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In post-Soviet Kazakhstan, the system of care for children with autism has been transforming over the past three decades. There is little known about the use of complementary and alternative medicine by families raising autistic children in the post-Soviet region. An exploratory qualitative focus group design was employed to study parents' experiences of using complementary and alternative medicine focusing on the perceived factors driving the utilization of complementary and alternative medicine by families of autistic children and the availability of complementary and alternative medicine. Six focus groups were conducted in five cities of diverse geographical locations in Kazakhstan. Data were analyzed using a framework analysis. Two overarching themes and subthemes are developed. The first "unmet needs" relates to predisposing factors that motivate parents to complementary and alternative medicine uptake and the second "chasing hope" relates to enabling factors that facilitate parents' uptake of complementary and alternative medicines. In summary, parents of autism spectrum disorder children in Kazakhstan face multiple challenges when seeking treatment for their children's condition and implement whatever complementary and alternative medicine interventions available. A decision to use, and the choice of intervention, mainly comes from perceptions of having no other choice rather than from rational decisions based on efficacy of complementary and alternative medicines. This study provides the first empirical conceptualization of parents' motives for choosing complementary and alternative medicine in Kazakhstan.

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. Plain Language Summary: An Exploratory-Descriptive Qualitative Study of Kazakhstani Gynecologists ' Knowledge and Attitudes Toward Dyspareunia Background: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: The aim is to clarify the prevalence of nonadherence to antidiabetic therapies among type 2 diabetes mellitus (T2DM) patients and identify its causes. Methods: A three-part questionnaire (general background, Knowledge-Attitude-Practice section, and nonadherence reasons) was developed. In total 324 diabetic patients were surveyed via telephone. The evaluation of patient adherence included both direct questions on adherence and a summary of patient responses to nonadherence comments. The analysis was performed on StataCorp Stata 14.2, and included descriptive analysis, simple and multivariate logistic regression. Findings: Among the sociodemographic variables, age group, work level, and alcohol consumption may influence medication adherence. The comorbidity status of patients was also of relevance. Both variables had stronger relationships with adherence to anti-diabetic treatments compared to those with no comorbidities or no additional medicines. A strength of the study is that it addresses various medical diseases and attitudes about them, as well as a wide range of causes for non-adherence to non-diabetic medications. [ABSTRACT FROM AUTHOR]

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 1–6—mild 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. [ABSTRACT FROM AUTHOR]

In post-Soviet Kazakhstan, the system of care for children with autism has been transforming over the past three decades. There is little known about the use of complementary and alternative medicine by families raising autistic children in the post-Soviet region. An exploratory qualitative focus group design was employed to study parents' experiences of using complementary and alternative medicine focusing on the perceived factors driving the utilization of complementary and alternative medicine by families of autistic children and the availability of complementary and alternative medicine. Six focus groups were conducted in five cities of diverse geographical locations in Kazakhstan. Data were analyzed using a framework analysis. Two overarching themes and subthemes are developed. The first "unmet needs" relates to predisposing factors that motivate parents to complementary and alternative medicine uptake and the second "chasing hope" relates to enabling factors that facilitate parents' uptake of complementary and alternative medicines. In summary, parents of autism spectrum disorder children in Kazakhstan face multiple challenges when seeking treatment for their children's condition and implement whatever complementary and alternative medicine interventions available. A decision to use, and the choice of intervention, mainly comes from perceptions of having no other choice rather than from rational decisions based on efficacy of complementary and alternative medicines. This study provides the first empirical conceptualization of parents' motives for choosing complementary and alternative medicine in Kazakhstan. 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

BackgroundPulmonary 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.AimWorking 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.MethodsA 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.FindingsThe 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.ConclusionsThe 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. [ABSTRACT FROM PUBLISHER]

Introduction: Evidence based care for COPD involves patients obtaining timely access to an integrated network of evidence based services delivered by staff with different skills working across different settings. Patient needs for these different services can vary over time as the status of their condition changes or they suffer sudden health crises. The primary care team (GPs and practice nurses) have a key role as a provider of and referrer to care but their awareness and use of evidence based care has been questioned [1]. This paper describes the nature and impacts of an innovative training programme that aimed to improve the quality and integration of care by increasing the primary care team's awareness and use of needed services. Intervention: Key characteristics of the training initiative included: targeting practices where COPD was most common; providers describing evidence based services that were available locally to support diagnosis through to end of life care; patients and carers presenting their experiences of living with COPD; practice based projects being used to pilot service improvement ideas. Evaluating the impacts of the training intervention: Qualitative assessment of the impacts of the training intervention is examining practitioners' views on its relevance, content and any factors that facilitate or constrain the adoption of good practice. Quantitative assessment is monitoring changes in care delivery processes and hospital admission rates. Results: Evaluation results to date have confirmed the need for the training initiative and the relevance of its content. Using local speakers facilitated knowledge about evidence based services that were currently under-used (e.g. for pulmonary rehabilitation) and prompted actions to increase referral rates. Patient and carer led sessions were probably most influential in changing professional behaviour and promoting a more patient centred approach to the delivery and integration of services. As one participant stated, "Remembering the individual and their journey of COPD and the impact it has on their life is the most important aspect the Health Worker should consider in providing supportive care" Conclusions: Efforts to increase the continuity and co-ordination of care for chronic conditions should include initiatives to ensure that existing evidence based services are used by health staff. Use of local speakers led to primary care staff having greater knowledge about available community based services thereby promoting better integration of care for patients. "Patient power" (patients and carers presenting their lived experiences) provided insight into the patient journey and the benefits of an integrated service response. [ABSTRACT FROM AUTHOR]

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.