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Little is known about the impact of environmental pollution on thyroid function in the non-occupationally exposed population of Kazakhstan. This study aimed to investigate serum levels of thyroxine (T4), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (TPO) antibodies in the environmentally exposed population of Kazakhstan in relation to symptoms of anxiety. A total of 1,388 nominally healthy individuals residing in areas exposed to three major types of environmental pollution prevalent in Kazakhstan—non-ferrous metallurgy, condensate gas extraction, and activities of the Semipalatinsk Nuclear Test Site (SNTS)—were enrolled. All comparisons were made with 493 individuals residing in settlements without industrial or military pollution. Serum-free T4, TSH, and anti-TPO levels were tested using a solid-phase chemiluminescent immunoassay. The Generalized Anxiety Disorder 7-item (GAD-7) inventory was utilized to screen for anxiety symptoms. The prevalence of subclinical hypothyroidism was significantly higher in residents of settlements near the condensate gas field than in control sites (20.3 vs. 15.0%). In comparison, the prevalence of overt hypothyroidism was insignificantly higher (0.7 vs. 0.6%). The prevalence of subclinical hyperthyroidism was insignificantly higher in residents of settlements around the SNTS. The prevalence of overt hyperthyroidism was insignificantly higher in residents of areas proximal to the condensate gas field compared to the controls. The prevalence of both normal and elevated serum levels of anti-TPO antibodies did not differ significantly between different sites. Moderate and severe anxiety symptoms were the least common in residents of the two control sites (5.9%). This study carries potential implications for tailored public health interventions and policies. [ABSTRACT FROM AUTHOR]

Background: Following its independence, Kazakhstan implemented several reforms, including the adoption of the Entrepreneurial Code in 2008. This study aims to evaluate the impact of these reforms on the number and per capita rates of epidemiologists, nurse epidemiologists, epidemiological surveillance centers, and infectious morbidity from 1998 to 2022. Such an evaluation is critical for informing policy decisions regarding the future of epidemiological services in Kazakhstan. Methods: An interrupted time series analysis using a best-fit epidemiological model was conducted to assess the impact of key interventions—specifically, the adoption of the Entrepreneurial Code of the Republic of Kazakhstan and subsequent legislation—on the number and per capita rates of epidemiologists, nurse epidemiologists, and epidemiological surveillance facilities with infectious morbidity across the country. Results: Infectious morbidity per million individuals ranged from 4698.14 to 2263.79, with a consistent downward trend observed throughout the study period. Over the study period, the per capita rates of urban epidemiologists exhibited a downward trend, whereas the rates of rural epidemiologists showed an upward trajectory. The per capita rate of epidemiological surveillance centers declined from 26.89 to 15.24 over the study period. Substantial disparities were observed between urban and rural areas, with the epidemiology workforce in urban settings being 3–4 times larger than that in rural areas. Conclusions: This evaluation is important for informing policy decisions regarding the future of epidemiological surveillance services in Kazakhstan. [ABSTRACT FROM AUTHOR]

Background/Objectives: There has been a lack of a holistic approach to evaluating antibiotic consumption in Kazakhstan over the past few years using an internationally recognized methodology. Therefore, this study aimed to provide a nationwide evaluation of antibiotic consumption in Kazakhstan during the period 2019–2023. Methods: Defined daily doses per 1000 inhabitants per day (DIDs) were calculated for systemic antibiotics (J01 code of the Anatomical Therapeutic Chemical Classification System (ATC)) following the methodology established by the Global Antimicrobial Resistance and Use Surveillance System (GLASS-AMC). The average annual percent change (AAPC) was computed for each chemical agent, pharmacological group, and J01 in general to evaluate past trends in antibiotic consumption. Results: The consumption of J01 antibiotics ranged between 10.869 DIDs (2022) and 14.470 DIDs (2020). There was an increase in antibiotic consumption during 2020 and 2021, but the overall trend was declining, with an AAPC of −2.45%. Azithromycin was the most consumed systemic antibiotic, followed by ceftriaxone and ciprofloxacin. The consumption of "Watch" group antibiotics prevailed in Kazakhstan during the study period, with the number of people consuming the top five "Watch" group antibiotics rising from 72,578 in 2019 to 94,617 in 2023. Conclusions: The findings of this study are crucial for the reorganization of the national antimicrobial stewardship program. [ABSTRACT FROM AUTHOR]

Background/Objectives: Few studies have examined the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in acute care hospitals in Kazakhstan. This study aimed to address this gap by conducting a point-prevalence survey (PPS) of HAIs and AMU, as well as evaluating hospital antibiotic consumption via internationally recognized methodologies. Methods: PPS was conducted in four acute care hospitals in Kazakhstan on 11 May 2022, following the methodology of the European Center for Disease Prevention and Control, and included 701 patients. Antibiotic consumption in the same hospitals was assessed via the Global Antimicrobial Resistance and Use Surveillance System methodology. Results: HAIs were observed in 3.8% of patients (27/701), with intensive care unit wards accounting for 48.1% of these cases (13/27). Pseudomonas aeruginosa was the most frequently identified pathogen (5 out of 14 documented cases, 35.7%). Resistance to carbapenems was the most common resistance, followed by resistance to glycopeptides and third-generation cephalosporins. The rate of AMU was 38.2%, with an average of 1.37 antibiotics administered per patient. Surgical prophylaxis lasting more than one day was the most common indication for antimicrobial prescription (44.8%). Ceftriaxone and cefazolin are the most commonly used antibiotics. Conclusions: The results of this study are important for understanding the current situation in Kazakhstan and for informing national antimicrobial stewardship and infection control strategies. [ABSTRACT FROM AUTHOR]

Background/Objectives: While multiple studies have investigated antibiotic consumption rates, there are few studies on the consumption of systemic antifungals and antiprotozoals. This study aims to fill this gap by providing a comprehensive analysis of nationwide consumption trends in Kazakhstan over a seven-year period (2017–2023). Methods: Defined daily doses per 1000 inhabitants per day were calculated for systemic antifungals (J02 code of the Anatomical Therapeutic Chemical Classification System (ATC)) and antiprotozoals (P01 code of the ATC). Time series analyses were applied to examine historical trends, evaluate the impact of the COVID-19 pandemic, and make future projections until 2030. Results: The total consumption increased over the study period, with an average annual percent change of 1.11% for antifungals and 5.48% for antiprotozoals. Fluconazole was the most consumed antifungal agent, whereas metronidazole was the most consumed antiprotozoal agent. The COVID-19 pandemic had a positive but insignificant effect on the consumption of antifungals and a negative and also insignificant effect on the consumption of antiprotozoals. Forecast modeling indicates that the future trends in antifungal and antiprotozoal consumption until 2030 will largely remain stable, with the exception of antiprotozoal consumption in the hospital sector, which is projected to decline. Conclusions: These findings offer valuable insights into the development and implementation of targeted antimicrobial stewardship programs in Kazakhstan. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, a ban on inspections of small businesses, including pharmacies, was imposed in Kazakhstan, which relaxed law enforcement efforts regarding the prohibition of over-the-counter antibiotic (AB) sales. This study aimed to investigate how this affected the knowledge, attitudes, and practices (KAP) related to AB and antimicrobial resistance (AMR), as well as to assess actual AB consumption at the community level. The study comprised two cross-sectional sub-studies: the first involved a KAP survey conducted in 2022 and 2024, utilizing the Special Eurobarometer questionnaire on AMR. The second sub-study analyzed AB consumption in 2021 and 2023, measured in defined daily doses per 1000 inhabitants. Results revealed an increase in the percentage of individuals reporting receipt of information about ABs and AMR in the past year (37.3% in 2022 vs. 52.9% in 2024, p < 0.001) and an increase in the percentage of individuals reporting AB use in the past year (49.0% in 2022 vs. 54.0% in 2024, p = 0.056). The most consumed ABs were from the Watch group, with azithromycin and ceftriaxone ranking highest. These findings support the hypothesis that the relaxation of law enforcement contributed to an increase in AB consumption and emphasize the need for public health policies to address this issue. [ABSTRACT FROM AUTHOR]

Cervical cancer (CC) continues to be a significant global health issue, which in part can be attributed to disparities in access to CC screening services. This study aims to conduct a trend of CC in Kazakhstan and to compare attitudes towards the screening program between women living in urban and rural areas. In the first stage, we conducted a trend study of CC indicators in Kazakhstan using official statistics. In the second stage, a cross-sectional study was conducted using a structured questionnaire to assess adherence to screening. The trend study reveals a decline in cervical cancer mortality rates (from 7.15 to 5.93 per 100,000 female inhabitants) over the period studied, while the incidence remains stable (from 18.51 to 19.38 per 100,000 female inhabitants). Regional variations in Period Prevalence rates were observed. Significant differences were found in screening participation rates between urban n = 41 (74%) and rural n = 23 (38%) women, p < 0.001, as well as awareness of the screening program (urban: n = 15 (27%), rural: n = 35 (58%), p < 0.001). The trend study highlights a decrease in cervical cancer mortality rates over the specified period, accompanied by a consistent incidence rate. Additionally, regional disparities in period prevalence rates of cervical cancer were observed. The primary factor contributing to the low adherence of rural women to screening was found to be a lack of awareness regarding the screening program. Therefore, increasing awareness about the importance of screening is crucial for improving adherence rates among rural women in Kazakhstan. [ABSTRACT FROM AUTHOR]

Background: Menopausal quality of life (MenQoL) is a common concern that primary healthcare workers often encounter. Menopause has a significant impact on women's health, but studies examining its effect on the MenQoL of menopausal healthcare employees have produced conflicting results. Objective: The aim of this study was to compare the quality of life related to menopausal status (pre-, peri-, or postmenopausal) in healthcare workers from various clinical settings in Kazakhstan. Design: This was a cross-sectional study. Participants: In total, 222 menopausal healthcare workers (physicians, nurses/midwives, administrative staff, and cleaners) were enrolled from hospitals affiliated with the University Medical Center (UMC) in Kazakhstan. Main Measures: The outcome variable was assessed using the Menopausal Quality of Life Questionnaire (MENQOL), which evaluates MenQoL across four domains of menopausal symptoms: physical, psychological, vasomotor, and sexual. Key Results: The most frequently reported menopausal symptoms were physical ones, such as feeling tired or worn out (70.7%), followed by feeling a lack of energy (65.3%) and dry skin (64.1%). The postmenopause group had the highest mean MenQoL score in the vasomotor domain (mean 3.46 ± 1.84). There was a borderline statistical significance when comparing postmenopause and perimenopause groups in the physical domain. The pairwise comparison of mean sexual scores revealed that postmenopause women had the highest average score (3.3 ± 2.36) compared to both premenopause (mean 2.3 ± 1.82) and perimenopause (mean 2.22 ± 1.58) groups (p < 0.05). Conclusions: Menopausal status has influence on the MenQoL of healthcare workers. The study findings could have important implications for policymakers as they provide insight into the factors influencing the quality of life of menopausal healthcare employees. Creating a more menopause-friendly work environment may not only enhance the well-being of healthcare personnel but also improve their overall job satisfaction and performance. [ABSTRACT FROM AUTHOR]

There is a scarcity of publications evaluating the performance of the national liver transplantation (LTx) program in Kazakhstan. Spanning from 2012 to 2023, it delves into historical trends in LTx surgeries, liver transplant centers, and the national cohort of patients awaiting LTx. Survival analysis for those awaiting LTx, using life tables and Kaplan–Meier, is complemented by time series analysis projecting developments until 2030. The overall per million population (pmp) LTx rate varied from 0.35 to 3.77, predominantly favoring living donor LTx. Liver transplant center rates ranged from 0.06 to 0.40. Of 474 LTx patients, 364 on the waiting list did not receive transplantation. The 30-day and 1-year survival rates on the waiting list were 87.0% and 68.0%, respectively. Viral hepatitis and cirrhosis prevalence steadily rose from 2015 to 2023, with projections indicating a persistent trend until 2030. Absent targeted interventions, stable pmp rates of LTx and liver transplant centers may exacerbate the backlog of unoperated patients. This study sheds light on critical aspects of the LTx landscape in Kazakhstan, emphasizing the urgency of strategic interventions to alleviate the burden on patients awaiting transplantation. [ABSTRACT FROM AUTHOR]

Universal health coverage relies on providing essential medical services and shielding individuals from financial risks. Our study assesses the progressivity of out-of-pocket (OOP) payments, identifies factors contributing to healthcare expenditure inequality, and examines catastrophic health expenditures (CHE) prevalence in Kazakhstan from 2018 to 2021. Using retrospective analysis of National Statistics Bureau data, we employed STATA 13 version for calculations CHE incidence, progressivity, Lorenz and concentration curves. In 2020–2021, OOP expenditures in Kazakhstan decreased, reflecting a nearly twofold reduction in the CHE incidence to 1.32% and 1.24%, respectively. However, during these years, we observe a transition towards a positive trend in the Kakwani index to 0.003 and 0.005, respectively, which may be explained by household size and education level factors. Increased state financing and quarantine measures contributed to reduced OOP payments. Despite a low healthcare expenditure share in gross domestic product, Kazakhstan exhibits a relatively high private healthcare spending proportion. The low CHE incidence and proportional expenditure system suggest private payments do not significantly impact financial resilience, prompting considerations about the role of government funding and social health insurance in the financing structure. [ABSTRACT FROM AUTHOR]

Background: During the 1990–2000, Kazakhstan experienced a decline in the number of healthcare professionals working in rural areas. Since 2009, the national government has been implementing financial incentives to encourage healthcare professionals to relocate to rural areas. This study aims to investigate the temporal and spatial patterns in the distribution of the rural healthcare workforce and evaluate the impact of this incentive scheme. Methods: Interrupted Time Series Analysis using ARIMA models and Difference in Differences analyzes were conducted to examine the impact of the incentive scheme on the density of different categories of the healthcare workforce in rural Kazakhstan in the period from 2009 to 2020. Results: There was a significant increase in the number of rural healthcare professionals from 2009 to 2020 in comparison to the period from 1998 to 2008. However, this increase was less pronounced in per capita terms. Moreover, a decline in the density of internists and pediatricians was observed. There is substantial variation in the density of rural nurses and physicians across different regions of Kazakhstan. The incentive scheme introduced in 2009 by the government of Kazakhstan included a one-time allowance and housing incentive. This scheme was found to have contributed insignificantly to the observed increase in the number of rural healthcare professionals. Conclusion: Future research should be undertaken to examine the impact made by the incentive scheme on other medical subspecialties, particularly primary practitioners. Addressing the shortage of healthcare workers in rural areas is a complex issue that requires a multifaceted approach. Aside from financial incentives, other policies could be considered to increase relocation and improve the retention of healthcare professionals in rural areas. [ABSTRACT FROM AUTHOR]

Despite well-established evidence supporting vaccination efficacy in reducing morbidity and mortality among infants and children, there is a global challenge with an increasing number of childhood vaccination refusals. This issue has intensified, especially during the COVID-19 pandemic. Our study aims to forecast mandatory childhood vaccination refusal trends in Kazakhstan until 2030, assessing the impact of mass COVID-19 vaccination on these rates. Utilizing annual official statistical data from 2013 to 2022 provided by the Ministry of Health of Kazakhstan, the study reveals a significant surge in refusals during the pandemic and post-pandemic periods, reaching record levels of 42,282 cases in 2021 and 44,180 cases in 2022. Notably, refusal rates sharply rose in specific regions, like Aktobe (13.9 times increase) and Atyrau (4.29 times increase), emphasizing the need for increased public healthcare attention in these areas. However, despite a decade of data, our forecasting analysis indicates a lack of volatility in childhood vaccine refusal trends for all vaccine types up to 2030, highlighting the statistical significance of the obtained results. The increasing trend in vaccine refusals underscores the necessity to enhance crisis response and support health initiatives, particularly in regions where a substantial rise in refusals has been observed in recent years. [ABSTRACT FROM AUTHOR]

This paper presents a model of the formation of a multiphase Akzhailau granitoid massif formed within a Caledonian block of the Earth's crust in the Hercynian time. This work is based on the results of major and trace element composition, geochronological, mineralogical and isotope-geochemical studies. Three stages of the formation of the Akzhailau massif are distinguished, which differ significantly from the previously accepted concepts about the multicomplex and polychronous origin of this intrusion: (1) the formation of moderately alkaline A2-type leuсogranites (308–301 Ma); (2) intrusion of monzodiorites into the base of leucogranites (~295 Ma), increasing degree of partial melting of protoliths with the formation of syenites and moderately alkaline granites of I-type (294–292 Ma); (3) intrusion of dikes and small bodies of alkaline ferroeckermannite A1-type leucogranites in the west and north of massif (~289 Ma). The Akzhailau massif was formed within about 15 Myr in the middle–upper crust through the interaction of plume-related subalkaline basitic magmas with metamorphosed crustal protolith of the orogenic structure. [ABSTRACT FROM AUTHOR]

Limited information is available regarding the prevalence of pressure ulcers (PUs) in residential homes in Central Asia. Therefore, the aim of this study was to identify the prevalence rates and risk factors associated with PUs among residents of long-term care medical institutions in the Republic of Kazakhstan. This cross-sectional study was conducted in four long-term care institutions in Kazakhstan. The study sample consisted of 640 patients who were assessed for the presence of PUs and associated risk factors. The evaluation was performed using the International Prevalence Measurement of Care Quality (Landelijke Prevalentiemeting Zorgkwaliteit, LPZ), the Braden scale, and the Care Dependency Score (CDS). The overall prevalence of PUs, classified as categories I–IV, was found to be 37%. When excluding category I PUs, the prevalence decreased to 35.6%. The odds ratios (ORs) for presenting with PUs were as follows: history of stroke (OR 5.22), diseases of the digestive system (OR 10.01), presence of spinal cord lesions/paraplegia (OR 20.50), recent reported confusion within the last 7 days (OR 184.00), and limited extent dependency according to the CDS (OR 4.44; 95%CI 1.31–16.1). It is imperative to establish specialized training programs aimed at equipping medical personnel, relatives, and patients themselves with the necessary skills to provide optimal care for individuals affected by PUs. [ABSTRACT FROM AUTHOR]

Kazakhstan is experiencing a high burden of cardiovascular disease (CVD), and the country has implemented a range of strategies aimed at controlling CVD. The study aims to conduct a content analysis of the policies implemented in the country and augment it with an analysis of official statistics over a 15-year period, from 2006 to 2020. The study also includes comparisons of incidence rates between urban and rural areas. A comprehensive search was conducted to identify policy documents that regulate the provision of primary, secondary, and tertiary prevention of cardiovascular diseases. Additionally, official data on the incidence of arterial hypertension, ischemic heart disease, acute myocardial infarction, and cerebrovascular disease were extracted from official statistics, disaggregated by urban and rural areas. Forecast modeling was utilized to project disease incidences up to 2030. The study reveals that Kazakhstan primarily focuses on tertiary prevention of cardiovascular diseases, with less attention given to secondary prevention, and primary prevention is virtually non-existent. In general, screening for arterial hypertension appears to be more successful than for ischemic heart disease. The incidence of arterial hypertension has increased threefold for urban residents and 1.7-fold for rural residents. In urban areas, residents saw a twofold increase in ischemic heart disease incidence, while it remained the same in rural areas. The findings of this study have practical implications for decision-makers, who can use the results to enhance the effectiveness of existing CVD prevention strategies. [ABSTRACT FROM AUTHOR]

Poor or suboptimal knowledge of appropriate antibiotic use is a cause for global concern and little is known about Central Asian countries. Therefore, this survey is aimed at evaluating awareness about antibiotic use and resistance among the adult population of Kazakhstan. A cross-sectional study of a random sample was conducted between October 2021 and February 2022 among 727 individuals without medical education and followed the methodology described in the WHO report "Antibiotic Resistance: Multi-country public awareness survey". Half of the respondents (50.4%) received antibiotic therapy within the last 12 months, 40.1% had no prescription for this and 40.4% received no advice from a medical professional. Nearly two-thirds of respondents (65.3%) never heard about antibiotic resistance and 57.2% believed that it is worth requesting the same antibiotic if it helped to treat a similar condition previously. In general, knowledge about antibiotic use proved to be low in 82.1% of respondents and 91.9% agreed with the statement that a common cold requires antibiotics. There is a need for awareness-raising campaigns to improve the knowledge about antibiotic use and resistance in the population of Kazakhstan. [ABSTRACT FROM AUTHOR]

A Global Burden of Disease (GBD) study reported that 9.6 million years lived with disability (YLDs) were lost due to hip and knee osteoarthritis (KOA) in 2017. Although the GBD study presents the disease burden at the global level, there is no information on any Central Asian country. This study aims to investigate the epidemiology of knee osteoarthritis in Kazakhstan. The data of 56,895 people with KOA between 2014–2020 was derived from the Unified National Electronic Health System of Kazakhstan and retrospectively analyzed. The majority of the cohort (76%) were women, of Kazakh ethnicity (66%), and older than 50 years of age (87%). The risk of gonarthrosis escalated for women after 50 years and peaked at 75 years with a rate of 3062 females admitted to hospital per 100,000 women in the population. This observation is approximately three times higher than for men of the same age group. A geographical analysis showed that the Jambyl oblast, West Kazakhstan, North Kazakhstan, and the Akmola oblast have the highest burden of disease. During the observation period, 127,077 age-adjusted YLDs were lost due to knee osteoarthritis. This is the first study in Kazakhstan to investigate the burden of knee osteoarthritis. This research recognizes age and sex-based differences, and regional disparities in the incidence of knee osteoarthritis. This knowledge can lead to the development of more specific diagnostic approaches and gender-personalized therapy protocols for patients. [ABSTRACT FROM AUTHOR]

The kidney and brain expressed protein (KIBRA) plays an important role in synaptic plasticity. Carriers of the T allele of the KIBRA (WWC1) gene rs17070145 C/T polymorphism have been reported to have enhanced spatial ability and to outperform individuals with the CC genotype in working memory tasks. Since ability in chess and science is directly related to spatial ability and working memory, we hypothesized that the KIBRA T allele would be positively associated with chess player status and PhD status in science. We tested this hypothesis in a study involving 2479 individuals (194 chess players, 119 PhD degree holders in STEM fields, and 2166 controls; 1417 males and 1062 females) from three ethnicities (236 Kazakhs, 1583 Russians, 660 Tatars). We found that frequencies of the T allele were significantly higher in Kazakh (66.9 vs. 55.1%; p = 0.024), Russian (44.8 vs. 32.0%; p = 0.0027), and Tatar (51.5 vs. 41.8%; p = 0.035) chess players compared with ethnically matched controls (meta-analysis for CT/TT vs. CC: OR = 2.05, p = 0.0001). In addition, none of the international chess grandmasters (ranked among the 80 best chess players in the world) were carriers of the CC genotype (0 vs. 46.3%; OR = 16.4, p = 0.005). Furthermore, Russian and Tatar PhD holders had a significantly higher frequency of CT/TT genotypes compared with controls (meta-analysis: OR = 1.71, p = 0.009). Overall, this is the first study to provide comprehensive evidence that the rs17070145 C/T polymorphism of the KIBRA gene may be associated with ability in chess and science, with the T allele exerting a beneficial effect. [ABSTRACT FROM AUTHOR]

Background: The asthma burden is growing worldwide, and this is predisposed by environmental and occupational exposures as well as individual risk factors. This study was aimed at a comparison of diagnostic accuracy of spirometry and peak expiratory flow rate (PEFR) in asthma screening of adult patients with lung function abnormalities that present at the level of primary care. Methods: This study was conducted in Shymkent city, South Kazakhstan, the third most populous city of the country with developed industries and high rates of pulmonary diseases. Four hundred and ninety-five adult patients with lung function abnormalities were enrolled in the study and underwent two screening tests (spirometry and PEFR). The diagnosis of asthma was verified by a qualified pulmonologist after performance of screening tests and was based on symptoms, medical history, and laboratory and lung function tests. Results: The sensitivity of spirometry was 0.97 and that of PEFR was 0.95 (p = 0.721), whereas the specificity of spirometry was 0.37 and that of PEFR was 0.28 (p = 0.227). Both tests yielded the same results for the positive predictive value (0.98). The negative predictive value was significantly higher for spirometry versus PEFR (0.23 versus 0.08; p = 0.006). The positive and negative likelihood ratios of the two tests also differed significantly (p = 0.001 and p = 0.006, respectively), whereas the overall accuracy was comparable between the two tests (0.96 for spirometry and 0.94 for PEFR; p = 0.748). Conclusion: Ambulatory PEFR monitoring is non-inferior to the monitoring of the forced expiratory volume in 1 second and could be used for screening purposes on equal grounds with spirometry. [ABSTRACT FROM AUTHOR]

Background: Despite ample international knowledge on cost-effectiveness of total knee arthroplasty (TKA), it has never been a subject of investigation in Kazakhstan or other post-Soviet economies. Our study aimed to carry-out the cost-utility analysis of TKA alone and in comparison with post-surgical rehabilitation and conservative treatment at health care facilities of Kazakhstan. Methods: Two hundred and forty four patients with knee osteoarthritis (KOA) who underwent TKA in orthopedic departments of Almaty, Nur-Sultan and Semey hospitals between January 1, 2019 and September 30, 2019 were followed-up for 12 months. The health-related quality of life was measured by the EQ-5D utility and Western Ontario and McMaster Universities Osteoarthritis Index was used to measure the patients' health status. The costs were estimated from the view of health care provider. We calculated the cost per QALY, the Cost-Utility Ratio and the Incremental Cost-Effectiveness Ratio. Results: At the time of 12-month follow-up patients who received TKA alone or with the course of rehabilitation showed benefit over patients from the group of conservative treatment in terms of overall health status. Mean QALY gained at 12 months constituted 1.66 for the group that received TKA with rehabilitation, 1.48 for the group that received TKA alone and 0.24 for the group that received conservative treatment. Mean cost per QALY gained was USD 30 795.75 for KOA patients under conservative treatment, USD 6 323.69 for KOA patients subjected to TKA and USD 2 670.32 for KOA patients with rehabilitation course after TKA. Conclusion: Both TKA and TKA with rehabilitation could be considered as highly cost-effective interventions. The data obtained could be of interest for policy makers, medical professionals and KOA patients. [ABSTRACT FROM AUTHOR]

The article describes the effect of the fluxing ability (FA) of ores used as a flux on slag formation and copper losses. In Kazakhstan, at the Balkhash copper smelting plant (BCSP), currently used fluxes have a very low SiO2 content—about 62%—whereas the Al2O3 content is 12%. Its fluxing ability (FA) was estimated, and it was shown that currently used silica fluxes have an exceedingly low FA. Only half of the fluxes participate in the slag formation. To obtain slags with a low magnetite concentration, a considerable surplus of flux must be added, which will result in a sharp reduction in its melt temperature, increased slag output, and therefore copper losses. The slag structure was studied by means of scanning electron microscopy and electron probe microanalysis (EPMA). To determine one of the primary causes of flux ores' low FA, it is necessary to use the microstructural pattern of experimental samples. [ABSTRACT FROM AUTHOR]

Studies of volcanic rocks in orogenic troughs of Eastern Kazakhstan were carried out. The troughs were formed at late-orogenic stages of evolution of Hercynian Altai collision system. Volcanic rocks are represented by basalts, andesites, dacites and rhyolites. Based on geochemical and isotopic data, the basalts and andesites derived from mafic magmas that formed as a result of partial melting of garnet peridotites in the upper mantle under the orogen. U–Pb zircon data prove two volcanic stages: more-scaled Middle Carboniferous (~311 Ma) and less-scaled Early Permian (297–290 Ma). Basalts and andesites in lower parts of the orogenic troughs and independent dacite-rhyolite structures were formed at the Middle Carboniferous stage. Parental mafic magmas were formed as a result of partial melting of mantle substrates in local transtensional zones along large shear faults. The formation of dacites and rhyolites could have been caused by partial melting of crustal substrates under effect of mafic magmas. Transtensional movements in the lithosphere of orogenic belts may indicate the beginning of collapse of orogens. A smaller volume of basalts and andesites formed at the Early Permian stage. Geochemical data prove the independent episode of partial melting in upper mantle. Synchronous basalts and andesites also appeared at wide territory in Tian Shan, Central Kazakhstan, and Central and Southern Mongolia. Early Permian volcanism indicates general extension of the lithosphere at the postorogenic stages. Large-scaled Early Permian mafic and granitoid magmatism in Central Asia has been interpreted in recent years as the Tarim Large Igneous Province caused by Tarim mantle plume activity. Thus, the extension of the lithosphere and associated volcanism in the Early Permian can be an indicator of the onset of the plume–lithosphere interaction process. [ABSTRACT FROM AUTHOR]

Biogenic sulfide production in oilfields results in lower quality of oil and gas and in corrosion of oil-producing equipment. Bactericidal agents are not used at the Karazhanbas oilfield (Kazakhstan), since sulfate concentrations in both injected and formation water are low or zero. However, increasing corrosion of steel equipment and sulfide release into formation water were observed in the course of the oilfield development. The goal of the present work was to reveal the potential agents of microbial corrosion and to investigate the possibility to suppress development of sulfidogens using nitrate. Environmental conditions and the composition of microbial communities in production and injection water were studied for the sites with different temperatures. High-throughput sequencing of the V3–V4 region of the 16S rRNA gene revealed predominance of thermophilic sulfate-reducing bacteria (genera Thermodesulfobacterium, Thermodesulfovibrio, Desulfotomaculum, Thermodesulforhabdus, Desulfovirgula, Defluviitoga, and Desulfonauticus) and archaea (genus Archaeoglobus) at the high-temperature horizon, as well as of thiosulfate-reducing (genera Thermoanaerobacter, Anaerobaculum, and Coprothermobacter) and syntrophic bacteria, while abundance of methanogens (genera Methanolinea and Methanothermobacter) was low. Communities from low-temperature horizons contained mesophilic methanogens (genera Methanococcus, Methanobacterium, and Methanothrix), thermophilic and mesophilic sulfate-reducing bacteria (genera Desulfovibrio, Desulfomicrobium, Desulfosarcina, Desulfoglaeba, Desulfotignum, and Desulfocurvus), syntrophic bacteria (genus Smithella), and members of the genera Marinobacter, Paracoccus, Alcaligenes, Arcobacter, and Halomonas. Enrichment cultures of bacteria producing sulfide were obtained from formation water, as well as the cultures reducing nitrate to nitrite and suppressing growth of sulfate- and thiosulfate-reducing bacteria. These findings may indicate the possibility of using nitrate as a competitive inhibitor of sulfidogenesis in this oilfield. Corrosion-active hydrogen-utilizing methanogens and acetogens were also found, which implies the necessity for monitoring the oilfield microbial communities. [ABSTRACT FROM AUTHOR]

Background: Pre-eclampsia (PE) still significantly contributes to maternal and neonatal morbidity and mortality. This study aimed at evaluation of the prevalence of PE among Kazakhstani women and on elucidation of the associated maternal and neonatal outcomes.Methods: The study followed a retrospective cross-sectional design and was based on the data obtained from the electronic patient registry comprising health records of all patients hospitalized to maternal facilities of Kazakhstan over the period of one year. The diagnosis of PE was made on the basis of criteria established by International Society for the Study of Hypertension in Pregnancy.Results: Out of 2548 patients, 2408 (94.5%) were non-PE cases, while 54 (2.1%) were early-onset PE cases and 86 records (3.4%) were late-onset PE cases. Birth weight of children born from PE pregnancy was significantly lower in pregnancies complicated with early onset PE and constituted 1565 g. Postpartum hemorrhage was more prevalent in pregnancies complicated with PE.Conclusion: The data obtained are needed to tailor public health interventions targeted on a reduction of PE problem in Kazakhstan. [ABSTRACT FROM AUTHOR]

Abstract The present study investigates the rates of depression, anxiety, somatic distress, and fatigue in a rural population of Abayskiy, Borodulikha and Mayskiy districts exposed to radiation from Semipalatinsk Nuclear Test Site in comparison with the unexposed population of Kurchum district. The sample size included 901 people, of whom 656 were residents of radioecological contaminated areas, while 245 resided at ecologically safe territories and had no radiation exposure in the past. Both study groups had no significant differences concerning age, sex, level of education, smoking habit, and alcohol consumption. The prevalence of depression, anxiety, somatic distress and fatigue in the exposed group was found to be considerably higher than that in the unexposed. Results of logistic regression analysis showed considerable differences in associations between depression and anxiety, as wells as between depression and somatic distress in the exposed group. Besides, depression was significantly associated with general fatigue, reduced activity, physical fatigue, reduced motivation and mental fatigue in the unexposed group. There is a need to tailor public health interventions focused on the identification and management of individuals exhibiting mental distress, including the provision of adequate information about radiation-induced health effects, quality routine check-ups and psychological counseling. Highlights • The population of Kazakhstan was exposed to radiation due to nuclear weapon testing. • People who are exposed to radiation have higher mental distress rates. • Associations between depression, anxiety, somatic distress, and fatigue were found. • There is the need to apply public health program to combat mental distress. [ABSTRACT FROM AUTHOR]

Abstract: The first detailed isotope-geochemical study of carbonate deposits has been performed in the Lower Famennian stratotype section of the northwestern Kuznetsk Basin (Kosoy Utyos), which was localized in the middle latitudes of the Northern Hemisphere in the Late Devonian. The δ13Ccarb, δ13Corg, and δ18O variation curves were constructed for the section deposits. Geochemical and petrographic studies of carbonates allowed allocation of samples that underwent postsedimentation alteration and exclude them from further interpretation. Compared with coeval sections in the other world''s regions, the Kosoy Utyos section is characterized by higher δ13Ccarb values, up to 5.4‰, whereas the maximum value in subequatorial area sections is 4‰. The isotope shift amplitude of the studied section reaches 4.6‰, which is 1.5‰ higher than those in other regions. The δ18O values are 3‰ lower than the ones of the world''s coeval sections. The results obtained show that δ13C and δ18O variation trends differ from those of coeval subequatorial sections. The high shift amplitude and maximum δ13Ccarb values in the Kosoy Utyos section are due to the shallow-water carbonate sedimentation environments on the Siberian continental shelf and, probably, the lower temperatures of waters in the middle latitudes as compared with the subequatorial areas. [Copyright &y& Elsevier]

Focuses on the analysis of breast milk to assess exposure to chlorinated contaminants in Kazakstan. Measurement of organochlorine pesticides and polychlorinated biphenyls in samples of breast milk; Adherence to the World Health Organization protocol for the assessing levels of chlorinated contaminants.

The genesis of leucogranite magmas is important issue of geodynamics, petrology and ore geology because leucogranites are associated with collisional belts, partial melting of sedimentary source rocks, and may host rare metal (Sn, W, Li, Nb Ta, and Be) mineralization. To establish the petrogenesis of large leucogranite intrusions, detailed studies of petrography, mineralogy, fluid regime, and the material and isotopic composition of rocks are required. The paper reports results of the studies of the Delbegetei massif of the intrusion in Eastern Kazakhstan. The massif is composed predominantly of leucocratic granites, while syenogranites are subordinate. Rocks of the massif belong to shoshonitic and high-K calc-alkaline series; demonstrate a predominance of K over Na, high ferroan and high contents of LREE and HFSE; which allows them to be classified as A-type granites. The age of Delbegetei massif, estimated by the U Pb zircon dating, varies in the range 249–240 Ma, which correspond the Early-Middle Triassic. The differences in rock composition and in temperatures of zircon saturation allow supposing that syenogranites and leucogranites formed from different parental magmas. Syenogranite magma formed as a result of partial melting of metamorphosed volcanic rocks (andesidacites or dacites) with possible influence of mafic magmas. Leucogranite magma formed as a result of fluid-present partial melting of metaterrigenous sedimentary rocks. Leucogranite magma underwent the feldspars differentiation in the fluid-present conditions. This led to composition variations of leucogranites. Analysis of the geological position, age and composition of the rocks allows concluding that the Delbegetei massif formed at the Early Triassic in an intraplate geodynamic setting and that the activity of the Siberian mantle plume is the most probable reason for their formation. • The Delbegetei massif is composed of the A-type syenogranite-leucogranite series. • The meta-volcanic rocks are possible source for syenogranites. • The metasedimentary rocks are possible source for leucogranites. • The age of massif is Early-Middle Triassic (249–240 Ma). • The Siberian LIP is the most probable reason for Delbegetei massif formation. [ABSTRACT FROM AUTHOR]

Background. Prostate cancer (PCa) is the second most commonly diagnosed cancer, and the sixth most common killer among men worldwide (Aubry et al., 2013). This research was motivated by the fact that PCa screening continues to be a controversial topic in the Kazakh medical community. This study aimed at description of how newly diagnosed PCa patients are managed in Pavlodar region of the Kazakhstan Republic and at presentation of a budget impact analysis (BIA) for PCa screening program. Also, we aimed to provide a comparative analysis of pricing system on medical services applied in both private and public healthcare sectors of the Kazakhstan Republic. Methods. New cases of PCa have been retrospectively analyzed for the period from January 2013 to December 2017 based on the information obtained from information system "Policlinic" maintained by the Pavlodar regional branch of the Republican Center for Electronic Health and from Cancer Registry of Pavlodar Regional Oncology Center. All data were analyzed with the help of SPSS 20.0 software. Results. The mean age of PCa patients was 68.34 years (SD = 8.559). The government of Kazakhstan invested 20,437,000 KZT (Kazakhstani tenge) in 2017 equivalently 61,188 USD—to fund a pilot study for examination of 9638 men. From 2013 to 2017, out of 49,334 men residing in Pavlodar region of Kazakhstan 1,248 men were diagnosed with prostate diseases, including 130 PCa cases. The PCa detection rate was equal to two cases per month. Only 22.8% of all PCa cases identified in the region within specified time period were revealed as a result of the government-funded PCa screening program. The average prostate cancer detection rate among the target group of Pavlodar region within the period of 5 years was equal to 0.23%. Conclusion. Based on the fact that the PCa screening program failed to enable adequate detection of new PCa cases, we would not recommend to continue this type of screening unless it is undergone careful revision and replanning. [ABSTRACT FROM AUTHOR]

The Kalba granitoid batholith formed in Early Permian is one of the largest in the western part of the Central Asian Orogenic Belt. Batholith granites are intruded by mafic and intemediate dykes forming several swarms. Previously it was believed that the dykes were Mesozoic and had no relationship with the formation of the batholith. Our geochronological studies allow to determine the age of the dykes at 279 Ma (also Early Permian). Dyke rocks are represented by dolerites, variolites, monzodiorites, and plagioclase porphyrites. The petrographic study of plagioclase porphyrites allow to find the sign of magma mixing. The another indicator of magma mixing are the contacts between mafic and felsic rocks in largest dykes of complex structure. A model for the interaction of mafic magmas with crustal substrates is proposed. Mafic magmas intruded from sublithospheric mantle, provoked a partial melting and then interacted with granitic melts at the basement level of granite batholith. Dyke swarms were formed after the cooling and consolidation of main volume of Kalba batholith by inrtusion of mafic and hybride magmas from the basement level of granite batholith. Chemical diversity of the mafic dykes was caused mainly by the differentiation of parental mafic magmas and also a lesser extent by their interaction with the granitoid magmas. Comparison with data on coeval magmatism in neighboring regions suggests that the Kalba batholith may be included in areal of Early Permian Tarim Large Igneous Province. • The dyke swarms cut the granites of the Kalba batholith in Eastern Kazakhstan. • The dykes and the Kalba batholith granites are Early Permian. • Dyke rocks composition was caused mainly by the differentiation of mafic magmas. • Parent mafic magmas formed in lithospheric mantle and provoked melting in crust. • Geodynamic setting was a post-orogenic extension with effect of Tarim mantle plume. [ABSTRACT FROM AUTHOR]

This is a synthesis of published and new data on the Kalba batholith in Eastern Kazakhstan, the large granitic body in the western part of the Central Asian Orogenic Belt. The batholith consists of granodiorite-granite and leucogranite rocks discriminated on the basis of major- and trace-element chemistry and isotope systematics. The granodiorite-granite rocks, which form the bulk of the batholith, are compositionally variable and can be classified as mixed S-I-type granites. The leucogranites occurring as a few large intrusions in the northwestern part of the batholith have more stable compositions, with high contents of REE, HFSE, F, Li, and B, typical of A-granites. Judging by the isotope systematics of the Kalba granites, compared with that of their potential parent rocks from the Kalba-Narym zone and its surroundings, the two groups originated by different mechanisms in two magmatic events. The granodiorite-granites were produced by large-scale melting of crustal material, including the metabasaltic basement and overlying metavolcanic and metasedimentary rocks. The origin of leucogranites was associated with low-degree partial melting of the deepest Kalba-Narym sediments under the effect of fluoride fluids. The batholith formation spanned about 21 myr: granodiorites and granites formed in the 297–286 Ma interval and leucogranites between 288 and 276 Ma. The ages of the two events bracket the intraplate postorogenic stage of the CAOB history that was coeval to the formation of the Tarim large igneous province. • The Kalba batholith formed at 297–276 Ma and includes I-S-type and A-type granites. • Both I-S-type and A-type granites were emplaced in three phases each. • MORB and OIB volcanic and metasediments were sources of granitic magma. • The formation of the Kalba batholith was coeval to the Tarim LIP. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency (VDD) is one of the serious and highly debatable public health problems affecting at least one billion of world population. This study objected to evaluate Vitamin D status in adult population of both sexes residing in different geographical areas of Kazakhstan and to elucidate the possible contributing factors related to VDD. This cross-sectional study covered 6 regions of Kazakhstan and applied the systematic random sampling to recruit 1347 healthy adults (of whom 819 were females) with mean age 44 ± 14 years. The concentration of 25-hydroxy vitamin D (25-OHD) was measured from May 2018 to August 2018 with Architect 25OH Vitamin D assay (Abbott Ireland Diagnostics Division Lisnamuck, Longford Co. Longford Ireland). Vitamin D deficiency was defined as 25-OHD values not exceeding 20 ng/mL as a reference threshold in healthy population. The median serum 25(OH)D concentrations in all studied regions of Kazakhstan were below the reference threshold (20 ng/mL). The lowest range of vitamin D (<10 ng/mL) was observed more commonly in females (34.6 % – 283) as compared to males (16.7 % – 88) and was significantly higher in Asians (33.2 % – 352) in contrast with Caucasians (6.7 % – 19) (χ2 = 177,939; D.f. = 3; p-value=<0,001). The proportion of severe VDD was higher in individuals with low body mass index (31.1 % – 188) vs. individuals with high body mass index (18.7 % – 50). In this study individuals aged 60 years and older had the most favorable situation with 25-OHD concentrations since these were normal in 14.4 % of observations (χ2 = 26,589; D.f. = 6; p-value=<0001). Studying the prevalence of VDD is an important public health task. Further research is needed to understand the epidemiology of VDD in more details to tailor intervention programs. [ABSTRACT FROM AUTHOR]