Health Sphere Research Articles

“We have to look deeper into why”: perspectives on problem identification and prioritization of women’s and girls’ health across United Nations agencies

Eliminating gender inequality and promoting population health are stand-alone goals in the Sustainable Development Goals (SDGs). It is crucial to understand goal setting and policy making processes aimed at promoting gender and health equality given the entrenched and structural natures of these inequalities. Our research examines the process of problem and solution representation, priority setting, and factors that shape the policymaking process concerning women and girls within the UN system in relation to the SDGs. Data for this study were collected from semi-structured one-on-one interviews with participants who have work experience within the United Nations (UN) (n = 9). The analysis was informed by a qualitative descriptive methodology. Our findings identify the role of political forces in influencing policy, the challenges of limited and tied financial resources, the role of scientific evidence and data, and the purpose of different mandates across agencies. Political forces were found to shape the work of UN agencies, often hindering advancement of the SDG agenda. At the same time participants noted how they navigated opposition or what they considered regressive approaches to women and girls’ health in order to pursue a more progressive agenda. Finite financial resources were also noted to play an important role in shaping SDG implementation pertaining to women and girls’ health. Identification of the types of knowledge, evidence, and data that drive and are given preference in policy creation and development can highlight shortcomings and strengths of current modes of policy development and implementation. Key stakeholders and future research in health and development policy spheres can draw from our findings to gain insight into problem representation and prioritization. This will help identify underlying assumptions that inform work on women’s and girls’ health and how they shape policy agendas.

"There Is No Peace", "We Are Just Persevering": Triggers, Manifestations, and Consequences of Intimate Partner Violence Against Men in Kenya.

Intimate partner violence (IPV) within heterosexual relationships affects both men and women, yet an in-depth description of IPV against men in developing countries is still limited. This study explored community perceptions of male IPV victimization in an informal settlement in Nairobi, Kenya. We conducted 12 focus group discussions (FGDs) with 118 ever-married participants (59 men and 59 women), divided into 6 FGDs for each gender. We performed thematic analysis using NVivo software. This article presents three main themes that emerged during data analysis: (a) triggers, (b) manifestations, and (c) consequences/effects of IPV against men. Both male and female participants perceived male IPV victimization as a significant concern in the community. The poor living conditions, coupled with alcohol use, seemed to be major underlying factors, often forming the basis of spousal conflict. Emotional abuse, including denial of basic needs, acts of humiliation, and coercive control, were the most frequently cited forms of violence. The consequences of what was considered IPV against men affected victims and their families including the violent female spouses, children, and the society at large. These effects upset the health, economic, and social spheres of life with some retriggering male IPV, thus creating a vicious cycle of abuse. Notably and of concern, IPV against women was highlighted as a consequence of male victimization. Although we set out to explore community perceptions, study participants openly shared their experiences of male IPV perpetration and victimization. These findings underscore the importance of recognizing men as potential victims of IPV and contextualizing IPV prevention strategies targeting the urban poor with the goal of designing and implementing policies and interventions that address IPV holistically.

On the issue of determining notions "medical malpractice", "yatrogeny" and "defect of medical care": social legal aspects

The article considers social legal aspects of concepts of "medical error", "iatrogenesis", "defect of medical care" in view of absence of their clear definition and understanding in public and professional communities. The usage of these concepts is distinguished by chronological continuity that is conditioned by influence of approaches existed at different stages. On the basis of analysis of scientific publications and normative legal base their genesis and peculiarities of definition are demonstrated. The social aspects affecting their transformation were revealed. It is established that initially traditional understanding of possible shortcomings in medical work was formed as conscientious delusion of physician because of insufficiency of existing medical knowledge about certain health problems. The results of original empirical study demonstrated stability of this understanding in professional community of practicing physicians. However, in conditions of development of new model of national health care based on application of new diagnostic and treatment tools oriented to individual approach to patient and under effect of mediatization of health sphere traditional understanding of medical errors became limited that resulted in occurrence of concept of "medical care defect". However, its application is limited due to ambiguity of interpretation because of absence of its definition in legal field. In this regard, the article emphasizes necessity of legal substantiation of relevant definitions due to increasing of both appeals from patients and the number of civil and criminal medical cases and proposes to introduce into legal circulation term "omission under provision of medical care".

DESCRIMINALIZAÇÃO DE DROGAS: UMA ANÁLISE ENTRE AS COMPETÊNCIAS DO LEGISLATIVO E JUDICIÁRIO

Drug use is proven to be harmful, both physically and intellectually. Currently, drugs are the main social evil, linked to all types of crime. The methodology used was the literature reference, and the STF decisions of 2023 and 2024 on the issue. In this sense, the objective of this research/article is to develop a study on the decriminalization of marijuana possession and its legal, economic, moral, and public health consequences. To do this, initially a definition of competences is made from the perspective of doctrine and jurisprudence regarding the limits of powers to legislate. It also addresses the main aspects related to drug use and its consequences; And, finally, the positive and negative points within the legal, moral, social, economic and public health sphere of this decision. It is concluded that this is a matter that should be entirely up to congress to decide, and that the STF usurps the functions of the Legislative and Executive branches by giving its opinion on topics that would be the responsibility of the technical body ANVISA. Even because they are decisions with broad repercussions, which could have major consequences for society, including in the field of public security, crime, society in general and public health.

The political economy of national health insurance schemes: evidence from Zambia.

Governments in low and middle-income countries (LMICs) are increasingly considering the introduction of national health insurance scheme (NHIS) as a strategy to achieve universal health coverage (UHC) targets. The literature has widely documented the technical challenges associated with implementing UHC policies in LMICs but much less is known about the political process necessary to pass UHC legislation. In this article, we document the political economy issues surrounding the establishment of the Zambia NHIS in 2018. We adapted a political economy framework incorporating, semi-structured interviews with diverse stakeholders and document analysis of policies, operational reports, and legislatures from 1991 and 2018. Our findings show the 26-year journey towards the establishment of the NHIS in Zambia involved a long sequence of policy dialogue, technical review and stakeholder engagement. Our interviews with key stakeholders suggest that the act was eventually passed due to strong political will and dominant leadership of the Ministry of Health. Passing the law required trade-offs between choices influenced by stakeholder pressures and recommendations from research and actuarial studies. Another equally critical factor was the high public support and legacies of past policies, such as the removal of user fees that had created quality gaps and inequities in the health system. Furthermore, global ideas about UHC and initiatives implemented by other countries also generated support for Zambia's NHIS. Overall, this study highlights the complex set of political economy factors that need to align in order for governments to be able to adopt health insurance in low-income settings. We show that political leadership and commitment to getting reforms passed is crucial. We also highlight how certain narratives about countries in the global health sphere can shape policies in other countries.

Hierarchy of value orientations and locus of control for students with disabilities

Introduction. Inclusive higher education is based on the principle of humanity and addresses the personal values of students. The purpose of the research is to examine the hierarchy of values and locus of control for students with disabilities. Materials and methods. Sample: 93 students aged 17 to 28. Methods: Rokeach Value Survey and the Level of Subjective Control questionnaire. Statistical processing methods: Mann-Whitney U test, mean values ranking procedure, binomial distribution procedure. Results. Students with disabilities attach high importance to both interpersonal relationships and independence. Students with disabilities more often have an external locus of control, particularly in the spheres of health, failure, family and, above all, industrial relations, but there is a small group of respondents with an internal locus of control. Respondents attributed their achievements and interpersonal relationships to both themselves and external factors. Respondents with an internal locus of control place higher values on a financial security and entertainment, while respondents with an external locus of control place higher values of mature love and a happy family life. Conclusions. Students with disabilities have different values and types of locus of control. Comparative analysis revealed differences between students with congenital and acquired disabilities, as well as students with internal and external locus of control. The research expands the perception of students with disabilities. This will allow you to get closer to solving the urgent problems of their adaptation and interaction with teachers and students. The research is of interest to psychologists and educators.

New challenges arise from consolidation of gender, health and transport research

BackgroundBased on a chapter in the recently published 3rd edition of Health of the Move, this article summarizes past and current knowledge regarding how gender, health and transport (GHT) interact, and implications for policy and practice in both transport and health spheres. MethodsThe chapter, ‘Gender, transport and health: Emerging trends and gaps in global research’, comprises an extensive review of research on these topics and their intersections in recent decades. It summarizes key concepts from the earliest publications regarding GHT issues and provides insights from 155 scientific articles published between 2000 and 2023. Results/findings“Gender”, a socially constructed concept reflecting culture-specific perspectives on the roles of men and women, is often used generically to reflect “sex”, that is solely the biological differences. Similarly, the assumption that transport is “gender neutral” remains a powerful arbiter, particularly within engineering and policy. Key findings are: 1) women's mobilities are significantly affected by violence. There is a need to address its association with hegemonic masculinity through sustained focus on the harmful attitudes and behaviours of this gender identity. 2) Women walk more and cycle less than men with positive and negative impacts to health depending on context. Transport infrastructure safety and accessibility must be improved to ensure women's health is equitably associated with travelling actively. 3) Women are more involved in caring for others than men. A gender-sensitive approach to mobilities must consider care-giving needs throughout the lifecycle. ConclusionsGender differences in travel are substantial and highly relevant to health equity. Gender-sensitive planning requires fuller integration of walking, cycling and intermodal solutions into regular transport planning, and requires strong policies to make all transport-related spaces accesible. Major gaps appear in research, particularly how hegemonic masculinity is related to road, gender and criminal violence that clearly limits the mobility of specific groups by gender.

History of health care development in the Republic of Kazakhstan

Introduction: The urgent need to modernize Kazakhstan's healthcare system arises from deep-rooted economic crises and systemic challenges exacerbated during the transition to capitalism from Soviet-era centralized planning. Objective: The research aims to analyze the stages of development of healthcare in the Republic of Kazakhstan since the country gained its independence. Methods: To solve the set tasks the authors applied such methods of knowledge as historical, comparative, systemic, and method of political-legal analysis. Results: Research results consist in the formulation of the basic stages of development of public health in Kazakhstan, the definition of advantages and disadvantages of functioning of the given branch on each of them, and also in the designation of transformations and innovations in the public health sphere for last years. Conclusions: The materials of this research can be applied in the applied and research spheres. In particular, the research may be of interest to the employees of the state authorities who are dealing with the problems of reforming the health care system in post-Soviet countries. In addition, the materials can be used in the work of scientists whose sphere of interest includes the formation of policy in the field of health care management

Data linkage in public health research: a scoping review of ethical, legal and societal aspects surrounding administrative data

ObjectiveThe application of data linkage for scientific research purposes in the public health sphere requires using personal and sensitive data on an individual level while results are analyzed from a population perspective. Considering this, ethical, legal and social issues (ELSI) must be considered. In this sense, our study aims to better understand how ELSI surrounding administrative data linkage use in public health has been addressed in the scientific literature. ApproachOur scoping review is based on the Joann Briggs Institute Manual for Evidence Synthesis and will be reported according to the Preferred Report Items for Systematic Reviews and Meta-Analyses – Scoping Review Guideline. Two independent authors searched for articles published between January 2013 and December 2023 in the PubMed/MEDLINE, Web of Science, EMBASE and LILACS databases, as well as in Scielo and Google Scholar platforms. Keywords used were related to ‘data linkage’, ‘administrative data’, ‘ELSI’, “public policies’ and ‘public health’ terms. Articles were screened initially by title and abstract, then by full-text read. ResultsAfter duplicate removal and articles screening, two independent authors are performing data extraction considering ethical, legal and regulatory basis as well as procedures for data access; data management process including record linkage; type of administrative data linked; data protection strategies; and data subjects rights. ConsiderationsThis scoping is underway, we intend to have our final results by April to present at the conference, in September.

Sociocultural code of the health sphere: typology, variability, possibility of impact

Introduction. In the formation of individual approaches to the treatment of diseases, taking into account the characteristics of each patient, the main attention is paid to the characteristics of the human genome and other biomarkers. At the same time, the individual culture of health, the worldview characteristics of patients, as a rule, are not taken into account, which determines the need for further development of the concept of the socio-cultural code of health and determination of the potential for its application. Materials and methods. Critical analysis of domestic and foreign literature, development of a conceptual approach that makes it possible to study the specifics of the attitude of representatives of various social communities to the sphere of health and the possibility of influencing it. Results. The sociocultural code of health is one of the subsystems of the sociocultural code as a whole. The complexity of the social organization makes it possible to single out the levels of the cultural code in accordance with the scale of the social community under consideration: national, ethnic, and corporate socio-cultural code of health. The variability of the socio-cultural code is largely due to the nature of the information space in which social communities are located. The study of indicators of the socio-cultural code by the methods of sociology allows obtaining qualitative and quantitative data characterizing the attitude of society towards the sphere of health. Research limitations. The study is limited by insufficient understanding of the nature of memory and the peculiarities of storing information in it, which limits the possibilities of studying the sociocultural code of the health sector. Conclusion. Taking into account not only predispositions to certain diseases due to the genetic code, but cultural attitudes towards health, prevention and treatment of diseases determined by the socio-cultural code of health, can improve both the quality of treatment and the effectiveness of preventive measures. Emphasis on ethnic, corporate, and occupational cultural characteristics of citizens provides the gain in the effectiveness of educational activities aimed at magnifying the value of health, personal responsibility for it, and raising public awareness about a healthy lifestyle, prevention measures and methods of treatment (as far as possible without resorting to specialists).

Pharmaceutical Dependence and Organization of a Criminal Subculture

Pharmacy drug addiction can lead to the formation of criminal subcultures and groups where people suffering from drug addiction can gather. This creates an environment in which criminal activity can become widespread, with the illegal trade in medicines contributing to increased crime rates in society. Access to prescription drugs (especially opioids, antidepressants, and psychostimulants) through the Internet and illicit channels is contributing to the rise in addiction among various segments of the population, especially among adolescents and young adults. A tendency immediately appears to organize a criminal subculture: its own circle, its own colloquial clichés. Pharmacy addiction causes serious damage to the health of young people, but also contributes to the development of a criminal subculture involved in the illegal trade and distribution of drugs. The author examines the causes leading to the development of addiction and analyzes the consequences for health and social sphere. Particular attention is paid to the structure and functioning of criminal groups involved in the illegal trade in medicines. The impact of these groups on society, including increased crime and economic losses, is examined. The article also proposes measures to prevent and combat pharmacy addiction and the criminal subculture, including strengthening control over the circulation of prescription drugs, prevention programs and law enforcement measures.

Measles and rubella are two controlled airborne infections: etiopathogenesis, epidemiology, clinical picture, diagnosis, treatment and prevention. Part 2. Rubella

The lecture is devoted to two infections controlled by specific means of prevention — measles and rubella, which still pose a danger both to the sphere of child and maternal health, and to healthcare in general. The second part of the lecture is devoted to rubella, which, despite its benign course in most cases, currently poses a serious problem for global health due to its ubiquity and high incidence of severe intrauterine lesions of the fetus. Despite significant advances in the field of diagnosis and immunoprophylaxis of rubella, it is still found in economically developed countries with confirmed elimination of the disease. Therefore, to prevent the return of this infection to our country, where its elimination was achieved by 2018, maximum coverage of the population with vaccinations against rubella is still necessary in all its regions. The lecture covers modern aspects of the etiopathogenesis, epidemiology, clinical picture, diagnosis, treatment and prevention of rubella. This information, given the increasing incidence of rubella, even in countries with confirmed elimination of the disease, may be useful for general practitioners, primarily family doctors.

Epidemiological evolution of dengue in the pre-pandemic to post-pandemic periods in the Americas and Brazil

Introduction: Dengue is an asymptomatic infection or present symptoms like low fever to disabling high fever, severe headache, retroocular, muscle and joint pain, in addition to skin rashes, and if associated with COVID-19, it can worsen the illness condition. Objective: investigate the epidemiological evolution of dengue in the pre-pandemic, pandemic and post-pandemic periods from an American and Brazilian perspective. Methodology: descriptive study, based on the search for information in epidemiological bulletins, data from DATASUS and the Pan American Health Organization/World Health Organization, in addition to articles available in databases provided by SciELO, ScienceDirect and Pubmed. Results: In the period before the pandemic, the high number of notifications was due to the DENV2 serotype, causing a large epidemic. In the years 2020-2021 there was a drop in the number of notifications due to the introduction of social and public health measures, misdiagnosis between the signs/symptoms of dengue and COVID-19, inaccurate serological tests and underreporting. In 2022 and 2023, the epidemiological scenario again points to increasing notification of dengue cases, mainly due to changes in routine vector control during the pandemic, combined with favorable environmental factors, such as increased rainfall. Conclusion: the neglect of both dengue fever and other diseases has negatively impacted the population today, since in order to mitigate the damage caused by the pandemic, actions to promote and prevent the health of endemic diseases in our territory, when placed in the background, have caused the underreporting of cases, influenced by changes in the political, economic and health spheres of society.

Widening the scope of mental health with a ‘youth centred’ approach: a qualitative study involving health care professionals in Sweden’s youth clinics

ABSTRACT Purpose The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of “youth-centeredness”. Methods Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke. Results The three themes were: 1) “youth mission—at the core of the YCs” work and challenged by a stronger involvement in mental ill health’; 2) “YCs” unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization’, and 3) “Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users” needs or to refer within an unreliable system’. Conclusion This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic “youth-centred” approach while expanding their work with mental health.

Pet loss support for clients and staff: the importance of clear communication

Anyone who works in the health and welfare sphere is aware of death, but it's not a topic that many people want to think about or find easy to work with. In relation to pets, the role that those in the veterinary world play in this ending brings many added pressures, from emotion and stress, to client reactions and moral injury, to name just a few. This article aims to address many of the areas that result from loss, and reiterates the importance of being mindful that empathy, compassion and communication relating to loss will vary from person to person and can improve or decline over time.

Biosecurity and the Constitutional Right to Protection of Health of Citizens: The Development of Biojurisprudence in the Sphere of Reproductive Health of Citizens

Biosecurity and the Constitutional Right to Protection of Health of Citizens: The Development of Biojurisprudence in the Sphere of Reproductive Health of Citizens

Systematic Review of Impacts of Educational Interventions to Control Breeding Sites of Aedes aegypti and Aedes albopictus Mosquitoes.

Community participation is a critical element in the management of Aedes aegypti and Aedes albopictus breeding sites. Many educational interventions have been conducted to encourage prevention and elimination of breeding sites among different community actors, such as government-run programs for vector surveillance aimed at preventing and eliminating breeding sites at the household level within a community. Getting people involved in prevention and elimination of vector breeding sites in their communities requires communication and social mobilization strategies to promote and reinforce those prevention actions that, in turn, should be effective from the entomological standpoint. Articles published in English, Spanish, and Portuguese, were reviewed to assess whether educational interventions targeting Ae. aegypti and Ae. albopictus were effective in reducing entomological indicators or in improving practices to prevent the presence of or eliminate breeding sites. The most widely used indicators were larval indices and the practices associated with reducing/eliminating breeding sites. We found that using a community-based approach adapted to eco-epidemiological and sociocultural scenarios explains the reduction of entomological indicators by educational interventions. Those who design or implement educational interventions should strengthen the evaluation of those interventions using qualitative approaches that provide a more complete picture of the social context and the barriers and facilitators to implementing vector control. Engaging school children in cross-sectorial collaboration involving the health and education spheres promotes the participation of the community in vector surveillance and reduces the risk of arboviral disease transmission.

The Epidemic of Non-Suicidal Self-Harm in Adolescents and Young Adults in the Kyrgyz Republic

Introduction During the last two years, many young people and adolescents in the Kyrgyz Republic started to visit specialists due to Non-suicidal self-harm. A significant rise in the amount of such cases allowed specialists from the Republican Center of Psychiatry in Bishkek to think about an “epidemic “of self-harming behavior. Non-suicidal self-harm (NSSH) is defined as repeated, deliberate, direct injury to the body without suicidal intent that is not socially acceptable (Nixon et al., 2002) to reduce psychological discomfort in the absence of a conscious intention to take one’s life (ICD-10 codes X60-X84, and ICD-11 codes PB80-PD3Z).ObjectivesTo determine the causes of NSSH among adolescents and young adults who approached specialists in mental health sphere at Institute of Behavioral Health at the American University of Central Asia.MethodsOver two years, forty-five adolescents and young adults under twenty-five who had committed self-harm visited specialists from the Behavioral Health Institute at the American University of Central Asia.All the patients received either dialectical behavioral treatment or cognitive processing treatment, medication (paroxetine) was used in three cases.ResultsThirty patients were girls under twenty-one, and fifteen were boys and young male adults. The overwhelming majority (40 people) had self-inflicted cuts, two had imposed burns with matches and cigarettes, and one had used self-suffocation without a bond. Reasons for self-harm were the following: releasing internal tension and anxiety, getting some rest from intrusive thoughts, relieving the inner pain, and a desire to “feel as a whole person.” All the patients underlined that they did not want to attract attention from their family members; moreover, they tried to hide the consequences of self-harm. Teens and young adults (twelve patients) from Kyrgyz traditional families visited a consultant or psychiatrist after a long drive through conventional or religious healers. All of the patients knew that they were addicted to self-harm, wanted to stop a problematic behavior, and could not stop it on their own. Ten patients have been diagnosed with borderline personality disorder. Two of them also had eating disorders. Five patients had PTSD, and five had social phobia. The others had recognizable anxiety symptoms.ConclusionsThe enormous rise of non-suicidal self-harm is a phenomenon that needs further research. Those cases often resist treatment due to the “addictive” component in the pathogenesis.Disclosure of InterestNone Declared

Measles and rubella are two controlled airborne infections: etiopathogenesis, epidemiology, clinical picture, diagnosis, treatment and prevention. Part 1. Measles

The lecture is devoted to two infections controlled by specific means of prevention — measles and rubella, which still pose a danger both to the sphere of child and maternal health, and to healthcare in general.
 The first part of the lecture is devoted to measles, one of the most contagious diseases, outbreaks of which can be successfully prevented through vaccination or, conversely, serve as an indicator of gaps in immunization programs and primary health care systems. The lecture covers modern aspects of etiopathogenesis, epidemiology, clinical picture, diagnosis, treatment and prevention of measles. In the context of an increase in the incidence of this infection in our country and a number of foreign countries in 2023, the information presented in the lecture may be useful for practitioners and, first of all, family doctors.

Mixed probiotics reduce the severity of stress-induced depressive-like behaviors

In recent years, the gut microbiome has gained significant attention in the spheres of research and public health. As a result, studies have increasingly explored the potential of probiotic dietary supplements as treatment interventions for conditions such as anxiety and depression. The present study examined the effect of mixed probiotics (Lacticaseibacillus rhamnosus and Enterococcus faecium) on inflammation, microbiome composition, and depressive-like behaviors in a macaque monkey model. The mixed probiotics effectively reduced the severity of depressive-like behaviors in macaque monkeys. Further, treatment with mixed probiotics gradually increased the abundance of beneficial bacteria in the gut, improving the balance of the gut microbiota. Additionally, macaques treated with the mixed probiotics showed decreased serum levels of inflammatory factors (P < 0.05), an increased rate of L-tryptophan metabolism (P < 0.05), and the restoration of 5-HT and 5-HTP levels (P < 0.05). Correlation analysis confirmed that Lacticaseibacillus and other beneficial bacteria exhibited a negative correlation with inflammation in the body (P < 0.05), and a positive correlation with tryptophan metabolism (P < 0.05). In conclusion, the mixed probiotics effectively restored intestinal homeostasis in macaques and enhanced tryptophan metabolism, ultimately alleviating inflammation and depressive-like behaviors.