Keyword: Health Care

ABSTRACT: Introduction. Routine indicators of rehabilitation effectiveness are rarely checked against validated measures in children. Kazakhstan mandates the Rehabilitation Routing Scale, whose properties in children are unknown. We tested whether its change agrees with change on the Gross Motor Function Measure and the Barthel Index.
Methods. We analyzed 318 consecutive admissions to a national pediatric rehabilitation center (August to September 2025) from anonymized discharge records. Change scores were available for 306 children (Routing Scale), 215 (Gross Motor Function Measure) and 150 (Barthel Index). We estimated the magnitude of change, Spearman correlations of change scores (hypothesis: at least 0.30) with bootstrap 95% confidence intervals, tertile agreement and classification agreement.
Results. Most children improved on every scale (88%, 92% and 96%); the Routing Scale never recorded a decline. Admission scores agreed moderately (correlation 0.69 with the Gross Motor Function Measure and 0.52 with the Barthel Index). Change scores did not: 0.04 (95% confidence interval -0.10 to 0.18; 208 children) and -0.05 (-0.21 to 0.12; 143 children), while change on the two validated scales correlated weakly, at 0.29 (0.08 to 0.48; 90 children). Among 86 children with all three scales, 40 improved on all three and 38 improved on both validated scales but not by a ratio of at least 1.10 on the Routing Scale. Sensitivity analyses gave similar results, except that the Barthel Index correlation changed sign between age groups.
Conclusion. The national scale tracked baseline severity, but its change was not interchangeable with change on validated measures. Effectiveness reports should use more than one instrument. Limitations include a single center, a short stay, no test-retest data and no external anchor.

ABSTRACT: Antimicrobial resistance continues to threaten the effectiveness of modern antimicrobial therapy, with ESBL-producing Escherichia coli emerging as a major cause of difficult-to-treat healthcare-associated infections. The global spread of these organisms is driven by antimicrobial selection pressure, genetic adaptability and transmission across healthcare, community and environmental reservoirs. This narrative review aimed to synthesise current evidence on the epidemiology, risk factors, transmission pathways, infection prevention strategies, antimicrobial stewardship approaches and emerging therapeutic options for ESBL-producing E. coli in healthcare settings.
A structured narrative review was conducted using literature published between 2016 and the search date (June 6, 2026) indexed in PubMed, ScienceDirect, Dimensions and Google Scholar as well as literature obtained through grey literature search and screening of reference lists.. Relevant studies, including epidemiological investigations, molecular studies, clinical research, systematic reviews, surveillance reports and treatment guidelines, were critically analysed through thematic synthesis.
The review found that ESBL-producing E. coli has become a globally distributed antimicrobial-resistant pathogen, with healthcare populations experiencing substantial intestinal carriage and infection burden. It was found that prolonged hospitalisation, previous antibiotic exposure, invasive devices, diabetes, chronic wounds and increased healthcare contact significantly contribute to colonisation and clinical infection. Furthermore, transmission is sustained through interactions between patients, healthcare workers, medical devices and contaminated environments. Antimicrobial stewardship, genomic surveillance, infection prevention measures and emerging therapies such as β-lactamase inhibitors, bacteriophage therapy and microbiome-based interventions represent important strategies for future control.
Overall, reducing the burden of ESBL-producing E. coli requires coordinated global action integrating surveillance, responsible antimicrobial use, infection prevention and innovation in therapeutic development.

ABSTRACT: Digital technologies are increasingly used to support healthcare and social care for older adults, yet their effects on access and satisfaction depend on technological, individual, and organizational conditions. This structured narrative review synthesized current evidence on the impact of digital technologies on access to and satisfaction with health and social care among older adults. A comprehensive literature search was conducted iteratively from February 2025 through May 2026 in seven international and regional databases and search platforms. English- and Russian-language publications addressing older adults, digital health technologies, healthcare or social care access, satisfaction, and related implementation outcomes were considered. Forty-eight publications were included. Because study designs, populations, technologies, and outcomes were heterogeneous, findings were synthesized narratively and organized thematically. Evidence most consistently suggested that telemedicine, electronic health technologies, mobile health technologies, remote monitoring, mobile applications, and wearable devices may reduce geographical and mobility-related barriers, support continuity of care and chronic disease management, and improve satisfaction when services are usable, trusted, and adequately supported. Satisfaction findings were more context-dependent than access outcomes. Digital literacy, connectivity, affordability, interface usability, privacy concerns, technophobia, and access to technical or professional support repeatedly influenced adoption. Evidence specifically addressing social care, long-term care, and integration between healthcare and social services was comparatively limited. Digital technologies may complement conventional care for older adults, but age-appropriate design, digital-literacy support, privacy safeguards, non-digital alternatives, and integration into existing care pathways are important for equitable implementation.

ABSTRACT: Background: Leadership effectiveness is a key determinant of organizational performance in healthcare systems. Although leadership styles and emotional intelligence have been widely studied in high-income countries, limited empirical evidence exists within transitional healthcare systems such as Kazakhstan. This study assessed leadership effectiveness among healthcare managers in Kazakhstan and examined associations between leadership effectiveness, leadership styles, and emotional intelligence.
Methods: A cross-sectional study was conducted between November 2024 and March 2025 among 77 healthcare managers from medical organizations in Astana and Almaty. Participants were selected using stratified random sampling across managerial levels. Leadership styles were measured using the Multifactor Leadership Questionnaire, emotional intelligence using the Emotional Competency Profiler, and leadership effectiveness using the Management Research Group framework. Reliability and content validity were confirmed. Descriptive statistics and Pearson correlation analysis were performed to examine associations between leadership effectiveness and independent variables.
Results: Among the 63 respondents who completed the survey, most reported moderate levels of effectiveness across all dimensions (creating vision, implementing vision, developing followership). Around 62-68% of participants rated their effectiveness as moderate, while approximately 22-33% reported as high. Implementing vision showed the lowest mean score (2.13). Correlation analysis showed that leadership effectiveness was positively associated with transformational (r = 0.45, p = 0.038) and transactional leadership (r = 0.54, p < 0.001), as well as emotional intelligence (r = 0.57, p < 0.001), with emotional intelligence suggesting the strongest relationship. In contrast, no significant association was observed for laissez- faire leadership (r = 0.2617, p = 0.1076).
Conclusion: Leadership effectiveness among healthcare managers in Kazakhstan is positively associated with active leadership styles and emotional intelligence. Strengthening competencies related to vision implementation and emotional intelligence may support leadership development within ongoing healthcare reforms. Further research using larger and more diverse samples is warranted.

ABSTRACT: Endocrine-disrupting chemicals (EDCs) are exogenous substances that interfere with the normal functioning of the endocrine system, leading to adverse effects on human health, particularly in relation to reproductive, developmental, and metabolic processes. Recent research has increasingly identified personal care products (PCPs) as a major source of EDC exposure. These often contain chemicals such as parabens, phthalates, and triclosan, which retain endocrine activity even at low concentrations. 
This narrative review aimed to consolidate current research on the exposure pathways, health effects, and regulatory frameworks associated with EDCs in PCPs.  
A narrative review approach was adopted, focusing on studies published between 2021 and 2026. A comprehensive literature search was conducted in PubMed and ScienceDirect. 
The review found that EDCs are widely present in personal care products and dermal absorption, oral ingestion, and inhalation are the primary pathways through which EDCs enter the body.  EDCs pose significant risks to human health, including reproductive dysfunction, developmental delays, metabolic disorders, and cancer risks with cumulative exposure exacerbating these risks. Regulatory frameworks vary globally, with many regions lagging in addressing the long-term impacts of EDC exposure.
Ultimately, the findings emphasize the urgent need to address the public health implications of EDC exposure from PCPs, which contribute to chronic diseases across multiple systems. Effective policy recommendations include stricter regulations on EDCs in consumer products, better monitoring systems, and enhanced consumer awareness. These findings will be of significant value to public health officials, regulatory bodies, industry stakeholders, and health professionals who can influence and implement strategies for reducing EDC exposure to protect human health.

ABSTRACT: In March 2026, Kazakhstan approved a new national Healthcare Development Concept for 2026–2029. This editorial provides a rapid critical analysis of the document, comparing it with its 2022–2026 predecessor. We identify genuine advances, including expanded indicator architecture, health technology assessment tools, digital health ambitions, and an explicit adolescent health agenda alongside persistent structural weaknesses: the absence of a theory of change, limited economic evaluation, no comprehensive human resources for health strategy, and a thin monitoring and evaluation framework. We also raise a chronic governance concern: the Concept was adopted without meaningful consultation with the professional and academic health community, in tension with President of Kazakhstan Tokayev's stated commitment to a hearing state.

ABSTRACT: This article presents a comprehensive analysis of the health system of the Republic of Kazakhstan, its current state, key achievements and remaining challenges. Using the Harvard “Five Control Knobs” analytical framework (financing, payment, organization, regulation and behavior), as well as analysis of the dynamics of the main medical and demographic indicators and human resources for 2017-2023, the article seeks to fill the gap in the systemic understanding of the effectiveness of the ongoing reforms and their impact on the health of the population. Particular attention is paid to the relationship between the various components of the system and the identification of priority areas for further improvement.
Our findings indicate a moderate improvement in population health, with average life expectancy increasing from 72.9 to 75.1 years and overall mortality returning to pre-pandemic levels. However, noncommunicable diseases continue to account for approximately 84% of all deaths. Total health expenditure remained low at 3.8% of GDP in 2023, while out-of-pocket spending accounted for 27.7% of current health expenditure, reflecting persistent gaps in financial protection. Although the introduction of mandatory social health insurance has expanded pooled financing, significant weaknesses persist in provider incentive structures, workforce distribution, and regulatory enforcement.
Overall, the results suggest that while gradual progress has been achieved, chronic underfunding, system fragmentation, and governance challenges continue to constrain equity and efficiency, underscoring the need for coordinated, evidence-based reforms.

ABSTRACT: Japan's healthcare system recognized for its achievements in universal healthcare coverage, for one of the highest life expectancies, and for low infant mortality rate. These impressive results achieved after decades of thoughtful policy making process and financial investments into the equitable access. In addition to that Japan has a long history of strong public health traditions and sophisticated insurance model. On the other hand, despite these achievements, the healthcare system recently faces growing pressure which may impact its sustainability and fairness.  One of the challenges is rapid aging of population.  In combination with persistently low fertility, these challenges are reshaping the demand for healthcare and long-term care services. Moreover, financial pressure in increasing with health-related and social security expenditures consume a growing share of the national budget. A shrinking number of workforces, unequal healthcare provider distribution, and fragmentation across nearly 3,000 health private insurers create additional inefficiencies and threaten equitable access of the population to healthcare services, especially in the rural areas. In addition, the healthcare system is under strain from rising number of multimorbidity and increasing mental health issues among young population. Advance in technological progress creates opportunities but at the same time requires substantial adaptation.

ABSTRACT: The COVID-19 pandemic accelerated the adoption of telemedicine and artificial intelligence (AI), transforming healthcare delivery worldwide. These technologies hold promise for improving access, efficiency, and diagnostic accuracy, but their benefits remain unevenly distributed. In many low- and middle-income countries (LMICs), persistent gaps in infrastructure, affordability, literacy, and governance risk turning digital innovation into a driver of health inequities. This paper examines the digital divide as a multidimensional health determinant encompassing infrastructure, affordability, human capacity, sociocultural inclusion, and governance. Using illustrative case studies from Africa, South Asia, Latin America, and high-income countries, this study highlights how telehealth and AI can enhance accessibility and enable task-shifting, while also demonstrating how exclusionary design and weak systems may perpetuate disparities. Building on these insights, the paper proposes a multi-sector framework for inclusive digital health, integrating investments in infrastructure, affordable and scalable models, digital literacy, culturally sensitive design, governance reform, sustainable financing, and public–private partnerships. To operationalize this framework, we recommend measurable indicators (e.g., affordability thresholds, literacy benchmarks, governance readiness indices) and propose implementation tools, including a logic model and barrier-to-action checklist. We argue that digital equity must be treated not as a peripheral issue but as a moral imperative for global health justice. Achieving this requires embedding equity into design, financing, and governance from the outset so that telehealth and AI reduce, rather than exacerbate, disparities in healthcare.

ABSTRACT: One of the major public health emergencies that has affected lives globally is infectious disease outbreaks. These issues are of great concern due to their potential to transcend borders. The control and management of such outbreaks even with the attention channelled towards it globally has been a difficult task in many developing and underdeveloped countries of the world of which the majority of sub-saharan african countries fall under. However, with this review, we aim to contribute to the body of knowledge dedicated towards control of infectious diseases by analyzing the preparedness of Sub-Saharan African (SSA) countries in managing infectious disease outbreaks based on lessons from recent outbreaks (with focus on COVID-19, Lassa fever and Ebola outbreaks). In carrying out this narrative review, we make use of PubMed and African Journals Online (AJOL) as the primary literature sources. To ensure we capture publications from reputable organizations that are solely involved in control of infectious diseases in the region, we carried out a grey literature search.
However in this review, we synthesized challenges such as weak healthcare systems, inadequate healthcare infrastructure, inefficient surveillance systems, poor data management and reporting practices, limited laboratory capacity and reliance on external donors for supplies during emergencies.
The review proposes potential interventional measures aimed at addressing these challenges aimed at enhancing the preparedness
The findings from this review provide critical insights into the preparedness gaps and potential interventions, informing policy and practice to enhance the region's resilience future outbreaks.

ABSTRACT: This editorial explores the transformative role of data analytics in healthcare, bridging clinical insights, personalized patient care, and population health management. By leveraging real-world data, predictive modeling, and AI, we highlight how data-driven strategies optimize treatment outcomes, enhance decision-making, and improve public health interventions—creating a seamless continuum from individual care to systemic health advancements.