Musculoskeletal Connective Tissue Research Articles

The Use of Risk Evolution Models in Evaluation of Risk Levels for Diseases Developing under the Influence of Factors of Occupational Environment and Work Process

Background: The analysis of temporal changes in the value of occupational risk for workers based on evolutionary models helps predict long-term effects of occupational factors and develop effective preventive measures. The objective of our study was to test application of evolutionary modeling to assessing the relationship between prevalence rates of occupational and occupation-related diseases in workers induced by various factors of occupational environment and work processes. Materials and methods: We made epidemiological assessment of the association between workers’ health and working conditions in compliance with the requirements of Guidelines R 2.2.1766–03. The parameters of paired mathematical models constructed for different exposure levels were used for risk evolution models accounting for accumulation of functional changes attributed to external causes. Results and discussion: The results of risk evolution modeling showed that 20 years of high occupational noise exposures exceeding the maximum permissible level posed a very high risk of developing sensorineural hearing loss by the age of 48, this risk being high and moderate in the age ranges of 36–47 and 24–35, respectively. According to the same model, 20-year-long high occupational vibration exposures exceeding the maximum permissible level posed a moderate risk of developing diseases of the musculoskeletal system and connective tissue in workers aged 46–65. The risk of developing diseases of the nervous system posed by xylene exposures below the maximum permissible level was assessed as negligible.

The importance of matrix metalloproteases in the pathology of the tempo-mandibular joint in children

Among the reasons for patients visiting a dentist, one of the most common is the pathology of the temporomandibular joint (TMJ), which occurs in 25-50% of the population [2,3,4]. According to the classification of ICD-10, TMJ diseases are classified as class XII " Maxillofacial abnormalities (including malocclusion) ”and Section 6“ Temporomandibular joint diseases ”, arthropathy and arthrosis of all joints of various etiologies are also described in class XIII“ Diseases of the musculoskeletal system and connective tissue ”. TMJ internal disorders are referred to in this classification by the terms “clicking jaw”, “TMJ dislocation and subluxation

On the state of child health in Ekaterinburg based on results of prophylactic medical examinations

Morbidity parameters in children aged 0–17 years have been analyzed based on results of prophylactic medical examinations conducted in Ekaterinburg between 2013 and 2019. The prophylactic medical examination coverage of pediatric population, distribution among the health status groups and frequency of regular medical check-ups have been studied. In 2019 versus 2013, children aged 0–17 years demonstrated a 1.6-fold increase in overall morbidity, and 2.3-fold increase in primary-care morbidity. In 2013–2017, a higher level of overall morbidity was found in children aged 15–17 years compared to children 0–4 years of age, owing to the emergence of newly diagnosed diseases. It was noted than the most frequently diagnosed diseases included diseases of the musculoskeletal system and connective tissue, diseases of the eye and eye appendages, diseases of nervous system, digestive system, endocrine system, nutritional disorders and metabolic disorders. Each year, based on results of prophylactic medical examinations, the proportion of children for whom the outpatient examination has been recommended amounts to 9.5%, outpatient treatment to 35.0%, and outpatient medical rehabilitation to 9.3%. The fraction of healthy children as of 2019 was 23.1% of all examined children. In 2019 the coverage for medical check-ups at the health facilities was 605.6 per 1000 children, that is 1.8 times higher than that in 2013 (334,0 per 1000 children).

On the state of child health in Ekaterinburg based on results of prophylactic medical examinations

Morbidity parameters in children aged 0–17 years have been analyzed based on results of prophylactic medical examinations conducted in Ekaterinburg between 2013 and 2019. The prophylactic medical examination coverage of pediatric population, distribution among the health status groups and frequency of regular medical check-ups have been studied. In 2019 versus 2013, children aged 0–17 years demonstrated a 1.6-fold increase in overall morbidity, and 2.3-fold increase in primary-care morbidity. In 2013–2017, a higher level of overall morbidity was found in children aged 15–17 years compared to children 0–4 years of age, owing to the emergence of newly diagnosed diseases. It was noted than the most frequently diagnosed diseases included diseases of the musculoskeletal system and connective tissue, diseases of the eye and eye appendages, diseases of nervous system, digestive system, endocrine system, nutritional disorders and metabolic disorders. Each year, based on results of prophylactic medical examinations, the proportion of children for whom the outpatient examination has been recommended amounts to 9.5%, outpatient treatment to 35.0%, and outpatient medical rehabilitation to 9.3%. The fraction of healthy children as of 2019 was 23.1% of all examined children. In 2019 the coverage for medical check-ups at the health facilities was 605.6 per 1000 children, that is 1.8 times higher than that in 2013 (334,0 per 1000 children).

The importance of matrix metalloproteases in the pathology of the tempo-mandibular joint in children

Among the reasons for patients visiting a dentist, one of the most common is the pathology of the temporomandibular joint (TMJ), which occurs in 25-50% of the population [2,3,4]. According to the classification of ICD-10, TMJ diseases are classified as class XII " Maxillofacial abnormalities (including malocclusion) ”and Section 6“ Temporomandibular joint diseases ”, arthropathy and arthrosis of all joints of various etiologies are also described in class XIII“ Diseases of the musculoskeletal system and connective tissue ”. TMJ internal disorders are referred to in this classification by the terms “clicking jaw”, “TMJ dislocation and subluxation”.

Dynamics of the incidence in the 15–17-year-old men in the Russian Federation

In recent decades, the Russian Federation has seen an increase in the incidence of the population, including children and adolescents.Objective: to identify trends in the incidence and “to chronize” the pathology of young men in the Russian Federation. Using the method of descriptive statistics, the authors analyzed the overall and for the first time recorded incidence in 15–17-year-old men in 2000–2017. The authors noted a 35,8% increase in the overall incidence rate and a 35,4% increase in the for the first time recorded incidence rate. The maximum increase in the overall incidence is observed in the following classes: neoplasms (2,6 times), blood and bloodforming organs diseases (2 times), congenital anomalies (malformations; 1,8 times), circulatory system diseases (1,7 times), the musculoskeletal system and connective tissue diseases (1,6 times), endocrine and metabolic disorders (1,5 times). Based on theoverall and for the first time registered incidence the authors calculated the “chronicity” of diseases. With a general growth rate of this indicator of 0,3% there is a significant growth of this indicator for certain diseases: mental disorders and behavioral disorders (2,1 times), congenital anomalies (malformations; 1,9 times), endocrine system diseases, metabolic disorders (1,5 times).

Occupational health risk among healthcare workers of the Bashkortostan infectious diseases service

The a priori and a posteriori factors of occupational health risks among workers of the infectious service have been studied. It has been shown that workers with a high a priori risk (harmful Class 3.3) have minimal risk levels in terms of occupational morbidity (Ипр = 0,0005). The occupational morbidity of healthcare workers in the infectious disease service does not reflect the levels of actual risk for their health. On physical examination, only 4 % of workers were found to be practically healthy, most often diagnosed with diseases of the musculoskeletal system and connective tissue (19.8 %), as well as diseases of the circulatory system (18.8 %). Psychosocial effects leading to stress reactions with the development of chronic fatigue and occupational burnout syndrome (OBS) rank first among health problems of workers. The formed OBS was observed in 19.2 % of doctors and 29.2 % of nursing staff. The studies conducted indicate the probability of the prediction of the development of a high posterior risk to the health of workers of the infectious disease service.

The characteristics of morbidity of population older than able-bodied age in the Russian Federation in 2012-2018

The indices of population health exhibit tendency to deteriorate with age. The high level of morbidity, prevalence of chronic diseases, polymorbidity, atypical course of disease, continuous rehabilitation period, frequent complications and exacerbations are specific for individuals over able-bodied age. The purpose of study is to analyze dynamic, structure and characteristics of morbidity of population over able-bodied age in the Russian Federation. The study established specific features in dynamics and structure of morbidity of elderly population during 2012-2018. They are associated with high prevalence of cardiovascular diseases, diseases of musculoskeletal system and connective tissue. Furthermore, there is variety in morbidity rates of neoplasms, endocrine, nutritional and metabolic diseases, mental and behavioral disorders, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, diseases of the eye and adnexa, diseases of ear and mastoid process and also symptoms, signs and abnormal clinical and laboratory findings, not classified in other rubrics. The analysis of indices of primary and common morbidity of pneumonia in elderly population of different regions of the Russian Federation was carried out.

ДИНАМИКА ЗАБОЛЕВАЕМОСТИ И ЕЁ ХРОНИЗАЦИИ У ДЕВУШЕК В РОССИЙСКОЙ ФЕДЕРАЦИИ

The health condition of the Russian Federation children, including adolescents, has been characterized by negative trends in the past thirty years. The aim of the study is to identify the main trends in the total and for the first time in the life registered incidence in girls 15-17 years old in the Russian Federation, as well as to track the quantity and dynamics of the indicator of chronicity of diseases. The data of form N12 of the federal statistical observation for the period 2000-2017 are analyzed, using the method of descriptive statistics. A significant increase was revealed both in the total incidence of girls (by 56.9%) and for the first time in the life registered incidence (by 63.0%). The maximum increase in total incidence is observed for the most classes of diseases, for example: neoplasms (2.4 times), injuries, poisoning and some other consequences of external causes (2.4 times), congenital anomalies (malformations) (2.3 times), cardiovascular system diseases (2 times), diseases of the musculoskeletal system and connective tissue (2 times). The growth for the first time in life registered incidence was revealed for the overwhelming majority of classes of diseases, for example: injuries, poisoning and some other consequences of exposure to external causes (2.5 times), diseases of the nervous system (2.2 times), cardiovascular system diseases (2 times), neoplasms (2 times), diseases of the ear and mastoid process (2 times), diseases of the musculoskeletal system and connective tissue (1.9 times). High figures of the chronicity index aggregative for all classes of diseases reflect the initially high level of chronic pathology in girls 15-17 years old, what is an unfavorable characteristic of their health condition. An analysis of the chronization index of the diseases among girls aged 15–17 years over the study period revealed its maximum growth for classes of congenital anomalies (malformations) (by 31.1%) and tumors (for 23.0%), and for certain nosologies: menstrual disorders (5.8 times) and renal failure (4.2 times). The health of children, and especially adolescents, determines the health of the nation in the nearest future; therefore, the issues of its preservation and improvement require thorough attention.

Health status of the population living in the zone of influence of radioactive waste repositories

Objective:To estimate the prevalence of diseases among the population depending on the length of residence in the zone of influence of technogenic factors of radioactive waste storage uranium-processing enterprise in Stepnogorsk.Material and Methods:The article presents the results of an observational epidemiological study on the impact of harmful factors of uranium mining enterprises on the health of the population living near radioactive waste storage facilities. The study covers 1,877 adults of both sexes. Group I primary (N=908) were represented by the population living in the villages of the Factory, Quartzite and Aksu, which are located in the surrounding area of the radioactive waste storage uranium-processing enterprises Hydrometallurgical plant of Stepnogorsk city and 972 constituting the control group.Results:The results revealed a high prevalence of chronic diseases in the population of the main group. Diseases of the circulatory system, respiratory diseases, diseases of the musculoskeletal system and connective tissue took the largest share in the structure of morbidity of the population of the main group. The pathology of the cardiovascular system, represented by essential arterial hypertension, as well as respiratory diseases, vertebrogenic lumbalgia and osteochondrosis, was the most characteristic for people living near radioactive waste storage facilities.Conclusion:Living conditions in the zone of influence of radioactive waste repositories determine the wide prevalence among the population of the main group living in the settlements of Zavodskoye and Aksu. The results of the study indicate an almost complete absence of healthy individuals living in the area. Diseases of cardiovascular, respiratory and musculoskeletal systems occupy the first rank places in the structure of disease prevalence among the population of the main group. Length of living near radioactive waste storage affect the formation and character of general somatic morbidity: increase the duration of life in the areas adjacent to the tailings, leading to increased incidence of chronic diseases.

CASES OF MORBIDITY WITH WORK DAYS LOST AMONG EMPLOYEES OF THE EMERCOM OF RUSSIA AND THE WORKING POPULATION IN RUSSIA

Relevance. Activities in extreme conditions likely involve stress on functional reserves and impaired health. Intention. Calculate the medical and statistical indicators of cases of morbidity with work days lost among employees of the EMERCOM of Russia and compare the above indicators with the working population in Russia in 2010–2015.Methodology. We analyzed cases of morbidity with temporary disability in employees of the EMERCOM of Russia units according to the automated database of the All-Russian Order of the Badge of Honor Research Institute for Fire Protection, EMERCOM of Russia, over 2010–2015 in about 80% of all employees who had special military ranks: senior commanding officers (officers, warrant officers), junior commanding officers (sergeants) and rank and file. The indicators are calculated per 1000 employees or in ‰. Cases of morbidity correlated with the International Classification of Diseases and Behavioral Disorders of the 10th Revision (ICD-10). Cases of temporary disability of workers in Russia was obtained from the database of the Unified Interdepartmental Information and Statistical System of Russia.Results and analysis. The average annual level of morbidity cases with work days lost among the personnel of the EMERCOM of Russia was (374.2 ± 9.6) ‰, including (345.2 ± 9.1) among the employees of the Federal Fire Service, (361.4 ± 28.3) ‰ in the Main Inspectorate for Small Boats, (339.3 ± 20.5) ‰ in the Search and Rescue Units, and (867.6 ± 97.6) ‰ in the Rescue Military Units. In the structure of cases of work days lost in the EMERCOM of Russia, the shares of employees of the divisions were distributed as follows: 81.5, 2.8, 2.1 and 13.6 %, respectively. The leading classes of diseases among the personnel of the EMERCOM of Russia were: respiratory diseases (Chapter X) with morbidity rate (167.7 ± 8.2) ‰ and 44.7% in the structure; injuries, poisoning and some other consequences of external causes (Chapter XIX) (41.8 ± 1.4) ‰ and 11.2 %; diseases of the musculoskeletal system and connective tissue (Chapter XIII) – (34.7 ± 1.2) ‰ and 9.3%; circulatory system diseases (Chapter IX) – (25.2 ± 1.6) ‰ and 6.7%; and some infectious and parasitic diseases (Chapter I) – (21.9 ± 2.9) ‰ and 5.9 %. For workers in Russia, the average annual level of morbidity cases with work days lost 1.4 times as high: (522.5 ± 28.1) ‰ (p < 0.01). The consistency of the indicators is high, negative, and approaches statistical significance (r = –0.75; p < 0.1), which may indicate the influence of multidirectional factors in the formation of cases of work days lost among the EMERCOM of Russia employees and working population in Russia. Trends over time, structure and morbidity rates for cases with work days lost among employees of the EMERCOM of Russia divisions are presented.Conclusion. Accounting for morbidity indicators with work days lost can contribute to a more rational allocation of resources during the operational activities of the EMERCOM of Russia.

Структура захворюваності людей похилого віку у демографічному контексті

Anna HakmanThe scientific article is devoted to the study of the incidence of elderly people through the prism of the demographic status of the population of Ukraine during 2010–2019. Purpose: to study the dynamics of aging of the population of Ukraine and determine the incidence of elderly people. Material & Methods: analysis of scientific, methodological, regulatory literature, research of data from the State Statistics of Ukraine, copying from medical records. The study processed 487 medical records of the elderly. Results: according to the State Statistics Service of Ukraine, it was determined that from 2010 to 2019 the proportion of people over working age is 1/6 of the country's population and has some upward trend. In the structure of the incidence of elderly people, diseases of the circulatory system, diseases of the musculoskeletal system and connective tissue, and diseases of the nervous system were most often encountered. Conclusions: in Ukraine, as in most countries of the world, the nation is aging. In connection with the deterioration in the health of the population of Ukraine, as evidenced by the results of screening studies, scientists pay attention to the problem of attracting to motor activity.

ТЕНДЕНЦИИ ЗАБОЛЕВАЕМОСТИ И ХРОНИЗАЦИИ ПАТОЛОГИИ У ЮНОШЕЙ В РОССИЙСКОЙ ФЕДЕРАЦИИ

An increase in the incidence of the population, including children and adolescents occurs in recent decades in the Russian Federation. The growth rates of the total and the first time registered incidence of young men aged 15–17 years are analyzed for the period 2000–2017, according to the data of the Federal Statistical Observation. An increase in the overall incidence of young men by 35.8% was detected, for the first time registered incidence — by 35.4%. The maximum increase in overall morbidity is observed in the following classes: neoplasms (up to 2,6 times), diseases of the blood and blood-forming organs (2 times), congen-
 ital anomalies (malformations) (1,8 times), diseases of the circulatory system (1,7 times), diseases of the musculoskeletal system and connective tissue (1,6 times), diseases of the endocrine system, metabolic disorders (1,5 times). The indicator of “chronicity” of diseases was calculated, based on the data of the total and for the first time registered incidence. With a general growth rate of this indicator 0.3%, there is a significant increase for some of classes of diseases: mental disorders and behavioral disorders (2,1 times), congenital anomalies (malformations) (1,9 times), diseases of the endocrine system, metabolic disorders (1,5 times).

ДИНАМИКА ЗАБОЛЕВАЕМОСТИ И ХРОНИЗАЦИИ ПАТОЛОГИИ У ДЕТЕЙ В РОССИЙСКОЙ ФЕДЕРАЦИИ

The health condition of the Russian Federation children has been characterized by negative trends in the past thirty years. The aim of the study is to identify the main trends in the total and for the first time in the life registered incidence in children 0–14 years old in the Russian Federation, as well as to monitor the quantity and dynamics of the indicator of chronicity of diseases. The data of form N12 of the federal statistical observation for the period 2000–2018 are analyzed, using the method of descriptive statistics. A significant increase was revealed both in the total incidence of girls (by 19.0%) and for the first time in the life registered incidence (by 19.3%). The maximum increase in total incidence is observed for the following classes of diseases: neoplasms (2.3 times), congenital anomalies (malformations) (1.8 times), diseases of nervous system (1.5 times), diseases of the musculoskeletal system and connective tissue (1.4 times). The growth for the first time in life registered incidence was revealed for the following classes: neoplasms (2 times), congenital anomalies (malformations) (1.6 times), diseases of the respiratory system (1.3 times). High figures of the chronicity index aggregative for all classes of diseases (1.262 in 2000 year and 1.259 in 2018 year) reflect the high level of chronic pathology in children 0–14 years old, what is an unfavorable characteristic of their health condition. An analysis of the chronization index of the diseases revealed its maximum growth for: asthma, asthmatic status (71.1%), allergic rhinitis 
 (hay fever) (43.0%), diseases characterized by high blood pressure (41.9%), urolithiasis (30.9%). The greatest decrease in the chronicity index was revealed by the following nosologies: cerebral palsy (19.8%), chronic and unspecified bronchitis, emphysema (18.7%), gallbladder and biliary tract disease (16.2%), and blood coagulation disorders (12.6%). The health of children determines the health of the nation in the nearest future; therefore, the issues of its preservation and 
 improvement require thorough attention.

(111) Trends in Diagnostic Coding for Musculoskeletal Conditions: An Evaluation of ICD-10 Use in the Veterans Health Administration

Musculoskeletal disorders (MSD) are the most common diagnoses among Veterans presenting with pain in the Veterans Health Administration (VHA). The implementation of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) sought to increase specification of diagnoses, but studies have yet to evaluate this effect. In this study, we examined the most frequently utilized MSD-related ICD-10 diagnostic codes and describe their association with Veteran characteristics. A cross-sectional analysis of all Veterans assigned an ICD-10 diagnostic “M-code” representing “Diseases of the Musculoskeletal System and Connective Tissue” in 2016 and 2017 was performed. Data were obtained from the VHA Musculoskeletal Disorders (MSD) Cohort, which includes over 5 million Veterans. We examined coding frequency among patient visits (n=31,619,884). A total of 36 of the possible 6,487 ICD-10 M-codes demonstrated a frequency of greater than 0.50% of all visits, accounting for 63.74% of all MSD coded visits. “Low Back Pain” (M54.5) was the most commonly used code (18.32%). The next most common codes were “Cervicalgia” (M54.2, 3.55%), “Pain in Right Knee” (M25.561, 3.09%), “Pain in Left Knee” (M25.562, 2.93%), and “Pain in Right Shoulder” (M25.511, 2.79%). Other codes of interest included “Gout, Unspecified” (M10.9, 1.99%), “Unspecified Osteoarthritis, Unspecified Site” (M19.90, 1.35%), “Rheumatoid Arthritis, Unspecified Site” (M06.9, 0.77%), and “Fibromyalgia” (M79.7, 0.61%). Of the 36 most used codes, 28 (77.78%) were nonspecific diagnoses that do not specify a site of involvement or that describe pain in a general anatomic region. Patient age, gender, race, and pain intensity scores were examined to compare demographic differences in diagnostic coding patterns. Our findings suggest that providers in VHA are selecting musculoskeletal diagnoses from a limited subset of ICD-10 codes. Despite over 6,000 possible M-codes, a small number of codes account for most MSD-related visits, possibly due to homogeneity in Veteran MSD conditions.

BASE TREND ON NUMBER OF RUSSIAN ADOLESCENTS (AGED 15-17) REQUIRE FOR MEDICAL SUPERVISION IN 2000-2015 YEARS

The increase in the incidence of adolescents in Russia is confirmed by many special studies. An analysis of the statistic data for 2000-2015 years, showed that in Russia there was an increase in the number of adolescents (15-17 years) require for medical supervision from 410 to 486 cases per 1000 of the corresponding population (18.5%), however over the last 5 years, it declines (an average annual growth of -1.1%). The highest growth in 15 years was found in the following classes: neoplasms (126.7%), congenital anomalies (malformations) (57.6%), diseases of the musculoskeletal system and connective tissue (58.2%), diseases of the cardiovascular system (55.0%). The decrease in the number of adolescents (15-17 years) require for medical supervision for the indicated period was in three classes: some infectious and parasitic diseases (-68.2%), mental and behavioral disorders (-46.2%), injuries and poisonings (-20.8%). The balance of the number of the studied group of adolescents in 2015 was negative and amounted to -9.1% due to the excess of the number of people taken out of the register (39.0%) over the number of registered persons (48.1%), what indicates a decrease in the number of adolescents require for medical supervision. At the same time, a positive balance was observed only in two classes: injuries and poisonings (42.1%), pregnancy, deliver and puerperium (9.1%). Negative balance of the studied contingent was observed for all other classes of diseases, the highest ones: congenital anomalies (malformations) (-17.9%), mental and behavioral disorders (14.9%), respiratory diseases (-14, 2). Since the health of children and adolescents determines the health of the future nation, its preservation is an important task, the implementation of which requires the development of prophylaxis for the prevention of diseases with the definition of their targeted introduction (school, home, healthcare institutions), as well as treatment of diseases of children and adolescents, including, the format of special medical observation.

INCIDENCE OF TEENAGE YOUNG MEN BY THE RESULTS OF MEDICAL EXAMINATION AT INITIAL MILITARY REGISTRATION

Teenagers’ health, the level and structure of incidence reflect totality of the influence of the factors and their living conditions, upbringing and training, a way of life, medical care. The results of medical examination of young men at initial military registration to a sufficient extent give an idea of the prevalence of pathology among this contingent and in many respects characterize the quality of labour and defendable potential. Material and methods . The results of medical examination of teenagers by the military physician board of the Novosibirsk Regional Military Registration and Enlistment Office from 2000 to 2014 with the total number of the examined subjects 252.2 thousand were used. The dynamic and comparative analyses of the indices for three time periods along with the assessment of the prevalence of the diseases by the disease classes, separate nosological groups and also the distribution of young men by the medical classification were carried out. Results. It was established that on average 62.7 % of the examined subjects had this or that pathology. At the same time, 22.5 % of all the diseases were revealed for the first time. It was shown that 87.7–88.7 % of all the pathology accounted for 8 basic classes of diseases. Among the diseases limiting the medical classification the main ones were mental and behavioral disorders and also the diseases of the musculoskeletal system and connective tissue. The temporary unfitness was determined by endocrine, nutritional and metabolic diseases, and the complete one was defined by mental disorders, diseases of the nervous system, endocrine pathology, diseases of the spine and their aftereffects, disorders of refraction and accommodation of the eyes, visual impairment, bronchial asthma, mental retardation, flat foot and other foot deformations, degenerative diseases of the nervous system, which accounted for 63.0 % of all. Conclusion . The study showed the feasibility of using the results of the medical examination to assess the health of teenage young men and the inclusion of these indices in social and hygienic monitoring.

Outpatient physiotherapy services in Latvian regional hospitals: Characteristics of receivers, the volume of services and source of funding

Objective: To analyse the outpatient physiotherapy services provided in the regional hospitals of Latvia in 2017 and the profile of their receivers. Methods: In the research, 7 regional hospitals of Latvia participated, in which the analysis of statistical documentation of 2017 was carried out. The following data was collected about the receivers of outpatient physiotherapy services: age, gender, clinical diagnosis and place of residence; about the volume of service provided – the number of visits per patient; about the source of funding (state budget, private resources, insurance). Results:In the regional hospitals of Latvia, outpatient physiotherapy services in 2017 were received by 6957 patients, the most commonly adults of working age with basic clinical diagnosis of the musculoskeletal system and connective tissue diseases, and children up to the age of one year with diagnosis of certain conditions originating in the perinatal period. Among the regional hospitals of Latvia there are significant differences in the volume of outpatient physiotherapy services provided to one patient with a similar clinical diagnosis and age. Latvian regional hospitals still do not have electronic records of all outpatient physiotherapy services, which does not allow to judge about provided services and their receivers, which are financed by patients private resources.

RESULTS OF MONITORING OF PRESCRIPTION OF POTENTIALLY DANGEROUS COMBINATIONS OF DRUGS IN PHARMACOTHERAPY UNDER INPATIENT TREATMENT

In case of combined pharmacotherapy, between drugs can occur interactions, which can be dangerous to the life and health of patients. Such combinations of drugs are considered to be one of the serious clinical problems, and are considered as errors that can be prevented. Therefore, it is relevant to determine the frequency of such appointments for further work on their prevention. Aim of the research. Determine the structure and prevalence of the appointments of potentially dangerous combinations of drugs in the treatment of patients under inpatient treatment for further optimization of pharmacotherapy. Materials and methods. In the automated mode, the lists of medical appointments of patients who were under inpatient treatment of 30 health facilities of Zhytomyr region in 2017 were monitored for the purpose of the simultaneous use of drugs, the interaction of which is dangerous. For further analysis by the levels of clinical significance using the Drug Interaction Checker system, the "Major" (hazardous) and "Moderate" (significant) combinations were selected on the Internet resource www.drugs.com. The frequency of the appointments of dangerous combinations, their prevalence by the nosological classes and the profiles of the offices of medical institutions was determined. Results. As a result of the monitoring of 69405 cases, it was found that the average number of prescriptions per patient was 5.6±1.2 titles. In 1390 cases of treatment (2.0 % of 69405) simultaneously prescribed medicines, the interaction of which could be dangerous. In the structure of dangerous combinations, 81.5 % is taken with the simultaneous administration of drugs containing active substances ketorolac and pentoxifylline. The frequency of potentially dangerous appointments was greatest in the treatment of patients with diseases of the blood and blood-forming organs (D50-D89) – 11.6 %, in diseases of the musculoskeletal system and connective tissue (M00-M99) – 7.7 %, in diseases of the nervous system – 5.0 % of all cases of treatment.

Reflexotherapy of diseases of the musculoskeletal system in children and adolescents. Educational and methodological guide

The training manual is based on many years of experience in the practical application of reflexotherapy in outpatient settings. The article presents a structural analysis of diseases of children and adolescents receiving treatment in the reflexology room of a childrens polyclinic, which revealed a high level of pathology of the musculoskeletal system and connective tissue and a steady growth trend of this group of diseases. Pathogenetic justifications, indications and contraindications for the use of reflexotherapy in Pediatrics and in diseases of the musculoskeletal system in particular are given. Principal therapeutic approaches and treatment regimens for patients with obstetric hand paralysis, spastic torticollis, migraine, Perthes disease and traumatic limb injuries are considered. Recommendations on the organization of outpatient use of reflexotherapy in Pediatrics, the methods used and their instrumental support are formulated. The training manual is intended for doctors who specialize in reflexology, already practicing reflexologists, orthopedic traumatologists and physiotherapists.