Digitalization of civil society: prospects and challenges for the regions of Ukraine.

Introduction: Breast cancer (BC) is the most frequently diagnosed and lethal neoplasm among women globally and in Brazil, constituting a significant public health burden. Mammography is the primary strategy for early detection of BC, but its effectiveness in reducing mortality is most evident in populations where adherence to the exam reaches at least 70% of the target population. In Brazil, unfortunately, there is a significant regional disparity in access to health services, raising concerns about the true effectiveness BC screening. In light of this, we aim to access the regional disparities in the consolidation of breast cancer screening, comparing the number of mammograms performed in Brazil by the five regions (North, Northeast, Southwest, South, and Midwest) between the years 2020 and 2024. Methodology: The DATASUS platform was used to collect data from the Cancer Information System (SISCAN), with analysis of the screening mammography variant according to the patient's state of residence and the year of the procedure. Additionally, data from the Brazilian Institute of Geography and Statistics (IBGE) was used to consult the target female population for screening between two thresholds: of 40 and 74 years old and 50 and 69 years old, according to the 2022 Demographic Census. Results: A total of 8,954,424 mammograms were performed in Brazil between 2020 and June 2024, with the Southeast region accounting for approximately 36.8% of this total. The Northeast region ranked second, with 30.8% of the exams, followed by the South (20.6%), Midwest (6.9%), and North (4.7%) regions. The proportion of mammograms per female population aged 40-74 years varied across regions, with the highest percentage found in the South (29.16%), followed by the Northeast (26.44%), Midwest (20.09%), Southeast (17.92%), and North (15.70%). Furthermore, when analyzing the proportion of mammograms in women aged 50-69 years, the South region achieved the highest mammography coverage rate (51.42%), followed by the Northeast (49.73%), Midwest (38.13%), Southeast (32.27%), and North (31.17%). Conclusion: The study revealed significant regional disparities in access to mammography screening across Brazil. The South and Northeast regions demonstrated the highest accessibility rates for the target population, while the North region faced alarmingly low rates. Regardless of the age range considered as the target population, the national percentages fell short of the recommended levels for adequate screening. This scenario can be attributed, primarily, to the lack of effective public policies that ensure equitable access to healthcare, a fundamental principle of Brazil's Unified Health System (SUS). This lack of equity hinders the consolidation of effective breast cancer screening nationwide. Citation Format: Letícia Pinheiro Amorim, Mariana Macambira Noronha, Valbert Oliveira Costa Filho, Pedro Robson Costa Passo, Duílio Reis da Rocha Filho, Leonardo Saraiva Pontes, Eric Lima Freitas Mota, Gabriel Sampaio Feitosa, Ígor Giordan Duarte Jorge, Izaberen Sampaio Estevam, Paulo Eduardo de Oliveira, Kevin Lucas Silva Ribeiro, Carlos Alberto Barbosa Neto, Josmara Ximenes Andrade Furtado, Markus Andret Cavalcante Gifoni, Márcio Marcondes Vieira, Elvis Lopes Barbosa, Luiz Gonzaga Porto Pinheiro, Paulo Henrique Diógenes Vasques, Eduardo Araújo Costa Lima, Gabriel Fontenelle Costa, Júlia Matos Dubanhevitz, Saulo Rabelo Costa, João Luiz Lima Pinheiro, Eduarda Severo Alvarenga, Fabrícia Cardoso Marques, Cecília Dias Caminha Gentile, Juliana Pinho da Costa Leitão, Danielle Calheiros Campelo Maia, Francisco Pimentel Cavalcante. Regional Disparities in Mammography Access in Brazil: The Impact on the Consolidation of Effective Breast Cancer Screening [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-06-08.

Even in health systems with universal health coverage (UHC), disparities in access to time-sensitive stroke interventions may persist, leading to inequities in patient survival. I aimed to quantify regional disparities in access to endovascular thrombectomy (EVT) and 1-year mortality among patients with acute ischemic stroke (AIS) in South Korea and to assess associations with individual and regional healthcare factors. This retrospective cohort study analyzed the 2021 National Health Insurance Service claims data of 29,755 adults hospitalized with AIS across 250 administrative districts in South Korea. Districts were classified as having no EVT center, a low-volume EVT center (<24 annual cases), or a high-volume EVT center (≥24 annual cases per year). Multilevel logistic regression models were used to assess the association between individual- and regional-level factors with EVT receipt and 1-year mortality. Regional inequalities were further evaluated using Gini coefficients across the adjustment levels. Of the 29,755 patients, 22.5% resided in districts without EVT centers, 20.5% in low-volume districts, and 57.0% in high-volume districts. After adjusting for age, sex, comorbidities, and stroke severity, patients residing in high-volume districts were more likely to receive EVT (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.10–1.46) and had lower odds of 1-year mortality (aOR, 0.80; 95% CI, 0.73–0.89) than those residing in districts without EVT centers. Regional inequality in EVT access increased after adjustment for individual factors (Gini coefficient, 0.0948 to 0.1353), and mortality inequality also increased (0.0449 to 0.1184), indicating that crude comparisons underestimated the disparities. In a nationwide UHC system, regional disparities in EVT access and 1-year mortality were modest but persistent and associated with the availability of high-volume EVT centers. Expanding EVT capacity and strengthening prehospital–hospital networks in underserved regions may be associated with reduced inequities in stroke care and improve survival outcomes in patients with stroke.

The article examines the process of forming the state policy of promoting civil society development in Ukraine, as well as its current directions. It is argued that in most developed democracies, there is a state policy to promote civil society. This is due to the realization that the activities of civil society institutions contribute to the reduction of paternalistic expectations of citizens, to the provision of socio-political stability, as well as to the formation of a high level of political culture. The state of civil society in Ukraine and the legal framework for the implementation of the state policy of promoting the development of civil society are analyzed. Today, the legal framework of the state policy of promoting civil society development is constituted by the Constitution of Ukraine, laws of Ukraine, decrees of the President of Ukraine, resolutions and orders of the Cabinet of Ministers of Ukraine, etc. The priority directions of the strategy of the state policy of promoting the development of civil society in Ukraine for the next period are offered in accordance with the current conditions and current challenges. The results of individual sociological surveys have been analyzed in the context of various aspects of the implementation of the state policy of promoting civil society development in Ukraine, problems and challenges have been identified. The strategy of the state policy for promoting the development of civil society in Ukraine for the next period (from 2021) should include: formation of an effective model of interaction between the state and civil society in Ukraine at three levels — national, regional, local; developing tools for involving citizens at decision-making at all levels; development of civic education in Ukraine; providing state financial support to civil society institutions; development of e-government; ensuring the effective response of law enforcement agencies to violations of the law on interaction with civil society by state bodies; continuation of work on implementation of measures aimed at implementation of international agreements.

Lymphedema has a significant impact on patient quality of life. However, it remains unclear whether the provision of lymphedema treatment in Japan is uniform across regions. This study aimed to clarify the current situation regarding lymphedema treatment with emphasis on complex decongestive therapies (CDT) availability and implementation in Japan. A nationwide web-based survey was conducted. Respondents included healthcare professionals from designated cancer care hospitals and other medical institutions treating lymphedema in Japan. The distribution of variables, including the implementation of lymphedema treatment, was compared between designated cancer care hospitals and other facilities using the chi-square test. Japan was divided into nine regions to compare and analyze access to medical institutions providing CDT for lymphedema on both inpatient and outpatient bases. Of the 372 facility responses analyzed, ˃95% reported treating secondary lymphedema of the extremities, whereas ˂30% treated head and neck lymphedema. The number of CDT inpatients per 100 000 people in the region with the lowest patient volume was approximately 2% of that in the region with the highest volume. Similarly, the number of CDT outpatients per 100 000 people in the lowest-volume region was one-third of that in the highest-volume region. There was no significant correlation between facilities with high outpatient numbers and those with low outpatient numbers (ρ =0.57, P-value=0.11). Eliminating regional disparities in access to lymphedema treatment facilities, particularly for inpatient CDT, would improve quality of life and enable patients to manage the condition regardless of where they live.

This study examines how federal distribution policies affected regional disparities in access to COVID-19 therapeutics over time in Texas. To evaluate therapeutic accessibility, drug-to-case ratios were calculated by comparing the amount of therapeutic supply to confirmed case counts across counties during each policy period. A Bayesian spatiotemporal Integrated Nested Laplace Approximation (INLA) model was used to analyse how healthcare infrastructure, demographic characteristics, and regional vulnerabilities affected access. During the period when distribution was managed by state authorities, supply was quickly mobilized but often lagged demand, particularly in rural areas and communities with high rates of diabetes and older populations. In the next phase, test-to-treat program expanded overall supply, but access remained limited in areas with high racial and ethnic vulnerability due to the absence of demographic targeting. In the final phase, when therapeutics were allocated based on population thresholds and replenished regularly, spatial distribution became more stable and racial disparities narrowed. However, certain high-risk populations continued to face lower access. Findings show that each policy phase not only reflected but also reshaped regional disparities in therapeutic access. While early centralized efforts enabled swift response, they failed to address local needs. Later phases offered improved consistency but were still limited in addressing demographic and health-related vulnerabilities. This study underscores the importance of developing unified yet flexible distribution strategies that can respond to population-specific risks and infrastructure gaps, ensuring equitable access to treatment in future public health emergencies.

The article examines the essence of civil society and reveals its main components in cooperation with business and government. The place and role of civil organisations and public are considered in the context of modern environmental requirements. An analysis of national features in the formation and development of civil society is provided. Trends in interactions of civil society, business and government in Ukraine have been revealed through the comparison with other countries. An attempt was made to understand the national civil movement as a prerequisite for the formation of civil society in Ukraine during the years of independence. Tools for assessing the sustainability and general viability of the civil society sector are classified according to various criteria. Global indicators of trust in various institutions of society and its institutional activity are analysed. There was carried out an analysis of the dynamics of the sustainability index for Ukraine. Guidelines for the institutional transformation of the interactions between domestic civil society, business, government have been worked out in order to substantiate the information and analytical provision.

Cancer care guidelines have been developed in many subspecialities, usually in advanced health systems. However, there are notable global disparities in healthcare access, which can impact sarcoma care. Unfortunately, there is a lack of global data on this subject. Our aim was to describe access to sarcoma care based on a comprehensive global survey among orthopaedic oncologists, and assess for global as well as regional differences. A 25-question survey was emailed to the attendees of the 2024 Birmingham Orthopaedic Oncology Meeting and included questions about the respondents' training and practice, access to sarcoma centres, and specific items for sarcoma diagnosis and treatment. For data analysis and comparison, countries were grouped geographically and per the World Bank's income classification. A total of 192 specialists from 47 countries completed the survey (67%). Overall, 40% declared that most patients in their country were treated in a specialized sarcoma centre. Declared access to specific diagnostic technology ranged from 69% (translocation studies) to 86% (various immunohistochemistry). Only 31% stated having access to proton therapy and 82% to all possible reconstruction methods. Compromise of ideal surgical management because of prior treatments and financial constraints was declared to have happened regularly in 40% and 17% of practices, respectively. Regions with better-developed healthcare systems had improved access to all aspects surveyed. Similar results were observed when comparing high-income countries against low- to middle-income countries. Our study highlights substantial global and regional disparities in access to sarcoma services, which could potentially impact clinical outcomes. Further studies are needed to clarify this reality.

The article gives a scientific analysis about the nature of civil society, which is the case in the works of the philosophers of ancient Greece and Rome; lit conceptual and categorical apparatus of the essence of civil society and the rule of law in the works N.Makivelli, D.Lokk, T.Hobbes, J.-F . Rousseau, C.-L.Monteske, I. Kant, G.V.F.Gegel, A.Gramshi. The evolution of theories of civil society as a set of natural forms of social activity of people who are called non-political means to provide for the needs of the citizens and their interests, discloses the structure of civil society and its beginning, based on self-realization of rights; notes that only in a democratic society is possible the development of civil society in Ukraine and the transition to a global civil society. The purpose of the article - to form the theoretical basis of civil society in the history of social and philosophical thought, the conditions of civil society, the nature and structure, which is important for further analysis of authentic civil society as a major concept study. It is noted that the first experience of scientific analysis regarding the nature of civil society has a place in the writings of the philosophers of ancient Greece and Rome, where you can find the concept of the idea of civil society that emerged in the polis democracy, Roman law, of the later ideas of John Locke's natural law and Hobbes. In ancient Greece the term included all the important areas of society: family, religion, education, literature, and art. Being a member of civil (civil) society meant to be a citizen, that is, to live and act in accordance with the laws, do not bring harm to other citizens. It was then that the understanding of society as totality citizens should be free to dispose of their property and their abilities. Civil society - a set of individuals, classes, groups, institutions, whose interaction is governed by civil law, and which is directly related to public policy. Civil society, according to Hegel, is a system of different needs that are based on private property and universal formal equality of people. Such a society appears with the emergence of bourgeois society in the historical arena. That is why civil society is a step in the development of the state but also depends on it. The foundation of civil society is private property, property interests and the formal equality of citizens. Higher interests of civil society are kept by law, court and police and therefore can not be realized without the participation of the state. Excessive development of some elements of civil society to the detriment of others can lead to unjust oppression of others. Maintenance of civil society - is the realm of the everyday interests of the individual methods of implementation - beliefs, legal and moral norms, traditions and customs. It reveals that the basis of civil society - is the free development of the individual with inalienable rights and political organization in which the individual realizes himself as a person. Characteristic features of civil society - the presence in society of free producers production methods, developed democracy, legal security of citizens, high level of civic culture, individual freedom and autonomy of citizens, freedom of forming and consistent expression of interest. It is noted that civil society serves as an area of economic, political, social, cultural, religious and other interests. Civil society is the foundation of the state, which, in turn, protects the principles of self-management of all NGOs that form civil society. Of civil society is a continuous process improvements citizen, society, government, politics, law, covering all areas of society without exception, providing conditions for the establishment of human personality, its national dignity. Only in a democratic society possible formation of civil society in Ukraine.

Mapping Civil Society and Peacebuilding in Ukraine: Peacebuilding by Any Other Name

Since Euromaidan, civil society in Ukraine faces new challenges and a new role in society. Volunteer work, donations and civic activism have increased vis-a-vis the humanitarian crisis and the war in Eastern Ukraine in an unprecedented dimension. Civil society’s takeover of state responsibilities depicts the compensation of state failure. But it is questionable whether the post-Euromaidan civil society contributes to Ukraine’s democratization process. Based on two case studies, in this article I examine new issues civil society in Ukraine deals with, what forms the basis of a new quality of civic activism and participation. Further, I describe structures, activities and interrelations of this new Ukrainian volunteer movement, with the aim to discuss its ambivalent role in fragile democratization.

Digital infrastructure is an important factor in socio-economic development, especially in the de-occupied (affected) territories that have been destroyed and need to be restored. Given the current challenges associated with digital transformation and economic integration, there is a need to develop methods for assessing the impact of digital infrastructure on local economic development. The article is aimed at developing approaches to assessing the impact of digital infrastructure on the local economic development of the de-occupied (affected) territories. Methods used in the study: modified multiplier method, system approach, analytical and indicator methods, etc. Research hypothesis: the development of digital infrastructure in the de-occupied territories will contribute to their economic growth, which needs to be evaluated through the use of unique methods due to martial law. Presentation of the main material. The article considers well-known scientific and methodological approaches to assessing the impact of digital infrastructure on local economic development and notes that the development of digital infrastructure usually has a positive impact on local economic development. It is proposed to use the method of a modified multiplier, which allows to assess the impact of digital transformation development on local economic development using special indices that have been tested. It is determined that the impact of the development of digital infrastructure in the Kyiv region is insufficient and/or slow during 2022-2024 according to the results of the calculation of the Index of Local Economic Development through the Digitalization of the Region and the Index of Transformation of the Digital Infrastructure of the Region. The originality and practical significance of the study lies in the feasibility of assessing the strength of the impact of the digital transformation of the de-occupied territories on local economic development and the possibility of using a modified multiplier of influence by local governments, scientists and experts in the field of regional development. The Digital Infrastructure Transformation Index (DDI) is a tool for measuring successive changes in the state of development of digital infrastructure and its readiness to support the digital economy, calculated as an increase in costs for the formation of digital infrastructure and/or the dynamics of changes in its components. The Index of Local Economic Development through Digitalization (IMERC) - is a tool for measuring the economic effect of digitalization through the development of digital infrastructure and the introduction of digital technologies in the life of the region. Conclusions. Digital infrastructure is a key element of the socio-economic recovery of the de-occupied territories, and the proposed assessment method will contribute to improving the quality of strategic planning for the development of the de-occupied (affected) territories. Further research is focused on adapting global digital transformation practices to local infrastructure development conditions.

Background. Civil society institutions play a crucial role in the state-building processes of independent Ukraine. Given this, the question of researching the peculiarities of civil society institutionalization in Ukraine is relevant. Ukrainian historiography lacks a unified interpretation of issues related to the formation and structural elements of civil society. This article explores various perspectives on the structuring of civil society institutions. The novelty of the research lies in synthesizing approaches to defining the term 'civil society' and its core institutions.The relevance of the study is driven by the need for theoretical understanding of the formation and functioning of civil society institutions in Ukraine, as they represent the interests and needs of Ukrainian citizens. The aim of the article is to analyze the affiliation of political parties with civil society institutions. Methods. Comparative research was carried out in the article, historical-comparative, historical-typological, historical-systemic methods and analysis were applied. Different views of researchers on political parties belonging to civil society institutions are analyzed. The normative legal documents of the period of restoration and development of the Ukrainian independent state, constitutional projects, works of modern researchers were worked out, which consider the issues of institutionalization of civil society in Ukraine. Results. Having worked out regulatory and legal documents, constitutional projects, works of researchers on this topic proved that political parties are one of the key institutions of civil society in Ukraine. The most important criterion for the justification of belonging to the institutions of civil society is the active involvement of citizens in solving political problems when they actively participate in the development of state policy aimed at solving problems that are relevant to society, through the involvement of specialists, the creation of analytical centers, the study of public opinion and holding public hearings. Conclusions. An important role in the functioning of the state and the life of society is played by political parties, which are one of the institutions of civil society in Ukraine, which represent and protect the interests of citizens in the political arena, attract broad segments of the population to discuss pressing problems.

The aim of the article is to study the scientific literature and regulations and practices of their application in relation to the functioning of civil society in Ukraine, to predict its further development, to find ways to improve the legal status of civil society in Ukraine. To achieve it, the following tasks were formed: to consider the theoretical and legal side of understanding the concept of civil society; to study the legal aspects of the existence, formation and functioning of civil society in Ukraine; to analyze the negative and positive influences of civil society in Ukraine. The methodological basis of the study was a set of general and special methods, techniques and tools of scientific knowledge, with their comprehensive application aimed at achieving the goals and objectives of the study. The author used general scientific methods, including the dialectical method, as well as laws and categories of dialectics, in particular, general categories that characterize the development of nature and society: content, form, essence, phenomenon, cause, effect; categories that reflect specific connections in the process of cognition: matter and consciousness, empirical and theoretical, abstract and concrete, historical and logical, etc. The author clarifies the different views on the nature and subjective composition of civil society. The position that the bodies of self-organization of the population are an element of the system of local self-government is substantiated, and therefore their functioning lies in the plane of exercising public power, not civil society. Clarification and argumentation of the position that civil society should not compete with the state, but only is an indicator of real democratic processes in it. At the same time, civil society has a diverse subject composition, where each subject has its own goals and objectives, which they undertake voluntarily.

The idea of this Special Issue appeared in early 2014, when the heat of the fire on Kyiv’s Independence Square had not fully cooled down and when many civic activists and newborn volunteers had turned their ceaseless energy to yet another fire first in Crimea and then in Eastern Ukraine. The events that seemingly put the state of Ukraine on the brink of its very existence were evolving too fast, but civil society’s response to them was no less prompt and adaptive. Volunteers and activists were trying on new roles each day as they were helping those escaping persecution, repression and hostilities, equipping and maintaining those who fought with weapons or joining their ranks, developing reform agenda and drafting legislative proposals. What seemed astounding back then, and still does today, was how those thousands of volunteers and millions of “ordinary citizens” who mobilized to support new civic initiatives took over the functions of the weak and nearly collapsed state eroded by corruption, nepotism, the neglect of its citizens and of the country’s national interests. Challenging a post-Soviet monster disguised behind the mask of electoral democracy and market economy, citizens were bringing in a new social contract based on trust and solidarity on which a new state could be built. The speed of events and the scale of civil society engagement precluded any long-term comprehensive analysis, yet researchers’ zeal to reflect upon what looked as a tectonic move in Ukraine’s political and social development took over. At first, our idea was to co-author an article examining civil society’s role in a post-Euromaidan Ukraine, but soon enough the task became too big. The initial idea thus evolved into producing an edited volume with different authors looking into their respective fields of civil society in Ukraine in order to grasp at least a small portion of change. We are grateful to many researchers in Ukraine and abroad who responded to our call for papers in May 2016 and who contributed their ideas to this Special Issue. Some of these ideas eventually turned into articles and we would like to give special thanks to those colleagues who bore with us through rounds of revisions till the very end of this journey. Their articles made this Special Issue happen. We are also grateful to the Kyiv-Mohyla Law and Politics Journal for hosting this Special Issue and for supporting our initiative from the early stages through review and editing to the publication process. We would like to thank UACES – the Academic Association for Contemporary European Studies, UESA – the Ukrainian European Studies Association and the Jean Monnet Centre of Excellence in European Studies at the National University of Kyiv-Mohyla Academy for their financial and logistical support in organizing the Final Conference of this project, which took place at the National University of Kyiv-Mohyla Academy on November 21, 2017, the fourth anniversary of the Euromaidan. We are also enormously grateful to all the participants of the Conference for their remarks, comments and questions. Finally, we would like to extend our gratitude to the Kyiv office of Baker McKenzie, which has provided financial support to the publication of this Issue.

The work examines the main trends in the functioning of the domestic IT sector and the formation and development of digital infrastructure. The main directions of the digital transformation of the national economy include support and stimulation of the development of the IT sector, development of the national digital infrastructure, expansion of the scale of digitization of business, state administration, social sphere and livelihood of the population, as well as the development of digital skills and digital culture of citizens in order to overcome the “digital divide”. It has been proven that digital infrastructure should be considered as an interconnected set of technical and technological means, software, services and processes that ensure the use of IR technologies in all sectors of the economy and spheres of social life. According to the performed functions and tasks, two types of digital infrastructure are distinguished – technical-technological and software-service, which, constantly developing and becoming more complicated, support and complement each other. It was determined that the main criteria for assessing the level of development of digital infrastructure should be compliance with technical, technological, ethical and regulatory standards, systematicity, complexity, transparency, controllability, legitimacy and inclusiveness. The need to ensure effective state regulation, supervision and control over the functioning of the national digital infrastructure as a component of the state’s digital sovereignty has been proven. It was determined that the development of the national digital infrastructure should become a strategic priority of the state, and its main objects should be broadband Internet, 5G mobile communication, the infrastructure of the Internet of Things and cyber security, as well as “Industry 4.0”. It has been proven that in order to combine centralized and decentralized management mechanisms for the processes of formation and development of digital infrastructure, it is necessary to use a system approach that ensures a high level of functionality of all technical and technological components of digital infrastructure, programs and services. The main principles of the introduction and use of the “Industry 4.0” technology and promising sectors of the domestic economy for its implementation are determined. The potential sources and forms of financing the development of the IT sector and the development of IR technologies are characterized.