ATO Zone Research Articles

Justice in war crimes cases in Ukraine: the first challenges

Justice in war crimes cases in Ukraine: the first challenges. Mass atrocities during the full-scale phase of armed aggression against Ukraine inevitably bring up the issue of justice and prosecuting those suspected of committing war crimes. Considering the role of the judiciary, which is essential in a state based on the rule of law as the guarantor of justice, both Ukrainian society and the legal community should be interested in ensuring that the war crimes trials as well as verdicts meet the generally recognized standards of justice. Based on the analysis of verdicts concerning Art. 438 of the Criminal Code of Ukraine (CCU) (violation of the laws and customs of war) issued after the beginning of the full-scale invasion and available in the State registry of court decisions in 19 criminal proceedings, the author identified the challenges that Ukrainian courts face when considering war crimes cases. In 14 criminal proceedings, the defendants were citizens of the Russian Federation (in 13 – servicemen of the Russian Armed Forces, in 1 – also members of a private military company), in 5 – citizens of Ukraine. 15 verdicts out of 19 became final, i.e. 9 of them were not appealed, 1 was changed by a court of appeal, 1 was upheld, and in 4 cases, the appeal proceedings were closed due to the withdrawal of appeals by the accused. War crimes cases are considered new for the Ukrainian judiciary. Therefore, the knowledge of criminal justice system personnel on basic provisions of International Humanitarian Law (IHL) and International Criminal Law is very limited, which resulted in the incorrect qualification of crimes committed in the ATO zone in 2014-2021 as either terrorism or ordinary criminal cases, although some of them had features of war crimes and crimes against humanity. The lack of knowledge on IHL remains relevant even after the full-scale invasion. The author identified it as a key challenge Ukrainian judiciary face when considering criminal proceedings concerning Art. 438 of the CCU. It should be emphasized, however, that according to the Criminal Procedure Code (Art. 337) the court is limited by the charges in the indictment and may go beyond the indictment only if it improves the situation of the accused person. Therefore, courts avoid any actions caused by the shortcomings of the indictment which might be interpreted as worsening the situation of the accused, even if it affects the quality of decisions. Thus, courts do not indicate specific provisions of international treaties to which Art. 438 CCU is referring (i.e. Geneva Conventions or Additional Protocol I) if they are not mentioned in the indictment or use the extensive description of the international armed conflict, which prevails over the assessment of the “nexus” of specific conduct of the accused to the armed conflict. Some other challenges Ukrainian judiciary face when considering war crimes cases including proportionality of the punishment and the impartiality of the judiciary, which were highlighted starting with the first trial in the Shishimarin case. Key words: justice, rule of law, court, violation of laws and customs of war, war crimes.

Оптимізація когнітивної нейрореабілітації пацієнтів iз бойовими травматичними ураженнями головного мозку

Останнім часом спостерігається зростання частоти бойової черепно-мозкової травми (БЧМТ) у результаті бойових дій у зонi АТО. Когнітивна реабілітація хворих iз гострими травматичними ураженнями головного мозку, а саме ЧМТ, тісно пов’язана з іншими напрямками реабілітації, включаючи медикаментозну та фізичну терапію, інтеграцію пацiєнта в суспільство, психологічну та просвітницьку роботу з членами його родини. Неадекватне та несистематичне лікування хворих із такими розладами часто є основною причиною тривалої декомпенсації захворювання, що значно погіршує рівень життя пацієнтів та знижує ефективність їх праці. Метою нашої роботи була оптимізація лікувальної тактики, а саме когнітивної реабілітації хворих із наслідками закритої БЧМТ середнього ступеня тяжкості на підставі вивчення клініко-когнітивних змін. Нами було обстежено 28 пацієнтів віком від 20 до 45 років, які знаходилися на стаціонарному лікуванні у відділеннях нейротравми та нейрореабілітації ДУ «Інститут нейрохірургії ім. акад. А.П. Ромоданова НАМН України» (м. Київ), із наслідками закритої БЧМТ (середнього ступеня тяжкості з давністю захворювання від 3 місяців до 1,5 року (шифр діагнозу за МКХ‑10 — Т90)). Усім пацієнтам на 1-й та 14-й день лікування проводилися клініко-неврологічні, інструментальні, нейропсихологічні обстеження. Усі хворi разом із препаратом Церебролізин 20,0 в/в краплинно отримували загальноприйняту симптоматичну терапію. Висновки: порушення когнітивних функцій є невід’ємною складовою клінічних наслідків закритої БЧМТ. Використання в лікувальній тактиці препарату Церебролізин у пацієнтів із наслідками БЧМТ середнього ступеня тяжкості покращує відновлення порушених неврологічних функцій, зокрема когнітивних.

A comprehensive mental health support system for volunteers working in the ATO/JFO zone

From the beginning of the Anti-Terrorist Operation (АТО) in the east of Ukraine, the number of volunteers and volunteer organizations that provide assistance to the soldiers of the Armed Forces of Ukraine has increased significantly. Taking into account data obtained in the process of a comprehensive examination of 97 people who were engaged in volunteer activities related to support of military in the combat zone for at least 1 year and suffered as a result of combat stress. A comprehensive system was developed of mental health support for volunteers working in the ATO zone. Monitoring of the psychological and mental state carried out during the study showed that clinical structure of post-stress disorders in the examined volunteers was represented by: adjustment disorders, post-traumatic stress disorder, panic disorder and generalized anxiety disorder. The basis of the program was complex application of pharmacotherapy, psychotherapy, and psychoeducation was also used. Pharmacotherapy was based on the specificity of the levels of hormones and mediators with differentiated use of drugs. Approbation of the proposed volunteer mental health support program proved its high efficiency. Against the background of the use of the developed program, positive dynamics of the mental state, stabilization of the emotional state, reduction of anxiety and depression indicators according to the Hamilton Anxiety and Depression Scales were noted. According to the Scale for assessing the impact of a traumatic event, a significant decrease in the indicators on the "intrusion" and "avoidance" scales was noted. Keywords: volunteering, combat stress, mental state, complex therapy.

Сравнительная характеристика политравмы мирного времени и боевой травмы в стационаре III уровня

Актуальность. Боевые сочетанные травмы протекают тяжелее, чем политравма мирного времени, из-за разницы в поражающих факторах, условиях получения травмы, сроках оказания помощи пострадавшим, массовости поражений. Цель исследования: провести сравнительный анализ тяжести состояния пострадавших с мирной и боевой политравмой при поступлении в стационар III уровня. Материалы и методы. Обследовано 79 пострадавших с политравмой мирного времени и 65 раненых из зоны АТО. Изучались изменения сознания по шкале комы Глазго, показатели гемодинамики, потребность в вазопрессорной поддержке и искусственной вентиляции легких, перистальтика кишечника, показатели общего анализа крови, печеночный и почечный комплекс, коагулограмма, показатели кислотно-основного и газового состава крови, уровень цитокинов (IL-6, IL-10) в сыворотке крови. Результаты. При мирной политравме достоверно чаще встречались черепно-мозговые травмы и торакоабдоминальные травмы, при боевой — травмы мягких тканей. Среди причин мирной политравмы преобладали дорожно-транспортные происшествия и высотные травмы, боевой — минно-взрывная травма. Раненые на 12,2 % чаще требовали ургентных оперативных вмешательств. Нарушения сознания в группе боевой травмы чаще были связаны с седацией, а мирной — непосредственно с черепно-мозговой травмой. Гипотензия и тахикардия при боевой травме были менее выражены за счет проведенных ранее противошоковых мероприятий и вазопрессорной поддержки. При боевой травме были более выражены гипоальбуминемия, гипокоагуляция и почечная дисфункция. В проявлениях цитолитического синдрома при боевой травме преобладало повышение уровня аспартатаминотрансферазы (АсТ), что, вероятнее всего, также объяснялось разрушением больших массивов тканей. Воспалительная реакция от характера травмы не зависела и ассоциировалась только с тяжестью и локализацией повреждений. Частота ­осложнений составила 41,8 % при мирной травме и 47,7 % — при боевой, летальность — 8,9 и 13,8 % соответственно. Выводы. Таким образом, при аналогичной тяжести травмы и объеме кровопотери боевая травма отличается от мирной по своей структуре и сопровождается более выраженными системными расстройствами, в основном печеночной, почечной и гемокоагуляционной дисфункцией. Это приводит к более высокой частоте осложнений и летальности.

State Institution “Institute for Children and Adolescents Health Care at the NAMS of Ukraine” – pages of history and modernity

The State Institution “Institute of Children and Adolescents’ Healthcare under the National Academy of Medical Sciences of Ukraine” (SI “ICAH of NAMSU”) is a multidisciplinary research, diagnostics & treatment, organizational & methodological center, the activities of which have been always responding to the most urgent needs of the contemporary healthcare. Functioning of this center has been always directed on solving the top priority tasks in the field of healthcare for school children and youth, including: prevention of chronic non-infectious diseases during childhood and adolescence; maintenance of the reproduction potential and of the psychological health among children and adolescents; prevention of the negative impacts from the educational process upon the health of school-age children and studying youth; scientific substantiation of the efficient use of new inventions in the related field; medical assistance for the patients of childhood and adolescence age under the conditions of healthcare sector reforms. As per the determined functions, the Institute is the only research institution of such specialization in Ukraine today. During the last decade, the state of health among Ukraine’ population of childhood age has been subject to negative changes: the morbidity rate has been growing along with the number of diseases, including non-infectious somatic pathologies. The share of healthy children of the school age does not exceed 5–10 %. Therefore, timely detection of the diseases of endocrine, reproduction, bronchopulmonary, cardiovascular, osteomuscular systems as well as of kidneys and liver becomes of vital importance. Attention should be particularly focused on the children and adolescents from the ATO zone and those suffered from the military actions, on the state of their psychological health and physical development. An important direction in maintaining and strengthening the health of children from the military conflict zone is the application of principles of the medical & psychological assistance based on organizational, curative and preventive measures carried out by the PI “ICAH of NAMSU”. The Institute’s personnel will be directing their further efforts towards solving the most acute and most socially important issues related to reformation of healthcare for children and adolescents below 18 y.o. as well as on the development of advanced medical technologies for diagnostics, treatment and rehabilitation of children and adolescents. Key words: children; adolescents; psychological health; psychical development; medical & psychological assistance.

Phenomenological structure of post-stress disorders in volunteers whose activities are related to military servicemen support in the ATO zone

To solve this goal in compliance with the principles of bioethics and deontology conducted a comprehensive clinical-psychopathological and pathopsychological examination of 97 volunteers. Associated with the support of the military in the combat zone, not less than 1 year. Among those surveyed were 57 women and 40 men with a mean age (30.6±4.7) years. According to the results of the study, the clinical structure of post-stress disorders in the examined volunteers was represented by the following nosologies: F43.2 – adaptation disorders (32.7% of men and 28.1% of women), F43.1 – post-traumatic stress disorder (27.6% of men and 22.9% of women), F41.0 – panic disorder (22.4% of men and 29.1% of women), F41.1 – generalized anxiety disorder (17.3% of men and 19.9% of women). According to the scale of severity of traumatic stress, 62.8% of respondents have a complete manifestation and 37.2% a clear manifestation of stress disorder. According to the scale of anxiety depression and Hamilton depression, 56.2% of subjects had a severe depressive episode, 62.1% had a severe anxiety episode, 42.3% had a moderate depressive episode, and 33.4% had a moderate anxiety episode. It was found that for volunteers who survived the fighting are characterized by severe clinical manifestations of PTSD, with a high level of impact of the traumatic event was observed on all scales of PTSD; excessive signs of stress disorder, severe or moderate depressive and anxiety episodes on the Hamilton scale. Keywords: PTSD, post-traumatic stress disorder, depression, anxiety, adjustment disorder, combat stress.

Clinical and psychopathological features of depressive disorders in survivors of hostilities

Psychosocial stressor (war) has a negative impact on the mental health of all citizens of our country, servicemen of the Armed Forces of Ukraine, soldiers of the National Guard and prisoners, their relatives and refugees who have been forced to leave their living places. A comprehensive examination was conducted of 150 patients with depressive disorders, both sexes, aged 20–55 years. Group I of the survey included 50 servicemen of the Armed Forces of Ukraine who took a direct part in hostilities in the ATO zone, group II included 50 internally displaced persons and group III included 50 volunteers whose activities are related to supporting the military in the ATO zone. According to the results of the study, the clinical structure of depressive disorders in the examined patients is presented as anxious (in 30 % of combatants; 24 % of migrants and 26% of volunteers), labile (in 26%; 30%; 22% of patients, respectively), apathetic (in 28% of patients of group I; 24% of group II; 28% of group III) and asthenic (in 16%; 22%; 24%, respectively) types. The data obtained during the study formed the basis for the development of a personalized program of psychotherapeutic support and prevention of suicidal behavior in patients with stress-related depressive disorders. Keywords: depressive disorders, hostilities, combat mental trauma, anxiety.

Modern model of formation for post-stress disorders among military service members and veterans

The clinical phenomenology of post-stress disorders was studied in combatants. We observed 150 servicemen of the Armed Forces of Ukraine, who took a direct part in the fighting in the ATO zone, in accordance with the principles of bioethics and deontology on the basis of the National Military Medical Clinical Center «Main Military Clinical Hospital» and the Military Medical Center of the Northern Region. It is shown, that the clinical structure of post-stress disorders in combatants is represented by posttraumatic stress disorder (PTSD), acute stress response and adjustment disorders. The clinical structure of PTSD in combatants is represented by anxious (35.2 % of men and 44.2 % of women), dysphoric (33.5 % and 9.4 %), asthenic (25.4 % and 32.6 %) and somatoform (5.9 % and 13.8 %) syndrome complexes. Adjustment disorders included prolonged depressive reaction (10.1 % of men and 15.7 % of women), mixed anxiety-depressive reaction (16.5 % and 10.2 %), adjustment disorders with a predominance of disturbances of other emotions (9.8 % and 7.4 %). The major risk factors for the development of stress-related disorders in combatants were identified: prolonged participation in combat, the need to see and touch the bodies of the dead, the threat of death from sniper’s fire, the death of friends in their own eyes, the impact of harmful combat factors, family conflicts, adverse social and economic circumstances. The correlation analysis was carried out. It was found, that the severity of psychopathological symptoms is determined by the severity of combat mental trauma. High scores on the Mississippi scale are associated with prolonged mental trauma (rxy=0.64), threat of death (rxy=0.58), death of comrades (rxy=0.54), participation in close combat (rxy=0.50), the offensive (rxy=0.41), the need to touch the bodies of the dead (rxy=0.46), with the killing of opponents (rxy=0.45). There is a strong correlation of combat mental trauma with anxiety intensity (rxy=0.78), fear (rxy=0.71), sense of internal tension (rxy=0.70), disturbance of the sleep-wake cycle (rxy=0.70), incontinence of affect (rxy=0.69) and depression (rxy=0.66). Keywords: post-traumatic stress disorder, adjustment disorders, acute stress response, combat mental trauma, correlation analysis.

Механізми формування та система психотерапевтичної корекції станів дезадаптації у студентів медичного закладу вищої освіти

Проведено комплексне обстеження 412 студентів ІІ–V курсів Харківського національного медичного університету обох статей, віком 17–22 років. Усіх обстежуваних було розділено на три групи: I група – 215 студентів, мешканців Східної України; II група – 87 студентів, мешканців Луганської та Донецької областей, які вступили на навчання до ХНМУ до початку АТО; III група – 110 студентів, переселенців з зони АТО. Як показали результати дослідження, студенти-переселенці виявляють більш високий рівень розладів адаптації, порівняно зі студентами І та ІІ груп. Встановлено, що структура розладів адаптації представлена депресивним, неврастенічним, тривожним та дисоціативним синдромокомплексами. Патогенетичну значущість у формуванні дезадаптивних станів у студентів-медиків мають: зміна життєвого стереотипу, важкий навчальний матеріал, недосконалість механізмів психологічного захисту, відсутність навичок саморегуляції, неконструктивні копінг-стратегії, ситуації тривалої психічної напруги. Для студентів-переселенців стресогенним чинником є необхідність адаптації у новому та статус вимушеного переселенця. Прогностично значущими у формуванні розладів адаптації є збудливість і неврівноваженість, конфліктність у відносинах, тривожна помисливість, дезорганізація поведінки, неспроможність до саморегуляції, нездатність успішно долати стресові ситуації, діяти в умовах невизначеності, ригідність, фіксованість на травматичних і негативних переживаннях. Базисом розвитку станів дезадаптації студентів є високі рівні соматизації, депресії та тривоги за шкалою SCL-90-R; переважання важкого депресивного та тривожного епізодів за шкалою Гамільтона; клінічні прояви за лікарняною шкалою тривоги і депресії, переважання інтенсивної та екстенсивної нервово-психічної напруги. Базуючись на отриманих даних, нами розроблено систему медико-психологічної підтримки студента-медика в період навчання, що передбачає застосування комплексного психотерапевтичного, психоосвітнього та психопрофілактичного впливів та доведено її ефективність.

ОСОБЛИВОСТІ СЕСТРИНСЬКОЇ ДОПОМОГИ ВІЙСЬКОВОСЛУЖБОВЦЯМ Й МИРНОМУ НАСЕЛЕННЮ, ЯКІ ПЕРЕБУВАЛИ В ЗОНІ БОЙОВИХ ДІЙ

Мета роботи. Проаналізувати основні напрямки сестринської допомоги військовослужбовцям та цивільному населенню, які перебували в зоні ведення бойових дій.
 Матеріали і методи. На базі військово-медичної служби ВМС УСБУ в Закарпатській області було проаналізовано анкетні дані 30 учасників АТО, 30 осіб із переселених військових територій та 20 осіб, які є близькими родичами учасників бойових дій, проживають і доглядають за ними щодо наявності посттравматичного стресу (тривоги та депресії). Використовували шкалу госпітальної тривоги та депресії (Hospital Anxiety and Depression Scale, HADS).
 Результати й обговорення. Аналіз даних, які ми отримали, свідчить про поширеність субклінічно вираженої депресії серед 56,7 % учасників АТО, клінічно вираженої депресії у 23,3 % ветеранів. При цьому субклінічно виражену депресію реєструють у 55,0 % осіб, які перебувають поруч із військовослужбовцями. Поширеність клінічно вираженої депресії серед осіб, переселених із зони АТО, становить 16,6 % субклінічно вираженої депресії – 46,7 % населення. Встановлено, що військовослужбовці та ветерани значною мірою відчувають напруження, страх перед невідомістю, вважають, що можуть легко розслабитись, часто бувають раптові відчуття паніки та дуже часто – відчувають внутрішнє напруження. Мирне населення, що перебувало в зоні АТО, теж характеризується помірним рівнем тривоги, який підтверджується частим відчуттям страху, що може щось трапитись, нечастими хвилюючими думками, частим відчуттям внутрішнього напруження. Порівнюючи отримані відповіді на твердження у блоці питань, що стосуються рівня депресії, можна говорити про середній рівень депресії у військовослужбовців та помірний – у цивільного населення, переселеного із зони АТО.
 Висновки. Особи, які несли військову службу або перебували в зоні АТО, їх близькі родичі потребують психологічного супроводу при зверненні до медичного закладу будь-якого профілю. Медичні сестри повинні знати методи надання екстреної психологічної допомоги, тому рекомендується включити в освітню програму для медсестер освітнього рівня «Магістр» курс за вибором «Екстрена психологічна допомога».

Dysphoric variant formation of post-traumatic stress disorder in combs

Nowadays, more combatants are suffering from the effects of an extreme event in the war zone. Specific mental trauma leads to psychiatric disorders that have common characteristics, which allows them to be separated into a separate heading - F43.1 (PTSD-post-traumatic stress disorder) in MKH-10. It is revealed that more than 26.5% of fighters from 324 respondents who returned from the ATO zone have clear signs of dysphoric variant of PTSD, including flashbacks, emotional numbness, unmotivated vigilance, maladaptation, and psychosomatic disorders. It is important to determine the criteria for the distribution of this condition, which is essential for the treatment and resolution of social issues. The purpose of the work is to identify the etiological factors and characteristic manifestations of dysphoric variant of PTSD in combatants. Materials and methods: On the basis of the Vinnitsa Regional Clinical Hospital of War Veterans (VRCHWV), as well as on the basis of the expert department of the scientific research institute of rehabilitation of the of disabled people of Mykola Pirogov VNMU (SRIRDP) surveyed 86 respondents suffering from dysphoric variant of PTSD. Basic methods of research: clinical anamnestic, clinical psychopathological (clinical interview), socio-demographic (questionnaire), psychodiagnostic, statistical. The results showed a significant correlation between the personal differential indices and the assessment of the level of neuro-psychic stability according to Pearson and Spearman correlation coefficients (P <0.01). Almost all respondents showed high and medium levels of self-esteem (6.4 and 92.3% respectively). According to the results of the surveys, the arithmetic mean of the assessment of neuropsychiatric resistance (25.62 ± 11.62) indicates a tendency for neuropsychiatric breakdowns. Conclusions: The relevance of anxiety level research is related not only to its high prevalence in patients, but also with the tendency to chronicize the process and fix symptoms in the form of persistent personality changes. Timely identification of problems will improve the effectiveness of the respondents' medical work.

Психологічні особливості опрацювання травматичного досвіду спільнотою воїнів, які набули бойовий досвід в АТО/ООС

У межах теоретичного підходу до вивчення особливостей колективного проживання травматичних подій (Штомпка, 2001) розглянуто психологічні стратегії опрацювання військовою спільнотою пережитого бойового досвіду. Ці стратегії інтерпретовано як частково не усвідомлювані, спрощені моделі поведінки, які можна проаналізувати за проявами когнітивного, конативного та поведінкового компонентів. Показано, що військовослужбовці, які були учасниками АТО/ООС, стикаються з труднощами відреагування травматичного досвіду, пристосування та адаптації до мирного життя. На основі результатів емпіричного дослідження виокремлено типові способи подолання травми військовослужбовцями, які мають бойовий досвід участі в АТО/ООС: контрольованість і доброзичливість зовнішнього світу; неконтрольованість зовнішнього світу; рефлексивне осмислення бойового досвіду; суб’єктивне переживання власного везіння; інтроспективна сконцентрованість; гостре переживання травми; сконцентрованість на власних емоціях; сконцентрованість на власних роздумах; застрягання в травматичному досвіді; позитивний образ себе і світу; відчуження від себе і світу. За ступенем адаптивного потенціалу виокремлені стратегії було поділено на дві групи – консервативно-рутинні і проактивно-трансформаційні. До консервативно-рутинних стратегій віднесено: гостре переживання травми, сконцентрованість на власних емоціях, сконцентрованість на власних роздумах, неконтрольованість зовнішнього світу, інтроспективну сконцентрованість, відчуження від себе і світу; до проактивно-трансформаційних – контрольованість та доброзичливість зовнішнього світу, позитивний образ себе та світу, рефлексивне осмислення бойового досвіду, суб’єктивне переживання власного везіння. Показано, що в процесі адаптації одні стратегії використовуються як тимчасові, перехідні до більш зрілих або, навпаки, більш регресивних, інфантильних реакцій, тоді як інші вже сформовані та закріплені в досвіді українських спільнот. Такий підхід дає змогу здійснювати диференційоване психологічне втручання, ефективно долати конкретні деструктивні стани, які провокують дезадаптивну поведінку військовослужбовців.

Targets of medical-psychological assistance for medical university students with adaptation disorders

Background. In the course of work is to identify and develop a system of measures for psychotherapeutic correction on the basis of identification and comprehensive evaluation of clinical and psychological manifestations and mechanisms of formation of maladaptive states in medical students.
 Objective – to comprehensively study the mechanisms of formation of students’ maladaptation states and develop a system of their psychotherapeutic correction and psychoprophylactic support in a medical institution of higher education.
 Materials and methods. Complying with the principles of bioethics and deontology, 412 students of the 2-5 academic years of the Kharkiv National Medical University (KhNMU), of both sexes, at the age of 17-22 years, were examined. All the surveyed people were divided into three groups: Group 1 included 215 students-inhabitants of the Eastern Ukraine; Group 2 consisted of 87 students-residents of Luhansk and Donetsk regions, who entered the study at the KhNMU before the ATO; Group 3 consisted of 110 students-migrants from the ATO zone.
 Results. Students-migrants have a higher level of adaptation disorders, compared with the students of the first and second groups. It was established that the structure of adaptation disorders is represented by depressive, neurasthenic, anxious and dissociative syndrome complexes. Prognostically significant elements in the formation of adaptation disorders are excitability and imbalance, proneness to conflicts in relationships, disturbing confidence, disorganization of behavior, failure to self-regulation, inability to successfully overcome stressful situations, act in conditions of uncertainty, rigidity, and focusing on traumatic and negative feelings. According to the results of the pathopsychological examination, high levels of somatization, depression and anxiety by the SCL-90-R scale; the prevalence of severe depressive and anxiety episodes by the Hamilton scale; clinical manifestations by the hospital anxiety and depression scale were characteristic for the examined students with disorders of adaptation. Based on the data obtained, a system of medical and psychological support of the medical student during the study period was developed, which envisages the use of complex differentiated psychotherapeutic, psychoeducational and psychoprophylactic influences.
 Conclusions. Against the background of the psychotherapeutic correction, a positive dynamic of the psychological state was noted: rapid reduction of anxiety and depressive symptoms, reduction of the level of neuro-psychic tension, increase of students’ psychophysical activity, positive change of coping strategy.

ЖИТТЄВІ ПЕРСПЕКТИВИ ОСОБИСТОСТІ, ЩО ЗНАХОДИТЬСЯ В УМОВАХ АТО (АНТИ-ТЕРОРИСТИЧНОЇ ОПЕРАЦІЇ)

The article deals with the peculiarities of the formation of the life perspective of people who are in the conditions of ATO. The main parameters, functions and forms of awareness of personal life perspectives are revealed. The following characteristics and components of the life perspective of the individual are singled out: differentiation / non-differentiation - the content component, optimism / pessimism - the emotional and experiencing component, realism / unrealism - the pragmatic-practical component, normativity / personality - the semantic component. According to these components, the author made the analysis of the structure of the life perspective of the respondents in the ATO zone, in particular ATO fighters, internally displaced people, residents of the gray zones and residents of stable territories of Ukraine. The divergences in the presented perspectives of their own lives in the consciousness of these groups of respondents were revealed and analyzed. It was stated that the least differentiated perspective is among the representatives of the military men participating in the ATO. Optimism about their own future was demonstrated by all categories of respondents. The sense of the own perspective is at a fairly high level for all groups of respondents related to ATO, but events are most often selected on a normative basis, as opposed to representatives of the group of stable territories. The reflexivity concerning the actions which are to be taken in order to reach this or that planned or anticipated event was shown by the representatives of IDP group, they surpassed the representatives of the group of stable regions for this indicator. According to the results of the conducted research, we can note that for the construction of a differentiated, optimistic, realistic and personal perspective of the individual, it is necessary to take into account the content of the perspective, its emotional assessment, semantic and pragmatic-practical component. The results of the above research can be used to create a program of psychological assistance to ATO fighters, IDP and residents of the border areas with the zone of ATO (gray zones) to facilitate the construction of their own future perspectives.

CLINICAL SPECIFICITY OF ADAPTATION DISORDERS IN STUDENTS

Aim: To study the clinical features of the adaptation disorders state of medical students. Material and methods of research: To solve the aim, following the principles of bioethics and deontology, a comprehensive clinical-anamnestic, clinical-psychopathological and psychodiagnostic examination of 412 students of both sexes (216 women and 196 men), Kharkiv National Medical University, average age 18.0±2.0 years. Among the surveyed 215 students of eastern Ukraine; 87 students – residents of Luhansk and Donetsk regions, enrolled in KhNMU to the beginning of the ATO and 110 students – migrants from the ATO zone. Research methods: clinical, psychopathological, psychodiagnostic, statistical. Results As shown by the results of the study, 27.0±1.7 % of students from eastern Ukraine, 36.4±1.9 % of students from residents of Luhansk and Donetsk regions who entered KhNMU for the beginning of the ATO and 92.2±3.1 % of students are migrants disadaptive states detected from the ATO zone. In the course of the work, it was established that disadaptive states of medical students manifest anxiety and depressive disorders. Depressive disorders were characterized by a lowered background of mood, affect of anguish and expectation of unhappiness, psychomotor inhibition, fixation on negative events, depressive self-assessment, reduction of the level of impulses, the presence of moderate and severe depressive episodes on the Hamilton depression scale Anxiety disorders were characterized by the dominance of the general anxious mood background with a sense of internal tension, anxiety with inability to relax, irritability, aptitude for affinity reactions, hyperesthesia, internal stress, violation of the sleep-wake cycle, presence of moderate and severe anxiety episodes on the Hamilton depression scale, high level of reactive anxiety and personal anxiety on the Spielberger-Khanin scale and excessive nervous and mental voltage on the Nemchin scale. Conclusions. Migrant students show a higher level of adaptation disorders, compared to students who enrolled in KhNMU at the beginning of the ATO, in 27.0±1.7 % of the examined I groups, 36.4±1.9 % of the examined II and 92.2±3.1 % III group revealed disadaptive states The clinical picture of disadaptive states of presentation is a combination of anxiety and depressive symptoms with a predominance of moderate and severe anxiety and depressive episodes, high levels of reactive anxiety and personal anxiety and excessive psychological stress.

Reotsocialization of youth from the ATO zone

Reotsocialization of youth from the ATO zone

ШЛЯХИ ПОДОЛАННЯ СОЦІОКУЛЬТУРНИХ КОНФЛІКТІВ У ПРОЦЕСІ ІНТЕГРАЦІЇ ВНУТРІШНЬО ПЕРЕМІЩЕНИХ ОСІБ У НОВІ ТЕРИТОРІАЛЬНІ ГРОМАДИ

The study considers specifics of sociocultural integration and adaptation of internally displaced persons (IDPs) in new territorial communities. As a result of the military and political conflict caused by the armed aggression of the Russian Federation, Ukraine since 2014 has been facing the problem of mass internal migration. The investigation of differences in values, socio-cultural attitudes and expectations of hosting communities in regard to IDPs (and vice versa, those of IDPs in regard to hosting communities) is important, as these attitudes and expectations significantly influence socio-cultural and overall communal atmosphere. The knowledge of socio-cultural moods and expectations of these social subjects serves as a scientific ground for the support of well-balanced relations between IDPs and hosting communities, including prevention of conflicts related to the discrimination of forced migrants. Adaptation of IDPs to the life in new communities depends on the reality of their expectations: both high and low, they negatively influence the process of adjusting to the new environment. It must be noted that most public and private initiatives aimed at helping IDPs have been successful, although such activities have been unsystematic, spontaneous, occasional, and fragmented. The sufficient level of satisfying of social, educational, and cultural needs is an important factor in adaptation of IDPs in new places of residence. This is especially indicated by school enrollment and psychological assistance provided to families with children. Most forced internal migrants state that employment constitutes for them the key problem, sometimes even greater than that of accommodation and social protection. Usually, such reasons for employment denial are mentioned: unwillingness to hire a person returned from the ATO zone due to their mental differences and mal-adaptation to local conditions. Thus, an account for sociocultural needs and value priorities as of IDPs so of local residents in the public and social life of the territorial community will have a positive influence on the overcoming of problems arising in the process of integration and adaptation of IDPs to their new life; prevent conflicts; increase the level of communication, and, in a larger sense, facilitate national unity and reconciliation.

SOCIAL INNOVATION IN ENTREPRENEURSHIP AND EDUCATION AS AN ADAPTATION TOOL FOR SERVICEMEN DEMOBILIZED FROM THE ATO ZONE

Introduction: The realities of our country today require Ukraine to shift the strategic benchmarks to the development zone and to support a favorable socio-economic environment for the implementation of the labor potential of vulnerable segments of the population, in particular demobilized participants from the combat zone. The labor potential of this category of the population can be effectively realized only under the condition of proper state support and socio-economic assistance. Moreover, promoting the development of small and medium enterprises among this category of people can become a powerful tool not only for social adaptation to peaceful life, but also to produce economic and social effects both at the level of our state and abroad.Hypothesis of scientific research. It is anticipated that the symbiosis of a two-factor combination of social innovation in entrepreneurship and education will allow developing an effective tool for the adaptation of socially unprotected segments of the population, including troops demobilized from the ATO zone, based on the diagnosis of requests and needs of integrators (forced migrants, combatants, combatants' families).The purpose of the article is to develop the theoretical framework for substantiating the effective algorithm of adaptation of servicemen demobilized from the ATO zone on the basis of a synergistic combination of social innovation in entrepreneurship and education.Methods of research: method of expert survey – for diagnostics of requests and needs of integrators (forced migrants, combatants, families of combatants); the method of system analysis and logical generalization – to substantiate and determine the role of symbiosis of social innovations in entrepreneurship and education for demobilized from the ATO zone; the method of critical thinking – to distinguish the prerequisites for the development and prospects of implementing social innovations in the field of entrepreneurship and education; GET TEST method for assembling business profiles; cluster analysis – for the distribution of future entrepreneurs by the level of development of entrepreneurial characteristics.Results: the experience of the international community regarding the implementation of the support system for servicemen demobilized from the ATO zone on the basis of social innovations has been analyzed; the role of the symbiosis of social innovations in the field of entrepreneurship and education for the development of their own business is determined; the results of diagnostics of requests and needs of integrators are presented, and based on their basis an algorithm of adaptation of servicemen demobilized from the ATO zone on the basis of a synergistic combination of social innovation in entrepreneurship and education is developed.Conclusions: the development of theoretical positions on the substantiation of the effective algorithm of adaptation of servicemen demobilized from the ATO zone on the basis of a synergistic combination of social innovation in entrepreneurship and education provided an opportunity to comprehensively approach the solution of the urgent issue of promoting the development of small and medium entrepreneurship among servicemen demobilized from the ATO zone.

Methodology and efficiency of the psychotherapeutic correction system of adaptation disorders of students

The aim: to develop a system of psychotherapeutic correction of adaptation disorders of medical university students.Materials and methods of research: to achieve the set aim with observance of the principles of bioethics and deontology, a comprehensive clinico-anamnestic, clinico-psychopathological and psycho-diagnostic examination of 412 students of both sexes, Kharkov National Medical University (KhNMU) at an average age of 18.0±2.0, 52.2 % of the surveyed (215 students) were residents of eastern Ukraine, 21.1 % (87 students) – residents of the Lugansk and Donetsk regions who entered the KhNMU at the beginning of the ATO and 26.7 % (110 students) internally displaced persons from the ATO zone.Research methods: clinical-psychopathological, psycho-diagnostic, statistical.Results. As the results of the study showed, the students-migrants from the ATO zone show a higher level of adaptation disorders, compared to students in eastern Ukraine and residents of the Lugansk and Donetsk regions who entered the KhNMU for education at the beginning of the ATO. We developed a system of psychotherapeutic correction of disadaptation conditions in students of the medical university which was aimed at overcoming adaptation disorders and potentiating adaptive personality mechanisms of students by revealing the pathogenetic nature of the conflict, determining the start of disadaptive reactions, processing the pathological behavior stereotype, forming a tendency to use constructive forms of coping, normalizing the system of emotional-volitional reaction, increasing self-esteem, activation of protective psychological mechanisms skill formation self psychological state. As shown by the results of dynamic observation against the background of the proposed system of psychotherapeutic correction of disadaptation states, the level of adaptation of students has significantly increased, anxiously depressive symptoms have been reduced, and the level of neuropsychic tension has become lowered. The obtained results of the research testified to the positive influence of psychotherapy on the optimization of the coping strategy of the problem-solving behavior of medical students.Conclusions. A system of psychotherapeutic correction of medical students' disadaptation conditions has been developed. This includes the use of rational psychotherapy (Dubois P., 1912), individual cognitive behavioral therapy (Beck A. T., 2006), autogenic training – psychotonic variant by A. M. Shogam, K. I. Mirovsky (1963) and art therapy using the techniques of "Drawing Yourself", "The Star of Senses". Sense-forming element of the developed system of psychotherapy is psychoeducation using information modules and training the formation of communicative skills and skills in solving problems of interpersonal interaction. Under the influence of psychotherapeutic correction of adaptation disorders, rapid reduction of anxious and depressive symptoms, normalization of emotional state, optimization of coping strategy of problem-solving behavior with predominance of coping of problem-oriented problem

LIMBS REAMPUTATIONS IN MILITARY PERSONNEL INJURED IN THE AREA OF THE ANTITERRORIST OPERATION IN EAST UKRAINE

The aim – to identify and analyze causes for reamputations in military personnel with limb amputations due to ATO in East Ukraine. Patients and methods. All military personnel of the AFU within ATO was eligible for the study with diagnosis of limb amputations in the period from 01.06.2014 to 30.06.2016, and which were treated in hospitals of the Ministry of Defense of Ukraine. Among 7091 patients with injuries, 152 patients with limb amputations were identified.
 Results and discussion. Out of 152 patients, 25 (16%) underwent limbs reamputation, whereas 127 (84%) patients underwent amputation once. Patients in the study groups did not differ in age. Amputation was performed on the upper limb in 41 (32%) in the group of patients with amputations, which is significantly higher as compared to 2 (8%) patients in the reamputation group (p = 0.014). Analyses the level of amputations of the upper extremity showed no difference in the parameters. In 23 (92%) patients in the group with reamputation amputation of the lower limbs were diagnosed significantly more often as compared to 86 (68%) patients in the amputation group (p = 0.014). Analyses of the level of amputation of the lower extremity revealed that almost 3 times more often amputation was performed at the level of the ankle in the group of patients with reputations - 8 (32%) patients, as compared to 15 (12%) patients in the amputation group (p = 0.03). However, linear regression did not show a significant difference of these parameters in reamputations. Amputation of one upper extremity in the reamputation group was diagnosed 7 times less frequent - 1(4%) patient less often than in the amputation group - 37(29%) patients (p = 0.005).
 Conclusions: The results of the study of the injured in a hybrid war indicate that reamputations are more often associated with amputations at the level of the upper limb, but are less often diagnosed in patients with amputation of the lower extremity. Reamputations are more often performed with trauma of one limb. Clinical features in patients injured in the ATO zone in the East Ukraine demonstrate the frequency and characteristics of re-arrests that are different from other armed conflicts.