Patient's site of first access to health system influences length of delay for tuberculosis treatment in Tajikistan

BACKGROUND: Tajikistan has the highest incidence rate of tuberculosis (TB) in Central Asia. Its health system still bears many features from Soviet times and is under-funded. Affordability is a major barrier to health care. Little is known about health care seeking of TB patients in post-Soviet countries and their delay until the start of TB therapy. The low estimated case detection rate in Tajikistan suggests major problems with access to care and consequently long delays are likely. METHODS: The study investigated extent and determinants of patient and health system delays for TB. A questionnaire was administered to a cohort of TB patients in twelve study districts representing a wide range of conditions found in Tajikistan. Common patterns of health care seeking were analysed. Cox proportional hazards models using eight predictor variables, including characteristics of health services delivery, were built to identify determinants of patient and health system delays. RESULTS: Two-hundred-and-four TB patients were interviewed. A common pattern in treatment-seeking was visiting a specialised TB facility at some stage. Typical delays until start of TB therapy were moderate and did not confirm the expectation of long delays. Median patient, health system and total delays to TB treatment were 21.5, 16 and 52 days, respectively. None of the investigated predictors was significantly associated with patient delay. The type of facility, where patients made their first contact with the health system, was the main determinant of health system delay (p > 0.00005). We show for the first time that patients who had fallen ill and first presented to health care in Russia had the longest delays. Those who first presented to peripheral primary care facilities also had relatively long delays. CONCLUSIONS: While overall delays were moderate, further improvement is needed for different subgroups. An international referral system between Russia and Tajikistan to reduce delays of Tajik migrants who develop active TB in Russia is urgently needed and would benefit both countries. Within Tajikistan, diagnostic pathways for patients in the periphery should be shortened. To achieve this, strengthening of sputum smear examination possibly including collection of sputa at peripheral primary care facilities may be needed

Seeing like the international community: how peacebuilding failed (and survived) in Tajikistan

Post-print version. 18 month embargo by the publisher. Article will be released April 2010.The international community claims transformative power over post-conflict spaces via the concept of peacebuilding. International actors discursively make space for themselves in settings such as the Central Asian state of Tajikistan which endured a civil war during the 1990s and has only seen an end to widespread political violence in recent years. With the work of James C. Scott, this paper challenges the notion that post-conflict spaces are merely the objects of international intervention. It reveals how, even in cases of apparent stability such as that of Tajikistan, international actors fail to achieve their ostensible goals for that place yet make space for themselves in that place. International peacebuilders may provide essential resources for the re-emergence of local forms of order yet these symbolic and material resources are inevitably re-interpreted and re-appropriated by local actors to serve purposes which may be the opposite of their aims. However, despite this ‘failure’ of peacebuilding it nevertheless survives as a discursive construction through highly subjective processes of monitoring and evaluation. So maintained, peacebuilding is a constitutive element of world order where the necessity of intervention for humanitarian, democratic and statebuilding ends goes unchallenged. This raises the question of what or where – in spatial terms – is the locus of international intervention: the local recipients of peacebuilding programmes (who are the ostensible targets) or ‘the International Community’ itself (whose space is re-inscribed as that of an imperfect but necessary regulator of world order)

Диагностика церебрального тромбоза вен и синусов у лиц молодого возраста на фоне COVID-19: клиническая характеристика и данные методов лучевой диагностики

Introduction. Cerebral venous thrombosis (CVT) is relatively rare, but leads to the development of cerebral venous infarction, intracranial hemorrhage, followed by severe disability and death. Due to the epidemiological situation caused by COVID-19, the incidence of CVT is increasing.Aims and objectives: to analyze clinical, laboratory instrumental and neuroimaging (multislice computed tomography (MSCT), MSCT — with intravenous contrast, magnetic resonance imaging of the brain (MRI) and MRI venography) data that confirmed the development of CVT in patients with COVID-19.Methods. Data of 5 young adults with cerebral venous thrombosis (CVT) associated with COVID-19 are presented.Results. Аmong 5 reported cases of COVID-19, two patients presented with venous infarcts (hemorrhagic and ischemic), 3 patients developed encephalopathy syndrome without acute cerebral infarction.Conclusion. Possibilities of modern imaging technologies permitted to timely diagnosis cerebral venous thrombosis associated with COVID-19, that can lead to immediate initiation of therapy and to prevent the development of cerebrovascular complications during the COVID-19 pandemic.Введение. Тромбоз церебральных вен и синусов (ЦВТ) встречается относительно редко, однако приводит к развитию церебрального венозного инфаркта, внутричерепного кровоизлияния с последующей тяжелой инвалидизацией и летальным исходом. В связи с эпидемиологической обстановкой, вызванной COVID-19, частота ЦВТ возрастает.Цели и задачи исследования: провести анализ клинических, лабораторно-инструментальных и нейровизуализационных (мультиспиральная компьютерная томография — МСКТ; МСКТ с контрастированием, магнитно-резонансная томография головного мозга — МРТ и МР-венография) данных, подтвердивших развитие ЦВТ на фоне COVID-19.Материалы и методы. Представлены результаты обследования 5 пациентов молодого возраста с церебральным тромбозом вен и синусов (ЦВТ) на фоне новой коронавирусной инфекции.Результаты. Из 5 прeдстaвленных случаев COVID-19 у 2 пациентов на фоне синус-тромбоза развился инсульт (геморрагический и ишемический), в 3 случаях отмечались признаки энцефалопатии, без нарушения мозгового кровообращения.Заключение. Современные возможности лучевой диагностики с учетом пандемии COVID-19 позволяют своевременно верифицировать ЦВТ, обеспечивая немедленное начало терапии, с целью предотвращения развития тяжелых цереброваскулярных осложнений

Remittances, Labour Supply and Activity of Household Members Left-Behind

This paper analyses the role of remittances on labour supply and activity of household members left behind, by explicitly distinguishing between different types of self employment. Contrary to the existing evidence, we find no ‘dependency’ effect of remittances. Our results show that remittances received by households in Tajikistan decrease the probability of wage employment and increase that of small-scale self employment activities of men staying behind, without affecting the number of job specific hours worked. Any positive effect on economic development would be, however, limited, as self-employment is in rather small-scale activities that do not generate a regular income stream

Interdisciplinary Integration of the Mother Tongue in the Primary Education System and its Importance

In this article, the science of the mother tongue is related to which subjects in primary education, and views on its importance are stated

ADVANTAGES AND PECULIARITIES OF USING FIBER-OPTIC COMMUNICATION LINES

This article describes the main benefits of fiber-optic communication lines to the cable lines, wired and wireless channel. Quantitative parameters of fiber-optic communication lines. A simplified model of a fiber-optic communication lines and structure of the optical fiber. Also considered types of optical fibers

Doubling Up or Moving Out? The Effect of International Labor Migration on Household Size

We use household panel data from Tajikistan to explore the change in living arrangements as a response to income shifts related to international labour migration. In addition, we analyse the interaction between the effect of idiosyncratic income increase resulting from a completed migration episode, and the effect of an aggregate shock – the global financial crisis – and show how different households adjust their household size during times of financial hardship. The empirical evidence indicates that while current migration is associated with an increase in household size, a completed migration episode two years before the interview was followed by family members moving out. At the same time, our empirical analysis demonstrates that migrant families doubled up in response to a financial crisis to the same extent as non-migrant families, which suggests that labour migration in Tajikistan does not insure against economic shocks in the long run.This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions

The research-action interface in sustainable land management in Kyrgyzstan and Tajikistan: Challenges and recommendations

International agencies and programmes introduced sustainable land management (SLM) to Central Asia after the former Soviet Republics became independent in 1991. An aim of early SLM initiatives was to address challenges linked to the transformation of the agricultural sector from a centrally planned economy to a decentralized market economy. This article analyses the knowledge–action interface in Kyrgyzstan and Tajikistan as it relates to SLM. The analysis focuses on the influence of underlying land management concepts by means of a literature review. Contemporary barriers at the research–action interface were identified using participatory appraisal. And a historically contextualized understanding of the effectiveness of interactions between researchers, policy makers and practitioners is based on an analysis of purposefully selected cases. The study concludes that knowledge of different stakeholder groups is often highly disconnected. Interdisciplinary and transdisciplinary studies are rare, and academic research on SLM has subsequently been ineffective at contributing to substantial benefits for society. Further, researchers, policy makers and practitioners in this context must recognize the differences between SLM and what is often referred to as the equivalent Soviet-era concept—rational use of land resources—and the resulting implications of these differences. The authors recommend the following: creating an enabling environment for SLM research through academic institutional reform removing structural constraints, making research outcomes more effective by applying systems approaches that produce evidence for policy makers on the multiple benefits of SLM, helping land users evaluate SLM strategies and investing in the establishment and maintenance of a multi-stakeholder SLM platform that allows dynamic exchange

Les islamistes d’Asie centrale : un défi aux États indépendants ?

Plus d’une décennie après l’accession à l’indépendance des États d’Asie centrale, alors qu’une multitude de mouvements et groupes islamistes contestent massivement les régimes en place hérités de l’ex-URSS, le caractère autoritaire de ces régimes est systématiquement mis en cause dans l’essor de l’islamisme. L’analyse des expressions de l’islamisme centre-asiatique est rendue complexe parce que, derrière la revendication d’un “retour” à un État islamique, s’exprime une volonté de retrouver une authenticité islamique oblitérée pendant toute la période soviétique. Rappelons que l’islam centre-asiatique s’est développé sous des formes variées, y compris sous des formes extrêmes, dans des sociétés musulmanes en mutation, et que, depuis la perestroïka, il s’est mis à regagner des espaces dont il avait été largement exclu à l’époque soviétique. Si complexe que soit la définition de l’islamisme, ce phénomène est ici appréhendé en tant que pratique politique émanant de diverses forces religieuses contestatrices. Pour cela, une analyse d’observations et de faits puisés au Kazakhstan, au Kirghizistan, en Ouzbékistan et au Tadjikistan, pays qui se différencient selon leur manière de répondre aux actions de harcèlement contre l’État faites au nom de l’islam, apporte un éclairage sur l’évolution de l’islam centre-asiatique dans ses fonctions politiques. Fruit d’une réflexion collective, le dossier des Cahiers d’Asie centrale propose divers regards portés par des chercheurs centre-asiatiques et européens sur une gamme variée des aspects de la question de l’islamisme dans les États indépendants d’Asie centrale. S’appuyant sur de solides enquêtes de terrain menées dans différents espaces géographiques de la vaste région, ce dossier met en relief la fragilisation des jeunes États indépendants d’Asie centrale qui, depuis la fin de l’URSS, sont confrontés à des revendications d’une “justice” de Dieu et à des violences de type jihadiste