Individualized Treatment Programs Research Articles

USE OF INDIVIDUAL PREDICTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS IN OBESE PATIENTS DURING DISPENSARY OBSERVATION

COPD is one of the main public health problems. 40.0% of all COPD patients tolerate at least 1 moderate or severe exacerbation within a year, and up to 16.0% - 2 or more. GOLD (2022) proposed for clinical practice a strategy based on "treatable traits," the key of which are exacerbations and persistent shortness of breath, but there are other numerous pulmonary and extrapulmonary features, the definition and consideration of which is useful when leaving individual management algorithms for patients with COPD.
 Purpose. To evaluate the clinical effectiveness of the use of individual prediction of COPD exacerbations in obese patients during clinical observation.
 Materials and methods. 106 people diagnosed with COPD between the ages of 18 and 80 were examined. The patient examination included an assessment of the number of outpatient exacerbations and hospitalizations to medical organizations over the past 12 months, a BMI calculation, a comprehensive assessment of COPD symptoms with CAT, the functional status of patients, and an assessment of biochemical blood parameters. Results. According to the examination results and BMI calculation, 80 patients (75.5%) were overweight (55 patients) or obese of various degrees (grade 1 obesity - 21 patients, grade 2 - 1 patient and grade 3 - 3 patients). According to GOLD (2023), all patients were classified as "high risk of exacerbations" - group E. The probability index of COPD exacerbation was calculated over the next 12 months using regression analysis. To prevent predicted exacerbations of COPD, individual treatment and rehabilitation programs were developed for patients, designed for use for 12 months of follow-up: treatment modification, personalized programs for optimizing physical activity, dietary recommendations, vaccination against influenza and pneumococcal infection, course therapy with melatonin, consultation with an endocrinologist. At the end of 12 months, compliance with the recommendations of the index of the probability of exacerbation of COPD for the next 12 months was low.
 Conclusions. In patients with frequent exacerbations of COPD, in order to achieve disease control, it is advisable to develop individual treatment and rehabilitation programs within the framework of clinical observation, given the "treatable signs," the correction of which has a significant positive effect on the course of COPD, achievement of control and prognosis of the disease.

Advancements in medical diagnosis and treatment through machine learning: A review

AbstractThe aptness of machine learning (ML) to learn from large datasets, discover trends, and make predictions has demonstrated its potential to metamorphose the medical field. Medical data analysis with ML algorithms can improve patient outcomes in terms of both treatment and diagnosis. This paper investigates the numerous possibilities of ML in the medical industries, including radiology, pathology, genomics, and clinical decision‐making. It also goes over the benefits and drawbacks of ML in various sectors as well as the limitations that come with its application. It illustrates the potential advantages of ML, such as better accuracy and efficiency in diagnosis and individualized treatment programs, through a review of previous studies. Lastly, it provides perspectives on prospective advancements and prospects for the discipline. This study also intends to investigate the applications of deep learning (DL) in the medical field. DL algorithms have performed exceptionally satisfactorily in several healthcare‐related fields. The main conclusions of the study are summarized, and their ramifications for the healthcare sector are discussed in this paper's conclusion. This paper intends to contribute to a greater understanding of the prevailing state of the discipline and the possibility for future developments by emphasizing the prospects of these methodologies to alter medical study and clinical practice.

The exploration of mitochondrial-related features helps to reveal the prognosis and immunotherapy methods of colorectal cancer.

Cancer cell survival, proliferation, and metabolism are all intertwined with mitochondria. However, a complete description of how the features of mitochondria relate to the tumor microenvironment (TME) and immunological landscape of colorectal cancer (CRC) has yet to be made. We performed subgroup analysis on CRC patient data obtained from the databases using non-negative matrix factorization (NMF) clustering. Construct a prognostic model using the mitochondrial-related gene (MRG) risk score, and then compare it to other models for accuracy. Comprehensive analyses of the risk score, in conjunction with the TME and immune landscape, were performed, and the relationship between the model and different types of cell death, radiation and chemotherapy, and drug resistance was investigated. Results from immunohistochemistry and single-cell sequencing were utilized to verify the model genes, and a drug sensitivity analysis was conducted to evaluate possible therapeutic medicines. The pan-cancer analysis is utilized to further investigate the role of genes in a wider range of malignancies. We found that CRC patients based on MRG were divided into two groups with significant differences in survival outcomes and TME between groups. The predictive power of the risk score was further shown by building a prognostic model and testing it extensively in both internal and external cohorts. Multiple immune therapeutic responses and the expression of immunological checkpoints demonstrate that the risk score is connected to immunotherapy success. The correlation analysis of the risk score provide more ideas and guidance for prognostic models in clinical treatment. The TME, immune cell infiltration, and responsiveness to immunotherapy in CRC were all thoroughly evaluated on the basis of MRG features. The comparative validation of multiple queues and models combined with clinical data ensures the effectiveness and clinical practicality of MRG features. Our studies help clinicians create individualized treatment programs for individuals with cancer.

Healthcare Revolution: How AI and Machine Learning Are Changing Medicine

This essay examines the enormous effects of machine learning and artificial intelligence (AI) on healthcare. Through data analysis, AI is transforming disease detection and prediction and improving the precision of diagnoses. By accelerating medication discovery and improving individualized treatment programs, it is revolutionizing both treatment and drug development. AI is promoting customized medicine by using genetic information to customize therapies. Through automation and optimized resource allocation, it is streamlining hospital processes. The importance of ethical considerations is significant; they center on data privacy, bias reduction, and accountability. The study highlights potential avenues for AI development, such as AI-driven drug discovery, predictive and preventative healthcare, advances in genomic medicine, enhanced medical imaging, and more robotics and automation. Predictive analytics, telehealth, AI virtual assistants, and AI in mental healthcare are all expected to grow. These developments have the potential to improve health care, streamline processes, and boost scientific inquiry. To use AI in healthcare in a fair and ethical manner, however, and usher in a future that is more patient-centric, accurate, and accessible internationally, difficulties related to data quality, ethics, regulation, and prejudice must be addressed.

A Brief Overview of Recent Pediatric Physical Therapy Practices and Their Importance.

Recent years have seen a substantial increase in interest in pediatric physical therapy, which is a reflection of improvements in its methods and the rising understanding of its significance in childdevelopment and rehabilitation. This review provides a concise overview of the latest trends and techniques in pediatric physical therapy, emphasizing the integration of innovative technologies, evidence-based interventions, and holistic approaches. For children with varied developmental, congenital, and acquired disorders, the significance of early intervention and individualized treatment programs is emphasized, underlining the important influence of prompt interventions on long-term functional results and quality of life. To guarantee comprehensive and coordinated care, the study also examines the interdisciplinary character of pediatric physical therapy placing special emphasis on collaboration with families, caregivers, educators, and healthcare professionals.It also emphasizes the importance of continuing research, instruction, and lobbying to improve the effectiveness and availability of pediatric physical therapy services, eventually promoting the overall well-being of kids and their families.

The association between socioeconomic status and health-related quality of life among young and middle-aged maintenance hemodialysis patients: multiple mediation modeling.

To explore the relationship between socioeconomic status (SES), illness perception, social functioning, and health-related quality of life (HRQoL) of young and middle-aged maintenance hemodialysis (MHD) patients and the internal mechanism of action. A multicenter cross-sectional study. An aggregate of 332 young and middle-aged MHD patients were enrolled from hemodialysis centers in four general hospitals in Guangzhou, Guangdong, China, from June to December 2022. The questionnaires used included one for general demographic data, the Brief Illness Perception Questionnaire (BIPQ), Social Dysfunction Screening Scale (SDSS), and the 12-item Short Form Health Survey (SF-12). Both SES and HRQoL were negatively correlated with illness perception and social functioning, respectively. SES was positively correlated with HRQoL. Illness perception was positively correlated with social functioning. The indirect effects of illness perception and social functioning on the relationship between SES and HRQoL were 0.33 and 0.31, making up 41.06% and 38.91% of the sum. The chain indirect effect of illness perception and social functioning was 0.10, making up 12.59% of the total effect, while gender did not play a moderating role. Illness perception and social functioning may independently and accumulatively mediate the association between SES and HRQoL. Nurses should consider developing individual intervention program for young and middle-aged MHD patients with low SES, focusing on establishing targeted counseling and health education strategies corresponding to illness perception and social functioning to help patients improve their HRQoL.

Digitalization in mental health care. New opportunities for specialists and patients

Digitalization – is one of the most promising trends of the healthcare system transformation, including mental health care. Telemedicine opportunities allow to improve health care system, to resolve the problem of the qualified specialist’s deficit and provide the remote territories with appropriate medical care, it also provides education possibilities for the mental health specialists from all over Russia offering continual training opportunities. Digital technologies can help substantially improve the science data collection in the field of mental health, remote access ensures patient enrollment from the different regions of the country, it allows to make the measures in the typical patient’s environment, data accumulated with the help of digital assistants open the new possibilities in the study of mental disorders. Digital behavior and behavior in the digital environment became the new research objectives in the field of mental health. Problem internet use with the behavior addiction development is in the research focus of the researchers aimed to elaborate early intervention and prevention programs. The use of the computerized programs, gamification, VR and mobile apps possibilities should become the essential part of the medical care provision in the field of mental health with the hybrid models implementation where the patient will have the option to choose individualized treatment program with the optimal ratio between digital and classic treatments options. Digital technologies should take their place in the prevention and mental health sustenance in the nearest future.

REHABILITATION AND PREVENTION OF THE MEDIAL TIBIAL STRESS SYNDROME IN MILITARY PERSONNEL

Abstract.Medial tibial stress syndrome is an injury that occurs as a result of cumulative and chronic damage to the lower extremities during excessive physical exertion. It is manifested by pain in the posterior medial part of the tibia, which is caused by microtraumas of the shin muscles and overstrain of their attachment sites, as well as tibial periostitis progressing to a stress fracture. It is most often found among athletes and military personnel and can significantly limit their ability to perform professional physical activities. The risk of receiving this injury is especially high among military personnel in their first year of service, which includes cadets of higher military educational institutions. Persons who have developed medial tibial stress syndrome are prone to relapses of the disease, and without proper treatment and rehabilitation, its chronic form may develop, which leads to deterioration of functioning. In addition, medial tibial stress syndrome is considered a precursor to a tibial stress fracture, requiring longer treatment and recovery.
 Based on the results of the analysis of the existing methodical approaches to physical therapy of people with medial tibial stress syndrome in Ukraine, a small number of publications dealing with this problem were found. Also, complex physical therapy programs for servicemen with injuries from heavy workload were not developed and implemented.
 Aim. The aim of the research is to analyze approaches to the rehabilitation and prevention of medial tibial stress syndrome among military personnel.
 Materials and methods. The publications selected on the basis of a search in the databases PubMed, PEDro, Cochrane Library, Google Scholar, and Vernadsky National Library of Ukraine were analyzed.
 Results. It was found that almost all physical therapy methods used in the treatment of the syndrome were part of an individual (standard) treatment program for military personnel with stress syndrome, which also included medication and surgical intervention as indicated. In only one research, after treatment of an acute period of the disease, patients were offered a multidisciplinary rehabilitation program based on therapeutic exercises, which were used to reduce symptoms, improve endurance, and return servicemen to duty.
 It has been established that therapeutic exercises, as the main means of physical therapy, are ineffective in the rehabilitation and prevention of medial tibial stress syndrome without combination with other interventions. The insufficient effectiveness of the treatment of the syndrome by combining therapeutic exercises with means of physical therapy was determined.
 It has been found that gait retraining in combination with therapeutic exercises accelerates recovery and prevents the occurrence of medial tibial stress syndrome in military personnel.
 Conclusions. The data obtained in the analyzed scientific researches, a significant difference in the organization of research, rehabilitation programs, and research methods make it impossible to draw certain conclusions about optimal approaches to therapy and prevention of medial tibial stress syndrome in military personnel. This makes it necessary to continue research on this issue.
 Since the results of the research did not reveal a consensus regarding effective physical therapy programs for the prevention and rehabilitation of medial tibial stress syndrome, as well as the lack of relevant research in Ukraine, it is important to continue studying this issue.

Problematic use of the internet among adolescents: A four-wave longitudinal study of trajectories, predictors and outcomes.

Problematic use of the internet (PUI) among adolescents has become one of the public problems around the world. Understanding the developmental trajectory of PUI may be beneficial to develop prevention and intervention. The current study aimed to identify the developmental trajectories of PUI among adolescents, considering individual differences over time. And also explored how familial factors contributed to the identified trajectories, and the relationship between PUI changes over time and social, mental health, and academic functioning. A total of 1,149 adolescents (Mage=15.82,SD=0.61; 55.27% girls at Wave 1) participated in assessments at four time points, using 6-month assessment intervals. Based on a latent class growth model, three trajectories of PUI were identified: Low Decreasing, Moderate Increasing, and High Increasing groups. Multivariate logistic regression analyses suggested that inter-parental conflicts and childhood maltreatment served as negative familial predictors for the risk trajectories of PUI (i.e., Moderate Increasing and High Increasing groups). Additionally, adolescents in these two groups displayed more estranged interpersonal relationships, more mental health difficulties, and poorer academic functioning. It is important to consider individual differences in understanding the developmental patterns of PUI among adolescents. Identifying family predictors and the behavioral outcome associated with groups with different developmental trajectories of PUI, which may help to understand better risk factors related to specific developmental patterns of PUI and its adverse correlates. The findings highlight a need to develop more specific effective intervention programs for individuals displaying different problematic developmental trajectories with PUI.

Musculoskeletal Asymmetries in Young Soccer Players: 8 Weeks of an Applied Individual Corrective Exercise Intervention Program

Introduction: In youth soccer, for examining injury prevention and exercise performance, most of the interventional studies concerning corrective postural asymmetries have applied general intervention programs, ignoring the specific individual corrective needs of each youth player separately. The aim, therefore, of the present study was to examine the effect of 8 weeks of an individualized corrective exercise intervention program on musculoskeletal asymmetries in young soccer players. Materials and Methods: Eighty young male soccer players (age: 14.4 ± 1.2 years; body height: 166.3 ± 9.6 cm; body mass: 59.1 ± 11.5 kg) participated in the current laboratory-based study. A battery of postural and musculoskeletal asymmetry evaluations were initially performed. After the completion of the initial assessment, each player was provided with an individual musculoskeletal asymmetry corrective exercise intervention program which lasted for 8-weeks, with the aim of restoring muscular asymmetries. Following the application of the intervention program, a re-evaluation of their musculoskeletal asymmetries was performed. Results: There was a significant improvement in the primary angle of trunk rotation (r = −0.56, p < 0.001), hamstring flexibility (right: r = −0.55, p < 0.001; left: r = −0.48, p < 0.001), hip external rotation (right: r = −0.46, p < 0.001; left: r = −0.26, p = 0.020), hip internal rotation (right: r = −0.26, p = 0.021; left: r = −0.35, p = 0.002), the opened-eyes Stork Test (right: r = −0.33, p = 0.003: left: r = −0.33, p = 0.003), the closed-eyes Stork Test (right: r = −0.39, p < 0.001; left: r = −0.43, p < 0.001), the Thomas test [right: (χ2(3) = 52.281, p = 0.001, γ^ = −0.751; left: (χ2(3) = 45.832, p = 0.001, γ^ = −0.696)] and of ankle prone passive dorsiflexion (flexed knees) (χ2(2) = 13.019, p = 0.005, V = 0.285). Conclusions: An 8-week individual corrective intervention exercise program may improve postural and musculoskeletal asymmetry status in young male soccer players.

New directions in male-tailored psychotherapy for depression.

Societal, cultural, and contextual norms about how men should be and behave (so called traditional masculinity ideologies; TMI) affect men's presentation of depressive disorders, psychotherapy use, and treatment engagement. Only recently, however, male-tailored psychotherapy approaches for depressive disorders have been developed, which aim to systematically soften dysfunctional TMI. In this review, we outline the necessary groundwork as well as recent advances in research on TMI, men's help-seeking, male depression, and their interrelatedness. Subsequently, we discuss the potential value of these findings for male-tailored psychotherapy for depressive disorders. A preliminary evaluation of a male-specific psychoeducation program found that a male-specific psychoeducation text could reduce negative affect as well as state shame and potentially elicit a shift from externalizing depression symptoms toward more prototypical depression symptoms. The James' Place program, a male-tailored community-based service, improved suicidal men's overall well-being, problems, functioning, and suicide risk. The Heads Up Guys! program, an eHealth resource aimed at depressed men, reported a high and increasing global interest in their website, with considerable visitor engagement. The Man Therapy online resource improved depressive symptoms, suicidal ideation, and help-seeking behavior. Finally, the Men in Mind program, an online training program for clinical practitioners, increased practitioners' capacity to engage and support men in therapy. Male-tailored psychotherapy programs for depressive disorders, which are informed by recent advances in TMI research, may potentially increase therapeutic effectiveness, engagement, and adherence. While recent preliminary analyses of individual male-tailored treatment programs show promising results, extensive and systematic primary studies evaluating these programs are pending but greatly needed.

Results of treatment of patients with poorly differentiated carcinoma of the thyroid gland

Introduction. Poorly differentiated carcinoma of the thyroid gland (PDTC) is characterised by aggressive, high rate of tumor growth, massive infiltration, early lymphogenous and hematogenous dissemination. Ways to improve treatment outcomes include developing individual treatment programmes. Given the unsatisfactory results of the treatment, the search for combined treatment options is well founded.Materials and methods. An analysis was made of the treatment of PDTC in patients from May 2014 to July 2021. The study included 24 patients aged 22 to 81 years (9 (37.5 %) men and 15 (62.5 %) women). Surgical treatment was performed in 14 (58.3 %) cases. In 8 (33.3 %) cases, a course of radioiodine therapy with a total dose of 3–4 Gbq was performed in the postoperative period. Seven (29.2 %) patients underwent external beam radiation therapy. In 2 (8.3 %) cases, chemotherapy with carboplatin was performed simultaneously with external beam radiation therapy. Four (16.7 %) patients were prescribed lenvatinib. For one reason or another, 9 (37.5 %) patients did not receive treatment.Results. For patients not treated, the overall survival rate was 5.8 ± 0.5 months, for patients treated – 9.6 ± 1.0 months (p <0.00095). According to the index Lenvatinib showed a significant increase in the general group of patients – up to 15 months.Conclusion. Combined treatment in the form of a combination of surgical, radiation and chemotherapeutic methods at PDTC, allows to achieve much higher survival. In order to achieve longer-term stabilization, further research is needed on new ways to enhance the anti-tumor effect of modern drugs.

Workup of difficult-to-treat asthma: implications from treatable traits.

Traditional stepwise approach usually adjusts the treatment regimen based on changes in asthma symptoms and severity to achieve good asthma control. However, due to the generalized heterogeneity and complexity of asthma, its therapeutic efficacy in difficult-to-treat asthma is limited. Recently, a precision medicine approach based on the identification and intervention of treatable traits of chronic airway disease has been proposed and appears to be of greater benefit to asthmatics. We reported a 71-year-old male with uncontrolled asthma and multiple exacerbations over the past year. He complained of persistent dyspnea despite high-dose of inhaled corticosteroids plus other controllers. Does this patient have some potential treatable traits contributing to difficult-to-treat asthma? Through a multidimensional assessment of three domains including pulmonary, extrapulmonary, and behavioral/risk factors, 15 treatable traits were identified in the patient, mainly including airflow limitation, eosinophilic airway inflammation, small airway dysfunction, exacerbation prone, dilated cardiomyopathy, diabetes mellitus, inhaler device polypharmacy, smoking, and the absence of an asthma action plan. After targeted treatment for these treatable traits, the patient experienced significant improvement in dyspnea and he could maintain good asthma control with low-dose inhaled corticosteroids and long-acting β2-agonist. This study shows that, in response to the limitation of a stepwise approach to therapy, treatable traits is a new strategy where patients are individually assessed for a specified set of treatable problems, and an individualized treatment program is developed and implemented based on this multidimensional assessment, especially for difficult-to-treat asthma.

COMPUTATIONAL INTELLIGENCE METHODS TO PATIENTS STRATIFICATION IN THE MEDICAL MONITORING SYSTEMS

Context. In modern medical practice the automation and information technologies are increasingly being implemented for diagnosing diseases, monitoring the condition of patients, determining the treatment program, etc. Therefore, the development of new and improvement of existing methods of the patient stratification in the medical monitoring systems is timely and necessary.
 Objective. The goal of intelligent diagnostics of patient’s state in the medical monitoring systems – reducing the likelihood of adverse states based on the choice of an individual treatment program:
 − reducing the probability of incorrectly determining the state of the patients when monitoring patients;
 − obtaining stable effective estimates of unknown values of treatment actions for patients (corresponding to the found state);
 − the choice of a rational individual treatment program for the patients, identified on the basis of the forecasted state.
 Method. Proposed methodology, which includes the following computational intelligence methods to patient’s stratification in the medical monitoring systems:
 1) method of cluster analysis based on the agent-based approach – the determination of the possible number of patient’s states using controlled variables of state;
 2) method of robust metamodels development by means artificial neuron networks under a priori data uncertainty (only accuracy of measurements is known) in the monitoring data: a) a multidimensional logistic regression model in the form of analytical dependences of the posterior probabilities of different states of the patients on the control and controlled variables of state; b) a multidimensional diagnostic model in the form of analytical dependences of the objective functions (quality criteria of the patient’s state) on the control and controlled variables of state;
 3) method of estimating informativeness controlled variables of state at a priori data uncertainty;
 4) method of robust multidimensional models development for the patient’s state control under a priori data uncertainty in the monitoring data in the form of analytical dependencies predicted from the measured values of the control and controlled variables of state in the monitoring process;
 5) method of reducing the controlled state variables space dimension based on the analysis of the variables informativeness of the robust multidimensional models for the patient’s state control;
 6) method of patient’s states determination based on the classification problem solution with the values of the control and forecasted controlled variables of state with using the probabilistic neural networks;
 7) method of synthesis the rational individual patient’s treatment program in the medical monitoring system, for the state identified on the basis of the forecast.
 Proposed the structure of the model for choosing the rational individual patient’s treatment program based on IT Data Stream Mining, which implements the «Big Data for Better Outcomes» concept.
 Results. The developed advanced computational intelligence methods for forecast states were used in choosing the tactics of treating patients, to forecast treatment complications and assess the patient’s curability before and during special treatment.
 Conclusions. Experience in the implementation of “Big Data for Better Outcomes” concept for the solution of the problem of computational models for new patient stratification strategies is presented. Advanced methodology, computational methods for a patient stratification in the medical monitoring systems and applied information technology realizing them have been developed. The developed methods for forecast states can be used in choosing the tactics of treating patients, to forecast treatment complications and assess the patient’s curability before and during special treatment.

Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study

Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also compared the likelihood of early treatment engagement. Results: Patients who received services through telehealth with video in the initial 14 days of diagnosis had a lower hazard of dropout, compared to patients receiving solely in-person services (0.64, 95% CI [0.46, 0.90]), while there was no difference in hazards of dropout between patients who received telephone and in-person services. Early use of telehealth, both via video (5.40, 95% CI [1.92, 15.20]) and telephone (2.12, 95% CI [1.05, 4.28]), was associated with greater odds of treatment engagement compared to in-person care. Conclusion: This study adds to the existing literature related to telehealth utilization and engagement in care and supports the inclusion of telehealth in SUD treatment programs for treatment-seeking individuals.

At the heart of change: Differences in young offenders' HRV patterns after the delivery of the PSYCHOPATHY.COMP program.

Literature has pointed the need for intervention programs specifically tailored to target the treatment needs of young offenders, as well as the need to test the efficacy of such programs through physiological indexes of emotion regulation (e.g., heart rate variability; HRV), complementing self-reports typically used as outcome measures. The PSYCHOPATHY.COMP is a 20-session individual intervention program based on Compassion Focused Therapy aiming to reduce psychopathic traits and disruptive behavior among young offenders through the development of a compassionate motivation, while stimulating the soothing system as a strategy to improve emotion regulation. Previous research with young offenders has shown decreases in vagally mediated HRV (vmHRV) when the soothing system is activated. This physiological pattern seems to mirror threat-like responses that contrast with relaxed states. To test the efficacy of the PSYCHOPATHY.COMP, a clinical trial was implemented encompassing a treatment (n = 56) and a control group (n = 53). Treatment participants attended the PSYCHOPATHY.COMP, while controls received the Treatment As Usual (TAU) delivered in Portuguese juvenile detention facilities. HRV data was collected throughout a standardized procedure (encompassing resting, reactivity and recovery phases) specifically designed to trigger the soothing system. Participants were assessed at pre-treatment, post-treatment and 6-months follow-up. Although treatment participants continued to process the soothing system as unpleasant (with decreased vmHRV), they seem to become able to adaptively recover from the stimuli without avoiding it or resorting to maladaptive coping strategies. The physiological pattern was in line with participants' decreases in difficulties in emotion regulation across the assessment periods. In contrast, controls seemed to have actively employed coping strategies associated with increases in vmHRV not only when the soothing system was triggered, but also when recovering from the stimuli. Congruently, for controls, increases in difficulties in emotion regulation were found, with increases in the lack of emotional clarity across the assessment periods. Findings offer new evidence for the efficacy of the PSYCHOPATHY.COMP program in improving emotion regulation in young offenders, assessed through both self-report and physiological measures. Additionally, findings support the assessment of the autonomic balance as a treatment efficacy index in future research, targeting the rehabilitation of these youth. ClinicalTrials.gov, identifier NCT03971682.

A Multidisciplinary Approach: Investigating Sustainable Interventions to Enhance Assent and Reduce Withdrawal in Autistic Children during Medical Procedures

This study This study investigates sustained therapeutic strategies to improve assent and reduce disengagement in autistic children undergoing medical procedures, given the rising prevalence of autism spectrum disorder (ASD). The challenges faced by these children, stemming from sensory sensitivity, communication difficulties, and heightened anxiety, hinder their ability to provide assent and often result in withdrawal behaviors. The research aims to analyze existing interventions, such as sensory-friendly environments and personalized treatment plans, emphasizing the crucial role of collaborative efforts among healthcare professionals, behavioral therapists, and educators in delivering comprehensive and specialized therapies. Methodologically, a literature review is employed to systematically assess the existing body of knowledge, allowing for a thorough examination of the difficulties experienced by autistic children during medical procedures and the exploration of potential solutions. The study’s findings and policy recommendations contribute to a deeper understanding of and improvements in the assent and withdrawal challenges faced by autistic children. Proposed policy measures include the development of sensory-friendly healthcare facilities, individualized treatment programs, research funding, and the establishment of interdisciplinary healthcare teams. Implementation of these recommendations aims to create a more inclusive and assent-focused healthcare environment, ultimately enhancing the overall health outcomes for children with autism spectrum disorder.

Effects of vestibular rehabilitation in patients with unilateral vestibular hypofunction

Purpose: To investigate the effect of physiotherapy on the balance parameters and fall risk in patients with unilateral vestibular hypofunction (UVH). Patients and Methods: Thirty patients diagnosed with UVH were included in the study. The number of falls, Visual Analog Scale, Modified Clinical Test for Sensory Interaction in Tandem and Balance, and dynamic visual acuity assessments was performed before and after treatment. The patients were included in an individual treatment program for 8 weeks. Physiotherapy sessions were given at 2-week intervals. Along with the level of development of the treatment applied to the patients, it was requested perform a home exercise program with ten repetitions three times a day. Results: After 8 weeks of vestibular rehabilitation, it was observed that the balance parameters of the participants improved and the number of falls decreased. Statistically significant results were obtained in the Eyes-closed Tandem test (P = 0.001). Significant changes occurred in the modified Clinical Test results for Sensory Interaction in Balance from 0.37 ± 0.19 s to 0.93 ± 0.11 s (P = 0.001). Vestibular symptoms and dynamic visual acuity scores also improved after treatment (P = 0.001). Conclusion: It was concluded that the physiotherapy program applied to our patients with UVH positively affected fall risk and significantly improved balance parameters.

Construction and validation of web-based nomograms for detecting and prognosticating in prostate adenocarcinoma with bone metastasis

Bone metastasis (BM) is one of the most common sites of metastasis in prostate adenocarcinoma (PA). PA with BM can significantly diminish patients’ quality of life and result in a poor prognosis. The objective of this study was to establish two web-based nomograms to estimate the risk and prognosis of BM in PA patients. From the Surveillance, Epidemiology, and End Results (SEER) database, data on 308,332 patients diagnosed with PA were retrieved retrospectively. Logistic and Cox regression, respectively, were used to determine independent risk and prognostic factors. Then, We constructed two web-based nomograms and the results were validated by receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA) , and the Kaplan-Meier analyses. The independent risk factors for BM in PA patients included race, PSA, ISUP, T stage, N stage, brain, liver, lung metastasis, surgery, radiation and chemotherapy. The independent prognostic predictors for overall survival (OS) were age, marital status, PSA, ISUP and liver metastasis. Both nomograms could effectively predict risk and prognosis of BM in PA patients according to the results of ROC curves, calibration, and DCA in the training and validation sets. And the Kaplan-Meier analysis illustrated that the prognostic nomogram could significantly distinguish the population with different survival risks. We successfully constructed the two web-based nomograms for predicting the incidence of BM and the prognosis of PA patients with BM, which may assist clinicians in optimizing the establishment of individualized treatment programs and enhancing patients’ prognoses.

ТНЕ ANALYSIS OF THE COMORBIDITY PREVALENCE IN MILITARY PERSONNEL WITH CORONARY ARTERY DISEASE AFTER ACUTE MYOCARDIAL INFARCTION

Objective: to determine the prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction.Research materials. An analysis of medical records of the 83 military personnel who were hospitalized to the National Military Medical Clinical Center "Main Military Clinical Hospital" in 2016-2020 with acute myocardial infarction was carried out using the method of random sampling. All patients were male, aged from 22 to 60 years (mean age 48,5±4,35 years). To study the age characteristics of the comorbidity prevalence, all patients were divided into two groups: the 1st group with individuals of 50 years old and younger (41 patients, average age 42,9±6,15 years) and the 2nd group who is 50+ years old (42 patients, average age 54,0±2,54 years).Methods. of investigation are bibliographic, statistical, systematic approach and analysis. Statistical processing was carried out using the Microsoft Excel 2007 program and the standard statistical package STATISTICA 6.0.Results. We found a high prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction. Arterial hypertension has been diagnosed in 60,2±5,4% of military personnel (58,5±7,7% of patients in the 1st group and 64,3±7,4% in the 2nd group, p>0.05). Another comorbid cardiovascular disease has been identified: carotid artery stenosis in 60,2±5,4% of patients (56,1±7,8% and 54,8±7,7% in 1st and 2nd groups, at p>0.05); dyscirculatory encephalopathy of the I-II stages in 37,3±5,3% (4,4±6,7% and 50,0±7,7% in 1st and 2nd groups, respectively, at p<0,05); peripheral artery disease in 4,8±2,3% of military personnel (in 0 and 9,5±4,5%, respectively, at p<0,05). The most common comorbid diseases of the digestive system in patients were: non-alcoholic fatty liver disease in 16,9±4,1% (22,0±6.5% in 1st group and 11,9±4,9% in 2th group, at p>0.05), chronic gastroduodenitis in 21,7±4,5% (26,8±6,9% and 16,7±5,8%, respectively, at p>0,05), peptic ulcer disease in 20,5±4,4% (7,1±5,8% and 23,8±6,6%, respectively, at p>0.05), chronic pancreatitis in 19,3±4,3% (19,5±6,2% and 19,0±6,1%, respectively, at p>0.05), chronic cholecystitis – 18,1±4,2% (14,6±5,5% and 21,4±6,3%, respectively, at p>0.05). Obesity was determined in 36,1±5,3% of patients (48,8±7,8% of patients in the 1st group and 23,8±6,6% in the 2nd group, at p<0,05); type II diabetes – in 13,3±3,7% (7,3±4,1% and 19,0±6,1%, respectively, at p>0,05), thyroid diseases – 13,3±3,7% (12,2±5,1% and 11,9±4,9%, respectively, at p>0,05). Chronic kidney disease was determined in 6,0±2,6% of patients: 4,8±3,3% and 7,2±4,0%, respectively, at p>0,05. Osteochondrosis of the spine was detected in 30,1±5,0% of military personnel (24,9±6,8% and 35,7±7,4%, respectively, at p>0,05).Conclusions. Our study demonstrated a significant prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction: the most prevalent comorbidities were arterial hypertension, carotid artery stenosis, obesity, osteochondrosis of the spine, gastrointestinal disease, type II diabetes, which must be taken into account when developing individual treatment programs to increase the effectiveness of treatment and prevent complications.No statistically significant difference has been determined regarding the frequency of detection of most comorbid diseases in the age group younger than and older than 50 years; only cerebrovascular diseases with discirculatory encephalopathy and peripheral artery disease were more often (statistical significant) in military personnel older than 50 years.