The Emergence of Healthcare Systems

Some sort of medical infrastructure has existed in all modern states and dependent territories. However, healthcare systems that provide legal entitlements to medical care at least for specific groups of the population, and that regulate access to and provision of healthcare on a national level only came into existence at the end of the nineteenth century. In our chapter, we trace the global emergence of healthcare systems and test whether their introduction date is related to a diffusion process through networks of trade, culture or health-related cooperation, or whether it is mainly influenced by domestic medical needs, capabilities, and wealth.

Rhetoric, the Pox, and the Grand Tour

In seventeenth- and eighteenth-century England, the Grand Tour, sex, and venereal disease became almost indivisible in the public imagination. The Grand Tour was an essential element of a well-born man's education. Yet a persistent belief developed that continental travel was infecting the youth of England with debilitating disease, and that they were bringing disease home to harm the nation. The belief sprang from medical ignorance and xenophobia, but also from the usefulness of associating pox with the Grand Tour, a rhetorical move that helped to palliate domestic medical problems, enrich sectors of the British economy, and lay groundwork for changes in the control of political power—and that has persisted into our own era's conception of the Grand Tour.

Synthesis of neural network structure for the analysis of complex structured ocular fundus images

This paper proposes an algorithm for synthesizing a neural network (NN) structure to analyze complex structured, low entropy, ocular fundus images, characterized by iterative tuning of the adaptive model’s solver modules. This algorithm will assist in synthesizing models of NNs that meet the predetermined characteristics of the classification quality. The relevance of automating the process of ocular diagnostics of fundus pathologies is due to the need to develop domestic medical decision-making systems. Because of using the developed algorithm, the NN structure is synthesized, which will include two solver modules, and is intended to classify the dual-alternative information. Automated hybrid NN structures for intelligent segmentation of complex structured, low entropy, retinal images should provide increased efficiency of ocular diagnostics of fundus pathologies, reduce the burden on specialists, and decrease the negative impact of the human factor in diagnosis.

Distress and Resilience in Resettled Refugees of War: Implications for Screening

There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about distress (Refugee Health Screener—15 (RHS-15)) and possible predictors of distress were collected at the domestic medical examination (T1) within 90 days of arrival and the civil surgeon examination (T2) 11–16 months after T1 for refugee groups from three countries (COU). Descriptive, correlative, analyses of variance, and regression techniques were used to determine trajectory type and their predictors. A higher percentage (7.3%) were distressed at T2 than at T1. By group, the Bhutanese became more distressed, the Burmese became less distressed, and Iraqi’s continued to have high distress. A regression model showed gender, loss, post-migration stress, and self-efficacy to be significant predictors of trajectory type (R2 = 0.46). When the T1 RHS-15 score was added to the model, observed variance increased (R2 = 0.53) and T1 RHS score accounted for the majority of variance (r = 0.64, p < 0.001), with post-migration stress accounting for markedly less (β = 0.19, p = 0.03). Loss and self-efficacy became less significant. Loss was, however, a strong predictor of delayed and chronic distress trajectory type. These data suggest that screening for distress should occur at least twice during resettlement to detect those with initial distress and those with delayed distress. Screening should be coupled with identifying other social determinants of health and a comprehensive assessment to determine the need for intervention for secondary prevention (i.e., reducing delayed distress) and treatment (reducing chronic distress).

THE MEDICAL SERVICES MARKET OF THE REPUBLIC OF CRIMEA: TRENDS AND PROSPECTS OF DEVELOPMENT

The article examines the trends in the development of the medical services market in the Republic of Crimea for the period 2015–2020. The analysis of the number of medical organizations by form of ownership, size and types of activity, capacity and technical equipment, provision of medical personnel, the volume of medical services in the context of public and commercial segments was carried out. In the period under study, there was an increase in the medical services market, due to an increase in the number of private medical organizations, the volume of mandatory medical insurance funds under the basic program. The expansion of the base and capacity of the sanatorium-resort complex, the growth of domestic medical tourism, laboratory services and telemedicine were identified as promising areas of market development.

Domestic Medical Tourism to Study the Expectations of Domestic Medical Tourists

The objective of the study was to document the features of the medical tourism sector in the state and analyse its possible implications on domestic healthcare in Jaipur, Rajasthan. In the present study, in-depth interviews were conducted with the key stakeholders in the state. The major finding that emerged from the study was that although there will be an improvement in the overall quality and availability of advanced healthcare services, accessibility to the services will be affected particularly for poorer sections due to increased cost of care. Policymakers believed the gradual growth of the private sector in healthcare and the decline of the public health sector will lead to the exclusion of a section of the domestic population from access to quality healthcare.

Issues of Medical Products Import Phase-out Applied in the Field of Traumatology and Orthopaedics of the Republic of Kazakhstan. Policy Brief

What the problem is? - Medical products applied in the field of traumatology and orthopaedics of Kazakhstan are fully import phase-out; - Measures carried out within the framework of medical products import phase-out applied in this field have been put on hold due to lack of funding. Policy options • Option 1. Regulatory and economic support from the state in particular an assistance in investors attracting for production growth of the domestic medical products applied in the field of traumatology and orthopaedics; • Option 2. Upgrade training of participants of the process on medical products import phase-out applied in the field of traumatology and orthopaedics of Kazakhstan for promotion of competitiveness on the market; • Option 3. Development of longstanding complex research and practice program for formation of clinical evidential base on efficiency and safety of medical products the manufacturing of which is planned within the framework of import phase-out policy. Policy options realization perspective Our three policy options are mutually supportive. The combined realization of these policy options will allow organizing the production of domestic medical products in the field of traumatology and orthopaedics with the aim of import phase-out. Conclusions Import phase-out of medical products in the field of traumatology and orthopaedics (prostheses, implants, various plates, etc.), of course, is an effective solution in terms of economics. However, to achieve this goal from the state, regulatory and economic support is needed. In turn, the manufacturer must also increase its own potential. We expect that after the stabilization of domestic production of medical products in traumatology orthopaedics and full-fledged import phase-out, problems associated with the export of these products may arise. We believe that a “vertical” strategy focused on the domestic market is most suitable for the development of domestic production of medical products. Key words: traumatology and orthopaedics, medical products, import phase-out, Kazakhstan

Evaluation of the effectiveness of research and innovative activities of medical universities and research organizations of the Republic of Kazakhstan

Despite the existing achievements of individual organizations, the effectiveness of the majority of Kazakhstani medical universities and research organizations continues to remain at a low level. By order of the Ministry of Health of the Republic of Kazakhstan dated December 23, 2020 №ҚР DSM-316/2020, the rules for assessing the effectiveness of research and innovative activities (RIA) were approved. As part of the implementation of the new Rules for assessing RIA, we assessed the performance of RIA of medical universities and reaearch organizations of the Republic of Kazakhstan for 2020, as well as an assessment of the dynamics of key indicators of RIA for the period from 2018 to 2020. When evaluating RIA of medical universities and resraerch organizations, the following key indicators were taken into account: The volume of profit from scientific research, The number of publications in the Web of Science (WoS), Scopus, Springer, Citation of scientific works, The number of patents and other titles of protection (in which, as a patent holder the organization itself is indicated), The level of commercialization of the RIA results, The level of participation in international conferences and forums. The assessment of the effectiveness of the RIA of Kazakhstani medical universities, research organizations over the past 3 years has revealed such positive aspects as an increase in the number of articles published annually in scientific journals indexed in authoritative databases by 44.4%, an increase in the share of publications of Kazakhstani authors in high-ranking journals (Q1-Q2) from 25.6% to 48.8%, an increase in the share of employees with the Hirsch index according to WoS / Scopus - from 7.7% to 10.2%, an increase in the average Hirsch index according to WoS / Scopus - from 0.15 to 0.18, an increase in the patent activity medical universities and research organizations - by 17.8%, an increase in the volume of profit received annually from the commercialization of research results - by 99.7%. On the other hand, there is a low activity of a fairly large share of domestic medical universities and research organizations in the field of science in terms of individual indicators. Taking into account the results of the study, further steps were proposed for the development of medical science in the Republic of Kazakhstan, as well as measures, the implementation of which is required at the level of medical universities and research organizations. Keywords: scientific and innovative activities, indicators of science, rating, medical science