"The habit of keeping silent": An exploratory-descriptive qualitative study of the knowledge and attitudes of Kazakhstani gynecologists toward dyspareunia.

BACKGROUND: Dyspareunia (pain during sex) is a common condition that causes physical and emotional stress for many women. This condition can be caused by various factors, including physical, hormonal, inflammatory, viral, neoplastic, psychological, and traumatic events. Anatomical causes include pelvic floor muscular weakness, uterine retroversion, hymenal remnants, and pelvic organ prolapse. The etiology of this condition is complex, causing it to be often overlooked. OBJECTIVES: The main aim of this study was to conduct a qualitative exploratory study and provide a comprehensive description of the knowledge and attitudes held by gynecologists in Kazakhstan on the medical validity, diagnosis, and treatment of dyspareunia. DESIGN: This is an exploratory-descriptive qualitative study. METHODS: Semi-structured online interviews were conducted with 10 physicians. They were identified as obstetrics and gynecology specialists, gynecologic oncologists, and outpatient gynecologists. The average number of years spent practicing their specialty is 15.7, with the shortest being 4 years and the longest being 35 years. All the participants are female. Braun and Clarke's six-stage, step-by-step methodology was used for the thematic analysis. RESULTS: Findings suggest that gynecologists in Kazakhstan have knowledge of the most common causes of dyspareunia, although they still often attribute women's distress to psychological rather than physical factors. It was found that due to stigma and mutual embarrassment open dialogue about sexual health was lacking between patients and physicians. In addition, gynecologists describe difficulties discussing symptoms and performing intimate examinations due to time constraints and a lack of privacy at state facilities. CONCLUSION: To knowledgeably diagnose and treat patients with dyspareunia, gynecologists recommend further training to acquire the requisite evidence-based knowledge and competencies.

An Exploratory-Descriptive Qualitative Study of Kazakhstani Gynecologists' Knowledge and Attitudes Toward DyspareuniaBackground: Dyspareunia (pain during sex) is a common condition that causes physical and emotional distress in many women. Biological and psychological factors contribute to the onset of this condition, making diagnosis and management difficult for physicians. This painful condition can have a significant impact on women's physical, emotional, and psychological well-being, as well as their close relationships. Why was the study conducted? A thorough understanding of dyspareunia's causes, risk factors, and treatment techniques is required for effective management of the condition, but little research has been conducted in Kazakhstan on gynecologists' understanding of and attitudes toward dyspareunia. What did the researchers do? A qualitative study used online semi-structured interviews with gynecologists in Kazakhstan. What did the researchers find? The findings show that participating gynecologists are aware of the most common causes of dyspareunia, although they frequently attribute the condition to psychological rather than physical causes. It was found that due to stigma and mutual embarrassment, patients and participants did not engage in open discourse about sexual health. Furthermore, gynecologists have difficulty initiating discussions about women's sexual health and performing intimate examinations due to consultation time restrictions and a lack of privacy at state facilities. What do the researchers conclude? Additional training is recommended to gain the necessary evidence-based knowledge and competencies to accurately diagnose and treat patients with dyspareunia, and to address the lack of treatment protocols for dyspareunia in Kazakhstan, clinical guidelines published worldwide, including those issued by the American College of Obstetricians and Gynaecologists, may be considered for use in Kazakhstan.

Number of palliative care nurse home visits and duration of palliative care associated with domains of the Good Death Inventory: A national survey of bereaved family caregivers in a middle income country.

Background: In the lower-middle-income country of Kazakhstan, palliative care services are in the early stages of integration into healthcare services. No prior studies have investigated associations between palliative care service factors and a good death in lower-middle-income countries, nor explored how palliative care nurses contribute to a good death. In this paper, a good death is referred to as the control of pain and symptoms, clear decision-making, a sense of closure, being recognized and perceived as an individual, preparation for death, and still being able to contribute to others, all taken together. Objectives: To identify new opportunities for palliative care service nurses by investigating associations between palliative care service factors and a good death, as measured by the Good Death Inventory. Methods: Family caretakers of deceased patients from palliative care units and hospices were surveyed across six different regions of Kazakhstan. Data collected included demographics for patients and caregivers, palliative care service data, and Good Death Inventory items. Poisson regression analysis with r variance and linear regressions were conducted to identify determinants for achieving a Good Death and for the 18 Good Death Inventory domains. Results: Two hundred and eleven family caregivers participated in the survey. Bivariate analysis revealed five statistically significant associations (p ≤ 0.05) with the outcome of a good death. In multivariate linear regression analyses, a palliative care duration of greater-than-6-months, compared to less-than-1-month, was associated with improvements in 10 out of 18 domains of the Good Death Inventory (p ≤ 0.05). More-than-once-weekly palliative care home visits by nurses, compared to no visits, were also associated with improvements in four domains (p ≤ 0.05). Conclusion: We provide new directions for improvements in palliative care services in low-middle-income countries, giving impetus for resource allocation to palliative care home visits by nurses for achieving a good death for greater numbers of patients.

Mental Health Changes in Healthcare Workers During COVID-19 Pandemic: A Systematic Review of Longitudinal Studies.

This study provides an overview of research findings on long-term effects on healthcare workers mental health and factors associated with positive or negative changes. Medline and PubMed databases were searched for observational longitudinal studies and 18 papers were included in the review (PROSPERO: CRD42021260307). 12 articles indicated negative changes over time and six studies revealed a positive trend in a variety of mental health outcomes (anxiety, depression, insomnia, and others). Female sex, younger age, nursing occupation, frontline work, longer working hours and concerns about contracting COVID-19 were identified to be associated with negative changes. Conversely, a supportive environment, access to psychological resources, provision of sufficient personal protective equipment and availability of COVID-19 tests were linked to positive changes. Therefore, our findings can assist governmental and institutional authorities with effective interventions to improve psychological care for healthcare workers.

"Who Else If Not Us": An Exploratory-Descriptive Qualitative Study of Kazakhstani Frontline Professionals' Experience and Perceptions During the Coronavirus Disease 2019 Pandemic.

Little is known about the experiences of frontline professionals in Kazakhstan. Although studies of frontline workers have been conducted worldwide, it is imperative that caution should be exercised when extrapolating findings from disparate societies and generalizing them to Central Asian countries. As such, the purpose of this study was to explore and describe the firsthand experiences, perceptions, and knowledge gained from the experience of Kazakh frontline physicians and nurses during the COVID-19 pandemic. An exploratory-descriptive qualitative (EDQ) study was conducted over the course of a year in COVID-19 hospitals in Kazakhstan, with physicians (n = 23) and nurses (n = 7). Each participant was interviewed three times between May 2021 and May 2022. Braun and Clarke's six-step method was used for the thematic analysis. Three overarching themes and subthemes were identified: (1) Longitudinal Journey ("Nobody knew, nobody understood, nobody was ready"; "It's just life"); (2) Facets of Professionalism ("In my lifetime this is something unique"; "Who else if not us"; "We survived the war and the enemy"); and (3) Facets of Resilience ("God's providence"; "A good word heals too"). In light of the lack of research that has previously been conducted in Kazakhstan, the results of this study offer important new insight into the experiences of medical professionals during the COVID-19 epidemic.

Factors Influencing on Pain in Patients Undergoing Pipelle Endometrial Biopsy for Abnormal Uterine Bleeding: Why a Personalized Approach Should Be Applied?

Objectives. Abnormal uterine bleeding (AUB) is a common complaint of women in different age groups, and endometrial biopsy is widely used to investigate the underlying causes. The aim of this observational study was to assess factors influencing pain in patients undergoing endometrial biopsy for AUB. Methods. Pain intensity before, during, and after Pipelle sampling was evaluated using the numerical rating scale (NRS), where "0" represents no pain at all, "10"­the worst pain ever possible. Pain rating was categorized as 1−6­mild to moderate, 7 and above as severe pain. Results. The study included 160 women who underwent Pipelle biopsy. The median age in the cohort was 42 (34−48) years, 18.1% of women were postmenopausal, 56.3% were either overweight or obese, 30% were nulliparous and 80% reported urban residency. The median pain score during the procedure was 2 (0−4). Pain scores of 5 (4−7) were reported with the junior gynecologist and 2 (0−4) in the senior gynecologist (p < 0.0001). Conclusion. The pain was found to have a strong association with the type of provider performing the endometrial sampling procedure. This fact suggests the need for a personalized approach and that psychological or informational interventions should be scheduled before the procedure to decrease pain and increase satisfaction.

Pipelle endometrial biopsy for abnormal uterine bleeding: do patient's pain and anxiety really impact on sampling success rate?

BACKGROUND: Pipelle endometrial biopsy is vital for the early diagnostics of endometrial pathology and is performed in outpatient setting in minimally invasive manner. One of the reported disadvantages of sampling with Pipelle curette is failure to collect enough tissue for histological analysis. The role of psychological factors such as anxiety and pain sensitivity in obtaining adequate samples is not well known. The study's objective was to explore whether there is relationship between severe pain, anxiety, and the rate of Pipelle failure. METHODS: Study included 158 women with median age of 42 who underwent Pipelle endometrial biopsy at Clinical Academic Department of Women's Health of the University Medical Center (UMC), Nur-Sultan City, Kazakhstan with an abnormal uterine bleeding from June 2019 to April 2021. Women were asked to fill survey on pain, anxiety before, during and after the procedure. RESULTS: 3.8%, 15.19% and 4.43% of women reported severe pain and 39.24%, 34.18% and 14.56% of women reported severe anxiety prior, during and after procedure, respectively. Women who experienced severe pain during procedure tend to be more anxious during procedure (p = 0.0001) and have higher number of sampling attempts (p = 0.0040). Pain level was higher among patients sampled by the junior OB/GYN specialist (p < 0.0001). We found no differences in Pipelle biopsy success rates in relationship to baseline, during and postprocedural pain and anxiety scores. CONCLUSION: Anxiety during procedure performance was significantly associated with severe pain during the procedure but did not represent a key element for the success of Pipelle biopsy.

"Chasing hope": Parents' perspectives on complementary and alternative interventions for children with autism in Kazakhstan.

LAY ABSTRACT: The article reports the findings of a qualitative research study on how and why parents of autistic children in Kazakhstan utilize complementary and alternative medicine. We found that parents turn to complementary and alternative medicine because of the lack of professional care options available to them and in pursuit for hope and opportunities for their children with ASD.

Patients with COPD tell their stories about living with the long-term condition: an innovative and powerful way to impact primary health care professionals' attitudes and behaviour?

BACKGROUND: Sub-optimal adoption of evidence based practice by primary health care professionals (PHCPs) is affecting the health of people with chronic obstructive pulmonary disease (COPD). This paper shows how 'patient stories' were used to engineer professional and organisational change. METHODS: 'Stories' were transmitted via a pre-planned question and answer session involving patients and carers. The impact on PHCPs' attitudes and behaviour was explored through observing the session, open-text questionnaires completed by the PHCPs at the end of the session and clinician interviews. FINDINGS: The stories about living with COPD, told by patients and their carers, were found to be an innovative and powerful way to impact PHCPs' attitude and behaviour. Strong motivational context was created, in which clinicians were able to see the relevance of learning through active engagement with real people. CONCLUSION: Long term conditions such as COPD have long term implications for the daily lives of patients and their carers. Hearing about these consequences in 'the first person' is an influential training tool with a powerful impact on PHCPs' attitudes and behaviour.

Working with primary care clinicians and patients to introduce strategies for increasing referrals for pulmonary rehabilitation.

BACKGROUND: Pulmonary rehabilitation (PR), a programme of exercise, education and psycho-social support, is recommended for patients with chronic obstructive pulmonary disease but referral rates are relatively low compared with need. AIM: Working with primary care clinicians (GPs and practice nurses) from eight practices, this project developed strategies for influencing clinician and patient behaviours as a means of increasing referral rates for PR. METHODS: A participatory action research design was employed. Semi-structured questionnaires captured clinicians' baseline knowledge of PR and their ideas for increasing referrals. Actionable changes were then recommended. Audits (at baseline, mid-point and end of project) were used to assess and initiate improvements in the quality of practice data about PR referrals. The impacts of these changes were explored via further clinician surveys (free text questionnaire). Semi-structured questionnaires, posted to patients eligible for PR, assessed their characteristics, and, where applicable, their views on PR referral processes and reasons for not wanting PR. FINDINGS: The baseline survey of clinicians (n=22) revealed inadequate knowledge about PR, particularly among GPs. Actionable changes recommended included in-house education sessions, changes to practice protocols, and 'pop-ups' and memory aids (mugs and coasters) to prompt clinician/patient discussions about PR. Audit findings resulted in changes to improve the quality and availability of coded information about patients eligible for PR. These changes, supported by clinicians (n=9) in the follow-up survey, aimed to facilitate and increase the quality of patient/clinician discussions about PR. Findings from the patient survey (n=126, response rate 25.7%) indicate that such changes will increase the uptake of PR as patients who accepted a referral for PR provided more positive feedback about their discussions with clinicians. CONCLUSIONS: The strategies introduced were relatively easy to implement and the anticipated advantage is more patients accessing the health and quality of life benefits that PR offers.