Vitaliy Koikov

Background: The menopausal transition is associated with cardiovascular remodeling, but it remains unclear whether regional alterations in left ventricular (LV) myocardial mechanics are present despite preserved global systolic function. This study investigated myocardial deformation and diastolic function in women during the menopausal transition, with particular attention to the effects of chronological age and cardiometabolic factors. Methods: This cross-sectional study included 153 women aged 45–55 years, comprising 93 perimenopausal and 60 menopausal women. Menopausal status was determined using menstrual history and hormonal assessment. Conventional echocardiography and two-dimensional speckle-tracking echocardiography were performed to assess LV structure, diastolic function, global longitudinal strain (GLS), and regional longitudinal strain. Multivariable regression models were adjusted for age, body mass index, and low-density lipoprotein cholesterol. Results: GLS was similar in menopausal and perimenopausal women (−19.62 ± 2.08% vs. −19.50 ± 1.96%; p = 0.723), whereas mean basal longitudinal strain was less negative in menopausal women (−18.14 ± 2.19% vs. −19.11 ± 2.22%; p = 0.009). This association persisted after multivariable adjustment (β = 1.07, 95% CI 0.27–1.88; p = 0.009). The largest segmental difference occurred in the basal inferior segment, which was considered an exploratory finding. Basal inferior strain was associated with LV diastolic dysfunction (OR 1.13 per 1 percentage-point shift toward less negative strain, 95% CI 1.01–1.26; p = 0.038). Its addition to the clinical model increased the apparent AUC from 0.619 to 0.667 (likelihood-ratio p = 0.035), although the difference between AUCs was not statistically significant by the paired DeLong test (p = 0.167). This finding should be considered exploratory and hypothesis-generating. Conclusions: Menopause was associated with a selective shift toward less negative basal LV longitudinal deformation and less favorable diastolic function despite preserved LVEF and GLS. In an exploratory analysis, basal inferior longitudinal strain was associated with LV diastolic dysfunction, although its apparent incremental discriminative value was modest. Regional longitudinal strain may provide complementary information on subclinical cardiac functional alterations associated with menopausal status, but its clinical utility requires validation in independent cohorts.

Background: Cervical cancer remains an important preventable cause of morbidity and mortality among women in Kazakhstan. Reliable assessment of beliefs related to cervical cancer screening requires instruments that are linguistically and culturally appropriate for the target population. This study aimed to cross-culturally adapt the CCS-HBMS for bilingual Kazakh–Russian administration and to evaluate the preliminary psychometric properties of this bilingual administration format. Methods: An exploratory cross-sectional psychometric study was conducted among 199 women aged 20–60 years attending primary healthcare facilities in Astana, Kazakhstan. The 35-item CCS-HBMS underwent forward and back translation, expert review, and pilot testing and was administered in a simultaneous Russian–Kazakh bilingual format. Psychometric analyses were performed in 196 participants with complete responses to all 35 items. Internal consistency was assessed using Cronbach’s alpha, and structural validity of the original five-factor model was evaluated using confirmatory factor analysis (CFA) with the weighted least squares mean- and variance-adjusted estimator. Exploratory factor analysis (EFA) was subsequently conducted because of inadequate CFA model fit. Composite reliability (CR), average variance extracted (AVE), and the heterotrait–monotrait ratio (HTMT) were also examined. Results: Internal consistency varied across the five original subscales, with Cronbach’s α ranging from 0.481 to 0.827. Reliability was highest for Barriers (α = 0.827) and Benefits and Health Motivation (α = 0.804), followed by Susceptibility (α = 0.725), whereas lower values were observed for Seriousness (α = 0.662) and Health Motivation (α = 0.481). The original five-factor CFA model showed inadequate fit (χ²(550) = 1952.71, p < 0.001; CFI = 0.751; TLI = 0.731; RMSEA = 0.114, 90% CI 0.109–0.120; SRMR = 0.137). Parallel analysis supported retention of six factors. The six-factor solution showed lower residual misfit than the original five-factor solution (RMSR = 0.045 vs. 0.055). Given the redistribution of items across factors and the exploratory nature of these analyses, no definitive alternative factor structure was established. Convergent validity was strongest for Susceptibility (CR = 0.766; AVE = 0.523), while weaker evidence was observed for Seriousness and Health Motivation. Conclusions: The original five-factor structure of the CCS-HBMS was not supported in the present exploratory bilingual sample, and only two of the five original subscales showed Cronbach’s alpha values above 0.80. Exploratory analyses suggested a different dimensional organization but did not establish a definitive alternative factor structure. These findings should be interpreted as preliminary evidence regarding the bilingual administration format rather than as separate validation of the Kazakh- or Russian-language versions, and further evaluation in larger, more diverse, and independent samples is required.

Introduction. Local Bioethics Committees (LBCs) are an integral part of the system for protecting the rights and safety of participants in biomedical research. Their activities must align with international ethical standards while being adapted to the specific national context. In Kazakhstan, as in many countries with an emerging research infrastructure, the operation of LBCs faces several organizational and procedural challenges. Objective. This review aims to systematize international experience in the organization and functioning of Local Bioethics Committees and to explore the potential for its application in the context of the Republic of Kazakhstan. Search strategy. A systematic literature review was conducted using the PICO model. The main question addressed was, does the implementation of international practices (e.g., GCP training, process standardization, digitalization, and KPI monitoring) improve the performance of LBCs in countries with developing research systems, such as Kazakhstan, compared to existing approaches? Searches were performed in PubMed, Scopus, Web of Science, and eLibrary databases for the period 2020–2024. The analysis was guided by Donabedian’s quality assessment model (structure – process – outcome). Results. The review found that developed countries emphasize the standardization of application submission and review processes, digitalization of interactions, mandatory GCP (Good Clinical Practice) training for LBC members, and implementation of performance monitoring systems (KPIs). These approaches ensure a high level of transparency, timeliness of ethical review, and trust from the research community. Conclusions. The analysis of international experience demonstrates that practices such as process standardization, digitalization, mandatory GCP training for committee members, and systematic KPI monitoring significantly enhance the transparency, timeliness, and credibility of ethical review. These approaches can be successfully adapted to the Kazakhstani context, considering the national setting and existing research infrastructure. The use of Donabedian’s model enables a systematic evaluation and optimization of LBCs in terms of structure, processes, and expected outcomes. Adopting international practices may become a crucial step toward strengthening bioethical oversight in Kazakhstan and ensuring the proper protection of research participants’ rights. Введение. Локальные комитеты по биоэтике(далее- ЛКБ) являются неотъемлемым элементом системы защиты прав и безопасности участников биомедицинских исследований. Их деятельность должна соответствовать международным этическим стандартам и адаптироваться к контексту конкретной страны. В Казахстане, как и в ряде стран с формирующейся исследовательской инфраструктурой, работа ЛКБ сопровождается рядом организационных и процедурных вызовов. Цель. Целью настоящего обзора является систематизация международного опыта в области организации и функционирования локальных этических комитетов, а также определение возможностей его применения в условиях Республики Казахстан. Стратегия поиска. Использован систематический подход к отбору литературы с применением модели PICO. Улучшает ли внедрение международных практик (например, обучение GCP, стандартизация процессов, цифровизация и KPI) работу локальных этических комитетов в странах с развивающейся исследовательской системой, таких как Казахстан, по сравнению с существующими подходами? Поиск проводился в базах данных PubMed, Scopus, Web of Science и eLibrary за период 2020–2024 гг. Анализ осуществлялся с опорой на модель оценки качества Донабедиана (структура – процесс – результат). Результаты. Обзор выявил, что в развитых странах c особое внимание уделяется стандартизации процессов подачи и рассмотрения заявок, цифровизации взаимодействия, обязательному обучению членов ЛКБ принципам надлежащей клинической практики (good clinical practice-GCP), а также внедрению системы мониторинга показателей эффективности (KPI). Эти подходы обеспечивают высокую степень прозрачности, своевременность этической экспертизы и доверие со стороны исследователей. Выводы. Анализ международного опыта показал, что внедрение таких практик, как стандартизация процедур, цифровизация процессов, обязательное обучение членов ЛКБ принципам надлежащей клинической практики (GCP), а также систематический мониторинг...

SARS-CoV-2 utilizes the angiotensin-converting enzyme 2 (ACE2) receptors located on membranes to enter host cells. Nevertheless, the ACE2 gene primarily encodes for a zinc metalloproteinase, which is a part of the renin–angiotensin system (RAS). ACE2 downregulation results in the deregulation of RAS in favor of pro-fibrosis, pro-apoptosis, oxidative stress, pro-inflammation, aldosterone production and release, and blood vessel contraction axis. ACE2 is highly expressed in the placenta. There are both axes of the RAS system in the placenta. This study aims to assess the perinatal outcomes with ACE2 receptor polymorphisms in pregnant women infected with SARS-CoV-2 during pregnancy. The case-control study was conducted to determine the association of ACE2 single-nucleotide polymorphisms in 171 COVID-19-positive pregnant subjects and 112 control subjects. The recessive mutations of rs2158082 and rs4830974 were associated with an increased risk of low birthweight and preterm birth, whereas the dominant mutation of rs2285666 (CT + TT) was associated with decreased odds of low birthweight. COVID-19 was not a significant factor contributing to the adverse perinatal outcomes in our sampling. These findings may help to clarify the controversy regarding the increased risk of adverse perinatal outcomes observed during COVID-19 as well as provide new perspectives for research on the genetic factors associated with a higher risk of adverse perinatal outcomes.

Access to medicines is a fundamental component of the full realization of the right to health. Equal access to medicines is a global priority. Alongside this, market access to innovative medicines is a crucial factor in improving the population's life expectancy and quality of life. The issue of improving the accessibility of medical services by ensuring equal access to quality healthcare is emphasized in the National Development Plan of the Republic of Kazakhstan until 2029. Market access to innovative technologies largely depends on citizens' willingness to adopt the technology. Therefore, patient participation in market access to medicines is crucial. Research Objective: To study the subjective opinion of the population on satisfaction with the outpatient medicine supply system, offering suggestions to improve its accessibility, effectiveness, and responsiveness to patient needs.Methods. A sociological study was conducted through a survey of the adult population using the Survey Monkey platform in an online format. The total number of respondents: adults - 1,730 people, including 710 men (41.05%) and 1,020 women (58.95%). Results. Almost 80% of respondents reported that medicines are always available in the pharmacy, but 18% noted that they are periodically absent, and 2.5% believe that free medicines are never available in pharmacies. 78% of the listed medicines that patients purchased independently are included in the List of free medicines. 23.41% of respondents took antibiotics without a doctor's prescription. 61.12% of respondents are not ready to pay the price difference between the original drug and the generic. The overall assessment of the free drug provision system in Kazakhstan is as follows: 35.47% of participants rated it as excellent, 47.58% as good, 9.14% as satisfactory, and 5.47% of respondents consider the work of the free drug provision system unsatisfactory. Conclusions. The survey results revealed problems in the provision of medicines guaranteed by the state. Overall, the free outpatient drug provision system in Kazakhstan is well-established, with patients receiving the necessary medicines on time for diseases managed at the outpatient level. However, there are problematic issues that require improvement in this area. Keywords: access to medicines, free drug provision, population satisfaction with drug provision.

BACKGROUND Understanding the research competence of incoming doctoral students in healthcare is crucial for ensuring the quality and effectiveness of future healthcare research. By addressing gaps in research competency early in their academic careers, doctoral programs can better equip students to tackle the complex challenges facing the healthcare industry. The study investigates the research competency of incoming doctoral students in the healthcare field. OBJECTIVE To assess the level of research competence of applicants (residency and master's programs graduates) who plan to pursue doctoral studies in healthcare specialties. METHODS A cross-sectional study was conducted among 500 resident and master students and graduates who are willing to pursue Ph.D. study in the healthcare sector from 1st November 2023 till 16th February 2024. Prospective Ph.D. candidates represent all seven medical universities of Kazakhstan. Level of research competencies was assessed by the 31-item questionnaire "Research competence of postgraduate students" [1]. This questionnaire consists of three domains - "knowledge", "skills" and "attitudes". A multifactorial regression analysis was applied to ensure the reliability of the obtained results. RESULTS The participant’s average age is 27.8 years (SD ±4.3). Of these, 353 (70.6%) are women and 147 (29.4%) are men. Most of them (350 (70.0%)) are residents, 92 (18.4%) - master students of 1st and 2nd years. Study results demonstrate that the main gaps in research competence in “knowledge” domain are the defining relevant theories of research and statistical methods understanding. In “skills” domain - lack of study planning skills, development of conceptual research model and identifying proper statistical method. In “attitude” domain - the respondents' greatest source of stress stems from the need to conduct research. The comparing domains between residents and master's students a statistically significant difference was found in the 'knowledge' domain (p<0.001) and the 'skills' domain (p<0.001). In assessing the overall mean value of research competency levels among candidates applying for admission to a Ph.D. program, it was found to be 85.9 points among master's students, corresponding to a high level, while among residents it was 80.3, corresponding to an average level of research competency. CONCLUSIONS While respondents demonstrate high and moderate levels of research competency in articulating objectives and relevance, further training is required in areas such as applying theories, selecting methodology, and conducting statistical analysis of data. The stress associated with research underscores the importance of providing participants with sufficient resources and support. These findings might inform the development of a pre-Ph.D. educational program in healthcare specialties.

The purpose of research: studying the level of research competencies of applicants for admission to PhD doctoral studies. Research based on a survey among graduates of postgraduate education programs (residency and master's programs) who plan to subsequently enter doctoral studies in medical specialties. The authors studied the influence of various social, gender factors, affiliated medical organization and other factors on the level of research competencies of future doctoral students. Methods. Authors adapted and translated into Russian and Kazakh the questionnaire “Research competence of postgraduate students” from the University of Nebraska, USA. The questionnaire consists of 31 questions divided into three domains - “knowledge”, “skills” and “attitudes”. The questionnaire was developed on the Google Form platform and distributed through the dean's offices and research schools of all medical universities in the Republic of Kazakhstan. To ensure the reliability of the results obtained, multivariate regression analysis was used. Results. A total of 73 young scientists applying for admission to doctoral studies were surveyed. The data obtained demonstrated that the strongest research competencies possessed by respondents include the ability to explain the relevance/importance of their research (x̅=2.93; standard deviation=0.751), formulating the purpose of the study (x̅=2.81; standard deviation=0.793 ). The weakest research competencies include knowledge of applying relevant theories to one's research (x̅=2.37; st. deviation=0.825), identifying research subjects (x̅=2.42; st. deviation=0.780), choosing the right methodology (x̅= 2.42; standard deviation = 0.815). Conclusion. The findings indicate the need for additional training in theoretical knowledge, methodology and data analysis, despite the overall average level of competence of the participants. This can help improve research quality and confidence in research work at PhD level.

Background: One of the key challenges facing the healthcare system of Kazakhstan is the need to take measures to improve the quality of practical training of nurses at the level of medical colleges (MC). To develop further steps to improve the training of nurses at the level of MCs, it is required an assessment of the key components of their activities for the organization and quality assurance of educational processes (EP), clinical processes (CP) and scientific processes (SP). Methods: The study of the quality of EP, CP, SP was carried out on the basis of a survey of 13110 students, 825 teachers and 199 administrators of 78 MCs. We have developed 3 types of questionnaires for each category of respondents. The survey was conducted on the SurveyMonkey platform in May-June 2020. Results: Teachers with little pedagogical experience and administrators with no/short duration of pedagogical experience tend to overestimate EP, CP, SP. Teachers and administrators give a much higher assessment of the effectiveness of teaching methods, the objectivity of assessment methods, ensuring the rights of students, key components of SP and CP than the students themselves, which, in fact, indicates insufficient contact between teachers and administrators with students in terms of assessing their needs. Administrators tends to give a higher assessment of the quality of the SP and CP than teachers and students. Conclusions: The discrepancy in the assessments of certain categories of respondents indicates the need for regular feedback from students, conducting a survey of teachers and administrators. It is necessary: to strengthen the selection of personnel for administrators' positions in MCs with the introduction of a mandatory requirement for the presence of teaching experience and academic degree; to encourage the practice of combining positions of teacher and administrator; to introduce mandatory attestation of MCs' teachers and administrators every 3-5 years according to clear KPI criteria. Key messages: The discrepancy in the assessments of certain categories of respondents indicates the need for regular feedback from students, conducting a questionnaire survey of teachers. It is necessary to require the presence of pedagogical experience and academic degrees in the selection of personnel for the positions of administrators in medical colleges.

Background: The relevance of the topic lies in the fact that anti-corruption measures in educational institutions today are an acute problem in the education system of the Republic of Kazakhstan. The facts of corruption in the field of education have a destructive effect on the process of training health professionals. Methods: The study of the level of anti-corruption culture was carried out on the basis of a survey of 13,110 students, 825 teachers and 199 administrators. We have developed 3 types of questionnaires for each category of respondents. The survey was conducted on the SurveyMonkey platform in May-June 2020. Results: An analysis of the level of anti-corruption culture indicates that the greatest risk of situations in which elements of corruption in college are most common occurs when entering college, passing midterm exams (ratings), and passing final exams and tests. As the main reasons for corruption in college, most respondents point to the low level of teacher salaries, low interest in learning among students. Teachers and administrators give much higher satisfaction with the level of response of the college administration to complaints about corruption and unethical attitudes than the students themselves. Conclusions: In order to ensure a timely response to the facts of corruption and the formation of an anti-corruption culture, it is necessary to ensure regular feedback from students, questioning of teachers and administrators. Activities aimed at identifying, suppressing and preventing corrupt practices should primarily relate to the process of entering college, passing midterm and final exams. Key messages: The discrepancy in the assessments of certain categories of respondents indicates the need for regular feedback from students, conducting a survey of college staff. Anti-corruption measures should relate primarily to the process of entering college, passing midterm and final exams.

Background: The reform of medical education and the introduction of the Bologna process into the higher medical school of the university changed the views on the research component in the process of studying a student in Kazakhstan following the principles of Soviet teaching of a medical school student. Methods: A questionnaire was developed based on the AGREE methodology. The questionnaire is posted on the SurveyMonkey online questionnaire resource. A total of 1,439 university's students participated in the survey. Results: About 85% of students in medical schools of universities in Kazakhstan agree on the trinity ‘science - education - practice' - the main principle of teaching students. When answering the question “Teachers at the university, when conducting lessons and lectures, always provide information about new research results,” 63% of respondents agree with this. About 77% of students believe that research is of high quality at the university. 78% of respondents noted the availability of research infrastructure at the university. About 80% of the respondents answered positively to the question of the relevance of research topics at the university. Students' participation in the research was assessed by them at a low level (about 45% of positive answers versus 51% of negative answers). Conclusions: Analysis of the current situation on student participation in research in medical schools of universities in Kazakhstan shows an insufficient level of student involvement in research activities and an insufficient commitment of universities to the principle of the trinity of science, education and practice. Students who are actively and productively engaged in research have professional competencies in using the acquired knowledge, skills and abilities in practice than their colleagues who are not involved in research. Key messages: The insufficient level of student involvement in research activities reflects the insufficient commitment of universities to the principle of the trinity of science, education and practice. Early involvement of students in research allows to generate their professional competence ispolzovanieya acquired knowledge and skills in practice.