War-related stress scale.

BACKGROUND: The current war in Ukraine has affected the well-being of people worldwide. In order to understand how difficult the situation is, specific stressors associated with war need to be measured. In response, an inventory of war-related stressors including its short form, has been developed. METHODS: A list of potential war-related stressors was created, and the content validity of each item assessed. The list, along with other validated scales, was administered to a representative sample of the Slovak population (effective N = 1851). Exploratory factor analysis, confirmatory factor analysis, convergent validity analysis and network analysis were carried out to determine the optimal scale (long and short form) focused on war-related stressors. RESULTS: The full version of the scale consists of 21 items, further divided into three factors: society-related stressors, person-related stressors, and security-related stressors. The short version of the scale comprises nine items loaded onto one factor. These items cover concerns for one's safety and future, access to necessities, potential worsening of the economic situation, and the risk of conflict escalation, including a nuclear threat. The results of the network analysis indicate that concern about escalation and fear of an economic crisis play a central role. CONCLUSIONS: The scale attempts to encompass a wide spectrum of areas that are affected by war and its potential consequences on individuals who reside outside the conflict zone. Given the complexity of the issue, researchers are invited to modify the scale, tailoring it to specific cultural, geographical, and temporal contexts.

Exploring Cascading Disaster Risk During Complex Emergencies: Chemical Industry Disaster Risk Assessment in the Aftermath of the Kakhovka Dam Bombing in Ukraine.

OBJECTIVE: This risk assessment aims to investigate the analysis of cascading disaster risks from the perspective of the chemical industry and public health subsequent to the Kakhovka dam bombing in Ukraine. METHOD: The study utilized a modified observational cross-sectional risk assessment method to assess disaster risk. The method involved identifying the location of chemical factories, determining flooded or at-risk factories, analyzing the type and frequency of chemical hazards, assessing population exposure, and plotting a disaster risk metric. Data on chemical industries and flood extent were collected from open-source secondary data. RESULTS: The destruction of the Kakhovka dam in June 2023 led to severe flooding, placing 42 000 individuals at risk. The analysis identified four chemical factories, with 1 affected by flooding and 3 at risk. The overall risk assessment indicated a high likelihood and severe consequences, including loss of life, environmental contamination, and property damage. CONCLUSION: The combination of complex emergencies and high-risk chemical facilities in Kherson Oblast poses a significant risk of a chemical industry disaster. The interplay between compound and cascading risks during complex emergencies amid the current war further exacerbates the situation, leading to the devastation and destruction of the environment to the detriment of life, and aligns with the characterization of ecocide.

Coping and emotions of global higher education students to the Ukraine war worldwide.

Trauma scientists have raised the alarm about the devastating consequences of the Ukraine war on mental health. We examined how higher education students-as indirect victims-coped with this conflict and how they emotionally reacted during 2022. We involved 2314 students from 16 countries through an online survey. A structural equation model indicated significant relations between war-related worry about military and macroeconomics domains and two coping strategies (opposition, support giving), in turn significantly linked with six emotions. The model was strongly invariant across gender, study field, and geographic area. The most frequent emotions were anger and anxiety, followed by two future-centred emotions (hopelessness and hope). Emotions were more frequent for females and students of the countries geographically close to the war region. Our findings call for evidence-based policy recommendations to be implemented by institutions to combat the negative short and long-term psychological sequelae of being witnesses of armed conflicts.

Size estimation of key populations and 'bridge populations' based on the network scale-up method in Ukraine.

INTRODUCTION: Correct estimation of the size of key and bridge populations is crucial for an efficient HIV/AIDS response in resource-limited settings, enabling efficient program planning and resource allocation. The hidden nature of these groups poses challenges to traditional methods, leading to the adoption of innovative approaches like the network scale-up method (NSUM). In this article we present the results of a NSUM study conducted in 2020 in Ukraine, focusing on four key populations and three bridge populations, highlighting challenges and contributions to development of the method. METHODS: From July to September 2020, we conducted a nationally representative survey in Ukraine via computer-assisted telephone interviews, and applied the known population method and summation method to estimate social networks sizes. Results were weighted based on individual sampling probability and adjusted for social respect and visibility factors to address potential limitations. RESULTS: Our study achieved a 20% response rate with 10,000 completed interviews. The social network size, using the known population method, was 213 people, and 125 using the summation method. Adjusting for the social respect and visibility, estimated key populations sizes were 295,857 [248,714-343,001] people who inject drugs, 152,267 [109,960-194,573] men who have sex with men, 78,385 [57,146-99,619] sex workers, and 9,963 [7,352-12,571] transgender people, detailed by age and gender. Bridge populations were estimated at 62,162 [50,445-73,879] sexual partners of people who inject drugs, 284,348 [233,113-335,583] clients of sex workers, and 13,697 [7,370-20,026] female partners of men who have sex with men. CONCLUSIONS: NSUM proves reliable for estimating key populations size with appropriate corrections. It shows promise for further use in Ukraine, considering limited geographic coverage of the integrated bio-behavioral studies to use multiplier-based methods. However, the validity concerns persist for estimating bridge populations size, emphasizing the need for further method refinement and addressing implementation issues, particularly those related to data collection.

Analysis of cases of premature rupture of membranes and preterm births to identify effective management measures to prevent them.

OBJECTIVE: Aim: Based on retrospective analysis recognize the key factors of development of premature childbirth and elaborate highly specific criteria for individual prognosis to improve perinatal outcomes. PATIENTS AND METHODS: Materials and Methods: A retrospective analysis of the birth histories of 250 women and their newborns with spontaneous preterm births at 22-36 weeks was conducted using archival data from the department for pregnant women with obstetric pathology of the State Institution "Institute of Pediatrics, Obstetrics and Gynecology named by academician OM Lukianova of the National Academy of Medical Sciences of Ukraine". RESULTS: Results: Important risk factors for premature rupture of membranes (PROM) in preterm pregnancy include the presence of sexually transmitted diseases (χ2=31.188, p=0.001), bacterial vaginosis (χ2=30.913, p=0.0001), a history of abortion and/or preterm birth (χ2=16.62, p=0.0002), SARS during pregnancy (χ2=16.444, p=0.0002), chronic adnexitis in anamnesis (χ2=11.522, p=0.0031), inflammatory cervical disease (χ2=11.437, p=0.0032), anaemia (χ2=10.815, p=0.0044), isthmic-cervical insufficiency (ІСІ) (χ2=10.345, p=0.0057), chronic pyelonephritis with exacerbation (χ2=9.16, p=0.01), smoking during pregnancy (χ2=10.815, p=0.0044). CONCLUSION: Conclusions: The results of a retrospective analysis of 250 cases of preterm birth at 22 to 36 weeks allowed us to identify ways to effectively use existing diagnostic measures to determine readiness for pregnancy and the possibility of prolonging pregnancy to the viability of the newborn. Ways to improve the prevention of preterm birth and the design of further research were identified.

Endometritis after hysteroscopic procedures in Ukraine: results a multicenter study.

OBJECTIVE: Aim: To determine the current prevalence of endometritis after hysteroscopic procedures and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and Methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 in fifteen hospitals from twelve regions of Ukraine. Definitions of endometritis were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST. RESULTS: Results: Among 13,872 patients with hysteroscopic procedures, 1027 (7.4%) endometritis were observed. Of these cases, 0.4% were detected after diagnostic hysteroscopy, and 7.0% were detected after operative hysteroscopy. Of all endometritis cases, 64.2% were detected after hospital discharge. The most commonly reported bacterial species were Escherichia coli (24.3%), followed by Enterobacter spp. (12.7%), Enterococcus spp. (8.3%), Pseudomonas aeruginosa (8.1%), Serratia marcescens (6.8%), Staphylococcus aureus (5.9%), Proteus mirabilis (5.8%), Klebsiella oxytoca (5.1%), Stenotrophomonas maltophilia (4.5%), Klebsiella pneumoniae (4.1%). A significant proportion of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials, varying widely depending on the bacterial species, antimicrobial group, and geographical region of Ukraine. CONCLUSION: Conclusions: Our data suggest a high prevalence of endometritis after hysteroscopic procedures. Risk for endometritis was higher after operative hysteroscopy compared with diagnostic hysteroscopy. Many most of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials. These data underscore the importance of tracking antimicrobial resistance of responsible pathogens of HAIs in hospitals.

Impact of meeting housing needs on human health.

OBJECTIVE: Aim: To identify the impact of meeting the housing needs on human health, which must be taken into account when developing the health care policy for the country's population. PATIENTS AND METHODS: Materials and Methods: The system of general scientific and special research methods was used during the research. The materials of the work were: statistical data; standards and recommendations regarding sanitary living conditions; court case-law; reports in mass media; scientific sources; regulatory legal acts of Ukraine. CONCLUSION: Conclusions: Sanitary and hygienic conditions of living in housing provide for the formation of a human life environment, where there is no harmful effect of its factors on human health and there are opportunities to ensure normal and to restore impaired body functions. Each person is responsible for maintaining own sanitary and hygienic living conditions in the housing. Sanitary and hygienic living conditions of a person must be considered through the principle of reasonableness and safety of public health.

Implementation of the classification of medical devices of Ukraine in international approaches.

OBJECTIVE: Aim: To study the level of compliance of the National Classifier of Ukraine ≪Classifier of Medical Devices of Ukraine NC 024: 2023≫ with international approaches to the classification and use of medical devices. PATIENTS AND METHODS: Materials and Methods: National Classifier of Ukraine ≪Classifier of Medical Devices of Ukraine NC 024: 2023≫ and the international nomenclature of medical devices Global Medical Device Nomenclature. Methods: bibliosemantic, of content analysis and of structural-and-logical analysis. CONCLUSION: Conclusions: In the course of the study, full compliance of the national classifier of medical devices of Ukraine NC 024: 2023 with the GMDN system was established.

Healthcare-associated infections in postoperative patients with intracranial aneurysm in Ukraine.

OBJECTIVE: Aim: to investigate the epidemiology, microbiology, and risk factors for healthcare-associated infections (HAIs) in postoperative patients with intracranial aneurysm in Ukraine. PATIENTS AND METHODS: Materials and Methods: Retrospective cohort study was conducted from January 2018 to December 2022 in four tertiary care hospitals of Ukraine. The diagnostic criteria were based on specific HAI site were adapted from the CDC/NHSN case definitions. RESULTS: Results: Of 1,084 postoperative patients with intracranial aneurysm, 128 (11.4%) HAIs were observed. The most common of HAI type was possible ventilatorassociated pneumonia (38.2%) followed by central line-associated bloodstream infections (33.8%), catheter -associated urinary tract infection (18.5%), and surgical site infection (9.6%). Inpatient mortality from HAI was 5.1%. Emergency admission, mechanical ventilation, taking antiplatelet aggregation drugs, albumin reduction, hyperglycaemia, hyponatremia, surgical procedure, operation time > 4 h, mechanical ventilation, urinary catheter, and central venous catheterization were risk factors associated with HAI in patients with intracranial aneurysm surgery. A total of 26% cases of HAIs by MDROs were notified over the study period. Klebsiella spp. - essentially K. pneumoniae - were the most frequent, followed by Enterobacter spp. and Escherichia coli. Carbapenemase production in Enterobacterales constituted the most frequent mechanism of resistance, while ESBL-production in Enterobacterales and meticillin-resistance in Staphylococcus aureus (MRSA) were detected in 65,7% 62,3% and 20% of cases, respectively. CONCLUSION: Conclusions: The present study showed that HAIs is a common complication in postoperative patients with intracranial aneurysm in Ukraine and multidrugresistant organisms the major pathogen causing infection.

Trends of Hepatitis A Virus Infection in Poland: Assessing the Potential Impact of the COVID-19 Pandemic and War in Ukraine.

Hepatitis A virus (HAV) is the most common cause of acute viral hepatitis, which is preventable by vaccination. This study analyzed trends of HAV infections in Poland according to socio-demographic features in the years 2009-2022 and assessed the potential impact of the COVID-19 pandemic (2020-2023) and the migration of war refugees from Ukraine (since February 2022). In 2009-2022, 7115 new cases of HAV infection were diagnosed in Poland, especially among men (66.4%) and in urban areas (77.4%). Infections among men were most common at the age of 25-34 (median rate 0.43 per 105) and in women aged 15-24 (median rate 0.39 per 105). Analysis of the 14-year frequency of HAV infections exhibited three trends, regardless of gender, age, and residence. The infections revealed a downward trend in 2009-2014, increased significantly in 2014-2018, and decreased again after 2018. A particularly rapid increase in HAV infections occurred between March 2017 and February 2018 (median rate 0.79 per 105). The high level of new infections persisted until the beginning of the COVID-19 pandemic, at which point it dropped significantly but did not reach the level recorded before March 2017. During the Omicron SARS-CoV-2 dominance period, the median rate of HAV infections was 0.053 per 105, with a four-fold increase being observed from February 2022 (when the migration of war refugees from Ukraine began) to August 2022. The presented results can serve as a reference point for further observations in Central Europe. The HAV epidemiological situation is unlikely to escalate in Poland but requires further monitoring.

Prevalence and correlates of ICD-11 prolonged grief disorder among adults living in Ukraine during the war with Russia.

BACKGROUND: Although high rates of bereavement are evident in war-affected populations, no study has investigated the prevalence and correlates of probable ICD-11 prolonged grief disorder (PGD) under these circumstances. METHODS: Participants were 2050 adults who participated in a nationwide survey exploring the effects of the Ukraine-Russia war on the daily lives and mental health of Ukrainian people. RESULTS: Of the total sample, 87.7% (n = 1797) of people indicated a lifetime bereavement. In the full sample, 11.4% met the diagnostic requirements for probable ICD-11 PGD, and amongst those with a lifetime bereavement, the conditional rate of probable ICD-11 PGD was 13.0%. Significant risk factors of ICD-11 PGD included the recent loss of a loved one (6 months to a year ago), being most affected by a partner or spouse's death, loved one dying in the war, no recent contact with the deceased prior to their death, and meeting depression and anxiety diagnostic requirements. CONCLUSION: The study reveals that a significant percentage of Ukrainian bereaved individuals have probable ICD-11 PGD, and identifying risk factors, particularly war-related losses, will aid in the development of intervention and prevention programs for bereaved adults.

Drug-Resistant Tuberculosis, Georgia, Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, 2017-2022.

In 2021, the World Health Organization recommended new extensively drug-resistant (XDR) and pre-XDR tuberculosis (TB) definitions. In a recent cohort of TB patients in Eastern Europe, we show that XDR TB as currently defined is associated with exceptionally poor treatment outcomes, considerably worse than for the former definition (31% vs. 54% treatment success).

Does HIV index testing bring patients into treatment at earlier stages of HIV disease? Results from a retrospective study in Ukraine.

BACKGROUND: Over one-third of people living with HIV (PLH) in Ukraine are not on treatment. Index testing services, which link potentially exposed partners (named partners) of known PLH (index patients) with testing and treatment services, are being scaled in Ukraine and could potentially close this gap. METHODS: This retrospective study included patient data from 14,554 adult PLH who initiated antiretroviral treatment (ART) between October 2018 and May 2021 at one of 35 facilities participating in an intervention to strengthen index testing services. Mixed effects modified Poisson models were used to assess differences between named partners and other ART initiators, and an interrupted time series (ITS) analysis was used to assess changes in ART initiation over time. RESULTS: Compared to other ART initiators, named partners were significantly less likely to have a confirmed TB diagnosis (aRR = 0.56, 95% CI = 0.40, 0.77, p < 0.001), a CD4 count less than 200 cells/mm3 (aRR = 0.84, 95% CI = 0.73, 0.97, p = 0.017), or be categorized as WHO HIV stage 4 (aRR = 0.68, 9% CI = 0.55, 0.83, p < 0.001) at the time of ART initiation, and were significantly more likely to initiate ART within seven days of testing for HIV (aRR = 1.36, 95% CI = 1.22, 1.50, p < 0.001). Our ITS analysis showed a modest 2.34% (95% CI = 0.26%, 4.38%; p = 0.028) month-on-month reduction in mean ART initiations comparing the post-intervention period to the pre-intervention period, although these results were likely confounded by the COVID epidemic. CONCLUSION: Our findings suggest that index testing services may be beneficial in bringing PLH into treatment at an earlier stage of HIV disease and decreasing delays between HIV testing and ART initiation, potentially improving patient outcomes and retention in the HIV care cascade.

LEGAL NATURE OF MEDICAL SERVICES: SPECIFICS OF UKRAINIAN DOCTRINE.

The purpose of the article is to analyze the specifics of the Ukrainian doctrine regarding the legal nature of medical services and areas for improving legal regulation. The research is based on the analysis and comparison of Ukrainian and EU law, content analysis of the terminology of legal sources, legal positions of the Constitutional Court of Ukraine, scientific researches, description and generalization of existing achievements and issues in the field of legal regulation of healthcare services. Research methods are monographic analysis, systematic and structural analysis, comparative and legal analysis, linguistic analysis, content analysis, method of generalization. The need to unify the special categorical apparatus of Ukrainian legislation has been substantiated. It has been proved that due to the improvement of domestic legislation through the implementation of the norms of European private law, the doctrine and practice of legal regulation will correspond to the nature of the regulated relations. The content, structure, and specific features of legal relations for the provision of medical services in the Ukrainian legal system have been determined. The authors have made a conclusion about the private legal nature of medical services in the domestic legal doctrine. Recommendations have been made for the legislation of Ukraine, which regulates civil relations for the provision of medical services, regarding the introduction of special norms related to the personal non-property rights of the relations' participants, contractual representation of a patient, legal terms for the provision of medical services without obtaining the consent.

Analysis of indicators of caries of permanent teeth in children according to the endemic features of the Poltava region, Ukraine.

OBJECTIVE: Aim: This research is focused at analyzing the indicators and substantiating the peculiarities of caries prevention in permanent teeth in schoolchildren of Poltava region, taking into account the endemic features of the Poltava region. PATIENTS AND METHODS: Materials and Methods: A comparative study was conducted among 608 pupils of secondary schools in Kremenchuk, who consumed drinking water with fluoride concentrations in the lower limits of the norm, and 1214 pupils of secondary schools in Poltava, who consumed drinking water with fluoride concentrations in the optimal upper limits of the norm. RESULTS: Results: The rates of caries in permanent teeth in children living in a region with fluoride concentrations in drinking water in the optimal-upper normal range are several times lower than in children of the same age living in a region with fluoride concentrations in drinking water in the lower normal range, and a significant increase in the prevalence and intensity of caries is observed from 7 to 9 to 12 years of age, as teeth after eruption are most vulnerable to caries. In a region where the fluoride concentration in drinking water is in the optimal-upper range of the norm, children with early forms of fluorosis have the lowest prevalence and intensity of caries. CONCLUSION: Conclusions: Endemic features of the region directly affect the prevalence and intensity of the caries process. In regions with a fluoride concentration in drinking water within the optimal upper limits of the norm, prevention of caries in permanent teeth in children should be carried out taking into account the presence of fluorosis.

The unified state qualification exam STEP-1 as a marker of the success of the education of pediatric doctors in Ukraine and Bogomolets National Medical University.

BACKGROUND: Ukraine's higher medical education goes deeper and deeper every year in the European integration processes in the field of «Health Care¼ knowledge. Since 2005, the integrated license integrated exam STEP "General medical training" has been introduced in the country to diagnose the quality of training of specialists in all medical specialties. Since 2019, Ukraine, unlike other countries in Europe and the world, has been training specialists in the specialty "Pediatrics" at the stage of undergraduate training. The quality control of the training of specialists is carried out in the form of passing the Unified State Qualification Exam STEP (USQE STEP) separately for each medical specialty (Medicine and Pediatrics). Therefore, the purpose of our research is to conduct a comparative analysis of the results of the success of the first stage of the USQE STEP-1 by students of higher medical education in the specialty "Pediatrics" with the specialty "Medicine" in Ukraine and in the Bogomolets National Medical University (Bogomolets NMU). METHODS: Analytical references to the results of the first stage of the USQE STEP-1 for the students who have completed theoretical medical disciplines specialty "Pediatrics" and the specialty "Medicine" in Ukraine and Bogomolets NMU, which are provided by the Testing Center at the Ministry of Health of Ukraine. Тhe statistical significance of comparative indicators was proved using Fisher's test, with a statistical error that corresponded to the specified value for ≤ 0.05. RESULTS: It is shown that in 2022, applicants of higher medical education of Ukraine with the specialty "Pediatrics" improved the overall success rate by 8.4%, and the success rate of subtests by an average of 10.5%, despite the state of war in Ukraine. The exception was the results of the licensing exam for the subtest component "Biochemistry": compared to 2021, the pass rate decreased by 3.6% in the specialty "Medicine" and by 6.4% in the specialty "Pediatrics". At Bogomolets NMU, the leaders of 2022 were the students of the "Pediatrics" specialty, their success rate is 2% higher than that of the "Medicine" specialty. CONCLUSIONS: The analysis of the results of USQE STEP-1 by applicants of higher medical education of the specialties "Pediatrics" and "Medicine" in Ukraine showed the effectiveness of the selection of the specialty "Pediatrics" into a separate section of the training of specialists at the undergraduate level in the field of "Health Care". Using the methods of mathematical statistics, the effectiveness of organizational methodological techniques in the organization of the educational process in the conditions of the martial law of Ukraine and Bogomolets NMU as a leader in the training of specialists in Pediatric doctors has been proved.

Healthcare-associated infections after neurosurgical procedures in Ukraine: a multicentre study (2020-2022).

OBJECTIVE: Aim: To investigate the epidemiology, microbiology, and risk factors for healthcare-associated infections (HAIs) after a neurosurgical procedure in Ukraine. PATIENTS AND METHODS: Materials and Methods: Prospective multicentre surveillance was conducted from January 2020 to December 2022 in 10 regional hospitals of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. RESULTS: Results: Of 8,623 neurosurgical patients, 1,579 (18.3%) HAIs were observed. The most frequently of HAI types were pneumonia (38.4%), surgical site infection (34.2%), urinary tract infection (18.1%) and bloodstream infection (9.3%). Death during hospitalization was reported in 11.3% of HAI cases. There was an association between HAIs after neurosurgical procedures and patients with diabetes mellitus, end-stage renal disease undergoing dialysis, and leukaemia. The strongest independent associations were observed for intubation, urinary catheters, and vascular catheters. Klebsiella pneumoniae were most commonly reported, accounting for 25.1% of all organisms, followed by Escherichia coli (17.6%), Staphylococcus aureus (9.9%), Pseudomonas aeruginosa (8.9%), Acinetobacter baumannii (8.5%), coagulase-negative staphylococci (6.8%), and Streptococcus spp. (5.5%). In total, 76.3% isolates from neurosurgical patients were MDROs. Antimicrobial resistance in Ukraine varies greatly by bacterial species, antimicrobial group, and region. CONCLUSION: Conclusions: Healthcare-associated infections are a cause for mortality and morbidity among neurosurgical patients. This is due to increase emergence of antimicrobial-resistant pathogens. Routinely collected surveillance data are of great value as a basis for studying the consequences of HAIs.

Comparative analysis of the quality of life of women who left the territory of Ukraine during the ongoing Russia - Ukraine war and women who stayed at their homes.

OBJECTIVE: Aim: To investigate the quality of life of women who left Ukraine and those who did not leave their homes under the threat of war. PATIENTS AND METHODS: Materials and Methods: We used the WHOQOL-100 questionnaire for quality assessment. 376 young women (aged 25-44) were interviewed using a Google questionnaire (WHOQOL BREF). The respondents were divided into 2 groups: group 1 - women who left the territory of Ukraine during the war (n-176); group 2 - women who did not leave their homes (n-200). RESULTS: Results: The general level of quality of life for group 1 (62.9% ± 9.3) was slightly lower than group 2 (66.7% ± 9.1). In terms of quality of life, group 2 prevails over group 1 in the domain of microsocial support. CONCLUSION: Conclusions: Therefore, women who did not leave their homes during the full-scale invasion of Russia on the territory of Ukraine rate their quality of life higher than women who left the territory of Ukraine. Respondents of group 2 are more satisfied with their social support, sexual life, support from friends, enjoy life more than respondents of group 1.