Ukraine. Nation’s Health

The impact of horse riding on the physical and psychological state of high school students

2026-01-27T12:28:55+02:00

The purpose of our study was to identify the impact of horseback riding on the physical and psycho-emotional state of higher education students. Materials and methods. This study involved 10 applicants from Lutsk National Technical University. All of them were young men and their age was 18–20 years (19.2 ± 1.517). The research was conducted at the «Antares» equestrian club (village Shepel, Volyn region). The experimental group consisted of 10 applicants who had no prior involvement in any form of equestrian sport; none of the young men had previously practiced horseback riding. Their physical and psycho-emotional state depended on the course and effectiveness of the training process. The following research methods were used in this scientific study: analysis of scientific and methodological literature; pedagogical observation; pedagogical experiment; methods of mathematical statistics. Results. On the results of the initial testing, it was found that after just one session of therapeutic horseback riding, nearly 80% of beginner riders showed improvements in both their psycho-emotional and physical condition. These results indicate that horseback riding has a positive effect on the health of young men and can be used as a means of human rehabilitation-both physically and psychologically. Conclusions. In this article, the authors demonstrated that horseback riding contributes not only to the improvement of a person’s physical condition but also to the recharge of their psycho-emotional state, replenishment of vital energy, and internal resources.

Patient experience journey mapping: established public health methodology or strategic decision-making element in a patient-driven healthcare?

2026-01-27T12:36:22+02:00

Purpose. This study aims to outline the evolution of patient experience research and PED generation, to analyze the existing methodological approaches and best practices to map patient experience journey and to substantiate the PEJM conceptual model. Materials and methods. The research combined literature review, expert opinions, and conceptual modeling done from January 2022 to October 2025. A bibliosemantic search covering 20 years (2005–2025) identified 82 eligible sources, including published and grey literature. Expert consultations involved 58 subject matter experts from patient communities, healthcare professionals, and others, conducted in digital and face-to-face formats. Feedback focused on generic patient journeys or pathways, PED sources and generation methods, evidence quality, validation, communication, design and visual presentation of PEJMs. The Patient Focused Medicines Development (PFMD) Working Group’s PED Navigator tool also informed the PEJM conceptual model development. Results. The research highlighted significant variability and inconsistent stakeholders’ understanding terms such as pathway, care continuum, patient journey, and patient experience map. Modern usage increasingly associates patient journey mapping with patient experience, identifying unmet needs and service gaps. Many published “patient journeys” are in fact aggregated PEJMs. Early patient journey mapping efforts (2006–2015) focused on disease stages, timelines, or locations of care. Various mapping approaches include key experiences, event sequences, stakeholder roles, and time-based events. Later, the ontology was proposed with dimensions of patient persona, medical timeline, and medical pathway, including emotional and physical journeys. This approach prototyped multidimensional consideration of patient experience but was intended for healthcare service reform rather than holistic PED consolidation. Recent tools like the Patient Experience Mapping Toolbox (PEMT) by the US National Health Council and the PFMD PED Navigator have advanced holistic PED consolidation, enabling navigation of impact areas defined by patients and various methods to capture PED. Based on existing good practices, pilots and prototypes, experts’ advice and literature search results, the PEJM conceptual model was developed and substantiated driven by multidimensional ontology with 8 PED attributes. Conclusions. Although this model summarizes existing approaches and good practices, it could be developed and implemented further through interactive digital solutions and wider piloting by several stakeholders across disease or therapeutic areas. Additional PEJM research and more detailed guidance is anticipated to address regulatory and HTA requirements in terms of PED submissions and appraisal procedures.

Public satisfaction with the quality of life in Ukraine during the war

2026-01-27T14:06:24+02:00

The purpose of the work is to investigate and compare the subjective level of satisfaction of the Ukrainian population with the quality of life before and during the war in terms of social, economic, and socio-political components and to develop practical recommendations for improving it. Materials and methods. The research was conducted in 2022–2024. The research involved 159 adult respondents aged 18 and older who lived in the Zhytomyr oblast of Ukraine at the time of the survey, including temporarily internally displaced persons. Research methods: theoretical analysis of literary sources, medical and sociological (survey), systematic approach, analysis and synthesis, mathematical and statistical. Results. It has been established that the quality of life of the Ukrainian population has deteriorated in all components (social, economic, and socio-political) during the war. In general, 76.3% of the respondents were satisfied with their lives before the war, and only 31.5% during the war. The most pronounced deterioration in the quality of life occurred in the following indicators: a sense of security (by 69.8%), the ability to visit cultural institutions (by 49.7%), adherence to a healthy lifestyle (by 42.7%), access to medical and psychological care (by 40.5%), living conditions and the possibility to purchase housing (by 34.6% and 30.2%, respectively); financial situation (by 15.1%), and the socio-political situation (by 30.2%). Practical recommendations for improving the quality of life of the Ukrainian population have been developed. Conclusions. The research results show that in the context of a full-scale war in Ukraine, the quality of life has deteriorated significantly for most Ukrainians. The developed recommendations can be used to establish standards for the quality of life of the Ukrainian population in the postwar period.

Obesity: disease and predictor of health complications

2026-01-27T14:24:18+02:00

Obesity leads to structural and functional changes that culminate in numerous organ-specific pathological complications, significantly affecting morbidity as well as the quality and length of life of obese individuals. The aim of the study was to determine the prevalence of complications associated with obesity. Payer, Jackuliak, and Nagyová [8] point to an association between obesity and the development of several malignant tumors, particularly breast, colorectal, and prostate cancer. Kováčová and Dókuš [9] suggest that pregnant women with obesity are also exposed to a higher risk of maternal and perinatal complications, with the risk increasing as BMI rises. Skin folds formed as a result of obesity and sweating induce skin inflammation, fungal infections, and eczema. Materials and methods. Data were collected using a questionnaire and bioimpedance measurement with the InBody 230 device, with an emphasis on gender differences. Biochemical parameters were determined using standard laboratory methods in cooperation with the Alpha Medical laboratory. The obtained data were analyzed using descriptive and inferential statistics. The data were evaluated using both descriptive and inferential statistics. In descriptive statistics, absolute (f) and relative frequencies (%) were used. For interval (continuous) variables, the arithmetic mean (AM), standard deviation (SD), median (Mdn), as well as minimum (min) and maximum (max) values were applied. Inferential statistics included tests for group comparisons and for identifying relationships between variables. Prior to selecting an appropriate test, data normality was assessed using the Kolmogorov–Smirnov test. As normality was not confirmed in all cases, non-parametric tests were employed. The Kruskal–Wallis test was used to compare multiple groups within a single variable. For nominal variables, the chi-square test of independence and the chi-square goodness-of-fit test were applied. When the assumptions for these tests were not met (expected frequencies < 5), Fisher’s exact test was used. The degree of association was evaluated using Spearman’s rank correlation. The level of significance was set at α = 0.05. Cohen’s d was used to determine the practical significance of relationships. Values close to dCohen = 0.2 are considered small, around 0.5 medium, approximately 0.8 large, and above 0.8 very large. In the case of Spearman’s correlation, the correlation coefficient itself indicates the effect size. Results. A statistically significant difference between men and women was found in the presence of skin diseases (χ²(1)=5.823, p=0.016). Among women (n=27), the prevalence of skin diseases was higher than among men (n=7). A statistically significant difference between men and women was also observed in the presence of spinal and joint diseases (χ²(1)=6.321, p=0.012). Differences were also identified in the prevalence of respiratory diseases (χ²(1)=6.757, p=0.009), which were more frequent in women (n=37) than in men (n=11). In selected laboratory parameters, a decrease in body weight in cases of elevated values does not always result in a significant shift toward normal ranges. Conclusions. The prevalence of obesity is increasing worldwide and leads to structural and functional changes. It reduces average life expectancy. In patients with class III obesity (BMI ≥ 40 kg/m²), life expectancy is reduced by approximately 8–10 years. In patients with a BMI of 30–35 kg/m², life expectancy is shorter by about 3 years, and with each additional increase in BMI of 5 kg/m², the risk of vascular mortality due to conditions such as ischemic heart disease, stroke, and other vascular diseases increases by 40%. Despite this, obesity is not considered a disease.Obesity should be regarded as a chronic disease as well as a risk factor for the development of other serious chronic conditions. Information on the number of overweight/obese individuals and their comorbidities constitutes a fundamental basis for disease prevention and the prevention of disability. Such information is of great importance for the planning and development of public health policy, as well as for general public health activities and preventive measures.

Prediction of emotional intelligence level of medical students based on multiple regression analysis

2026-01-27T14:28:30+02:00

Emotional intelligence (EI) is a key competency for future medical professionals that influences academic performance, communication effectiveness, and stress resilience in clinical settings. Recent reviews and empirical studies demonstrate consistent associations between EI and academic performance, psychological well-being, stress-coping skills, and clinical outcomes, although the strength of these associations varies depending on context and measurement methodology. Purpose. The aim of this study was to develop a mathematical model for predicting the level of EI among 4th–6th-year students of Ternopil National Medical University using the Wong and Law Emotional Intelligence Scale (WLEIS) based on multivariate regression analysis. Materials and methods. The study was conducted using a cross-sectional design. A total of 474 students (from the 4th, 5th, and 6th years) completed the WLEIS questionnaire throughout the academic year. No analysis was performed based on the year of study. The collected data were analyzed using medical-statistical methods, including multivariate regression analysis and analysis of variance (ANOVA), to assess the impact of one or more categorical variables (factors) on a single dependent continuous variable. Additionally, a bibliosemantic method was employed to analyze the scientific literature, and a structural-logical analysis was used to build the predictive model of emotional intelligence. Results. The results indicated that the ability to recognize and understand others’ emotions was relatively high, whereas the regulation and effective use of one’s own emotions demonstrated lower scores. Conclusions. The developed mathematical model enables the prediction of EI levels among students and can be applied to design targeted educational programs and interventions aimed at enhancing emotional competence. The implementation of such strategies will contribute to improved communication, teamwork, and emotional resilience among future medical professionals. The proposed model can serve as an analytical tool for the early identification of at-risk groups concerning students’ emotional well-being and the development of targeted educational interventions.

Exploring the Link Between Physical Activity and Mobile Phone/Smartphone Addiction in University Students

2026-01-27T14:35:38+02:00

Purpose. The aim of this paper is to provide an overview of the research concerning the relationship between physical activity (PA) and mobile phone addiction/smartphone addiction (MPA/SA) among university students, recognized as a high-risk group. Material and methods. We employed general scientific methodologies, including comprehensive literature search, analytical review, synthesis, and generalization. Relevant studies were retrieved from the PubMed electronic database, covering publications dated between January 1, 2021, and October 1, 2025. Results. This literature review reveals a notable inverse relationship between PA and MPA/SA among university students. PA consistently emerges as a significant negative predictor of MPA/SA within this demographic. Its protective role is closely tied to enhancements in psychological well-being, as PA demonstrates positive associations with self-control, self-acceptance, core selfevaluation, and resilience, while concurrently mitigating stress, negative affect, anxiety, and depressive symptoms. Furthermore, both the intensity and type of PA are critical in optimizing these benefits: moderate to vigorous exercise is linked to reduced likelihood of MPA/SA compared to low-intensity activity, with aerobic exercise showing the most pronounced effect in lowering addiction levels. Conclusions. This evidence supports the use of PA not only as a general health recommendation but as a targeted, evidence-based strategy to reduce the risk of MPA/SA in student populations.

Reducing high school students’ stress indicators in the process of physical exercises

2026-01-27T14:43:40+02:00

The purpose of the work is to investigate the dynamics of stress and motor indicators of high school students in the process of physical exercises (using the example of boxing). Materials and methods. The research involved 64 high school students (boys) (17 years old). A pedagogical experiment was conducted, for which two groups were formed: control (CG, n = 31) and experimental (EG, n = 33). The CG high school students were trained according to the current physical education curriculum, and the EG high school students were trained according to the methodology we proposed, which involved boxing. The following indicators were studied: stress indicators (anxiety, stress resistance, stress level); motor indicators (coordination and strength endurance, speed and strength endurance). Results. A methodology for reducing high school students’ stress indicators as well as improving the motor indicators through boxing in the process of physical education has been developed. Testing the methodology’s effectiveness has shown significantly better results in the EG high school students than in the CG in all stress and motor indicators. Thus, from boxing training, the EG high school students showed statistically significant reduction the stress and anxiety level, and improvement in stress resistance and speed and strength endurance, as well as coordination and strength endurance level. Conclusions. A high level of development of physical qualities in the dynamics of boxing training sessions, a decrease in the level of anxiety and stress in high school students, as well as an increase in stress resistance, will contribute to strengthening the physical and mental health of high school students, improving their academic performance, and achieving self-realization in the future.

Stress level of cadets during training under martial law depending on their temperament type

2026-01-27T14:50:42+02:00

The purpose of the work is to investigate the frequency of stress symptoms and the level of mental health in cadets during training under martial law, depending on their temperament type. Materials and methods. The research was conducted in 2024–2025 at National Academy of Internal Affairs (Ukraine, Kyiv, NAIA). The study involved 276 male cadets studying at the bachelor’s level in the specialty “Law Enforcement”. Four groups of cadets were formed, depending on their temperament type: choleric (Group C, n = 58), sanguine (Group S, n = 92), phlegmatic (Group P, n = 87), and melancholic (Group M, n = 39). Research methods: theoretical analysis and generalization of literature sources, survey, psycho-diagnostic methods, methods of mathematical statistics. Results. Conducted studies show that choleric and melancholic cadets show psychosomatic symptoms of stress more often than sanguine and phlegmatic cadets. That is, cadets with a choleric and melancholic type of temperament are more likely to get stressed during training in martial law conditions than cadets with a sanguine and phlegmatic type of temperament. It was established that such indicators of mental health of cadets as stress level, tendency to develop stress, level of stress resistance, neuro-emotional stress, and reactive anxiety are reliably (р ≤ 0.05–0.01) worse and more negatively expressed in melancholic and choleric cadets, compared to sanguine and phlegmatic cadets. Conclusions. This determines the need to take into account the individual psychological properties of cadets, in particular the type of temperament, when justifying the means of stress prevention during training under martial law, as well as for the restoration of the physical and psycho-emotional state of cadets.

The role of hygienic, demographic, social determinants in the formation of occupational morbidity in Ukraine depending on the employment of the population, demand and supply on the labor market in pre-war and wartime

2026-01-27T15:12:19+02:00

The identification, registration, and analysis of occupational diseases remains a pressing issue, especially when the regulatory framework governing this process has changed significantly, and changes in the composition of the population, its employment, and organizational difficulties in conducting diagnostics and recording occupational diseases during military operations against the backdrop of widespread migration of the population within the country and beyond its borders. Therefore, the identification, registration, and analysis of regional characteristics in the formation of occupational disease indicators in Ukraine remains a pressing issue, and its relevance will increase during the post-war reconstruction phase, when a predicted shortage of working-age population will arise. The aim of the scientific research is to identify the characteristics of the formation of occupational disease indicators in dynamics for the period 2011–2024 (for the years before the start of hostilities on the territory of Ukraine and during various stages of the armed aggression), as well as changes in regional conditions and factors influencing their formation. Materials and methods. Determination of the number of occupational diseases based on the principle of complete statistical sampling of primary data for all cases first detected and registered in Ukraine in the period 2011–2024, taking into account military, hygienic, and social aspects. Statistical data were obtained from the State Labor Service of Ukraine and the Pension Fund of Ukraine. The materials were processed using generally accepted methods of sanitary statistics and descriptive epidemiological analysis. The following methods were used during the study: bibliosemantic, medical-statistical, and structural-logical analysis. Results. It was found that the number of occupational diseases detected in the period from 2011 to 2024 changed from 2011 to 2013, when the war in Ukraine began, from 2014 to 2021 – a period of adaptation of workers to the changed conditions of life in society, and the years 2022–2024 – a period of martial law. The registration of occupational diseases decreased by 3.3 times compared to the pre-war period due to underreporting associated with the closure of enterprises, a decrease in the working population in manufacturing, widespread migration of the population, and the destruction of the structure of medical care for workers. In 2024, not a single case of occupational disease was registered in 12 regions of Ukraine. A significant share of the reduction in employment fell on industrially developed regions, in particular, there was a significant reduction in employment in the Kharkiv, Dnipropetrovsk, Odesa, Mykolaiv, Kyiv regions and in the city of Kyiv. The share of the simplest professions decreased the most. In the professional structure of registered unemployed persons, there is a decrease in the share of machine and equipment maintenance workers, and a shortage of workers in traditionally male professions is becoming noticeable. Conclusions. In the dynamics of observation for 2011–2024, three periods can be distinguished: 2011–2013 as pre-war; 2014–2021 as the period of the beginning of the war, the occupation of Crimea, Donetsk and Luhansk regions; 2022–2024 as the period of full-scale Russian invasion of Ukraine. During all these periods, there was a transformation of socio-economic and demographic determinants, changes in migration processes, the labor market, and medical care for the working population. These phenomena were reflected in occupational disease indicators. Thus, in 2024, despite a significant decrease in the total number of occupational disease cases in Ukraine, relatively high and very high indicators were observed in the Dnipropetrovsk, Lviv, Donetsk, and Zaporizhzhia regions. In 12 regions of Ukraine, not a single case of occupational disease was registered. Overall, there was a decline in the effectiveness of the occupational health service in terms of prevention, detection, recording, and registration of occupational diseases. Against the backdrop of domestic and European trends and taking into account the negative impact of the war on working conditions, the quality of life of workers, and their medical care, programs to preserve the country’s labor potential and promote the use of new forms of employment will be necessary in the post-war period. In the post-war period, recovery programs should promote the use of new forms of employment, which, in particular, requires the development of domestic labor legislation in terms of further promoting flexible forms of employment and preventing the risks associated with their use, efforts to create decent working conditions, medical and social technologies for maintaining and improving the health of workers.

Predictors of professional motivation for the development of emotional burnout syndrome among medical workers worldwide and in Ukraine

2026-01-27T15:18:27+02:00

According to the Ukrainian Public Health Center, emotional burnout among healthcare workers ranges from 20–75%. The most frequent symptoms include emotional and physical exhaustion (82%), sleep disturbances (70%), chronic fatigue (68%), and feelings of insecurity with fear of making mistakes, especially in extreme conditions (63%). The purpose. To investigate the influence of professional motivation on the formation of emotional burnout syndrome in medical workers, as well as to identify the main psycho-emotional and motivational factors that are predictors of the risk of developing this syndrome, with the aim of further developing effective measures for its prevention. Materials and methods. The work was based on a systematic review, meta-analysis, and content analysis of publications from the Scopus, PubMed, and ResearchGate scientometric databases, as well as materials from professional publications, including. The literature search was conducted using the keywords: “motivation,” “professional activity,” “emotional burnout”. Results. The results revealed alarming trends: 58.1% of respondents noted a loss of interest in their professional activities, 60.1% had difficulty concentrating, 58.8% expressed dissatisfaction with their work, and 63.5% reported increased irritability. Signs of social isolation–the desire to avoid communication with colleagues and patients–were observed in 53.4% of respondents, and 59.5% reported difficulties in making professional decisions. Conclusions. More than half of healthcare workers show worrying signs of reduced professional well-being: 58.1% report losing interest in work, 60.1% struggle with concentration, and 58.8% do not feel satisfied with their professional activity.

Transformation of Inpatient Healthcare Under Financing Reform, Pandemic, and Martial Law: A Case Study of Hospitals in Zhytomyr Region (2014–2024)

2026-01-27T15:25:52+02:00

Purpose: to analyze the dynamics of hospital bed capacity, inpatient care volumes, and staffing in Zhytomyr region hospitals during 2014–2024 to assess the impact of healthcare financing reform, COVID-19 pandemic, and martial law on the regional inpatient care system functioning. Materials and methods. A retrospective descriptive-analytical study was conducted using official statistical data from Zhytomyr Regional Medical Statistics Center for 2014–2024. Annual reporting forms No. 20 data were analyzed regarding staff positions, bed capacity, discharged and deceased patients, and average length of stay. Systems analysis, time series analysis, comparative and structural analysis methods were applied. Statistical processing included growth rate calculations, linear and segmented regression. Results. Total staff positions decreased by 22.3% (from 25,071.75 to 19,474), with the greatest reduction among junior medical staff (–32.3%). Bed capacity decreased by 13.8% (from 9,180 to 7,912), but increased by 10.9% in 2023–2024. After a 35.0% drop in 2020, treated patients reached a record 319,644 in 2024, exceeding pre-war 2019 levels by 18.1%. Average length of stay decreased from 10.3 to 7.6 days (–26.2%). Bed turnover increased from 31.8 to 40.4 (+27.0%), reaching maximum values. Physician workload increased from 57.7 to 69.7 patients (+20.8%). Conclusions. The inpatient care transformation in Zhytomyr region demonstrated successful adaptation to multiple crises. Implementation of per-patient payment catalyzed resource utilization efficiency, compensating for pandemic and war impacts while achieving record productivity. Despite reduced resources, the system showed high adaptive capacity, ensuring increased healthcare accessibility. Critical challenges include increased staff workload requiring compensatory mechanisms for long-term sustainability.

Corporate culture as a tool for implementation of lean management principles in hospitals in Slovakia

2026-01-27T15:34:54+02:00

Purpose. The main objective of our research was to examine the relationship between corporate culture and lean management in hospitals in Slovakia and to find out the possible reinforcing effect of dynamic managerial skills in this relationship. Materials and methods. The research aimed at investigation of the interrelationship between corporate culture and the implementation of lean management principles in healthcare organizations in the Slovak Republic and at identification of the moderating effect of dynamic managerial capabilities in this relationship. The sample consisted of 175 managers from 35 hospitals. The SEM method in Smart Pls 3.3 software was used to test the hypotheses at a significance level of 0.05. Results. We found out that there is a statistically significant association between a balanced corporate culture of healthcare organizations and the implementation of lean principles. Dynamic managerial capabilities strengthen the effect of culture on lean implementation. Conclusions. Our research shows the clear importance of building a balanced corporate culture as an organizational factor in the application of lean management principles in healthcare, simultaneously with work on the development of dynamic managerial capabilities as an individual factor for the development of lean management.

The importance of cooperation between physician and patient for the effectiveness of surgical care organization in patients with glaucoma

2026-01-27T15:43:46+02:00

Purpose: to investigate the effectiveness of interaction between ophthalmologists and glaucoma patients in promoting patient adherence to necessary surgical care at early stages of the disease. Materials and methods. Medical records of 500 patients with stage 3–4 glaucoma and survey data from 1,200 ophthalmologists and 1,500 patients were analyzed using social-hygienic, medical-statistical, and sociological methods to identify reasons for late surgical referrals. Results. The reasons for patients seeking surgical treatment at advanced stages of glaucoma were identified: in 42.6 ± 2.2% of cases, the disease was diagnosed too late; in 37.3 ± 2.2% of patients, ophthalmologists had not provided recommendations regarding surgical intervention; and in 20.1 ± 1.8% of cases, patients expressed distrust toward surgical treatment. The vast majority of surveyed physicians (96.7 ± 0.5%) are well-versed in current guidelines governing glaucoma management and apply them in clinical practice. However, only 44.5 ± 1.4% are able to accurately determine the necessity of surgical treatment for a patient, and only 29.7 ± 1.3% can select the appropriate type of surgical procedure. For 89.2 ± 0.9% of patients, the decisive factor in choosing a treatment method is the professional qualification of the physician. Furthermore, 85.2 ± 1.2% of patients are more willing to undergo surgery in the fellow eye due to a positive prior experience. Conclusions. Patient adherence to surgical treatment depends on effective communication by the ophthalmologist. Enhancing physician knowledge and patient awareness of surgical safety and efficacy can improve trust in surgical management and reduce the risk of vision loss.

Private capital in the transformation of healthcare systems: international experience and lessons for Ukraine

2026-01-27T15:49:31+02:00

Purpose. The purpose of the study is to conduct a comprehensive analysis of the role of private capital in the transformation of healthcare systems based on international experience, to assess its impact on the efficiency, innovativeness, and quality of medical services, as well as to develop practical recommendations for adapting these mechanisms to modernize Ukraine’s healthcare sector under the conditions of martial law and European integration Materials and methods. The study employed methods of comparative analysis, case analysis, SWOT analysis, and statistical analysis. The research materials included official reports of international organizations (WHO, Eurostat), analytical materials from leading consulting companies (Bain & Company, McKinsey), data from the State Statistics Service of Ukraine, scientific publications, and program documents of regulatory initiatives (Joint Commission International, USA; QHA Trent, United Kingdom; Australian Council on Healthcare Standards International, Australia). The research covered private capital value creation strategies, their impact on the financial sustainability of medical institutions, and the adaptation of international experience for Ukraine. Results. The findings demonstrate the ambivalent impact of private capital: on the one hand, it drives infrastructure modernization, operational efficiency (with potential annual savings of up to USD 265 billion), and technological innovation (reducing costs by 5–10%); on the other hand, it leads to increased debt burden, higher service prices (by 6.7%), and deterioration in healthcare quality (a 25% rise in complications). The future development of Ukraine’s healthcare system will be shaped by the combination of global trends in digitalization, integration into the European space, and internal reforms in financing and management. The involvement of private capital is viewed not merely as a financial tool but as a structural factor of transformation – through infrastructure modernization, managerial optimization, and enhanced resource efficiency. To systematically assess the potential and challenges, a two-part SWOT analysis was conducted, which identified that: Ukraine’s healthcare system is gradually entering a phase of structural modernization, where private capital and international accreditation serve as catalysts for managerial, technological, and regulatory transformation; in the context of developing the healthcare service sector in Ukraine, it is advisable to implement a hybrid model of public–private partnership, which does not entail full hospital privatization but focuses on creating forms of co-ownership or co-management. Conclusions. Private capital is a powerful catalyst for structural change in healthcare systems, yet it requires a careful balance between financial efficiency and social responsibility. For Ukraine, the optimal path lies in combining strategic partnerships with longterm investment funds and implementing comprehensive reforms alongside the development of public–private partnerships.

Attenuation coefficient measurement in screening for metabolic dysfunctionassociated steatotic liver disease: between diagnostic accuracy and economic reality

2026-01-27T15:56:03+02:00

Purpose – to evaluate the diagnostic performance of ultrasound attenuation coefficient measurement (ACM) in detecting and grading hepatic steatosis and to assess its economic feasibility as a primary screening tool for metabolically associated steatotic liver disease (MASLD) in routine clinical practice. Materials and methods. The study included 168 adult patients aged 18–64 years who underwent comprehensive liver assessment under real-world clinical conditions. All participants received conventional B-mode ultrasound examination with attenuation coefficient measurement and hepatorenal index assessment, as well as magnetic resonance imaging with proton density fat fraction (MRI-PDFF). MRI-PDFF was used as the reference standard for the presence and severity of hepatic steatosis. Hepatic steatosis was defined using established MRI-PDFF thresholds, including binary classification (presence or absence of steatosis) and stratification by steatosis grade. Diagnostic performance of attenuation coefficient measurement was evaluated using receiver operating characteristic (ROC) curve analysis with calculation of the area under the curve (AUC), sensitivity, specificity, and optimal cut-off values. Comparative analyses were performed to assess differences in diagnostic accuracy between attenuation coefficient measurement and the hepatorenal index. Economic evaluation was conducted from the healthcare provider perspective and included estimation of the cost per correct diagnosis, the cost-to-accuracy ratio (cost/AUC), and the incremental cost-effectiveness ratio (ICER), based on representative market prices of diagnostic procedures in Ukraine. Results. Attenuation coefficient measurement demonstrated high diagnostic accuracy for the detection of hepatic steatosis, with an AUC of 0.94 (95% confidence interval 0.88–0.96), significantly exceeding the diagnostic performance of the hepatorenal index. The method enabled reliable discrimination between different grades of steatosis using predefined cut-off values, with sensitivity and specificity exceeding 80% for clinically relevant steatosis. Attenuation coefficient values showed a strong and statistically significant association with MRI-PDFF, confirming the ability of this ultrasound-based method to quantitatively reflect hepatic fat content. Diagnostic performance of attenuation coefficient measurement remained stable across patient subgroups, including individuals with elevated body mass index, indicating reduced dependence on anthropometric factors compared with other ultrasound-based approaches. Decision curve analysis demonstrated that attenuation coefficient measurement provided the highest net clinical benefit across clinically relevant threshold probabilities for referral, outperforming controlled attenuation parameter–based elastography and MRIPDFF in primary screening scenarios. From an economic perspective, attenuation coefficient measurement showed the most favourable efficiency profile among the evaluated non-invasive diagnostic modalities. The cost per unit of diagnostic accuracy (cost/AUC) was substantially lower for attenuation coefficient measurement than for controlled attenuation parameter–based elastography and magnetic resonance imaging with proton density fat fraction (MRI-PDFF). Modelling of population-level screening scenarios indicated that the use of attenuation coefficient measurement as a first-line screening tool could reduce overall diagnostic expenditures by approximately 70–85% while maintaining high sensitivity for clinically significant hepatic steatosis. Conclusions. Ultrasound attenuation coefficient measurement is a diagnostically accurate, accessible, and economically feasible method for the primary screening of metabolically associated steatotic liver disease. Integration of this method into routine liver ultrasound examinations may improve early identification of hepatic steatosis, support appropriate patient stratification, and optimize the use of healthcare resources, particularly at the level of primary healthcare and in health systems with limited budgets.

Administrative and legal principles of international cooperation between healthcare institutions in Ukraine and Slovakia

2026-01-27T16:14:50+02:00

Purpose. The purpose of the article is to study the managerial-legal and digital-technological foundations of cooperation among healthcare institutions in the context of Ukraine’s European integration, particularly regarding cross-border provision of medical services, the formation of shared databases, digital integration, and the exchange of medical information. Materials and methods. In the course of the research, dialectical, formal-logical, system-analytical, axiological, comparativelegal, and prognostic methods were applied. The source base consists of the founding treaties and legal acts of the EU, the national legislation of Ukraine and Slovakia, as well as scholarly works on the digital transformation of the healthcare system and contemporary studies on the legal regulation of healthcare, medical data exchange, and personal data protection. Results. The research results indicate that the effectiveness of cooperation among healthcare institutions depends on the degree of alignment in legal regulation, the interoperability of digital systems, and the reliability of medical data management. It has been established that the EU legal system provides a solid foundation for developing cross-border patient mobility and the exchange of medical information; however, Ukraine must continue aligning its legislation with the EU acquis to fully participate in these mechanisms. The implementation of unified digital standards such as HL7 FHIR, SNOMED CT, and ICD-10 is a necessary prerequisite for ensuring the compatibility of medical data and the continuity of patient care in the context of cross-border cooperation. It is emphasized that the secure administration of shared medical databases requires strict adherence to the principles of personal data protection, cybersecurity standards, and ethical norms in accordance with the requirements of the GDPR and EHDS. The research results also highlight the significant potential of integrating analytical systems based on artificial intelligence and neuro-fuzzy models for monitoring epidemiological trends, forecasting the workload of healthcare institutions, and optimizing resource allocation in crossborder regions. Such tools can significantly strengthen and enhance the efficiency and adaptability of healthcare systems in crisis situations, particularly during the war in Ukraine and the resulting migration crisis. Conclusions. The paper proposes directions for improving the legal mechanisms and digital infrastructure necessary to establish an integrated European healthcare space. It is substantiated that the implementation of the principles of digital interaction and interoperability will enhance the efficiency of healthcare system management in Ukraine and promote its institutional compatibility with models of good governance in the healthcare sector, ensuring the unity of standards, improvement in the quality of medical services, and legal alignment with EU norms.

Patient Service Pathways as an Organizational and Legal Mechanism of Public Administration in Healthcare: The Experience of a Regional Clinical Hospital

2026-01-27T16:21:04+02:00

Purpose. The study’s purpose is to provide a scientific justification for the implementation of patient service pathways as an effective organizational and legal mechanism of public management in the medical care sphere, as well as to analyse the outcomes of their practical implementation using the case of the Municipal Enterprise “Rivne Regional Clinical Hospital named after Yurii Semeniuk” of the Rivne Regional Council (hereinafter – RRCH). Materials and methods. The object of the study is the process of implementing patient service pathways within the operational activities of a multidisciplinary regional healthcare facility. The research is based on a comprehensive methodological framework that combines general scientific and applied methods. The systems and analytical approach was applied to conceptualize patient service pathways within the structure of public management mechanisms in medical care sphere. Descriptive and comparative methods were used to analyse changes in service processes before and after the implementation of the “outpatient clinic without queues” policy. Sociological methods were employed to process patient survey data and feedback, while generalization and visualization methods were applied to present empirical results. The empirical base of the study includes internal regulatory documents and management reports of the hospital, statistical data on patient visits and complaints, analytical monitoring materials, Service Contact Centre’s records, and patient satisfaction survey results collected during 2022–2025. Results. The study demonstrates that the implementation of patient service pathways as part of a comprehensive patient-cantered service model has led to significant improvements in the organization of medical care services. The reform included the establishment of a centralized Service Centre responsible for primary patient communication, implementation of IP-based contact centre technologies, standardized communication scripts, digital appointment scheduling, automated SMS notifications, and systematic post-visit feedback collection. These measures reduced the administrative burden on registration desks and “live” queues by more than 70%, improved coordination between clinical and non-clinical units, and increased transparency of service processes. Centralization of communication channels also contributed to better accounting of provided services and reduced opportunities for informal payments. As a result, the number of patient complaints related to medical care organization and medical services quality decreased by 74.2% in 2025 compared to 2022 indicating a substantial reduction in conflict situations and the service failures. The average waiting time for a physician appointment was reduced to 11.62 minutes, and 83.4% of patients rated the received medical services as high quality. Additionally, the workload on traditional registration desks and “live queues” was reduced by more than 70%, contributing to improved internal logistics and more efficient use of human resources. The findings indicate that patient service pathways not only optimize service processes but also function as a public management mechanism that enhances accountability, coordination, and responsiveness within healthcare institutions. The obtained results are consistent with international research on integrated care and service pathways, which highlights the role of standardized yet patient-cantered service processes as a key driver of medical care quality and public management efficiency. In line with European and global studies, the experience of the Rivne Regional Clinical Hospital confirms that patient service pathways complement clinical pathways by addressing organizational, communicative, and navigational dimensions of care, as well as patients’ emotional needs. The institutionalization of service pathways as part of hospital governance contributed to greater predictability of care processes, reduction of service-related errors, and improved coordination among healthcare professionals. The integration of digital tools and standardized service algorithms strengthened managerial transparency and accountability, while the observed growth in patient satisfaction and trust supports existing evidence that service pathway optimization reduces administrative burden on medical staff and enhances continuity and accessibility of medical services. Conclusions. The study proves that patient service pathways represent an effective organizational and legal mechanism of public management in medical care, facilitating the implementation of the patient-cantered principle, improving medical service quality and accessibility, increasing transparency of managerial processes, and strengthening patient trust in public healthcare institutions. The experience of the Rivne Regional Clinical Hospital confirms that the integration of organizational, legal, and digital solutions can significantly enhance service performance without substantial additional financial expenditures. The proposed model has strong potential for scaling and adaptation in other secondary and tertiary healthcare institutions across Ukraine, contributing to the development of a unified national approach to service-oriented healthcare governance in the context of ongoing health system reform.

Influence of proton pump inhibitor intake on the course of ulcerative colitis in patients with concomitant GERD

2026-01-27T16:26:49+02:00

Ulcerative colitis (UC) is a chronic relapsing inflammatory disease of the large intestine. Among the potential factors that may lead to remission breakdown and UC exacerbation is the intake of medications by patients for comorbid conditions. One such condition for which patients with UC may be prescribed proton pump inhibitors (PPIs) is gastroesophageal reflux disease (GERD). PPI intake in patients with UC may be associated with worsening clinical symptoms, as well as laboratory and endoscopic changes. Although the exact mechanisms remain unclear, multiple studies suggest that PPIs can negatively influence the gut microbiota, reduce beneficial bacteria such as Bifidobacterium, and promote the overgrowth of opportunistic organisms including Enterobacteriaceae, Clostridioides difficile, Salmonella, and Escherichia-Shigella. Moreover, PPIs may alter bile acid metabolism and reduce short-chain fatty acids while increasing the level of toxic compounds such as hydrogen sulfide, thus contributing to mucosal inflammation. Structural changes in epithelial cells, including cytoskeletal alterations and weakened barrier function, have also been reported, facilitating microbial translocation and triggering colonic inflammation. Purpose. To retrospectively analyze the effect of PPI intake on the course of UC in patients with comorbid GERD. Materials and methods. We conducted a retrospective comparative study at the Department of Internal Medicine №1 of Bogomolets National Medical University from September 2024 to December 2025. The study involved 40 patients (30 men/10 women) with histologically confirmed UC and comorbid GERD. Patients were divided into two groups based on PPI intake. The first group (n=20) received PPIs once daily for 12 weeks in addition to standard UC therapy. The second group (n=20) underwent lifestyle modification without PPI use. GERD was diagnosed based on clinical symptoms (heartburn ≥2 times per week), endoscopic findings per the Los Angeles classification (grades B–D), and 24-hour pH impedance monitoring (DeMeester score >14.7 or acid exposure time >6%). The UC course was evaluated using the PRO2 scale, fecal calprotectin levels, and colonoscopy findings with the Mayo Endoscopic Score (MES) at baseline and after 4, 8, and 12 weeks. Results. At baseline, both groups were comparable in terms of age, sex distribution, and initial clinical/laboratory parameters, including fecal calprotectin levels and PRO2 scores. After 4, 8, and 12 weeks, patients receiving PPIs demonstrated a consistent increase in fecal calprotectin: 65, 120, and 180 μg/g respectively, compared to stable normal levels in the non-PPI group (p<0.05). According to the PRO2 scale, patients in the PPI group showed clinical deterioration, with increased daily stool frequency and the presence of blood in stool (scores of 2+2) by week 12, while the control group maintained stable scores (0–1). Endoscopic assessment revealed worsening mucosal inflammation in the PPI group: by week 12, MES scores of 1–2 were recorded, indicating mild to moderate inflammation, compared to MES 0 (remission) in the non-PPI group. Conclusions. PPI use in UC patients with comorbid GERD adversely affects clinical outcomes, as well as laboratory and endoscopic indicators of disease activity. The findings suggest that PPI therapy may contribute to relapse or flare-ups in UC, possibly due to alterations in gut microbiota and mucosal immune response. Further prospective studies with microbiota profiling and larger cohorts are needed to elucidate the mechanisms and determine optimal management strategies for GERD in patients with inflammatory bowel diseases.

The experience of the Medical University of Warsaw in conducting an OSCE for first-year students of the specialty “Nursing”

2026-01-27T16:41:05+02:00

The purpose of the study is to present the experience of conducting OSKI exams in the discipline “Propaedeutics of Nursing” for first-year bachelor’s degree applicants in the specialty “Nursing” at the Medical University of Warsaw, in order to study it, analyze it, and apply it in the educational process of our university. We believe that this evidence is important and interesting for participants in the educational process when organizing and conducting both final module controls and graduate certification. Materials and methods. The OSCI exam consisted of five examination stations located in two rooms. Each station contained a separate practical task that addressed the skills acquired during the classes. Two stations in the field of aseptic and two – non-aseptic activities, and the task of calculating drug doses. The candidates collected the necessary equipment from the prepared work area themselves. All tasks were assessed based on original checklists developed in accordance with current medical care standards. The following methods were used during the research: bibliosemantic, content analysis, structural and logical analysis. Results. During the certification of applicants in the discipline “Propaedeutics of Nursing”, five stations are provided: two nonaseptic and two aseptic, and one station for completing a theoretical task. At non-aseptic stations, candidates perform scenarios such as placing a nasogastric tube for enteral nutrition of the patient, or washing the stomach with a thick gastric tube; placing a gas evacuation tube, or a cleansing enema. At the aseptic station, the following scenarios were performed: performing subcutaneous or intramuscular injections; taking blood from a vein with a vacutimer, or placing a peripheral catheter with intravenous administration of drugs. Along with practically-oriented scenarios, during the exam, students solved tasks that consisted of calculating the dose of the drug that must be administered to the patient, taking into account the degree of dilution, non-standard dosage, and the rate of administration through an infusion machine: antibiotics, insulin, and other medications. The student chose the task randomly. The duration of the task is 15 minutes. The result of this stage was evaluated according to the criterion “passed/failed”. Highlighting critically important points in the checklist, failure to complete which automatically leads to a negative result, contributes to the formation of responsibility and discipline in students. It was noted that the distribution of time at the stations (5 minutes – preparation, 10 minutes – execution) allows students to demonstrate the full cycle of performing the manipulation – from preparing the workplace and equipment to the final disposal of the materials used. Experience has shown that such a structure stimulates the formation of algorithmic thinking in students, which corresponds to the real conditions of clinical practice. A feature of the described experience is the use of a scenario method using mannequins and the role of a standardized patient, which is performed by the teacherexaminer. This allowed us to assess not only technical skills, but also communicative competencies, such as obtaining informed consent, explaining the procedure to the patient, interpreting the clinical situation, and adapting the action algorithm in case of contraindications. This approach, combined with communicative tasks, contributes to the development of patient-oriented interaction skills in students. It is also important that even at the early stages of training, students are faced with tasks of increased complexity – for example, identifying contraindications to performing a manipulation and making a decision to change the algorithm of actions. This forms clinical thinking and the ability to act in non-standard situations, which is one of the key competencies of a nurse. Analysis of the exam results showed that most students successfully completed the tasks, but some of them had difficulties with the correct selection of instruments, compliance with asepsis and accurate dosing of drugs. The difficulties identified in some students confirm the need for additional training sessions before administering the OSCЕ, which is consistent with Zayyan’s (2011) recommendations for preparing for this type of assessment. The introduction of trial sessions, individual feedback, and simulations in small groups can help reduce the proportion of unsatisfactory results. Conclusions. Thus, conducting an exam for nursing students in the OSCЕ format increases the objectivity and transparency of assessment, promotes the development of clinical thinking, and forms integrated professional competencies (technical, communicative, and cognitive), which meets international standards for the training of nurses.

Moral distress in nurses of gastroenterological and proctological departments: psychological features and ways to overcome

2026-01-27T16:47:46+02:00

Aim. The study aimed to theoretically and empirically investigate the psychological characteristics of moral distress among nurses working in gastroenterology and proctology departments, and to develop practical recommendations for reducing its prevalence and preventing its negative effects on professional health and the quality of nursing practice. Materials and methods. The study was conducted in 2024–2025 at the Volyn and Zhytomyr Medical Institutes. The sample included 115 medical workers with more than one year of work experience. Standardized psychodiagnostic methods were used: the Social Adaptation and Reappraisal of Life Events Scale, developed by T. Holmes and R. Rahe, the Professional Quality of Life Scale (ProQOL, B. Stamm), and the Impact of Event Scale–Revised (IES-R, M. Horowitz et al.). Data collection involved questionnaires, surveys, and structured observation. Statistical processing was carried out using SPSS v.27 and Microsoft Excel (2019). Results. The findings demonstrated a significant prevalence of low and medium stress resilience. Over 90% of respondents showed average, threshold, or low resistance, indicating vulnerability to stress factors in the clinical environment, while only 1.7% reported high resilience. The Professional Quality of Life Scale revealed that nearly half of respondents experienced insufficient compassion satisfaction. Compassion fatigue was high in 39.1% of participants, and burnout symptoms were detected in 40.9%. Analysis of the Impact of Event Scale identified avoidance as the most frequent coping mechanism, reported by 25.2% of respondents. Intrusion, manifested through repetitive thoughts and sleep disturbances, was observed in 11.3%, while 7% demonstrated hyperarousal. Although avoidance provides temporary protection, it tends to cause long-term consequences, including emotional withdrawal, diminished empathy, and impaired communication with patients and colleagues. Overall, the study confirmed that moral distress is widespread and strongly correlated with emotional exhaustion and burnout. The coexistence of low stress resilience and high burnout levels forms a cycle of moral burden that deepens psychological vulnerability. These findings correspond to international studies, confirming that moral distress represents a universal challenge in healthcare systems across specialties. Conclusions. The research established the high prevalence of moral distress among nurses in gastroenterology and proctology units in Ukraine and demonstrated its close link with professional burnout and reduced resilience. The results emphasize the need for national strategies to support nursing personnel. Such strategies should integrate psychological support services, structured training in burnout prevention, and resilience-building interventions. These measures are particularly important within postgraduate education and institutional healthcare support systems. The obtained results can serve as a foundation for further applied research and the design of evidence-based interventions aimed at improving the psychological climate in hospital units. Future studies should assess the effectiveness of implemented programs and explore the long-term impact of moral distress on professional motivation, retention of nursing staff, and the quality of patient care. Addressing moral distress proactively can strengthen both the well-being of healthcare providers and the overall effectiveness of medical services.

Medical, Social, and Educational Support for Children with Hearing Impairments: The Path to Effective Rehabilitation and Socialization

2026-01-27T16:32:31+02:00

The article presents a study on the effectiveness of an optimized organizational model for the rehabilitation of children with hearing impairments. The proposed model combines medical, social, and educational services through face-to-face, outpatient, and remote interventions. A total of 224 children aged 6–10 years participated, divided into two equal groups: one received rehabilitation under the new comprehensive program, while the other followed standard procedures. Over 12 months, assessments included physical, speech, cognitive, psycho-emotional, and social-educational parameters. The purpose: to optimize the rehabilitation system for children with hearing impairments by improving the organizational model of medical, social, and educational support, enhancing recovery effectiveness, quality of life, and social integration. Materials and methods. The study applied organizational-legal, historical, content analysis, and structural-organizational modeling methods. Sociological tools, such as questionnaires and interviews with parents and teachers, were used. Statistical analysis employed Student’s t-test, χ², and Microsoft Excel and Statistica 6.0 software. Results. Children who participated in the new rehabilitation program showed greater improvement in auditory perception, speech intelligibility, vocabulary, fine motor skills, and emotional stability compared to the standard group. They also demonstrated higher confidence, social engagement, and academic success. The use of cochlear implants and active family involvement enhanced rehabilitation outcomes, while barriers included limited access in rural areas and a shortage of specialists. Conclusions. The integrated, family-centered model proved more effective than traditional approaches, improving functional, emotional, and social development. Broader implementation and long-term evaluation are recommended.

Comparative analysis of diagnostic parameters of postural stability in patients with chronic lower back pain and healthy individuals

2026-01-27T16:35:54+02:00

Chronic lower back pain remains one of the leading health problems, which has a significant impact on the working capacity and quality of life of the population. Impaired postural stability mechanisms in such patients can limit functional activity, contribute to the formation of compensatory movement strategies, and increase the risk of falls. At the same time, scientific research data on the relationship between pain syndrome and balance parameters remain contradictory. This necessitates a comprehensive study of diagnostic indicators of postural stability in individuals with chronic lower back pain. Purpose: The aim of the study was to conduct a comparative analysis of postural stability parameters and stability limits in patients with chronic radicular pain in the lower back and healthy individuals in the control group in order to identify differences and determine their possible clinical significance. Materials and methods. The study included 42 patients with chronic lower back pain lasting more than 3 months and 30 healthy individuals without complaints of back pain or musculoskeletal disorders. All participants provided written informed consent. Exclusion criteria included specific lower back pain, vestibular disorders, regular use of medications that affect balance, pregnancy, and spinal deformities. Pain intensity was assessed using a visual analog scale (VAS). The Biodex Balance System was used to analyze postural stability, which allowed recording PSI indices (total, anterior-posterior, and mediolateral) and stability limits (direction control — DC, task execution time — T). For statistical processing, we used the t-test, ANOVA with Bonferroni correction, and effect size calculation (Cohen’s d). Results. No statistically significant differences were found between the groups in terms of age, height, body weight, and body mass index (p > 0.05), confirming their comparability. Patients with chronic low back pain had significantly worse overall stability index (OASI) and anterior-posterior stability index (APSI) scores compared to healthy participants (p < 0.001). The values of the mediolateral stability index (MLSI) did not differ significantly (p = 0.34). Stability limits were also significantly altered: patients with back pain showed a decrease in directional control (DC) and an increase in task completion time (p = 0.001 and p = 0.01, respectively). The calculated effect size values (Cohen’s d > 0.9 for LOS and d > 2.8 for PSI) indicate the high clinical significance of the differences found. The results suggest that patients with chronic low back pain have pronounced impairments in motor control and proprioceptive regulation. Conclusions. Chronic lower back pain negatively affects diagnostic indicators of postural stability and its limits. The changes in postural stability parameters may be the result of motor control and proprioception disorders in patients with chronic low back pain. The results confirm the advisability of including the assessment of postural stability and its limits in the comprehensive examination of patients with chronic lower back pain.