Andrej Mechislavovich Grjibovski

The use of artificial intelligence in medical education is expanding and is considered a tool to improve the learning of analytical disciplines, including biostatistics. It is important to identify the factors that influence information comprehension during learning and the effectiveness of its use. Aim. To assess the factors and their interrelations that influence the level of information comprehension in the discipline “Biostatistics” and the effectiveness of its application in professional work. Methods. A quantitative analytical cross-sectional study was conducted using an online sur-vey of 589 students from six medical universities and two schools of medicine within multidisciplinary universities. The model included six latent variables: perceived usefulness, engagement in AI use, learning satisfaction, perceived career value, perceived educational effectiveness. The analysis was performed using the PLS-SEM in SmartPLS with assessment of reliability, validity, structural between variables were assessed. Results. Statistically significant relationships were found between perceived usefulness and engagement (β=0.270; p<0.001), engagement and learning satisfaction (β=0.360; p<0.001), satisfaction and career value (β=0.751; p<0.001), and career value and educational effectiveness (β=0.252; p<0.001). Perceived usefulness also had a direct effect on overall effectiveness (β=0.548; p<0.001). Additionally, a consistent indirect effect was identified (β=0.018; p<0.001), including that the influence between the indicators is mediated by other factors. Conclusion. Educational effectiveness is associated not only with the use of technology but also plays a key role in student engagement and satisfaction with learning. The findings highlight the importance of the quality of the learning experience and the professional value of digital competencies.

Background: Informal caregivers play a central role in supporting older adults with functional limitations, yet caregiving may impose substantial physical, psychological, social, and occupational demands. Objectives: This study aimed to explore caregiving experiences, sources of burden, and unmet healthcare and social support needs among informal caregivers of older adults with high caregiver burden. Methods: This qualitative study represented the second phase of a sequential explanatory mixed-methods study. Ten caregivers were purposively selected from the preceding quantitative phase based on a high caregiver burden, Caregiver Strain Index Plus (CSI+) score ≥ 7. In-depth semi-structured interviews were conducted in Kazakh or Russian across four cities of Kazakhstan and analyzed using inductive reflexive thematic analysis. Results: Six themes were identified: (1) physical and psychological impact of caregiving; (2) work–care balance and social isolation; (3) gender roles in the care of older adults; (4) insufficient support from healthcare and social services; (5) unmet caregiver needs; and (6) limited awareness of available support and services. Participants described increasing physical and emotional strain, disruption of employment and social life, and gendered expectations surrounding family caregiving. They also reported limited professional guidance and recognition, unmet needs for respite and practical assistance, and limited awareness of available health and social services, with informal networks and online sources often used to obtain information. Conclusions: Strengthening caregiver support within primary healthcare and improving access to information, practical assistance, and respite services may help address the needs identified among caregivers with high caregiver burden.

The high prevalence of periodontal inflammatory diseases (PID) among adolescents underscores the need to develop simple, non-invasive methods for their timely detection. Oral fluid is considered a promising diagnostic substrate, enabling the assessment of various biomarkers, particularly alkaline phosphatase (ALP), which is involved in inflammatory and reparative processes in periodontal tissues. However, there is a paucity of studies analyzing the diagnostic significance of this enzyme. Objective. To investigate the association between salivary ALP levels and clinical signs of PID in individuals aged 15–17 years permanently residing in the European North of Russia. In a cross-sectional study, participants (n = 439) residing in the Nenets Autonomous Okrug (n = 171), the Komi Republic (n = 146), and Murmansk Oblast (n = 121) underwent a dental examination with recording of periodontal parameters (bleeding, dental deposits, presence of periodontitis) and provided mixed saliva samples for subsequent determination of ALP activity. Data analysis was performed using Poisson regression models; unadjusted and adjusted (for sex, age, and place of residence) relative risks were calculated, and linear trends were assessed across quartiles of ALP distribution. Results: а direct statistically significant association was observed between enzyme concentration and the number of sextants exhibiting bleeding in the multivariable regression model, p for trend = 0.037. No statistically significant association was found between ALP levels and the likelihood of detecting periodontitis (p for trend = 0.404) or dental calculus (p = 0.521). Our results suggest that elevated ALP levels in the oral fluid of adolescents are associated with a greater prevalence of gingival bleeding. This suggests that this parameter may serve as a potential indicator of the severity and extent of generalized inflammation in periodontal tissues, although it is not specific for a diagnosis of periodontitis. Further prospective studies are required to definitively establish the clinical and diagnostic utility of ALP and to justify its application in routine clinical practice.

Objective — to study the prevalence and experience of dental caries in 12-year-old children and 15-year-old adolescents in Syktyvkar, Komi Republic. Material and methods. The study included 134 children and 146 adolescents. Dental examination was conducted according to the WHO methodology (2013). Caries experience was assessed using the DMFT index and its components. Caries prevalence was presented as proportions with 95% confidence intervals (CI). Comparisons of proportions were conducted using Pearson’s chi-squared tests or Fisher’s exact tests. DMFT index and its components was analyzed using Mann—Whitney tests. Results and discussion. The prevalence of caries was 79.1% (95% CI: 71.5—85.1) and 91.8% (95% CI: 86.2—95.2) among 12-year-old children and 15-year-old adolescents, respectively, with no gender differences. The corresponding mean values for the DMFT index were 3.38 (95% CI: 2.90—3.86) and 5.74 (95% CI: 5.04—6.44). No gender differences in the number of decayed, filled, and missing teeth were observed in the 12-year-olds. Among adolescents, the DMFT index was significantly greater in girls (p=0.005) due to more filled teeth (p=0.002). Conclusions. The high prevalence of caries among adolescents and the average level among children warrant improvement in preventive measures.

A BSTRACT: Background: Chlorinated pesticides and related persistent organochlorine pollutants (POPs), including polychlorinated biphenyls (PCBs), dioxins (2,3,7,8-tetrachlorodibenzo-p-dioxin [TCDD]), and hexachlorobenzene, are persistent environmental contaminants whose reproductive effects have been studied predominantly in women, leaving evidence for male reproductive health fragmented. Objective: To summarize human evidence on exposure-response relationships between chlorinated pesticides, related POPs, and male fertility outcomes. Methods: A structured, nonsystematic search was conducted in PubMed, OpenAlex, and Elicit, covering chlorinated pesticides (dichlorodiphenyltrichloroethane, lindane, dieldrin, aldrin, endosulfan, chlordecone, and 1,2-dibromo-3-chloropropane [DBCP]) and related POPs (PCBs/CB-153, TCDD/dioxins, hexachlorobenzene). Studies were included if they assessed human males, measured exposure, reported a fertility outcome, and provided a quantifiable exposure measure, per CINAR narrative-review guidelines. Results: The most consistent finding was an inverse exposure-response association with sperm motility, with formal dose-response evidence shown for compounds such as CB-153, p,p’-DDE, β-hexachlorocyclohexane (HCH), TCDD, and DBCP, while γ-HCH showed a binary exposure-response association (detectable versus non-detectable) rather than a formally tested dose-response trend. Sperm concentration and morphology showed less consistent associations, evident mainly during peripubertal exposure. A “testosterone paradox” emerged: very high chronic exposures were associated with elevated testosterone and estradiol, whereas moderate exposures showed suppression, though the mechanism remains hypothetical. Developmental timing critically modified effects, and exposure-response associations, including dose-response trends, were also documented for sperm DNA fragmentation, aneuploidy, and epigenetic alterations. Conclusions: Available evidence suggests exposure-response associations between chlorinated pesticides, related POPs, and impaired male fertility, most consistently sperm motility, with developmental timing as an important effect modifier. Given the largely cross-sectional evidence base, causal inference should remain cautious. Prospective cohorts assessing developmental exposure windows are needed, particularly in under-studied regions such as Central Asia.

Malnutrition affects the somatic health of elderly patients and worsens their rehabilitation potential. The interaction between malnutrition and impaired physical status is still unknown. The aim of the study was to examine the association between nutritional status and selected geriatric syndromes in hospitalized elderly patients. Material and methods . The study was conducted on a sample of 479 elderly and senile patients admitted in a hospital. Each patient underwent a comprehensive geriatric examination with an assessment of physical status parameters: nutritional status, walking pace, balance, basic functionality, the risk of falls by Morse Scale, orthostatic hypotension, chronic pain syndrome, the “Time up and go” test. Results and discussion . Walking pace was reduced in patients at risk of malnutrition to a greater extent than in those without nutritional problems, all patients with malnutrition showed reduced walking pace. The walking pace, balance test times, and Barthel scale performance decreased in the malnutrition and risk-malnutrition groups. The time to complete the Timed Up and Go test increased. Patients at high risk of falls according to the Morse scale, with high-intensity chronic pain syndrome are at risk of malnutrition and malnutrition. The visual analog pain scale value increases in groups at risk of malnutrition and malnutrition. Walking pace increased by 73 % (odds ratio (OR) 1.73; 95% confidence interval (95 % CI) 1.13−2.65), time to complete the Timed Up and Go test decreased by 78 % (OR 0.22; 95% CI 0.04−1.16), the Barthel Index increased by 139 % (OR 2.39; 95 % CI 1.53−3.75) with increasing Mini Nutritional Assessment scale score. Conclusions . When writing an individual rehabilitation program for an elderly patient, it is necessary to assess the nutritional status and take into account the possibilities of correcting malnutrition.

Background: Informal caregivers of stroke survivors face substantial physical, emotional, and cognitive demands, particularly when patients exhibit cognitive impairment. Despite their pivotal role in post-stroke recovery, many caregivers lack adequate preparation, knowledge, and practical skills, placing them at risk for stress, depression, and reduced quality of life. Evidence-based guidance for supporting informal caregivers, particularly in regional contexts remains limited. Objective: This study aims to examine determinants of caregiver burden and the relationships among quality of life, depression, and social support in informal caregivers of stroke survivors with cognitive impairment during the first six months post-stroke. Methods: A mixed-methods design will be conducted in Aktobe, Kazakhstan. The quantitative component includes a longitudinal study of 88 caregivers to assess changes over time and a cross-sectional sample of 310 caregivers to examine associations between caregiver burden and potential determinants. Data will be collected at three time points, 1-, 3-, and 6-months post-stroke, using the iVICQ (iMTA Valuation of Informal Care Questionnaire) questionnaire alongside validated measures of social support and depression. The qualitative component involves semi-structured interviews to explore caregivers’ lived experiences, perceived needs, and challenges. Integration of quantitative and qualitative findings will provide a more comprehensive understanding of informal caregiving experiences and support the development of context-specific caregiver support strategies. Conclusions: This study will provide the first comprehensive assessment of caregiver burden and unmet needs among informal caregivers of stroke survivors with cognitive impairment. The findings are expected to advance understanding of informal caregiving dynamics and support the integration of caregiver support into healthcare systems. Введение: Лица, осуществляющие неформальный уход за пациентами, перенесшими инсульт, сталкиваютсясо значительными физическими, эмоциональными и когнитивными трудностями, особенно когдау пациентов наблюдаются когнитивные нарушения. Несмотря на их ключевую роль в восстановлении после инсульта, многим лицам, осуществляющим уход, не хватает надлежащей подготовки, знаний и практических навыков, что подвергает их риску возникновения стресса, депрессии и снижения качества жизни. Научно обоснованные рекомендации по оказанию поддержки неформальным лицам, осуществляющим уход, особенно в региональных условиях, остаются ограниченными. Цель исследования: изучение детерминант бремени ухода, а также взаимосвязей между качеством жизни, депрессией и социальной поддержкой у неформальных лиц, осуществляющих уход за пациентами, перенесшими инсульт и имеющими когнитивные нарушения, в течение первых шести месяцев после инсульта. Материалы и методы:Исследование с использованием смешанных методов будет проводиться в городе Актобе, Казахстан. Количественный компонент включает лонгитюдное исследование из 88 лиц, осуществляющих уход, для оценки изменений во времени, а также поперечную выборку из 310 лиц, осуществляющих уход, для изучения взаимосвязей между бременем ухода и потенциальными детерминантами. Данные будут собираться в три временные точки - через 1, 3 и 6 месяцев после инсульта с использованием опросника iVICQ (iMTA Valuation of Informal Care Questionnaire), а также валидированных инструментов оценки социальной поддержки и депрессии. Качественный компонент включает полуструктурированные интервью, направленные на изучение жизненного опыта лиц, осуществляющих уход, их воспринимаемых потребностей и трудностей. Интеграция количественных и качественных результатов позволит получить более всестороннее понимание опыта неформального ухода и будет способствовать разработке контекстно-ориентированных стратегий поддержки лиц, осуществляющих уход. Выводы: Данное исследование позволит впервые провести комплексную оценку бремени ухода и неудовлетворённых потребностей среди неформальных лиц, осуществляющих уход за пациентами, перенесшими инсульт и имеющими когнитивные нарушения. Ожидается, что...

The appearance of the skin and its appendages, including eyelashes and eyebrows, is an important component of physical and psychosocial well-being and substantially affects quality of life. The condition of eyelashes and eyebrows is determined by a complex interplay of endogenous and exogenous factors, including environmental exposure, systemic diseases, and cosmetic procedures. Interest has recently grown in cosmetic products aimed at stimulating growth and improving the quality of eyelashes and eyebrows; however, the evidence base supporting the effectiveness of many active ingredients remains limited. This narrative review summarizes current research on the potential of dihydroquercetin in combination with adenosine, kopyrrol, and several other compounds in cosmetic formulations intended to promote eyelash and eyebrow growth. We focus on the challenges of low solubility and bioavailability of dihydroquercetin and on current strategies for overcoming these limitations, including cyclodextrin encapsulation and other pharmaceutical and technological approaches. We present data on the molecular mechanisms underlying hair growth stimulation, including activation of the Wnt/β-catenin, AKT, and MAPK/CREB signaling pathways and induction of growth factors. We also review clinical and experimental studies evaluating adenosine, kopyrrol, arabinogalactan, and peptides for hair, eyebrow, and eyelash growth. Based on the analyzed data, we discuss the potential for synergistic effects of combined formulations, and outline key directions for further experimental and clinical research needed to substantiate the efficacy and safety of such cosmetic products in reducing the impact of adverse environmental factors and preserving aesthetic appearance, quality of life, satisfaction with appearance, and social functioning.

Prion diseases (PD) represent a group of rare yet fatal neurodegenerative disorders caused by the conformational transformation of the cellular prion protein into its pathological isoform. Despite their low incidence, these diseases remain a significant medical and social challenge due to the lack of effective treatments and the risk of iatrogenic transmission. Purpose of the review was to identify key unresolved issues in PD research, including molecular mechanisms of pathogenesis, opportunities for early diagnosis, and promising therapeutic approaches, as well as to outline the most critical directions for future studies. A systematic literature search was conducted in PubMed, Google Scholar, eLibrary, and CyberLeninka databases for the period 2016–2025. Fifty-one relevant publications were selected, comprising original studies, reviews, and clinical cases. The analysis was performed in accordance with CINAR guidelines and SANRA criteria. Modern diagnostic techniques (RT-QuIC, DWI-MRI) have significantly improved the detection of PD, though their widespread implementation is hindered by high costs and the need for specialized expertise. The most promising therapeutic strategies include monoclonal antibodies (PRN100), antisense oligonucleotides, and CRISPR/Cas9 technology. Epidemiological data confirm a decline in variant Creutzfeldt – Jakob disease (vCJD) cases due to enhanced biosafety measures, though risks associated with prolonged incubation periods persist. To enhance the diagnosis and treatment of PD, it is essential to establish a national registry, expand laboratory networks, train specialists, and strengthen biosafety protocols. Future research should focus on combined therapeutic strategies and in-depth exploration of the molecular mechanisms underlying these disorders.

The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) emphasize that the widespread implementation of vaccination against measles, diphtheria, poliomyelitis, and other infectious diseases significantly reduces morbidity and mortality rates. The aim of this study was to explore parental attitudes toward childhood vaccination and to identify key motivations and barriers influencing immunization decisions. Materials and methods. A qualitative study was conducted in Aktobe, Kazakhstan, between September and December 2024. Individual in-depth interviews were carried out with 15 parents of children aged 0–7 years who attended primary health care centers. A purposive sampling strategy was employed to include parents of fully vaccinated, partially vaccinated, and unvaccinated children. The interviews lasted between 15 and 30 minutes, were audio-recorded with participants’ consent, transcribed verbatim, and analyzed using the MAXQDA 2020 software. Results. Parents of fully vaccinated children perceived immunization as a socially significant measure for protecting health. Among partially vaccinated parents, a strategy of “selective responsibility” was observed—choosing vaccines based on individual risk assessment. For unvaccinated parents, the main barrier was personal or observed negative experiences related to vaccination, which fostered distrust toward the healthcare system and official information sources. Conclusions. To strengthen public confidence in vaccination, it is essential to ensure transparent communication about vaccine safety, composition, and quality control, as well as to develop targeted informational strategies that take into account parents’ varying levels of trust and motivation. Аннотация. Всемирная организация здравоохранения (ВОЗ) и Центры по контролю и профилактике заболеваний (CDC) подчёркивают, что широкое применение вакцинации против кори, дифтерии, полиомиелита и других инфекционных заболеваний значительно снижает уровень заболеваемости и смертности. Цель данного исследования заключалась в изучении отношения родителей к вакцинации детей и выявлении основных мотивов и барьеров, влияющих на принятие решений об иммунизации. Материалы и методы. Качественное исследование проведено в городе Актобе (Казахстан) в период с сентября по декабрь 2024 года. Проведены индивидуальные глубинные интервью с 15 родителями детей в возрасте от 0 до 7 лет, посещающими учреждения первичной медико-санитарной помощи. Применялся целенаправленный отбор респондентов, включавший родителей полностью, частично и невакцинированных детей. Интервью длились от 15 до 30 минут, записывались с согласия участников, транскрибировались дословно и анализировались с использованием программы MAXQDA 2020. Результаты. Родители полностью вакцинированных детей рассматривали иммунизацию как социально значимую меру защиты здоровья. Среди частично вакцинированных родителей наблюдалась стратегия «избирательной ответственности» — выбор вакцин на основе индивидуальной оценки риска. Для родителей невакцинированных детей основным барьером выступал личный или наблюдаемый негативный опыт, связанный с вакцинацией, формирующий недоверие к системе здравоохранения и официальным источникам информации. Выводы. Для повышения доверия к вакцинации необходимо обеспечить прозрачную коммуникацию о безопасности и контроле качества вакцин, а также разрабатывать адресные информационные стратегии с учётом уровня доверия и мотивации родителей. Түйін. Дүниежүзілік денсаулық сақтау ұйымы (ДДҰ) мен Ауруларды бақылау және алдын алу орталықтары (CDC) қызылша, дифтерия, полиомиелит және басқа да жұқпалы ауруларға қарсы вакцинацияны кеңінен енгізу сырқаттанушылық пен өлім-жітім деңгейін едәуір төмендететінін атап өтеді. Осы зерттеудің мақсаты – ата-аналардың балаларды вакцинациялауға деген көзқарасын зерттеу және иммундау жөніндегі шешім қабылдауға әсер ететін негізгі уәждер мен кедергілерді айқындау. Материалдар мен әдістер. Сапалық зерттеу 2024 жылдың қыркүйек–желтоқсан айлары аралығында...