Cervical cancer trend in the Republic of Kazakhstan and attitudes towards cervical cancer screening in urban and rural areas.

Cervical cancer (CC) continues to be a significant global health issue, which in part can be attributed to disparities in access to CC screening services. This study aims to conduct a trend of CC in Kazakhstan and to compare attitudes towards the screening program between women living in urban and rural areas. In the first stage, we conducted a trend study of CC indicators in Kazakhstan using official statistics. In the second stage, a cross-sectional study was conducted using a structured questionnaire to assess adherence to screening. The trend study reveals a decline in cervical cancer mortality rates (from 7.15 to 5.93 per 100,000 female inhabitants) over the period studied, while the incidence remains stable (from 18.51 to 19.38 per 100,000 female inhabitants). Regional variations in Period Prevalence rates were observed. Significant differences were found in screening participation rates between urban n = 41 (74%) and rural n = 23 (38%) women, p < 0.001, as well as awareness of the screening program (urban: n = 15 (27%), rural: n = 35 (58%), p < 0.001). The trend study highlights a decrease in cervical cancer mortality rates over the specified period, accompanied by a consistent incidence rate. Additionally, regional disparities in period prevalence rates of cervical cancer were observed. The primary factor contributing to the low adherence of rural women to screening was found to be a lack of awareness regarding the screening program. Therefore, increasing awareness about the importance of screening is crucial for improving adherence rates among rural women in Kazakhstan.

Knowledge, Attitudes, and Practices of Sun Exposure and Sun Protection among the Population of Kazakhstan: A Cross Sectional Study.

OBJECTIVE: The aims of this study were to assess knowledge, attitudes, and practices regarding sun exposure and sun protection among the population of Kazakhstan. METHOD: A cross sectional study was conducted by administering an online questionnaire via social networking sites to residents of Kazakhstan. The questionnaire was designed to determine demographic information as well as knowledge, attitudes and practices regarding sun exposure and sun protection. RESULT: The responses of 249 participants were analysed.  Descriptive tests, bivariate analyses, and multiple linear regression were used to statistically analyse the data. The mean age of the participants was 31.7 ± 11.5 (SD) years. Most participants were of Kazakh nationality (88.7%), female (71.0 %), urban residents (93.9 %), and possessed higher education degrees (88.0 %). The level of knowledge and attitudes were found to be moderate amongst the population whilst practices were determined to be low.  Knowledge (p=0.002), attitudes (p=0.002), female gender (p=0.002), and having children educated in school about sun safety (p=0.018) were significantly associated with improved sun-protective practices. CONCLUSION: This study has demonstrated low adoption of sun protective practices in the Kazakhstan population, despite the identification of certain characteristics associated with higher rates of practice.

Liver Cancer Incidence in Kazakhstan: Fifteen-Year Retrospective Study.

OBJECTIVE: The aim is to study the trends of liver cancer (LC) incidence in the regional context in Kazakhstan. METHODS: The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. RESULTS: Between 2005 and 2019, 13,510 cases of LC were documented, comprising 59.3% males and 40.7% females. Most diagnoses were seen in age groups 55-59 years (13.3%) to 75-79 years (11.7%). LC patients' average age increased from 63.6 to 64.5 years. Incidence rates per 100,000 peaked at ages 65-69 years (35.1±1.0) and 70-74 years (43.3±1.0). LC incidence notably rose in the 70-74 years age group (APC=+0.89), contrasting with declining trends in younger age groups. Regional incidence variations revealed diverse patterns, mostly demonstrating unimodal increases, and some regions displaying bimodal growth. The age-standardized incidence rate was 5.7±0.1 per 100,000, declining from 2005 to 2012 (APC: -3.93), then rising until 2019 (APC: +1.13). Gender-specific standardized rates showed varied trends. Analyses of standardized indicators indicated declining trends in most regions but increased values in specific areas. Thematic maps classified incidence rates based on standardized indicators: low (up to 5.22), average (5.22 to 7.11), high (above 7.11 per 100,000 for the entire population). CONCLUSION: The study on liver cancer in Kazakhstan reveals marked gender and age differences. The standardized incidence rate among men was twofold greater than that among women. A distinct rise in cases was noted among individuals aged 70-74 years. Regional variations in incidence were evident. These findings emphasize the necessity for focused research to comprehend the causes behind these differences, enabling customized interventions for Kazakhstan's population.

Classification of buckwheat honey produced in Kazakhstan according to their biochemical ingredients and bioactivities by chemometric approach.

Herein, nineteen buckwheat honey samples collected from 19 stations of different ecological zones of Kazakhstan were analysed for their pollen density, physicochemical properties, chemical composition, antioxidant, anticholinesterase, tyrosinase inhibitory, and urease inhibitory activities with chemometric approaches. Twelve phenolic compounds and fumaric acid were identified using HPLC-DAD, and mainly fumaric, p-hydroxybenzoic, p-coumaric, trans-2-hydroxy cinnamic acids, and chrysin were detected in all samples. The honey samples collected from the Northern zone exhibited best antioxidant activity in lipid peroxidation inhibitory (IC50:8.65 ± 0.50 mg/mL), DPPH• (IC50:17.07 ± 1.49 mg/mL), ABTS•+ (IC50:8.90 ± 0.65 mg/mL), CUPRAC (A0.50:7.51 ± 0.30 mg/mL) and metal chelating assay (IC50:10.39 ± 0.71 mg/mL). In contrast, South-eastern zone samples indicated better acetylcholinesterase (55.57 ± 0.83%), butyrylcholinesterase (49.59 ± 1.09%), tyrosinase (44.40 ± 1.21%), and moderate urease (24.57 ± 0.33%) inhibitory activities at 20 mg/mL. The chemometric classification of nineteen buckwheat honey was performed using PCA and HCA techniques. Both were supported by correlation analysis. Thirteen compounds contributed significantly to the clustering of buckwheat honey based on geographical origin.

ANALYSIS OF ANTIDIABETIC THERAPY FOR TYPE 2 DIABETES IN PRIMARY HEALTH CARE (WESTERN KAZAKHSTAN).

Diabetes Mellitus Type 2 (T2D) represents a significant global health challenge, with increasing prevalence and the need for effective management strategies. Despite the widespread nature of the disease, there is disagreement regarding the optimal glycemic targets for patients with Type 2 diabetes. The American Diabetes Association recommends aiming for an HbA1C level of less than 7% (53 mmol/mol). About 50% of diabetes patients do not meet their glycemic targets, leading to an increased risk of chronic complications associated with diabetes. Although lifestyle modifications are crucial for prevention and management, most T2D patients eventually need pharmacotherapy to maintain control over their blood glucose levels. In Western Kazakhstan, a study was conducted to evaluate the efficacy of antidiabetic therapy in primary healthcare settings. Aim - to assess the proportion of patients with uncontrolled glycemia among adult patients with T2D, and to analyze antidiabetic therapy in the primary health care (Western Kazakhstan). The cross-sectional study involved 96 participants, divided into two groups based on their HbA1c levels: 32 patients with an HbA1c <7%; 64 patients with an HbA1c >7%. In the study 58 patients (60,6%) were female and 38 patients (39,4%) were male. Data analysis was performed using IBM SPSS 26 and GraphPad, employing Kolmogorov-Smirnov and Shapiro-Wilk tests for distribution, medians and interquartile ranges for non-normal variables, Chi-squared and Fisher's Exact tests for nominal variables, and representation of nominal data in absolute and percentage values. The study found that 66.67±5.89% of participants had unsatisfactory glycemic control at enrollment, with only 33.33±8.33% achieving the desired HbA1c level of <7% (p<=0.005; t=3.26). Statistical analysis showed a significant association between higher glucose levels and the type of therapy, with insulin therapy more common in patients with glucose levels >7 (χ²=5.500, df = 1, p <0.05) and a similar correlation with SGLT-2 inhibitors (Fisher's Exact Test, p<0.01). Analysis of the data collected from urban polyclinics in Aktobe highlighted a troubling fact: two-thirds of the participants (66.67%) had unsatisfactory glycemic control. This is considerably lower than the 45% to 60% control rates reported internationally, indicating an area for significant improvement in the regional management of T2D. The study underscores the importance of a tailored therapeutic approach, balancing drug efficacy, patient response, and individual healthcare needs. Higher variability and blood sugar peaks were observed in patients with HbA1c levels above 7%. In the Western region of Kazakhstan, metformin was the most commonly prescribed antidiabetic drug, consistent with its first-line therapy status. Patients with HbA1c >7% were more likely to receive insulin therapy and SGLT-2 inhibitors, indicating their role in more intensive treatment strategies. Less use of incretins and sulfonylureas was noted among patients with HbA1c <7%, possibly due to their efficacy, safety profiles, or availability of newer alternatives. The findings call for enhanced strategies to improve diabetes management and increase the percentage of patients achieving their glycemic targets, aiming for a more personalized, patient-centered care model in Kazakhstan and potentially similar healthcare settings.

ANALYSIS OF RISK FACTORS FOR ISCHEMIC STROKE IN RURAL RESIDENTS OF THE AKTOBE REGION.

Stroke continues to be a major global health concern, accounting for the fifth highest death rate and a sizable portion of the world's disability burden. Over 40,000 stroke cases are reported annually in the Republic of Kazakhstan, of which 5,000 people die within the first 10 days and an additional 5,000 within a month after discharge. Even with the establishment of regional stroke centers, a state anti-stroke program, and substantial efforts, rural communities still experience higher rates of stroke-related morbidity and mortality. The purpose of this research is to examine the complex factors, such as disparities in emergency care and elevated risk factors, that contribute to the variation in the incidence of stroke between rural and urban areas. Rural inhabitants' lesser knowledge of stroke symptoms is a result of educational and socioeconomic differences, which causes systemic delays in care. Just 1% of rural residents live within 60 minutes of a primary stroke center, indicating a lack of access to specialized stroke care. In terms of intravenous thrombolysis performed, urban hospitals perform better than rural ones. The study shows that the mean age of the patients is 62.2±11.9 years, confirming the presence of an average age in the group. Women make up 40.2%, men - 59.8%. An average BMI of 27.6±4.5 may indicate a predominance of excess weight. The NIHSS score decreases from admission (7.64±4.85) to discharge (5.98±6.02), which may indicate a positive effect of treatment. A decrease in MRS reflects improvement in disability after treatment. Analyzing the dependence on place of residence, it was revealed that the largest number of patients came from districts 5 and 10. Analyzing the NIHSS and MRS indicators, statistically significant differences were identified depending on the presence of diabetes, arrhythmia and atherosclerosis. The rate of stroke severity and disability on admission is significantly higher in patients who die. A model for predicting unfavorable outcome was developed, which showed the statistical significance of the factors of cardiac arrhythmia and NLR.

Pulmonary tuberculosis epidemiology and genetics in Kazakhstan.

Background: Tuberculosis (TB) is a major public health emergency in many countries, including Kazakhstan. Despite the decline in the incidence rate and having one of the highest treatment effectiveness in the world, the incidence rate of TB remains high in Kazakhstan. Social and environmental factors along with host genetics contribute to pulmonary tuberculosis (PTB) incidence. Due to the high incidence rate of TB in Kazakhstan, our research aimed to study the epidemiology and genetics of PTB in Kazakhstan. Materials and methods: 1,555 participants were recruited to the case-control study. The epidemiology data was taken during an interview. Polymorphisms of selected genes were determined by real-time PCR using pre-designed TaqMan probes. Results: Epidemiological risk factors like diabetes (χ2 = 57.71, p < 0.001), unemployment (χ2 = 81.1, p < 0.001), and underweight-ranged BMI (<18.49, χ2 = 206.39, p < 0.001) were significantly associated with PTB. VDR FokI (rs2228570) and VDR BsmI (rs1544410) polymorphisms were associated with an increased risk of PTB. A/A genotype of the TLR8 gene (rs3764880) showed a significant association with an increased risk of PTB in Asians and Asian males. The G allele of the rs2278589 polymorphism of the MARCO gene increases PTB susceptibility in Asians and Asian females. VDR BsmI (rs1544410) polymorphism was significantly associated with PTB in Asian females. A significant association between VDR ApaI polymorphism and PTB susceptibility in the Caucasian population of Kazakhstan was found. Conclusion: This is the first study that evaluated the epidemiology and genetics of PTB in Kazakhstan on a relatively large cohort. Social and environmental risk factors play a crucial role in TB incidence in Kazakhstan. Underweight BMI (<18.49 kg/m2), diabetes, and unemployment showed a statistically significant association with PTB in our study group. FokI (rs2228570) and BsmI (rs1544410) polymorphisms of the VDR gene can be used as possible biomarkers of PTB in Asian males. rs2278589 polymorphism of the MARCO gene may act as a potential biomarker of PTB in Kazakhs. BsmI polymorphism of the VDR gene and rs2278589 polymorphism of the MARCO gene can be used as possible biomarkers of PTB risk in Asian females as well as VDR ApaI polymorphism in Caucasians.

Improving the level of water quality and plant species diversity in the reservoir accumulating natural effluents from the reclaimed uranium-containing industrial waste dump.

Due to the need to achieve the principles of sustainable development and to understand the processes of formation of phytocenoses in areas that were adversely affected by the industrial impact, this study assessed the condition of the Grachevsky uranium mine (Kazakhstan), which underwent conservation procedures about 25 years ago. The purpose is to determine the level of water quality and phytocenosis of the shores of the reservoir accumulating natural effluents from reclaimed dumps and anthropogenic sites of a uranium mine, as well as quality indicators and toxicology. The assessment included a qualitative research method (analysis of documents) to determine agro-climatic conditions and empirical methods of collecting information. The authors studied the intensity of ionizing radiation of the gamma background of the water surface of the reservoir (and sections of the shoreline and territories adjacent to the reservoir), and hydrochemical parameters of the waters of the reservoir, and performed a description of the botanical diversity. The vegetation cover of the sections of the reservoir shore is at different stages of syngenesis and is represented by pioneer groupings, group thicket communities, and diffuse communities. Favorable ecological conditions for the settlement and development of plants develop within the shores of the reservoir. The intensity levels of ionizing radiation do not exceed the maximum permissible levels and practically do not affect the formation of phytocenoses. An anthropogenically modified dry meadow with the participation of plants typical of the steppe zone has been formed on the floodplain terrace. Concerning the indicators of quality and toxicology of this reservoir, the water can be used for household and drinking purposes under the condition of prior water treatment. It can be concluded that a high level of natural purification of the reservoir waters occurred within twenty years after the reclamation of the uranium mine.

Examining a 12-year experience within Kazakhstan's national heart transplantation program.

Kazakhstan has one of the lowest heart transplantation (HTx) rates globally, but there are no studies evaluating the outcomes of HTx. This study aimed to provide a comprehensive analysis of the national HTx program over a 12-year period (2012-2023). Survival analysis of the national HTx cohort was conducted using life tables, Kaplan‒Meier curves, and Cox regression methods. Time series analysis was applied to analyze historical trends in HTx per million population (pmp) and to make future projections until 2030. The number of patients awaiting HTx in Kazakhstan was evaluated with a regional breakdown. The pmp rates of HTx ranged from 0.06 to 1.08, with no discernible increasing trend. Survival analysis revealed a rapid decrease in the first year after HTx, reaching 77.0% at 379 days, with an overall survival rate of 58.1% at the end of the follow-up period. Among the various factors analyzed, recipient blood levels of creatinine and total bilirubin before surgery, as well as the presence of infection or sepsis and the use of ECMO after surgery, were found to be significant contributors to the survival of HTx patients. There is a need for public health action to improve the HTx programme.

Genetic markers of cardiac autonomic neuropathy in the Kazakh population.

BACKGROUND: Cardiac autonomic neuropathy (CAN) is a complication of diabetes mellitus (DM) that increases the risk of morbidity and mortality by disrupting cardiac innervation. Recent evidence suggests that CAN may manifest even before the onset of DM, with prediabetes and metabolic syndrome potentially serving as precursors. This study aims to identify genetic markers associated with CAN development in the Kazakh population by investigating the SNPs of specific genes. MATERIALS AND METHODS: A case-control study involved 82 patients with CAN (cases) and 100 patients without CAN (controls). A total of 182 individuals of Kazakh nationality were enrolled from a hospital affiliated with the RSE "Medical Center Hospital of the President's Affairs Administration of the Republic of Kazakhstan". 7 SNPs of genes FTO, PPARG, SNCA, XRCC1, FLACC1/CASP8 were studied. Statistical analysis was performed using Chi-square methods, calculation of odds ratios (OR) with 95% confidence intervals (CI), and logistic regression in SPSS 26.0. RESULTS: Among the SNCA gene polymorphisms, rs2737029 was significantly associated with CAN, almost doubling the risk of CAN (OR 2.03(1.09-3.77), p = 0.03). However, no statistically significant association with CAN was detected with the rs2736990 of the SNCA gene (OR 1.00 CI (0.63-1.59), p = 0.99). rs12149832 of the FTO gene increased the risk of CAN threefold (OR 3.22(1.04-9.95), p = 0.04), while rs1801282 of the PPARG gene and rs13016963 of the FLACC1 gene increased the risk twofold (OR 2.56(1.19-5.49), p = 0.02) and (OR 2.34(1.00-5.46), p = 0.05) respectively. rs1108775 and rs1799782 of the XRCC1 gene were associated with reduced chances of developing CAN both before and after adjustment (OR 0.24, CI (0.09-0.68), p = 0.007, and OR 0.43, CI (0.22-0.84), p = 0.02, respectively). CONCLUSION: The study suggests that rs2737029 (SNCA gene), rs12149832 (FTO gene), rs1801282 (PPARG gene), and rs13016963 (FLACC1 gene) may be predisposing factors for CAN development. Additionally, SNPs rs1108775 and rs1799782 (XRCC1 gene) may confer resistance to CAN. Only one polymorphism rs2736990 of the SNCA gene was not associated with CAN.

Seeds of the Settler Colony: How Peasant and Kazakh Knowledge, Environment, and Bureaucracy Shaped Steppe Agronomy in the Late Russian Empire.

At the turn of the twentieth century, Russian imperial officials hoped to transform the Kazakh Steppe from a zone of pastoral nomadism into a zone of sedentary grain farms. They planned to accomplish this transformation by importing peasants from European Russia and settling them in the steppe along with advanced scientific agricultural practices, equipment, and infrastructure. It was a project that linked steppe settlement and the Russian Empire to a global story of settler colonialism, science, and technology in the first decades of the twentieth century. An examination of this project through the lens of the expansion of grain farming reveals that the changes it wrought were not solely due to European science and technology but were contingent, dependent on local knowledge, the vagaries of climate, and adaptation to the realities of the steppe environment.

Attitude toward vaccination against COVID-19 and acceptance of the national "QazVac" vaccine in the Aktobe city population, West Kazakhstan: A cross-sectional survey.

The scale of emergency caused by COVID-19, the ease of survey, and the crowdsourcing deployment guaranteed by the latest technology have allowed unprecedented access to data describing behavioral changes induced by the pandemic. The study aimed to present the survey results identifying attitudes toward vaccination against COVID-19 among the population of West Kazakhstan, the level of confidence in the national QazVac vaccine, and the role of different sources of information on COVID-19 in decision-making concerning vaccination. A computer-assisted survey was conducted using WhatsApp messenger. Overall, 2,009 participants responded, with a response rate of 92%. Most (83.1%) were immunized against COVID-19; among them, 20.1% obeyed the request of their employers that had been practiced within non-pharmaceutical interventions to contain the disease. The youngest respondents, individuals with a college education, students, and employed people, as well as those with chronic diseases, showed positive attitudes toward vaccination (all p<0.05). About two-thirds of respondents (69.2%) expressed trust in all types of vaccines against COVID-19. Of those who refused vaccination (16.9%), about one-third feared vaccination consequences, and more than a third (38.2%) reported anti-vaccine sentiments. The decisive factors in accepting vaccination were trust in official sources of information (reports of medical experts, etc.) and, mainly, subjectively interpreted sufficiency of information about the disease, which had increased the odds of being vaccinated by 63.9% (OR 1.71, 95% CI [1.3;2.26], p<0.05). Confidence in the domestic QazVac vaccine was expressed by 37.7% of respondents. History and severity of COVID-19 disease did not play a role in positive perceptions of vaccination, while illness after vaccination substantially affected vaccination approval (p 0.021). No significant differences have been observed regarding the overall performance across five vaccines (QazVac, Sputnik V, CoronaVac, Hayat-Vax, and BioNTech/Pfizer) available for Kazakhstan's population (p 0.27).

Mosses as bioindicators of air pollution with potentially toxic elements in the Burabay State National Natural Park, Kazakhstan.

The Burabay State National Natural Park is a national park of the great natural and historical values located in the north of Kazakhstan, which has been exposed in recent years to significant anthropogenic impact. The moss biomonitoring was performed in the Borovoye resort community, an important tourist destination in the national park, to identify the level of air pollution. Mosses collected at 29 locations were subjected to neutron activation analysis to determine 36 elements and additionally to ICP-OES to detect the level of Cu and Pb. Factor analysis was applied to check if there are any associations between identified elements and to link them with possible emission sources. According to contamination factor and pollution load indices the investigated area belongs to three classes of pollution: unpolluted, suspected and moderate. Potential ecological risk index calculated for selected elements revealed harmless risk to human health. The level of element obtained in Burabay State National Natural Park was compared with the data available for other national parks.

A severe case of Plasmodium falciparum malaria in a traveler returning from Kazakhstan, a malaria-free country.

Following a 2-week trip to Kazakhstan, a 42-year-old woman presented at the emergency department in Germany with fever, headache, nausea, and neurological symptoms. An infection with Plasmodium falciparum was rapidly diagnosed. The patient was immediately treated with intravenous artesunate and transferred to an intensive care unit. The initial parasite density was as high as 30% infected erythrocytes with 845,880 parasites/µL. Since Kazakhstan was declared malaria-free in 2012, molecular testing for Plasmodium has been initiated to identify a possible origin. Genotyping of the msp-1 gene and microsatellite markers showed that the parasites are of African origin, with two different alleles indicating a polyclonal infection. After a hospitalization of 10 days, the patient was discharged in good health. Overall, our results emphasize that malaria must be on the list of differential diagnoses for patients with fever of unknown origin, even if they come from countries where malaria does not commonly occur.

Psychological Approach in the Interpretation of 20th Century Kazakh Postmodern Literature.

The aim of the study is to analyse contemporary postmodern literary works of Kazakhstan through the conceptual prism of Freudian and Jungian psychoanalysis. To achieve research goals, the following methods were used: axiomatic, content analysis, and comparative. The results of the study determined that contemporary Kazakh writers characterise a large field of motives and ideas that are revealed through text, symbols, and characters. Strong tools for their interpretation were the psychological approaches of Freud and Jung, which are the standards of psychoanalysis and have their own specific features of semantic content. Content analysis of postmodern materials has established that Kazakh stories trace the motives of mythology, religion, relationships and inner spiritual development, which consider the mental differences of the heroes of the storylines. During the psychoanalysis of the works, it was emphasised that postmodernism in the literature of Kazakhstan reflects the rejection of absolute truths, blurring the boundaries between genres, playing with traditional forms and content. Many of the characters in the stories are experiencing an identity crisis, which has been analysed through the Freudian triad and Jung's archetypal images. Kazakh literature, being woven into the cultural and historical heritage of the nation, reflects the features of mentality, socio-cultural transformations, identity and spiritual quest of heroes.

The impact of incentive scheme on rural healthcare workforce availability: a case study of Kazakhstan.

BACKGROUND: During the 1990-2000, Kazakhstan experienced a decline in the number of healthcare professionals working in rural areas. Since 2009, the national government has been implementing financial incentives to encourage healthcare professionals to relocate to rural areas. This study aims to investigate the temporal and spatial patterns in the distribution of the rural healthcare workforce and evaluate the impact of this incentive scheme. METHODS: Interrupted Time Series Analysis using ARIMA models and Difference in Differences analyzes were conducted to examine the impact of the incentive scheme on the density of different categories of the healthcare workforce in rural Kazakhstan in the period from 2009 to 2020. RESULTS: There was a significant increase in the number of rural healthcare professionals from 2009 to 2020 in comparison to the period from 1998 to 2008. However, this increase was less pronounced in per capita terms. Moreover, a decline in the density of internists and pediatricians was observed. There is substantial variation in the density of rural nurses and physicians across different regions of Kazakhstan. The incentive scheme introduced in 2009 by the government of Kazakhstan included a one-time allowance and housing incentive. This scheme was found to have contributed insignificantly to the observed increase in the number of rural healthcare professionals. CONCLUSION: Future research should be undertaken to examine the impact made by the incentive scheme on other medical subspecialties, particularly primary practitioners. Addressing the shortage of healthcare workers in rural areas is a complex issue that requires a multifaceted approach. Aside from financial incentives, other policies could be considered to increase relocation and improve the retention of healthcare professionals in rural areas.

Medical and forensic aspects of performing a remote interrogation of persons with disabilities / Aspectos médicos y forenses de la realización de un interrogatorio a distancia a personas con discapacidad / Aspectos médicos e forenses da realização de um interrogatório remoto de pessoas com deficiências

The purpose of the study is to develop new proposals for improving criminal procedural legislation in the field of conducting remote investigative actions with disabled persons, taking into account their physiological and functional characteristics. Research material and methods: This study is based on an analysis of the norms regarding the criminal procedural legislation of the Republic of Kazakhstan and a number of foreign states that regulate the procedure for conducting remote investigative actions - as well as scientific publications on the research topic in the field of psychology and medicine. An integrated approach involves considering the studied phenomena of communication during an investigative action as a set of interconnected and interdependent elements, i.e., consideration of the issue from the medical, psychological and legal points of view. Situational and systemic types of analysis, complex sociological analysis, diagnostics and forecasting investigative situation were also used. Methods of analysis and synthesis, induction, deduction, methods of qualitative and quantitative analysis were employed to clarify the legal essence of the studied phenomenon. Findings: practical recommendations aimed at improving and developing the performance of remote investigative actions involving persons with disabilities (further ­ FWDs) y creating optimal conditions for the transfer of verbal, medical, and psychological information, as well as technical and forensic support for conducting RIAs. The following conclusions were made: in order to improve the current legislation, it is advisable to consider the issue of developing and including a special norm in the legislation, taking into account the characteristics of the communicative competencies of persons with disabilities. This norm regulates the procedure for conducting investigative actions involving the mute, deaf, blind and other persons with disabilities.

El objetivo del estudio es elaborar nuevas propuestas de mejora de la legislación procesal penal en el ámbito de la realización de actuaciones de investigación a distancia con personas con discapacidad, teniendo en cuenta sus características fisiológicas y funcionales. Material y métodos de investigación: Este estudio se basa en un análisis de las normas relativas a la legislación procesal penal de la República de Kazajstán y de una serie de Estados extranjeros que regulan el procedimiento para llevar a cabo acciones de investigación a distancia -, así como publicaciones científicas sobre el tema de investigación en el campo de la psicología y la medicina. Un enfoque integrado implica considerar los fenómenos estudiados de comunicación durante una acción de investigación como un conjunto de elementos interconectados e interdependientes, es decir, considerar la cuestión desde los puntos de vista médico, psicológico y jurídico. También se utilizaron los tipos de análisis situacional y sistémico, el análisis sociológico complejo, el diagnóstico y la previsión de la situación de investigación. Se emplearon métodos de análisis y síntesis, inducción, deducción, métodos de análisis cualitativo y cuantitativo para aclarar la esencia jurídica del fenómeno estudiado. Conclusiones: recomendaciones prácticas destinadas a mejorar y desarrollar la realización de acciones de investigación a distancia en las que participen personas con discapacidad (en adelante - RIA) y crear condiciones óptimas para la transferencia de información verbal, médica y psicológica, así como apoyo técnico y forense para la realización de las RIA. Se llegó a las siguientes conclusiones:con el fin de mejorar la legislación actual, es aconsejable considerar la cuestión de desarrollar e incluir una norma especial en la legislación, teniendo en cuenta las características de las competencias comunicativas de las personas con discapacidad. Esta norma regula el procedimiento para llevar a cabo acciones de investigación en las que estén implicadas personas mudas, sordas, ciegas y otras personas con discapacidad.

O objetivo do estudo é desenvolver novas propostas para aprimorar a legislação processual penal no campo da realização de ações investigativas remotas com pessoas com deficiência, levando em conta suas características fisiológicas e funcionais. Material e métodos de pesquisa: Este estudo baseia-se em uma análise das normas relativas à legislação processual penal da República do Cazaquistão e de vários países estrangeiros que regulamentam o procedimento para a realização de ações investigativas remotas, bem como em publicações científicas sobre o tópico de pesquisa no campo da psicologia e da medicina. Uma abordagem integrada envolve a consideração dos fenômenos estudados de comunicação durante uma ação investigativa como um conjunto de elementos interconectados e interdependentes, ou seja, a consideração da questão dos pontos de vista médico, psicológico e jurídico. Também foram usados tipos de análise situacional e sistêmica, análise sociológica complexa, diagnóstico e previsão da situação investigativa. Métodos de análise e síntese, indução, dedução, métodos de análise qualitativa e quantitativa foram empregados para esclarecer a essência legal do fenômeno estudado. Resultados: recomendações práticas com o objetivo de aprimorar e desenvolver o desempenho de ações investigativas remotas envolvendo pessoas com deficiência (mais adiante - FWDs), criando condições ideais para a transferência de informações verbais, médicas e psicológicas, bem como suporte técnico e forense para a realização de RIAs. Foram feitas as seguintes conclusões: para aprimorar a legislação atual, é aconselhável considerar a questão do desenvolvimento e da inclusão de uma norma especial na legislação, levando em conta as características das competências comunicativas das pessoas com deficiência. Essa norma regulamenta o procedimento para conduzir ações investigativas envolvendo pessoas mudas, surdas, cegas e outras pessoas com deficiência.

Evaluation of liver transplantation services in Kazakhstan from 2012 to 2023.

There is a scarcity of publications evaluating the performance of the national liver transplantation (LTx) program in Kazakhstan. Spanning from 2012 to 2023, it delves into historical trends in LTx surgeries, liver transplant centers, and the national cohort of patients awaiting LTx. Survival analysis for those awaiting LTx, using life tables and Kaplan-Meier, is complemented by time series analysis projecting developments until 2030. The overall per million population (pmp) LTx rate varied from 0.35 to 3.77, predominantly favoring living donor LTx. Liver transplant center rates ranged from 0.06 to 0.40. Of 474 LTx patients, 364 on the waiting list did not receive transplantation. The 30-day and 1-year survival rates on the waiting list were 87.0% and 68.0%, respectively. Viral hepatitis and cirrhosis prevalence steadily rose from 2015 to 2023, with projections indicating a persistent trend until 2030. Absent targeted interventions, stable pmp rates of LTx and liver transplant centers may exacerbate the backlog of unoperated patients. This study sheds light on critical aspects of the LTx landscape in Kazakhstan, emphasizing the urgency of strategic interventions to alleviate the burden on patients awaiting transplantation.

An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021.

Universal health coverage relies on providing essential medical services and shielding individuals from financial risks. Our study assesses the progressivity of out-of-pocket (OOP) payments, identifies factors contributing to healthcare expenditure inequality, and examines catastrophic health expenditures (CHE) prevalence in Kazakhstan from 2018 to 2021. Using retrospective analysis of National Statistics Bureau data, we employed STATA 13 version for calculations CHE incidence, progressivity, Lorenz and concentration curves. In 2020-2021, OOP expenditures in Kazakhstan decreased, reflecting a nearly twofold reduction in the CHE incidence to 1.32% and 1.24%, respectively. However, during these years, we observe a transition towards a positive trend in the Kakwani index to 0.003 and 0.005, respectively, which may be explained by household size and education level factors. Increased state financing and quarantine measures contributed to reduced OOP payments. Despite a low healthcare expenditure share in gross domestic product, Kazakhstan exhibits a relatively high private healthcare spending proportion. The low CHE incidence and proportional expenditure system suggest private payments do not significantly impact financial resilience, prompting considerations about the role of government funding and social health insurance in the financing structure.