Indira Karibayeva

Background/Objectives: Health misinformation on social media is a growing public health concern, yet less is known about whom the public holds primarily responsible for reducing it. This study examined sociodemographic differences in U.S. adults’ perceived responsibility for reducing health misinformation on social media. Methods: This cross-sectional study used nationally representative data from the Health Information National Trends Survey 6 (HINTS 6, 2022). Respondents were asked who has the main responsibility for reducing false or misleading health information on social media. Descriptive analyses reported unweighted counts and weighted percentages. Survey-weighted multinomial logistic regression with jackknife replicate variance estimation was used to examine associations with age, sex assigned at birth, race/ethnicity, education, marital status, full-time work status, and household income, and design-adjusted Wald tests assessed the overall association of each characteristic. Results: Among 6252 respondents, the largest weighted proportion attributed responsibility to social media platforms such as Facebook, Twitter, or YouTube (31.40%), followed by individual social media users (18.55%), the government (15.87%), medical providers and health care systems (13.79%), the news media (12.60%), and other sources (3.97%). In the adjusted model (n = 5306), age (p = 0.032) and education (p = 0.014) were associated with perceived responsibility overall. Compared with adults aged 65 years or older, adults aged 18–34 years had lower odds of naming platforms (AOR = 0.59, 95% CI: 0.41–0.85), the government (AOR = 0.57, 95% CI: 0.35–0.93), the news media (AOR = 0.48, 95% CI: 0.26–0.87), and medical providers and health care systems (AOR = 0.31, 95% CI: 0.19–0.52) rather than individual users, and adults aged 35–49 years showed a similar pattern. Adults with less than a high school education had higher odds than college graduates of selecting the government (AOR = 3.13, 95% CI: 1.45–6.76), the news media (AOR = 3.24, 95% CI: 1.15–9.14), and platforms (AOR = 2.12, 95% CI: 1.03–4.38). In sensitivity analyses, the direction of the main age and education estimates was broadly consistent; however, the overall age association was not statistically significant with an alternative age classification (p = 0.321) or among social media users only (p = 0.071). Conclusions: Perceived responsibility for reducing health misinformation on social media differs mainly by age and education, although statistical evidence for the age association depended on the age classification and the population analyzed. As a policy implication, the findings support a shared-responsibility approach involving platforms, public health agencies, health care systems, news media, and users; whether tailoring interventions to these sociodemographic differences improves their effectiveness should be tested in future studies.

Background/Objectives: Long-term real-world evidence on golimumab in axial spondyloarthritis (axSpA) from Central Asia is limited. We evaluated clinical outcomes through week 144, treatment persistence through 36 months, factors associated with discontinuation, and reasons for discontinuation in Kazakhstan. Methods: This prospective observational cohort included 113 adults with axSpA enrolled at two rheumatology centers in Almaty in October 2019. All had received golimumab 50 mg subcutaneously every four weeks for at least 12 weeks before enrollment. Time zero for persistence analyses was the enrollment date. Clinical assessments were performed at baseline and weeks 12, 24, 52, 104, and 144. Treatment persistence was estimated using Kaplan–Meier analysis, and factors associated with confirmed discontinuation were explored using Cox regression. Clinical responses were assessed using non-responder imputation (NRI; N = 113). Results: During 36 months, 24 patients had confirmed permanent discontinuation; two patients lost to follow-up without confirmed discontinuation were censored. Kaplan–Meier estimated persistence was 89.3% (95% CI, 83.8–95.2%) at 12 months, 79.4% (72.2–87.3%) at 24 months, and 78.5% (71.2–86.5%) at 36 months. Among 88 patients with paired baseline and week 144 assessments, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score based on erythrocyte sedimentation rate (ASDAS-ESR), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) improved significantly (all p < 0.001). With NRI, 64.6% achieved BASDAI50, 59.3% ASDAS inactive disease, and 54.9% ASDAS major improvement at week 144. Higher Rheumatic Disease Comorbidity Index (RDCI) score (adjusted hazard ratio [HR] 1.312, 95% CI, 1.042–1.653) and functional class III–IV versus I–II (adjusted HR 2.412, 95% CI, 1.037–5.611) were associated with higher discontinuation hazards in exploratory analyses. Loss of effectiveness was the most frequent reason for discontinuation (54.2%). Adverse events were recorded only when they led to discontinuation and therefore do not represent overall safety incidence. Conclusions: Golimumab was characterized by substantial 36-month treatment persistence and clinical improvement among patients who remained on treatment and were evaluable at week 144 (n = 88). Full-cohort NRI analyses also demonstrated clinically relevant responses at week 144. Comorbidity burden and poorer functional class were associated with discontinuation in exploratory analyses. These findings add long-term real-world evidence from an under-represented geographic setting.

Background: Neonatal mortality remains a major contributor to child mortality globally, with the greatest burden concentrated in the early neonatal period. Sex differences in neonatal survival are consistently reported, yet population-level evidence on sex-specific patterns of all-cause burden across neonatal subperiods in Central Asia remains limited. This study aimed to quantify temporal trends and sex differences in early (0–6 days) and late (7–27 days) neonatal all-cause mortality and disease burden in Kazakhstan from 2010 to 2023, and to examine projected trajectories to 2030. Methods: We conducted a population-based time-trend study using Global Burden of Disease 2023 estimates for Kazakhstan. Outcomes included mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs), expressed as age-specific rates per 100,000 person-years within the corresponding neonatal age interval. Analyses were stratified by sex and neonatal subperiod. Temporal patterns were described, and sex differences were assessed using comparative rates. Log-linear models were used to estimate projected trends to 2030. National mortality statistics were used for external trend consistency. Results: Neonatal mortality and DALY rates declined between 2010 and 2023 in both early and late neonatal periods, with substantially higher rates observed in the early neonatal period. Across all years, males consistently exhibited higher mortality, YLLs, and DALYs than females in both neonatal subperiods; YLD rates followed a different pattern, being modestly higher among females in the early-neonatal period but nearly equal between sexes in the late-neonatal period. YLLs accounted for the vast majority of DALYs, indicating that mortality rather than non-fatal disability drives neonatal burden. Projections suggest continued declines through 2030, male point estimates for mortality and DALYs remained higher than female estimates throughout, although the magnitude of this difference narrowed substantially and became statistically uncertain in the most recent years, with rate-ratio uncertainty intervals spanning or approaching unity. Conclusions: Despite substantial reductions in neonatal mortality in Kazakhstan, male point estimates for mortality and burden remained higher than female estimates throughout the study period, although this difference narrowed substantially and became uncertain in recent years; mortality remained heavily concentrated in the early neonatal period. These findings highlight persistent, though narrowing, epidemiologic inequalities within improving population health trends.

Foreign-born adults make up a growing and diverse share of the U.S. population. Yet much of what is known about adult vaccination comes from studies conducted before the COVID-19 pandemic. Many focused on a single vaccine or treated immigrants as a single group. We examined influenza, COVID-19, shingles, and pneumococcal vaccination among U.S.-born adults, foreign-born U.S. citizens, and foreign-born noncitizens. We also assessed the extent to which observed differences were attenuated after adjustment for socioeconomic conditions and access to healthcare. Data came from 31,362 adults who participated in the 2024 National Health Interview Survey. We used survey-weighted modified Poisson regression and adjusted sequentially for demographic, socioeconomic, and healthcare access factors. Family income was pooled across ten NCHS imputations. Noncitizens had the lowest unadjusted vaccination prevalence. Influenza vaccination was 32.2% among noncitizens compared with 43.5% among U.S.-born adults. Shingles vaccination rates were 24.3% versus 45.1%, and pneumococcal vaccination rates were 34.5% versus 67.2%. After full adjustment, the influenza difference was no longer evident (adjusted prevalence ratio or aPR 1.07; 95% CI 0.98–1.17). The gap in shingles vaccination narrowed substantially (aPR 0.85; 95% CI 0.71–1.02). In contrast, disparities in pneumococcal vaccination persisted among both noncitizens (aPR 0.70; 95% CI 0.55–0.90) and foreign-born U.S. citizens (aPR 0.85; 95% CI 0.78–0.94). A different pattern emerged for ever receipt of at least one COVID-19 vaccine dose. Both foreign-born groups were more likely than U.S.-born adults to have ever received at least one dose; because this outcome is cumulative receipt since 2020, it does not indicate whether respondents were up to date with current COVID-19 vaccination recommendations. Overall, disparities among foreign-born adults depended on the vaccine being examined. Differences in influenza and shingles vaccination were substantially attenuated after adjustment for socioeconomic and healthcare access characteristics, whereas the pneumococcal difference was not.

Background/Objectives: Nurses and nursing students are central to HIV prevention and care, but studies of their general HIV-related knowledge, attitudes, and practices use heterogeneous populations, instruments, scoring systems, and thresholds. This review had three objectives: (1) to meta-analyze, separately, the prevalence of study-defined high/good general HIV knowledge, mean general knowledge scores, prevalence of study-defined positive/favorable general attitudes, and mean favorable-attitude scores; (2) to synthesize HIV-related clinical-practice findings narratively when measures were not comparable; and (3) to explore whether pooled knowledge and attitude estimates differed between practicing nurses and nursing students. General outcomes excluded narrowly focused PrEP-, PEP-, stigma-only, and item-level constructs. Methods: PubMed/MEDLINE, Scopus, PsycINFO, and CINAHL Complete were searched for eligible quantitative studies. Four knowledge and attitude outcomes were meta-analyzed in separate random-effects models; practice outcomes were not pooled. Heterogeneity, 95% prediction intervals, leave-one-out influence, possible small-study effects, subgroup differences, and certainty of evidence were assessed. Results: Thirty-four studies were included. The pooled prevalence of high/good HIV-related knowledge was 52.4% (95% CI 30.4–73.5%; I² = 97.5%; 95% prediction interval 3.6–97.0%), and the pooled mean knowledge score was 66.3% of the possible score (95% CI 60.8–71.8%; I² = 99.8%; prediction interval 40.0–92.5%). Positive/favorable attitudes had a pooled prevalence of 41.6% (95% CI 7.3–86.5%; I² = 99.1%; prediction interval 0.0–99.9%), and the pooled mean favorable-attitude score was 48.1% of the possible range (95% CI 41.9–54.2%; I² = 99.7%; prediction interval 21.3–74.8%). Thus, all four meta-analyses showed extreme heterogeneity and wide prediction intervals. Prespecified subgroup tests did not detect nurse-versus-student differences for either knowledge outcome or favorable-attitude prevalence; a higher pooled mean favorable-attitude score among students was observed in one exploratory comparison. Four studies reported non-equivalent practice indicators (16.0–85.3%), which were not pooled. Certainty was very low for all meta-analyzed outcomes. Conclusions: The pooled estimates should be interpreted as descriptive summaries across heterogeneous operationalizations rather than as precise global nursing-workforce benchmarks or common competency thresholds. More standardized measurement, objective assessment of clinical practice, and longitudinal and interventional research are needed.

Introduction. Health-related quality of life is impaired in patients with heart failure with preserved ejection fraction and type 2 diabetes mellitus, but clinical factors remain poorly characterized. Baseline assessment is needed to interpret treatment-related changes. Objective. To assess baseline health-related quality of life before tirzepatide therapy, compare the tirzepatide and standard-care groups, and identify clinical, anthropometric, metabolic, and echocardiographic correlates. Methods. Baseline data from a single-center prospective controlled study of 60 patients were analyzed: 30 allocated to tirzepatide and 30 to standard care. Quality of life was assessed before treatment using the 36-Item Short Form Health Survey; complete data were available for 58 participants. Associations were examined using Spearman correlation and multiple linear regression adjusted for age, sex, and treatment group. Results. Patients allocated to tirzepatide were younger and had a higher body mass index. Most domains were comparable. The between-group difference in mental health (p=0.037) did not meet the Bonferroni-adjusted significance threshold. The lowest scores were observed for role limitations due to physical health, role limitations due to emotional problems, and vitality. In adjusted analyses, each 1 kg/m² increase in body mass index was associated with a 1.78-point decrease in physical functioning (p=0.002). Each one-unit increase in the ratio of early transmitral inflow velocity to early diastolic mitral annular velocity was associated with a 2.08-point decrease in general health (p=0.015). No significant associations were found with glycated hemoglobin, N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction, or global longitudinal strain. Conclusion. Before treatment, the quality-of-life profile was dominated by physical limitations and restrictions in usual activities. Associations with body mass index and estimated left ventricular filling pressure highlight the need to consider metabolic and hemodynamic characteristics when evaluating tirzepatide efficacy. Keywords: quality of life, patient reported outcome measures, diastolic heart failure, diabetes mellitus, tirzepatide.

Sleep supports cognition across the lifespan, but its significance may differ developmentally: in adults, it largely maintains and restores functioning within mature neural systems, whereas in children and adolescents it may also support the formation of cognitive, emotional, and self-regulatory capacities. This systematic review and evidence and gap map, prospectively registered in PROSPERO and conducted according to PRISMA 2020, searched PubMed, PsycINFO, Scopus, and Web of Science for studies of sleep duration, quality/fragmentation, timing/regularity, and daytime sleepiness in relation to executive function/self-regulation, attention/vigilance, emotion/behavior regulation, and academic functioning among typically developing children and adolescents. Twenty-five studies contributed 46 study–outcome links. Across nearly all populated evidence cells, more adequate sleep profiles were associated with better developmental outcomes. The strongest and most experimentally supported evidence concerned sleep duration in relation to executive function, emotion/behavior regulation, and academic functioning; evidence for sleep timing/regularity and daytime sleepiness was weaker and predominantly cross-sectional. Unlike adults, for whom sleep primarily restores a mature system, children may lose not only today’s functioning but tomorrow’s developmental trajectory when sleep is chronically curtailed. Sleep duration currently provides the strongest basis for intervention, whereas the long-term developmental effects of sleep quality, timing, regularity, and sleepiness require further longitudinal and experimental investigation during this formative period.

Background/Objectives: Rotavirus remains a major cause of acute gastroenteritis among children under five years of age, particularly in regions with heterogeneous vaccine implementation. In Central Asia, differences in the timing and coverage of rotavirus vaccination may influence circulating genotype patterns, yet regional evidence remains fragmented. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251274198). Electronic databases (PubMed, Web of Science, ScienceDirect, and Google Scholar) were searched without date restrictions. Studies reporting laboratory-confirmed rotavirus infection and genotype distribution among children under five years in Central Asia were included. Random-effects meta-analysis of proportions was performed to estimate the pooled genotype proportions among rotavirus-positive children, with subgroup analyses comparing the before and after vaccine introduction periods. Results: Six studies (ten before vaccine introduction strata and four after vaccine introduction strata; N = 1713 rotavirus-positive children) were included. A significant decline in the G1P[8] genotype was observed following vaccine introduction, with pooled prevalence decreasing from 0.468 (95% CI: 0.363–0.577) to 0.068 (95% CI: 0.034–0.133) (p < 0.001). In contrast, G2P[4] increased from 0.134 to 0.485 (p < 0.001), while G9P[4] and G9P[8] also increased significantly. G3P[8] and mixed genotypes declined, whereas G4P[8], G12P[8], and untypable strains showed no statistically significant subgroup differences. Substantial heterogeneity was observed (I² > 90%), and evidence certainty was very low for all genotype outcomes. Conclusions: The available evidence suggests that rotavirus genotype distribution among children under five in Central Asia may have changed after vaccine introduction, with lower pooled proportions of G1P[8] and higher proportions of selected heterotypic genotypes in after vaccine introduction strata. Strengthened molecular surveillance using standardized genotyping protocols is needed to determine whether these patterns represent sustained genotype replacement or temporal fluctuation. These estimates are based on a small, heterogeneous evidence base with very low certainty and should be considered hypothesis-generating rather than confirmatory of a causal vaccine effect.

Background and Objectives: Antimicrobial resistance in Neisseria gonorrheae threatens the effectiveness of empirical gonorrhoea treatment. Although global surveillance evidence is increasingly available, resistance data are not consistently reported separately for men with urethral or urogenital infection. This review evaluated antibiotic-specific resistance in N. gonorrhoeae isolates from this clinically defined population and examined the geographic and reporting limitations of the available evidence. Materials and Methods: PubMed, Scopus, ScienceDirect, Google Scholar, and relevant WHO GASP/EGASP resources were searched from inception to [updated search date]. Eligible observational or surveillance studies reported categorical resistance classifications or extractable antibiotic-specific resistant counts and denominators for male urethral or urogenital isolates. Antibiotic-specific proportions were synthesized using random-effects meta-analysis where pooling was considered appropriate. Sparse-event outcomes were additionally evaluated using study-specific estimates and aggregate resistant/tested counts. Certainty of evidence was assessed using the GRADE framework adapted for prevalence outcomes. Results: Six studies met the eligibility criteria, including the 2025 multinational EGASP study. Cefixime resistance was reported in 748 of 13,154 isolates, corresponding to an aggregate proportion of 5.69%; however, the random-effects estimate was unstable because three studies reported no resistant isolates and events were concentrated in two large datasets. Ceftriaxone resistance varied from 0% to 5.17%, with a pooled estimate of 0.32% (95% CI 0.05–2.15; I² = 97.8%). Resistance was high but heterogeneous for ciprofloxacin (71.84%, 95% CI 7.53–98.77; I² = 97.3%) and penicillin (62.47%, 95% CI 36.87–82.58; I² = 98.1%). Spectinomycin resistance was 2.57% (95% CI 1.58–4.16; I² = 0%), while azithromycin resistance was 6.38% (95% CI 4.38–9.21; I² = 94.9%). Certainty of evidence was very low for all outcomes. Conclusions: Evidence specifically reporting resistance in male urethral or urogenital N. gonorrhoeae isolates remains limited and geographically uneven. Contemporary EGASP data demonstrate that ceftriaxone resistance is not uniformly low across surveillance settings. The pooled estimates should be interpreted as exploratory summaries rather than current global prevalence values or an independent basis for treatment selection. Standardized reporting of sex, anatomical site, breakpoints, MIC distributions, and resistant/tested counts is needed to improve future surveillance synthesis.

Background and Objectives: Breast cancer is the leading oncological diagnosis among women in Kazakhstan, yet a substantial proportion of cases are still detected beyond the earliest stages, particularly in peripheral regions such as Aktobe. Despite a national mammography screening programme covering women aged 40–70 years since 2018, structural differences in access to early diagnosis—related to geography, socioeconomic circumstances, and the diagnostic pathway—may compromise outcomes. We aimed to identify factors independently associated with early-stage presentation and to characterise the temporal pattern of early-stage presentation without assuming a monotonic trend. Methods and Materials: We conducted a retrospective, population-based analytical study of all confirmed breast cancer cases (ICD-10 C50) registered in the Aktobe regional cancer registry and diagnosed between 1 January 2015 and 31 December 2025 (n = 2232). The outcome was early-stage presentation, defined literally as Stages I–IIa at diagnosis, with Stages IIb–IV as the comparator; this is a stage-at-presentation classification and is not intended to indicate surgical operability or treatment sequence. Multivariable logistic regression estimated adjusted odds ratios (aORs). Two models were used: Model A included age, sex, residence, administrative nationality, employment/social status, and calendar year; Model B additionally included the diagnostic pathway, which may lie on the causal pathway between structural determinants and stage. Calendar year was modelled as a categorical variable, and a complementary phase-based model (2015–2017, 2018–2019, 2020–2022, 2023–2025) was fitted. A residence-by-year interaction; a multinomial sensitivity analysis separating Stages IIb, III, and IV; discrimination (AUC, Brier score); and calibration (Hosmer–Lemeshow test, calibration plot) were also assessed. Results: Of 2232 patients (99.1% female; mean age 57.0 ± 12.5 years), 1323 (59.3%) presented at Stages I–IIa. In Model A, rural residence (aOR 0.77, 95% CI 0.64–0.93; p = 0.006), unemployment relative to employment (aOR 0.69, 95% CI 0.52–0.90; p = 0.007), Russian administrative nationality (aOR 0.64, 95% CI 0.50–0.82; p < 0.001), and other non-Kazakh nationalities (aOR 0.73, 95% CI 0.58–0.94; p = 0.012) were independently associated with lower odds of Stage I–IIa presentation. In Model B, patient-initiated (self-referral) presentation was associated with lower odds relative to clinical examination room detection (aOR 0.46, 95% CI 0.30–0.72; p < 0.001), whereas organised screening was not significantly associated (aOR 1.52, 95% CI 0.95–2.43; p = 0.082). The calendar-year pattern was clearly non-linear (categorical vs. linear year: likelihood-ratio χ² = 76.1, df = 9, p < 0.001): odds of Stage I–IIa presentation peaked in 2018 (aOR 2.49, 95% CI 1.57–3.93 vs. 2015), were lowest in 2022 (aOR 0.64, 95% CI 0.42–0.97), and partially recovered thereafter. In the phase-based model (reference 2015–2017), the aORs were 1.62 (95% CI 1.22–2.15) for 2018–2019, 0.54 (95% CI 0.41–0.69) for 2020–2022, and 0.62 (95% CI 0.46–0.84) for 2023–2025. Model discrimination was limited (AUC 0.648, 95% CI 0.625–0.671; Brier score 0.226) with acceptable calibration (Hosmer–Lemeshow χ² = 8.38, df = 8, p = 0.40). Conclusions: In this registry-based cohort, rural residence, unemployment, non-Kazakh administrative nationality, and patient-initiated presentation were independently associated with lower odds of early-stage breast cancer presentation. The temporal pattern was non-monotonic, with the highest odds around the 2018 screening expansion, a marked reduction during 2020–2022, and only partial recovery thereafter. These are observational associations rather than causal or programme-evaluation findings; they should be interpreted as hypothesis-generating and require confirmation with screening-process, service-capacity, and patient-level access data.