The military aggression of the Russian Federation and active hostilities gave a powerful impetus to the development of the direction of rehabilitation in Ukraine, but the war showed the need to develop approaches to the rehabilitation of military traumas, according to the participants of a roundtable on topical issues of medical and psychological rehabilitation held at Interfax-Ukraine on September 5.
“We started building a rehabilitation system in Ukraine since 2014, but today there are problems that have not yet been resolved. The rehabilitation system depends on many things, including money, because rehabilitation is quite an expensive thing,” Executive Director of the Ukrainian Association for Stroke Prevention (UABI), doctor of physical and rehabilitation medicine Maryna Huliayeva said.
Huliayeva said that in “those clinics that do not have multidisciplinary teams for rehabilitation, rehabilitation is at a low level, the lack of specialists leads to the fact that the process and quality of rehabilitation care is hindered.”
Commenting on the rehabilitation packages, according to which the National Health Service of Ukraine (NHSU) contacts clinics under the Medical Guarantee Program, the expert said that “most of the package is spent on a patient who is already stabilized, but the issue of acute rehabilitation is hung.”
“Unfortunately, it happens that the stroke unit does not have a physical therapist in staff, but there is one in a rehabilitation department. Therefore, there is not enough staff for acute rehabilitation, where major complications are prevented,” she said.
Huliayeva said that, in particular, the military and patients with military traumas should also be examined by a specialist in physical and rehabilitation medicine, but there are no such specialists in military hospitals, so these patients are consulted by civilian doctors.
“I think that such medical care should be developed within the framework of the financing of the Armed Forces of Ukraine. Military doctors are ready to cooperate, we advise military hospitals, we come once or twice a week, we accept them for a rehabilitation package, we work with them,” she said.
At the same time, Huliayeva said that the approach to the rehabilitation of the military should take into account the purpose of rehabilitation, which depends on the severity of traumas.
Huliayeva believes that to develop the rehabilitation of the military, a decision is needed at the state level, “to introduce those positions [in the area of rehabilitation] in military hospitals that were introduced into civilian medicine.”
According to Huliayeva, in addition to introducing rehabilitation into military rehabilitation, it is necessary to develop palliative medicine, as well as rehabilitation at the outpatient level.
In turn, Vadym Kerestey, head of the rehabilitation direction of the ADONIS medical group of companies, also said that the war gave a start to the development of rehabilitation medicine, but if “civilian rehabilitation medicine develops, then rehabilitation in the military in hospitals stands still.”
“Unfortunately, there is a catastrophic lack of specialists. They do not open positions for physical therapists, ergotherapists and other specialists who are part of multidisciplinary teams. There are no such rehabilitation teams in military hospitals that could provide high-quality medical care specifically for the military, who often have severe polytrauma,” he said.
The expert said that “military hospitals are overcrowded with patients with severe traumas, but there are not enough specialists.”
“It is important that the military introduce the position of physical therapists in military hospitals. Perhaps the subcommittee of the Verkhovna Rada, which deals with rehabilitation, could initiate this, so that positions of doctors of physical and rehabilitation medicine could be opened in the military structures,” Kerestey said.
Commenting on the development of rehabilitation in military medicine, Kerestey also noted the importance of rehabilitation goals.
“Rehabilitation terms vary from several weeks to several months, since different patients may have different goals of rehabilitation. For some, this is a return to the ranks of the Armed Forces of Ukraine, for others, at least self-service,” he said.
He also believes that at present in Ukraine “the number of qualified doctors of physical and rehabilitation medicine is very small, they are sorely lacking.” In particular, according to Kerestey, currently in Kyiv “there are about five to six rehabilitation high-quality rehabilitation centers where patients can be treated, starting with intensive care units,” the rest of the centers in Kyiv can only work with already stabilized patients, and things are much worse in the regions.”
“Rehabilitation requires equipment, but it is not the main thing. It is important that the department has specialists: psychologists, ergotherapists, physical therapists, their assistants,” he said.
At the same time, Yehor Prokopovych, head of the Department of Physical and Medical Rehabilitation at Kyiv City Hospital No. 6, said that this clinic has enough specialists of the required profile. At the same time, in connection with the war, the hospital also accepts military personnel for treatment.
“Before March 2022, our hospital accepted [for rehabilitation] only patients with stroke and for rehabilitation under the orthopedic package. Since March, the hospital has been included in the list of hospitals that provide rehabilitation to the military, and we had to reorganize something in our work. For example, we did not know that narcotic analgesics could be prescribed in rehabilitation, that there could be patients with colostomy, with concomitant traumas, that they could have complications that we did not foresee in rehabilitation. We had to learn how to treat in rehabilitation and pneumonia, and cystitis, and urethritis, and much more,” he said.
Prokopovych said that before the war, the department had mainly “patients aged above 50, and now they are young patients who have severe injuries.”
The expert also stressed the absence of “the NHSU package for military rehabilitation.”
“We code them as ordinary neurological patients, and since the beginning of the war we have not received any clarification from the NHSU regarding the military,” he said.
“We see a big push in the field of rehabilitation, but there are practical problems. For example, this is the transfer of a patient from us to another medical facility, building codes or equipment. For example, now we need two devices for the rehabilitation of the military, one of them costs about EUR 10,000, the second is EUR 14,000,” he said.
For his part, commenting on the issues of psychological rehabilitation in wartime, psychiatrist and psychotherapist Yevhen Voronkov said that “not everyone has PTSD, but many people suffer from PTSD and complex PTSD.”
“It is necessary to distinguish between PTSD in combatants and in the civilian population who suffered from the consequences of the occupation, violence, bombing. In many cases, people turn to the general psychiatric service, but this is a level of disorders that no psychiatric services are adapted to in reality,” he said.
At the same time, according to Voronkov, psychiatric education is currently focused on the treatment of severe mental illness, and not the treatment of conditions “that require individual and long-term, but mainly psychotherapeutic management with some medication component and pharmacological support.”
Voronkov believes that there are specialists in Ukraine who can be qualified to work with a person in war conditions in a psychotherapeutic sense, including in the direction of PTSD, “but they are not trained in public structures, they are trained as part of international projects, most of them work individually or in small teams.
“Some of our psychotherapists work with those who have returned from captivity, have received severe injuries. But these are only a few of the therapists who are involved in the work. There is a problem in training military psychologists or psychologists,” he said.
The expert said that the psychological rehabilitation of patients in wartime requires a conceptual development, since “this is a new situation in such a mass plan, it is only six months old.”
“Neither the structure nor the characteristics of these patients is clear. There is only a general understanding of what to do with it. And it is clear that patients need to be distinguished: one thing is those who were in the occupation, the other is the military, the third is children, internally displaced persons, and so on. It will be a large complex, for which, I believe, the psychiatric service is not ready,” he said.
In addition, Voronkov said that “there are no systematic studies of the military on PTSD.”
“Such studies require a pool of patients, besides, PTSD does not occur immediately, it is a delayed syndrome. A burst of PTSD can manifest itself in its most real forms several months after traumatic situations. Sometimes it is weeks, but more often after months we can see the formation of specific PTSD. It is difficult to work with such patients, this is a very difficult contingent not only for rehabilitation, but also for treatment in an acute condition,” he said.
At the same time, Voronkov said that the developments that were made by foreign specialists in the course of local military conflicts of past years may now be ineffective in Ukraine, since “it is necessary to take into account huge transcultural differences, in psychology the transcultural aspect is very important.”
“Severe PTSD is a very serious disease. Doctors are not adapted to work in such conditions, it is impossible to train such specialists in advance,” he said.
In turn, the head of the Department of Nephrology and Renal Replacement Therapy of the National University of Health Protection, Professor Dmytro Ivanov said that the Ukrainian Association of Nephrologists, based on international experience, prepared recommendations for rehabilitation in the specialty of nephrology.
“They relied on world experience, because there are military conflicts, and there is an array of information to form recommendations,” he said.
At the same time, according to Ivanov, about 600 out of nearly 10,000 Ukrainians, who were on dialysis at the beginning of the war, left for the EU countries.
CONFERENCE, Huliayeva, KERESTEY, MEDICINE, nhsu, Prokopovych, REHABILITATION, АДОНИС, Воронков, ИВАНОВ, уаби
In January-August 2022, Ukraine exported 265.5 thousand tons of poultry meat and offal, which is only 9.9% less than the figure for the same period in 2021, the Union of Poultry Breeders of Ukraine Association reported on the website.
At the same time, it is noted that in monetary terms, the export of these products for the specified period increased by 32.8% – up to $589.2 million. Such an increase in export earnings became possible due to an increase in prices in the traditional export markets of Ukrainian products, in particular the EU countries and the Middle East.
The largest importers of meat and edible poultry offal from Ukraine in August 2022 were Saudi Arabia (24%), the Netherlands (16%) and Slovakia (10%). According to the results of January-July, these countries became the largest consumers of Ukrainian poultry meat.
At the same time, the import of poultry meat to Ukraine for the same period amounted to 49.7 thousand tons, which is 36% less than for the same period in 2021. The entire volume came from EU countries, mainly from Poland.
Structure of Ukraine’s GDP in 2021 (production method, graphically)
SSC of Ukraine
About 7,000 restaurants and cafes have closed in Ukraine since the start of the war, and more than 2,000 new establishments have opened, Olha Nasonova, co-founder of the National Restaurant Association of Ukraine, told Interfax-Ukraine.
“There are no exact statistics, because. it is simply not being carried out now, among these 7 thousand there are closed establishments and those about which there is no data (in the occupied territories, in shelling zones). The market shrank by about 25% compared to February 2022. In some regions, the market decline was more than 50% (Kharkiv, Mykolaiv, Zaporozhye, Lugansk regions), in Kyiv, Odessa, Dnepropetrovsk regions – a drop of up to 30%,” Nasonova said.
At the same time, according to her, positive dynamics is observed in the western regions. In Lviv and the region, the number of restaurants and cafes increased by approximately 30%, in the Transcarpathian, Chernivtsi, Ivano-Frankivsk regions, an increase of approximately 20% was noted.
“Bythe beginning of summer, the market decline was more significant. But since June, restaurants began to open in Kyiv, as well as in the western regions, in general, more than 2 thousand establishments. The restaurant market developed most intensively in Lviv – more than 500 new establishments in the region since the beginning of the war. Of all the cities in western Ukraine, Lviv is the most cosmopolitan and the busiest,” Nasonova said.
According to her, among the summer openings of Lviv were establishments of “promoted” chains: Bao Casual (owner Taras Seredyuk), “Ostannya Barrikada” (Dmitry Borisov), a number of franchising establishments.
At the same time, the expert noted that it is incorrect to talk about the “relocation” of restaurants. “In fact, truly displaced, i.e. those who transported equipment, furniture, etc., are few. More often the restaurant turned out to be simply destroyed, or in the occupied territory, and there was simply nothing to take out. Therefore, new restaurants were opened,” Nasonova said.
In her opinion, restaurant investors began to consider cities in Western Ukraine as more profitable for starting a new business. As for expansion abroad, there are still few such examples. “It is planned to open Chernomorka, institutions of Borisov, Sukhomlin. Countries – Poland and Germany, but more Poland. There are more Ukrainians there, and the mentality of the Poles is closer to ours,” the expert said.
Established in 2021, the National Restaurant Association of Ukraine (NRAU) for May 2022 unites more than 50 members, 450 restaurants and cafes.
Ukraine, in the context of a full-scale Russian military invasion in January-August 2022, exported 59.4 thousand tons of dairy products, which is comparable to last year.
As reported on the Facebook page of the association “Ukrainian Agrarian Business Club” (UCAB) on Monday, the supply of dairy products to foreign markets grew especially rapidly in August – up to 12.7 thousand tons, which is twice as high as in August 2021.
According to the UCAB, in August 2022, Ukraine exported 3.58 thousand tons of non-condensed milk and cream (a threefold increase compared to June), 3.26 thousand tons of condensed milk and cream (twice as much), 273 tons of butter dish (50% less), 2.53 thousand tons of whey (72% more), 2.14 thousand tons of butter (3.5 times more), 1 thousand tons of cheeses of all types (62% more more).
In addition, in the summer of 2022 (June-August), Ukraine exported 31.5 thousand tons of dairy products, which is 52% of actual exports for the eight months of this year, as well as 40% more than in the same period of 2021.
The largest importers of Ukrainian products for eight months of 2022 were Moldova – 4.4 thousand tons, Poland – 2.4 thousand tons, China – 900 tons.
As noted by UCAB, imports of dairy products to Ukraine are gradually declining. Thus, according to its data, 42.3 thousand tons were imported in eight months, which is 37% less than last year. In August, 5 thousand tons of dairy products were imported, of which the majority were cheeses of all kinds (3.1 thousand tons).
“In January-August, the foreign trade balance is passive and amounts to $2.3 million. If in September the export rates remain the same as in August, then the foreign trade balance may already be active and overall trade will be more positive for the industry,” – the association quotes the expert Maxim Gopka.
As reported, in May 2022, the Union of Dairy Enterprises of Ukraine association predicted that this year milk production would decrease by 13-16% – to 7.33-7.56 million tons from 8.73 million in 2021, the depth crisis in the industry will be determined by the development of hostilities.
It is expected that the average milk consumption in Ukraine per capita in 2022 will increase by 8% – from 212 kg in 2021 to 229 kg this year due to internal and external migration of the population.
The stock indices of the largest countries of the Asia-Pacific region (APR) are mostly down on trading on Wednesday, with the exception of the Chinese Shanghai Composite, which is growing slightly.
The Japanese Nikkei 225 fell by 0.76% by 8:24 Moscow time.
The leaders of the fall among the components of the index are the shares of the transport company Nippon Yusen K.K. (-7.3%), electronics manufacturer Sharp Corp. (-6.5%) and transport Mitsui O.S.K. Lines Ltd. (-6.1%).
Quotations of shares of the largest clothing retailer in Asia, Fast Retailing, grow by 0.5%, Nissan Motor Co. – by 2.3%.
China’s Shanghai Composite added 0.04% by 8:31 Moscow time, while Hong Kong’s Hang Seng fell by 1.74%.
China’s foreign trade surplus unexpectedly fell to $79.39 billion in August, a three-month low, according to data from the General Administration of Customs of the People’s Republic of China. A month earlier, the indicator reached a record $101.26 billion.
At the same time, analysts expected an average reduction in August to $92.7 billion, reports Trading Economics.
Exports reached $314.92 billion, which is 7.1% higher than in August last year. For the first time since April, growth rates are expressed in a single-digit number in percentage terms. Imports in August increased by 0.3% in annual terms – up to $235.53 billion.
Experts on average assumed an increase of exports by 12.8% per hour, imports – by 1.1%.
The leaders of the decline in Hong Kong are the shares of the Internet giant Baidu Inc. (SPB: BIDU) (-4.15%), Budweiser Brewing Co. APAC Ltd. (-3.7%) and Alibaba Health Information Technology Ltd. , which provides services for the collection and use of medical data, (-3.5%).
Shares of Tencent Holdings Ltd. fall by 2% on the news that the company acquired a minority stake in the holding company that controls the publisher of the popular video game “Assassin’s Creed” Ubisoft Entertainment SA.
The South Korean Kospi index fell by 1.5% by 8:29 Moscow time.
Shares of one of the world’s largest manufacturers of chips and consumer electronics, Samsung Electronics Co. fell in price by 1.9%, while Hyundai Motor – by 0.5%.
The Australian indicator S&P/ASX 200 has decreased by 1.4% since the opening of the market.
Australia’s GDP in the second quarter of 2022 increased by 0.9% compared to the previous quarter, according to official statistics. Growth was recorded for the third quarter in a row. Australia’s economy grew by 0.7% in the first quarter. Analysts on average expected GDP growth in the second quarter by 1%, according to Trading Economics.
The market value of the world’s largest mining companies BHP and Rio Tinto decreased by 2.1% and 1.5%, respectively.
