Association of problem gambling with psychosocial characteristics among undergraduate students in Astana, Kazakhstan

Background. The prevalence of probable pathological gamblers among college students worldwide doubled in 15 years. While gambling addiction causes financial and social losses, there is lack of studies on gambling involvement in Kazakhstan. Aims. The current research aims to find the prevalence of gambling, explore the link with sociodemographic and psychological variables among college and university students is Astana, Kazakhstan. The study also aims to evaluate the association between gambling and school satisfaction, which was not reported before. Methods. The analysis included questionnaires of 399 students from three universities and three colleges in Astana, using random sampling. The survey consisted of demographic questions, and scales on anxiety and depression, alcohol use, school satisfaction, family cohesion and suicide ideation. Results. From 399 questionnaires analyzed, 5.76% were classified as pathological gamblers according to the gambling scale used. The most popular gambling type was betting on sport events with bookmakers. 12.4% reported placing a bet through bookmakers at present time, and of them 91.5% were male, around half (46.8%) were categorized as some-problem gamblers, and one-third (36.1%) as pathological gamblers. Two-third of them (66%) did not reach legal age for gambling. Pathological gamblers in comparison with non-gamblers/non-problem gamblers are more likely to be male, aged older than 21, have alcohol use disorders, have lower family cohesion, more frequent suicide ideation, and their fathers have no after school education. Some-problem gamblers in comparison with non-gamblers/non-problem gamblers are more likely to be male, have lower school satisfaction, show symptoms of depression, and do not combine work and study. Conclusions. The study gives the first overview for gambling problem and associated problems among undergraduate students in Astana. Associates of problem gambling is consistent with the literature. Since every fourth male in the study places a bet with bookmakers, and majority had a gambling problem, there is need for developing interventions to increase awareness and prevent problem gambling and associated psychosocial problems

The Horror of Our Love: Hannibal Lecter and the Reclaiming of Queer Villains

Gender and sexual diversity have a history of being invoked, explicitly or implicitly, to further the monstrosity of villainous characters, including those who are (nominally) human. One such example is popular culture’s most famous cannibalistic serial killer, Hannibal Lecter. This paper traces the meanings constructed by queerness in the Hannibal Lecter stories, beginning by addressing the implications of queerness within Thomas Harris’s tetralogy and Jonathan Demme’s The Silence of the Lambs. Next, this paper turns to Bryan Fuller’s 2013 television adaptation, Hannibal, and its inheritance of homophobic depictions of villains, both from broader gothic and horror contexts and from its direct source material. Despite this legacy of queercoding, Hannibal breaks from the longstanding connections between queerness and villainy, using gothic tropes and aesthetics to readdress queer monstrosity through the gothic context where it emerged. Fuller’s choice to center his adaptation on a love story between two men resists the negative connections between queerness and monstrosity. Instead of recreating homophobic tropes, I argue that Fuller’s adaptation provides a space for reclamation, where Hannibal’s queer desires are not a furthering of villainy but a sign of his humanity

Risk factors of postoperative complications after radical cystectomy with continent or conduit urinary diversion in Armenia

To estimate the surgical volume and the incidence of in-hospital complications of RC in Armenia from 2005 to 2012, and to investigate potential risk factors of complications. The study utilized a retrospective chart review in a cohort of patients who had RC followed by either continent or conduit urinary diversion in all hospitals of Armenia from 2005 to 2012. A detailed chart review was conducted abstracting information on baseline demographic and clinical characteristics, surgical procedural details, postoperative management and in-hospital complications. Multivariable logistic regression analysis was applied to estimate the independent risk factors for developing ‘any postoperative complication’. The total study sample included 273 patients (mean age = 58.5 years, 93.4 % men). Overall, 28.9 % (n = 79) of patients had at least one in-hospital complication. The hospital mortality rate was 4.8 % (n = 13). The most frequent types of complications were wound-related (10.3 %), gastrointestinal (9.2 %) and infectious (7.0 %). The ischemic heart disease (OR = 3.3, 95 % CI 1.5–7.4), perioperative transfusion (OR = 2.0, 1.1–3.6), glucose level [OR = 0.71 (0.63–0.95)], and hospital type (OR = 2.3, 95 % CI 1.1–4.7) were independent predictors of postoperative complications. The rate of RC complications in Armenia was similar to those observed in other countries. Future prospective studies should evaluate the effect of RC complications on long-term outcomes and costs in Armenia. Policy recommendations should address the issues regarding surgeon training and hospital volume to decrease the risk of RC complications

Assessment of unmet needs and barriers to end-of-life care provision in Kazakhstan

Palliative care, a holistic multidisciplinary approach for those persons with terminal diseases, providing relief for physical, emotional, psychosocial and spiritual suffering of both the patients and their families and to support the dignity of all involved in the process of dying¹. Palliative care has developed recently, and an understanding of unmet needs and barriers, especially in Kazakhstan, can be addressed through innovative rigorous qualitative research methods covering all the stakeholders involved. Palliative care is an integral Nazarbayev University’s commitment to improving health services in Kazakhstan. The published literature shows a lack of palliative care providers in Kazakhstan and the few existing services are underdeveloped2,3. Our current will substantially characterize more in-depth and more broadly on opportunities and barriers for national expansion of quality palliative care in Kazakhstan

Adapting continuing medical education for post-conflict areas: assessment in Nagorno Karabagh - a qualitative study

Background: One of the major challenges in the current century is the increasing number of post-conflict states where infrastructures are debilitated. The dysfunctional health care systems in post-conflict settings are putting the lives of the populations in these zones at increased risk. One of the approaches to improve such situations is to strengthen human resources by organizing training programmes to meet the special needs in post-conflict zones. Evaluations of these training programmes are essential to assure effectiveness and adaptation to the health service needs in these conditions. Methods: A specialized qualitative evaluation was conducted to assess and improve a post-conflict continuing medical education (CME) programme that was conducted in Nagorno Karabagh. Qualitative research guides were designed for this post-conflict zone that included focus group discussions with physician programme participants and semi-structured in-depth interviews with directors of hospitals and training supervisors. Results: Saturation was achieved among the three participating groups in the themes of impact of participation in the CME and obstacles to application of obtained skills. All respondents indicated that the continuing medical education programme created important physician networks absent in this post-conflict zone, updated professional skills, and improved professional confidence among participants. However, all respondents indicated that some skills gained were inapplicable in Nagorno Karabagh hospitals and clinics due to lack of appropriate medical equipment, qualified supporting human resources and facilities. Conclusion: The qualitative research methods evaluation highlighted the fact that the health care human resources training should be closely linked to appropriate technologies, supplies, facilities and human resources available in post-conflict zones and identified the central importance of creating health professional networks and professional confidence among physicians in these zones. The qualitative research approach most effectively identifies these limitations and strengths and can directly inform the optimal adjustments for effective CME planning in these difficult areas of greatest need

Improving palliative care outcomes in remote and rural areas of LMICs through family caregivers: lessons from Kazakhstan

Approximately 60 million people require palliative care worldwide, and nearly 80% of them live in low- and middle-income countries (LMICs). Providing palliative care in remote and rural areas of LMICs requires special consideration to ensure equitable access to healthcare. This perspective aims to deliver pragmatic, context-oriented policy recommendations designed to improve palliative care outcomes in Kazakhstan by capitalizing on existing resources and considering its unique geopolitical and sociocultural context. With approximately half of the population in Kazakhstan residing in remote and rural regions, the provision of healthcare services – specifically palliative care – mandates particular attention to ensure equal access to high-quality care. To understand challenges of implementing palliative care in remote and rural regions of Kazakhstan and to propose tailored solutions, 29 key stakeholders, including family caregivers, health professionals, and palliative care administrators, were identified in five regions of Kazakhstan. The main challenges encountered by family caregivers include lack of palliative care skills, the need for home-based care from mobile services, and high out-of-pocket expenditures. The challenges highlighted by healthcare providers and administrators were the lack of formal education in palliative care, shortage of opioids, and limited societal awareness and state support. Based on challenges elaborated from stakeholders and existing literature in palliative care and family caregiving, this perspective advocates against replicating the strategies implemented in high-income countries. Family caregivers play a critical role in implementing affordable and efficient palliative care in resource-limited settings. Enhancing their competencies through digital training and increasing access to palliative care services through mobile teams are tailored and localized solutions that address specific challenges in Kazakhstan. It is postulated that these recommendations may find utility in other LMICs, potentially benefiting nearly 48 million individuals who require these services

Challenges for Developing Palliative Care Services in Resource- Limited Settings of Kazakhstan

Background: Approximately 40 million people in need of palliative care worldwide, while 80% of them live in low- and middle-income countries. Kazakhstan, a low-to middle-income country with a reforming healthcare system, is committed to improving quality and accessibility of care for its 100,000 terminal patients in need of palliative care.Policy Options and Recommendations: To join the group of countries where palliative care is available, accessible, and affordable, Kazakhstan must integrate palliative services into the mainstream healthcare system at all levels, from primary healthcare to hospices, and from major cities to remote villages. Based on the evidence thoroughly collected directly from the Ministry of Health, authors propose a feasible set of recommendations regarding palliative policy, paint relief, infrastructure, workforce, and education, which could be implemented in LMICs beyond Kazakhstan.Conclusion: This study presents an analysis of challenges, recent developments, and needs of palliative care in Kazakhstan, including funding, policy, workforce, education, and infrastructure, providing an evidence base and recommendations for future development of palliative care in Kazakhstan and in other LMICs

INCIDENCE AND MORTALITY RATES OF STROKES IN KAZAKHSTAN IN 2014–2019

There is a lack of information on the epidemiology of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in developing countries. This research presents incidence and mortality rates of stroke patients based on hospital admission and discharge status in one of the Central Asian countries by analysis of large-scale healthcare data. The registry data of 177,947 patients admitted to the hospital with the diagnosis of stroke between 2014 and 2019 were extracted from the National Electronic Health System of Kazakhstan. We provide descriptive statistics and analyze the association of socio-demographic and medical characteristics such as comorbidities and surgical treatments. Among all stroke patients, the incidence rate based on hospital admission of AIS was significantly higher compared to SAH and ICH patients. In 5 year follow-up period, AIS patients had a better outcome than SAH and ICH patients (64.7, 63.1 and 57.3% respectively). The hazard ratio (HR) after the trepanation and decompression surgery was 2.3 and 1.48 for AIS and SAH patients; however, it was protective for ICH (HR = 0.87). The investigation evaluated an increase in the all-cause mortality rates based on the discharge status of stroke patients, while the incidence rate decreased over time

A free weekly iron-folic acid supplementation and regular deworming program is associated with improved hemoglobin and iron status indicators in Vietnamese women

Background Anemia due to iron deficiency is recognized as one of the major nutritional deficiencies in women and children in developing countries. Daily iron supplementation for pregnant women is recommended in many countries although there are few reports of these programs working efficiently or effectively. Weekly iron-folic acid supplementation (WIFS) and regular deworming treatment is recommended for non-pregnant women living in areas with high rates of anemia. Following a baseline survey to assess the prevalence of anemia, iron deficiency and soil transmitted helminth infections, we implemented a program to make WIFS and regular deworming treatment freely and universally available for all women of reproductive age in two districts of a province in northern Vietnam over a 12 month period. The impact of the program at the population level was assessed in terms of: i) change in mean hemoglobin and iron status indicators, and ii) change in the prevalence of anemia, iron deficiency and hookworm infections. Method Distribution of WIFS and deworming were integrated with routine health services and made available to 52,000 women. Demographic data and blood and stool samples were collected in baseline, and three and 12-month post-implementation surveys using a population-based, stratified multi-stage cluster sampling design. Results The mean Hb increased by 9.6 g/L (95% CI, 5.7, 13.5, p < 0.001) during the study period. Anemia (Hb<120 g/L) was present in 131/349 (37.5%, 95% CI 31.3, 44.8) subjects at baseline, and in 70/363 (19.3%, 95% CI 14.0, 24.6) after twelve months. Iron deficiency reduced from 75/329 (22.8%, 95% CI 16.9, 28.6) to 33/353 (9.3%, 95% CI 5.7, 13.0) by the 12-mnth survey, and hookworm infection from 279/366 (76.2%,, 95% CI 68.6, 83.8) to 66/287 (23.0%, 95% CI 17.5, 28.5) over the same period. Conclusion A free, universal WIFS program with regular deworming was associated with reduced prevalence and severity of anemia, iron deficiency and h