Public management of public healthcare under the COVID-19 outbreak: experience of Ukraine.

OBJECTIVE: Aim: The research is aimed to study certain aspects and experience of functioning of the Ukrainian Public Healthcare public management mechanisms during an outbreak of the acute respiratory disease COVID19. PATIENTS AND METHODS: Materials and Methods: The studied materials include personal observations and accumulated practical material, as well as generalization of the collected data and their empirical treatment, conducted by the scientists, according to the present legislation requirements. The study was held using general scientific methods, including observation, description of results, specification and statistical data generalization. CONCLUSION: Conclusions: Generalization, arrangement and analysis of the Ukrainian experience of the Public Healthcare public management during the outbreak of the acute respiratory disease COVID19, provides exchange of experience between all subjects of the process. This helps to produce certain practical decisions, aimed at effective responding of the state healthcare system onto management of the COVID19 outbreak. Such activities are also directed at detection of flaws in the whole system, with their subsequent correction, and elimination or neutralization of possible negative outcomes. To adopt the priority activity directions within public relations, which make the subject of the study, the authors have studied a complex of activities against spread of the COVID19 in 2019-2020. These activities include issues, related to prompt responding onto the infection spread and approving quick professional decisions; fulfilling epidemiological supervision and introducing anti-epidemic activities; providing diagnostics, and accessibility of the safe and high-quality vaccine.

CORRELATION BETWEEN THE RIGHT TO HEALTH CARE AND THE RIGHT TO HOUSING WITHIN MEDICAL AND LAW-ENFORCEMENT PRACTICE IN TERMS OF THE COVID-19 PANDEMIC.

The purpose of the article is to identify the correlation between the right to health care and the right to housing in medical and enforcement practices in terms of the COVID-19 pandemic. The materials of the research were the legislation of the EU, Georgia, Ukraine, as well as information from World Health Organization, the World Bank, the media, and statistical data related to the COVID-19 pandemic. Dialectical, axiological, statistical, comparative and legal methods were applied during the research. Having studied the experience of Georgia, Ukraine and the EU countries allowed us to conclude that individual self-isolation in the housing is a necessary preventive tool in the fight against the COVID-19 pandemic. The essence of self-isolation in terms of COVID-19 pandemic has been determined; its legal regimes have been singled out. It has been concluded that the self-isolation of a person in a dwelling (individual self-isolation) led to the emergence of a phenomenon in the form of a correlation between the right to health protection and the right to housing. In fact, there is a situation when the maintenance of public health has become possible, in particular, due to the self-isolation of a person in a dwelling.

Food-related consumer behaviours in times of crisis: Changes in the wake of the Ukraine war, rising prices and the aftermath of the COVID-19 pandemic.

When the COVID-19 pandemic subsided, the war in Ukraine led to further disruptions in consumers' daily behaviours, with rising prices for food and energy. We conducted a survey study on self-reported changes in food-related consumer behaviour in ten European countries and compared the results to a similar study conducted two years ago. A latent class cluster analysis distinguished five clusters and showed that different types of consumers can be distinguished based on how they react to the crisis as regards their eating habits. 19% of survey participants reported no major changes, and 32% reported changes mostly in terms of more price sensitivity. Among those that reported changes beyond reacting to higher prices, there are indications of more mindful eating and more deliberate choices. The changes already found earlier in response to the COVID-19 pandemic therefore seem to have been strengthened and supplemented by reactions to price increases. The results present a challenge to the food industry in terms of supplying healthy and sustainable food at affordable prices.

ASSESSMENT OF THE CONSEQUENCES OF THE DETERIORATION OF THE EPIDEMIOLOGICAL SITUATION DURING HOSTILITIES.

OBJECTIVE: The aim: Scientific substantiation of the methodology for predicting the consequences of the worsening of the epidemic situation on the territory of Ukraine during military operations for the timely adoption of measures for the medical protection of military personnel in conditions of biological contamination. PATIENTS AND METHODS: Materials and methods: Determination and generalization of the impact of biological contamination due to the use of biological weapons were carried out considering the main determinants of the epidemic process using the index and coefficient of medical protection. Applied methods of scientific research: epidemiological, system, and information approach. RESULTS: Results: The authors proposed indicators that consider the pathogenicity of the infectious agent, contagiousness, the degree of non-specific protection of servicemen, specific protection of servicemen, and the sanitary-epidemiological state of the area of operations of troops (forces). Relevant epidemic situations were simulated, and the index and coefficient of medical protection were calculated to predict the consequences of the worsening of the epidemic situation to make timely decisions regarding the implementation of medical protection measures for military personnel in conditions of biological contamination during the repulsion of armed aggression. CONCLUSION: Conclusions: In the conditions of biological contamination, when biological weapons and biological terrorism are used, the epidemic process in the army is intensified, which requires timely decisions regarding the implementation of medical protection measures for military personnel in conditions of biological contamination.

RISK FACTORS OF IN-HOSPITAL INFECTIONS OCCURRENCE IN HEALTHCARE INSTITUTIONS IN UKRAINE AND EU COUNTRIES.

The rapid development of modern scientific medicine and practice (development of genetic engineering, coronary angiography, use of microprocessors (microminiature implant in eye retina, 3D-print of implants, prostheses) is connected with the scientific-technical progress in recent years, which gave impetus to introduction of extremely complex treatment and diagnostic methods. The use of high-tech medical equipment requires the implementation of modern sanitary and anti-epidemic measures of disinfection and sterilization after each manipulation to prevent in-hospital infection/infectious diseases which are related to the grant of medicare (IHI/IPNMD). Every year in the USA, up to 2 million patients who received medical services are registered with IHI/IPNMD cases. IHI/IPNMD is the cause of increased mortality, disability, lengthens stay period of patients in hospitals, increases the financial burden on both patients and healthcare system. According to WHO data mortality from IHI/IPNMD among adult patients ranges from 18.5% to 29.6% and in countries with low- and middle-income level fluctuate in the range of 8.8%-88.9%. Thus, the vital issue today is to strengthen the control system over IHI/IPNMD at all stages of its spread, namely: early detection of sick persons and carriers among patients and medical personnel, monitoring resistance to antibiotics and control over their use in patients treatment, expanding the range of scientific research in the development of new groups of antibacterial drugs, compliance with the sanitary-epidemic regime in hospitals, including the elaboration of modern disinfectants and sterilization agents.

High energy and fertilizer prices are more damaging than food export curtailment from Ukraine and Russia for food prices, health and the environment.

Higher food prices arising from restrictions on exports from Russia or Ukraine have been exacerbated by energy price rises, leading to higher costs for agricultural inputs such as fertilizer. Here, using a scenario modelling approach, we quantify the potential outcomes of increasing agricultural input costs and the curtailment of exports from Russia and Ukraine on human health and the environment. We show that, combined, agricultural inputs costs and food export restrictions could increase food costs by 60-100% in 2023 from 2021 levels, potentially leading to undernourishment of 61-107 million people in 2023 and annual additional deaths of 416,000 to 1.01 million people if the associated dietary patterns are maintained. Furthermore, reduced land use intensification arising from higher input costs would lead to agricultural land expansion and associated carbon and biodiversity loss. The impact of agricultural input costs on food prices is larger than that from curtailment of Russian and Ukrainian exports. Restoring food trade from Ukraine and Russia alone is therefore insufficient to avoid food insecurity problem from higher energy and fertilizer prices. We contend that the immediacy of the food export problems associated with the war diverted attention away from the principal causes of current global food insecurity.

Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine.

INTRODUCTION: People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C virus (HCV). Non-governmental organizations (NGOs) provide PWID with needles/syringes, condoms, HIV/HCV testing and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost-effectiveness among PWID. METHODS: A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011-2017). The model assumed 37-49% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997-2021) and future (2022-2030, compared to no NGO activities from 2022) impact of NGOs in terms of the proportion of HIV/HCV infections averted and changes in HIV/HCV incidence. We estimated the future impact of scaling-up NGOs to 80% coverage with/without scale-up in OAT (5-20%) and ART (64-81%). We estimated the cost per disability-adjusted life-year (DALY) averted of current NGO provision over 2022-2041 compared to NGO activities stopping over 2022-2026, but restarting after that till 2041. We assumed average unit costs of US$80-90 per person-year of NGO contact for PWID. RESULTS: With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0% (95% credibility interval: 13.3-26.1) and 9.6% (5.1-14.1) of new HIV and HCV infections among PWID over 1997-2021, respectively, and will avert 31.8% (19.6-39.9) and 13.7% (7.5-18.1) of HIV and HCV infections over 2022-2030. With NGO scale-up, HIV and HCV incidence will decrease by 54.2% (43.3-63.8) and 30.2% (20.5-36.2) over 2022-2030, or 86.7% (82.9-89.3) and 39.8% (31.4-44.8) if OAT and ART are also scaled-up. Without NGOs, HIV and HCV incidence will increase by 51.6% (23.6-76.3) and 13.4% (4.8-21.9) over 2022-2030. Current NGO provision over 2022-2026 will avert 102,736 (77,611-137,512) DALYs when tracked until 2041 (discounted 3% annually), and cost US$912 (702-1222) per DALY averted; cost-effective at a willingness-to-pay threshold of US$1548/DALY averted (0.5xGDP). CONCLUSIONS: NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled-up to help achieve HIV and HCV elimination. Disruptions could have a substantial detrimental impact.

Economic impact of vaccine safety incident in Ukraine: The economic case for safety system investment.

BACKGROUND: Vaccine confidence and coverage decreased following a death temporally but not causally related to measles vaccination in Ukraine in 2008. Large measles outbreaks including international exportations followed. Herein we characterize this experience including associated costs. METHODS: Mixed-methods were used to characterize this vaccine safety incident and quantify health and economic costs. Qualitative interviews illuminate the incident, social climate, and corruption that influenced vaccine confidence in Ukraine. A literature review explored attitudes toward vaccines in the USSR and post-independence Ukraine. Infectious disease incidence was examined before and after the vaccine safety incident. An economic analysis estimated associated healthcare costs, including prevention and outbreak control measures, additional vaccination activities due to failure of the 2008 campaign, treatment costs for new cases domestically and foreign exportation, and productivity loss from treatment time and mortality for new cases. FINDINGS: Vaccine hesitancy and distrust in government and public health programs due to corruption existed in Ukraine before the vaccine safety incident. The mishandling of the 2008 incident catalyzed the decline of vaccine confidence and prompted poor procurement decisions, leading to a drop in infant vaccination coverage, increased domestic measles cases, and exportation of measles. The estimated cost of this incident was approximately $140 million from 2008 to 2018. INTERPRETATION: Absent a rapid and credible vaccine safety response, a coincidental death following immunization resulted in major outbreaks of measles with substantial economic costs. Adequate investments in a post-licensure safety system may help avoid similar future incidents.

Impact and cost-effectiveness of non-governmental organizations on the HIV epidemic in Ukraine among MSM.

OBJECTIVE: Non-governmental organizations (NGOs) in Ukraine have provided HIV testing, treatment, and condom distribution for MSM. HIV prevalence among MSM in Ukraine is 5.6%. We estimated the impact and cost-effectiveness of MSM-targeted NGO activities in Ukraine. DESIGN: A mathematical model of HIV transmission among MSM was calibrated to data from Ukraine (2011-2018). METHODS: The model, designed before the 2022 Russian invasion of Ukraine, evaluated the impact of 2018 status quo coverage levels of 28% of MSM being NGO clients over 2016-2020 and 2021-2030 compared with no NGO activities over these time periods. Impact was measured in HIV incidence and infections averted. We compared the costs and disability adjusted life years (DALYs) for the status quo and a counterfactual scenario (no NGOs 2016-2020, but with NGOs thereafter) until 2030 to estimate the mean incremental cost-effectiveness ratio (cost per DALY averted). RESULTS: Without NGO activity over 2016-2020, the HIV incidence in 2021 would have been 44% (95% credibility interval: 36-59%) higher than with status quo levels of NGO activity, with 25% (21-30%) more incident infections occurring over 2016-2020. Continuing with status quo NGO coverage levels will decrease HIV incidence by 41% over 2021-2030, whereas it will increase by 79% (60-120%) with no NGOs over this period and 37% (30-51%) more HIV infections will occur. Compared with if NGO activities had ceased over 2016-2020 (but continued thereafter), the status quo scenario averts 14 918 DALYs over 2016-2030 with a mean incremental cost-effectiveness ratio of US$600.15 per DALY averted. CONCLUSION: MSM-targeted NGOs in Ukraine have prevented considerable HIV infections and are highly cost-effective compared with a willingness-to-pay threshold of 50% of Ukraine's 2018 GDP (US$1548).

NATIONAL ASSESSMENT OF PNEUMONIA MORBIDITY IN CHILDREN IN THE PERIOD 1993-2017 AND PROGNOSIS FOR 2025.

OBJECTIVE: The aim: To assess national trends in the morbidity of pneumonia in children aged 0-6 years, 7-14 years and 15-17 years in the period from 1993 to 2017 and mathematically predict the dynamics of the morbidity in 2025. PATIENTS AND METHODS: Materials and methods: Data from the Center for Medical Statistics of the Ministry of Health of Ukraine for the period 1993-2017 were used to calculate the morbidity rate of pneumonia in children aged 0-6 years, 7-14 and 15-17 years. RESULTS: Result: The period from 1993 to 2017 is characterized by high incidence of pneumonia in children in Ukraine (from 6.74 to 8.21 per 1000). In children aged 0-6 years, the morbidity 1000 ranged from 11.45 to 11.17, in children aged 7-14 years - from 4.65 to 6.46, in adolescents aged 15-17 years - from 1.99 to 10.47 . In Ukraine, the morbidity rate has significantly exceeded the that in European countries. In 2025, the morbidity of children under 6 years old in Ukraine may make up 3.84 per 1,000. CONCLUSION: Conclusions: In Ukraine, a significant increase in the morbidity rate of pneumonia in adolescents is predicted by 2025. It is necessary to develop a national strategy to improve the health of children and adolescents to implement policy and management measures in the health care system, aimed at effective prevention and quality treatment of pneumonia in children and adolescents.

Public health and social measures to mitigate the health and economic impact of the COVID-19 pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland during 2020-2021: situational analysis.

BACKGROUND: The COVID-19 pandemic had a colossal impact on human society globally. There were similarities and differences in the public health and social measures taken by countries, and comparative analysis facilitates cross-country learning of contextual practices and sharing lessons to mitigate the COVID-19 pandemic impact. Our aim is to conduct a situational analysis of the public health and social measures to mitigate the health and economic impact of the COVID-19 pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland during 2020-2021. METHODS: We conducted a situational analysis of the COVID-19 pandemic response in Turkey, Egypt, Ukraine, Kazakhstan, and Poland from the perspectives of the health system and health finance, national coordination, surveillance, testing capacity, health infrastructure, healthcare workforce, medical supply, physical distancing and non-pharmaceutical interventions, health communication, impact on non-COVID-19 health services, impact on the economy, education, gender and civil liberties, and COVID-19 vaccination. RESULTS: Since the onset of the COVID-19 pandemic, Turkey, Egypt, Ukraine, Kazakhstan, and Poland have expanded COVID-19 testing and treatment capacity over time. However, they faced a shortage of healthcare workforce and medical supplies. They took population-based quarantine measures rather than individual-based isolation measures, which significantly burdened their economies and disrupted education. The unemployment rate increased, and economic growth stagnated. Economic stimulus policy was accompanied by high inflation. Despite the effort to sustain essential health services, healthcare access declined. Schools were closed for 5-11 months. Gender inequality was aggravated in Turkey and Ukraine, and an issue was raised for balancing public health measures and civil liberties in Egypt and Poland. Digital technologies played an important role in maintaining routine healthcare, education, and public health communication. CONCLUSIONS: The COVID-19 pandemic has exposed weaknesses in healthcare systems in the emerging economies of Turkey, Egypt, Ukraine, Kazakhstan, and Poland, and highlighted the intricate link between health and economy. Individual-level testing, isolation, and contact tracing are effective public health interventions in mitigating the health and economic impact of the COVID-19 pandemic in comparison to population-level measures of lockdowns. Smart investments in public health, including digital health and linking health security with sustainable development, are key for economic gain, social stability, and more equitable and sustainable development.

RESOURCES OF CARDIOLOGICAL CARE (ON THE EXAMPLE OF THE KYIV REGION OF UKRAINE).

OBJECTIVE: The aim: To analyze the network, resources of outpatient clinics in the Kyiv region (Ukraine) that provide cardiac care. PATIENTS AND METHODS: Materials and methods: With the help of the medical - statistical method the analysis of the network of outpatient clinics of the Kyiv region which render cardiological medical care and their resources in dynamics from 1995 to 2019 was carried out. During the analysis the methods of statisticalgrouping, compilation, generalization, statisticalcomparisonwere used. The materials for the analysis were the data of reporting statistical forms № 20 "Report of the treatment and prevention institution" and form № 17 "Report on medical staff" of the Kyiv region individual institutions and districts, as well as statistical directories of the information-analytical center. CONCLUSION: Conclusions: On the basis of the analysis of the network, resources and activity of outpatient clinics of the Kyiv region that provide cardiac care the existing problems of this type of care were revealed. The provision of cardiac diagnostic tests over five years did not change, which is proved by analysis made. It is established that at the present stage of providing high-quality and affordable cardiac medical services within the existing system of cardiac outpatient care to the population of the Kyiv region has great difficulties and needs to be solved.

Relationship between Socio-Demographic Factors and Posttraumatic Stress Disorder: A Cross Sectional Study among Civilian Participants' Hostilities in Ukraine.

BACKGROUND: Even though there is an extensive body of literature on posttraumatic stress disorder (PTSD) in individuals who have experienced armed conflict, there are still many grey areas, especially in relation to civilian participants in hostilities. This article evaluates how socio-demographic factors and the interactions between them have influenced PTSD among civilians involved in the recent war in Ukraine. METHODS: This cross-sectional study included a convenience sample of 314 adults, 74 women, and 235 men. The mean age was 34.08 years. We used the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C). RESULTS: Our findings show that predictors of posttraumatic stress are loss of a loved one, place of residence, gender, continuation of education, and health insurance. We demonstrated that PTSD produced by the loss of a loved one as a result of war is determined by participation in the education system, whatever the level of education. The literature emphasises the importance of social support, e.g., from the family. We demonstrated that having children is associated with a risk of more severe PTSD, causing serious mental strain among participants of hostilities. We discovered that material security lowers PTSD, but only among people who have no children. CONCLUSIONS: PTSD is the result of not only the violence and damage caused by war but also of other stressful circumstances associated with the social and financial conditions of life. Further research needs to focus on identifying modifiable risk factors and protective factors that could be embraced by intervention strategies. Our findings can inform the goals behind therapeutic support for civilian participants of hostilities, and implications for social work. Social work professionals are encouraged to engage in direct questioning and to maintain a supportive and safe environment for participants in hostilities, e.g., in the area of education. Trauma-affected people need to be given opportunities to build up their strengths and increase their psychological resources towards well-being. Social security (health insurance, savings, material security) should be taken into account when working with people affected by PTSD.

Assessment of internal exposure to 131I and short-lived radioiodine isotopes and associated uncertainties in the Ukrainian cohort of persons exposed in utero.

This study revised the thyroid doses for 2582 Ukrainian in utero cohort members exposed to Chornobyl fallout (the Ukrainian in utero cohort) based on revision of: (i) 131I thyroid activity measured in the Ukrainian population, (ii) thyroid dosimetry system for entire Ukraine, and (iii) 131I ground deposition densities in Ukraine. Other major improvements included: (i) assessment of uncertainties in the thyroid doses considering shared and unshared error, and (ii) accounting for intake of short-lived radioisotopes of tellurium and iodine (132Te+132I and 133I). Intake of 131I was the major pathway for thyroid exposure, its median contribution to the thyroid dose was 97.4%. The mean prenatal and postnatal thyroid dose from 131I was 87 mGy (median = 17 mGy), higher than previous deterministic dose of 72 mGy (median = 12 mGy). For 39 individuals (1.5%) the dose exceeded 1.0 Gy, while the highest dose among the cohort members was 2.7 Gy. The geometric standard deviation (GSD) of 1000 individual stochastic doses varied from 1.9 to 5.2 with a mean of 3.1 and a median of 3.2. The lowest uncertainty (mean GSD = 2.3, median GSD = 2.2) was found for the subjects whose mothers were measured for 131I thyroid activity, while for individuals, whose mothers were not measured, the mean and median GSDs were 3.4. Uncertainties in thyroid doses were driven by shared errors associated with the parameters of the ecological model.

Impact of uncertainties in exposure assessment on thyroid cancer risk among cleanup workers in Ukraine exposed due to the Chornobyl accident.

A large excess risk of thyroid cancer was observed among Belarusian/Russian/Baltic Chornobyl cleanup workers. A more recent study of Ukraine cleanup workers found more modest excess risks of thyroid cancer. Dose errors in this data are substantial, associated with model uncertainties and questionnaire response. Regression calibration is often used for dose-error adjustment, but may not adequately account for the full error distribution. We aimed to examine the impact of exposure-assessment uncertainties on thyroid cancer among Ukrainian cleanup workers using Monte Carlo maximum likelihood, and compare with results derived using regression calibration. Analyses assessed the sensitivity of results to various components of internal and external dose. Regression calibration yielded an excess odds ratio per Gy (EOR/Gy) of 0.437 (95% CI - 0.042, 1.577, p = 0.100), compared with the EOR/Gy using Monte Carlo maximum likelihood of 0.517 (95% CI - 0.039, 2.035, p = 0.093). Trend risk estimates for follicular morphology tumors exhibited much more extreme effects of full-likelihood adjustment, the EOR/Gy using regression calibration of 3.224 (95% CI - 0.082, 30.615, p = 0.068) becoming ~ 50% larger, 4.708 (95% CI - 0.075, 85.143, p = 0.066) when using Monte Carlo maximum likelihood. Results were sensitive to omission of external components of dose. In summary, use of Monte Carlo maximum likelihood adjustment for dose error led to increases in trend risks, particularly for follicular morphology thyroid cancers, where risks increased by ~ 50%, and were borderline significant. The unexpected finding for follicular tumors needs to be replicated in other exposed groups.