Bibliosemantic Methods Research Articles

DIAGNOSTIC APPROACHES TO PAINFUL TEMPOROMANDIBULAR JOINT DYSFUNCTION: A LITERATURE REVIEW

Introduction. The temporomandibular joint (TMJ) is an anatomically and biomechanically complex structure, essential for critical functions such as chewing, breathing, verbal and non-verbal communication, and facial expressions. The term “temporomandibular joint disorders” encompasses a range of conditions characterized by pain with diverse, often polymorphic, manifestations. Purpose of this study is to analyze the trends and directions in publications on the diagnosis of painful temporomandibular joint disorders from 2017 to 2024 (up to March 31, 2024) across international and Ukrainian scientific resources. Materials and methods. We used the bibliosemantic method, the methods of the system approach and content analysis. We searched for scientific publications for the period from 2017 to 2024 as of 03/31/2024 in Google Academy and Medline (accessed via PubMed) using the following words and their combinations: “dysfunctional temporomandibular joint conditions” and “temporomandibular joint dysfunction”, “temporomandibular dysfunction and condylare position”, “temporomandibular dysfunction and classification”. Inclusion criteria were as follows: a) studies aimed at evaluating the anatomy of the temporomandibular joint; b) studies conducted with cone beam computed tomography images; c) research on humans; d) data of persons aged 18 to 60 years. Exclusion criteria were as follows: a) clinical cases; b) discussions; c) research with the participation of children and adolescents (under the age of 18). Results. For the period 2017-2024 (as of 31.03.2024), the main research topics on the painful form of temporomandibular joint dysfunction are the following: the prevalence of temporomandibular joint disorders (11 publications), the influence factors of the dysfunction development of the temporomandibular joint (42 publications), the improvement of existing and the search for new diagnostic criteria (17 publications); the anatomical and the morphological features of the temporomandibular join as the development predictors for the temporomandibular joint dysfunction (20 publications); search for new models for predicting the course and effectiveness of treatment for temporomandibular join dysfunction (4 publications). Conclusion. Researchers have primarily focused on examining factors influencing the clinical progression of temporomandibular joint dysfunction, accounting for 44.7% of all publications. Studies on anatomical and morphological features as predictors of temporomandibular joint dysfunction, along with new predictive models, remain contentious and highlight the need for further investigation.

A PATIENT WITH OSTEOARTHRITIS AND HYPERTENSION IN GENERAL MEDICAL PRACTICE

Osteoarthritis is one of the most common diseases in Ukraine and worldwide, often leading to early disability in people of working age, making it both a medical and social concern. According to the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases, as well as the International Society for the Study of Osteoarthritis, it is known that a middle-aged patient with osteoarthritis typically has four accompanying pathologies. In elderly patients, in addition to osteoarthritis, up to eight other chronic conditions are often diagnosed. Comorbidity is frequently observed in middle-aged patients with osteoarthritis. Understanding the pathogenetic links between osteoarthritis and comorbid conditions plays an important role in the timely diagnosis and treatment of these diseases, helping to maintain a high quality of life for patients. Objevtive: the study of the pathogenesis of osteoarthritis and arterial hypertension, along with the proposed therapy for treating comorbidities in patients with both osteoarthritis and arterial hypertension, aims to enhance the treatment outcomes. Materials and methods. Analytical and bibliosemantic methods were used in this study. During the scientific search, 38 modern literature sources were reviewed and analyzed concerning the pathogenetic impact on the development of osteoarthritis and arterial hypertension, as well as their shared mechanisms in the development and progression of both conditions. The study was carried out at the Department of Family Medicine and Therapy of the Regional Rheumatology Center, M. V. Sklifosovsky Poltava Regional Hospital. A total of 50 people were examined; the main group consisted of 35 individuals with stage II hypertension, grade 2, combined with stage II knee osteoarthritis (according to the Kellgren-Lawrence scale), with joint dysfunction of stages 1-2. These patients were aged 40-65 years (mean age 51.8±2.14 years). The duration of hypertension was 10.07±1.24 years, and the duration of manifested osteoarthritis was 8.56±1.03 years. The comparison group consisted of 20 individuals with stage II, grade 2 hypertension (mean age 52.5±2.38 years), with a mean hypertension duration of 11.31±1.17 years. The clinical diagnosis of osteoarthritis was established according to the recommendations of the European Alliance of Associations for Rheumatology (2018). The diagnoses of comorbid conditions were confirmed in accordance with relevant orders from the Ministry of Health of Ukraine, with verification by specialized experts. Patients with osteoarthritis received standard treatment, and, when necessary, additional treatment for comorbid conditions was prescribed (a hypotensive combination of an ACE inhibitor and long-acting calcium. Results: The presence of osteoarthritis exerts an additional negative impact on heart rate variability in patients with hypertension. The reduction of the Low Frequency/High Frequency (LF/HF) index due to the use of this therapy (a combination of an ACE inhibitor and a long-acting calcium antagonist in doses of 4/5 mg, 4/10 mg, 8/5 mg, 8/10 mg) in the treatment of patients with comorbidity of hypertension and osteoarthritis contributes to the activation of the sympathetic nervous system, reduction of patient mortality, balancing of the nervous system by inhibiting sympathetic nervous tone, and lowering high blood pressure. Conclusions: The proposed combination therapy for patients with osteoarthritis and hypertension contributes to prolong remission of both the primary disease and comorbid conditions, reduces the frequency of hospitalizations, and shortens inpatient treatment by 3-4 days.

SPECIFICITIES OF PHYSICAL DEVELOPMENT OF CHILDREN WITH CEREBRAL PARALYSIS IN A FAMILY-ORIENTED MODEL OF INTERVENTIONS

Families with a child with cerebral palsy (CP) face a number of medical, economic, legal, educational and psychological problems from the moment of birth. The main responsibility for the child's development lies with families, as it is there that key aspects of the child's personality are formed. There is a clear dependence of a child's psychological and physical health on the psychological climate of the family. Children with such disorders need to be provided with favorable conditions that will help compensate for the consequences of their disabilities. They need the support of qualified specialists and, most importantly, a warm and friendly attitude from their parents and the environment [1]. It should be emphasized that there are a number of factors that contribute to the psychological maladjustment of children with cerebral palsy in the family environment, which should be known to the child's relatives. First and foremost, it is the inadequate assessment of physical and mental development by parents, as well as the psychological atmosphere in the family. These factors cause deformation of the child's psyche and complicate his or her social adaptation, and negatively affect motor activity and treatment and rehabilitation processes. There are two sides to this situation: on the one hand, parents who find it difficult to understand the complexity of the situation and the child who needs special care, treatment and education. Physical rehabilitation requires the active participation of the person being rehabilitated, but with children, especially young children, this process is too complex for quality rehabilitation and requires the participation of parents. It is also important to take into account the role of the family in the development of motor skills, as it helps to integrate therapeutic techniques into the child's daily life. The aim of the study was to analyze the latest research and approaches to determine the peculiarities of cooperation between a physical therapist and families raising children with cerebral palsy. Using the Internet search databases and the bibliosemantic method, the peculiarities of applying a family-centered approach, motor training, principles of neuroplasticity and home exercise programs to improve the motor activity of children with cerebral palsy were determined. This article describes some peculiarities of physical therapist's work with patients suffering from cerebral palsy. The peculiarity is that these patients are children and when working with children, unlike adults where motivation comes first, intervention approaches in children are formed on the basis of pleasure. Accordingly, various specialists should be involved at all stages to ensure the normal functioning and development of the child. However, the role of parents in this process remains no less important, as they should be the main link that connects these processes for the well-being of the child. The review analyses research on motor training and home exercise programs. The family-centred approach to physical rehabilitation for children with cerebral palsy emphasizes the role of the family as a key factor in achieving goals and improving the child's quality of life. Involving the family in physical therapy helps to integrate therapeutic techniques into the daily life of the child and his or her family. Conclusions. The family-centred approach is characterised by the active participation of the family in the rehabilitation process. This is important because the family plays a crucial role in supporting and motivating the child during treatment. This approach not only provides treatment, but also provides the family with the knowledge, skills and resources to continue to help the child in their daily lives. This approach aims not only to improve the child's functioning, but also to help the child become part of the wider family and social environment. This promotes greater integration and independence. Thus, the family-centred approach to physical rehabilitation of children with cerebral palsy demonstrates the importance of family support and integration during treatment, contributing to the comprehensive improvement of both the physical and psychosocial condition of the child.

Medical and social aspects of euthanasia of palliative patients in the Netherlands, Belgium and Germany

In the palliative and hospice medicine of Ukraine, there are a number of unresolved legal and organizational problems that stand in the way of a dignified existence of hopelessly ill patients in the last days and months of their lives. First of all, these are unresolved issues with the coverage of treatment and care of a sufficient number of categories of patients: palliative care is provided mainly to patients with oncological, cardiovascular and neurological profiles of treatment. Secondly, it is the lack of adequate analgesia for a significant number of inpatients and the vast majority of patients receiving treatment at home. Availability of recently legalized medical cannabis remains low for palliative care patients, and palliative care euthanasia is not legalized. In our previous research, we found out that Ukrainian society is not ready for a dialogue about the need to legalize euthanasia, and that the best model of preparing society for euthanasia is the Canadian one, which is based on a comprehensive study of the opinions of the general public and direct participants of the Medical Assistance in Dying (MAiD), as well as on the implementation of decisions federal court. The article is devoted to legal procedures and socio-medical aspects of euthanasia and MAiD in the Netherlands, Belgium and Germany. Certain aspects of legalization, its context and circumstances, compared with the conditions of Ukraine. The article is an original theoretical study performed using the method of systematic analysis, comparative and bibliosemantic methods. Note that we are clarifying the terminology of the previous stages of the study: MAiD is performed by the patient himself, euthanasia is performed by the doctor. In our opinion, Ukraine needs the legalization of euthanasia and MAiD for all age categories, and with the implementation of special additional consent procedures for adult incapacitated patients. In the experience of the countries of the current comparison, we paid special attention to the prevention of abuses in the implementation of these procedures, in the conditions of frequent disregard for the norms of the law since the beginning of the war. Keywords: palliative and hospice care, suicides of palliative patients, Medical Assistance in Dying, right to life, right to die.

Neuromyelitis optica spectrum disorder. Clinical case

Background. Neuromyelitis optica spectrum disorder (NMOSD) has been masked under other diagnoses for many years. Modern diagnostic criteria expand diagnosis possibilities, but they need approbation in real clinical practice. The purpose was through the analysis of a clinical case and literature search to analyze the algorithm for making a diagnosis of neuromyelitis optica based on the new clinical guideline “Diagnosis and treatment of the neuromyelitis optica spectrum disorders” developed in 2023 in Ukraine, to identify marker signs that exclude alternative diagnoses, to analyze the effectiveness of patient treatment in dynamics. Materials and methods. We used the bibliosemantic method, as well as methods of systematic and comparative analysis. We presented the results of our own clinical experience and conducted a dynamic analysis of a clinical case of neuromyelitis optica. Results. Over the past six years, 23 patients diagnosed with neuromyelitis optica were treated at the neurological department of the Lviv Regional Clinical Hospital: 1 patient in 2018, 5 in 2019, 3 in 2020, 6 in 2021, 8 in 2022. We examined the clinical case of a 52-year-old patient who sought medical help at the Department of Neurology of Danylo Halytskyi Lviv National Medical University in 2023. We analyzed the patient’s path to the diagnosis of neuromyelitis optica with the dynamics of changes on magnetic resonance imaging from 2019, considering current diagnostic criteria in which neuromyelitis optica was included in the single term NMOSD. The presence of even one of the six main clinical manifestations, in combination with the presence of AQP4-IgG, gives grounds for making a diagnosis of NMOSD. We carried out a differential diagnosis with other pathologies. Based on this, we identified marker signs to exclude multiple sclerosis, acute disseminated encephalomyelitis, infectious myelitis, and other diseases. Diagnostic aspects of NMOSD and treatment options were considered. An analysis of the effectiveness of the patient’s treatment in dynamics was carried out. Conclusions. The new Ukrainian clinical guideline for neuromyelitis optica spectrum disorder, which is based on international consensus diagnostic criteria, improves the standardization of the approach to patients with NMOSD and can be effectively used in real clinical practice. In our clinical case of a patient with myelitis without optic neuritis, the presence of AQP4-IgG and careful differential diagnosis with other pathologies play a key role in the diagnosing.

Medical and social aspects of euthanasia of palliative patients in Ukraine, Switzerland, Canada, the USA and Israel

Medical Assistance in Dying (MAiD) is legally used in such countries as the Netherlands, Belgium, Luxembourg, Switzerland, Colombia, Canada, Australia, Spain, Germany, and the USA. Portugal and New Zealand are considering legal euthanasia laws. MAiD is performed by injecting a lethal substance into a terminally ill person by a doctor or the patient himself. Euthanasia is one of the services that palliative patients need in the last months and days of their lives. The availability of MAiD increases the country's ranking in the Quality of Death Index and reduces the need for euthanasia tourism. Ukraine needs the legalization of MAiD, as well as the improvement of the palliative and hospice care system in general. The research was conducted using the methods of systematic analysis, the comparative method and the bibliosemantic method with the search for literary sources and legal acts in Google, Google Scholar and PubMed, with an emphasis on Ukraine, Switzerland, the USA, Canada and Israel. During the comparative analysis, it was concluded that the Canadian model of the MAiD is optimal for Ukraine, taking into account the experience of its construction, society's perception and problems related to the application of the legislative norms of the MAiD. The Canadian health care system, the MAiD practice is guided by the social perception of its work models. Legislators respond sensitively to thorough scientific research and court decisions, which respect state and social institutions. The analyzed results of scientific research in Switzerland, the USA and Israel warn researchers and legislators against possible abuses in the implementation of MAiD. But at the same time, they attest to the importance of an accessible MAiD procedure for terminally ill palliative patients, which should be available for the realization of the right to a dignified death along with quality palliative medicine for the realization of the right to a dignified life. Keywords: palliative and hospice care, health care system reform, Medical Assistance in Dying, Quality of Death Index, right to life, right to die.

Clinical and epidemiological characteristics of disabling neurological diseases (literature review)

Disabling neurological diseases are accompanied by disturbances in motor activity, sensitivity, cognitive impairment and chronic pain, often reduce the quality of life in its last years and months, cause death, and therefore they are proposed to be considered as palliative diseases. To determine the list of these diseases, we made a selection from the analytical report of the Global Burden of Disease Study for 1990–2010, published in the Lancet journal in 2012. Of 289 disabling diseases, based on the criteria of direct or frequent comorbid damage to the nervous system, the presence of chronic pain, cognitive decline and limitation of motor activity, which are the causes of a significant decrease in the quality of life and work capacity, we chose the following diseases and pathological conditions: malignant neoplasms, AIDS, severe injuries, strokes, demyelinating diseases, epilepsy, depression and suicide, musculoskeletal disorders (neck, lower back pain, arthritis), tension headache, migraine, loss of vision and hearing, dementia of adults, severe and profound mental retardation of children, children’s cerebral palsy, congenital malformations. We studied the trend of increasing or decreasing the burden of selected diseases depending on the number of years lived with disability and analyzed the interpretation of these trends according to literary sources. Special attention in the review was paid to disabling neurological diseases, which are unjustifiably not considered in the health care systems of most countries as palliative: epilepsy, multiple sclerosis and dementia. The clinical and epidemiological characteristics of these diseases were also studied by the bibliosemantic method. The search for literature sources for the review was conducted in PubMed and Google Scholar. It is concluded that the treatment of patients with disabling neurological diseases as palliative patients, with appropriate organizational solutions in national health care systems, will help to improve the quality of life and reduce suffering of both patients and their family members.

Medical assistance in dying for palliative patients in different countries of the world: lessons on euthanasia legalization

Background. The practice of countries in legalizing euthanasia is useful for other countries that have not yet allowed Medical Assistance in Dying (MAiD). Palliative patients in these countries have varying levels of access to medical care, including adequate analgesia. Medical care in many countries does not meet the needs of palliative patients, and systems of palliative and hospice care are often poorly developed. MAiD can be an alternative to the suffering of palliative patients at the end of life. Aim. Analysis of legal, social and financial aspects of euthanasia legalization in different countries of the world. Materials and Methods. The method of system analysis, comparative method and bibliosemantic method were used for the research. Results and Conclusions. The path to the legalization of euthanasia begins with a wide public debate. Important is the opinion of medical professionals, who are usually divided into two camps: those who deny the necessity and humanity of euthanasia, as well as those who advocate legalization to end the suffering of their patients, seeking to satisfy their persistent and conscious desire to exercise their "right to die". Countries take different paths and at different speeds to legalize euthanasia. The difference between the models of legalized euthanasia lies, first of all, in its permitted type (passive or active), distribution to different age categories of hopeless patients (in particular, to children), to incapacitated patients with cognitive disorders. Active euthanasia is allowed in such European countries as the Netherlands (since 2001), Belgium (since 2002), Luxembourg (since 2009), Spain (since 2010), Switzerland (since 2011). Since these years, there has been a change in the attitude towards medically assisted death of the European Court of Human Rights, which previously categorically regarded euthanasia as intentional murder. In all countries that have legalized euthanasia, an active discussion continues regarding the rules for its implementation. A common feature of countries that have already legalized euthanasia is the approval of the procedure by at least a third of medical professionals. Keywords: medically assisted suicide, suicide tourism, Quality of Death Index, suicide of critically ill palliative patients, right to life, right to die.

Neurodevelopmental Disorders in Children with Hereditary Diseases (Review of Literature, Clinical Case Report)

Introduction. The majority of studies on disturbed neurodevelopment in children focus on psychiatric or psychological-pedagogical issues, but the genetic component of pathology also occupies an important place, in which is important to conduct genetic investigation to verify hereditary pathology, and to identify target organs inherent in particular hereditary disease. The aim of the study. To conduct a review of current literature dedicated to the problem of impaired neurodevelopment in children with hereditary diseases, to describe a clinical case of A. Rett genetic syndrome, accompanied by impaired neurodevelopment in a child. Materials and methods. The method of systematic and comparative analysis, as well as the biblio-semantic method of studying modern views on the influence of hereditary diseases in the disruption of neurodevelopment in children were used. As much as 25 recent publications were analyzed. A clinical case of A. Rett syndrome in a child is described, where the analysis of clinical symptoms and laboratory-instrumental examinations were used, the main of which is the molecular genetic method of next generation sequencing (NGS). Results. Based on the literature analysis it was estimated that clinical cases of rare A. Rett syndrome in children occur with a frequency of 1:10.000-1:15.000. This syndrome is caused by a mutation in the MECP2 gene associated with X-linked A. Rett syndrome/atypical A. Rett syndrome (UID MedGen: 48441) or X-linked MECP2 duplication syndrome (MedGen: 337496). Conclusions. For a long time, the connection of impaired neurodevelopment with other clinical symptoms was not payed much attention, but the enhanced frequency of cases when a child with impaired neurodevelopment was diagnosed with other symptoms or a multisystem lesion stimulated research in this area. This is the story how the term ″syndromal autism″ was born. This term means developmental delay or autism spectrum disorder in children with symptoms of another hereditary disease.

COMPLICATIONS OF CONSERVATIVE AND SURGICAL TREATMENT OF FRACTURES OF THE MANDIBULAR CONDYLAR PROCESS (LITERATURE REVIEW)

One of the most pressing problems in modern maxillofacial surgery is the treatment and rehabilitation of patients with fractures of the condylar process of the mandible. According to various statistical data, the incidence of fractures at this site is 19-37%, and these fractures are the most controversial in terms of diagnosis and treatment. In recent years, there has been an increase in severe forms of mandibular condyle fractures: bilateral, combined, intra-articular, leading to serious complications that affect the functioning of the temporomandibular joint. The data obtained indicated the need for a detailed study of this pathology in order to make a qualitative diagnosis and improve the available treatment methods. The aim of the study – to analyse and summarise current data from the scientific literature on possible complications in the treatment of the condylar process fractures of the mandible. Materials and methods. The bibliosemantic method was used to clarify the state of the problem, to study the analysis of the results of previous scientific research based on the literature sources and electronic resources. Results and discussion. The management of patients with mandibular condylar fractures is widely discussed in the literature due to their high prevalence, but there is still no consensus on the optimal management of patients with this pathology. To date, there are many studies that highlight certain complications of conservative and surgical treatment, but they are not generalised or systematised. Conclusions. Summarizing, we can conclude that complications occur during both conservative and surgical treatment of patients with mandibular condyle fractures. Complications are most often associated with incomplete diagnosis, incorrect choice of treatment method, and depend on the method of access and fixation in surgical treatment.

PRE- AND POST-NATAL METHODS FOR PREVENTING EARLY CHILDHOOD CARIES

In general, the world recognizes the lack of preventive measures against dental caries in children, as evidenced by itsprevalence and intensity with a signifi cant range of fl uctuations.The aim of the study. To describe modern approaches to the prevention of early childhood dental caries in children basedon the analysis of foreign and domestic literature.Materials and methods. The study used the bibliosemantic method and structural and logical analysis. The electronicdatabases PubMed, MEDLINE, Scopus, Web of Science and EMBASE were used to search modern scientifi c literature using the key words «early childhood caries», «macro and trace elements», «probiotics», «prenatal prevention», «postnatal prevention», «oral cavity microfl ora».Results and discussion. At this stage of caries development, the most eff ective prevention programs are those developedon the basis of methods to minimize the impact of risk factors for the development of the disease, such as microbial plaque,low resistance of dental tissues to demineralization, frequent consumption of carbohydrates. The practical implementation of comprehensive prevention programs is very diffi cult, as it should be carried out before the birth of a child and continue throughout life. Often the role of the dentist is to organize and monitor the program, while specifi c preventive measures can and should be implemented by health and education authorities, medical personnel, parents and educators. The greatest impact will be achieved through collaboration among specialists in various medical and non-medical fi elds.Conclusions. Based on the analysis of the literature, there is a great interest of the world’s leading scientists in the prevention of early childhood caries. However, the problems of developing adapted preventive measures taking into account etiologic factors remain relevant.

Practical aspects of pain relief in palliative medicine

Background. Treatment of chronic pain in adults and children is regulated by the national standard of Ukraine, which recommends adherence to the choice of painkillers in accordance with the WHO three-step protocol. But the treatment standard does not detail the use of painkillers according to nosological units. The aim of the work was to determine the need for different types of analgesia in palliative patients depending on the main palliative diagnosis. Materials and Methods. System analysis, aggregation and bibliosemantic methods were used. The list of palliative diagnoses was determined when studying the need and forecasting the need for palliative and hospice care according to the methodology of the Ukrainian Center for Social Data (2019), improved by us in 2021–2024. Results and Conclusions. The conducted research made it possible to determine the predominant types of pain, their possible intensity and corresponding groups of pharmaceutical drugs with an analgesic effect in the units from the list of palliative diseases proposed by us. Neuropathic pain is mainly present in diabetes (diabetic polyneuropathy) and phenylketonuria. Predominantly nociceptive pain is present in cardiovascular diseases of palliative stages, tuberculosis, rheumatoid arthritis, cystic fibrosis and chronic hepatitis in children. Predominantly mixed (nociceptive and neuropathic types of pain at the same time) characteristic of HIV/AIDS, epilepsy, dementia, multiple sclerosis, fibrosis and cirrhosis of the liver, chronic obstructive pulmonary disease, palliative stage kidney disease in adults, cerebral palsy, inflammatory diseases of the central nervous system and mucopolysaccharidoses in children. We proposed to clarify the national standard for treatment of chronic pain in adults and children, and to define the necessary non-steroidal anti-inflammatory drugs, non-narcotic analgesics, weak and strong opioids, anticonvulsants, antidepressants, and other adjuvants with an analgesic effect. The perspective of further studies is to detail the dosage of drugs with an analgesic effect and to calculate the need at the national level for reimbursement under the "Affordable Medicines" program. Keywords: neuropathic pain, nociceptive pain, analgesics, opioids, reimbursement.

IMPROVING THE QUALITY OF ORTHOPEDIC DENTISTRY TEACHING USING INNOVATIVE TECHNOLOGIES

The need to implement innovative technologies and create a student- oriented environment in a higher medical school is determined by the challenges of time to create a motivated, active student – a future competitive specialist.The purpose of our study was to analyze the features of innovative methods used in teaching orthopedic dentistry and to choose directions for further optimization of the educational process. A number of research methods were used to fulfi ll the set goal: the bibliosemantic method with the processing of literature sources and electronic resources, methods of analysis, synthesis, generalization, comparison and systematization. Also a number of cases regarding the application of innovative technologies for teaching the discipline «Orthopedic Stomatology» at the Department of Prosthetic Dentistry of Bukovinian State Medical University were highlighted.Modern students perceive the interactive technologies, visualization of educational material with an individually diff erentiated approach much better. Of the interactive methods when studying orthopedic stomatology, we use the PRES method, brainstorming, discussion, working in small groups, situational modeling, and the case method most often. Adherence to the algorithm when performing practical skills and simulation technologies allow students to acquire eff ectively the competencies provided by the program, as well as successfully pass the OSCE.Therefore, improving the organization of the educational process in the discipline «Orthopedic dentistry» using innovative teaching methods allows providing high-quality education to dental students. The introduction of a student- centered educational environment, on the one hand, helps to form competent, creative, proactive personalities of future dentists, but, on the other hand, requires teachers to continuously improve their own methods of teaching the discipline, acquire new skills based on the principles of facilitation, and create new simulation scenarios and their thorough training with students on a powerful material and technical base.

PRESERVING AND EXPANDING OLYMPIC SPORT HERITAGE: EXAMINING THE "PAGER" FRAMEWORK FOR SUSTAINABLE DEVELOPMENT

Objective. This review aims to investigate literature on the heritage of Olympic sport participation from 2000 to 2023 in order to assess the advancement of consistency and achievements from participation in Olympic sports.
 Methodology. The bibliosemantic method was used to clarify the state of the problem, study the analysis of the results of previous scientific research based on printed literature and electronic sources. This review study analysed broad sections including the demographic dimension, the social dimension and the intervention process. Five main research themes were summarised from these three broad sections using the PAGER system.
 Results. After the 2022 Winter Olympics in Beijing, Chinese officials declared that the goal of "attracting 300 million people to play sports on ice and snow" had been achieved. Historically, the London 2012 Olympic Games had a similar goal: to increase participation in sports for all through the hosting the Olympic Games. Given the goals highlighted, the impact of the Olympic Games on sport participation has certainly been significant. This impact can be called the heritage of Olympic sport, the intangible heritage of the Olympics. This has attracted the attention of many researchers in the academic field in recent years.
 Unlike previous reviews of sport heritage, this review applies the Patterns, Advances, Gaps, Evidence of Practice, and Research Recommendations (PAGER) framework in the stage of result analysis to enhance the quality of the findings. Numerous related studies have been studied in this review, and their scope ranges from the study of state sports policy to the impact of social, economic and cultural policies on the heritage of participation in Olympic sports.
 Conclusion. Current research, as reviewed here, tends to prioritize phenomenological descriptions and recommendations for future planning in Olympic sports. Notably, considerable progress has been made in this area. Several studies highlight the importance of collaboration and long-term planning between various government agencies and stakeholders for achieving success in Olympic sports and realizing their lasting social, cultural, and political impact.

A comprehensive view of the etiology of ChRAS, taking into account potential risk factors

Summary. Chronic recurrent aphthous stomatitis (ChRAS) is currently one of the most common diseases affecting the oral mucosa, affecting 5 to 66 % of the population in different countries worldwide. The pathogenesis of ChRAS is unknown, and it is considered a multifactorial disease associated with local and systemic factors. Further research can be valuable for the prevention and treatment of ChRAS. The aim of the study – to analyze data from scientific literature sources regarding potential risk factors, mechanisms of pathogenesis, including the immune response of mucous membranes and mechanisms of its modification to optimize the diagnosis and treatment of ChRAS. Materials and Methods. The bibliosemantic method was applied to clarify the state of the problem, study the analysis of results of previous scientific research based on literature sources and electronic resources. Results and Discussion. Clinical characteristics of ChRAS are well-defined, but its etiology and pathogenesis remain unresolved. The comprehensive investigation of the occurrence and recurrence of the disease is crucial for understanding the fundamental pathogenetic links, which would be valuable for the prevention and treatment of ChRAS. Potential risk factors for ChRAS, such as a family history, psychological stress, hormonal changes, food allergies, nutritional deficiencies, vitamins and minerals deficiencies, gastrointestinal disorders, certain viral and bacterial infections, medication use, and mechanical trauma to the oral mucosa, are reported. Genetic predisposition and genetic risk factors altering individual susceptibility to ChRAS play a significant role. Various DNA polymorphisms, widespread throughout the human genome, especially those associated with changes in interleukin metabolism, are involved. The unbalanced composition of the oral microbiota may play a key role, although no specific causative agents have been conclusively proven. Food markers related to vitamin and micro- and macroelement deficiencies are also reported, and these are more common in patients with ChRAS. These findings preliminarily explain the main mechanisms through which the oral mucosa is a potential high-risk site for ChRAS, providing evidence for future prevention and treatment strategies. Conclusions. The results of the processed literature sources show that ChRAS is considered a multifactorial disease, but little is known about the mechanisms of pathogenesis and the possibilities of influencing its main links. Therefore, a comprehensive approach and the development and organization of complex rehabilitation plans are extremely important and decisive for assessing the condition of patients suffering from ChRAS.

Contemporary perspectives on vitamin D provision in children and adolescents with obesity: a literature review and clinical case description

Introduction. Vitamin D deficiency is currently considered a global epidemic. Recent data highlight its pivotal role in the development of metabolic disorders, including obesity in children and adolescents. The aim of the study. To review current literature on the problem of vitamin D provision in children and adolescents with obesity, and to present a clinical case of a child with obesity, vitamin D deficiency, and accompanying metabolic disorders. Materials and methods: The study included literary review using content analysis, systemic and comparative analysis methods, as well as biblio-semantic methods to explore current data on the problem of vitamin D provision in children and adolescents with obesity. Sources included PubMed-NCBI, Medline, CochraneLibrary, EMBASE, ResearchGate databases using keywords as follows: children, adolescents, insulin resistance, obesity, vitamin D deficiency, VDR (Vitamin D Receptor) gene polymorphism, leptin, adipocytes. 66 English-language articles were analyzed, highlighting the role of vitamin D in human metabolic processes, its association with obesity, mechanisms of its deficiency impact including the inhibitory effect of leptin and interleukin 6, and the peculiarities of vitamin D biological action through nuclear VDR-mediated control of target genes. The prevalence of vitamin D deficiency in obese children in various countries was determined. Results. Obesity can induce altered protein binding and accelerated metabolic clearance of 25(OH)D, leading to reduced levels of 25(OH)D in the blood serum. It was identified that lower serum vitamin D levels and VDR gene polymorphism are associated with a predisposition to obesity in children and its severe consequences, this link apparently can help to identify VDR features that predict an increased risk of developing obesity, potentially leading to new therapeutic strategies for this metabolic condition. This will also increase public awareness about the psychosocial and clinical consequences of vitamin D deficiency and VDR gene polymorphism in obese children. Children with excessive weight and obesity are often diagnosed with hypovitaminosis, including vitamin D deficiency. Many studies around the world have found that vitamin D deficiency in obese children is at a critical stage and requires a change in diagnostic and treatment strategies. The clinical case described involves a patient who had obesity in association with vitamin D deficiency, and characteristic biochemical changes typical of this pathology. Biochemical indices included vitamin D deficiency, dyslipidemia, insulin resistance, leptin resistance, and hypothyroidism. Bioimpedance analysis revealed the presence of excessive body fat and its abnormal abdominal distribution in the child. Conclusions. Currently vitamin D deficiency is considered a global epidemic, causing concern among physicians and researchers of various specialties. Recent data underscore its leading role in the onset of metabolic disorders, including obesity in children and adolescents. The literature review confirmed the significant impact of vitamin D on the primary biochemical and metabolic processes in the human body, its crucial role in the emergence of obesity and various complications in children and adolescents. The presence of overweight or obesity in these patients requires a number of laboratory indeces, including serum vitamin D, leptin and thyroid hormones levels, protein, carbohydrate and lipid metabolism parameters, to be estimated. The use of bioimpedance analysis and ultrasound examination of the thyroid gland is advisable.

Вплив стресофакторів на стан організму людини та органів і тканин порожнини рота (огляд літератури)

Abstracts. In today’s environment, every citizen of Ukraine is exposed to varying degrees of psycho-emotional and physical stress. It is impossible to underestimate the negative impact of stressors on the tissues and organs of the oral cavity in particular, as quite often the first signs of general pathologies appear in this complex. The aim of the study is to analyse data from scientific literature sources and provide updated information on the impact of psycho-emotional stress on the development of periodontal diseases in the current conditions. Materials and Methods. The bibliosemantic method was used to clarify the state of the problem, to study the analysis of the results of previous scientific research based on the sources of literature and electronic resources. Research results and discussion. The current conditions dictated by the war on the territory of our country is cause a state of permanent stress among the population of Ukraine, which is related to the basic human instinct of survival. In general, a person can be affected by one or more groups of objective causes of stress. The citizens of Ukraine are experiencing severe stress as a result of the ongoing conflict. This includes combatants, relatives and friends of these combatants, civilians living in the area close to the hostilities, the wounded, medical workers, and internally displaced persons. The stress factor provokes the emergence and rapid development of new mental and somatic diseases, it leads to the progression of existing diseases, but the reaction to the stimulus is different for each person and is an individual manifestation. The state of the oral cavity is a very sensitive complex to any changes in the body’s homeostasis, and often the first signs of general pathologies appear in it. Among the significant risk factors that contribute to the development and aggravate the course of periodontal disease, stress is one of the most important. Long-term exposure to stress can suppress the acquired immune response, causing an imbalance between pro-inflammatory and anti-inflammatory factors. Experimental studies in rat glands have demonstrated that acute stress induces dystrophic and necrobiotic changes in the gland, resulting in a reduction in its protein synthesis function. Psychological stress can contribute to disruption of the usual lifestyle, which adversely affects hygiene. Conclusions. After analysing scientific research data and reports on the current state of psycho-somatic health of people in Ukraine in modern realities, it is obvious that the prevalence and intensity of periodontal tissue diseases may have a new negative development. The peculiarities of the development, prevention and treatment of periodontal diseases in people experiencing severe psycho-emotional and sometimes physical stress require additional study and analysis. Key words: psycho-emotional stress, stress factor, periodontium, oral cavity

Studying of psycholinguistic features of doctors' professional communication under war conditions.

Aim: Studying of psycholinguistic features of doctors' communication competence in Ukraine under war conditions. Materials and Methods: Bibliosemantic method; method of system analysis, comparison and generalization; empirical methods - direct observation of the doctors' and patients' living language, typology of empirical data according to socio-demographic indicators. Results: Within the study, 286 dialogues were collected. With voluntary consent, they were recorded in video and audio formats in compliance with ethical, bioethical, and legal norms. Next, initial typology of dialogues, their lexical and semantic analysis with identification of typical positive and negative communicative strategies were carried out. With the help of the ≪Textanz≫ specialized computer software, 48 dialogues were subjected to the content analysis procedure for two separate ≪Doctors≫ and ≪Patients≫ samples. Conclusions: The results of the analysis of ≪Doctor-Patient≫ dialogues enabled identifying and describing psycholinguistic markers of typical physiological, mental, social, and spiritual states of individuals seeking medical help under martial law. Thus, the markers of positive emotional states (optimism, confidence, empathy, etc.) and affective, negative emotional processes (anxiety, fear, anger, aggression, sadness, depression, etc.) were identified.

RISK REDUCTION ASSESSMENT: EPIDEMIOLOGY AND NOVEL APPROACHES

Introduction. Today, there are new approaches to assessing the potential impact of alternative nicotine delivery systems, such as systemic toxicology and biomarker assessment. The modern development of science and technology, including laboratory research, allows for a detailed assessment of the biological effects of a substance or complex of substances on the human body as a whole.
 The aim of the study: to compare and assess based on literature data possibility to broaden the standard approach for risk reduction assessment for lifestyle (potentially correctable) risk factors, especially tobacco smoking (TS). While epidemiology remains a golden standard for risk reduction assessment, novel approaches are based on preventive or system toxicology analysis and biomarkers of harm evaluation, thus it is crucial to understand both benefits and limitations of novel and standard approaches to complete risk reduction assessment for potentially correctable risk factors.
 Materials and methods. The thematic scientific papers, published predominantly during the last decade, constituted the study material. The research methodology involved bibliosemantic method and structural and logical analysis.
 Results and discussion. Level of modern scientific development already can help us to assess the harm made by new/emerging products based on epidemiological, toxicological data and evaluation of biomarkers of potential harm for specific risk or disease. For TS biomarkers of harm are mostly well established and include 15 Harmful and Potentially Harmful Constituents (HPHCs) of tobacco smoke and their metabolites in the body. Reduction in Total-3-OH-B[a]P, S-PMA, COHb and other can show reduction in harm and risk caused by new/emerging product. So far most comprehensive analysis of reduction in HPHCs and biomarkers manifestation was concluded for tobacco heating system as TS alternative. Switching from cigarettes to THS for 5 days resulted in 56 % to 96 % reductions in 15 exposure biomarkers in the THS group compared to the TS group. These values approached the decrease in effect observed in the group of complete refusal of TS. Similar observations were made for the 90-day studies, where the reduction observed on day 5 was maintained until the end of the three-month studies and confirmed by other 3 clinical studies.
 Conclusions. In general, the results of the risk reduction assessment based on novel approaches
 confirms that THS is an acceptable alternative to cigarettes for adult smokers, and based on the positive biological effects, the transition to THS represents a lower risk for the smoker’s body with regard to the effects of HPHCs.

Requirements and expectations regarding the professional readiness of the nurse to provide palliative care to oncological patients

The nurses training in the field of palliative care is a prerequisite for qualified care and psychological support of incurable patients.Objective – to analyze the professional readiness of nurses in the field of palliative care provision depending on their competencies.Material and methods. The bibliosemantic method was applied. A survey of 20 nurses of the Chernivtsi Regional Clinical Oncology Hospital was conducted to determine their readiness to work with incurable patients in 3 areas: capability, willingness, and resilience [10].Results. The main structural elements of the competency approach to the professional readiness of a nurse in the palliative field are based on thorough knowledge of palliative care, understanding of the essence of phenomena, practical skills and abilities in this field, the ability to choose action methods that are adequate to specific circumstances, spiritual and emotional stability, individual empathy and compassion, a sense of responsibility for the obtained results, constant self-improvement through self/learning and purposefulness. The analysis of 3 scales (ability, readiness and stability) showed high internal consistency and readiness to work in the conditions of the oncology hospital of 95% of the surveyed nurses. Conclusion. A competent approach in the nurse practical activities with an empathetic, spiritual and personal peculiarities to the medical support of palliative patients is a fundamental criterion of professional suitability.