The diagnostic accuracy of spirometry versus peak expiratory flow test for follow-up of adult asthma patients at primary care level.

Background: The asthma burden is growing worldwide, and this is predisposed by environmental and occupational exposures as well as individual risk factors. This study was aimed at a comparison of diagnostic accuracy of spirometry and peak expiratory flow rate (PEFR) in asthma screening of adult patients with lung function abnormalities that present at the level of primary care. Methods: This study was conducted in Shymkent city, South Kazakhstan, the third most populous city of the country with developed industries and high rates of pulmonary diseases. Four hundred and ninety-five adult patients with lung function abnormalities were enrolled in the study and underwent two screening tests (spirometry and PEFR). The diagnosis of asthma was verified by a qualified pulmonologist after performance of screening tests and was based on symptoms, medical history, and laboratory and lung function tests. Results: The sensitivity of spirometry was 0.97 and that of PEFR was 0.95 (p = 0.721), whereas the specificity of spirometry was 0.37 and that of PEFR was 0.28 (p = 0.227). Both tests yielded the same results for the positive predictive value (0.98). The negative predictive value was significantly higher for spirometry versus PEFR (0.23 versus 0.08; p = 0.006). The positive and negative likelihood ratios of the two tests also differed significantly (p = 0.001 and p = 0.006, respectively), whereas the overall accuracy was comparable between the two tests (0.96 for spirometry and 0.94 for PEFR; p = 0.748). Conclusion: Ambulatory PEFR monitoring is non-inferior to the monitoring of the forced expiratory volume in 1 second and could be used for screening purposes on equal grounds with spirometry.

Enhancing nursing documentation in Kazakhstan: assessing utilization and standardization for improving patient care.

Background and aim: This article stresses the importance of comprehensive nursing documentation in scientific medicine and discusses the adoption of standardized terminologies in Europe. The study also presents findings from a cross-sectional study conducted in Kazakhstan, assessing the utilization of standard operating procedures and nursing documentation in various clinical scenarios. The aim was evaluate the level of use of the form of nursing documentation and Standard Operating Procedure within the framework of reforming the Republic of Kazakhstan. Materials and methods: During the period from December 2021 to February 2022, a cross-sectional study was conducted in Kazakhstan, involving a randomly selected sample of nurses with technical and vocational education as well as those with applied/academic baccalaureate degrees in nursing. Results: In this cross-sectional study of 2,263 female nurses, 75.3% were nurse practitioners, and 44% held the highest qualification category. Awareness levels varied, with around 64.7% aware of the pilot program for care services, 65.8% aware of the deputy head position, and 73.8% familiar with the "extended practice nurse" role. Only 55.2% knew about the International Clinical Nursing Classification, and 54.5% observed changes in their nursing approach due to education. The limb edema measurement checklist was not used by the majority (88.4%) of respondents, and 68% did not utilize the antibiotic susceptibility testing checklist. Various other checklists and algorithms had limited utilization, with percentages ranging from 9.1 to 69.3%, indicating varying levels of adoption among participants. For assisting children with cerebral palsy, the "Assessment of hand use capacity according to the MACS classification system" was utilized by 9.1%, while 90.9% did not employ it. In the context of communication, 30.7% of the respondents utilized the "Algorithm of actions of a medical registrar when communicating with a patient," while 69.3% did not use it. These findings highlight variable adoption rates among participants for these medical procedures and protocols. Conclusion: In Kazakhstan, nursing documentation forms and Standard Operating Procedures face challenges and limited utilization, but their implementation has shown positive impacts on patient care and healthcare outcomes. Overcoming resistance to change, increasing awareness, and addressing resource constraints are essential for further improvement.

Molecular Aspects of Allergen-Specific Immunotherapy in Patients with Seasonal Allergic Rhinitis.

A systematic review and narrative synthesis of publications was undertaken to analyze the role of component-resolved diagnosis technology in identifying polysensitization for the provision of allergen-specific immunotherapy to patients with seasonal allergic rhinitis. A search of publications was carried out in electronic databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search helped to identify 568 publications, 12 of which were included in this review. Overall, 3302 patients were enrolled. The major finding was that component-resolved diagnostics change the choice of relevant allergens for allergen-specific immunotherapy in at least 50% of cases. Sensitization to allergen components differs with age, type of disease, and overall disease duration. Patients who had both bronchial asthma and allergic rhinitis were sensitized to a larger number of allergens than patients who had bronchial asthma alone.

Epidemiology of cerebral palsy in the Republic of Kazakhstan: Incidence and risk factors.

Background: There is a paucity of robust data on the incidence and causes of cerebral palsy (CP) in Central Asian countries, while this information is important for planning local healthcare services. This epidemiological study was designed to clear the gap in knowledge on both the incidence of CP and the underlying risk factors in the Republic of Kazakhstan. Methods: This was a retrospective study that comprised two stages. At the first stage, a cross-sectional analysis of CP frequencies was performed on the basis of official statistics obtained from the Republican Center for Health Development. A study with age- and sex-matched controls was carried out at the second stage to elucidate the maternal and neonatal risk factors associated with CP. Results: Mild variability in national CP incidence was observed, ranging from 68.7 to 83.3 per 100,000 population. A number of maternal risk factors were significantly associated with CP, including arterial hypertension, thrombocytopenia, diabetes mellitus, pathology of fetal membranes, premature rupture of membranes, and acute respiratory illness during pregnancy. Low Apgar score, gestational age, birth weight, and presence of intraventricular hemorrhage or periventricular leukomalacia were among the important neonatal risk factors. Conclusion: There is a need for a more comprehensive prospective study to document the extent of the CP problem in Kazakhstan. In addition, a national CP registry must be envisaged to overcome the lack of essential data.

Post-conflict acute stress reactions in Kazakhstan in the aftermath of January 2022 unrests: A national survey.

Background: In January 2022 Kazakhstan experienced unprecedented nationwide protests that quickly turned to violent riots. Although the number of individuals affected physically by the disturbances were cited, the emotional toll of the events remains undetermined. The aim of this study was to evaluate the comparative rates of acute stress reactions in Kazakhstan in the aftermath of the unrests. Methods: A cross-sectional, population-based online survey was conducted one month after the start of the disturbances. The study questionnaire were completed anonymously and included the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and the General Anxiety Disorder-7 (GAD-7), as well as socio-demographic and event exposure information. Results: Of the 7021 people who initially agreed to participate, 6510 were able to complete the full survey. For a cut-off of ≥3 on the PC-PTSD-5, 14.8 % of the study participants exhibited symptoms. With a cut-off of ≥4, this percentage reduced to 4.6 %. Participants from Almaty city and Almaty region who experienced the most extensive disturbances showed a doubled prevalence compared to the national level (30.0 % for a cut-off of ≥3, and 10.1 % for a cut-off of ≥4). At the national level, the prevalence of anxiety symptoms, defined as a score of ≥10 on the GAD-7, stood at 10.9 %. This prevalence decreased to 4.2 % when considering a cut-off of ≥15. Conclusion: Health authorities of riot-affected areas ought to be aware of the population level mental health impact of the civil conflict and consider provision of targeted interventions to mitigate the long-term consequence of these lifespan disorders, while also seeking for the peaceful resolution of the ensuing conflicts.

Early integration of palliative care into oncological care: a focus on patient-important outcomes.

BACKGROUND: Globally, cancer remains one of the leading causes of mortality. Palliative care is designed to meet a range of cancer patients' priority issues, including the management of pain and other cancer-associated symptoms. Routine palliative care envisages the provision of not just medical therapy, but also psychological support, social support and spiritual assistance. What constitutes the best model for palliative care remains a matter of debate. AIM: This review was undertaken with the aim to discuss different aspects of early integration of palliative care into oncological care, with a focus on patient-important outcomes. METHODS: A comprehensive search of publications was conducted with a focus on integrative palliative care for incurable cancer patients. For this purpose, the following databases and search engines were used: Scopus, PubMed, Cochrane Library, Research Gate, Google Scholar, eLIBRARY and Cyberleninka. RESULTS: A comprehensive approach with early integration of different medical services appears to be the most promising. Integrative palliative care is best provided via specialised interdisciplinary teams, given that all members maintain systemic communications and regularly exchange information. This model ensures that timely and adequate interventions are provided to address the needs of patients. CONCLUSION: Further research is needed to pinpoint the most optimal strategies to deliver palliative care and make it as tailored to the patient's demands as possible.