Medical Statistical Methods Research Articles

Risk factors for the formation of gastroesophageal reflux disease and erosive lesions of the esophagus in adolescents

Background. Gastroesophageal reflux disease (GERD) is a common chronic relapsing disease of the upper digestive tract, both among adults and children and adolescents. Among the adult population, this disease is most often detected in people older than 60, while in children, a significant increase in its prevalence is no­ted with age, with a maximum in adolescents. GERD is characte­rized by a long-term course, polymorphism of clinical (esophageal and extraesophageal) manifestations, often subtle (which causes patients to seek medical help late), and can lead to the development of severe complications (erosive-ulcerative reflux esophagitis, Barrett’s esophagus, adenocarcinoma) and even sudden death in children. Therefore, it is important to identify risk factors (RF) for the development of GERD and destructive lesions of the esophagus in order to timely diagnose the disease and improve the effectiveness of its treatment. The authors provide up-to-date data on the RF for GERD in adults and children. However, in available scientific literature, there is practically no information on statistically significant combinations of RF for both GERD and destructive lesions of the esophageal mucosa in adolescents, which determined the need to conduct this study. The purpose was to find out the statistically significant RF for GERD and destructive lesions of the esophageal mucosa in adolescents and to develop the corresponding prognostic mathematical models. Materials and methods. To identify RF for GERD, a survey of 106 schoolchildren aged 15–17 and 81 adolescents suffering from GERD was conducted using a questionnaire developed by authors, pre-verified and adapted for the pediatric cohort, which included 68 questions (socio-psychological, socio-economic, socio-hygienic and biological). The diagnosis of GERD was verified according to the 2015 international NICE guidelines “Gastro-oesophageal reflux disease in children and young people: diagnosis and management”, updated 2019; the diagnosis of reflux esophagitis — according to the Los Angeles classification system. Prognostic mathematical models were created using correlation-regression, univariate and multivariate analysis, stepwise discriminant and Fisher’s discriminant analysis. Statistical processing was carried out using generally accepted methods of medical statistics. Results. The main statistically significant combinations of RF for GERD were burdened family history, pathology of the gastroduodenal zone, sliding hiatal hernia, obesity, chronic stress, smoking/alcohol consumption. For destructive lesions of the esophagus, such RF were as follows: burdened GERD family history, recurrent oral herpes, neurological disorders, obesity, sliding hiatal hernia, chronic stress. Given statistically significant RFs, corresponding prognostic mathematical models were created, and examples of their practical use were provided. Conclusions. The clarified RFs made it possible to create appropriate prognostic mathematical models that have sufficiently high sensitivity and specificity, positive and negative prognostic value and can be used in the practice of pediatricians, family doctors and pediatric gastroenterologists.

Prevention of vision disorders at school age: view of secondary school teachers on the problem

Background. The relevance of the study is due to the importance of maintaining full vision functions from childhood, which allows for having healthy visual perception for a quality life, learning and work capacity in adolescence and adulthood. The problem is gaining global importance, because according to the forecasts of international experts, the spread of ophthalmic pathology in 2050 will reach such a scale that almost a third of the planet’s population will have impaired vision, with most of cases diagnosed already in childhood. Scientific studies reveal an increase in the frequency of visual impairment among school-aged children. Thus, 8–10 % of the first-graders are diagnosed with ophthalmic pathology, and upon completion of schooling, this indicator can increase to 30–50 %. The purpose was to study the awareness of teachers and lecturers of secondary educational institutions (schools, lyceums) regarding the problems of visual impairment among schoolchildren, their attitude to the problem and willingness to participate in preventive measures. Materials and methods. The materials for the research were the results of a sociological survey of educators of secondary educational institutions from all regions of Ukraine (lecturers, teachers at schools and lyceums), a total of 6,215 questionnaires were subject to analy­sis. The tool for conducting sociological research was the deve­loped Questionnaire of secondary school educators regarding their awareness and willingness to participate in preventive programs to preserve eyesight from childhood. The procedure for filling out the questionnaire included an interview with an interviewer, who verbally informed about the purpose, tasks of sociological research, and its anonymity. Only after obtaining preliminary voluntary verbal consent to participate in the study, respondents were offered to proceed to filling out the questionnaire, which took an average of 15–20 minutes. The research methods were sociological survey, analytical-synthetic, medical-statistical methods, in particular the latter was used to calculate the representativeness and reliability of the survey results. Results. The results of the study prove the importance of the participation of secondary school educators in measures to prevent impairment of visual functions in school-aged children. Despite the high readiness of lecturers and secondary school teachers to engage in preventive activities, their awareness of preventing visual impairment among schoolchildren was found to be insufficient, as was the level of preventive work of medical personnel in schools. It was found that most educators are convinced that a school education worker should be aware of the signs of visual impairment in children (90.46 ± 0.37 %), participate in preventive measures and be familiar with the hygienic norms of visual stress in children (86.39 ± 0.43 %). Most respondents expressed the feasibility of introducing regular systematic supervision of vision functions in school-aged children (99.40 ± 0.10 %) and supporting the implementation of state preventive programs to preserve vision from childhood in Ukraine (97.38 ± 0.20 %), self-critically recognizing the need for informational support regarding the detection of signs and symptoms of these diseases in children (71.70 ± 0.57 %). Conclusions. Visual impairments in children of different ages are of great medical and social importance, as they affect the formation of disorders of socialization and human performance. The results of the study open the prospect of involving secondary school educators in the activities of interdisciplinary comprehensive programs to prevent the development of ophthalmic pathology among school-aged children. The search for effective ways of informational support for educators on the issues of modern preventive technologies, risk factors for the formation of visual impairments in schoolchildren in order to prevent the formation of stigma about children with disabilities and visual impairments in their environment requires scientific justification.

Особливості соматометричних показників, формування складу тіла та прихильність до медико-дієтичних рекомендацій в українських педіатричних пацієнтів із муковісцидозом

Patients with cystic fibrosis (CF) are prone to nutritional disorders due to malabsorption associated with this disease. Systematic assessment of nutritional status and organization of medical dietary therapy is an integral part of the management of patients with CF. Aim - to determine the peculiarities of somatometric data, formation of body composition and eating behavior in Ukrainian pediatric patients with CF. Materials and methods. 203 medical histories of children with CF since 2012 were retrospectively analyzed and 68 children were prospectively examined. Body weight (Wa) and height (Ha) for age, body mass index (BMI) were assessed. Body composition was determined according to the Slaughter-Lohmann equation based on the measurement of the thickness of 3 fat folds. The clinical course, indicators of spirometry and dynamometry were evaluated. The Eating attitude test 26 (EAT-26) was used to establish the reasons for violation of dietary recommendations. Generally accepted methods of medical statistics were used for data analysis. Results. With age, the phenomenon of simultaneous lag in Wa and Ha increases in pediatric Ukrainian patients, isolated low body weight is found in a third of children. From the age of 10, a large stratum of children with excessive body weight is found, after the age of 15, every fifth patient is obese. No corresponding changes in BMI were noted. With age, there is an increase in the percentage of fat mass (%FM) in boys, although it is reduced in a third of boys under the age of 10, and another third has a deficiency. In girls in all age cohorts, a deficiency of %FM was noted. Absolute fat mass (AFM) increases, and absolute lean mass (ALM) decreases with age in boys with CF. Deficiency of AFM and %FM were noted, ALM was in the range of 25-50‰ in girls. A strong direct relationship between the index of AFM, %FM and ALM with the key indicators of spirometry and dynamometry was revealed. According to the EAT-26 questionnaire, children with CF feel the daily "burden of the disease" and relate to dietary recommendations through the prism of their own perception of the diagnosis. Conclusions. The BMI, as a screening tool, appeared to be not a sufficiently sensitive indicator of the real presence of deviation in nutrition. Determining body composition according to the Slaughter-Lohmann equation is an informative tool for assessing the nutritional state of children with CF at the ambulatory follow-up. The detected changes in body composition in Ukrainian patients are characterized by a decrease in ALM and an increase in body fat mass and correlates with worse indicators of respiratory function. The use of the EAT-26 questionnaire allows timely to start correction of eating behavior. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

QUALITY OF LIFE IN HIV-INFECTED PATIENTS IN PENITENTIARY INSTITUTIONS

Background. Prisoners have a lower quality of life compared to the general population. The decline in their quality of life may be due to unfavorable social and demographic factors, as well as a number of physical and mental health problems, in particular human immunodeficiency virus. Purpose of the work. The purpose of this study was to assess the quality of life of infected persons with human immunodeficiency virus in penitentiary institutions of Azerbaijan and their relationship with various indicators. Material and methods. The study was conducted in penitentiary institutions of Azerbaijan among prisoners meeting the inclusion criteria, a cross-sectional design was used. The study was approved by the Ethics Committee of the Azerbaijan Medical University (P.23/19.05.2022). Demographic and clinical data including age, gender, course of human immunodeficiency virus infection, antiretroviral therapy, drug use and length of incarceration were collected using a structured questionnaire. Standardized assessment methods were used, including the Hospital Anxiety and Depression Scale and the Mini Mental Test to assess neurocognitive performance. The quality of life of patients was assessed using the SF 36 questionnaire.The obtained quantitative and qualitative data were statistically processed using medical statistics methods. Results. The average score for the “physical health” domain of quality of life was 55.2 points, and the average score for the “mental health” domain was 52.8. Subjects with HIV-associated dementia had the lowest quality of life scores in the categories of “physical functioning” (p=0.05), “mental health” (p<0.001), “body pain” (p<0.001), “vitality” (p=0.001) and “general health” (p=0.001) compared with those with asymptomatic and mild neurocognitive disorders. The lowest scores in all areas of quality of life were observed in patients with severe depression and severe anxiety (p<0.001). At the same time, the subjects who were not diagnosed with either anxiety or depressive disorders showed the highest scores when assessing quality of life (p<0.001). Conclusion. Low quality of life was associated with the presence of varying degrees of depression, anxiety disorders, and cognitive impairment (p<0.001). At the same time, the age of the patients, gender, education, years of imprisonment, antiretroviral therapy did not affect the quality of life. The results of this study will help assess the overall quality of life of human immunodeficiency virus positive prisoners, identifying possible connections with various aspects of the disease itself and its neurological complications.

Study of risk factors for cataracts in a chronically exposed population cohort

BACKGROUND: The likelihood of developing cataracts is influenced by many factors, such as age, gender, ethnicity, the presence of somatic pathology (diabetes mellitus, hypertension), dietary habits and lifestyle (obesity, level of education), etc.
 AIM: To study the risk of developing cataracts in exposed people in the long term after chronic radiation exposure, taking into account the influence of radiation dose and non-radiation factors.
 MATERIAL AND METHODS: The total study group consisted of 14,751 people examined in the hospital of the Ural Scientific and Practical Center for Radiation Medicine from 1955 to 2019. Cataracts were diagnosed in 4,658 people. The statistical methods were based on case-control. To assess the association of the studied factors with the risk of developing cataracts, the odds ratio (OR) and 95% confidence interval (CI) were calculated. Morbidity rates were calculated using medical statistics methods per 1000 people. When studying the incidence of cataracts, individualized indicators of radiation dose to the lens of the eye were used.
 RESULTS: The study revealed an increase in the incidence of cataracts as the cohort ages. There was a tendency for the risk of cataracts to increase (OR=1.10; 95% CI=1.00–1.21) with increasing radiation dose. The incidence of cataracts was associated with the presence of arterial hypertension (OR=2.01; 95% CI=1.81–2.22), diabetes mellitus (OR=1.36; 95% CI=1.17–1.58), cerebrovascular diseases (OR=1.14; 95% CI=1.03–1.26), increased body mass index (OR=1.61; 95% CI=1.45–1.78), as well as belonging to Turkic group (OR=1.58; 95% CI=1.44–1.71), living in the city (OR=1.26; 95% CI=1.15–1.38), having no family (OR=1.72; 95% CI=1.63–1.97), employment primarily in mental work (OR=1.34; 95% CI=1.22–1.48).
 CONCLUSION: A tendency for the influence of radiation dose on an increase in the risk of cataracts has been established, medical and social factors that increase the likelihood of developing senile cataracts have been identified.

Dual-energy computed tomography in supporting prostatic artery embolization for benign prostatic hyperplasia.

Objective: Our study aims to evaluate the value of 256-slice dual-energy computed tomography (DECT) in supporting prostatic artery embolization (PAE) under digital subtraction angiography (DSA) for benign prostatic hyperplasia (BPH). Methods: The study was conducted on 88 patients who underwent PAE to treat BPH from January 2022 to November 2023. Of these, 38 patients who had PAE without DECT were placed in group 1, while the other 50 patients with pre-interventional DECT were assigned to group 2. The results of DECT imaging of the prostate artery (PA) were compared with the results of DSA imaging. Test for statistically significant differences between the variables of the two research groups using the T - student test and Mann-Whitney test algorithms with p < 0.05 corresponding to a 95% confidence interval. The data were analyzed according to medical statistical methods using SPSS 20.0 software. Results: DECT can detect the PA origin in 96.1% of cases, identify atherosclerosis at the root of the artery with a sensitivity of 66.7% and a specificity of 89.5%, and present anastomosis with a sensitivity of 72.7% and a specificity of 72.2%. There is no statistically significant difference in PA diameter on DECT compared to DSA with 95% confidence. Group 2 used DECT for 3D rendering of the PA before PAE had procedure time reduced by 25.8%, fluoroscopy time reduced by 23.2%, dose-area product (DAP) reduced by 25.6%, contrast medium volume reduced by 33.1% compared to group 1 not using DECT, statistically significant with 95% confidence. Conclusion: DECT is a valuable method for planning before PAE to treat BPH. 3D rendering DECT of PA provides anatomical information that minimizes procedure time, fluoroscopy time, dose-area product, and contrast medium volume.

Mechanical asphyxia in the structure of violent death in the Russian Federation from 2013 to 2022 years

The objective of the study is to examine the death incidence from mechanical asphyxia in the Russian Federation in the period from 2013 to 2022 yr., to determine the dynamics of changes in indicators of its main types and to reveal territorial specificity. The results obtained with the use of medical statistics methods can be applied to implement measures for health protection, prevent risk factors of fatal outcome among population, to improve the training of forensic medical experts.

The mirror therapy effectiveness as a part of physical rehabilitation program of servicemen after lower limb amputation due to mine-explosive injury

Introduction. The article considers the possibilities of using the developed program of physical therapy for military personnel after amputation of the lower limbs due to mine-explosive injury with the use of kinesiotherapy and mirror therapy for phantom pain syndrome in the conditions of trauma hospitals. Mirror therapy is an additional method of motor rehabilitation and can be used both in a hospital and independently by the patient at home. The application of this method does not require significant time expenditure for the specialist or significant financial costs for the institution or the patient.&#x0D; Purpose. To determine the effectiveness of the physical therapy program for military personnel after amputation of the lower limbs due to mine-explosive injury.&#x0D; Materials and methods. The following methods were used to solve the tasks: analysis of scientific and methodical literature; methods of researching violations of structures, functions, limitations of activity and participation according to the ICF; generally accepted methods of medical statistics. In the course of the study, the condition of the patients was monitored for the effective construction of a physical therapy program, which included therapeutic exercises in the form of mirror therapy to reduce pain in the postoperative period. Also, this method was used to reduce pain in the stump.&#x0D; Result. The patients of the selected groups had a significant phantom pain syndrome, which increased in the evening, was evaluated by the visual-analog pain scale, and was from 7 to 9 points at rest. The VAS survey was conducted before and after the mirror therapy session. Peculiarities of mirror therapy: 1) to improve motor function: simple (basic) and functional movements are performed. Therapy is strictly individualized, the technique depends on the strength of the "mirror illusion" and the severity of motor function impairment; 2) for the purpose of correcting neglect, bilateral sensory stimulation is performed and observation of different hand positions in the mirror; 3) to reduce hypertension: unilateral movements are performed with a healthy limb; 4) to restore sensitivity: bilateral sensory stimulation is performed, that is, bilateral synchronous movements are performed; 5) to reduce the pain syndrome: unilateral motor and sensory exercises are performed with the healthy limb. The advantage of the technique of mirror therapy is its effectiveness, simplicity, safety and availability, the possibility of independent use by the patient. This technique corresponds to the basic principles of motor rehabilitation – high intensity and repetition of goal-oriented tasks in combination with feedback.&#x0D; Conclusions. Conducted studies using the mirror therapy method in people with amputation of the lower limb due to mine-explosive injury show that this method of physical therapy can be an effective way to reduce the level of phantom pain, pain in the stump. Also, during the application of mirror therapy, an increase in the amplitude of joint mobility is observed.

Особливості захворюваності дорослого населення Дніпропетровської області на урологічні хвороби

Purpose: to determine the regional features of urological morbidity and its specific weight in the structure of the general morbidity of the adult population of the Dnipropetrovsk region. Materials and methods. Bibliosemantic, analytical, and medical-statistical methods were used, which make it possible to characterize the current state of health of the population and determine trends in the incidence and prevalence of diseases. The results. The average long-term indicator of the primary morbidity of the population of the Dnipropetrovsk region for all classes of diseases was 7,272.23 per 10,000 adult population, total morbidity was 22,250.84 per 10,000 adult population with a tendency to increase, hospital morbidity was 2,167.9 per 10,000 adult population, with a general tendency to decrease the level of hospitalization. Diseases of the genitourinary system rank second, fourth, and sixth in the structure of primary morbidity, prevalence of morbidity, and hospital morbidity of the adult population, respectively. The leading nosological groups of urological diseases registered for the first time in the adult population of the region are cystitis - 64.88 cases per 10 thousand population, kidney infections - 43.23 per 10 thousand population and kidney and ureter stones - 17.92 per 10 thousand population with a tendency to increase indicators during the studied period, with the exception of kidney and ureter stones. Similar trends persist for the prevalence of diseases. The level of hospitalization of the population of the region turned out to be the highest for kidney and ureter stones - 25.28 per 10 thousand population and kidney infections - 20.01 per 10 thousand population, remained relatively stable during 2012-2019, while during 2020- In 2021, a significant decrease was noted for kidney and ureter stones, kidney infections, while the indicator of hospital morbidity for kidney and ureter stones remained relatively stable. Conclusions. Significant levels of morbidity and prevalence of diseases of the genitourinary system, including urological diseases, negative trends towards their increase require improvement of monitoring of the health status of the population, prevention, timely and complete detection of urological pathology, and high-quality treatment.

Age fertility rates in Transcarpathian region of Ukraine and analysis of birth rates by women who are not in registered marriage

Ukraine is going through difficult times of a prolonged demographic crisis.The objective: to study and analyze the age-related birth rates in the Transcarpathian region of Ukraine and analyze the birth rates among women who are not in a registered marriage.Materials and methods. In the course of the study, official data from sectoral statistical reporting for 2000–2021 were used in the cross-section of the administrative territories of Transcarpathian region. The research was conducted in four stages. Bibliosemantic and medical-statistical methods and the method of structural logical analysis are used.Results. It was established that the total birth rate in Transcarpathian region during the study period decreased by 16.4% and in 2021 it was 1.534. At the same time, a decrease in the birth rate was registered in the age groups of women from 15 to 39 years, and among women in the age category 40–49 years, a tendency to increase the birth rate was revealed.In the age group of 15–19 years the birth rate decreased by 1.31 times and amounted to 39.6; in the age group of 20–24 years, the birth rate decreased by 1.33 times and amounted to 133.3; in the age group of 25–29 years the birth rate decreased by 1.34 times and amounted to 88.9; in the age group of 30–34 years the birth rate decreased by 1.09 times and amounted to 51.3; in the age group of 35–39 years the birth rate decreased by 1.08 times and amounted to 21.0; in the age group of 40–44 years the birth rate increased by 1.13 times and was 5.2; in the age group of 45–49 years, the birth rate increased by 3.0 times and was 0.3.The rate of children who were born in mothers who were not in a registered marriage increased by 1.8 times in 2021 and accounted for 24.3% of the total number of live births. A uniform growth of the specified indicator was registered both in cities and in rural areas.Conclusions. The results of the study provide a basis for ascertaining the negative dynamics of the birth rate in Transcarpathian region, which will further intensify due to the consequences of the war against Russian aggression.

Хімічні канцерогени у навколишньому середовищі України: ризик для населення, шляхи попередження, удосконалення гігієнічного регламентування

The purpose of this work was to determine the carcinogen-hazardous factors in the environment and the criteria for assessing their danger to the population in modern conditions (pre-war period). Materials and methods of research: reports of research works of the Laboratory of Hygiene of Carcinogenic Factors and Nanomaterials of the SI «O.M. Marzieiev Institute for Public Health, NAMS of Ukraine» and own publications over the past 5 years. Bibliosemantic, analytical, hygienic and medical-statistical methods were used to process the materials. Results. The analysis of field and analytical studies has shown that over the past 20-25 years old, against the backdrop of a reduction in industrial emissions, the volume of use of plant protection products and plant products in agricultural activity has increased significantly, and in everyday life – household chemicals, cosmetics, etc., most of which contain specific substances – endocrine disruptors. It was shown that over the years, the rate of increase in the rate of cancer of the endocrine organs (cancer of the mammary, thyroid, prostate glands), uterine body and ovaries increases. The obtained data indicate a trend towards rejuvenation of oncological diseases of hormone-dependent organs. The danger of atmospheric air pollution in cities has been studied; a comparative assessment of carcinogenic and non-carcinogenic risk for the population in a highly industrialized city with a complex of ferrous metallurgy enterprises and a city where there are no specific sources of pollution was carried out. It was concluded that for study of environmental issues regarding the state of the air environment, it is sufficient to use hygienic indicators - maximum permissible concentrations and total pollution indicators, while for the assessment of the impact on human health, the use of risk indicators is more adequate. This raises the question of the compliance of domestic hygienic (medical and sanitary) regulations with international risk indicators. This is especially true for factors with mutagenic and carcinogenic properties. The analysis of risk indicators for a number of carcinogenic substances included in the domestic regulatory and methodological bases at the level of their maximum permissible concentrations proved that the standards for atmospheric air according to the international classification scale correspond to an acceptable risk (1 - 104) for only 26% of substances, and for air of the working area - 45% of substances. Consequently, most of the hygienic standards, both in the atmospheric air of populated areas and in the air of the working area, according to international standards, do not meet the safety requirements for the population and need to be revised using international approaches and focusing on the risk criteria for the development of neoplasms due to the action of individual compounds. Conclusions: the real air pollution in populated areas poses a certain danger to the population and requires preventive measures to reduce it. The currently existing national regulatory framework for the permissible content of carcinogenic substances in the air environment (atmospheric air and air of the working area) does not meet the requirements of the EU and the USA.

DYNAMICS IN COSTS AND THE NUMBER OF PATIENTS OF THE FIVE MOST RESOURCE-CONSUMING DISEASES PAID WITH PUBLIC FUNDS FROM THE NATIONAL HEALTH INSURANCE FUND FOR HOME TREATMENT

On a global scale, health care costs are constantly growing, with a large part of them taking up the costs of medicinal products. The trend for the increase in the consumption of medicinal products is due to the following main reasons: the aging of the population, the possibility of medical treatment of more and more diseases and the development of new medicinal products. A challenge for the governments of individual countries is how, with limited financial resources, to ensure access for the widest possible range of patients to the best medicines. One way to contain health care costs is the reimbursement method. At the same time, a guarantee is needed that decisions to pay for publicly funded medicines are based on cost-effectiveness criteria.The purpose of the current study is to track the dynamics of the costs of medicinal products, medical devices and dietetic foods for home treatment and the number of sick health insured persons from the five most resource-intensive diseases, paid with public funds from the National Health Insurance Fund in Bulgaria for 2021 and 2022.Materials and methods: Documentary method - monthly statements of the National Health Insurance Fund for costs and number of patients for medicinal products, medical devices and dietary foods for home treatment, according to the ICD code of the disease; Economical analysis; Medical statistical methods; Tabular and graphical analyzes - to visualize the obtained results.Results and analysis: Based on the results obtained from the study, it is clear that for the observed period the total costs of medicinal products for home treatment reimbursed by the NHIF increased by 11.43%. Of the five most resource-intensive diseases, the disease for which the most public funds are spent on medicinal products for home treatment is Non-Insulin-Dependent Diabetes Mellitus, with neurological complications, and the highest rate of increase in spending in 2022 is Non-Insulin-Dependent Diabetes Mellitus, without complications – with 18.3%.Conclusion: In contrast to the upward trend in the costs of medicinal products, we observe a slight downward trend in the total number of sick persons with mandatory health insurance in 2022 compared to 2021. In the total number of patients for whom public funds were spent on medicinal products for home treatment by the NHIF, the reduction was 0.97%. Despite the general trend, with the most resource-intensive diseases under consideration, the number of patients slightly increased, with the exception of only one of them.

DETERMINING COMMITMENT TO THE UNIVERSITY CLINIC OF O. O. BOGOMOLETS NATIONAL MEDICAL UNIVERSITY

Introduction. The article reveals the role of university clinics (hereinafter - UC) in the system of healthcare institutions in Ukraine and their role in implementing the right of every citizen to receive free medical care in state and communal healthcare institutions at the expense of the state budget under the program of medical guarantees. The results of a medical and social study to determine patients' attitudes towards UCs and identify risk factors for non-acceptance are presented.&#x0D; The aim. To determine the place of the University Clinic of the O.O. Bogomolets National Medical University in the medical-industrial cluster system of Kyiv city, conduct a medical and social study of patient attitudes towards the university clinic, and identify the main factors of non-acceptance.&#x0D; Materials and methods. The study was conducted on the principle of systematicity, using medical-statistical methods, methods of anonymous questionnaire survey, and analytical generalization. The construction of the sample of respondents is based on the fact that, based on the study of their opinion, it is possible to draw conclusions about the public opinion of potential clients.&#x0D; The results of the study show that university clinics, as a component of the healthcare system, meet the needs of citizens in terms of the effectiveness of services provided and accessibility to the population. With innovative equipment and the involvement of highly qualified specialists from the University's departments in the diagnostic and treatment process, university clinics are increasingly gaining the trust and support of patients.&#x0D; The results of the survey confirm that the university clinic of the National Medical University named after O.O. Bogomolets has successfully integrated into the medical-industrial cluster of Kyiv, establishing cooperation with the university, the Ministry of Health, other ministries and agencies, as well as with patients.&#x0D; Analysis of the socio-demographic indicators of the respondents in 2022 showed a significant volume of services provided by the clinic to the population of Kyiv and other regions of Ukraine (with the highest number of visits from pensioners - 83, and civil servants - 57 out of 213 surveyed), thus ensuring the implementation of the state program of medical guarantees for citizens. The risk of low probability recommendations by the clinic is influenced by increasing age (p=0.013) and decreasing educational level (p=0.040) of patients. The risk of low satisfaction with the comfort of the clinic increases (p=0.002) when patients visit the medical facility on the recommendation of acquaintances (patients of the clinic).&#x0D; Conclusions. The positive conclusion of the survey is the absence of a risk of probability of re-appealing to the UC based on the analyzed characteristics.

Виробничий травматизм в Україні: епідеміологічній аналіз і виклики часу

Introduction. Accidents are one of the causes of work-related mortality and disability. According to the ILO estimates, about 2.3 million men and women in the world die each year as a result of workplace accidents or work-related diseases. In recent years, a gradual decrease in the level of industrial injuries (II) has been noted in Ukraine. Statistical indicators indicate the complexity of the situation regarding the formation of the number of injuries at work, depending on socio-economic conditions, the state of labor protection, medical and demographic characteristics of workers, changes in legislation regarding compliance with international requirements. II is closely related to the level of GDP, financial crises, as well as such challenges of the time as the COVID-19 pandemic, the conduct of military operations after the invasion of the Russian Federation in Ukraine, the occurrence of danger when performing work in the conditions of hostilities. The purpose of the study is to reveal the regularities of the formation of indicators of industrial injuries in Ukraine during the years of independence, in the conditions of the COVID-19 pandemic, during the period of martial law. Research materials and methods of studying the prevalence of industrial injuries was carried out according to the principle of continuous statistical sampling of primary documents compiled for all cases of occupational accidents first detected and registered in Ukraine, for the years 1991-2022. The analysis of II was carried out by types of economic activity. The materials were processed in accordance with the tasks set by classical methods of medical statistics, the relationship between statistical indicators was determined using the Spearman correlation coefficient to assess the relationship of individual indicators. Research results and their discussion. During the years of independence, the formation of II indicators was determined by the factors of socio-economic, regulatory and legal transformations, the number and employment of the population in the labor process. The coefficient of frequency of accidents (CFA) is on average 0.31, while in the coal industry - 7.89, transport - 1.6, agriculture - 1.14, mining and non-metal industry - 0.99%, metallurgical industry – 0.96, mechanical engineering - 0.48. The weight coefficient - CW has a somewhat different ranking, with an average Kт of 26.42, the first place belongs to transport - 65.02, the second - to the mining and non-mineral industry - 48.13, the third - to the coal industry - 36.96, the fourth - to the metallurgical industry - 32 ,8, the fifth - construction - 32.72, the sixth - gas industry - 31.08, the next - machine building - 26.32. The number of cases of COVID-19 among medical workers has significantly decreased from 2020 to 2022. A significant number of accidents were registered among those working during the performance of labor duties in the conditions of hostilities at critical life support enterprises, such as oil and gas production, state administration and defense, electricity supply, transport, engineering, health care. Conclusions: 1. Over the years of independence, there has been a significant decrease in the total number of workplace injuries. In 2022, the total number of injuries decreased by more than 40.0 times compared to 1992, the number of deaths at work - by more than 5.0 times. 2. The level of injury depends on the challenges of time in certain defined periods of the formation of the state, which causes fluctuations or a surge in occupational accidents. 3. The assessment of the relationship between GDP and structural changes in II (the Is index) reflects the percentage of fatal cases in the structure of injuries, and is one of the indicative characteristics of the state of labor protection in Ukraine. The increase in GDP in the period 1992-2014 correlates with Is rs=0.97 (Spearman correlation coefficient p&lt;0.05), and the correlation coefficient with the number of working persons for these years reaches values of rs=-0.90 (p&lt;0, 05). The decrease in GDP in the period 2016-2022 has the same trend with changes Is rs=0.71 (p&lt;0.1). From the above, it can be determined that the economic factor was of great importance until 2016, and later its importance remained, but greatly decreased due to the epidemic of COVID-19 and a significant increase in hostilities. 4. Among the causes of accidents with a fatal outcome, organizational - 46.2%, technogenic, natural, ecological and social -40.0%, technical - 7.6%, psychophysiological - 6.2% prevail.

Значення мультидисциплінарного, міжвідомчого і міжсекторального підходів як умов впровадження системи паліативної та хоспісної допомоги в Україні

Purpose - to carry out medical and social analysis of conditions and organizational aspects of the Palliative and Hospice Care (PHC) System implementation and development in Ukraine. Materials and methods. There were analyzed: domestic and foreign scientific literary sources; data of official statistics of the State Statistics Service and the Ministry of Health of Ukraine; normative-legal documents of Ukraine and authoritative international professional organizations. Аnd the following research methods were applied: bibliosemantic, system approach and system analysis, comparative content analysis and generally accepted medical-statistical methods. Results. The peculiarities of the medical and demographic situation in Ukraine in recent decades are the rapid population aging, high morbidity and mortality from cancer and severe complications of chronic noncommunicable diseases, significant spread of HIV/AIDS, tuberculosis, viral hepatitis B and C etc. This requires the creation and improvement of an adequate regulatory framework (RF), which regulates the development of an accessible multidisciplinary, interagency and intersectoral PHC System, which requires the development of outpatient PHC services and inpatient PHC facilities, coordination of institutions and agencies subordinate to various ministries and agencies, first of all, the Ministry of Health of Ukraine and the Ministry of Social Policy of Ukraine; introduction of a system of motivation and training of PHC providers and involvement primary health care facilities medical staff in the palliative care provision at home. Thus, affordable and high-quality PHC should be integrated into the Health Care and Social Protection System, as PHC in the early stages of a life-threatening or incurable disease can significantly reduce suffering and improve the quality of life for both palliative patients (PPs) and their families. Conclusions. The urgency of the problem of creating and developing a System of affordable, high quality and effective PHC in Ukraine is due to the unfavorable medical and demographic situation - population aging, increasing morbidity and mortality from cancer and chronic diseases, often accompanied by chronic pain syndrom and other severe symptoms that significantly reduce the quality of life of PPs. The implementation of the PHC System for the population requires political support from the Government of Ukraine, Regional and Local Authorities, appropriate financial support and the whole society participation. Implementation and development of the PHC System in Ukraine with adequate funding from the State Budget (National Health Service of Ukraine), as well as through state, regional and local targeted PHC Programs will provide quality and effective multidisciplinary and interagency palliative care on equal terms, regardless of the nosology of the disease, PPs place of residence/stay and social status. The results of the study allowed to adapt international experience and identify different forms of PНC, which, depending on the severity of the disease and at the request of PPs and their families, can be provided in specialized inpatient PНC facilities, PНC departments of secondary and tertiary health care facilities or outpatient settings, including at home, as well as in PHC facilities of any form of ownership and departmental affiliation, subject to compliance with the standards and requirements of the RF. No conflict of interests was declared by the authors.

Epidemiological Studies of the Eye Pathology over a Long-Term Follow-Up Period in the Population Affected by Chronic Radiation Exposure in the Southern Urals

Objective of the study: to analyze cataract incidence rates over the period from 1955 through 2019 in the cohort of the population exposed in the Southern Urals and to analyze radiation risk of cataract incidence.Methods. For the first time cataract incidence was assessed over a long- term period from 1955 through 2019 in people who were chronically exposed in a low-to-moderate dose range. The registry of eye pathologies created in the URCRM was used as the basis for the study. Analysis of incidence rates was conducted with account of the individualized doses to the lens. The incidence rates were calculated using the methods of medical statistics per 1,000 people. The odds ration (OR) of cataract development was also evaluated using the case-control study.Results. In total the studied group consisted of 14,751 people (1955–2019) who underwent examinations in the outpatient department of the URCRM. As of December 2020 4,658 patients with cataract were registered. According to the findings of the study (1955–2019) it has been stated that cataract incidence increases with age and thus with the aging of the cohort, improvement of the quality of the diagnosing procedures and examination of the patients. The number of cataracts in women significantly exceeds that in men (3,169 and 1,489, respectively). Standardized incidence rate of cataract over all the years of the follow-up is 172.94 (95 % CI: 168.10–177.78). In the course of the study of the cataract incidence dependence on the dose to the lens, it has been revealed that cataract incidence tends to increase with the increasing dose. Risk value of cataract development (OR) depending on the dose to the lens obtained as a result of the case-control study made up 1.10 (95 % CI: 1.00–1.21).Conclusion. The incidence of cataract in the studied cohort increases with the follow-up periods. The number of cataracts in women is greater than that in men, the age characteristics are approximately the same. A trend of increased effect of the dose on the increase in the risk of cataracts was established based on the results of the performed analysis.

RISK FACTORS ASSOCIATED WITH CANCER PATHOLOGY

The aim of the study is comparative assessment of the main risks of the global burden of cancer in the total burden of death. Materials and methods: A comparative assessment of the main risks of the global burden of cancer within the overall burden of deaths was carried out based on the data of the Global Burden of Disease Study (GBD), data from the Center for Medical Statistics of the Ministry of Health of Ukraine, the National Cancer Registry of Ukraine. The methods of comparative analysis, systematic approach and system analysis, bibliosemantic and medical-statistical methods were used. Results: Higher attributable risk of death in most nosological forms of cancer among the population of Ukraine (bronchial, tracheal and lung cancer, laryn-geal, pharyngeal, lip and esophageal cancer) have been observed. Behavioral factors at the level of Ukraine, compared to the world level, are characterized by signi!cantly higher rates of attributable risk with regard to tobacco smoking (cancer of the larynx, pharynx, lower lip, esophagus) and alcohol consumption (pharynx, liver, lower lip). Environmental and occupational factors in Ukraine do not exceed the global exposure rates, and are lower for some cancer nosol-ogies, namely bronchial, tracheal, lung and laryngeal cancer. Unlike global trends, metabolic factors prevail among the mortality risks of patients with liver, esophageal, uterine and kidney cancer in Ukraine. Conclusions: Behavioral, occupational, environmental and metabolic risk factors for cancer mortality have high attributable risk. Behavioral risk factors for cancer mortality have the most pronounced impact both globally and in Ukraine, and notably, for the majority of nosological forms of cancer in Ukraine mortality risks are higher compared to the global data.

Lipid profile peculiarities and matrix Gla protein concentration in Ukrainian pediatric patients with heterozygous familial hypercholesterolemia

Atherosclerotic changes in the vascular walls begin early in childhood, especially in association with familial hypercholesterolemia (FH). The process may be subclinical, which nevertheless requires therapeutic and preventive measures. Purpose - to evaluate baseline lipid profiles, the thickness of carotid intima-media complexes, blood pressure indices and the association with concentration changes of dephosphorylated-uncarboxylated matrix Gla protein (dp-uc MGP) as a marker of subclinical arterial lesions in different age groups of pediatric patients with FH. Materials and methods. Children with heterozygous FH (n=15), stratified by age and sex, were included in the study. The control group consisted of healthy peers (n=21). Blood samples were analyzed to determine levels of total (TC), low-density (LDL-C), very-low-density (VLDL-C), high-density (HDL-C), remnant (rC) and non-high-density (non-HDL-C) cholesterol, triglycerides (TG), apolipoproteins A1 (apoA1) and B (apoB), lipoprotein (a), and dp-uc MGP. The intima-media complex thickness of the common carotid artery and blood pressure were measured in all study subjects. The obtained data were processed using the accepted methods of medical statistics and SAS® OnDemand for Academics. Results. Lipid profile changes in pediatric patients with FH were characterized by high levels of LDL-C, non-HDL-C and lipoprotein (a) in the 5-9 years age group; in the 10-14 years age group - high levels of LDL-C, TG, rC, non-HDL-C and lipoprotein (a); in the 15-18 years age group - high levels of LDL-C, TG, non-HDL-C and lipoprotein (a). At the same time, the most marked dyslipidemia changes were evident in children aged 10-14 years in the FH group. apoA1 levels were significantly decreased in all FH children. Elevated levels of lipoprotein (a) (&gt;30 mg/dL) in FH children were found in all age groups, suggesting that elevated lipoprotein (a) levels can be used as a factor for cardiovascular risk stratification. Dp-uc MGP levels were significantly elevated in all age groups of FH children compared to healthy peers. Conclusions. A lipid profile examination is necessary to diagnose FH in children, along with family health history and cascade screening. As atherosclerotic changes at 5-18 years of age remain subclinical, and the instrumental tests available in routine medical practice are not sensitive enough to detect them, therefore, preventive or therapeutic measures cannot be initiated promptly. The evaluation of circulating matrix Gla protein in pediatric patients with FH can be used as a marker of vascular wall calcification, which may allow early preventive measures against microcalcification to be developed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

THE INFORMATIVE VALUE OF MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF RECTAL TUMOR INVOLVEMENT AGAINST THE BACKGROUND OF COMBINED TREATMENT

The aim of the study is to prove the informative value of magnetic resonance imaging in the diagnosis of rectal tumor involvement against the background of combined treatment for the patients (chemotherapy + radiation therapy) on the basis of the AI "Republican Oncological Dispensary", Cheboksary. All patients underwent magnetic resonance imaging on Elekta Synergy linear accelerator with a multi-leaf collimator, an integrated XVI X-ray volumetric imaging system and iViewGT portal imaging system, Mosaiq information and control system. Statistical processing was performed using standard methods of medical statistics using the SPSS Statistics package (version 17.0), arithmetic mean (M), standard deviation from the general mean age, mean value errors (m), Student's t-test were also calculated. Magnetic resonance imaging diagnostics made it possible to identify and dynamically control the change in the tumor involvement of the rectum against the background of the treatment: a change in the localization of the tumor in different parts of the rectum, a change in localization depending on the distance from the anal margin, a change in the thickness of the tumor wall, a change in the size and number of lymph nodes. Extramural venous invasion (EMVI), marginal resection boundary (CRM) of the tumor and invasion into surrounding tissues after surgical intervention were evaluated. This article examines the incidence of rectal cancer depending on age, gender, complaints, oncological history, risk factors contributing to the development of this pathology, as well as the presence of concomitant diseases that aggravate treatment. According to the results of the study, rectal cancer is revealed to be most often found in people aged 60–70, while men are most susceptible to the disease. According to histomorphological data, adenocarcinoma prevailed in 94 persons. Rectal cancer before and after chemoradiotherapy, according to magnetic resonance imaging (MRI) findings, prevailed in the rectal lower ampulla (before chemoradiotherapy – in 51 persons, after chemoradiotherapy – in 48), while the malignant neoplasm was at the distance of 21-30 mm from the anal margin in 27 persons, with the average wall thickness of 21.5 mm according to MRI findings before chemoradiotherapy and 13.9 mm after chemoradiotherapy. The difference in the average wall thickness according to the findings of two MRI studies was 7.61 mm (33.3%), which indicates the effectiveness of chemoradiotherapy.

Issues of therapy for post-acne post-inflammatory hyperpigmentation

Introduction. Post-acne post-inflammatory hyperpigmentation most often develops in patients with moderate to severe acne. Post-acne pigmentation can be persistent and last from months to several years, which has a negative impact on the patients’ quality of life. It occurs at any age with the same frequency in men and women.Aim. To evaluate the effect of dermatocosmetic products – a triple effect serum (containing thiamidol, salicylic acid and lycochalcone A) and SPF30 fluid for problematic skin on the skin condition in patients with moderate and severe post-acne post-inflammatory hyperpigmentation.Material and methods. A total of 57 patients with post-acne post-inflammatory hyperpigmentation localized on the facial skin were under observation. The age of the patients was 22.4 ± 2.7 years. 32 patients were diagnosed with mild post-acne PIH, 25 patients – with moderate post-acne PIH. All patients used dermocosmetic products such as the triple effect serum (containing thiamidol, salicylic acid and lycochalcone A) and SPF30 fluid for problematic skin. Efficacy was evaluated with due account for mexametry findings, GSS, dermatology life quality index. Digital data were processed using standard medical statistical methods: calculation of the arithmetic mean value (X), square deviation (σ), Student’s t-test (t).Results. After 12 weeks the mexometric index decreased: 92.7 and 85.9% in mild and moderate post-acne PIH, respectively. The DLQ index reduced by 84.9 and 83.8% by the end of the treatment,Conclusions. The use of innovative dermocosmetic products containing salicylic acid and licochalcon A effectively reduces post-acne pigmentation. All patients noted good organoleptic properties: skin application comfort and excellent tolerability of the products.