A Comparison of Ukrainian Hospital Services and Functions Before and During the Russia-Ukraine War.

Importance: Since the full-scale Russian invasion, hospitals in Ukraine have been compelled to close or operate at reduced capacity due to inadequate supplies, damage, or destruction caused by war. Objective: To analyze hospital services in Ukraine during the period before and after the Russian invasion. Design, Setting, and Participants: Of the 450 hospitals currently functioning in Ukraine, a cross-sectional survey was carried out with the participation of 74 hospitals from 12 oblasts. Hospital administrators responded to an online survey with questions on the use of hospital services. Data were abstracted from hospital databases for the prewar period (before February 23, 2022) and during the war (February 23, 2022, to May 30, 2023). Main Outcomes and Measures: Hospital services (including emergency services, preventive services, screenings, laboratory tests, obstetrics, telehealth, pharmacy, and rehabilitation services) were compared during the prewar and war periods. Results: Of 450 Ukrainian hospitals in operation, 74 hospitals (16.0%) across 12 oblasts provided data for the current analyses. During the war, daily emergency admissions increased to 2830, compared with 2773 before the war. At the same time, hospitals reported reduced laboratory testing (72 [97%] vs 63 [85%]), tobacco education (52 [70%] vs 36 [49%]), cancer screening (49 [66%] vs 37 [50%]), gynecological services (43 [58%] vs 32 [43%]), rehabilitation services (37 [50%] vs 27 [36%]), pharmacy services (36 [49%] vs 27 [36%]), and telehealth programs (33 [45%] vs 21 [28%]). Hospitals reported additional difficulties during the war, including disruptions in the supply chain for essential equipment and pharmaceuticals, shortages of laboratory test kits, delays in the delivery of crucial medications, and problems around appropriate medication storage due to power outages. Conclusions and Relevance: The ongoing war has inflicted profound devastation on Ukraine's hospitals. The findings of this cross-sectional survey offer valuable insights into the formidable challenges that hospitals confront in war-affected regions and underscore the pressing necessity for bolstering support to sustain and enhance hospital services during wartime.

Significance of plasma relaxin-2 levels in patients with primary hypertension and type 2 diabetes mellitus.

BACKGROUND: This study aimed to evaluate plasma relaxin­2 (RLN-2) levels in patients with arterial hypertension (AH) and their relationships with clinical and laboratory parameters. METHODS: The study involved 106 hypertensive patients, including 55 with type 2 diabetes mellitus (T2DM), and 30 control subjects. Plasma RLN-2 levels were measured using an enzyme-linked immunosorbent assay kit. RESULTS: RLN-2 levels were reduced in patients with AH compared to healthy volunteers (p < 0.001), and hypertensive patients with T2DM had lower RLN-2 levels than those without impaired glucose metabolism (p < 0.001). RLN­2 was negatively correlated with systolic blood pressure (SBP) (p < 0.001) and anthropometric parameters such as body mass index (BMI; p = 0.027), neck (p = 0.045) and waist (p = 0.003) circumferences, and waist-to-hip ratio (p = 0.011). RLN­2 also had inverse associations with uric acid levels (p = 0.019) and lipid profile parameters, particularly triglycerides (p < 0.001) and non-HDL-C/HDL­C (p < 0.001), and a positive relationship with HDL­C (p < 0.001). RLN­2 was negatively associated with glucose (p < 0.001), insulin (p = 0.043), HbA1c (p < 0.001), and HOMA-IR index (p < 0.001). Univariate binary logistic regression identified RLN­2 as a significant predictor of impaired glucose metabolism (p < 0.001). CONCLUSIONS: Decreased RLN-2 levels in patients with AH and T2DM and established relationships of RLN­2 with SBP and parameters of glucose metabolism and lipid profile suggest a diagnostic role of RLN­2 as a biomarker for AH with T2DM.

Plasma catestatin levels are related to metabolic parameters in patients with essential hypertension and type 2 diabetes mellitus.

Catestatin (CST) is a pleiotropic peptide with cardioprotective and metabolic effects. CST is involved in the pathogenesis of both arterial hypertension (AH) and type 2 diabetes mellitus (T2DM), which are the risk factors of cardiovascular diseases. In this study, we aimed to investigate the plasma CST levels in hypertensive patients, especially with T2DM, as well as compare those with healthy volunteers, and explore the relationship between CST levels and clinical, anthropometric and laboratory parameters. 106 Hypertensive patients, 55 of which had comorbidity T2DM, and 30 healthy volunteers were enrolled in the study. All subjects underwent clinical examination, including vital signs and anthropometric data assessment, medical history interview, and blood sample collection. Plasma CST levels were measured by an enzyme-linked immunosorbent assay (ELISA), using a commercial diagnostic kit. The plasma CST levels were significantly lower in hypertensive patients (N = 106) compared with healthy subjects (N = 30) (5.02 ± 1.09 vs. 6.64 ± 0.72; p < 0.001). Furthermore, hypertensive patients with T2DM (N = 55) have significantly reduced CST levels in comparison with those without T2DM (N = 51) (4.47 ± 1.16 vs. 5.61 ± 0.61; p < 0.001). CST significantly correlated with anthropometric characteristics, in particular, weight (r = - 0.344; p < 0.001), BMI (r = - 0.42; p < 0.001), neck (r = - 0.358; p < 0.001), waist (r = - 0.487; p < 0.001), hip (r = - 0.312; p < 0.001), wrist circumferences (r = - 0.264; p = 0.002), and waist-to-hip ratio (r = - 0.395; p < 0.001). Due to its antihypertensive effect, CST has significant associations with systolic BP (r = - 0.475; p < 0.001) and duration of AH (r = - 0.26; p = 0.007). CST also has an inverse relationship with insulin (r = - 0.382; p < 0.001), glucose (r = - 0.45; p < 0.001), index HOMA-IR (r = - 0.481; p < 0.001) and HbA1c (r = - 0.525; p < 0.001), that indicate its involvement in T2DM development. Besides, CST has significant correlations with uric acid levels (r = - 0.412; p < 0.001) as well as lipid parameters, especially HDL-C (r = 0.480; p < 0.001), VLDL-C (r = - 0.238; p = 0.005), TG (r = - 0.4; p < 0.001), non-HDL-C/HDL-C (r = - 0.499; p < 0.001). Multiple linear regression analysis indicated BMI (ß = - 0.22; p = 0.007), AH duration (ß = - 0.25; p = 0.008), HbA1c (ß = - 0.43; p = 0.019) and HDL-C levels (ß = 0.27; p = 0.001) as independent predictors of CST levels. The hypertensive patients have significantly decreased CST levels that are even more reduced in the presence of comorbid T2DM. The established correlations with anthropometric and laboratory parameters indicate not only antihypertensive but also metabolic effects of CST. Our results suggest the probable role of CST in the pathophysiology of cardiometabolic diseases and the development of cardiovascular complications.

Evaluation of health-promoting self-care behaviors in hypertensive patients with concomitant chronic kidney disease in primary care.

AIM: This study was to investigate the relationships among health behaviors and quality of life (QOL) and to test a proposed model among people with hypertension and concomitant chronic kidney disease (CKD) in primary care. In addition, the mediation effect of modifiable risk factors between self-care health behaviors and QOL was examined. METHODS: This study was prospective, conducted in the centers of primary medical care in the period from January 2018 to January 2020. In total, 170 patients diagnosed with hypertension and CKD at least 12 months previously were included in this study. The following parameters were measured: self-efficacy, self-care health behaviors with the subscales of health responsibility, exercise, consumption of a healthy diet, stress management, and smoking cessation; modifiable risk score; and QOL (assessed using the 36-item Short-Form Health Survey instrument). RESULTS: Self-efficacy had a significantly positive direct effect on self-care health behaviors, with a standardized regression coefficient of 0.87 (P = 0.007), a negative indirect effect on risk factors, with a standardized regression coefficient of 0.11 (P = 0.006), and a positive indirect effect on QOL, with a standardized regression coefficient of 0.62 (P = 0.008). Self-care health behaviors had a significantly positive direct effect on QOL, with a standardized regression coefficient of 0.72 (P = 0.012); there was also an indirect effect of 0.053 (P = 0.004). The direct effect of risk factors on QOL was significant, with a standardized regression coefficient of 0.44 (P = 0.018). The direct effect of self-care health behaviors on QOL was 0.77 (P = 0.008), which has been reduced to 0.72 (P = 0.012). The reduced effect of 0.05 was significant (P = 0.004), confirming the mediating role of modified risk factors. CONCLUSIONS: This study indicates health-promoting behaviors in hypertensive patients with CKD have a potential impact on their QOL in primary care. Primary care physicians should focus on motivation strategies to encourage individuals to perform self-care health-promoting behaviors associated with the improved QOL, in order to achieve better outcomes in risk factor management.

Efficacy and Safety of Masitinib in Corticosteroid-Dependent Severe Asthma: A Randomized Placebo-Controlled Trial.

Background: Masitinib is an oral tyrosine kinase inhibitor that selectively targets mast cell activity and platelet-derived growth factor receptor (PDGFR) signaling, both of which are implicated in various mechanisms of asthma pathogenesis. Objective: Assessment of masitinib as an add-on to standard maintenance therapy as compared with placebo in the treatment of oral corticosteroid-dependent severe asthma. Methods: We conducted a randomized (2:1), placebo-controlled study of masitinib (6 mg/kg/d) in adults with severe asthma uncontrolled by high dose inhaled corticosteroids and long-acting beta-adrenoreceptor agonists plus oral corticosteroids (OCS) (≥7.5 mg/d). No minimum baseline blood eosinophil count was specified. Following a protocol amendment, the primary endpoint was reduction of annualized severe asthma exacerbation rate adjusted for the overall time on treatment (SAER). Subgroup analysis according to yearly cumulative OCS intake was also performed, a higher OCS dose indicating more severe asthma that is harder to control. Results: Following an average exposure of approximately 13 months, masitinib (n = 240) reduced the SAER by 35% relative to placebo (n = 115) (rate ratio (RR) 0.65 (95% CI [0.47-0.90]; P = 0.010)). For patients with eosinophil ≥150 cell/µL, masitinib (n = 181) reduced SAER by 38% relative to placebo (n = 87); RR 0.62 (95% CI [0.42-0.91]; P = 0.016). Benefit of masitinib was shown to increase in the most severely affected patients (OCS intake of >1000 mg/year), with a significant (P < 0.01) reduction in SAER of 50%-70%. Safety was consistent with the known masitinib profile. Conclusion: Orally administered masitinib reduces the risk of asthma exacerbations in severe asthma patients, with an acceptable safety profile. Masitinib may potentially provide a new treatment option for oral corticosteroid-dependent severe asthma.

EVALUATION OF DIABETES SELF-MANAGEMENT EDUCATION IN PATIENTS WITH CONCOMITANT CHRONIC KIDNEY DISEASE.

OBJECTIVE: The aim: Was to evaluate the quality of DSME provided by primary care physicians to people with diabetes mellitus. PATIENTS AND METHODS: Materials and methods: A descriptive cross-sectional study was conducted among 120 primary care physicians. The quality of diabetes self-management training provided by physicians was assessed on a personal scale of 39 Likert questions obtained from the American Association of Diabetes Educators in seven areas of diabetes self-monitoring. The Cronbach's reliability coefficient for each domain / subscale was ≥ 0.7. The data were analyzed using an independent selective t-test and one-way ANOVA. RESULTS: Results: More than half of the doctors provided "inadequate quality" of diabetes self-management in all areas. Doctors had the highest average score in the domain of "drug intake" (4.46 ± 0.61). Average scores in the "problem-solving domain" (3.52 ± 0.63) and " being active domain" (3.46 ± 0.75) were low. The quality of DSME provided by physicians was not related to any of the characteristics of the physician. CONCLUSION: Conclusions: The quality of doctors' communication on DSME in this study was suboptimal. Most adequately informed cases of diabetic behavior associated with self-management have been associated with reduced risk factors and an orientation towards disease. Thus, training of primary care physicians in diabetic self-management is recommended because of the key role that these doctors play in managing diabetes.

Self-management Education in Type 2 Diabetes in Primary Care.

INTRODUCTION: Diabetes self-management education (DSME) is defined as a systematic intervention involving active participation of the individual in self-monitoring of health parameters and/or decision making using knowledge and skills. The goal of DSME is to create opportunities for people with diabetes to be informed and motivated to continuously participate in effective methods and methods of self-monitoring of diabetes. AIM: To evaluate the quality of DSME provided by primary care physicians to people with diabetes mellitus. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among 120 primary care physicians. The quality of diabetes self-management training provided by physicians was assessed on a personal scale of 39 Likert questions obtained from the American Association of Diabetes Educators in seven areas of diabetes self-monitoring. The Cronbach's reliability coefficient for each domain/subscale was ≥ 0.7. The data were analysed using an independent selective t-test and one-way ANOVA. RESULTS: More than half of the doctors provided "inadequate quality" of diabetes self-management in all areas. Doctors had the highest average score in the domain of "drug intake" (4.46±0.61). Average scores in the "problem-solving domain" (3.52±0.63) and "being active domain" (3.46±0.75) were low. The quality of DSME provided by physicians was not related to any of the characteristics of the physician. CONCLUSION: The quality of doctors' communication on DSME in this study was suboptimal. Most adequately informed cases of diabetic behaviour associated with self-management have been associated with reduced risk factors and an orientation towards disease. Thus, training of primary care physicians in diabetic self-management is recommended because of the key role that these doctors play in managing diabetes.