Functional disability, health care access, and mental health in Ukrainians displaced by the 2022 Russian invasion.

Armed conflict has negative mental health impacts on internally displaced people and refugees, however, much less is known of its effects on the mental health of displaced people and refugees with disabilities. We use pan-European data (N = 9,676), collected via an internet health needs survey across April-July 2022, to examine the mental health impacts of the 2022 Russian invasion of Ukraine on the mental health of displaced people with disabilities during the first months of the war. Regression models separately examined associations between functional impairment (vision, walking, existing mental health condition), access to healthcare, welfare payments, and anxiety and sleep quality, controlling for sociodemographic variables. The presence of pre-existing mental health conditions, mobility and vision impairment were each associated with higher levels of anxiety and poorer sleep quality. The ability to access health services and social security payments was also associated with better sleep and lower levels of anxiety. Humanitarian and local authorities must ensure Ukrainian refugees and IDPs are reviewed for their mental health needs, with particular attention to those with known disabilities.

Disability trends among elderly Ukrainians in war conditions: a 10-year retrospective study.

AIM: Non-communicable diseases (NCDs) in elderly are a significant problem in Ukraine. It is expected that the ongoing war will augment this problem. The study aimed to analyze the trends of disability due to NCDs s in newly-diagnosed elderly patients between 2013 and 2023. METHODS: This retrospective study included data obtained from the official document "Report on the Causes of Disability and Indications for Medical, Professional, and Social Rehabilitation" commissioned by the Ministry of Health of Ukraine. The data on disability due to NCDs s were obtained from for 2013-2023. RESULTS: During the 2013-2021 the average number of disabled elderly patients due to NCDs per 10,000 elderly persons was significantly lower in compare with working-age. During the first year of full-scaled war the average number of disabled elderly patients due to NCDS s per 10,000 elderly persons dramatically increased by 2-fold, and in 2023 - by 2.8-fold against 2013 value (p < 0.05), while in working-age the disability rate increased significantly only in 2023 by 1.4-fold compared to the pre-war level. In 2013-2021 the main causes of disability among those related to NCDs in elderly were cardiovascular diseases, followed by cancer. In 2022 compared to the pre-war level, the indicators of disability of the elderly due to CVD increased by 1.5 times, due to cerebrovascular diseases - by 2.2 times, due to cancer - by 1.7 times, due to musculoskeletal diseases - by 2 times (p < 0.05). The most significant increase in the number of elderly people with disabilities during the full-scale war occurred due to coronary artery disease - by 55.1%, and osteoarthritis - by 83.4% from baseline in 2013. It estemated the differences in indicators of disability of elderly between regions of Ukraine, significantly higher indicators of disability of the elderly due to cardiovascular diseases, cancer, cerebrovascular diseases, musculoskeletal diseases were noted in the frontline regions. CONCLUSIONS: Data on primary disability among elderly Ukrainians indicates a significant increase in NCDs-related disability during the war in compare with working population, especially in frontline regions and regions with a high concentration of displaced persons. In this structure of NCDs-related increasing disability, CVD, oncology and musculoskeletal diseases system prevailed.

Impact on seafarers of extreme events: A case study arising out of the situation in Ukraine.

BACKGROUND: Maritime transportation is the lifeblood of the world's economy. However, seafarers are exposed to isolated, confined and particularly extreme environments. Maritime operations in the face of geopolitical conflicts profoundly impact seafarers' mental health, well-being and safety. MATERIALS AND METHODS: The study comprises 27 seafarer interviews and 21 stakeholder interviews covering 4 maritime education and training institutions, 11 crewing agencies, 4 medical facilities and 2 maritime authorities. An online questionnaire survey of seafarers who were affected by the conflict in Ukraine and had sailed in the conflict zone in the period 24 February 2022 to 30 September 2023 yielded 319 valid responses. RESULTS: The study suggests that seafarers in the conflict zone are exposed to constant imminent threats to personal safety, constant stress and anxiety, prolonged lack of sleep, limited opportunities of contact with families, and high risk to mental health among other things further exacerbated by a lack of mental health support from company, and anxiety resulting from loss of access to shore-based training facilities and uncertainty in updating competency certificates. CONCLUSIONS: The study presents rare insights on the psychological and emotional toll on seafarers who continue to serve the critical needs of the maritime transportation industry in a newly ordained role as keyworkers. This study underscores the need for improved mental health support and counselling services within the maritime industry, in particular, maritime stakeholders likely affected by geopolitical conflicts. HIGHLIGHTS: From the practical perspective, this is among the first studies to focus on the mental health and well-being of seafarers arising out of the situation in Ukraine since 24 February 2022. From the theoretical perspective, this is a maiden study attempting an exploration of social conditions in three different dimensions by integrating three distinct theoretical constructs namely, UN Human Security Framework, Holmes & Rahe Social Readjustment Rating Scale and ILO Maritime Labour Convention framework.

Ukrainian women's maternity care strategies in Poland after the outbreak of the full-scale war: Understanding unequal access to quality care.

The outbreak of the full-scale war launched by Russia against Ukraine and, following it, significant migrations have not only increased the diversity of the Ukrainian migrant population in Poland, but also added to the complexity of their health needs and strategies. This study seeks to explore Ukrainian migrant women's experiences and practices related to the use of maternity care services. The article is based on fieldwork conducted between February and October 2023 and included 23 semi-structured interviews with Ukrainian migrant women who gave birth in Poland after February 24, 2022. To understand Ukrainian women's pathways to maternity care in Poland and unpack the differences in experiences within this group of migrants, we explore participants' healthcare strategies against the background of existing inequalities in access to quality care in Poland and Ukraine, in particularly the division between private and public services. We consider the role of financial, social and cultural resources and distinguish for this purpose between three groups of permanent, circular and wartime migrants. We show the decisive role of economic resources, nonetheless in articulation with the creation and mobilisation of social networks and time spent in Poland, which play a role in shaping migrant women's capacity to access better maternity care.

Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing.

OBJECTIVE: To molecularly characterize several extensively drug-resistant isolates from a single hospital admission screening of a war injured patient from the Ukraine. METHODS: Admission screening included swabs from skin, wounds, catheters, nasopharyngeum and rectum. Bacterial identification, antimicrobial susceptibility testing (AST) and rapid multiplex PCR assays targeting resistance genes were performed during routine diagnostics. Isolates positive by PCR had their genomes sequenced using short- and long read-platforms (MiSeq and MinION) to confirm species, identify resistance genes and plasmids and investigate clonality with core genome MLST (cgMLST). RESULTS: Seven Gram-negative pathogens (Acinetobacter baumannii (n=2; ST78, ST2), Klebsiella pneumoniae (n=2; ST395), Pseudomonas aeruginosa (n=1; ST1047), Escherichia coli (n=1; ST46), Enterobacter cloacae complex (n=1; ST231)) were molecularly confirmed non-identical. AST showed resistance to carbapenems (7/7 isolates) and last resort treatment options such as ceftazidime-avibactam (6/7 isolates) and cefiderocol (4/7 isolates). All isolates were colistin susceptible. Sequencing identified the E. cloacae complex as E. hormaechei subsp. xiangfangensis. Six acquired carbapenemase genes (blaIMP-1, blaNDM-1, blaOXA-48, blaNDM-5, blaOXA-23 and blaOXA-72) were detected. Both A. baumannii isolates differed in sequence type, carbapenemases and cefiderocol susceptibility. Both K. pneumoniae isolates shared sequence type and some resistance genes on an IncR plasmid but were different in cgMLST and carbapenemases (OXA-48 or NDM-1). One vancomycin-resistant Enterococcus faecium was also detected (VanA). CONCLUSION: War injured patients from Ukraine may carry different clones of multidrug-resistant pathogens with limited treatment options and diverse resistance genes at risk for dissemination. Infection control measures should include early molecular characterization of isolates for detection of routes of transmission.

Epidemiology and risk factors for healthcare-associated maternal peripartum infections in Ukraine: results a multicenter study.

OBJECTIVE: Aim: To estimate the frequency of different types of healthcare-associated maternal peripartum infections and their risk factors among women in Ukraine. PATIENTS AND METHODS: Materials and Methods: Multicenter prospective cohort study was conducted in nine regional perinatal centers of Ukraine between January 1, 2021, to December 31, 2023. The criteria for specific healthcare-associated maternal peripartum infections (endometritis, episiotomy infection, and maternal sepsis) site were adapted from the CDC/NHSN case definitions. Surveillance was performed during the hospitalization period and up to 30 days after hospital discharge. RESULTS: Results: A total of 3600 deliveries by the vaginal route were performed during the study period, 600 (16.7%) maternal peripartum infections were observed. Of all maternal peripartum infection cases, 79.7% were detected after hospital discharge. The most common maternal peripartum infections include endometritis (54.8%), episiotomy infections (34.4%), and maternal sepsis (10.8%). According to the multivariate logistic regression analysis, the body mass index >25, placenta previa, premature rupture of membrane, prolonged rupture of membranes, manual removal of the placenta, multiple vaginal examinations, bacterial vaginosis, aerobic vaginitis, gestational diabetes mellitus, and anemia during pregnancy were independent risk factors for maternal peripartum infections. CONCLUSION: Conclusions: Results this study suggest a high prevalence of healthcare-associated maternal peripartum infections in Ukraine. Several factors have been associated with increased risk of maternal peripartum infections, including pre-existing maternal conditions, placenta previa, prolonged rupture of membranes, and spontaneous or provider-initiated conditions during labour and childbirth.

Standing strong: War-related challenges in Ukrainian biomedical research and opportunities for support.

The prolonged war in Ukraine is having a strong impact on all sectors of the Ukrainian society, including biomedical research. Although the material and psychological conditions are challenging, the country and its researchers are courageously managing to continue their activities. This perspective paper describes the multiple challenges faced by Ukrainian biomedical researchers during wartime and outlines strategies to support and enhance collaboration with the global scientific community. Ukraine has a rich scientific history and modern expertise in biomedical research, and developing more international collaborations with Ukraine can have mutual benefits for all involved parties.

Enhancing trauma care in Ukraine amid conflict: A successful implementation of the modified advanced trauma life support course in an active war zone.

BACKGROUND: Following the 2022 Russian invasion, Ukraine's healthcare system suffered extensive damage, with over 1000 medical facilities destroyed, exacerbating the trauma care crisis. The absence of standardized trauma training left Ukrainian healthcare providers ill-equipped to manage the surge in trauma cases amid conflict. To bridge this gap, we implemented advanced trauma life support (ATLS) courses in Ukraine amid active warfare, aiming to enhance trauma care expertise among healthcare professionals. METHODS: A consortium, including the International Medical Corps, Harvard Humanitarian Initiative, and others, responded to a request from the Ukrainian Ministry of Health. The ATLS curriculum, translated into Ukrainian, guided the training, with US-based instructors sent to Ukraine for teaching. Despite logistical challenges, such as missile attacks and curfews, the courses ran in multiple Ukrainian cities over 3 months. Course effectiveness was evaluated through pre- and post-course knowledge tests, self-efficacy surveys, and satisfaction assessments. RESULTS: Ten ATLS courses trained 213 Ukrainian healthcare providers across five deployments. Significant improvements in knowledge scores (p < 0.05) and enhanced self-reported confidence in trauma management were observed. Notably, no casualties were reported among instructors or students, highlighting program safety despite security challenges. CONCLUSIONS: Our study demonstrates successful ATLS course implementation in an active war zone, filling a critical gap in trauma education in Ukraine. Despite challenges, the program significantly enhanced participants' trauma care knowledge and confidence. Collaboration between international and local partners was pivotal. This model can serve as a valuable framework for trauma education globally, improving outcomes in conflict zones and resource-limited settings.

Ukrainian refugees in Romania: perception and social challenges.

Millions of people from Ukraine have been forced to flee their homes to seek safety, protection, and assistance owing to armed conflict. This study aims to draw a parallel between the meaning and importance of the initial impact of Russian military aggression in February 2022 and the recent plight of Ukrainian refugees on Romania's territory. It is based on the results of a dedicated thematic survey of Ukrainian refugees as part of fieldwork carried out by the authors between March and April 2022 and a survey launched by the United Nations Refugee Agency in Romania between October 2022 and August 2023. The study emphasises the importance of raising awareness and building solidarity and support to counterbalance the effects of the crisis with respect to: (i) refugees in their hometowns and losses incurred; (ii) refugees' needs, help provided, and expectations; (iii) the need to integrate refugees into different fields of daily life; and (iv) a return to Ukraine.

Use of telemedicine for trauma care since the Russian invasion of Ukraine: A qualitative assessment.

INTRODUCTION: Ukraine's health and trauma system has been detrimentally impacted since the start of the Russian invasion in February 2022. Use of telemedicine became critical to providing timely medical care. As such, the aim of this study was to describe telemedicine's use in the health and trauma system of Ukraine following the full-scale invasion. METHODS: We conducted qualitative key informant interviews with military and civilian health care workers using an expanded version of the Global Trauma System Evaluation Tool which had components focusing on telemedicine use. Thematic content analysis was used to derive key telemedicine themes from interviews. RESULTS: We conducted 36 key informant interviews. Most respondents described using telemedicine through informal means of communication such as messaging apps to meet patient care needs. Concerns and challenges with use of telemedicine included weapons targeting, internet connections and safety of communications from Russian hackers. A unified system for telemedicine would greatly improve use in country both during and post conflict. DISCUSSION: Telemedicine use has rapidly increased in Ukraine during the current conflict particularly in the scope of providing trauma care when numerous specialties are needed. Development of a unified, secure telemedicine system with mechanisms for integrating multinational medical support would aid in providing swift medical care to persons injured in the conflict or unable to access a specialty provider in their proximity.

Wartime penetrating traumatic brain injury of the anterior skull base involving the paranasal sinuses: a single-center, first-year experience from Dnipro, Ukraine.

OBJECTIVE: Since February 2022, the number of casualties in the Russian-Ukrainian war have dramatically increased, with a high incidence of penetrating traumatic brain injuries (pTBIs). To date, there has been limited evaluation of pTBI of the anterior skull base involving the paranasal sinuses. The objective of this study was to highlight the authors' experience with this injury pattern and identify specific factors associated with favorable short-term (1-month) outcome and survival. METHODS: The authors conducted a single-institution retrospective review of patient data collected from the 1st year of the Russian-Ukrainian war at a frontline civilian Ukrainian hospital. To prevent complications from conservative treatment of pTBI with paranasal sinus injury, a protocol of early primary neurosurgical treatment including debridement/hematoma evacuation, repair of dural defects with vascularized pericranial flaps, and titanium plating of external/skull base defects was implemented. Using 1-month postoperative Glasgow Outcome Scale scores, the authors defined a favorable outcome as good recovery/moderate disability and a poor outcome as severe disability/vegetative state/death. Patient demographics, injury characteristics, imaging findings, and postoperative complications were assessed. Logistic regression models were used to estimate the effect of patient characteristics on unfavorable outcome or survival. RESULTS: From February 2022 to February 2023, there were 141 pTBIs (20%) involving the paranasal sinuses, 134 (95%) due to blast fragmentation. One hundred eighteen patients (84%) had a favorable outcome. Most patients with pTBIs (69%) had other nonbrain-related injuries. While 48 patients (34%) presented with preoperative CSF leak, only 1 patient (0.7%) had persistent postoperative CSF leak, which was managed with lumbar drainage. High admission Glasgow Coma Scale (GCS) score, favorable injury lateralization (single hemisphere involved), and low Injury Severity Score (ISS) were associated with significantly increased odds of favorable short-term outcome, whereas high admission GCS scores and no midline shift were associated with significantly increased odds of survival. CONCLUSIONS: This was the largest single-year study on neurosurgical treatment of wartime pTBI involving the paranasal sinuses. Implementation of primary neurosurgical intervention at the time of presentation demonstrated promising early results and a shift away from expectant management of this injury pattern. The association of high admission GCS score, low ISS, favorable injury lateralization, and no midline shift on favorable short-term outcomes or survival has not been previously documented with this injury pattern.

Antimicrobial susceptibility to last-resort antibiotics in carbapenemase-producing bacteria from Ukrainian patients.

Since March 2022, an increase was observed in multidrug-resistant microorganisms (MDRO), associated with the hospital transfer of Ukrainian patients. The goal was to collect phenotypic susceptibility data and assess clinical implications. Carbapenemase-producing Enterobacterales (CPE, n = 96), Pseudomonas aeruginosa (CPPA, n = 20), and carbapenem-resistant Acinetobacter baumannii-calcoaceticus (CRAB, n = 6) from Ukrainian patients were obtained from March to December 2022 from the Dutch MDRO surveillance. Antimicrobial susceptibility testing was performed using broth microdilution (BMD) when available, fosfomycin agar dilution, disk diffusion (DD) for cefiderocol, and diverse gradient strips. All isolates were sequenced with Illumina next-generation sequencing. For meropenem, aminoglycosides, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-relebactam, susceptibility rates were low (0%-30%), due to the high number of blaNDM-positive isolates (79/122; 65%). For cefiderocol, results depended on reading with or without microcolonies, applying EUCAST or CLSI breakpoints, and whether DD or BMD was used; e.g., for Klebsiella pneumoniae, 30%-97% were susceptible. For colistin, 103/111 (93%) non-intrinsically resistant CPE/CPPA/CRAB isolates were susceptible. For most CPE, a low minimal inhibitory concentration (MIC) of <0.5 mg/L was measured for tigecycline and ceftazidime-avibactam-aztreonam. For CPPA, cefiderocol tested susceptible in 65%-100% of isolates. For CRAB, ampicillin-sulbactam MICs were ≥128 mg/L; for sulbactam-durlobactam, 1-2 mg/L. Admission in a Ukrainian hospital in the last year was a risk factor for MDRO, and majority were screening isolates (79%). There is extensive phenotypic resistance to last-resort antibiotics in MDRO from Ukrainian patients. Interpretation of cefiderocol susceptibility results depends on several variables. When treating patients recently admitted in Ukraine, suspected for Gram-negative bacterial infection, this should be taken into consideration. IMPORTANCE: Since March 2022, multidrug-resistant microorganisms associated with Ukrainian patients have been detected in national surveillance systems of several European countries. We studied the phenotypic antimicrobial susceptibility to last-resort antibiotics of multidrug-resistant microorganisms from Ukrainian patients in the Netherlands and assessed clinical implications. Our research revealed that there was extensive phenotypic resistance to last-resort antibiotics. Healthcare professionals should be aware of multidrug-resistant microorganisms when treating patients recently admitted in Ukraine, suspected for Gram-negative bacterial infection.

Barriers of Ukrainian refugees and migrants in accessing German healthcare.

BACKGROUND: This study focused on Ukrainian refugees and migrants, a population that, with an ongoing war, is expected to grow in Germany. Over 1 million Ukrainians with exceptional legal status and access to public insurance in Germany significantly burden governmental services, especially German healthcare. It is thus essential to facilitate their integration into the healthcare system and ensure its proper usage. Identifying the obstacles Ukrainian refugees and migrants encounter while accessing healthcare services is crucial to ease their integration. METHODS: A qualitative study was conducted from February 2023 to April 2023. Thirty semi-structured interviews were performed with Ukrainian migrants and refugees. The interviews were transcribed verbatim, organized, and categorized. Thematic analysis was performed to identify barriers related to the use of German healthcare services. To assess possible differences in the experiences of Ukrainian refugees and migrants, the responses of these two groups for each topic were analysed separately. RESULTS: Ukrainian migrants and refugees experience similar barriers while accessing German healthcare services. Predominantly, language barriers and a lack of understanding of the German healthcare system posed the main barriers in both groups. Additionally, structural challenges, such as differences in referral processes, appointment scheduling, and consultation duration, presented further challenges. CONCLUSION: This research study emphasizes the importance of addressing cultural and structural barriers to improve healthcare accessibility and utilization for Ukrainian refugees and migrants in Germany to better facilitate their integration into the healthcare system.

Paving the Way to Innovative, Child-Friendly Pediatric Diagnostic Methods for Tuberculosis: Introduction of Stool-Based Testing in Ukraine.

Like many countries, Ukraine faces challenges with diagnosing tuberculosis (TB) in children due to the paucibacillary nature of the disease and difficulty obtaining respiratory samples. To improve diagnostic efficiency, stool testing is being integrated into routine pediatric TB services. This started with a pilot introduction at 12 regional TB facilities, where stool was collected for children with a preliminary diagnosis of TB, based on clinical and/or radiological or laboratory findings, in addition to routine testing. For 168 children, a stool test was conducted between November 2021 and September 2022, with samples submitted in all 12 pilot regions. For 132 children, other samples were available in addition to stool. Mycobacterium tuberculosis (MTB) was bacteriologically confirmed in 37 children (in stool for 18 children). For 7 of the 18 children with MTB in stool, stool was the only sample in which MTB was detected. Rifampicin resistance was detected in seven children (in stool for three). This noninvasive TB diagnostic sample is especially beneficial for young children who cannot produce sputum. Early detection of TB and its drug-resistant strains in children will allow medical workers to provide safer and more effective treatment and save more lives. Based on the pilot implementation, Ukraine's national TB program began implementing stool testing throughout the country.

The Russian threat and the consolidation of the West: How populism and EU-skepticism shape party support for Ukraine.

Support for Ukraine against Russian aggression has been strong across Europe, but it is far from uniform. An expert survey of the positions taken by political parties in 29 countries conducted mid-2023 reveals that 97 of 269 parties reject one or more of the following: providing weapons, hosting refugees, supporting Ukraine's path to European Union membership, or accepting higher energy costs. Where the perceived threat from Russia is most severe, we find the greatest levels of support for Ukraine. However, ideology appears to be far more influential. The level of a party's populist rhetoric and its European Union skepticism explain the bulk of variation in support for Ukraine despite our finding that many strongly populist and European Union-skeptical parties take moderate pro-Ukraine positions when in government.

The influence of the psychosocial stress on oral health status in the conditions of being in Ukraine during the prolonged state of martial law.

OBJECTIVE: Aim: To study the presence of clinical and biochemical correlations between psycho-emotional stress, level of cortisol and periodontal oral health status of the patients in Ukraine during prolonged martial law. PATIENTS AND METHODS: Materials and Methods: The comprehensive clinical and laboratory study covered 49 persons, including 20 patients with Gingivitis (40.8%) and 29 with Periodontitis (59.2%). Biochemical blood test was performed to determine the level of "stress hormone" - cortisol. Patients filled out the questionnaire by the method of V. Zung (low mood-subdepression scale) to determine psycho-emotional state in the conditions of prolonged martial law in Ukraine. RESULTS: Results: The research results showed that in the conditions of martial law in Ukraine, "stabilization" and "improvement" of the process of patients with Gingivitis was established in 50%, with Periodontitis - only in 41.4% of patients. In 54% of patients, a significant deterioration of clinical indices was established, compared to the indicators before the war. In patients with Periodontitis, РВІ index was 1.33 (0.62-1.43) score, which was not statistically significantly different from the initial level (p>0.05). Biochemical blood tests revealed an increased level of the hormone cortisol in 18% of patients. According to the method by V. Zung scale of mental states, the majority of patients (87%) showed low mood and emotional instability within the medium level (range 2 and 3). Correlation was identified, according to the Spearman coefficient (R=0.39, р<0.05), between scale assessments by V.Zung and the blood level of cortisol. CONCLUSION: Conclusions: Psycho-emotional stress is one of the leading pathogenetic factors in the deterioration of oral health status and the development of periodontal diseases, especially in people in Ukraine during prolonged martial law. Indicators of method by V. Zung scale of mental states and the level of cortisol are optimal markers of the need to correct the psycho-emotional state. For patients with increased levels of stress and fear, it is necessary to create special treatment-prevention schemes, taking into account greater attention to motivation to maintain the health of the oral cavity, as well as more frequent hygiene procedures.

The Russia-Ukraine conflict, soaring international energy prices, and implications for global economic policies.

This study examines the economic impact of soaring international energy prices during the Russia-Ukraine conflict from February 23, 2022, to May 31, 2022. Notably, by applying a CGE model, this study offers insights into energy policies at both macroeconomic and industrial levels, emphasizing the model's utility in analyzing complex economic interactions under geopolitical stress. Findings indicate that: (1) Russia, a critical energy-producing country, faced severe economic setbacks due to sanctions, with its GDP contracting by 5.5 %, household income decreasing by 4 %, and consumer spending dropping by 3.5 %. This was accompanied by a significant reduction in domestic investment by 6 %, a decline in output by 5 %, and a decrease in societal welfare indicators. (2) Other energy-producing countries or regions, such as the Middle Eastern oil-producing countries, Australia, Canada, Mexico, and Southeast Asia, experienced economic benefits from the global energy market's "crowding-out effect." These regions saw an increase in GDP ranging from 2 % to 4.5 %, output growth by 3 %-6 %, and household income and consumption improvements by approximately 3 %-5 %. However, these benefits were tempered by a 1 %-2.5 % decline in domestic investment due to rising local energy costs. (3) Developed and developing regions, suffered adverse impacts, including the US, UK, EU, Japan, China, South Asia, Middle Eastern non-oil-producing countries, and Africa. These regions reported a decrease in GDP by 0.5 %-3 %, a decline in household income by 2 %-4 %, and lower consumption rates by 1.5 %-3.5 %. The economic strain was further exacerbated by an inflation increase of up to 2 % across these economies. This research offers valuable insights for governments and policymakers globally to address the challenges posed by the Ukraine crisis-induced energy crisis, underscoring the need for strategic energy policy adjustments and economic resilience planning.

Formation of communicative competence of massage therapists with visual impairments: A research study.

Background: Communicative competence for massage therapists with visual impairments is an important aspect in ensuring their successful integration into the profession and society. However, visually impaired massage therapists face numerous barriers to effective communication during their education, hiring process, and professional employment. Aim: To study why communicative competence is important for students with visual impairments; to research features of communication of persons with visual impairments; to identify barriers and effective strategies for formation of communicative competence in the educational process. Design: A qualitative descriptive study with focus groups and semi-structured interviews. Settings: Higher education institution in Lviv (Ukraine) offering a nursing programme for students with visual impairments. Participants: Three groups of respondents, namely visually impaired alumni of Lviv Medical Academy, Ukraine (n = 6), alumni's employers and co-workers (n = 4), and experts in the education of visually impaired persons (n = 11), participated in the research. Methods: Two focus groups and in-depth semi-structured interviews were used to collect data. Interviews were transcribed verbatim and thematic coding was used to analyze transcripts. Results: Five themes arose: significance of communication for nurse massage therapists with visual impairments; features of communication of persons with visual impairments; barriers to communication of persons with visual impairments; tools and approaches to improve communicative competence of massage therapists with visual impairments; ineffective methods in teaching communication to visually impaired students. Conclusions: Communication barriers faced by visually impaired nursing students include isolation in specialized institutions, parental hypervigilance, and the challenge of establishing eye contact, which impedes reading nonverbal cues. To enhance communicative competence, it is essential to implement interactive teaching methods, involve students in various activities, ensure educational accessibility, and adopt an individualized and empathetic approach. Both inclusive and special education have advantages and disadvantages. It is recommended to advocate for a "reasonable accommodation" model to ensure high-quality education for visually impaired massage therapists.

Mycobacterium caprae tuberculosis in a captive lion in Ukraine - Case Report.

Introduction and Objective. Because of the armed conflict in Ukraine, companion, farm and captive wild animals have been moved in a simplified procedure across the Polish-Ukrainian border. For that reason, in 2022, Poznan Zoo provided support for almost 200 wild animals before movement to facilities in other countries. The aim of the study is to identify the under-recognized risk of moving animals that may be infected with zoonotic pathogens, such as Mycobacterium caprae, between countries. Materials and Method. Sections of the heart, lungs, and mesentery of 4-year-old lioness from Ukraine were taken for histopathological and bacteriological examination. Results. Microbiological examinations confirmed the presence of Mycobacterium caprae, SB0418 spoligotype. Conclusion. TB is a zoonotic disease present globally. Movement of captive wild animals from regions with MTBC cases, or lack of MTBC surveillance, such as UA may pose a potential threat to public health.