Acute Situations Research Articles

Therapeutic plasma exchange in the intensive care unit and with the critically ill, a focus on clinical nursing considerations.

Therapeutic plasma exchange (TPE) is a blood purification technique removing antibodies and plasma proteins to modulate disease and promote recovery. The procedure has different methods, using a membrane or plasma separator with many elements similar to continuous renal replacement therapy (CCRT) in the Intensive Care Unit (ICU). These nursing knowledge and skill sets apply where ICU nurses are providing TPE with increasing need. However, different care models are also in place where TPE is the responsibility of apheresis and nephrology teams visiting the ICU. The plasma replacement volume and prescribing is aligned with published guidelines but is variable when critical illness overlays the primary indication for TPE. There are some important considerations for TPE with respect to anticoagulation, machine settings, prescribing, and associated nursing management. TPE can be performed concurrent with CRRT in acute situations using Y‐piece and valve connectors and is a new and recent advanced blood purification for the ICU.

Child well-being in early childhood education and care during COVID-19: Child sensitivity in small, fixed groups.

The article explores child well‐being in Danish early childhood education and care (ECEC) during the time of COVID‐19. A phased reopening of Denmark occurred in spring 2020 under strict health guidelines. Two ECEC institutions were followed first‐hand to observe the impact of the pandemic on pedagogy and child well‐being. Observations and interviews were conducted with follow‐up interviews and an online survey a year later. The findings suggest that the pandemic caused pedagogues to work in a more child‐sensitive way with elevated staff/child ratios and children in small, fixed groups; however, child well‐being was not negatively affected, despite the acute situation

783 Use of Multidisciplinary Collaboration to Establish a Standardized Endotracheal Tube Wiring Guideline

IntroductionPediatric patients with facial burns and advanced airway needs precipitate acute situations requiring multidisciplinary team member collaboration. Significant facial burns, particularly involving considerable edema or smoke inhalation, may warrant dental or circum-mandibular endotracheal tube (ETT) wiring for stabilization. Guidelines were created, trialed, and revised based on patient outcomes and clinician feedback at a pediatric verified burn center.MethodsThe guideline was created by the burn team in 2019. This standard work was utilized with pediatric burn cases presenting to the burn center. Guideline variances, such as prolonged time from door to ETT wiring, prompted a gap analysis need to improve the process. Through two case review sessions held in 2020, a multidisciplinary team consisting of the burn providers, emergency department providers, nursing, and respiratory therapists revealed process knowledge deficits, unclear role expectations, and supply issues. Literature was reviewed and a myAmeriburn listserv inquiry of current practice was made to seek additional guidance.ResultsBased on feedback from the multidisciplinary group and data gathered from the literature and collegial burn community, action plans and guideline modifications were developed in 2021. The respiratory therapy department developed education for their staff highlighting use of twill tape and taping. The use of ETT suturing was removed from the guidelines.ConclusionsMultidisciplinary contribution and engagement was necessary to produce, execute, and evaluate the pediatric endotracheal tube wiring guidelines. Through dialogue, patient trial, and constructive feedback, guidelines were amended to produce a smoother team process and better patient experience. The standard work is currently being evaluated in its modified version.

Influence of the general data protection regulation on data quality in registry data collection : Selection bias due to data protection requirements and the impact on key indicators for measuring the quality of care in alevel 1 trauma center

Due to the new general data protection regulations (GDPR), the requirements for correct patient information on the documentation of pseudonymized data in aregistry have increased enormously. In particular, written consent applies to the TraumaRegister DGU® as it is not always possible to get written permission from severely injured patients in acute situations. Therefore, the study aimed to investigate the influence of undocumented cases due to alack of clarification on the standardized mortality rate (SMR). In 2019, 274patients meeting the criteria of the baseline dataset were retrospectively recorded. In the remaining 197patients, the RISCII score could be calculated in all cases. In addition, due to state-specific law, all deceased patients were documented in our trauma center. In this study with 197 primary care patients (72% male), 147 (74,6%) were informed and gave permission or died and were subsequently documented. The predicted mortality, actual mortality and SMR were 18.5%, 19.0% and 1.03, respectively. For patients who were not informed (n = 50), the predicted mortality, actual mortality, and SMR were 7.0%, 0% and0. When these cases are included, the SMR is significantly more favorable at 0.93. Due to the lack of written consent from surviving patients, only about 75% of all patients at Leipzig University Hospital could be documented for the TraumaRegister DGU®. On the other hand, since the local legal situation permits registry documentation of deceased patients, this has adetrimental effect on the standardized mortality rate (SMR), which is about 10% higher in our collective than it actually is.

Salivary testosterone, testosterone/cortisol ratio and non-verbal behavior in stress

The relationship between hormone release and non-verbal communication under stress conditions is still not sufficiently explored. The aim of the present study was to test the hypothesis that salivary testosterone concentrations and testosterone/cortisol (T/C) ratios correlate positively with assertive behavior representing a non-aggressive form of dominance during an acute stress situation. As a stress model, a socially evaluated cold pressor test was investigated in healthy men. The non-verbal behavior was analyzed according to the ethological coding system for interviews described by Troisi (1999). Salivary testosterone concentrations did not change throughout the stress test. The T/C ratios decreased significantly over time only in subjects showing high stress perception. The duration of affiliative and the frequency of flight behavior was higher in subjects with high stress perception compared to those with low stress perception. A significant positive correlation between the duration of prosocial behavior and values of T/C ratios was found in the whole sample. The area under the curve values of testosterone positively correlated with the duration of assertive behavior in the group with high stress perception and negatively in the other group. Our findings allow suggesting that the changes in non-verbal behavior during acute psychosocial stress situations may be more pronounced in subjects showing high stress perception. Obtained results motivate further research on a better understanding of the consequences of the lack of sense of full facial expressions, such as wearing face masks, on the balance between hormones and non-verbal behavior under stress conditions.

Evaluation of an estimation formula for the biological nutritional status in unexpectedly hospitalized elderly people

A reliable interpretation of albumin is essential for the elderly's biological nutritional assessment (BNA), but is complex because many parameters change it. The main objective was to evaluate the extrapolation of a correction formula proposed for prolonged inflammation to acute biological inflammation situations: corrected albuminemia = measured albuminemia + CRP/25. This prospective, single-center observation study included patients over 65years of age who were unexpectedly hospitalized in geriatrics and internal medicine at Grenoble University Hospital, excluding carriers of active neoplasia, hepatic insufficiency, nephrotic syndrome, and those for whom a ABI persisted on the eighth day. A clinical and biological collection was made on the first and eighth days. The primary endpoint was the comparison of albuminemia corrected by the formula on day 1with measured albuminemia on day 8. One hundred and seventy-five patients were analyzed. The average CRP was 64 (3; 324) mg/L on day 1and 24 (3; 99) mg/L on day 8. Between corrected albumin at day 1and albumin at day 8, the correlation was ρ = 0.58, 95%CI [0.47; 0.67], P < 0.001, and the mean difference of 2.9 (-13,5; 18) mg/L, 95%CI [-3.68;-2.20], P < 0.001. Between D1albumin and D8albumin, the correlation was ρ = 0.74, 95%CI [0.66; 0.80], P < 0.001, and the mean difference of 0.4 (-14; 11) mg/L, 95%CI [-0.24; 1.02], P = 0.23. The proposed formula cannot be extrapolated to acute inflammatory situations. Measured albuminemia appears to be stable during acute biological inflammation situations. Measured albuminemia could be used as a reference for BNA, integrated into a clinical history.

Direct oral anticoagulant plasma level measurement in clinical practice: A French single-institution retrospective study

Direct oral anticoagulant (DOAC) use is increasing but, although DOAC plasma level assays are available, information on DOAC measurements in clinical practice is scarce. To describe patient characteristics and clinical situations where DOAC assays were ordered and determine whether the assays indications and subsequent patient management were consistent with current guidelines. Retrospective study of data for patients with prescriptions for three DOACs: dabigatran, rivaroxaban and apixaban treated at Percy Military Hospital between 2016 and 2019. During the study period, 196 DOAC measurements were performed on 148 patients (median age: 82.5 years). The most frequently prescribed DOAC was rivaroxaban (57.5%) and the commonest indication was nonvalvular atrial fibrillation (77%). Measurements were performed on 3.5% of patients with an active prescription for DOAC, and DOAC prescriptions complied with the product's characteristic summary in 62.8%. The number of assays performed increased 2.5-fold between 2017 and 2019. Most DOAC assays were ordered due to emergency surgery or procedures (46.9%), bleeding (19.9%) or a risk of drug accumulation (13.8%). Reasons for ordering DOAC measurements were consistent with the guidelines in 87.2% of the cases. Subsequent clinical decisions were consistent with the guidelines in 86.2% of the cases. DOAC assays orders were rare but are increasing. Acute clinical situations were the most common source of test orders. Management followed correct interpretation of the results in most, but not all, cases, indicating a need for additional education to raise awareness of test indications and result interpretation for clinicians.

Pulmonologists' work and clinical life during the COVID-19 pandemic: a society-led survey.

The continuous and ongoing coronavirus disease 2019 (COVID-19) pandemic has highly affected pulmonologists and pulmonology residents worldwide. To identify where additional work and resources must be focused, it is important to explore on what parameters the pulmonologists and residents are challenged. We present the results of a society-led survey on pulmonologists' and pulmonology residents' work and clinical life during the pandemic. A total of 579 pulmonologists and pulmonology residents completed the survey (5.9% of the European Respiratory Society's physician members) and most respondents answered that they have had sufficient training on how to handle patients with COVID-19 (e.g. how to handle patients to prevent virus spread). However, more than a third of the respondents (n=210, 36.3%) had performed procedures they did not feel competent in due to the pandemic and, for example, relocation to COVID-19 units. We must strive for investment in research on medical education and potentially simulation-based training in technical procedures to ensure competence and decrease the insecurity about new procedures, especially in the setting of worldwide pandemics or acute critical situations.

The relationship between neurocognitive performance and HRV parameters in nurses and non‐healthcare participants

Nurses represent the largest sector of the healthcare workforce, and it is established that they are faced with ongoing physical and mental demands that leave many continuously stressed. In turn, this chronic stress may affect cardiac autonomic activity, which can be non‐invasively evaluated using heart rate variability (HRV). The association between neurocognitive parameters during acute stress situations and HRV has not been previously explored in nurses compared to non‐nurses and such, our study aimed to assess these differences. Neurocognitive data were obtained using the Mini‐Mental State Examination and Cognistat psychometric questionnaires. ECG‐derived HRV parameters were acquired during the Trier Social Stress Test. Between‐group differences were found in domain‐specific cognitive performance for the similarities (p = .03), and judgment (p = .002) domains and in the following HRV parameters: SDNNbaseline, (p = .004), LFpreparation (p = .002), SDNNpreparation (p = .002), HFpreparation (p = .02), and TPpreparation (p = .003). Negative correlations were found between HF power and domain‐specific cognitive performance in nurses. In contrast, both negative and positive correlations were found between HRV and domain‐specific cognitive performance in the non‐nurse group. The current findings highlight the prospective use of autonomic HRV markers in relation to cognitive performance while building a relationship between autonomic dysfunction and cognition.

Evaluating biological nutritional status in elderly people with unscheduled hospitalisation.

A reliable interpretation of albumin levels is essential when assessing nutrition in elderly people, but this is complex as it is affected by a number of parameters. The main objective of this study was to evaluate whether a correction formula proposed for prolonged inflammation could be extrapolated to acute biological inflammation situations: corrected albuminemia = measured albuminemia + CRP/25. This prospective, single-centre observation study included patients over 65 years of age who were the subject of an unscheduled hospitalisation in the geriatrics and internal medicine departments of Grenoble University Hospital, excluding carriers of active neoplasia, hepatic insufficiency, nephrotic syndrome and those who continued to present with an acute biological inflammation on the eighth day. Clinical and biological samples were taken on the first and eighth days. The primary objective was the comparison of albumin levels, corrected using the formula on day (d) 1, with albumin levels measured on d8. One hundred and seventy-five patients were analysed. Average CRP was 64 (3; 324) mg/L on d1 and 24 (3; 99) mg/L on d8. Between the corrected albumin levels on d1 and albumin levels measured on d8, the correlation was ρ = 0.58, 95% CI [0.47; 0.67], P < 0.001, with a mean difference of 2.9 (-13.5; 18) mg/L, 95% CI [-3.68-2.20], P < 0.001. Between the albumin levels measured on d1 and d8, the correlation was ρ = 0.74, 95%CI [0.66; 0.80], P < 0.001, with a mean difference of 0.4 (-14; 11) mg/L, 95%CI [-0.24; 1.02], P = 0.23. The proposed formula cannot be extrapolated to acute inflammatory situations. Albumin levels appear to be stable during acute biological inflammation. Albumin levels could be used as a reference for biological nutritional assessments and be integrated into the patient's clinical history.

Student assistantship programme: an evaluation of impact on readiness to transit from medical student to junior doctor

BackgroundStudies report that medical graduates are not prepared for practice as expected, and interventions have been developed to prepare them for practice. One such intervention is the assistantship, which provides hands-on opportunities to hone clinical skills and undertake responsibilities under supervision. The Lee Kong Chian School of Medicine (LKCMed) is Singapore’s newest medical school, and students undergo a Student Assistantship Programme (SAP) to prepare for practice as junior doctors (PGY1). This study evaluated the SAP from the students’ and clinical supervisors’ perspectives.MethodsStudents completed online questionnaires to assess readiness for practice before and after SAP, and a subsample were interviewed about their experiences of SAP and its impact on their preparedness for PGY1. In addition, after our graduates had begun work as PGY1 doctors, their clinical supervisors completed an online questionnaire and were interviewed about the perceived benefits of SAP and the attributes of our graduates as junior doctors.ResultsFifty (96%) students completed the pre-SAP questionnaire and 46 (92%) completed the post-SAP questionnaire. Levels of preparedness increased post-SAP (mean scores range pre-SAP: 2.38 to 4.32 vs post-SAP: 3.08 to 4.48); so did opportunities to undertake PGY1 duties (pre-SAP: 56% vs post-SAP: 96%), and hands-on experience in medical emergencies (pre-SAP: 76% vs post-SAP: 89%).Experience of acute care situations increased except “paracetamol overdose”. Readiness to be first respondents in ten acute situations improved (statistically significant for asthma, chronic obstructive pulmonary disease exacerbation, gastrointestinal bleed, sepsis, and adverse drug reactions). Three themes emerged from twenty-five student interviews: learning about the work environment, opportunities to learn in a safe environment, and enhancing SAP for future students. Thirty-three supervisors completed the questionnaire, and 70% rated SAP positively in preparing students for PGY1. Eight supervisors interviewed shared positively about the content, timing, and duration of SAP; and suggested future SAPs help students to develop coping and reflective skills.ConclusionsThe SAP improved students’ preparedness and experience across clinical areas, and students felt the SAP helped bridge undergraduate curriculum and work, provided opportunities to hone their skills and learn from junior doctors. Most clinical supervisors rated the SAP effective in preparing students for PGY1. This is the first formal evaluation of an assistantship in Singapore, and the findings are encouraging from the perspective of students and PGY1 supervisors.

Провокуючі фактори дебюту моторних симптомів хвороби Паркінсона

Актуальність. Хвороба Паркінсона (ХП) — одне з найбільш частих нейродегенеративних захворювань. Незважаючи на 200-річчя його наукового вивчення, етіологія ХП залишається до кінця невідомою. Раніше встановлено, що латентна і премоторна фаза на 4–10 років передують розвитку класичних проявів ХП. Залишається відкритим питання виділення провокуючого фактора клінічної маніфестації моторних симптомів ХП. Мета дослідження: визначити найбільш часті провокуючі фактори розвитку моторних симптомів ХП шляхом проведення анкетного опитування пацієнтів. Матеріали та методи. Опитано 120 пацієнтів з ХП. Анкета розроблена автором для виявлення факторів, що провокують маніфестацію ХП. Отримані клінічні дані й результати анкетування піддали статистичній обробці. Рівень значущості р приймали рівним 0,05. Результати. 53,33 % (64 пацієнта) зв’язали розвиток моторних симптомів ХП із перенесеною значущою гострою психотравмуючою ситуацією. Часовий інтервал між дією стресового чинника і дебютом захворювання варіював від 1 дня до 4 років (медіана (Me) 5,2 місяця; 95% ДІ 2,1–9,1 місяця). Перенесені гострі респіраторні інфекції в дебюті розвитку або за 2–4 місяці до розвитку ХП відзначили 3,33 % (4 людини). Больові синдроми різної локалізації були виявлені у 8,33 % (10 осіб). Відсутність будь-якого провокуючого фактора відзначили 35 % (42 опитаних). Обробка клінічних даних (стать, вік дебюту ХП і склад за клінічними формами ХП) не виявила статистично значущих відмінностей між групами з різними провокуючими факторами дебюту ХП. Висновки. Розвиток моторних симптомів ХП у багатьох пацієнтів може бути спровоковано низкою факторів, серед яких переважав дистрес. Сформульована автором гіпотеза формування зони абсолютної рефрактерності в дофамінергічній системі після стресового впливу в дебюті моторних симптомів ХП потребує експериментального підтвердження.

Content validity of the Work Rehabilitation Questionnaire (WORQ) for persons with spinal cord injury: A mixed methods study

Mixed methods. The aim of our study was to investigate the content validity of the Work Rehabilitation Questionnaire (WORQ) for use in persons with post-acute and chronic spinal cord injury (SCI). A university-based Rehabilitation Center in The Netherlands. Contents of the WORQ, brief ICF core sets for SCI for post-acute care and for chronic situation were compared with semi-guided interviews with persons with SCI and controlled for relevance by SCI rehabilitation professionals in two group meetings. Fourteen interviews with persons with SCI were performed. Two group meetings with 8 and 9 SCI rehabilitation professionals were held. Thirty seven of the 46 ICF categories (80%) of the WORQ were confirmed by both sources: mentioned in interviews with persons with SCI and considered important by the SCI professionals. The remaining 9 categories (20%) were confirmed by either the persons with SCI or the SCI professionals. Fourteen ICF categories that are part of the brief ICF core set for SCI for acute care and/or chronic situation, however are not part of the WORQ, have revealed importance by persons with SCI and SCI professionals. Our study confirms that most categories of the WORQ are important to consider for VR in persons with SCI, however, there are ICF categories that are absent in the WORQ and deemed relevant for use in VR in persons with SCI. Consequently, the content validity of the WORQ without additional items is insufficient for persons with SCI.

Юридико-психологический анализ особенностей взаимодействия с гражданами сотрудников органов внутренних дел в условиях провокационного поведения

In a media-dominated society, all organizations have certain reputational risks. In recent years, the public image of the internal affairs bodies of the Russian Federation has been largely determined by the Internet environment. On the one hand, favorable images are created in it, on the other, the exposure of abuse and illegal actions. As a rule, the latter, on the basis of the action of the regularities of the formation of a conditioned reflex and the emergence of emotions and feelings, have a greater impact on the public. The authors note that the effectiveness of external communication of employees of internal affairs bodies is interconnected with its positioning in society, which ensures a positive or negative emotional attitude towards the Ministry of Internal Affairs of Russia on the part of others. In this regard, interaction with citizens in legal situations is an image-forming component.&#x0D; The article analyzes the acute conflict situation of interaction between an employee of the internal affairs bodies with citizens, which is posted on the video hosting You Tube (channel of the public project "Movement") in the form of videos about citizens visiting the Reception of the Ministry of Internal Affairs of Russia ("Kneeling in front of the lieutenant colonel of the Ministry of Internal Affairs of Russia! Sercons continued", " Serkons Bought the Police? Bloggers At the Reception of the Minister of the Ministry of Internal Affairs "). The main methods of psychological influence are highlighted, which made it possible to destabilize this situation, the regulatory legal framework is analyzed, which can be used by police officers in an acute crisis situation and in the process of performing operational and service actions.

Central venous catheter access and procedure compliance: A qualitative interview study exploring intensive care nurses’ experiences

ObjectiveTo explore intensive care nurses’ experiences with and perceptions of using a standardised central venous catheter procedure to prevent bacterial contamination when accessing patients’ central venous catheters. Design and methodologyThis study employed an interpretative qualitative design. Data was collected through semi-structured, individual interviews and Qualitative Content Analysis was used in data analysis. SettingSeven Norwegian intensive care nurses were recruited using a purposeful sampling strategy. FindingsThree main themes were identified. 1). Individualised practice revealed varying knowledge of and commitment to following the central line procedure. 2). Risk desensitisation revealed a continuous use of central lines, acute situations and a lack of information on infections, which affect usage. 3). Professional working culture showed nurse-to-nurse interaction, which promoted compliance with the procedure. Their interplay created a team spirit whereby nurses worked together to improve patient safety. ConclusionsThis study shows the diversity and complexity of factors affecting intensive care nurses’ procedure compliance when accessing central lines. The themes of Individualised practice and Risk desensitisation pose a substantial threat to healthcare quality and patient safety in the ICU. Exposure to infection risks could be reduced by applying these themes to inform and strengthen continuing education programs and audit processes. The theme of Professional working culture shows the positive influence nurses can have on each other, promoting compliance when accessing central lines. Intensive care nurses should be aware that their voice matters and that challenging poor practice does not have to be confrontational. Leadership should look for ways to encourage this type of nurse-to-nurse interaction.

Принятие решений о выборе способа реагирования в конфликтных ситуациях у лиц с аффективными расстройствами

In order to research the relationship between individual psychological characteristics and the decision-making process in the perception of acute conflict situations in persons with affective disorders, an empirical study was conducted. 39 people aged 19 to 55 years (M=24, SD=10.3) were examined, of which 67% were females. The main group consisted of persons with affective disorders (N=11), the comparison group were mentally healthy. The research looked into volitional, intellectual regulation and the choice of the method of reaction after the subjects were presented some video recordings of single and long-term acute conflict situations, as well as neutral situations. The diagnostic complex included: methods of “Verbal-color interference”, “Comparison of similar patterns”, questionnaires “Style of self-regulation of behavior”, “Methods of coping behavior”, “Melbourne Decision-making Questionnaire”, “Hospital Anxiety and Depression Scale” (HADS). The stylistic features of decision-making, self-regulation of behavior and ways of coping behavior in persons with affective disorders were highlighted. It was revealed that people with affective disorders tend to make impulsive decisions, prefer avoidance strategies and confrontation in acute conflict situations. Specific changes of volitional and intellectual regulation in persons with affective disorders depending on the presented situation are shown. It was concluded that in persons with affective disorders, the speed of choosing a response method is associated with the stylistic features of decision–making. The rigidity of cognitive style is associated with the stylistic features of self-regulation of behavior and coping behavior.

Anatomical Injury Clusters in Polytrauma Patients.

Polytrauma is a major cause of death in young adults. The trial was to identify clusters of interlinked anatomical regions to improve strategical operational planning in the acute situation. A total of 2219 polytrauma patients with an ISS (Injury Severity Score) ≥ 16 and an age ≥ 16 years was included into this retrospective cohort study. Pearson's correlation was performed amongst the AIS (Abbreviated Injury Scale) groups. The predictive quality was tested by ROC (Receiver Operating Curve) and their area under the curve. Independency was tested by the binary logistic regression, AIS ≥3 was taken as a significant injury. The analysis was conducted using IBM SPSS® 24.0. The highest predictive value was reached in the combination of thorax, abdomen, pelvis and spine injuries (ROC: abdomen for thorax 0.647, thorax for abdomen 0.621, pelvis for thorax 0.608, pelvis for abdomen 0.651, spine for thorax 0.617). The binary logistic regression revealed the anatomical regions thorax, abdomen pelvis and spine as per-mutative independent predictors for each other when a particular injury exceeded the AIS ≥3. The documented clusters of injuries in truncal trauma are crucial to define priorities in the polytrauma management.

EVALUATION OF THE ACTIVITY OF THE UNIVERSITY MEDICAL CABINETS FROM CLUJ-NAPOCA

PREMISES: Romanian and foreign students of the six Cluj universities are increasing in number, spending five and six years respectively in Cluj Napoca to complete their studies. University medical offices have an important role in providing preventive and curative medical assistance to students aged 18-26 during their study years (bachelor’s, master’s, doctorate level). The medical staff ensures both the management of acute illness situations, the provision of first aid, primary prevention, health education and the dispensary of chronic diseases. OBJECTIVES: evaluation of the activity of university medical units during an academic year MATERIAL AND METHOD: the activity report consisted in analyzing and comparing the monthly statistical data completed by the medical staff regarding the activity of the Cluj university medical units during the academic year 2021-2022 (hybrid education, online and on site) RESULTS: In the academic year 2021-2022, a number of 24406 consultations were carried out at the medical units, of which 4053 foreign students, 3144 treatments, 24577 triages (4221 triages for accommodation in dormitories and 20356 triages in special epidemiological conditions), 2193 COVID tests, 549 vaccinations, 4478 simple and electronic prescriptions were prescribed, 3576 referral tickets for specialist consultations were issued, 3767 preventive health examinations were carried out, 934 hygienic-sanitary checks were carried out in dormitories and student canteens, 5530 medical certificates were issued; 469 SARS-COV2 positive students were also monitored, of which 418 were detected and confirmed at the student medical units through rapid antigenic tests. The distribution of these activities on student medical units was different considering the type of education (online, hybrid or on site), the specifics of the universities and the number of students enrolled. CONCLUSIONS: As it emerges from the evaluation of the activity of medical units, their role is an important and imperative one to ensure preventive and curative medical assistance during the years of study, both in the educational units where the didactic activity is carried out and and in the accommodation spaces. The activity of medical units in the collectives of children and young people is complex, combining hygienic-sanitary, epidemiological, legislative, preventive and curative medicine aspects.

USA - Africa: Secretary of State Antony J. Blinken’s Visit to Kenya, Nigeria, and Senegal (November 2021). Part 2

In the second part of the article three topics are reviewed. The US secretary of state visit to Senegal (November 20, 2021). Senegal was of particular interest to the United States as a member of French speaking community of African countries and a 2022 chairmen of the African Union. A. Blinken was received by President M. Sall. A comprehensive discussion with Foreign minister Aissata Sall was devoted to the cooperation in five areas of “common interests - global health, the climate crisis, inclusive economic growth, democracy, peace and security”. During the visit the Senegal government and four American companies signed a Memorandum of $1 billion investments into infrastructural projects of the country. The remarks made by the secretary during his stay in Africa provide the materials for the assessment of the US position on four acute conflict situations on the continent. Proposed schemes of settlement: Ethiopia - end of hostilities between the Federal government and the Tigray People&amp;apos;s Liberation Front, dialogue and negotiated political agreement; Somalia - the conclusion of parliament formation and presidential elections; Sudan and Mali - transit from military regimes to democratic civilian led governments. The author cites factual aspects of Africa participation in the virtual global “Summit for democracy” initiated by President Biden (December 8-10, 2021). The Summit was conceived as a step toward the establishment of the US-led global alliance against China and Russia under the cover of democracy protection from “authoritarianism”. Out of 54 African states only 17 were invited. Surprisingly Algeria, Morocco, Tunisia and Egypt were left out.

Проблемные зоны экспертного исследования по факту суицида у несовершеннолетних

The psychological analysis of 41 complex inpatient psychological and psychiatric examination of the suicidal state of minors was carried out. The purpose of the work: to identify psychological phenomena that mask the true experiences and states of adolescents before the realization of suicide. Significant categories of analysis have been identified that determine the structure of this expert study. Various manifestations of the self-image in minors are described, determined by the mobility of the psyche and the processes of adaptation to various life circumstances, requirements, expectations of the microsocium; the absence of external stable signs of mood decline and suicidal readiness in a significant part of suicides. The phenomenon of masking pre-suicidal states in adolescents, its predictors and mechanisms are revealed. The revealed dissociation between the absence of external manifestations of the presuicidal state, an objectively acute psychotraumatic situation and the act itself makes it difficult to assess the measure of subjective intolerance for a minor of his position, to determine the true motives and reasons for suicide, broadcast and hidden emotions.