Patient-reported Satisfaction with Current Clinical Management of Systemic Lupus Erythematosus in Kazakhstan

BACKGROUND: Over the past decades, patient satisfaction has been increasingly recognized as a powerful tool to measure the quality of health-care services. AIM: This study evaluated the satisfaction of systemic lupus erythematosus (SLE) patients with current clinical management in Semey, East Kazakhstan, and explored the factors associated with dissatisfaction. METHODS: All adult SLE patients registered at health-care facilities of Semey were enrolled in a cross-sectional study. RESULTS: Out of 67 patients, 66 were females and their mean age was 39 years. Symptoms associated with the musculoskeletal system were the most commonly reported (95.5%), followed by fatigue (88.1%) and neurological symptoms (53.7%). None of the patients were very satisfied or satisfied with current clinical management and the overall rate of patient dissatisfaction was 83.6%. Education (p = 0.04), monthly income (p = 0.01), SLE disease activity index score (p = 0.031), therapy with biologic agents (p = 0.029), immunosuppressants (p = 0.01), and corticosteroids (p = 0.01) were predictors of patient dissatisfaction in multiple logistic regression analysis. CONCLUSION: This real-world study is the first effort to understand the experience of SLE patients within the health-care system of Kazakhstan and the results may facilitate doctor-patient discussions on the initiatives that need to be taken to improve the quality of the medical services provided

QUALITY-OF-LIFE ASSESSMENT OFWOMEN UNDERGOING IN VITRO FERTILIZATION IN KAZAKHSTAN

Infertility is a problem that affects millions of couples worldwide and has a significant impact on their quality of life. The recently introduced “Fertility Quality of Life Questionnaire (FertiQoL)” quickly became a gold standard for evaluation of the quality of life of patients suffering from infertility. The aim of this study was to determine the quality of life of Kazakhstani women coping with infertility problems by FertiQoL and assess the validity of the questionnaire. This cross-sectional study involved women of reproductive age undergoing an in vitro fertilization (IVF) cycle at a large IVF center in Kazakhstan in the period from 1 September 2020 to 31 September 2021. A total of 453 women out of 500 agreed to participate in the study, and the response rate was 90.6%. The overall Core FertiQoL was 56.95 14.05, and the Treatment FertiQoL was 66.18 11.13 points. Respondents with secondary infertility had statistically significantly higher Emotional (p < 0.001), Mind–body (p = 0.03), Social (p < 0.001), Environment (p = 0.02), and Treatment (p < 0.001) domains of FertiQoL than women with primary infertility. Respondents with a low income had the lowest levels of Total FertiQoL (56.72 11.65). The longer duration of infertility of women undergoing IVF treatment presented the worse scale of Treatment and Total FertiQoL. Cronbach’s alpha revealed good internal reliability for all FertiQoL subscales on the Kazakhstan women’s questionnaire and averaged 0.8, which is an indicator of a high degree of reliability. The Total FertiQoL of Kazakhstan women undergoing IVF treatment was 59.6 11.5, which is considerably lower than European countries. We identified statistically significant differences across medical and demographic groups. As this questionnaire had validity in Kazakhstan survey it possibly be used for both medical counseling and future investigation in our country

Detection of the Frail Elderly at Risk of Postoperative Sepsis.

With the increase in the elderly population, surgery in aged patients is seeing an exponential increase. In this population, sepsis is a major concern for perioperative care, especially in older and frail patients. We aim to investigate the incidence of sepsis in elderly patients receiving diverse types of surgical procedures and explore the predictive capacity of the Hospital Frailty Risk Score (HFRS) to identify patients at high risk of incidence of postoperative sepsis. This study relies on information from the Spanish Minimum Basic Data Set, including data from nearly 300 hospitals in Spain. We extracted records of 254,836 patients aged 76 years and older who underwent a series of surgical interventions within three consecutive years (2016-2018). The HFRS and Elixhauser comorbidity index were computed to determine the independent effect on the incidence of sepsis. Overall, the incidence of postoperative sepsis was 2645 (1.04%). The higher risk of sepsis was in major stomach, esophageal, and duodenal (7.62%), followed by major intestinal procedures (5.65%). Frail patients are at high risk of sepsis. HFRS demonstrated a high predictive capacity to identify patients with a risk of postoperative sepsis and can be a valid instrument for risk stratification and vigilant perioperative monitoring for the early identification of patients at high risk of sepsis.S

Towards an Accurate Estimation of COVID-19 Cases in Kazakhstan: Back-Casting and Capture–Recapture Approaches

Background and Objectives: Coronavirus disease 19 (COVID-19) has emerged as the most devastating syndemic of the 21st century, with worrisome and sustained consequences for the entire society. Despite the relative success of vaccination programs, the global threat of the novel coronavirus SARS-CoV-2 is still present and further efforts are needed for its containment and control. Essential for its control and containment is getting closer to understanding the actual extent of SARS-CoV-2 infections. Material and Methods: We present a model based on the mortality data of Kazakhstan for the estimation of the underlying epidemic dynamic—with both the lag time from infection to death and the infection fatality rate. For the estimation of the actual number of infected individuals in Kazakhstan, we used both back-casting and capture–recapture methods. Results: Our results suggest that despite the increased testing capabilities in Kazakhstan, official case reporting undercounts the number of infections by at least 60%. Even though our count of deaths may be either over or underestimated, our methodology could be a more accurate approach for the following: the estimation of the actual magnitude of the pandemic; aiding the identification of different epidemiological values; and reducing data bias. Conclusions: For optimal epidemiological surveillance and control efforts, our study may lead to an increased awareness of the effect of COVID-19 in this region and globally, and aid in the implementation of more effective screening and diagnostic measures

Association between serum 25-hydroxyvitamin D concentration and severity of seasonal allergic rhinitis in Karaganda region (Kazakhstan)

Background: Vitamin D deficiency (VDD) is the one of the major public health problem affecting approximately one billion people all over the world. In recent years, the relationship of allergic diseases with a low concentration of vitamin D has been studied worldwide. An association has been found between small count of serum vitamin D and the development of immune disorders. Patients with allergic disorders and, in particular, with respiratory allergy are susceptible for VDD. Objective: The study was aimed to assess the levels of serum 25-hydroxyvitamin D (25(OH)D) and their associations with the severity of seasonal allergic rhinitis in the Karaganda region (Kazakhstan). Material and methods: This cross-sectional study included 416 patients with seasonal allergic rhinitis aged 18-65 years (mean age 39±8 years), 267 of whom were females. VDD was defined as serum concentrations of 25(OH)D below 20 ng/ml. Results: The median concentration of 25(OH)D in blood serum was below the reference threshold (20 ng/ml) and amounted to 16.1 ng/ml. 75% of patients with seasonal allergic rhinitis had VDD and this was common in all age categories. VDD was more prevalent in female patients (82.8%) as compared with the male patients (61.1%) (p&lt;0,01). Of interest is the fact that low serum 25(OH)D concentration correlated with the severity of symptoms (r =-0.94 and r =-0.67). Conclusion: According to our study, the significant part of patients with allergic rhinitis residing in Karaganda region (Kazakhstan) had deficient status of 25(OH)D and this correlated with the severity of symptoms

NEUROPSYCHOLOGICAL ASSESSMENT OF COMMUNITY-DWELLING OLDER ADULTS IN ALMATY, KAZAKHSTAN

Cognitive impairment in older adults is a major public concern for Kazakhstan’s aging population. We aimed to (1) administer a neuropsychological test battery (NTB) in domains relevant to aging-associated cognitive impairment in a sample of adults aged 60+ without dementia in Almaty, Kazakhstan; (2) investigate the associations between demographic factors and test performance; and (3) provide information on the distribution of NTB scores as preliminary local normative data relevant for this population. A cross-sectional evaluation of 276 participants aged 60+ in Almaty, Kazakhstan, was conducted using cognitive instruments including tests of memory, attention, language, executive functions, visuospatial abilities, and processing speed. Multiple linear regression analyses were used to examine the association of demographic factors with neuropsychological test performance. The results from the regression analysis showed that those who are younger, have more years of education, are women, and are of Russian ethnicity had significantly better performance. The current study illustrated (1) the feasibility of administering the NTB to older adults in the general population in Kazakhstan; (2) the preliminary local normative neuropsychological measures; and (3) their independent associations with age, education, gender, and ethnicity. The findings are a platform for future research on dementia and cognitive impairment in older adults in Kazakhstan

The Burden of Disease due to COVID-19 (BoCO-19): A study protocol for a secondary analysis of surveillance data in Southern and Eastern Europe, and Central Asia

Introduction The COVID-19 pandemic has had an extensive impact on public health worldwide. However, in many countries burden of disease indicators for COVID-19 have not yet been calculated or used for monitoring. The present study protocol describes an approach developed in the project “The Burden of Disease due to COVID-19. Towards a harmonization of population health metrics for the surveillance of dynamic outbreaks” (BoCO-19). The process of data collection and aggregation across 14 different countries and sub-national regions in Southern and Eastern Europe and Central Asia is described, as well as the methodological approaches used. Materials and methods The study implemented in BoCO-19 is a secondary data analysis, using information from national surveillance systems as part of mandatory reporting on notifiable diseases. A customized data collection template is used to gather aggregated data on population size as well as COVID-19 cases and deaths. Years of life lost (YLL), as one component of the number of Disability Adjusted Life Years (DALY), are calculated as described in a recently proposed COVID-19 disease model (the ‘Burden-EU’ model) for the calculation of DALY. All-cause mortality data are collected for excess mortality sensitivity analyses. For the calculation of Years lived with disability (YLD), the Burden-EU model is adapted based on recent evidence. Because Covid-19 cases vary in terms of disease severity, the possibility and suitability of applying a uniform severity distribution of cases across all countries and sub-national regions will be explored. An approach recently developed for the Global Burden of Disease Study, that considers post-acute consequences of COVID-19, is likely to be adopted. Findings will be compared to explore the quality and usability of the existing data, to identify trends across age-groups and sexes and to formulate recommendations concerning potential improvements in data availability and quality. Discussion BoCO-19 serves as a collaborative platform in order to build international capacity for the calculation of burden of disease indicators, and to support national experts in the analysis and interpretation of country-specific data, including their strengths and weaknesses. Challenges include inherent differences in data collection and reporting systems between countries, as well as assumptions that have to be made during the calculation process.Peer Reviewe

The mortality burden related to COVID-19 in 2020 and 2021 - years of life lost and excess mortality in 13 countries and sub-national regions in Southern and Eastern Europe, and Central Asia

IntroductionBetween 2021 and 2023, a project was funded in order to explore the mortality burden (YLL–Years of Life Lost, excess mortality) of COVID-19 in Southern and Eastern Europe, and Central Asia.MethodsFor each national or sub-national region, data on COVID-19 deaths and population data were collected for the period March 2020 to December 2021. Unstandardized and age-standardised YLL rates were calculated according to standard burden of disease methodology. In addition, all-cause mortality data for the period 2015–2019 were collected and used as a baseline to estimate excess mortality in each national or sub-national region in the years 2020 and 2021.ResultsOn average, 15–30 years of life were lost per death in the various countries and regions. Generally, YLL rates per 100,000 were higher in countries and regions in Southern and Eastern Europe compared to Central Asia. However, there were differences in how countries and regions defined and counted COVID-19 deaths. In most countries and sub-national regions, YLL rates per 100,000 (both age-standardised and unstandardized) were higher in 2021 compared to 2020, and higher amongst men compared to women. Some countries showed high excess mortality rates, suggesting under-diagnosis or under-reporting of COVID-19 deaths, and/or relatively large numbers of deaths due to indirect effects of the pandemic.ConclusionOur results suggest that the COVID-19 mortality burden was greater in many countries and regions in Southern and Eastern Europe compared to Central Asia. However, heterogeneity in the data (differences in the definitions and counting of COVID-19 deaths) may have influenced our results. Understanding possible reasons for the differences was difficult, as many factors are likely to play a role (e.g., differences in the extent of public health and social measures to control the spread of COVID-19, differences in testing strategies and/or vaccination rates). Future cross-country analyses should try to develop structured approaches in an attempt to understand the relative importance of such factors. Furthermore, in order to improve the robustness and comparability of burden of disease indicators, efforts should be made to harmonise case definitions and reporting for COVID-19 deaths across countries

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit