Different Categories Of Patients Research Articles

Characteristics, treatment, and outcomes of spontaneous renal artery dissection: a 10-year retrospective single-center experience.

Spontaneous renal artery dissection (SRAD) is a rare cause of renal failure and renovascular hypertension, with the diagnosis often being delayed and treatment varying across different centers. The objective of this retrospective cohort study was to scrutinize the characteristics, treatment modalities, and outcomes of patients with SRAD at our center over the past ten years. Furthermore, the study sought to identify the most suitable treatment options for different categories of patients with SRAD. Data from 21 consecutive patients who presented with symptoms of SRAD from December 2013 to December 2023 were collected. Lesion characteristics, treatment options, blood pressure (BP) control, serum creatinine and estimated glomerular filtration rate (eGFR) were analyzed. A paired t-test was used for comparisons of BP, serum creatinine, and eGFR. An independent samples t-test was used to analyze baseline BP and BP change in different treatment groups. The mean age, weight, and height of patients with SRAD was 49.2±13.0 (range, 18-69) years, 69.0±9.7 (range, 50-80) kg, and 1.7±0.1 (range 1.6-1.8) m, respectively. New-onset hypertension was found in 8 (38.1%) patients. Renal artery dissecting aneurysm and renal artery stenosis were found in 1 (4.8%) and 4 (19.0%) patients, respectively. Supportive medical treatment alone, endovascular intervention, and nephrectomy were required in 15, 4 and 2 cases, respectively. Stable renal function and satisfactory hypertension control were obtained in all treatment groups, with a median follow-up of 18.1 (range, 12-32) months. Medical management is a reasonable choice in most patients with SRAD. Interventional management is an efficacious strategy for the management of renovascular hypertension and the preservation of renal function.

Latent profile analysis of perceived stress and influencing factors in colorectal cancer patients†

Abstract Objective To understand the latent categories of perceived stress in colorectal cancer patients and analyze the characteristics of different categories of patients. Methods A total of 255 colorectal cancer patients receiving treatment in the gastrointestinal surgery and oncology departments of a tertiary Grade A hospital in Sichuan Province, from January 2023 to June 2023, were selected as the study subjects. General information questionnaire, Chinese version of the Perceived Stress Scale (CPSS), and Comprehensive Score Table for Patient-Reported Outcome Measures of Economic Toxicity (COST-PROM) were used for data collection. Results Perceived stress in colorectal cancer patients was classified into 3 latent categories: C1 “Low stress-stable type” (19.2%), C2 “Moderate stress-uncontrolled type” (23.9%), and C3 “High stress-anxious type” (56.9%). The average score of perceived stress was (34.07 ± 5.08). Compared with C1 type, patients with a monthly household income of ≤3000 RMB were more likely to belong to the C2 and C3 types (P < 0.05), and patients without a stoma were less likely to belong to C3 type (P < 0.05). Compared with C2 type, male patients were more likely to belong to C3 type (P < 0.05), and patients without a stoma were less likely to belong to C3 type (P < 0.05). Compared with C3 type, patients with higher economic toxicity scores were more likely to be classified into C1 and C2 types (P < 0.05). Conclusions Perceived stress in colorectal cancer patients exhibits distinct categorical features. Male gender, lower income, presence of a stoma, and higher economic toxicity are associated with higher levels of perceived stress in colorectal cancer patients.

Sphingolipid Metabolism Is Associated with Cardiac Dyssynchrony in Patients with Acute Myocardial Infarction.

Sphingolipids are a class of complex and bioactive lipids that are involved in the pathological processes of cardiovascular disease. Fabry disease is an X-linked storage disorder that results in the pathological accumulation of glycosphingolipids in body fluids and the heart. Cardiac dyssynchrony is observed in patients with Fabry disease and left ventricular (LV) hypertrophy. However, little information is available on the relationship between plasma sphingolipid metabolites and LV remodelling after acute myocardial infarction (AMI). The purpose of this study was to assess whether the baseline plasma sphingomyelin/acid ceramidase (aCD) ratio predicts LV dyssynchrony at 6M after AMI. A total of 62 patients with AMI undergoing primary angioplasty were recruited. Plasma aCD and sphingomyelin were measured prior to primary angioplasty. Three-dimensional echocardiographic measurements of the systolic dyssynchrony index (SDI) were performed at baseline and 6 months of follow-up. The patients were divided into three groups according to the level of aCD and sphingomyelin above or below the median. Group 1 denotes lower aCD and lower sphingomyelin; Group 3 denotes higher aCD and higher sphingomyelin. Group 2 represents different categories of patients with aCD and sphingomyelin. Trend analysis showed a significant increase in the SDI from Group 1 to Group 3. Logistic regression analysis showed that the sphingomyelin/aCD ratio was a significant predictor of a worsening SDI at 6 months. AMI patients with high baseline plasma sphingomyelin/aCD ratios had a significantly increased SDI at six months. The sphingomyelin/aCD ratio can be considered as a surrogate marker of plasma ceramide load or inefficient ceramide metabolism. Plasma sphingolipid pathway metabolism may be a new biomarker for therapeutic intervention to prevent adverse remodelling after MI.

FEATURES OF PHYSICAL THERAPY FOR SCOLIOSIS

Introduction. The article analyzes contemporary domestic and foreign publications regarding the effectiveness of physical therapy (PT) in scoliosis treatment. Physical therapy is one of the key methods in treating scoliosis, a condition characterized by abnormal curvature of the spine. Scoliosis is a common problem that can occur at any age, but it is more frequently detected in children and adolescents. However, despite its prevalence, many people have a limited understanding of the effectiveness and importance of PT in treating this condition. Therefore, highlighting the importance of PT in scoliosis treatment, including its role in improving the patient's condition, preventing the progression of spinal curvature, and enhancing the quality of life of patients, is relevant. The aim of the study. The aim of the study is to investigate the effectiveness of physical therapy in scoliosis to determine optimal approaches to treating this condition and improving the quality of life of patients. Conclusions: Scoliosis is a common problem, especially among children and adolescents, and its treatment is an important medical issue. Since scoliosis can lead to serious health consequences, including pain, spinal deformity, and functional limitations, the search for effective treatment methods is crucial to ensure optimal outcomes for patients. Physical therapy is one of the potentially effective methods for treating scoliosis, as it aims to strengthen the back muscles, improve flexibility, and maintain proper spinal alignment. However, despite several studies confirming the effectiveness of PT, further scientific research is needed to establish its optimal parameters, such as types of exercises, duration, and intensity of training loads, as well as the impact of PT on different categories of patients with various degrees and forms of scoliosis.

Potential profiling of self-management skills in older co-morbid patients

BackgroundUnder the general trend of global aging, geriatric comorbidity is increasingly common, which may have some impact on the quality of life of the older people. Self-management can effectively improve patient compliance, subjective initiative, and improve patient quality of life. However, the present situation of self-management in different old people is different. Therefore, this study classifies older co-morbid patients through potential profiling analysis, understands the category characteristics of self-management level of older co-morbid patients, and discusses the influencing factors of self-management level of different categories of older co-morbid patients, which can provide reference for personalized intervention programs for different comorbidity characteristics of elderly people in the future. MethodThrough a cross-sectional study, 616 cases of older co-morbid patients in three districts of Zhengzhou City, Henan Province, were selected as survey subjects by using the whole cluster sampling method. The General Information Questionnaire, Chronic Disease Self-Management Scale, Health Literacy Scale, Electronic Health Literacy Scale, Collaborative Social Support Scale, and Health Empowerment Scale were used to conduct the survey.ResultsThe result of LPA shows that the self-management characteristics of older co-morbid patients should be classified into 3 categories: good self-management (19.4%), medium self-management(27.9%), and low self-management (52.7%). The results of multivariate logistic regression analyses show that literacy, religiosity, health literacy, e-health literacy, appreciative social support, and health empowerment are influential factors for self-management among older co-morbid patients (p < 0.05).ConclusionThere is obvious heterogeneity in the self-management level of older co-morbid patients. It is recommended that healthcare professionals give targeted interventions for their weaknesses according to the self-management characteristics of different categories of patients in order to enhance the self-management level of this population and improve their quality of life.

МАТЕМАТИЧЕСКИЕ МОДЕЛИ И ЧИСЛЕННЫЕ МЕТОДЫ В КАРДИОЛОГИИ: СОБСТВЕННЫЙ ОПЫТ

Вackground. In the era of digital transformation in medicine, which is radically changing the way patient information is stored, processed and used, medical professionals need new tools and approaches that can efficiently process and interpret data for fast and accurate decision making. These methods also enable the creation of personalized treatment approaches, taking into account individual patient characteristics and risks. In this article, the authors share their own experience in applying numerical methods in cardiology. Purpose of the study. To develop methods of effective risk assessment of cardiovascular outcomes in different categories of patients. Characteristics of patients and methods of the study. Three variants of outcome prediction were included in the study. The 1st - assessment of the total risk of one-year cardiovascular outcomes after myocardial infarction with ST-segment elevation, the 2nd - assessment of the risk of postinfarction chronic heart failure, the 3rd – assessment of the risk of progressive course of atherosclerosis. Statistical analysis methods included the free cross-platform visual programming system Orange, the SPSS 22.0 package, and the C programming language console. Results and Conclusion. The conducted study has shown that the application of different approaches: regression analysis, machine learning, Excel programming capabilities, C programming language and console interface allows to develop models of cardiovascular outcomes prediction with high accuracy.

Estimating cost of prostate cancer management: an experience from Tanzania

BackgroundProstate cancer (PC) is a significant public health problem affecting men worldwide and ranks third in incidence and mortality in East Africa. Cost of prostate cancer management is high in low-income countries because majority of patients presents with advanced (metastatic) PC. The cost related to management of PC including castrate resistant cancer in Tanzania has remained unknown; hence, policy makers do not have enough information for planning and resource allocation. This study therefore aimed to document costs related to the management of patients with prostate cancer including castrate resistant prostate cancer (CRPC) at Muhimbili National Hospital in Tanzania.MethodsThis was a retrospective descriptive hospital-based study which was conducted at Muhimbili National Hospital (MNH). Case notes of patients who were treated for prostate cancer were retrieved from medical records for review. A structured checklist was used to extract information regarding age, clinical presentation, investigations, stage of disease, type of treatment, payment modality and reimbursement. We considered data on the direct costs of prostate cancer management (diagnosis, treatment and follow-up) based on hospital price list of different categories. Costs reported were based on payment category in total and unit cost but also source of funding. Descriptive statistics were prepared and summarized as tables and figures.ResultsA total of 292 case notes of patients with prostate cancer were reviewed of which 189 patients received androgen deprivation therapy. Ninety-six (50.8%) met the criteria for the diagnoses of CRPC, and their mean age was 71.23 ± 4.2. Most of the patients had a poorly differentiated histology with prostate-specific antigen (PSA) over 100 ng/l. Bilateral orchiectomy was the most common treatment modality offered for advanced prostate cancer. Total cost for all PC patients was $148,136.4, equivalent to a unit cost per patient of $507.3. However, patients were in different categories of payment, 53% were public patients with an average cost of $471.3 per patient; 36.6% were cost sharing patients with an average cost of $441.8 per patient; 8.2% were National Health Insurance (NHIF) patients with an average cost of $893.8 per patient; and only 2.2% were private patients with an average cost of $1060.9 per patient.ConclusionCosts related to prostate cancer management need harmonization to accommodate different categories of patients in need.

Matching Market Design: Resource Matching Optimization in the Epidemic and Application of the Matching Theory

During the Covid-19 pandemic, the problem of inefficiency and one-sidedness of resources matching occurred, and economists proposed an innovative scheme-- reserve system. Different categories of patients, such as those with different symptoms, health care workers, and the elderly and young population, need to be matched with extremely limited medical resources (ventilator as study object in this research) in the epidemic. The upgrade from the current priority system to the reserve system which is capable of classified allocation is more in line with the fair and comprehensive ethical values, thus solving the complex matching problem better. Based on this original reserve system, this study further assists in explaining the concept connotation of its research on matching process, proposes possible improvements, and clarifies its effects and value. Moreover, based on this idea of matching, this study analyzes its role in the matching problem of "undergraduate-college".

Obstructive jaundice: routing, diagnostics, treatment tactics

Aim. To analyze three-level system of medical care for different categories of patients with obstructive jaundice on the example of Pavlov University.Materials and methods. The paper presents a retrospective analysis of treating patients with obstructive jaundice. The analysis covered the period from January 2015 to April 2023 and involved an etiology of obstructive jaundice, range of performed surgical interventions, postoperative complication rate, and mortality.Results. The study involved 2494 patients, including 1569 (62.9%) with cholelithiasis. The total mortality accounted for 7.2%, the incidence of postoperative complications – 13.9%. A choice of decompression procedure in patients with malignant tumors depended on the block level. Interventions included percutaneous transhepatic drainage, cholecystostomy, stenting of common bile duct. Hybrid surgery was performed in patients with calculous cholecystitis and choledocholithiasis. A number and size of concrements, a diameter of common bile duct influenced the choice of interventions and their volume. Two-stage tactics for stricture of biliodigestive anastomosis included percutaneous transhepatic drainage and reconstructive surgery. Endoscopic intervention was performed for choledocholithiasis. Procedures for stricture of biliary anastomoses after orthotopic liver transplantation involved endoscopic papillosphincterotomy, balloon dilatation of stricture and stenting of bile duct. Management of obstructive jaundice against the background of gestation included endoscopic papillosphincterotomy, lithoextraction, and, if necessary, treating the pregnancy termination threat.Conclusion. The routing of patients with obstructive jaundice to the 2nd and 3rd level of healthcare units is found necessary to be differentiated, depending on the etiology and severity of their condition. Obstructive jaundice in pregnant women requires the patient to be referred to the hospital of the 3rd level. Creation of a shared dispatch service responsible for a certain territory can reduce a number of routing stages.

Modeling Survival Time to Death among Stroke Patients at Jimma University Medical Center, Southwest Ethiopia: A Retrospective Cohort Study.

Stroke is a life-threatening condition that occurs due to impaired blood flow to brain tissues. Every year, about 15 million people worldwide suffer from a stroke, with five million of them suffering from some form of permanent physical disability. Globally, stroke is the second-leading cause of death following ischemic heart disease. It is a public health burden for both developed and developing nations, including Ethiopia. This study is aimed at estimating the time to death among stroke patients at Jimma University Medical Center, Southwest Ethiopia. A facility-based retrospective cohort study was conducted among 432 patients. The data were collected from stroke patients under follow-up at Jimma University Medical Center from January 1, 2016, to January 30, 2019. A log-rank test was used to compare the survival experiences of different categories of patients. The Cox proportional hazard model and the accelerated failure time model were used to analyze the survival analysis of stroke patients using R software. An Akaike's information criterion was used to compare the fitted models. Of the 432 stroke patients followed, 223 (51.6%) experienced the event of death. The median time to death among the patients was 15 days. According to the results of the Weibull accelerated failure time model, the age of patients, atrial fibrillation, alcohol consumption, types of stroke diagnosed, hypertension, and diabetes mellitus were found to be the significant prognostic factors that contribute to shorter survival times among stroke patients. The Weibull accelerated failure time model better described the time to death of the stroke patients' data set than other distributions used in this study. Patients' age, atrial fibrillation, alcohol consumption, being diagnosed with hemorrhagic types of stroke, having hypertension, and having diabetes mellitus were found to be factors shortening survival time to death for stroke patients. Hence, healthcare professionals need to thoroughly follow the patients who pass risk factors. Moreover, patients need to be educated about lifestyle modifications.

Personalized approach to pharmacotherapy of overactive bladder

The article provides an overview of modern approaches to pharmacotherapy of overactive bladder. It has been shown that the choice of drug therapy for overactive bladder should be made taking into account the pathophysiological mechanisms of the development of the disease, the characteristics of its clinical course, as well as the potential risks of developing side effects of treatment. A pathogenetic rationale for the choice of treatment tactics for different categories of patients is presented, including those with a hypersensitive bladder, bladder outlet obstruction, neurological and geriatric patients. The pharmacological properties of the β3-adrenergic receptor agonist mirabegron are described, which provide high efficacy and a favorable safety profile in the treatment of patients with overactive bladder. The practical issues of prescribing mirabegron in various clinical situations are considered.

Prediction of Atrial Fibrillation from Sinus-Rhythm Electrocardiograms Based on Deep Neural Networks: Analysis of Time Intervals and Longitudinal Study

ObjectiveArtificial Intelligence (AI) in electrocardiogram (ECG) analysis helps to identify persons at risk of developing atrial fibrillation (AF) and reduces the risk for severe complications. Our aim is to investigate the performance of AI-based methods predicting future AF from sinus rhythm (SR) ECGs, according to different characteristics of patients, time intervals for prediction, and longitudinal measures. MethodsWe designed a retrospective, prognostic study to predict AF occurrence in patients from 12-lead SR ECGs. We classified patients in two groups, according to their ECGs: 3,761 developed AF and 22,896 presented only SR ECGs. We assessed the impact of age on the overall performance of deep neural network (DNN)-based systems, which consist in a variation of Residual Networks for time series. Then, we analysed how much in advance our system can predict AF from SR ECGs and the performance for different categories of patients with AUC and other metrics. ResultsAfter balancing the age distribution between the two groups of patients, our model achieves AUC of 0.79 (0.72-0.86) without additional constraints, 0.83 (0.76-0.89) for ECGs recorded in the last six months before AF, and 0.87 (0.81-0.93) for patients with stable AF risk measures over time, with sensitivity of 90.62% (80.70-96.48) and diagnostic odd ratio of 20.49 (8.56-49.09). ConclusionThis study shows the ability of DNNs to predict new onsets of AF from SR ECGs, with the best performance achieved for patients with stable AF risk score over time. The introduction of this time-based score opens new possibilities for AF prediction, thanks to the analysis of long-span time intervals and score stability.

Deep reinforcement learning-based control of chemo-drug dose in cancer treatment

Background and objectiveAdvancement in the treatment of cancer, as a leading cause of death worldwide, has promoted several research activities in various related fields. The development of effective treatment regimens with optimal drug dose administration using a mathematical modeling framework has received extensive research attention during the last decades. However, most of the control techniques presented for cancer chemotherapy are mainly model-based approaches. The available model-free techniques based on Reinforcement Learning (RL), commonly discretize the problem states and variables, which other than demanding expert supervision, cannot model the real-world conditions accurately. The more recent Deep Reinforcement Learning (DRL) methods, which enable modeling the problem in its original continuous space, are rarely applied in cancer chemotherapy. MethodsIn this paper, we propose an effective and robust DRL-based, model-free method for the closed-loop control of cancer chemotherapy drug dosing. A nonlinear pharmacological cancer model is used for simulating the patient and capturing the cancer dynamics. In contrast to previous work, the state variables and control action are modeled in their original infinite spaces to avoid expert-guided discretization and provide a more realistic solution. The DRL network is trained to automatically adjust the drug dose based on the monitored states of the patient. The proposed method provides an adaptive control technique to respond to the special conditions and diagnosis measurements of different categories of patients. Results and conclusionsThe performance of the proposed DRL-based controller is evaluated by numerical analysis of different diverse simulated patients. Comparison to the state-of-the-art RL-based method, which uses discretized state and action spaces, shows the superiority of the approach in the process and duration of cancer chemotherapy treatment. In the majority of the studied cases, the proposed model decreases the medication period and the total amount of administrated drug, while increasing the rate of reduction in tumor cells.

Procalcitonin is elevated in severe malaria and is a promising biomarker of severe malaria and multi-organ dysfunction: A cross-sectional study and meta-analysis

BackgroundElevated procalcitonin (PCT) has been reported in bacterial infection and is positively associated with the severity of the disease. Patients with severe Plasmodium falciparum malaria also display higher procalcitonin levels compared to those with non-severe disease, indicating a possible role for bacterial infection in severe disease, however this observation remained variable in different study population. Furthermore, the significance of PCT in different clinical categories of severe malaria has not been evaluated so far. MethodsA total of 74 P. falciparum-infected subjects were enrolled in the study comprising of 55 cases complicated malaria [cerebral malaria- 14; non-cerebral severe malaria- 21; multi-organ dysfunction- 20] and 19 uncomplicated cases. Serum levels of PCT were quantified by fluorescence immunoassay. For meta-analysis, the literature search was performed in different databases, and all relevant articles were screened, and eligible reports were identified based on predefined inclusion and exclusion criteria. The meta-analysis was performed by comprehensive meta-analysis software V3 and MedCalc 20.218. ResultsPatients with severe P. falciparum malaria had significantly higher PCT levels compared to uncomplicated cases (p = 0.01). Analysis of PCT in different categories of patients with severe malaria revealed significantly elevated PCT in multi-organ dysfunctions compared to those with uncomplicated malaria (p = 0.004) and cerebral malaria (p = 0.05). Interestingly the receiver operating characteristics curve analysis showed procalcitonin as a promising biomarker for differentiating severe malaria (AUC: 0.697, p = 0.01) and multi-organ dysfunction (AUC: 0.704, p = 0.007) from uncomplicated malaria and other clinical categories of falciparum malaria, respectively. Furthermore, meta-analysis also revealed an elevated procalcitonin in severe malaria and it could be an important biomarker in the management of severe disease. ConclusionsPCT is elevated in P. falciparum-infected patients and could be a good biomarker for diagnosis of severe malaria and multi-organ dysfunction. It can help in the management of severe disease with additional treatment options.

Evaluation of knowledge and experience of fungal infections (mycoses) among clinical doctors in Senegal.

In order to assess the knowledge and experience of fungal infections (FIs) among clinicians in Senegal, a cross-sectional survey was carried out among medical practitioners in Senegal via a questionnaire designed with "Google Forms" between 24 January and 24 April 2022. A total of 100 clinicians responded to the questionnaire. Clinicians in the 31- 40-year-old age group formed the majority of respondents (51%). Male respondents were predominant (72%). Forty-one percent of respondents were general practitioners, 40% were specialist doctors, and the rest were residents. Dermatologists were the most common at 15% (6/40). In terms of clinicians' general knowledge of fungi, FIs and their therapeutic management, an average of 70% correct answers was recorded. The majority (70%) of respondents cared for between two to four different categories of patients at risk of invasive FIs (IFIs) at a time, with diabetes predominating. Eighty percent confirmed that they had been confronted with FIs, including 43% with superficial FIs, 3% with subcutaneous FIs and 5% with IFIs. Thirty-four percent of doctors stated that they had never suspected an IFI. Candidiasis was the most commonly mentioned mycosis by doctors. To support the diagnosis of these FIs, 22% of the clinicians said that they had recourse only to the clinical diagnosis. In total, 79% of clinicians responded that they had never used an antifungal chemoprophylaxis. In addition, 28% and 22% of practicing physicians chose a combination of antifungals for the chemoprophylaxis of invasive candidiasis and invasive aspergillosis, respectively. This survey shows that both clinicians' knowledge and experience of fungi, antifungals, FIs and their therapeutic management, as well as chemoprophylaxis, need to be improved. Indeed, half of the clinicians seem to be unaware of the incidence of FIs, in particular IFIs, which, nevertheless, represent some of the deadliest infectious diseases in the world.

Kinesiophobia and its associated factors in patients with coronary heart disease: a cross-sectional study based on latent feature analysis

ObjectivesThe aim of this study was to explore the current situation of kinesiophobia in patients with coronary heart disease, classify it based on potential profile analysis and explore the relevant...

Risk Factors for the Development of Parastomal Hernia: A Narrative Review.

Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.

Therapeutic learning as an organizational technology of tomorrow

BACKGROUND: According to the World Health Organization, global population aging is the main trend in the development of the society on the planet. Russia ranks 116th worldwide in terms of life expectancy. The development and implementation of measures aimed at preserving the able-bodied population of the country and slowing down the current trend of aging of the population with a focus on increasing life expectancy is manifested in national projects such as Health and Demography. Health-saving technologies for prolonging effective professional longevity of medical workers of older age groups will preserve a labor resource of the country and exclude economic losses of the state.&#x0D; AIM: The study aimed to determine the significance of individual risk factors affecting the professional effective longevity of physicians and form a set of measures to prolong the professional competence of physicians of older age groups.&#x0D; METHODS: In this study, the unit of observation is a physician providing medical care in the outpatient segment of Moscow and the Moscow region. The total number of subjects was 378. Sociological, analytical, and statistical methods and the method of organizational modeling were used. The main method was a face-to-face survey that included questionnaire data, questions on training, seniority, category, workload, and information assurance, and two blocks of questions to assess professional competencies and cognitive functions.&#x0D; RESULTS:&#x0D; &#x0D; An age-related decrease in the level of the physicians professional competence.&#x0D; An age-related decrease in the effectiveness of the prescribed treatment.&#x0D; A tendency toward an age-related increase in the proportion of cognitive disorders among physicians.&#x0D; Data analysis showing the need to implement a set of measures aimed at supporting the professional effective longevity of physicians of older age groups.&#x0D; &#x0D; CONCLUSIONS: The organizational technology represented by a complex of measures providing prolongation of professional effective longevity of physicians of older age groups was proposed. Essentially, the organizational technology is the prevention of chronic non-infectious diseases in conjunction with measures to optimize work activities and stimulate the professional competence of the physician. Therapeutic Learning Technology is a parallel annual dispensary examination of physicians of older age groups followed by a therapeutic and rehabilitation course based on the morbidity profile and combined with a cycle of continuing medical education. The therapeutic and rehabilitative course should include older physicians undergoing cognitive training and hemodynamic stabilization. Information support (a block of federally approved training materials, i.e. normative legal acts regulating medical activity, clinical guidelines, video manuals on schools for different categories of patients, and other materials) is placed at the geriatric contact center, providing each physician from the target group with prompt access both for the period of treatment and rehabilitation course and the entire period of the physicians medical activity.

Socio-psychological features in patients with pulmonary tuberculosis

BACKGROUND. The effectiveness of the therapy of patients with pulmonary tuberculosis (TB) of various categories is largely related to the psychotraumatic nature of the disease and treatment, however, their social and psychological features and the need for psychological help have not been sufficiently studied.&#x0D; OBJECTIVE. To study the socio-psychological features of patients with pulmonary TB depending on the category of the case and the terms of treatment.&#x0D; MATERIALS AND METHODS. 200 patients with pulmonary TB were interviewed anonymously, including 45 (22.5 %) – with new cases, 27 (13.5 %) – with repeated treatment, 128 (64.0 %) – with multiple drug resistance (MDR-TB), according to the special form of primary social and psychological assessment of a patient with TB – Patient Health Questionnaire (PHQ-9).&#x0D; RESULTS AND DISCUSSIONS. The difference in the presence of unfavorable social factors among TB patients of different categories was revealed: low income, unemployment, disability, bad habits, retirement age, negative social history (were in prisons, migrants or internally displaced, lack of permanent work) met 2-3 times more often among repeated cases of the disease and MDR-TB, than in patients with new cases of the disease. Depressive disorders at the initial stage of treatment were found in 95.0 % of all TB patients, and mostly the signs of depression were pronounced, as evidenced by: very low interest or satisfaction in ordinary things in 52.0 %; bad mood, depression or a feeling of helplessness in 91.5 %; difficulty falling asleep, interrupted or too long sleep in 90.0 %; a feeling of fatigue or exhaustion – loss of strength in 94.5 %; poor appetite or, on the contrary, overeating in 89.5 %; negative thoughts about oneself in 57.5 %; difficulty concentrating in 57.0 %. The duration of these symptoms for more than 7 days during the last 2 weeks in many interviewees indicates a significant expressiveness of depressive disorders in the vast majority of TB patients. The dependence of the psychological state of TB patients on the category of the case and the duration of treatment was established and statistically proven. In patients with repeated treatment and MDR-TB, symptoms of depressive disorders were not only more frequent, but also more severe than in patients with new cases. If 74.8 % of patients with repeated cases and 57.0 % of patients with MDR-TB had mild and moderate depression, then 77.8 % of patients with new cases had mild (subclinical) depression. In patients who were treated for more than 4 months, signs of depressive disorders were more pronounced compared to those who were treated for less.&#x0D; CONCLUSIONS. This study not only confirms the need for differentiated psychological support of the treatment process in phthisiology (depending on the category of the case and the duration of treatment), but also encourages the search for new approaches to the medical, social and psychological rehabilitation of TB patients, taking into account the negative impact of the war in Ukraine on the social and psychological condition of such patients and the characteristics of their management in wartime conditions. There is a need to introduce rates of psychologists and psychiatrists for constant counseling of TB patients.

The relationship between the dynamics of the spread of socially dangerous diseases and social inequalities and wartime conditions in Ukraine

The article analyzes the theoretical aspects of scientific researches the problems of spread the socially dangerous diseases and development of health sociology; highlights the results of expert survey of the specialists of public health centers, medical institutions, non-governmental organizations, scientists, conducted by employees of the Department of the Social expertise of the Institute of Sociology of NAS Ukraine in June-August 2022; the influence of existing social inequalities and military time on the spread of socially dangerous diseases is determined. The purpose of the article is to study the interrelation of the dynamics of spread the socially dangerous diseases with social inequalities and conditions of military time in Ukraine. The author made a detailed analysis of the current scientific approach in the field of health sociology, in particular: Ch. Winslow’s theory of "Factors", E. Wilson’s "Sociobiology", concepts of "Stressors" by H. Sale, "Disease of Civilization" by Ch. Rosenberg and "Social Maladaptation" by A. Honneth. The author paid special attention to studying the impact of social inequalities on the spread of socially dangerous diseases in Ukrainian society. In particular, the author highlighted unequal opportunities in access to medical care for different categories of patients with socially dangerous diseases, stigmatization (such forms as discrimination and self-stigmatization), territorial-spatial limitations and various quality of medical care. The analysis of the results of an expert survey of specialists of public health centers and medical institutions, non-governmental organizations and scientists, conducted by members of the Department of social expertise, Institute of Sociology, National Academy of Sciences of Ukraine in June and August 2022 made it possible to establish the influence of social inequalities on the spread of socially dangerous diseases in Ukrainian society. Special attention is paid to the role of Russian military aggression in the worsening situation with the spread of the socially dangerous diseases due to mass destruction of health care facilities, spontaneous movement of large populations, interruptions in the receipt of medicines for therapy, shortage of medical personnel and lack of access to free testing.