine. Research questions: How do Ukrainian FDs (Delphi group experts) define the CVs of FM in Ukraine and how important are these CVs to a wider population of Ukrainian FDs in their everyday practice? Methods: A mixed method study was conducted in two steps during August and September 2020 in Ukraine. The first part was a qualitative Delphi round (three rounds) design among 20 Ukrainian FDs who were familiar with teaching and terms like CV. A consensus list of six CVs has emerged from the Delphi round study. The second part was a quantitative survey among Ukrainian FDs, who were not specially used to discussing CVs. The consensus list of those six CVs was then submitted to 2000 FDs (randomly selected) who were not involved in the Delphi team, to rank those values from one to nine, according to the importance from their personal point of view. Demographic characteristics have been assessed for all the participants of the Delphi round and quantitative survey. Results: Twenty FDs were involved as experts in the first Delphi round, whereas only five experts continued their participation in the second and the third rounds of the survey. The following six CVs emerged from the Delphi round: comprehensive approach, care coordination, first recourse, continuity of care, integrated approach, and patient and family centered care. The final sample consisted of 375 FDs (19% response rate). There were 323 (88.7%) female and 34 (9.3%) male FDs in the sample. The mean age of the participants was 44.6±13.5 years. Discussion/Conclusion: Defining CVs for FM by Ukrainian FDs in a given socio-economical and historical-cultural setting is crucial to optimize primary medical care and to guarantee an appropriate and successful implementation of WONCA standards as well as CVs in different countries including those where reformation of the health system is ongoing.
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Affiliation(s)
- Pavlo Kolesnyk
- Department of Family Medicine and Outpatient Care, Medical Faculty#2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France
| | - Ivanna Shushman
- Department of Family Medicine and Outpatient Care, Medical Faculty#2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Andrew Kolesnyk
- Department of Family Medicine and Outpatient Care, Medical Faculty#2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - George Kuodza
- Department of Family Medicine and Outpatient Care, Medical Faculty#2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Zalika Klemenc-Ketiš
- Community Health Centre Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Frese
- Department of General Practice & Family Medicine, Medical Faculty, Martin-Luther University Halle, Halle, Germany
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Amgalan N, Shin JS, Lee SH, Badamdorj O, Ravjir O, Yoon HB. The socio-economic transition and health professions education in Mongolia: a qualitative study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:16. [PMID: 33678178 PMCID: PMC7938553 DOI: 10.1186/s12962-021-00269-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Former socialist countries have undergone a socio-economic transition in recent decades. New challenges for the healthcare system have arisen in the transition economy, leading to demands for better management and development of the health professions. However, few studies have explored the effects of this transition on health professions education. Thus, we investigated the effects of the socio-economic transition on the health professions education system in Mongolia, a transition economy country, and to identify changes in requirements. Methods We used a multi-level perspective to explore the effects of the transition, including the input, process, and output levels of the health professions education system. The input level refers to planning and management, the process level refers to the actual delivery of educational services, and the output level refers to issues related to the health professionals, produced by the system. This study utilized a qualitative research design, including document review and interviews with local representatives. Content analysis and the constant comparative method were used for data analysis. Results We explored tensions in the three levels of the health professions education system. First, medical schools attained academic authority for planning and management without proper regulation and financial support. The government sets tuition fees, which are the only financial resource of medical schools; thus, medical schools attempt to enroll more students in order to adapt to the market environment. Second, the quality of educational services varies across institutions due to the absence of a core curriculum and differences in the learning environment. After the transition, the number of private medical schools rapidly increased without quality control, while hospitals started their own specialized training programs. Third, health professionals are struggling to maintain their professional values and development in the market environment. Fixed salaries lead to a lack of motivation, and quality evaluation measures more likely reflect government control than quality improvement. Conclusions Mongolia continues to face the consequences of the socio-economic transition. Medical schools’ lack of financial authority, the varying quality of educational services, and poor professional development are the major adverse effects. Finding external financial support, developing a core curriculum, and reforming a payment system are recommended.
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Affiliation(s)
- Nomin Amgalan
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jwa-Seop Shin
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Seung-Hee Lee
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Oyungoo Badamdorj
- Division of Educational Policy and Management, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oyungerel Ravjir
- Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hyun Bae Yoon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea.
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Kolesnyk P, Frese T, Vinker S, Shushman I, Zharkova A, Messaadi N, Kolesnyk A, Bayen S. Steps towards implementing evidence-based screening in family medicine in Ukraine: SWOT-analysis of an approach of multidimensional empowerment. BMC FAMILY PRACTICE 2021; 22:20. [PMID: 33446099 PMCID: PMC7808735 DOI: 10.1186/s12875-021-01367-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022]
Abstract
Background The purpose of this study is to forward the implementation of an operational evidence-based state screening program of common diseases in Ukraine, where currently no state-based and evidence-based screening (EBS) exists. EBS should be performed by Family Doctors in a primary care setting and concern prevalent diseases in adults, such as: obesity (BMI), hypertension (BP measurement), diabetes (glycaemia), dyslipidemia (cholesterol/lipids), colon cancer (FOBT/colonoscopy), breast cancer (mammography), STIs (chlamydia, syphilis), HIV, HBV, HCV (i.e. serology or other rapid tests), HPV (swabs), cervical cancer (test Pap). depression (i.e., PHQ-9), and smoking (i.e., Fagerstrom). Methods Four needs-based research actions were led among citizens and healthcare professionals, based on multidimensional empowerment. Internal Strengths and Weaknesses of the ongoing implementation process were identified through these studies, whereas external Opportunities and Threats were determined by the present socio-cultural and political context. This SWOT analysis is likely to guide future state-based initiatives to accomplish EBS implementation in Ukraine. Results Internal Strengths are the bottom-up multidimensional empowerment approach, teaching of EBS and the development of an internet-based platform “Screening adviser” to assist shared decision making for person-centred EBS programs. Internal Weaknesses identified for the Family Doctors are a heterogeneous screening and the risk of decreasing motivation to screen. External Opportunities include the ongoing PHC reform, the existent WONCA and WHO support, and the existence of EBS programs in Europe. External Threats are the lack of national guidelines, not fully introduced gate keeping system, the vulnerable socio-economic situation, the war situation in the East of Ukraine and the Covid-19 pandemic. Conclusions We started EBS implementation through research actions, based on a multidimensional empowerment of citizens, HCP and in EBS pathways involved stakeholder teams, to foster a sustainable operational human resource to get involved in that new EBS pathway to implement. The presented SWOT-analysis of this ongoing implementation process allows to plan and optimize future steps towards a state based and supports EBS program in Ukraine.
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Affiliation(s)
- Pavlo Kolesnyk
- Department of Family Medicine and Outpatient Care, Medical Faculty #2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Thomas Frese
- Department of General Practice & Family Medicine, Medical Faculty, Martin-Luther University, Magdeburger Straße 8, 06112, Halle /Saale, Germany.
| | - Shlomo Vinker
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ivanna Shushman
- Department of Family Medicine and Outpatient Care, Medical Faculty #2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Albina Zharkova
- Department of Family Medicine, Sumy State University, Sumy, Ukraine
| | - Nassir Messaadi
- Department of General Practice, University of Lille, Lille, France
| | - Andriy Kolesnyk
- Department of Family Medicine and Outpatient Care, Medical Faculty #2, Education Scientific Family Medicine Training Centre, Uzhgorod National University, Uzhgorod, Ukraine
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France.,Department of Medical Pharmacology & Neurology, INSERM UMRS 1172, University of Lille, Lille, France
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A randomized-controlled trial of community-based transdiagnostic psychotherapy for veterans and internally displaced persons in Ukraine. Glob Ment Health (Camb) 2021; 8:e32. [PMID: 34513001 PMCID: PMC8392687 DOI: 10.1017/gmh.2021.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is limited research on community-based mental health interventions in former Soviet countries despite different contextual factors from where most research has been conducted. Ongoing military conflict has resulted in many displaced persons and veterans and their families with high burdens of mental health problems. Lack of community-based services and poor uptake of existing psychiatric services led to the current trial to determine the effectiveness of the common elements treatment approach (CETA) on anxiety, depression, and posttraumatic stress symptoms (PTS) among conflict affected adults in Ukraine. METHODS We conducted a three-armed randomized-controlled trial of CETA delivered in its standard form (8-12 sessions), a brief form (five-sessions), and a wait-control condition. Eligible participants were displaced adults, army veterans and their adult family members with elevated depression and/or PTS and impaired functioning. Treatment was delivered by community-based providers trained in both standard and brief CETA. Outcome data were collected monthly. RESULTS There were 302 trial participants (n = 117 brief CETA, n = 129 standard CETA, n = 56 wait-controls). Compared with wait-controls, participants in standard and brief CETA experienced clinically and statistically significant reductions in depression, anxiety, and PTS and dysfunction (effect sizes d = 0.46-1.0-6). Comparing those who received standard CETA with brief CETA, the former reported fewer symptoms and less dysfunction with small-to-medium effect sized (d = 0.20-0.55). CONCLUSIONS Standard CETA is more effective than brief CETA, but brief CETA also had significant effects compared with wait-controls. Given demonstrated effectiveness, CETA could be scaled up as an effective community-based approach.
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Tomycz LD, Markosian C, Kurilets I, Lovha M, Kashyrina O, Netliukh A, Kostiuk K, Cheburakhin V, Polishchuk A, Forbes J, Cohen M, Miley J, Geck M, Siryk H, Mykytyn T, Diakiv V, Salo V, Yushchak I, Soroka M, Kurilets I. The Co-Pilot Project: An International Neurosurgical Collaboration in Ukraine. World Neurosurg 2020; 147:e491-e515. [PMID: 33385604 DOI: 10.1016/j.wneu.2020.12.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aim to provide a thorough description of the efforts and outcomes of the Co-Pilot Project in Ukraine, which facilitates neurosurgical collaboration between American and Ukrainian physicians. METHODS The Co-Pilot Project, which operates under its parent nonprofit organization, Razom, organized multiple trips for American physicians to Ukraine. Activities included consulting in clinic, assisting with neurosurgical operations, and providing didactic lectures. Further efforts have included coordinating training opportunities for Ukrainian surgeons. We retrospectively reviewed all operations performed by Ukrainian partner physicians alongside American co-pilot physicians across Ukraine since August 2016. RESULTS Teams of Ukrainian and American physicians operated on 78 patients (24 children and 54 adults) for a total of 84 procedures in 5 different cities (Kyiv, Lutsk, Lviv, Odessa, and Stryi) of Ukraine. Operations were classified into the following categories: adult brain tumors (n = 39), adult spine tumors (n = 1), epilepsy (n = 9), pain (n = 2), pediatric brain tumors (n = 11), vascular/endovascular (n = 10), and miscellaneous (n = 12). Four illustrative cases are described in detail. Of the patients with brain tumors, 43.5% (20/46) had giant tumors, and gross total resection or near-total resection was achieved in 78.3% (36/46). CONCLUSIONS Profound disparities in neurosurgical care exist globally, which has led to the formation of collaborative relationships between physicians from various countries. We hope that the work of the Co-Pilot Project in Ukraine can serve as a template for effective international neurosurgical collaboration in other low-to-middle-income countries.
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Affiliation(s)
- Luke D Tomycz
- New Jersey Brain and Spine, Montclair, New Jersey, USA.
| | - Christopher Markosian
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | | | | | | | | | | | | | - Jonathan Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael Cohen
- Department of Neurosurgery, Northern Light Neurosurgery and Spine, Bangor, Maine, USA
| | - Jefferson Miley
- Department of Neurology, University of Texas Dell Medical School, Austin, Texas, USA
| | - Matthew Geck
- Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas, USA; Seton Spine and Scoliosis Center, Austin, Texas, USA
| | - Hanna Siryk
- International Neurosurgery Center, Kyiv, Ukraine
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Quirke E, Suvalo O, Sukhovii O, Zöllner Y. Transitioning to community-based mental health service delivery: opportunities for Ukraine. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1843288. [PMID: 33235691 PMCID: PMC7671671 DOI: 10.1080/20016689.2020.1843288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 05/28/2023]
Abstract
Background and objectives: Ukraine's mental health system has been found to be inadequate and unresponsive to the needs of the population, in view of its emphasis on inpatient service delivery. This study sought to identify potential changes to the organization and financing of mental health services within the Ukrainian health system that would facilitate the delivery of mental health services in a community-based setting. Methodology: A systematic literature review was undertaken to identify organizational and financing features that have been successfully used to enable and incentivize the delivery of community-based mental health services in Central or Eastern European and/or former Soviet Union countries. Results: There was limited literature on the organizational and financing features that facilitate the delivery of community-based care. Key facilitators for transitioning from institution-based to community-based mental health service delivery include; a clear vision for community-based care, investment in the mental health system, and mechanisms that allow health funding to follow the patient through the health system. Conclusions: Ukraine should adopt strategic purchasing mechanisms to address inefficiency in the financing of its mental health system, and prioritize collaborative planning and delivery of mental health services. Ongoing reform of the Ukrainian health system provides momentum for instituting such changes.
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Affiliation(s)
- Eleanor Quirke
- Hamburg University of Applied Sciences, Hamburg, Germany
| | | | - Oleksii Sukhovii
- Centre for Mental Health and Monitoring of Drugs and Alcohol Ministry of Health of Ukraine, Kyiv, Ukraine
| | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
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Pachołek A, Krotos A, Drwiła D, Kalarus Z, Piotrowicz K, Gąsowski J, Tomasik T. Comprehensive geriatric assessment in primary care practices: a multi-centered, cross-sectional study in Krakow, Poland. Hippokratia 2020; 24:173-181. [PMID: 35023893 PMCID: PMC8747576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA), as a complex diagnostic process, allows medical specialists to recognize the capabilities and limitations of the patient in older age. This study aimed to evaluate the prevalence and severity of deficits typical of seniors and find relationships between CGA results and selected factors. METHODS A cross-sectional questionnaire study was performed in Krakow among patients aged 65 years and over visiting their general practitioners (GPs). CGA was conducted using eight scales: the Activities of Daily Living (ADL), Mini-Mental State Examination, Instrumental Activities of Daily Living (IADL), Geriatric Depression Scale, Timed Up and Go Test, Mini Nutritional Assessment Short Form, Clinical Frailty Scale, and Athens Insomnia Scale. RESULTS Four hundred and thirty-eight patients, aged between 65 and 96 years, were examined. Most of them received high scores in the assessed aspects. The most common abnormalities were sleep disorders (42 %), symptoms of frailty (33 %), and depressive tendency (32 %). Age correlated with every aspect assessed in CGA and worsened as patients grew older (in all cases p <0.05). Male gender reduced the chance of depressive disorders [odds ratio (OR) =0.6 (0.39-0.92); p =0.02]. The strongest association was found between ADL and IADL scales [OR =153.56 (34.86-676.48); p <0.001]. CONCLUSIONS Even though patients who attended general practices were functioning well in everyday life, after analysis, they manifested deficits in some areas of CGA. The most widespread problems in the geriatric population were depressive symptoms, frailty, and insomnia, and that is why GPs should ask about sleep and mood disorders during visits and assess the occurrence of frailty. HIPPOKRATIA 2020, 24(4): 173-181.
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Affiliation(s)
- A Pachołek
- Department of Family Medicine, Jagiellonian University Medical College, Krakow
| | - A Krotos
- Department of Internal Medicine, Ludwik Rydygier's Poviat Hospital, Brzesko
| | - D Drwiła
- Department of Coronary Disease and Heart Failure, John Paul II Hospital
| | - Z Kalarus
- Department of Gastroenterology, 5th Military Clinical Hospital
| | - K Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College Krakow, Poland
| | - J Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College Krakow, Poland
| | - T Tomasik
- Department of Family Medicine, Jagiellonian University Medical College, Krakow
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Gils T, Laxmeshwar C, Duka M, Malakyan K, Siomak OV, Didik VS, Lytvynenko N, Terleeva Y, Donchuk D, Isaakidis P. Preparedness of outpatient health facilities for ambulatory treatment with all-oral short DR-TB treatment regimens in Zhytomyr, Ukraine: a cross-sectional study. BMC Health Serv Res 2020; 20:890. [PMID: 32957966 PMCID: PMC7507621 DOI: 10.1186/s12913-020-05735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care. METHODS This is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support. RESULTS We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support. CONCLUSION Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.
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Affiliation(s)
- Tinne Gils
- Médecins Sans Frontières, 64 Berdychivska St., Huiva, Zhytomyr, Oblast, Ukraine.
| | - Chinmay Laxmeshwar
- Médecins Sans Frontières, 64 Berdychivska St., Huiva, Zhytomyr, Oblast, Ukraine
| | - Marve Duka
- Médecins Sans Frontières, 64 Berdychivska St., Huiva, Zhytomyr, Oblast, Ukraine
| | - Khachatur Malakyan
- Médecins Sans Frontières, 64 Berdychivska St., Huiva, Zhytomyr, Oblast, Ukraine
| | | | | | - Natalia Lytvynenko
- National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Yana Terleeva
- Department of Tuberculosis Programme Coordination, Public Health Centre of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Dmytri Donchuk
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Petros Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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Harris M, Kolesnyk A, Taylor G, Kolesnyk P. Introducing primary care research teaching in Ukraine: description and evaluation of the 'ABC' research methods course. EDUCATION FOR PRIMARY CARE 2020; 32:43-48. [PMID: 32910864 DOI: 10.1080/14739879.2020.1812441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ukraine has a developing and expanding system of general practice, but only a rudimentary academic primary care system and no research skills training for general practitioners (GPs). We designed and evaluated a transnational primary care research skills course for Ukrainian GPs.The ABC course is series of three 2-day workshops, designed to teach the basics of primary care research to early-career Ukrainian GPs. It was delivered by Ukrainian and British experts, using innovative, interactive teaching methods. Evaluation measures included participants' assessment of their research abilities, and changes in their attitudes, intentions and actions regarding their research practice.Seventeen Ukrainian GPs took part. There was a 1.32-point increase in research ability self-assessment 5-point Likert scores, with particular increases in literature review and budgeting abilities. Scores for research attitudes, intentions and actions increased by 4.0%, though limited by a ceiling effect. Many participants subsequently developed their own research projects, and some set up primary care research skills courses in their own Ukrainian academic organisations.The course resulted in increased levels of self-confidence and ability to plan primary care research, with improvements in participants' stages of change. It sets out a model for providing and evaluating innovative educational interventions in post-soviet countries, and gives them a basis for high-quality primary care research.
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Affiliation(s)
- Michael Harris
- Shupyk National Academy of Postgraduate Education, Kyiv, Ukraine.,Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Bern, Switzerland
| | - Andriy Kolesnyk
- Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine
| | | | - Pavlo Kolesnyk
- Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine
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Engidaw NA, Abdu Z, Chinani I. Prevalence and associated factors of common mental disorders among residents of Illu Ababore zone, southwest Ethiopia: a cross-sectional study. Int J Ment Health Syst 2020; 14:64. [PMID: 32817756 PMCID: PMC7425137 DOI: 10.1186/s13033-020-00394-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background A common mental disorder is characterized by anxiety, depression, and unexplained somatic symptoms that usually encountered in community and primary care settings. Both short and long term bio psychosocial disabilities are inevitable if common mental disorder is not treated. Despite its impact, the prevalence of common mental disorder in the Illu Ababore zone is not well known. Therefore, this study aimed to assess the prevalence and associated factors of common mental disorder among Ilu Ababore zone residents, Southwest Ethiopia. Method A community based cross-sectional study was conducted from July 1 to August 30, 2018. A multi-stage sampling technique was applied to recruit participants. Self-Reporting Questionnaire (SRQ-20) was used to assess the presence of common mental disorder. The data were entered into Epidata version 3.1 and analyzed by using SPSS version 23 software. Bivariate and multivariate binary logistic regressions were computed to identify the associated factors. Statistical significance was considered at P value < 0.05. Result A total of 690 participants were enrolled in this study with a response rate of 91.39%. The prevalence of common mental disorder was 27.2% (95% CI, 23.9, 31.0%). Being female (AOR = 1.76, 95% CI = 1.15, 2.69), unable to read and write (AOR = 3.06, 95% CI = 1.37, 6.82), living in the rural area (AOR = 3.53, 95% CI = 2.01, 6.18), having a family member with mental illness (AOR = 2.68, 95% CI = 1.6, 4.5), having a chronic physical illness (AOR = 3.48, 95% CI = 2.26, 5.34) and lifetime alcohol use (AOR = 4.55, 95% CI = 2.93, 7.0) had a significant association with common mental disorder. Conclusion The current study showed that the proportion of the common mental disorder was high. Females showed a higher prevalence of the common mental disorder. Having a chronic physical illness, resides in the rural areas and history of lifetime alcohol use were also significantly associated with CMD. Psychological and social interventions with greater emphasis on females who have low educational status and residing in the rural area are recommended. Strategies that focus on the proper treatment of chronic physical illness can be also helpful to minimize the occurrence of common mental disorder.
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Affiliation(s)
- Nigus Alemnew Engidaw
- College of Health Sciences, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia
| | - Zakir Abdu
- Faculty of Public Health and Medical Science, Mettu University, Mettu, Ethiopia
| | - Ishwari Chinani
- Faculty of Public Health and Medical Science, Mettu University, Mettu, Ethiopia
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Medical Education in the Former Soviet Union: Opportunities in Armenia. Ann Glob Health 2020; 86:99. [PMID: 32864351 PMCID: PMC7427658 DOI: 10.5334/aogh.2960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Medical education is a critical aspect of healthcare quality and thus requires sufficient investment to meet international standards. The Republic of Armenia, a nation that became independent of the Soviet Union in 1991, has not experienced significant advancement of its medical education system as the Western world has. In 2018, the country underwent a revolution to oust systematic corruption and transition to a true democracy, providing an opportunity for future efforts to improve medical education. The Armenian diaspora, which consists of approximately two to three times more individuals than the country’s population, includes healthcare professionals who are motivated and willing to contribute to the advancement of medical education. Assessing the perspectives of stakeholders is a key first step in this endeavor. We conducted a survey of recent medical graduates in Armenia, which revealed self-awareness of deficiencies in clinical, research, and leadership skills, desire to receive further training to improve these skills, and positive attitudes toward diaspora engagement. Thus, it is critical to incorporate a coordinated effort from the diaspora in addition to the local physician workforce, educational institutions, and government to bring about improvements in medical education in Armenia.
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Power T, Suvalo O. Developing a capacity-building programme to support a mental health service modernisation pilot project in Lviv region of Western Ukraine. BJPsych Int 2020; 18:40-42. [PMID: 34287428 PMCID: PMC8274430 DOI: 10.1192/bji.2020.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/04/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022] Open
Abstract
This paper reflects on the development of a capacity-building programme to support a mental health service modernisation pilot project based in the Lviv region of Western Ukraine. National programmes that aim to modernise mental health services now have the experience of other countries on which to draw. The challenges faced by such modernisers have much in common. Nevertheless, although there are lessons to be learned from what has worked well elsewhere, we caution that the local context can have a profound effect on the successful implementation of plans based on best practice.
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Affiliation(s)
- Tracey Power
- MA, Management of Community Care, Managing Director, Implemental Worldwide, UK.
| | - Orest Suvalo
- MD, Psychiatrist, Coordinator of Community-Based Mental Health Services Development, Mental Health for Ukraine Project, Ukraine
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Ryzhov A, Bray F, Ferlay J, Fedorenko Z, Goulak L, Gorokh Y, Soumkina O, Michailovich Y, Znaor A. Recent cancer incidence trends in Ukraine and short-term predictions to 2022. Cancer Epidemiol 2020; 65:101663. [PMID: 31882366 DOI: 10.1016/j.canep.2019.101663] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Using data from the National Cancer Registry of Ukraine (NCRU), we analyzed recent trends in incidence rates (2003-2012) and used these to predict the future cancer incidence burden up to 2022. METHODS All cancer cases (excluding non-melanoma of skin) for the years 2003-2012 were retrieved from the NCRU's database (n = 1,459,851). Age-standardized incidence rates (ASRs) were estimated and the numbers of new cases and incidence rates predicted for 2022 using age-period modeling. RESULTS ASR increased from 2003 to 2012 for most cancers except lip and stomach cancers (in both sexes) and laryngeal and lung cancers (in males). Assuming these trends will continue, lung cancer will remain the most common male cancer in 2022 (ASR 40.5/100,000), followed by prostate cancer (36.8/100,000), colorectal cancer (34.6/100,000), and cancers of the oral cavity and pharynx (18.5/100,000). In females, the order of the four most common cancers will not change in 2022 compared with 2012, with cervical cancer remaining the fourth most common cancer (17.5/100,000). We predict an overall increase of 18 % in the number of cancer cases in Ukraine (relative to 2012) to 179,493 cases in 2022. CONCLUSION The anticipated increase in the number of cancer patients in Ukraine clearly has knock-on effects on a healthcare system undergoing reforms. Tobacco control appears to be the only functioning aspect of cancer prevention in the country, and there is a need for a broader national cancer control plan. The continued monitoring and evaluation of implemented cancer control measures by the NCRU will help prioritize targets and allocate future resources to cancer services.
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Affiliation(s)
- Anton Ryzhov
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Taras Shevchenko National University of Kyiv, Kyiv, Ukraine.
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Zoya Fedorenko
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Liudmyla Goulak
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Yevgeniy Gorokh
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Olena Soumkina
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Yuriy Michailovich
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, Ukraine
| | - Ariana Znaor
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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RESULTS OF ANALYSIS AND FORECASTING OF THE MAIN FINANCIAL INDICATORS OF THE HEALTH INSURANCE MARKET DEVELOPMENT IN UKRAINE. EUREKA: HEALTH SCIENCES 2019. [DOI: 10.21303/2504-5679.2019.001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In recent years Ukraine against the background of systemic crisis trying to reform socially-oriented areas of society, including voluntary health insurance, which must combine market and social burdens. Under these conditions, an important scientific and practical research is forecasting financial indicators of domestic insurance companies.
Aim. Conducting analysis and forecasting of the basic indicators that characterize the financial state of development of the domestic health insurance market.
Materials and methods. Research materials were selected from the official websites of the National Commission which carry out state markets regulation of financial services and the League of Insurance Organizations of Ukraine for 2009–2018 years. We used historical, analytical and comparative, systematic, logical, hypothetical-deductive, mathematical and statistical methods.
Results. To forecast the financial indicators of the health insurance market in Ukraine (gross insurance premiums and payments; operations transferred to reinsurance, including non-residents; net insurance premiums and payments) for 2019–2020 years; the time interval was set from 2009 year. According to the results of the calculations, we obtained regression models for different financial indicators (6 models). With the help of the selected mathematical tools, the main financial indicators of the market development for 2019–2020 years were forecasted. The analysis of the data revealed that the highest value growth rate (%) in 2020 year will be characteristic of reinsurance operations, including those transferred to non-residents (49.06 %) and the lowest - to gross insurance payments (14,41 %).
It is established that the indicator of net insurance payments since 2010 year has been steadily decreasing (from 78.19 %), and according to the forecasted data in 2019 year it may be equal to 46.77 %, and in 2020 year – 44.98 %, the trend will continue to decrease. However, this indicator since 2016 year (53.9 %) and the data forecast for 2019–2020 years are in the regulatory range (from 30.0 % to 60.0 % for different types of insurance activities).
Conclusions. According to the results of the research, it is established that in spite of the financial and economic crisis since 2014 year, the domestic health insurance market is characterized by positive dynamics of growth of the main financial indicators (gross insurance premiums and payments, net insurance premiums and payments). At the same time, there is a tendency to decrease the level (%) of net insurance payments indicator from 78.19 % in 2010 year to the forecast in 2020 year – 44.98 %.
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Ooms G, Kruja K. The integration of the global HIV/AIDS response into universal health coverage: desirable, perhaps possible, but far from easy. Global Health 2019; 15:41. [PMID: 31215446 PMCID: PMC6582556 DOI: 10.1186/s12992-019-0487-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The international community's health focus is shifting from achieving disease-specific targets towards aiming for universal health coverage. Integrating the global HIV/AIDS response into universal health coverage may be inevitable to secure its achievements in the long run, and for expanding these achievements beyond addressing a single disease. However, this integration comes at a time when international financial support for the global HIV/AIDS response is declining, while political support for universal health coverage is not translated into financial support. To assess the risks, challenges and opportunities of the integration of the global HIV/AIDS response into national universal health coverage plans, we carried out assessments in Indonesia, Kenya, Uganda and Ukraine, based on key informant interviews with civil society, policy-makers and development partners, as well as on a review of grey and academic literature. RESULTS In the absence of international financial support, governments are turning towards national health insurance schemes to finance universal health coverage, making access to healthcare contingent on regular financial contributions. It is not clear how AIDS treatment will be fit in. While the global HIV/AIDS response accords special attention to exclusion due to sexual orientation and gender identity, sex work or drug use, efforts to achieve universal health coverage focus on exclusion due to poverty, gender and geographical inequalities. Policies aiming for universal health coverage try to include private healthcare providers in the health system, which could create a sustainable framework for civil society organisations providing HIV/AIDS-related services. While the global HIV/AIDS response insisted on the inclusion of civil society in decision-making policies, that is not (yet) the case for policies aiming for universal health coverage. DISCUSSION While there are many obstacles to successful integration of the global HIV/AIDS response into universal health coverage policies, integration seems inevitable and is happening. Successful integration will require expanding the principle of 'shared responsibility' which emerged with the global HIV/AIDS response to universal health coverage, rather than relying solely on domestic efforts for universal health coverage. The preference for national health insurance as the best way to achieve universal health coverage should be reconsidered. An alliance between HIV/AIDS advocates and proponents of universal health coverage requires mutual condemnation of discrimination based on sexual orientation and gender identity, sex work or drug use, as well as addressing of exclusion based on poverty and other factors. The fulfilment of the promise to include civil society in decision-making processes about universal health coverage is long overdue.
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Affiliation(s)
- Gorik Ooms
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH UK
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