Pregnancy planning in patients with rheumatic diseases (RD) is a multifaceted public health issue that includes complex strategies targeting underlying disease activity and reproductive potential. Patients with autoimmune diseases, including those with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren syndrome, systemic sclerosis (SSc), and spondyloarthritis, present with heightened risks of adverse maternal and fetal outcomes, including miscarriage, fetal growth restriction, preeclampsia, preterm birth, and increased utilization of assisted reproductive technologies. Available evidence suggests that conception during sustained disease remission, alongside tailored drug therapies, enhances maternal-fetal outcomes. Critical determinants of obstetric prognosis include disease-specific activity indices, serologic markers, organ involvement, and prior gonadotoxic exposures which compromise ovarian reserve. Structured preconception counseling that integrates contraception strategies, fertility preservation, ovarian reserve assessment, and multidisciplinary follow-up is essential to mitigate these risks. Current management paradigms advocate the continuation of pregnancy-compatible disease-modifying antirheumatic drugs (DMARDs), while strictly avoiding teratogenic therapies. Despite these advances, substantial unmet needs exist in early risk stratification, patient education, and systematic integration of reproductive health counselling into routine RD management. This review synthesizes contemporary evidence, delineates existing gaps, and provides a strategic framework for optimizing pregnancy planning and reproductive outcomes in women with RDs. The review addresses the key domains, including preconception risk stratification, disease-specific considerations, fertility assessment, ovarian reserve evaluation, and optimization of drug therapies. A multidisciplinary, treat-to-target approach is essential to improve pregnancy outcomes and long-term maternal health in this high-risk population.

Background: In Kazakhstan, transformation of the private healthcare sector as the country transitioned from lower-middle-income to upper-middle-income status has rarely been a subject of academic debate. This study aimed to analyze of health sector indicators disaggregated by type of ownership over the period of 10 years (from 2011 to 2020).Methods: This was a retrospective cross-sectional study, which was based on official healthcare statistics presented by the Ministry of Health. Relative change (RC) was computed to identify trends in changes over time and was expressed as a proportion with 95% confidence intervals.Results: In contrast with the government-owned health facilities, the overall number of private facilities increased over time, although this growth was less obvious in per capita terms. The number and density of private PHC facilities grew more substantially than those of outpatient facilities. PHC practitioners employed by the government-owned facilities admit more patients than practitioners of the private PHC facilities do. There is an uneven presence of the private health sector in different medical specialties with maternity, ophthalmology, dentistry, narcology, multidisciplinary, as well as palliative and nursing care being the most common.Conclusion: Such data are needed by decision-makers to tailor public health strategies focused on the stewardship of the private health sector, which would help improve the availability and affordability of medical services.

Background This article focuses on the importance of nurses’ work in the field of palliative care, emphasizing their role in providing comprehensive care and support to patients with incurable diseases. Purpose The researchers analyzed both international and local scientific articles over the past 15 years to assess the importance of nurses’ role in patient care in palliative medicine. Method and materials Then, in the period from September to November 2022, a crosssectional study was conducted.The aim of the study was to evaluate the activities of nurses in palliative care centers in Kazakhstan and determine the level of patient satisfaction with this care. Result To do this, 99 patients from three palliative care centers in Kazakhstan were interviewed.In the second stage, Pearson’s chi-squared (χ2) statistical method was used to analyze potential relationships between various variables and patient satisfaction levels in relation to the work of nurses in palliative care centers. The third stage included a binary logistic regression analysis to assess the impact of nurses’ behavior on patient satisfaction. The results of the statistical analysis indicate that the amount of information provided by nurses has an impact on the level of patient satisfaction with the quality of nurses’ work. This assistance includes an integrated approach, which includes both medical care and psychological, social and spiritual support, providing comprehensive care for the patient and his loved ones. Conclusion The results of this study can serve as a basis for strengthening the work of nurses, who are an integral element in the medical care system, playing a key role in supporting palliative patients at a difficult life stage. Bangladesh Journal of Medical Science Vol. 24 No. 01 January’25 Page : 136-144

Inflammatory rheumatic diseases (IRDs) present substantial risks of infection-related comorbidities during pregnancy. This study evaluates the knowledge, experience, and perceptions of healthcare professionals concerning the prevention of these risks. An international, cross-sectional survey was administered using the SurveyMonkey platform. The survey was disseminated to healthcare professionals specializing in rheumatology, obstetrics, infectious diseases, internal medicine, general practice, and related disciplines through social media channels. Developed in accordance with European Alliance of Associations for Rheumatology (EULAR) recommendations, this survey comprised 30 questions, including multiple-choice, Likert-type, and open-ended formats. A total of 201 healthcare professionals from thirty-six countries participated in the study, with rheumatologists comprising the majority ( n = 145, 72.1%). Systemic lupus erythematosus ( n = 183), systemic vasculitis ( n = 141), and rheumatoid arthritis ( n = 86) were identified as the diseases associated with the highest risk of infection-related comorbidities. The most frequently recommended infectious conditions for screening included Hepatitis B ( n = 142), urinary tract infections ( n = 141), and Hepatitis C ( n = 129). The primary risk factors were uncontrolled disease activity ( n = 176), high-dose corticosteroid use ( n = 164), and high disease severity ( n = 162). The most significant systemic barriers were insufficient number of specialists ( n = 156), and absence of multidisciplinary teams ( n = 155). This study identifies structural and educational deficiencies in the management of infection-related comorbidities among pregnant patients with IRD. The results underscore the need for targeted clinical guidelines, enhanced multidisciplinary care models, and expanded pre-pregnancy counseling.

Introduction. Patient safety is widely recognized as a priority in modern healthcare systems. Reporting adverse events is an important mechanism for identifying weaknesses in healthcare processes and improving the quality of care. Nevertheless, underreporting remains a common problem in many healthcare organizations. Nurses are closely involved in clinical care and therefore play a key role in patient safety. Their willingness to report adverse events may depend on several factors, including organizational culture, peer expectations, perceived blame, and the clarity of reporting procedures. The Reporting of Clinical Adverse Events Scale (RoCAES ) is frequently used to examine healthcare professionals’ attitudes toward reporting practices. Aim. To assess nurses’ attitudes toward adverse event reporting using the RoCAES scale. Materials and Methods. A cross-sectional study was carried out from September to November 2025 in primary healthcare organizations located in six cities of Kazakhstan. The study involved 468 practicing nurses who met the inclusion criteria and agreed to participate. Attitudes toward adverse event reporting were assessed using the 25-item RoCAES instrument, which includes five subscales: perceived blame, perceived criteria for reporting, perceptions of colleagues’ expectations, perceived benefits of reporting, and perceived clarity of reporting procedures. Data were collected anonymously using an online questionnaire. Statistical analysis was performed in IBM SPSS Statistics (version 29.0). Descriptive statistics were calculated and the internal consistency of the instrument was evaluated using Cronbach’s alpha. Results. The findings indicate differences in attitudes across the RoCAES dimensions. The highest mean score was observed for the subscale Perceptions of Colleagues’ Expectations (M = 2.43, mean score), suggesting that peer-related norms may influence reporting attitudes. Moderate values were found for Perceived Criteria for Reporting (M = 2.41) and Perceived Blame (M = 2.36). Lower mean scores were observed for Perceived Benefits of Reporting (M = 1.97) and Perceived Clarity of Reporting Procedures (M = 1.92), reflecting generally positive evaluations of these aspects. Overall, structural aspects of reporting were evaluated more positively than socio-cultural factors. Conclusion. The results suggest that nurses’ attitudes toward adverse event reporting are shaped by both structural and socio-cultural factors. While reporting procedures and perceived benefits appear to be relatively well understood, peer expectations, uncertainty regarding reporting criteria, and concerns about blame may still influence reporting behavior. Strengthening supportive professional norms and maintaining a non-punitive reporting environment may contribute to improving reporting practices in healthcare organizations.

Inflammatory rheumatic diseases disproportionately affect women of reproductive age and pose challenges from preconception to delivery. Although patient and specialist awareness in the field is growing, the evidence base for pregnancy management in this population is primarily based on observational studies and expert opinion. Ethical issues limit the availability of high-quality randomized controlled trials. This article presents a multidisciplinary framework that integrates patient, obstetric, and rheumatological perspectives, along with recent advances in artificial intelligence. From the patient perspective, voluntary childlessness due to concerns about medication safety, inadequate counseling, and psychosocial stressors remains a big public health issue. The obstetric perspective emphasizes increased risks of preeclampsia, preterm birth, intrauterine growth restriction, and postpartum disease flare, highlighting the necessity for structured high-risk monitoring and coordinated multidisciplinary care. The rheumatologist’s responsibilities include monitoring disease activity, discontinuing teratogenic medications, assessing ovarian reserve, screening for infections, planning rehabilitation, and managing comorbidities before conception. Artificial intelligence and machine learning technologies hold promise for risk stratification, early warning systems, and patient education, though challenges such as algorithmic bias and data limitations persist. International surveys are warranted to identify patient and specialist knowledge gaps, practice variations, and patient experiences across different health systems and cultural settings. Special consideration is warranted for Central Asia and the Turkic world, where structural barriers to specialist care, cultural expectations regarding childbearing, and limited regional research output contribute to a unique and underserved public health environment. This article provides guidance for health professionals and as a foundation for future research, promoting individualized, evidence-based, and culturally sensitive care for women with inflammatory rheumatic diseases throughout pregnancy.