MEDLINE

Aim: The purpose of the article is to study the dynamics of medical tourism development in Ukraine in recent years before the full-scale invasion of the Russian Federation, and also to identify the main directions of its recovery in the post-war period. Materials and methods: The study is based on an interdisciplinary approach that combines legal analysis, economic modeling, and elements of sustainable urban development research. The methodological framework includes systemic-structural and functional-legal analysis of Ukrainian legislation on healthcare, investment policy, and regional development, as well as empirical data on the state of medical tourism in the pre-war period. Analytical methods were used to identify relationships between the development of medical tourism and the resilience of urban environments under crisis conditions. Results: The article analyses examples of successful implementation of public-private initiatives, in particular, the creation of Dnipro Medical Cluster. Particular attention is paid to the consideration of medical tourism as a factor in the formation of economic and legal resilience of Ukrainian cities. It is substantiated that the development of medical tourism has contributed to increasing the resilience of the urban environment to external crises. The article considers new challenges - ensuring access to medical services for internally displaced persons, organisation of rehabilitation of victims, emergence of the phenomenon of forced medical tourism. Conclusions: The strategic guidelines for the development of medical tourism in the post-war period are proposed. It is concluded that the restoration and development of medical tourism in Ukraine has a double meaning - as an economic tool and as a means of ensuring the sustainability of urban systems in the period of post-war transformation. Implementation of the proposed measures will contribute not only to economic growth, but also to strengthening the resilience of Ukrainian cities as centres of medical, social and investment opportunities.

Background and Objective: Unexplained infertility is a major challenge in reproductive medicine and requires advanced diagnostic approaches to identify the underlyingfactors accurately. This study aims to evaluate the utility of risk factor analysis and a genepanel in diagnosing unexplained infertility using the next-generation sequencing (NGS)technology. Our study aimed to characterize and identify risk and genetic factors associatedwith unexplained infertility. Materials and methods: A cohort of patients with unexplainedinfertility was comprehensively screened for risk factors and genetic variations using atargeted gene panel (10 couples with unexplained infertility (UI) and 36 fertile couples).108 articles were selected (58 on female infertility and 50 on male infertility) presentinggenes that may be associated with unexplained infertility. A gene panel for unexplainedinfertility was compiled based on the literature data. A customized virtual panel wascreated from the exome sequencing data. Results: In the female group, controls had a highermean age, while in the male patients, both groups were similar in terms of age. Both gendergroups had comparable BMI values. No significant associations (p > 0.05) between riskfactors and unexplained infertility were found when evaluating anthropometric parameters and other sociodemographic characteristics. In two male patients (20%), a moleculardefect was detected in NGS variants classified aspossible benign and probably benignIn particular, missense variants were identified in the UGT2B7 and CATSPER2 genes, Amolecular defect classified as probably damaging was found in five female patients (50%).In particular, missense variants were identified in the CAPN10, MLH3, HABP2, IRS1, GDF9,and SLC19A1 genes. Conclusions: The study emphasizes that unexplained infertility is oftenrelated to mechanisms beyond causative mutations and highlights the need for integrativegenomic research involving broader gene panels and multi-faceted approaches, includingtranscriptomics and epigenetics, to uncover latent genetic predispositions.

The purpose of the article is to analyze the specifics of the Ukrainian doctrine regarding the legal nature of medical services and areas for improving legal regulation. The research is based on the analysis and comparison of Ukrainian and EU law, content analysis of the terminology of legal sources, legal positions of the Constitutional Court of Ukraine, scientific researches, description and generalization of existing achievements and issues in the field of legal regulation of healthcare services. Research methods are monographic analysis, systematic and structural analysis, comparative and legal analysis, linguistic analysis, content analysis, method of generalization. The need to unify the special categorical apparatus of Ukrainian legislation has been substantiated. It has been proved that due to the improvement of domestic legislation through the implementation of the norms of European private law, the doctrine and practice of legal regulation will correspond to the nature of the regulated relations. The content, structure, and specific features of legal relations for the provision of medical services in the Ukrainian legal system have been determined. The authors have made a conclusion about the private legal nature of medical services in the domestic legal doctrine. Recommendations have been made for the legislation of Ukraine, which regulates civil relations for the provision of medical services, regarding the introduction of special norms related to the personal non-property rights of the relations' participants, contractual representation of a patient, legal terms for the provision of medical services without obtaining the consent.

Lakes supply multiple ecosystem services (ES), key to supporting socio-ecologic systems and human well-being. In the context of future land use and climate changes, it is imperative to anticipate potential impacts on lake ES supply. Hence, studies that deal with future lake ES, such as mapping, are lacking. In this work, we mapped and assessed the future supply of three ES: (1) maintenance of nursery conditions (nursery ES), (2) maintenance of chemical conditions of freshwaters (nutrient regulation ES), and (3) direct and indirect cultural outputs (recreation ES) in Lithuania. Four future scenarios were utilised, integrating land use and climate changes: A0 - business as usual; A1-urbanisation; A2: land abandonment and afforestation; and A3 - agricultural intensification. The projected year was 2050, following the intermediate Representative Concentration Pathway (RCP 4.5). The future scenarios were simulated using the open-source software Dinamica EGO based on a 6-step modelling framework. Statistical differences among the scenarios and ES were analysed by applying a Kruskal-Wallis ANOVA test. Spatial analysis was done by performing a Moran's I and Getis-Ord (Gi∗) hotspot analysis. The results showed significant differences in nursery and nutrient regulation ES. The highest supply in nursery ES was observed for the A0 scenario. For nutrient regulation ES, the lowest ES supply was identified for the A1 scenario and for recreation ES, the highest was found in the A2 scenario. The eastern and northeastern regions of Lithuania showed a high ES supply. Hot spots were only identified in the eastern region. These regions are associated with a high area covered by forests and protected areas. The central region shows a low ES supply, identified as a cold spot where the agricultural landscape dominates. The results of the PCA analysis revealed an association between nursery and recreation ES. Nutrient regulation was not associated with the other two ES. Mapping and assessing the impact of future scenarios is vital to anticipating the potential dynamics of lake ES, especially in the context of climate change. This information is essential in the context of environmental management, helping decision-makers to ensure a sustainable ES supply and contributing to human wellbeing.

Coastal and marine ecosystems supply multiple Ecosystem Services (ES). Nevertheless, these ecosystems are among the most impacted by human activities, harming the ES sustainable supply. Since ES are a spatial phenomenon, mapping can contribute to understand ES supply. For this, we use quantitative spatio-temporal frameworks to map and assess the supply of one provisioning (food from fisheries) and two regulating ES (nursery habitats and nutrient regulation), considering two periods: Baltic Sea Holistic Assessment (HOLAS) 2 (2011–2016) and 3 (2016–2021). The ES supply was assessed following a process-based modelling approach, using bio-physical indicators as proxies. The three ES models were applied and validated, showing moderate results. For fisheries and nursery ES the results showed a significantly higher supply in HOLAS 3 than in 2, and for nutrient ES the opposite. This indicates that the assessed ES changed due to environmental activities. The Anselin Local Moran's results showed that most ES index values aggregate in the High-High cluster; Moran's I and semi-variogram results showed a clustered pattern; and the Getis Ord* analysis showed that hot and cold spots corresponded to high and low supply areas. For fisheries, high ES supply areas were located in the central-southern part of the Baltic Sea, while low-supply regions were located in the northern part. For nursery ES, high supply areas were located in the southwestern Finnish and western Estonian coasts. For nutrient ES, high supply areas occurred in the central- and eastern-southern parts close to the coast. Correlations showed a statistically significant negative correlation between fisheries and nursery ES and a significant positive correlation between fisheries and nutrient ES. No statistically significant correlations were observed between nursery and nutrient ES supply. The results obtained are essential to support coastal and marine management and planning in the Baltic Sea as well as international environmental policies and directives.

The burden of children’s disease in many low-and middle-income countries is associated with poor sanitation, including unsafe disposal of children’s stool. Infants and toddler stools pose a greater public health risk than adults. Studies on stool disposal in Sub-Saharan Africa (SSA) and Ghana have focused on prevalence, patterns, and associated factors. Nevertheless, these studies have not focused on factors that independently influence rural and/or urban child stool disposal. This study, therefore, examines factors associated with safe child stool disposal in rural areas separately from urban areas towards Ghana’s readiness for ending open defaecation by 2030.

The present study focuses on the role of family support to young adult children during COVID‐19 in ameliorating the negative financial impact of the pandemic. Guided by the Conservation of Resources (COR) Theory of stress and coping, we conceptualize the negative financial impact due to COVID‐19 as a source of financial stress that would be associated with lower levels of both financial wellbeing and positive outlook of young adults. We rely on data collected from a multinational sample of young adults (ages 18–30) from six countries (China, Italy, Lithuania, Portugal, Slovenia, US; N  = 2102) over a 3‐month period (July 2020–September 2020). We tested the potential effects of two types of support (i.e., parental financial support and family emotional support) using path analysis. While we find a consistent positive association between family emotional support and both financial wellbeing and positive outlook, we also find a consistent negative association between parental financial support and financial wellbeing, and a nonsignificant or negative association (Lithuania only) with a positive outlook. The significant interaction between COVID‐19 financial impact and family emotional support on young adults' positive outlook reveals that the benefit of family emotional support is more evident when the negative financial impact is low or moderate. We discuss the implications of these findings in assisting young adults to cope with financial disruptions.