УДК: 614.2+336.14:614+339.13.012:614.2 

РЕЗЮМЕ: Актуальність. Повоєнне відновлення України потребує стрімкого економічного та соціального розвитку, зокрема в сфері охорони здоров’я. Якість життя та активна участь у суспільстві значною мірою залежать від міцного здоров’я, особливо для громадян, які зазнали фізичних та психологічних травм через російську агресію. Мета роботи – дослідити потенціал експорту медичних послуг з України та приваблення міжнародних пацієнтів. Матеріали та методи. Огляд літератури щодо розвитку світових медичних послуг та ринків охорони здоров’я; аналіз статистичних даних про стан і можливості сектора охорони здоров’я України; вивчення найкращих практик інших країн у галузі медичного туризму; оцінка економічних показників та їх кореляція зі зростанням міжнародних медичних послуг. Результати та їх обговорення. Дослідження показує, що Україна має значний потенціал для розвитку міжнародних медичних послуг. Цей потенціал зумовлений високою кваліфікацією українських лікарів, відносно низькою вартістю медичних послуг і наявністю сучасних медичних технологій у деяких лікарнях. Сприяння розвитку міжнародних медичних послуг може залучити іноземні інвестиції, підвищити якість медичних послуг і принести значні економічні вигоди. Приплив міжнародних пацієнтів генерує експортні надходження, що сприяє державному бюджету та балансуванню національної платіжної системи. Проте для повної реалізації цього потенціалу необхідно подолати такі виклики, як покращення інфраструктури, забезпечення міжнародної акредитації та ефективний маркетинг.

Висновки. Розвиток міжнародних медичних послуг в Україні може значно покращити національну економіку та систему охорони здоров’я. Стратегічний фокус на цей сектор може принести такі вигоди, як підвищення якості медичних послуг, збільшення іноземних інвестицій та значні економічні повернення. Для успіху важливо подолати існуючі виклики та використати сильні сторони країни у сфері охорони здоров’я.

Ключові слова: охорона здоров’я України, світові медичні послуги, економічний розвиток, міжнародні пацієнти, глобалізація, медичний туризм.

ABSTRACT: Background. Post-war recovery in Ukraine necessitates rapid economic and social development, including in the healthcare sector. The quality of life and active participation in society are highly dependent on robust health, especially for citizens affected by physical and psychological trauma due to the russian aggression. Purpose – to explore the potential for exporting medical services from Ukraine and attracting international patients.

Materials and Methods. Review of the literature on the development of global medical services and healthcare markets; analysis of statistical data on the state and capa-bilities of Ukraine’s healthcare sector; study of best practices from other countries in the field of medical tourism; assessment of economic indicators and their correlation with the growth of international medical services.

Results. The study reveals that Ukraine has significant potential to develop its international medical services sector. This potential is driven by the high qualifications of Ukrainian doctors, the relatively low cost of medical services, and the availability of advanced medical technologies in some hospitals. Promoting international medical services can attract foreign investment, enhance the quality of healthcare, and generate substantial economic benefits. The influx of international patients would generateexport revenues, contributing to the state budget and balancing the national payment system. However, challenges such as infrastructure improvements, international accreditation, and effective marketing need to be addressed to fully realize this potential.

Conclusions. Developing international medical services in Ukraine can significantly enhance the national economy and healthcare system. Strategic focus on this sector can yield benefits like improved healthcare quality, increased foreign investment, and significant economic returns. Addressing challenges and leveraging the country’s strengths in healthcare are essential for success.

Key words:Ukrainian healthcare, global medical services, economic development, international patients, globalization, medical tourism.

The effects of natural clinoptilolite originated from the Transcarpathian region in the Western Ukraine and its composites doped with metal ions were studied toward: (1) cultured pseudo-normal mammalian cell and murine macrophages; (2) neutrophils of blood of healthy human donors; (3) mice immunized with model antigen; (4) mice under air-pouch model for estimation of microvasculature damage; (5) Candida albicans fungi. Silver doping enhanced cytotoxic action of natural clinoptilolite, while zinc doping did not do that. Clinoptilolite-Ag(NH₃)²⁺ was non-toxic for murine macrophages and moderately toxic for human HEК293 cells. Toxicity of clinoptilolite-Ag⁺ composite toward HEК293 cells was comparable with the effect in positive control. Natural clinoptilolite and its silver derivatives enhanced the humoral immune response in mice and the levels of antibodies were comparable with such levels at response to standard adjuvant, which, however, damaged the microvasculature in mice. Furthermore, natural and Ag-enriched clinoptilolite were capable of activating neutrophils with a release of neutrophil extracellular traps. Finally, we showed that both clinoptilolite-Ag(NH₃)²⁺ and clinoptilolite-Ag+ possessed much higher antifungal activity toward Candida albicans compared to such activity of the nonmodified clinoptilolite, while their doping with zinc did not show such enhancement. Thus, the Transcarpathian clinoptilolite possesses low toxicity toward mammalian cells and activates neutrophils in vitro, while silver doping enhanced the cytotoxicity of this material. Silver-doped derivatives demonstrated stimulating action on antibody production and the antifungal effect. Thus, the developed clinoptilolite-based composites are perspective for use as novel natural immuno-stimulators and antifungal agents.

 Keywords Clinoptilolite · Cytotoxicity · Immune-stimulation · Antifungal activity

Introduction and objective. Many studies have indicated numerous nutrition mistakes among school-aged children and adolescents in both urban and rural environments. The aim of this study was to assess the nutritional habits of the Polish population, consisting of 7,974 individuals aged 12–17, from rural and urban environments, as well as to identify environmental variations of these habits and to verify the existing information on the incorrect nutrition of school-age children and adolescents.
Materials and method. The research covered a group of 7,974 respondents – school-age adolescents with a similar age structure (12–17 years). The study on subjects from secondary school grades 1 – 3 was conducted in randomly selected schools from 2 random Polish provinces; 5 counties were randomly selected, followed by a choice of 2 communes: one rural and one urban. The research technique was a self-designed survey questionnaire. The obtained results were subjected to statistical analysis using the Pearson Chi 2 and V Cramer test.
Results. The research revealed environment-based differences in subjects’ nutrition. Breakfast was consumed daily by a statistically significantly fewer subjects from the rural environment (36.31%) than from the urban areas (51.32%); second breakfast was consumed by an insignificantly smaller proportion of respondents from the urban environment (40.00%) than from the rural one (46.00%); dinner was eaten daily by 86.00% of urban subjects and 82.00% of rural respondents; afternoon tea and supper were eaten rarely by respondents from both environments. The diet of respondents was dominated by anti-health behaviours.
Conclusions. Most of the respondents displayed incorrect nutritional behaviours. Nutritional mistakes occurred among respondents from both rural and urban environments, with the predominance of the rural areas. 

This paper presents a comparative assessment of mortality in Poland and Ukraine, including due to alcohol consumption, by sex, place of residence, and age groups. Mortality from alcohol consumption is and remains one of the health problems of the state’s population. The aim of this study was to establish the difference in mortality, including due to alcohol consumption, in the two neighboring countries. The analysis was conducted in 2008 and 2018 according to statistical institutions in Poland and Ukraine. Data from the codes of the International Statistical Classification of Diseases of the 10th edition: F10, G31.2, G62.1, I42.6, K70, K86.0, and X45 were used to calculate mortality due to alcohol consumption. The share of mortality caused by alcohol consumption in Ukraine in 2008 was 3.52%, and 1.83% in 2018. At the same time, in Poland, there is an increase in this cause of death from 1.72% to 2.36%. Mortality caused by alcohol consumption is the main share of mortality in the section “Mental and behavioral disorders” in both Ukraine, at 73–74%, and Poland, at 82–92%. Changes in the mortality rate in the cities and villages of Ukraine and Poland showed different trends: Poland nated, a significant increase in mortality, while in Ukraine it has halved on average. Overall and alcohol mortality rates in both countries were higher among the male population. The analysis of mortality among people of working age showed that the highest proportion of deaths from alcohol consumption in both countries was among people aged 25–44. Despite the geographical proximity, and similarity of natural and climatic characteristics and population, mortality rates in each country reflect the difference in the medical and demographic situation, and the effectiveness of state social approaches to public health.

ABSTRACT
The aim: To evaluate the dynamics of the interferon and collagen-IV systems in bronchoalveolar lavage in the treatment of chronic obstructive pulmonary disease using the tiotropium bromide medication.
Materials and methods: The study involved 60COPD patients with bronchial obstruction of the II degree before and on days 30 and 60 of therapy using conventional treatment regimens and inhalations of tiotropium bromide a the dose of 18 mcg once a day.The collagen-IV levels in bronchoalveolar fluid were determined by means of enzyme-linked immunoassay using “StatFax 303 Plus” analyzer and “Biotrin Collagen IV EIA” reagents. The level of IFN-γ was identified with the help of enzyme-linked immunoassay using “StatFax 303 Plus” analyzer and “ProKon” reagents (LLC “Protein Contour”, Russia) in bronchoalveolar fluid obtained during fiber-optic bronchoscopy.
Results: When examining GroupI patients on the 30th day we found out that the content of collagen-IV in the bronchoalveolar fluid had decreased by only 10.29% (p <0.05).
Detection of collagen-IV indices in Group II patients on the 30th day of tiotropium bromide use showed the 29.43% (p <0.05) decrease in its content as compared to the initial indices. In Group III patients, the concentration of collagen-IV had a maximum tendency to normalize and made up (24.72 ± 1.15) ng/ml, and decreasedby 2.44 times (p <0.05) as compared to the initial indices. Our examination of 12 patients from the comparison group I on the 60th day of treatment revealed even a slight increase in the content of collagen-IV in the bronchoalveolar fluid, as compared with the data obtained on the 30th day. Theidentified IFN-γ deficiency is indicative for the COPD of the II degree of bronchial obstruction, and its indices were 2.29 times lower than those observed in people from the control group. On day 30, we found out that the content of IFN-γ in Group I patients increased by only 10.29% (p>0.05). Detection of IFN-γ in Group II patients showed 42.27% (p<0,05) increase in its content as compared to the initial indices. The most favorable dynamics of IFN-γ levels in bronchoalveolar contents wasobservedin Group III patients, and at the time of observation itmadeup (1.16 ± 0.08) pg/ml, having 2 times (p<0.05) increasedas comparedtotheinitial indices. However, in contrast to those taking tiotropium bromide, we examined 12 patients from Group I on the 60th day of treatment and found no significant positive dynamics of IFN-γ content in bronchoalveolar fluid as compared to the indices obtained on day 30.
Conclusions: The obtained findings indicate the effect of tiotropium bromide on the reduction of interferon-γ and reduce of collagen-IV levels, which depend on the duration of its use.