Ministry Of Health Research Articles

PECULIARITIES OF THE EXOCRINE SECRETORY FUNCTION OF THE PANCREAS IN NEONATES WITH PERINATAL PATHOLOGY

Introduction. Post-asphyxia syndrome in newborn infants due to experienced intrauterine hypoxia and asphyxia at birth remains a relevant issue in neonatology. The intestines and glands of internal and external secretion are target organs of pathologic hypoxic influence. Their ischemic damage can be a cause of digestive disorders against the background of multiple organ damage of a newborn child. Objective of this study is to determine peculiarities of the exocrine secretory functions of the pancreas in full-term neonates with perinatal pathology. Material and methods. One hundred fifty five Full-term neonates with the signs of perinatal pathology were examined. I group included 82 neonates with severe perinatal pathology, II group – 73 moderate pathology, 50 healthy infants constitute III control group. Inclusion criteria were gestational age more than 37 full weeks, clinical-paraclinical signs of maladjustment syndrome at birth and/or during the early neonatal period, parents’ written consent to participate in the study. Exclusion criteria were gestational age less than 37 full weeks; congenital defects; low body weight (size) at birth; signs of infectious processes. Clinical examination of patients and biochemical blood tests were carried out on the base of the clinical laboratory of the Municipal Non-Profit Institution «Municipal Clinical Maternity Home №2» of Chernivtsi Municipal Council, and German-Ukrainian laboratory «Bukintermed» (Chernivtsi). The study was conducted in accordance with the 'Rules of Ethical Principles of Conducting Scientific Medical Research with Human Participation,' approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EU Directive No. 609 (24.11.1986), the Order of the Ministry of Health of Ukraine No. 690 (23.09.2009), and the approval of the Biomedical Ethics Board of Bukovinian State Medical University. For statistical analysis, licensed software programs were used, including Statistica (StatSoft Inc., Version 7), Microsoft Excel (AtteStat, Version 12.5), and MedCalc Software Ltd (Version 22.021). Results and discussion. The examination groups were representative according to their gestational age and anthropometric parameters at birth, and gender characteristics. A comprehensive clinical-paraclinical examination of infants showed that severe disorders of infants in I group were caused by the signs of severe (13.4 %) and moderate (13.4 %) asphyxia at birth, meconium aspiration syndrome (20.7 %), severe respiratory disorders (53.6 %), hypoxic-ischemic damage of the central nervous system (39.0 %), convulsive syndrome (13.4 %), birth trauma (7.3 %) etc. Moderate maladjustment in infants from II group were associated with the signs of perinatal damage of the central nervous system (65.8 %), hemolytic diseases of the newborns (27.4 %), neonatal jaundice (28.8 %), respiratory disorders (35.6 %) etc. The condition of neonates from ІІІ group was satisfactory during the period of early postnatal adaptation. The results of additional examination methods found certain peculiarities of the exocrine secretory function of the pancreas in full-term neonates with perinatal pathology. Thus, blood amylase activity in the first day of life in the infants from І group was 0.39 ± 0.03 Un/L, ІІ group – 0.29±0.02 Un/L, ІІІ group – 0.14±0,01 Un/L (рІ-ІІ = 0.016, рІ-ІІІ < 0.0001, рІІ-ІІІ < 0.0001). According to the examination group, activity of the enzyme in the blood of infants at the end of their first week of life was 17.8 ± 0.81, 15.28 ± 0.22 and 14.81±0.06 Un/L respectively (рІ-ІІ = 0.006, рІ-ІІІ = 0.009, рІІ-ІІІ = 0.0435). The study found similar tendencies in changes of lipase activity in the blood of full-term infants. During the first day of life it was 0.35±0.01 Un/L in I group, ІІ group – 0.31±0.01 Un/L, ІІІ group – 0.32 ± 0.01 Un/L (рІ-ІІ = 0.003, рІ-ІІІ = 0.01, рІІ-ІІІ > 0.05). Activity of the enzyme in the blood of infants at the end of their first week of life was 19.7±0.22, 19.1±0.13 and 18.9±0.37 Un/L respectively (рІ-ІІ = 0.021, рІ-ІІІ > 0.05, рІІ-ІІІ > 0.05). Conclusion. The results obtained were indicative of a reliable increase of amylase and lipase activity in the blood of full-term neonates in all the examination groups in the dynamics of observation. It is associated with physiological stimulation of the exocrine secretory function of the pancreas in the early neonatal period. Attention should be paid to a direct correlation between an increased activity of the enzymes and severity of perinatal pathology both in the first day of life and at the end of the first week. It can be indicative of an excessive activation of pancreatic function due to pathologic hypoxic damage.

Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone

BackgroundIn outbreak-prone settings, community-based surveillance (CBS) systems can alert health authorities to respond in a timely manner where suspected cases of disease are being reported. After the 2014–2016 Ebola outbreak, the WHO and other stakeholders supported the establishment of CBS in Sierra Leone, for which community health workers (CHW) were trained to collect and report symptoms data of 11 priority health conditions in their communities. Our study objective was to assess feasibility and challenges to sustain CBS in a low resource setting as part of a World Bank evaluation of Sierra Leone’s Ministry of Health and Sanitation’s (MoHS) CBS and electronic Integrated Disease Surveillance & Response (eIDSR) systems.MethodsIn 2019 we conducted a mixed methods assessment consisting of a household incidence survey, health facility survey, household case verification survey, a costing analysis, and in-depth interviews and focus group discussions with key stakeholders of the CBS system in eight chiefdoms of 4 purposefully selected districts in Sierra Leone. The study period for primary data collection was February through April 2019. We also conducted secondary data analysis of surveillance data in DHIS2 of all 32 chiefdoms.ResultsIn districts where CBS was ‘fully functional’, the number and type of CBS alerts corresponded to the number and type of diseases reported through facility based eIDSR system in the same period. However under-reporting of diarrhea and measles suspects from the community still appeared to occur, and reporting deteriorated when primary health care staff including CHWs reported the stoppage of stipends. The annual budget impact for CBS was estimated at 4.4 million USD in 2018. The majority of costs were made at community level (73%) compared to regional (0.3%), primary health unit (21%), district (4%) and national (2%) level. The most important costs drivers were training of CHWs (59% of total costs) and salaries (including stipends of the CHWs) of human resources (15%). Barriers included sustainable financing of human resources, internet connectivity, as well as limited trainings and supportive supervision, and unsupported transportation costs for CHWs and peer supervisors (PS). CHWs and community members reported that communities are more willing to share information about health issues compared to the pre-CBS implementation period.ConclusionsThe similarity between CBS and IDSR reports support the possibility that CBS increases the sensitivity of disease surveillance to the level of the community, which would enable local authorities to take early prevention measures when and where impact will be the greatest. Qualitative interviews suggest that CBS has improved the interface between the community and primary level of the health system. However if the barriers to sustainability are left unaddressed, opportunities for CBS to prevent disease outbreaks will go unrealized.

ACCREDITATION EXPERTISE OF THE “GENERAL MEDICINE” TRAINING PROGRAM FOR THE SPECIALTY 222 “MEDICINE” OF THE SECOND (MASTER’S) LEVEL OF HIGHER EDUCATION AT IVAN HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY OF THE MINISTRY OF HEALTH OF UKRAINE

The article characterizes the procedure of accreditation expertise of the “General Medicine” training program for the second (master’s) level in the specialty 222 “Medicine”, implemented at Ivan Horbachevsky Ternopil National Medical University of the Ministry of Health of Ukraine. The relevance of the topic is determined by new approaches to the accreditation of educational programs in Ukraine, which require the implementation of autonomous methods for managing the quality of education in accordance with European standards. The results of the expertise carried out by the members of the expert group and the sectoral expert council of the National Agency for Higher Education Quality Assurance (NAQA) was analysed. The article describes how the Ministry of Education and Science of Ukraine, the Accreditation Commission, and the National Agency for Higher Education Quality Assurance conduct monitoring of training programs through assessing their compliance with established standards. The research shows that accreditation not only determines the quality of education but also helps identify the strengths and weaknesses of training programs, providing information to all stakeholders. The main results of the expert evaluation highlight a high level of training for specialists in line with current labour market demands and emphasize the importance of adapting curricula to the conditions of healthcare reform. The article underscores the significance of ongoing monitoring of education quality to enhance the competitiveness of graduates. The manuscript focuses on the uniqueness and advantages of the training program, its evaluation, as well as the recommendations and suggestions provided by NAQA experts.

Concordance Between Pharmaceuticals and Medical Devices Agency Review and Ministry of Health, Labour and Welfare Decision Among New Drug Applications in Japan

New drug applications (NDAs) in Japan are reviewed by the Pharmaceuticals and Medical Devices Agency (PMDA). Those that pass the review are subsequently subject to deliberation by the Ministry of Health, Labour and Welfare Pharmaceutical Affairs and Food Sanitation Councils (MHLW‐PAFSC), and the MHLW legislatively grants approval based on its positive opinions. However, little is known regarding the relationship between the PMDA review and the MHLW decision. We retrospectively assessed the MHLW decision of NDAs that passed the PMDA review at the initial MHLW‐PAFSC deliberation from 2002 to 2022. The reasoning behind a non‐supportive opinion from the MHLW‐PAFSC and the sponsor's actions to overcome unresolved issues were also documented. A total of 2,117 of 2,153 (98.3%) NDAs that passed the PMDA review were approved at the initial MHLW‐PAFSC deliberation with a positive opinion. The remaining 36 applications were not approved at the initial deliberation and subjected to continued deliberation because of a non‐supportive opinion from the councils, although 29 were finally approved through revision of the application document (24 applications), re‐analysis of the data (1 application), or additional clinical trials (4 applications). Seven applications have not been approved, of which one was refused, four were withdrawn, and two were unknown. The MHLW approves NDAs that passed the PMDA review at the initial deliberation at a high rate, suggesting that NDAs only suitable for approval passed the review and reached the MHLW‐PAFSC deliberation. Only a few NDAs were not approved at the initial deliberation; however, most of them were finally approved.

Assessment of the relevance of a prescribing competency framework in Kuwait – An e-Delphi study

Abstract Introduction Prescribing is the most common intervention used to manage patients. Globally, prescribing competency frameworks have been developed to standardize prescribing practice across all healthcare disciplines1. Research on prescribing practice in different chronic diseases in Kuwait has shown some inconsistencies in the quality of care delivered to patients. Aim This study assesses the relevance of the National Pharmaceutical Society (NPS) MedicineWise Prescribing Competency Framework statements amongst physicians, dentists, and pharmacists in Kuwait as a first step in developing a National Prescribing Competency Framework for Kuwait. Methods Ethical approval was granted by Kuwait’s Ministry of Health (MOH) for this project. A 4-phase adopt and adapt approach was planned to develop the Prescribing Competency Framework for Kuwait. This study covers phases 1 and 2 of this approach. Phase one involved translating the Framework into Arabic using parallel translation. Phase two utilised the e-Delphi method to reach consensus on the relevance of 48 statements (divided into 7 Competency Areas) for prescribing in Kuwait. For this phase, a survey, with a 4-point Likert scale, was developed using Google Forms and distributed to experts participating in the e-Delphi process. Purposive and snowballing method was used to recruit the experts, targeting all doctors, dentists, and pharmacists working in MOH. Participants were asked to rate their agreement with the relevance of the statements to Kuwait and allowed to leave comments. Statements achieving a consensus level ≥90%, with no answer as strongly disagree, were deemed relevant. Statements not reaching consensus will be reevaluated in Round 2 of the e-Delphi process (planned for July-September 2024). Results The translation phase yielded a bilingual framework that could be utilised by prescribers in Kuwait. Round 1 of the e-Delphi included 36 experts (22 doctors, 8 dentists, and 6 pharmacists). Out of the seven Competency Areas in the NPS framework, four Competency Areas reached 100% consensus (Areas 1, 4, 5, and 6). 90% of the statements in Competency Area 2 reached consensus, while only 40% of the statements in Competency Area 3, and 85.7% of the statements in Competency Area 7 reached consensus. Competency statements that did not reach consensus will be re-assessed in Round 2 of the e-Delphi process. Conclusion To our knowledge, this is the first study conducted to initiate the process of adopting and adapting a Prescribing Competency Framework in Kuwait. Competency statements involving patient engagement in their management plan seemed to gain the least consensus in Round 1 of our study, which will be explored further in Round 2 of our e-Delphi process. This is consistent with current published literature in the Middle Eastern and North African regions which shows that there is no clear understanding by healthcare professionals of how to apply patient-centred care2,3. Limited comments on disagreed statements in Round 1 require further clarification. There is a need to standardize the prescribing process due to the complexity of choosing the right medication, the imperative to optimize medication use, a change in the patient's care models, and the possibility of other healthcare professionals taking on prescribing roles.

The Development of Operational Model Integrating Digital Technologies into Public Mental Healthcare Services in Nigeria

The availability and utilization of digital technologies can leverage the challenges of the sharp-depleting workforce due to the consistent migration of healthcare professionals (HCPs), the alarming ratio of the number of patients to HCPs, discretional use of digital technologies among HCPs in providing effective therapeutic interventions and mental healthcare services. This study aimed to develop an operational model that integrates digital technologies in mental healthcare service delivery for public facilities in Nigeria. The practice-oriented theory guides the development of the model. A qualitative method assessed the digital technologies used during the COVID-19 pandemic. A non-probability, purposive sampling technique that employed the snowball method was used in selecting the sixteen (16) HCPs from four (4) neuropsychiatric hospitals in South-West Nigeria. Thematic analysis was conducted on qualitative data. Findings from the qualitative analysis revealed several challenges in providing adequate and efficient services in public mental healthcare facilities in Nigeria, such as human resource challenges, brain drain, lack of infrastructure, and strains on HCPs. Findings from this study indicated that digital technologies are sparingly utilized in public mental healthcare service delivery due to a lack of policy and framework. HCPs perceive digital technologies to be beneficial to themselves and their clients. The highlighted benefits to patients are reduced stigmatization levels, decreased financial burden, enhanced accessibility to therapists, strengthened adherence, mitigated relapse incidences and improved intervention. The transition from the traditional/conventional space of mental healthcare service delivery to digital space requires a collaborative approach with Computer scientists (software developers, database administrators), Data scientists, investors, stakeholders and mental HCPs. The proposed model serves as a contemporary framework that the Government, policymakers in the Ministry of Health and management of mental health facilities in Nigeria can adopt, providing the needed awareness of the benefit of technological intervention.

Changes in the functional connections of the brain in patients with hypersomnia in acute ischemic stroke

BACKGROUND: The Disorders of cerebral circulation and sleep are inextricably related, since sleep disorders, including hypersomnia, are closely intertwined with cardiovascular diseases and increase the risk of stroke. Research works on visualization of functional brain changes in patients with sleep disorders and acute ischemic stroke are very few and need more study. AIM: to determine the functional connections of the brain in hypersomnia in patients with acute ischemic stroke by performing functional magnetic resonance imaging at rest. A study of 40 patients with acute ischemic stroke and sleep disorders was performed on the basis of the Federal State Budgetary Institution Almazov Research Center of the Ministry of Health of the Russian Federation. All patients underwent neurological examination, assessment of sleepiness, worry and depression, magnetic resonance imaging was performed on tomographs with a magnetic field induction force of 1.5T, using a standard protocol and special pulse sequences of T-gradient echo 3D MPRAGE and BOLD. Functional magnetic resonance imaging of the brain at rest was used to assess functional connections. Postprocessing was performed using specialized CONN-TOOLBOX software with an appropriate graphical representation of quantitative results based on the selection of areas of interest. RESULTS: Among the examined patients, 23 had hypersomnolence; of these, 8 patients were diagnosed with secondary hypersomnia associated with sleep apnea syndrome. Thus, in the examined sample, post-stroke hypersomnolence was detected in 15 patients (34%). Patients with an unspecified subtype of stroke and right-sided lesions showed a high degree of drowsiness (p 0.05). With the help of functional magnetic resonance imaging of the brain at rest, changes in functional connections between the main nodes of the default mode network with the left temporal pole, cerebellum, central cerebral cortex on the left, angular gyrus on the left, with the dorsal attention network on the right are determined (p 0.05). CONCLUSION: The use of complex magnetic resonance imaging, which includes structural and functional magnetic resonance imaging in patients with acute ischemic stroke and sleep disorders, allows us to identify structural changes and changes in functional connectivity and identify neuroimaging markers of this pathology. Hypersomnolence is typical for patients with an unspecified subtype of ischemic stroke and damage to the right hemisphere of the brain.

Peculiarities of the course of gestation in women with a history of reproductive loss

Aim. Тo assess the frequency of extragenital pathology, features of obstetric and gynecological history and the course of pregnancy in women with a history of reproductive loss. Materials and methods. The study was conducted on the basis of the Municipal non-profit enterprise “Maternity house No. 9” of the Zaporizhzhia City Council with the involvement of 75 pregnant women with one reproductive loss in history. The control group consisted of 30 women without a history of reproductive loss. Women who had reproductive losses were divided into 2 groups. Group I (main group) includes 38 pregnant women who registered for pregnancy and began their participation in this study after the start of a full-scale war on the territory of Ukraine. II (comparison) group included 37 women who were registered for pregnancy before the start of the full-scale war. It should be noted that 17 pregnant women (44.7 %) had the status of an internally displaced person. The average age of women in group I was 30.10 ± 5.86 years, in group II – 28.80 ± 6.07 years, and 26.50 ± 4.95 years in the control group. The anamnesis data and features of the course of gestation were studied in all patients. Management of pregnancy and childbirth of women was carried out in accordance with the current Orders of the Ministry of Health of Ukraine. Variational and statistical processing of the results was carried out using the Statistica 13 program. Results. According to the results of the study, it was established that the frequency of extragenital pathology in women with one reproductive loss was higher, compared to women who had no such experience. Diseases of the cardiovascular and urinary systems occupy a leading place in this category of women. According to obstetric and gynecological anamnesis, a significant predominance among women of I and II groups of diseases of the reproductive system, compared to women of the control group, was established. Also, in the corresponding groups, a high frequency of miscarriage was established both in the period up to 12 weeks (28.95 % in the I group, 43.2 % in the II group against 6.67 % in the control group), and in the period of 12–22 weeks (34.20 % in the I group, 29.73 % in the II group vs. 13.33 % in the control group). Conclusions. Based on the conducted analysis, a high frequency of pregnancy complications was established for pregnant women who had a history of one reproductive loss. This contingent of women also has a high frequency of extragenital and gynecological concomitant pathology. Such results make it possible to assume a connection between the presence of one reproductive loss in women in the anamnesis and gestational complications of the next pregnancy.

Treatment for acute alcoholic-alimentary pancreatitis with peritoneal syndrome

A large number of publications on surgical treatment of acute alcohol-induced pancreatitis (AAP) with peritonitis indicates the importance of the problem and the need for a differentiated approach to treatment. The aim of this study is to determine the optimal treatment policy for acute alcohol-associated pancreatitis with peritonitis. The study included 114 male patients diagnosed with acute alcoholic pancreatitis and peritoneal sepsis, with an average age of 48.6 ± 6.4 years. They were admitted to the surgical departments of clinical hospitals between 2013 and 2023. The diagnosis of AAP was confi med based on clinical, laboratory, and instrumental findings. The classification of acute pancreatitis recommended by the National Clinical Guidelines of the Ministry of Health of the Russian Federation (2015 and 2020) has been applied. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scale has been used to assess the severity and prognosis of the disease, while the Sequential Organ Failure Assessment (SOFA) scale has been used to evaluate organ failure. Based on the results, an algorithm for the treatment of acute alcoholic and alimentary pancreatitis with peritoneal syndrome has been proposed, taking into account the type of pancreatic necrosis, the extent of pancreatic damage, and the nature of fl uid accumulation. For patients with edematous pancreatitis, small-focal sterile pancreatic necrosis, and enzymatic peritonitis, percutaneous ultrasound-guided abdominal and omental drainage is recommended. In severe and moderate acute alcoholic-alimentary pancreatitis, with enzymatic peritonitis (more than 8 points on the APACHE II scale), which is manifested during diagnostic and sanitation laparoscopy by the presence of a hemorrhagic effusion and a large number of plaques of steatonecrosis on the parietal peritoneum and the large omentum, we should use an endovisual method of draining the abdominal cavity and the omentum to minimize anesthesiological and surgical aggression and to form and maintain general cavities, as well as to create good access to the pancreatic area. For patients with large-focal, infected subtotal or total pancreatic necrosis and purulent peritonitis, it is advisable to perform laparotomy, abdominalization of the pancreas, necrectomy, omentobursostomy, and drainage of purulent foci in the abdominal cavity and retroperitoneal tissue.

The implementation process of decentralization of health services: a qualitative perspective from Sudan

BackgroundHealth system reform initiatives have increasingly embraced decentralization as a key trend. The implementation process and its outcomes are influenced by a myriad of factors, including economic forces, political dynamics, and ideological factors. Comprehending and carefully examining the implementation phase of decentralization and its consequences to achieve desired outcomes is crucial. Notably, this phase is often considered the weakest aspect of policy reforms, especially in developing countries. Therefore, this study aimed to explore and analyze the implementation phase of decentralization and its implications as essentials for achieving intended goals. The study objectives evolved around examining the entire decentralization as a multifaceted social and political process in Khartoum State, Sudan, from its early stages of decision-making, policy formulation, and implementation process and the influencing contextual factors.MethodsThis study was an exploratory qualitative study that employed in-depth interviews to gather perspectives of healthcare providers and policymakers, semi-structured observations, and thematic analysis. The study utilized Grindle’s framework for analysis.FindingsThis study revealed a political nature of decision-making, with a top–down approach to the implementation, which also lacked stakeholder involvement. It showed a lack of transparency, official documentation, and proper handover procedures from the Ministry of Health to the devolved hospitals during the implementation process. A conflict of interest between the federal and the state level was also reported. It is important to note that this process occurred within the context of structural adjustment program (SAP) schemes, which had already empowered the private sector in Sudan.ConclusionThis study documented the implementation process of decentralization of health services and its influencing factors. The study recommended reforming the decentralization policy through consultative stakeholder involvement and by implementing a concurrent responsibility paradigm that divides authority between the federal and state levels.

Voluntary information and price sharing database: a scoping review of the pricing and procurement landscape across eight commonwealth member states

Abstract Introduction Launched in 2021, the Voluntary Information and Price Sharing Database (VIPSD) aims to support procurement methods with an emphasis on price transparency, reducing costs, and sharing information on health products, suppliers, and supply chains amongst Commonwealth member states. The creation and implementation of the VIPSD has been endorsed by successive Commonwealth Ministries of Health, during their annual meetings, in 2021 and 2022. To date, there has been limited deployment of the database in member states, in part due to various pooled procurement initiatives that were set up during and post-pandemic. In 2023, the Commonwealth Health Ministers meeting highlighted several issues around medicines shortages, of which pricing and price transparency were cited as some contributory factors1-3. VIPSD was seen as a valuable resource to help address some of these issues. Aim This scoping review aimed to explore the procurement landscape of medical products and establish how VIPSD can support procurement systems in select Commonwealth member states. Methods Eight Commonwealth member states (out of 56) were selected from the regions of Africa, Asia, Europe, Pacific, the Caribbean, and the Americas: Bangladesh, Dominica, Kenya, Malaysia, Malta, Solomon Islands, South Africa, St. Vincent and the Grenadines. Selected countries represented health systems’ diversity, larger and smaller populations, established and developing procurement pathways and Commonwealth regionality. Data collection was conducted using a standardised proforma and predefined inclusion criteria: procurement/pricing of pharmaceuticals, vaccines and other goods; public sector stakeholders; IT systems/databases and their scope; issues to consider e.g. registration, regulation, detection of substandard medicines. Evidence was screened using Excel and thematically analysed until saturation. No ethical approval was required for this review. Results The results of the pricing landscapes, in the 8 countries chosen for the scoping review, showed a diverse range of pricing policies and approaches to ensure affordable access to medicines. Three (3) countries (Malaysia, Malta and South Africa) had national pricing policies, 3 countries (Bangladesh, Dominica and Kenya) did not have any national pricing policy and for 2 countries (Solomon Island, and St Vincent and Grenadines) this information was unclear. The scoping also showcased a diverse array of legislative frameworks, models and successes of the procurement landscapes in the various countries. Across the 8 countries there were numerous pricing and procurement systems/databases currently in use, mainly led and managed by their respective governments, through centralised teams. Some of the challenges in the pricing and procurement landscape included: lack of comprehensive framework leading to medicine price disparities, stock-outs and shortages, budgetary constraints and delayed procurement process. Discussion/ Conclusion Across all 8 countries scoped, our review highlighted that a database such as VIPSD would be valuable in supporting pricing and procurement in key areas such as enhanced transparency and fair pricing, collaboration for improved access, mitigating price disparities, equitable access to innovative health commodities, routine reporting and data driven decision making. However, several challenges of VIPSD, such as the scope and remit of VIPSD, issues around data completeness and transparency in pricing, and funding for VIPSDs’ development, deployment and maintenance also need to be addressed.

Changes in heart rate variability and subclinical heart failure with preserved left ventricular ejection fraction in workers of the main professions at the coal industry

Introduction. The high prevalence of diseases of the circulatory system necessitates their detection and prevention at an early stage, especially in regions with high industrial potential. The occurrence of subclinical heart failure depends on a cascade of processes that are already occurring in the body and may eventually manifest themselves in clinically pronounced diseases. One of the possible mechanisms of its development is a violation of the balance of the autonomic nervous system with a violation of adaptive capabilities to the labour process, characterized by severe physical overloads among miners. The study aims to evaluate changes in heart rate variability in workers of the main professions at the coal industry with signs of heart failure with a preserved left ventricular ejection fraction. Materials and methods. The study included 78 employees of the main professions at the coal industry. Specialists performed ultrasound examination of the heart according to generally accepted methods with the study of longitudinal deformation of the myocardium. The concentration of NT-proBNP in the blood serum was determined by solid-phase enzyme immunoassay. The authors also conducted an analysis of heart rate variability, determined temporal, spectral and linear parameters. Results. Specialists revealed a decrease in longitudinal myocardial deformation in 38.5% of the examined patients, signs of diastolic dysfunction in 41%; in these groups, a tendency to increase the concentration of NT-proBNP was revealed. In the examined miners with heart failure with preserved ejection fraction, they revealed a significant decrease in the SDNN index and an increase in IC values. The increase in DFA and LF/HF indicators reflects a vegetative imbalance towards sympathetic activation observed in all surveyed miners. Limitations. This study is limited to a sample of employees of the main professions of the coal industry undergoing periodic medical examination at the Research Institute of Complex Problems of Hygiene and Occupational Diseases. Conclusion. The revealed relationship between indicators of heart failure and heart rate variability (SDNN, LF/HF, DFA and IC) in miners allows us to identify a group of people at greatest risk of adverse outcomes. Ethics. The study was conducted in compliance with the standards of the Bioethical Committee of the Research Institute of Complex Problems of Hygiene and Occupational Diseases, established in accordance with the Helsinki Declaration of the World Medical Association "Ethical Principles of Conducting medical Research with human participation as a subject" as amended in 2013 and the "Rules of Good Clinical Practice" approved by Order No. 200n of the Ministry of Health of the Russian Federation dated 04/01/2016. The subjects signed an informed consent to participate in the study.

Assessment of age-related features of the condition of heavy-duty truck drivers based on spectral analysis of EEG-ECG and stress tests during mass occupational examinations

The authors studied the physiological characteristics of drivers of heavy-duty coal mine vehicles based on spectral analysis of EEG-ECG and stress tests, which have prognostic value in professional activity. The study aims to assess the functional condition of heavy-duty truck drivers of different age groups based on a comprehensive spectral analysis of EEG-ECG under occupational examinations. During the survey, the authors have studied the spectral parameters of the EEG‒ECG in 300 male drivers aged 25 to 66 years. Specialists have performed EEG registration when placing electrodes in the 10–20 system. The EEG analysis was performed with a preliminary visual analysis followed by the removal of artifacts. The scientists assessed the level of representation of the main alpha rhythm and its spatial distribution. The ECG registration was in the first lead. The duration of EEG-ECG registration is about 15 minutes in a typical sequence of stress tests: baseline, rhythmic photostimulation, hyperventilation with recovery periods. The spectral analysis of the EEG‒ECG was performed automatically on a Neurotravel device (Italy). The authors found lower alpha and delta activity in the initial EEG spectra in older drivers aged 45–66 years, which contributed to the cumulative effect of stress load. Light stress stimulation significantly reduced alpha and delta activity and increased beta EEG activity in both groups, while in the older group the high-frequency range significantly exceeded the low-frequency range. Simultaneously with the changes in the EEG, stress photostimulation increased the energy of the ECG spectra in all frequency ranges. The authors established the appearance of additional stress indicators during light stimulation in older drivers based on the correlation of EEG‒ECG spectra (alpha/delta) and the absence of such changes in the group of young drivers aged 25–35 years. Moreover, the EEG–ECG correlation coefficients and their critical values increased in groups in increments of 6 years — from 35 to 65 years. Elderly drivers, based on neuro-cardiodynamic indicators, were in a state of chronic stress and the resulting risks to health and professional activity, and the identified physiological mechanisms of stress may be at the heart of ways to prevent it. Limitations. The study is limited to the assessment of EEG and ECG indicators in 300 heavy truck drivers. Ethics. The study was performed using non-invasive methods and approved by the Bioethical Committee of the Research Institute of Complex Problems of Hygiene and Occupational Diseases, Protocol No. 5, § 1 dated 12/26/2018, in accordance with the Helsinki Declaration of the World Medical Association "Ethical Principles of conducting medical research with human participation as a subject" as amended in 2013 and the "Rules of Good Clinical Practice" approved by by Order of the Ministry of Health of the Russian Federation No. 200n dated April 1, 2016. All the examined patients signed a voluntary informed consent to participate in the study.

The results of the assessment of burnout syndrome in outpatient clinic staff for the development of personalized rehabilitation

In conditions of increased workload on the medical staff of outpatient clinics, the need to preserve their physical and mental health, reduce the socially significant consequences of emotional burnout comes first, which makes it necessary to search for new directions of prevention, correction and rehabilitation using personalized medicine methods. The study aims to assess the state of health and the syndrome of emotional burnout in medical workers of the outpatient clinic. Specialists have examined 100 medical workers of outpatient and inpatient departments of the medical institution in equal numbers. The average age of outpatient medical staff was 49 [46;59] years, and inpatient — 43 [33;53] years. The average work experience of the examined medical personnel was the same both in outpatient settings (20 [16;28] years) and in hospital (20 [13;31] years). The authors have performed general clinical, laboratory and instrumental examinations. In addition to the standard examination scheme, the scientists assessed emotional burnout using the V.V. Boyko method and the quality of life according to the EQ-5D questionnaire in modification 3L and the hospital anxiety and depression scale HADS, and also conducted a questionnaire on a new coronavirus infection and the detection of post-COVID syndrome. As a result of the study, the authors proved a decrease in the psychological and physical components of the quality of life of medical workers, which are associated with both work experience and a new coronavirus infection. It was confirmed that according to the results of the Boyko questionnaire, employees of the outpatient clinic, compared with their colleagues from the hospital, often have a higher unfavorable total score. According to the results of the survey, we observe an improvement in the psychological and physical components of the quality of life of medical personnel after individual rehabilitation. This study showed the importance of assessing the state of health and emotional burnout syndrome in medical workers, high scores were revealed according to the Boyko questionnaire. Limitations. This study is limited to a sex-and-age sample of medical staff at a medical institution. Ethics. The study was conducted in accordance with the Helsinki Declaration "Recommendations for Doctors on Biomedical research in Humans" (2013), the World Association "Ethical Principles of Scientific Medical Research with Human Participation" as amended in 2000 and the "Rules of Clinical Practice in the Russian Federation", approved by Order of the Ministry of Health and Social Development of the Russian Federation No. 266 dated 06/19/2003, according to the developed protocol.

Prevalence and Factors Associated with the Fourth Standard Antenatal Care Utilization among Pregnant Women Attending Ruli District Hospital, Rwanda

Purpose: The purpose of this research is to identify the prevalence of adherence to the recommended four antenatal care (ANC) visits and to analyze factors associated with achieving the fourth ANC visit among pregnant women attending Ruli District Hospital in Gakenke District, Rwanda. The study aims to address gaps in ANC attendance, focusing on improving maternal and fetal health. Methodology: A cross-sectional study design was used, with a sample size of 421 women, determined through Fisher et al.'s (1998) formula. Systematic sampling was employed to select participants between November 20, 2023, and January 20, 2023. Data collection included informing participants about the study and obtaining consent. Confidentiality was maintained by anonymizing participant data. Analysis was conducted using SPSS version 25, applying descriptive statistics such as percentages, means, and frequencies. Bivariate and multivariate regression analyses were used to identify relationships between independent and dependent variables, with significance assessed at p < 0.05. Findings: The study found that 57.5% of respondents adhered to the four recommended ANC visits, while 42.5% attended fewer than four. Factors significantly associated with increased ANC attendance included higher educational attainment, abstinence from alcohol by both the mother (AOR=1.953, CI: 1.202-3.174, P<0.007) and husband (AOR=2.041, CI: 1.112-3.747, P<0.002), planned pregnancies (AOR=4.159, CI: 1.975-10.326, P<0.001), and absence of mistreatment toward women (AOR=3.040, CI: 1.367-6.762, P=0.006). Unique Contribution to Theory, Practice and Policy: The study recommends enhanced supportive supervision and mentorship of Community Health Workers for home visits to pregnant women. Additionally, improving customer care and the quality of ANC services is advised. These insights are expected to guide policymakers in Rwanda, including the Ministry of Health, Ruli District Hospital, and other stakeholders, in enhancing ANC adherence and improving maternal health outcomes.

Bibliometric analysis of scientific literature on the use of suppositories in the treatment of prostate cancer patients

Nowadays, cancer remains one of the main causes of death worldwide. Statistical data from various literary sources indicate that more than 130,000 people in Ukraine receive this diagnosis as a sentence every year. Cancer can affect any organs of the human body and, over time, the entire organism. In 2024, the agency of the World Health Organization on cancer and the International Agency of Cancer Research published the latest statistical estimates of this pathology in a global format, where prostate cancer is among the five most common oncological pathologies and takes the fourth place. Oncological diseases are one of the priority areas of healthcare development in accordance with the Order of the Ministry of Health of Ukraine No. 1832 dated 07.10.2022 “On Approval of Priority Areas of Healthcare Development for 2023–2025”. It was this fact that determined the choice of the direction of this research in the matter of finding information on the provision of pharmaceutical care, namely the use of a drug – a rectal suppository for the treatment of prostate cancer. The aim of the work is to carry out a bibliometric analysis and further generalize the data of the scientific literature to study the prognostic value and features of the prescription of suppositories in the treatment of prostate cancer. Materials and methods. The data search was conducted in the PubMed electronic database using the following key terms: “prostate cancer and suppositories”, “prostate cancer”. To monitor and analyze international scientific research, with the help of visualization tools and modern SciVal citation metrics using the online platform, bibliometric analysis can be performed. Using the VOSviewer functional program, bibliometric networks were constructed and visualized. Results. A map of the relationships between the most used keywords on the topics of “prostate cancer” and “prostate cancer and suppositories”, grouped into clusters for the period from 1986 to 2024, was built. The clustering of the most used keywords on the subject of “prostate cancer” for the specified period is summarized. According to the bibliographic analysis, interest in the above topic was highest in 2014 and 2021. Conclusions. According to the bibliographic analysis, the interest in the subject of the patients’ treatment with prostate cancer disease continues to grow from 1998 up to the present. The analysis of publication activity using the visualization tool of bibliometric networks VOSviewer for the period from 2014 to 2024 for the key words “prostate cancer” has shown the presence of 14 clusters. The largest cluster is devoted to modern methods of prostate cancer treatment, studies of gene rearrangement, target therapy, carcinogenesis.

Functional study of the brain based on magnetic resonance imaging in patients with insomnia disorders

BACKGROUND: Insomnia has a significant impact on the quality of life of patients. Despite the progress in understanding the pathophysiological mechanisms of insomnia, the possibilities of its objective diagnosis remain insufficiently studied. This study can contribute to understanding the neural mechanisms of insomnia, contribute to the development of new diagnostic and treatment methods, and personalize therapeutic approaches to improve the quality of life of patients with insomnia disorders. AIM: to evaluate changes in the brain connectome in patients with psychophysiological and paradoxical insomnia by performing functional magnetic resonance imaging. MATERIALS AND METHODS: A total of 31 patients were examined who applied for a somnologist appointment at the Federal State Budgetary Institution Almazov National Medical Research Centre of the Ministry of Health of the Russian Federation with diagnosed chronic insomnia. All patients underwent polysomnographic examination using Embla N 7000 (Natus, USA) and SOMNO HD (SOMNOmedics, Germany) for one night with an assessment of the main characteristics of sleep according to the rules of AASM 2.5. Also, all study participants underwent magnetic resonance imaging of the brain on tomographs with a magnetic field induction force of 3.0 Tl at two time points. Statistical analysis of MRI data was performed using MathLab 2023a, CONN v22.a packages. Descriptive statistics, the Kolmogorov–Smirnov criterion were used for processing materials, depending on the characteristics of the data, the Mann–Whitney U-criterion and Pearson Chi-squared were used to analyze demographic data. DISCUSSION: The study demonstrates the possibilities of functional magnetic resonance imaging in obtaining data on the functional connections of the brain in insomnia. The detected changes in the activity of various brain regions indirectly or directly involved in the regulation of sleep and wakefulness are consistent with the most common pathogenetic models of insomnia, in particular with the theory of hyperactivation and the model of sleep reactivity to stress. CONCLUSION: The results of the study emphasize the relevance of studying functional changes in the brain in insomnia, opening up new opportunities for more accurate diagnosis and the development of personalized treatment methods.

Combining quality improvement and critical care training: Evaluating an ICU CPR training programme quality improvement initiative at the National Hospital in Tanzania

BackgroundThe United Republic of Tanzania has had a 41.4% mortality rate in the intensive care unit. In Tanzania, the Ministry of Health and Social Welfare has implemented quality improvement (QI),...

Low back pain prevalence and associated factors among nurses: cross sectional study from Palestine

IntroductionThe prevalence of low back pain among nurses is notably high, which negatively affects their job performance and overall work quality.Aim of studyThis research aimed to evaluate the prevalence of low back pain among nurses in Nablus city and investigate how personal and work-related factor and the occurrence of low back pain in this population.MethodEmploying a cross-sectional study design, we employed validated instruments, including the Nordic Musculoskeletal Disorder Questionnaire. The study encompassed 258 nursing employees from both the largest and smallest Ministry of Health (MOH) and private sector hospitals in Nablus city, West Bank, Palestine. Data were collected through a self-administered questionnaire.ResultA total of 258 nurses participated in the study, yielding a response rate of 98%. The lifetime prevalence of Low Back Pain (LBP) was 82% (n = 212) throughout their life. Additionally, the prevalence of LBP in the 12 months preceding data collection was 78% (N = 201), 71% (N = 182) in the month leading up to the study, and 61% (N = 156) on the day of data collection.ConclusionThe study disclosed a high prevalence of low back pain among nurses, underscoring the urgency for effective solutions. These findings highlight the need for more comprehensive research to better understand and address this issue.

Comorbidity problems in patients with osteoporosis

BACKGROUND: Osteoporosis is a metabolic skeletal disease characterized by decreased bone mass, impaired microarchitecture of bone tissue and, as a consequence, fractures with minimal trauma. The social significance of osteoporosis is determined by its consequences — fractures of the vertebral bodies and bones of the peripheral skeleton, leading to high medical costs and causing a high level of disability, including disability and mortality. Osteoporosis is most often combined with cardiovascular diseases caused by atherosclerosis, which are widespread and are the leading cause of disability and mortality. A small number of studies have been devoted to the study of the features of clinical manifestations of cardiovascular diseases in the combination of coronary heart disease and osteoporosis. AIM: To identify the frequency and severity of comorbid diseases and their risk factors in postmenopausal osteoporosis. MATERIALS AND METHODS: A retrospective and prospective cohort study was conducted from 2013 to 2023. 8250 women with postmenopausal osteoporosis were examined and the data from the medical records of these patients who applied to the Osteoporosis Center of the North-Western State Medical University named after I.I. Mechnikov of the Ministry of Health of the Russian Federation from 2013 to 2020 were analyzed. At the prospective stage, two comparison groups of 100 patients with and without postmenopausal osteoporosis were formed from 500 patients with comorbid diseases (coronary heart disease, hypertension, type 2 diabetes, stroke, transient ischemic attack). Bone mineral density was assessed based on the Hologic Discoveri Wi dual-energy X-ray absorptiometry at 2 points in the lumbar spine (L1–L4) and the femoral neck. Along with traditional laboratory examination methods, bone metabolism markers (total calcium, phosphorus, vitamin D, urine analysis for deoxypyridinoline, C-terminal telopeptide of type 1 collagen, osteocalcin, alkaline phosphatase, parathyroid hormone) were assessed dynamically. In all the patients, along with a general clinical examination, an assessment of risk factors for cardiovascular disease and osteoporosis was performed. RESULTS: Body mass index was higher in the group of patients with osteoporosis — 28.4 (26.9–32.4) kg/m2 (p 0.001), versus 27.64 (25.8–30.0) kg/m2 (p 0.05). Bone mineral density in the group of patients with osteoporosis was statistically lower than in the group without osteoporosis. In the group of patients with osteoporosis, the risk of fractures was high and amounted to 37 (95% confidence interval 15.0–38.50) %, p 0.001), versus in the control group 9.55 (95% confidence interval 7.67–15.0) % (p 0.001) according to the FRAX questionnaire for the Russian Federation. In the group of patients with osteoporosis, the Charlson index values were 5.1 (95% confidence interval 4.7–5.6) points. As a result of the correlation analysis, a reliable positive relationship was revealed between low bone mineral density L1–L4 and hip with bone metabolism: alkaline phosphatase, C-terminal telopeptide of type 1 collagen, vitamin D, osteocalcin, urinary deoxypyridinoline. We found a negative relationship between bone mineral density and the Charlson index, absolute ten-year risk of hip fracture and the duration of early menopause, and the level of hypertension. To assess the dependence of QRISK3-2018 on osteoporosis risk factors in the group of patients with osteoporosis, multiple linear regression was performed. This model was characterized by a statistically significant correlation between the factors and the dependent variable of high tightness. The coefficient of determination was 0.608, indicating a 60.8% contribution of the factors taken into account in the model to the variance of QRISK3-2018. CONCLUSIONS: In women with postmenopausal osteoporosis, comorbid pathology is more common, aggravating the course of the disease. Knowledge of the prevalence of concomitant pathology and joint risk factors will make it possible to simultaneously form groups at increased risk of development, which will ensure prevention of both diseases with the same non-medical means and drugs.