Primary Medical Care Research Articles

Лихоманка в дітей до 5 років: наскільки є безпечним домашнє телеконсультування

The use of home teleconsultation in outpatient pediatric practice has become widespread in many countries over the world, regardless of their economic situation. Each country has its own experience in the practical implementation of home teleconsultation in medical care for patients, but the issue of increasing its effectiveness remains topical. Purpose - to consider the issue of improving the efficiency and safety of home teleconsultation for children under 5 years old with fever. Materials and methods. The terms «home teleconsultation», «telemedicine sorting», «children», «fever» were searched using Pub Med Central databases. The data of the regulatory and legal protocols in Ukraine were taken into account while determining the recommendations. Results. Research in recent years proves that new forms of communication between a doctor and a patient, his parents or guardians create both additional opportunities and risks regarding various aspects of the quality of medical care. According to the data of literary sources, conclusions were made that the quality of home teleconsultation for children under 5 years of age is affected by: social and ethical features of communication with children and their parents; lack of standards/scenarios for telephone consultation for a specific pathology; lack of appropriate professional training of doctors. The article provides measures to improve home teleconsultation: the use of telesorting scenarios (NICE protocol/standard for children under 5 years with fever) using a «traffic light system», alarm symptoms («red flags») to predict the risk of serious illness and taking into account the availability of the use of the «safety net». There is a well-founded need for professional training of medical workers in the field of telemedical consultation. Conclusions. The implementation of home teleconsultation services in outpatient pediatric practice in situations where a child’s condition is assessed by a medical professional who cannot examine him because the child is geographically distant will contribute to a faster setting of priorities for the provision of primary medical care. In today’s environment, the NICE (2021) protocol/standard for the assessment and initial treatment of fever in children under 5 years of age is a clinical scenario that meets the requirements for home teleconsultation. The introduction of the leading international experience of organizing home teleconsultation for children under 5 years of age is the basis for improving programs of continuous professional experience of medical workers who provide assistance to children. No conflict of interests was declared by the authors.

Pediatric Ophthalmology Scope of Practice

ABSTRACT Purpose To determine practice patterns of pediatric ophthalmologists with respect to types of medical conditions cared for and age of patients treated due to limited data regarding pediatric ophthalmologists’ scope of practice. Methods A survey was sent to 1408 international and United States members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) membership through the group’s internet listserv. Responses were collated and analyzed. Results Ninety members (6.4%) responded. 89% of respondents confine their practices to pediatric ophthalmology and adult strabismus. The percentages of respondents who provide primary surgical and medical treatment of the following conditions include 68% for ptosis and anterior orbital lesions, 49% for cataracts, 38% for uveitis, 25% for retinopathy of prematurity, 19% for glaucoma, and 7% for retinoblastoma. For conditions other than strabismus, 59% restrict their practice to patients less than 21 years of age. Conclusion Pediatric ophthalmologists provide primary medical and surgical care for children with a wide variety of ocular conditions, including complex disorders. Awareness of this variety of practice might prove beneficial in encouraging residents to consider careers in pediatric ophthalmology. Consequently, fellowship education in pediatric ophthalmology should include exposure to these areas.

Empanelment of the Population to the Primary Medical Care Institution of Sri Lanka: A Mixed-Methods Study on Outcomes and Challenges.

The registration of individuals with designated primary medical care institutions (PMCIs) is a key step towards their empanelment with these PMCIs, supported by the Primary Health Care System Strengthening Project in Sri Lanka. We conducted an explanatory mixed-methods study to assess the extent of registration at nine selected PMCIs and understand the challenges therein. By June 2021, 36,999 (19.2%, 95% CI-19.0-19.4%) of the 192,358 catchment population allotted to these PMCIs were registered. At this rate, only 50% coverage would be achieved by the end of the project (December 2023). Proportions of those aged <35 years and males among those registered were lower compared to their general population distribution. Awareness activities regarding registration were conducted in most of the PMCIs, but awareness in the community was low. Poor registration coverage was due to a lack of dedicated staff for registration, misconceptions of health care workers about individuals needing to be registered, reliance on opportunistic or passive registration, and lack of monitoring mechanisms; these were further compounded by the COVID-19 pandemic. Moving forward, there is an urgent need to address these challenges to improve registration coverage and ensure that all individuals are empaneled before the close of the project for it to have a meaningful impact.

The model of a primary medical care specialist for cardiovascular diseases

Highlights. Ineffective clinical management of primary health care in the form of staffing shortage and low competence within the model of cardiovascular surgeons further contribute to the progression and complication of cardiovascular diseases. Primary health care specialist for cardiovascular diseases acts as a functional basis for clinical and organizational management of the processes of primary and secondary prevention of cardiovascular complications, the development of patients' adherence to recommendations and the formation of a healthy lifestyle. Improving professional skills and competencies of cardiovascular surgeons providing comprehensive medical care – surgical and conservative (the functional medicine model) remains an urgent healthcare issue.Aim. To develop a model of a PHC specialist (cardiovascular surgeon) in CVD and evaluate the clinical and managerial effectiveness of its implementation.Methods. The study (2016–2022) was conducted at the clinical diagnostic center of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow), “SM-Clinic” (Moscow) and Department of Health Organization, Medication Provision, Medical Technologies and Hygiene of the Medical institute RUDN University. The subject of the study is the competencies and skills of a cardiovascular surgeon in primary care. The development of a model of a PHC specialist was carried out on the basis of personal improvement and integration of professional competencies and skills of cardiovascular surgeons in the aspect of applying clinical management technology in CVD (Kicha D.I., Goloshchapov-Aksenov R.S., 2019). The study included patients over 65 years of age (n = 422). The mean age of the patients was 77±8.6 years. The subjects of the study were cardiovascular surgeons (n = 4) with ≥5 years of work experience. The effectiveness of the model was evaluated according to clinical and managerial indicators of achieving the goal in the implementation of the author's algorithm for the organizational and technological management of PHC (2020). The follow-up was 36 months. We compared the results of 2016–2018 – before the introduction of the model and 2019–2022 – period of use of the model. Research methods were as follows: content analysis, statistical, mathematical, analytical, comparative, expert. The t-White test was used to assess the significance. Differences in the compared parameters were considered significant at p&lt;0.05.Results. The developed model of a PHC specialist included components of patient orientation, the time of primary and repeated outpatient consultations, competencies and skills, adherence to surgical care and long-term clinical management, informatization, automation and systematization of the PHC process, interdisciplinary integration, implementation of the PHC algorithm and assessment efficiency. The obtained performance of the model is confirmed by significant differences in the compared indicators for the periods of 2016–2017 and 2018–2022: an increase in the availability of surgical endovascular care for patients with advanced atherosclerosis from 7 to 100% and the commitment of cardiovascular surgeons to surgical care and long-term continuous clinical management for the basis of improving and integrating the skills and competencies of mastering surgical and endovascular treatment technologies (from 25 to 100%); decrease in the frequency of repeated hospitalizations of patients during 3 years from 33% to 13% (p&lt;0.05) and ambulance calls from 9% to 0.13% (p&lt;0.05), a decrease in the incidence of acute cardiovascular diseases – primary acute myocardial infarction from 12 to 0% (p&lt;0.05) and recurrence of critical ischemia of the lower extremities from 36 to 0.1% (p&lt;0.05). The 3-year survival of patients was 96%. The main cause of death (sudden) in 17 patients (mean age 85±1.03 years) was the progression of heart failure.Conclusion. The developed model of a PHC specialist in cardiovascular diseases is an effective component that contributes to 96% survival rate of elderly and senile patients during 3 years of follow-up.

Non-face-to-face Treatment in Korea: Suggestions for Essential Conditions

Since February 24, 2020, non-face-to-face treatment has been temporarily allowed in Korea to protect patients and medical staff from COVID-19, and it has continued to be conducted until now. And on May 3, 2022, the Presidential Transition Committee announced the ‘National Tasks’ to be focused on, including the institutionalization of non-face-to-face treatment centered on primary medical care. Concerns about non-face-to-face treatment in the medical community are increasing, but non-face-to-face treatment is currently being conducted without any restrictions. In this article, I would like to propose essential conditions for the safety of patients so that non-face-to-face treatment can be performed as a complementary means of face-to-face treatment.

Gender-Affirming Clinics Subject to Onslaught of Threats, Harassment

Gender-Affirming Clinics Subject to Onslaught of Threats, Harassment

Estimating the prevalence of alcohol-related disorders and treatment utilization in Bremen 2016/2017 through routine data linkage.

In Germany, most individuals with alcohol dependence are recognized by the health care system and about 16% per year receive addiction-specific care. This paper aimed to analyze the prevalence and treatment utilization rate of people with alcohol dependence by type of addiction-specific care in the federal state of Bremen using routine and survey data. The number of individuals with alcohol dependence was estimated using data from the 2018 Epidemiological Survey of Substance Abuse (ESA). Furthermore, linked routine data of two statutory health insurances (SHIs), the German pension insurance (GPI), and the communal hospital group Gesundheit Nord - Bremen Hospital Group (GeNo), from 2016/2017, were analyzed. Based on SHI data, the administrative prevalence of various alcohol-related diagnoses according to the International Classification of Diseases (ICD-10), in various treatment settings, was extrapolated to the total population of Bremen. Based on all routine data sources, treatment and care services for individuals with alcohol dependence were also extrapolated to Bremen's total population. Care services included outpatient addiction care visits and addiction-specific treatments, [i.e., qualified withdrawal treatment (QWT), outpatient pharmacotherapy as relapse prevention, and rehabilitation treatment]. Of the survey-estimated 15,792 individuals with alcohol dependence in Bremen, 72.4% (n = 11,427) had a diagnosis documented with an ICD-10 code for alcohol dependence (F10.2) or withdrawal state (F10.3-4). One in 10 individuals with alcohol dependence (n = 1,577) used one or more addiction-specific care services during the observation period. Specifically, 3.7% (n = 675) received outpatient addiction care, 3.9% (n = 736) initiated QWT, 0.8% (n = 133) received pharmacotherapy, and 2.6% (n = 405) underwent rehabilitation treatment. The share of seeking addiction-specific treatment after diagnosis was highest among younger and male patients. Although more than half of the individuals with alcohol dependence are documented in the health system, utilization rates of addiction-specific treatments are low. These low utilization rates suggest that there are existing barriers to transferring patients with alcohol dependence into addiction-specific care. Strengthening primary medical care provision in dealing with alcohol-related disorders and improving networking within the addiction support system appear to be particularly appropriate.

Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study.

The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0-23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.

Minimum standard for equipping Moscow clinics with ultrasound diagnostic devices

BACKGROUND: A variety of ultrasound equipment and a lack of generally accepted classifications lead to inefficient equipment of medical organizations, incorrectly selected types of device, sets and probes characteristics, as well as a level of study quality. A systematic approach to equipping similar medical organizations with ultrasound devices will ensure the availability and improve the quality of primary medical care in outpatient centers.&#x0D; AIM: To develop a calculation algorithm and recommendations for the minimum standard for equipping regional outpatient medical facilities of the state healthcare system based on the Moscow example.&#x0D; MATERIALS AND METHODS: In conducting the study, we used software for statistical and comparative analysis based on the data of the Material Support Management System of the Unified Medical Information and Analytical System (MSMS UMIAS), Form No.30 of Federal Statistical Observation, as well as a number of assigned population to the outpatient center (hereinafter referred to as the OC), technical data, and reviews of modern ultrasound diagnostic devices.&#x0D; RESULTS: The developed minimum standard for equipment considers the following factors: 1) need to provide medical care to children and adult populations separately; 2) compliance with modern diagnostic technologies; 3) ensuring the territorial availability of diagnostics under the condition of efficient equipment operation.&#x0D; CONCLUSIONS: Standardization of equipment of outpatient medical facilities with ultrasound diagnostic devices contributes to improving the quality of diagnostics and the availability of providing required examinations to the assigned population, reducing the waiting time for examinations, reducing the shortage of necessary equipment, expanding the range of medical services provided to the city population, and minimizing duplicate studies at subsequent stages of medical care.

ANALYSIS OF MAIN TRENDS OF DEVELOPMENT OF HEALTH CARE IN UKRAINE.

The aim: To substantiate the conceptual approaches of building a cluster model of primary medical care at the level of the hospital district in terms of the development of family medicine, in particular, the consolidation of health care institutions as the main providers of medical services in the provision of primary medical care in the hospital district and improving its efficiency. Materials and methods: Methods of structural and logical analysis, bibliosemantic, abstraction and generalization were used in this work. Results: The analysis of the legal framework in the field of health care of Ukraine demonstrated multiple attempts to reform it in order to increase the availability and efficiency of medical and pharmaceutical services. The practical implementation of any innovative project becomes much more difficult or even impossible without a carefully developed plan. Today in Ukraine there are 1,469 united territorial communities, 136 districts, so more than one thousand primary health care centers (further written as PHCCs) have been created against, a possible 136. A comparative analysis indicates the economic validity and possibility of such changes - the creation of a single health care facility at the level of a hospital cluster to provide primary medical care. For example, the Bucha district of the Kyiv region consists of twelve territorial communities, and 11 primary health care centers (PHCCs), the latter have separate subdivisions under their control in the form of: general practice-family medicine dispensary (GPFMD), group practice dispensary (GPD), paramedic and midwifery points (PMP), paramedic points (PP). Conclusions: The implementation of a cluster model of providing primary medical care in the form of the creation of a single health care facility at the level of a hospital cluster has a number of advantages in the short term. For the patient, it is the availability and timeliness of medical care, at least at the level of the district, not the community; cancellation of paid medical services during the provision of primary medical care regardless of the place of its provision. For the subject of governance (the state) - cost reduction during the provision of medical services.

Fatigue Among Family Medicine Physicians in Slovenia.

Different authors define fatigue in different ways even though it is considered a very common symptom in the primary medical care. To explore level of fatigue among Slovene family physicians and factors contributing to fatigue. Modified Fatigue Impact Scale was used in our research. The link to the questionnaire website was sent through the mailing list of Medical Chamber of Slovenia, the Family Medicine Union - Praktik.um, the Family Medicine Association and the Young Physicians. 231 physicians answered the questionnaire in full. There were 180 (77.9%) females and 51 (22.1%) males. The average age was 45.3±10.4 years and their capitation amounted to averagely 2245.8±544.2. On average they had spent 13.1±11.3 years working as specialists. Women have significant higher levels of fatigue, 57.2% have scored above the threshold of 38 points. Working in the office after working hours at least three times in a week was significantly associated with total fatigue, adding 10.07 points to the score. The years working as a specialist is not an important statistical factor in differentiating fatigue among physicians, nor is the level of patient load. Working irregular hours is also not an important statistical factor. Slovenian family physicians are tired, as they have exceeded the limit given in the literature. Women are more tired, the most characteristic factor that contributes to fatigue is the extension of work in the clinic at least three times a week.

THEORETICAL AND PRACTICAL SPECIAL COMPETENCIES OF GENERAL PRACTICE DOCTORS-FAMILY PHYSICIANS IN PROVIDING MEDICAL ASSISTANCE FOR DISEASES OF THE EAR, THROAT, AND NOSE

Introduction. Currently, the health care system of Ukraine needs to be restored and optimized due to the situation caused by the military aggression of the Russian Federation against Ukraine and its consequences. At the same time, the availability of medical care is provided by primary medical care on the basis of general medical practice - family medicine. To provide the population with ear, throat, and nose diseases with quality medical care, family doctors must have special theoretical and practical competencies. This determined the relevance of the study. The objective of the study: to determine special theoretical and practical competencies for general practitioners-family doctors in providing medical care for diseases of the ENT organs and the optimal ways to acquire them. Materials and methods. Methods: bibliosemantic, expert assessments, statistical, structural, and logical analysis. Independent experts: 25 specialists according to the defined profile of providing medical care. Materials: project of special competencies of general practitioners-family doctors in providing medical assistance for diseases of the ear, throat, and nose. Results and their discussion. In the course of the study, special theoretical and practical competencies were determined for general practitioners-family doctors in providing medical care for diseases of the ENT organs and the optimal ways of acquiring them to provide the population with high-quality primary health care for otolaryngological diseases. Theoretical special competencies provide family doctors with knowledge of the anatomy and physiology of the external, middle, and internal ear, throat, and nose; clinical symptoms, diagnosis and treatment of the main diseases of the ENT organs and their prevention in the age aspect, as well as the principles of providing emergency care for urgent ENT pathology. The special practical competencies of family doctors in medical care for diseases of the ear, throat, and nose allow doctors to conduct a diagnostic examination and provide emergency medical care and treatment. Conclusion. Theoretical and practical competencies for general practitioners-family doctors in providing medical assistance for diseases of the ENT organs and the optimal ways of their acquisition have been determined by experts.

Fatigue Among Family Medicine Physicians in Slovenia.

Different authors define fatigue in different ways even though it is considered a very common symptom in the primary medical care. To explore level of fatigue among Slovene family physicians and factors contributing to fatigue. Modified Fatigue Impact Scale was used in our research. The link to the questionnaire website was sent through the mailing list of Medical Chamber of Slovenia, the Family Medicine Union - Praktik.um, the Family Medicine Association and the Young Physicians. 231 physicians answered the questionnaire in full. There were 180 (77.9%) females and 51 (22.1%) males. The average age was 45.3±10.4 years and their capitation amounted to averagely 2245.8±544.2. On average they had spent 13.1±11.3 years working as specialists. Women have significant higher levels of fatigue, 57.2% have scored above the threshold of 38 points. Working in the office after working hours at least three times in a week was significantly associated with total fatigue, adding 10.07 points to the score. The years working as a specialist is not an important statistical factor in differentiating fatigue among physicians, nor is the level of patient load. Working irregular hours is also not an important statistical factor. Slovenian family physicians are tired, as they have exceeded the limit given in the literature. Women are more tired, the most characteristic factor that contributes to fatigue is the extension of work in the clinic at least three times a week.

Expanding mental health services in low- and middle-income countries: A task-shifting framework for delivery of comprehensive, collaborative, and community-based care.

This paper proposes a framework for comprehensive, collaborative, and community-based care (C4) for accessible mental health services in low-resource settings. Because mental health conditions have many causes, this framework includes social, public health, wellness and clinical services. It accommodates integration of stand-alone mental health programs with health and non-health community-based services. It addresses gaps in previous models including lack of community-based psychotherapeutic and social services, difficulty in addressing comorbidity of mental and physical conditions, and how workers interact with respect to referral and coordination of care. The framework is based on task-shifting of services to non-specialized workers. While the framework draws on the World Health Organization's Mental Health Gap Action Program and other global mental health models, there are important differences. The C4 Framework delineates types of workers based on their skills. Separate workers focus on: basic psychoeducation and information sharing; community-level, evidence-based psychotherapeutic counseling; and primary medical care and more advanced, specialized mental health services for more severe or complex cases. This paper is intended for individuals, organizations and governments interested in implementing mental health services. The primary aim is to provide a framework for the provision of widely accessible mental health care and services.

Supplemental Material for Further Mapping of the MMPI-3 Onto HiTOP in a Primary Medical Care and a College Student Sample

Supplemental Material for Further Mapping of the MMPI-3 Onto HiTOP in a Primary Medical Care and a College Student Sample

Oncologists' Perspectives on Cancer Survivorship: What Role Should Primary Care Play?

Background: Despite calls for an enhanced role for primary care for individuals with a history of cancer, primary medical care's role in adult survivorship care continues to be marginal.Methods: We conducted in-depth interviews with 8 medical oncologists with interest in cancer survivorship from 7 National Cancer Institute designated comprehensive cancer centers to understand perspectives on the role of primary care in cancer survivorship.Results: Two salient overarching thematic patterns emerged. (1) Oncologist's perspectives diverge on if, how, and when primary care clinicians should be involved in survivorship, ranging from involvement of primary care throughout treatment to a standardized hand-off years post-therapy. (2) Oncologist's lack understanding about primary care's expertise and subsequent value in survivorship care.Conclusion: As oncology continues to be overwhelmed by rising numbers of aging cancer survivors with multi-morbidities, NCI-designated cancer centers should take a leadership role in integrating primary care engaged cancer survivorship.

НОВІ ПІДХОДИ ДО ВЕДЕННЯ ХВОРИХ НА САРКОЇДОЗ ЛЕГЕНЬ (методичний посібник)

Sarcoidosis is an inflammatory multi-systemic disease of unknown origin with wide spectrum of clinical manifestations. Sarcoidosis may affect practically any organ — predominantly lungs, lymphatic system, skin, eyes alone or in combination. The disease is characterized by formation of non-caseous granuloma. In 1999 American Thoracic society (ATS), European Respiratory society (ERS) and World Association of Sarcoidosis and Other Granulomatous diseases (WASOG) adopted an international consensus statement on diagnosis and treatment of sarcoidosis «Statement on Sarcoidosis». Based on ATS, ERS and WASOG 1999 Statement the national documents such as “Evidence-based adapted clinical guideline on sarcoidosis” and “Unified clinical protocol of primary, secondary (specialized) and tertiary (highly-specialized) medical care for sarcoidosis” approved by MOH of Ukraine (decree # 634 dated 08 Sep 2014) were developed by current authors in Ukraine. For a more detailed description of the principles of diagnosis and treatment of pulmonary sarcoidosis, we have developed and published methodological guidelines "Diagnosis of respiratory tract sarcoidosis" (2014) and "Treatment of pulmonary sarcoidosis" (2018). In 2020 ATS experts published an updated «Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline», according to which the diagnosis of sarcoidosis was based on 3 criteria: compatible clinical symptoms, presence of non-necrotizing granulomatous inflammation in one or more tissue samples (not always required) and exclusion of alternative causes of granulomatous disorder. Finally, in 2021 ERS task force report was published “ERS clinical practice guidelines on treatment of sarcoidosis”, which outlined completely new approaches to management of sarcoidosis patients. According to this document, a decision about treatment of patient depends on 2 major factors: risk of death or organ failure and deterioration of quality of life of a patient. In addition, main principle of management of sarcoidosis patients is a balance between: a) minimization of risk of disability or death due to lung injury and decrease of quality of life, and b) risk of comorbidity and reduction of quality of life due to corticosteroid or other therapies. Methodical guideline focuses on analysis of major statements of these documents, disputable questions of initial therapy choice in patients with pulmonary sarcoidosis.

ПЕРВИННА ПСИХОЛОГІЧНА ДОПОМОГА ПОТЕРПІЛИМ ІЗ СИМПТОМАМИ ГОСТРОГО СТРЕСОВОГО РОЗЛАДУ

Considering the high level of stressogenicity in the conditions of the existing war threat in Ukraine, the ability of psychologists to differentiate post-stress symptoms and to provide initial psychotherapeutic help to the victims in a timely manner is important and relevant. Analyzing the psychotherapeutic experience of Israeli, German, Czech, American, and Lithuanian colleagues, the article highlights the features of initial psychotherapeutic help that is in demand in Ukraine today. The author presents and compares the symptoms that arise as a result of psychological trauma, which are identified in the unified Ukrainian clinical protocol of primary, secondary and tertiary medical care and in IKH-10. The purpose of the article is to determine the psychological features of providing initial psychotherapeutic assistance to victims, in particular to military personnel. Research methods: theoretical analysis of scientific sources, observation of servicemen in hospital conditions, conversations with servicemen and doctors, interviews with foreign colleagues. As a result of theoretical and empirical research, it was found that initial psychological assistance is more effective if it is provided in a timely and comprehensive manner in cooperation with medical assistance; if the recommended exercises are performed systematically by the victim; if a certain algorithm for providing initial psychotherapeutic assistance is used. Conclusions. The author presents his own algorithm for providing initial psychological assistance to military personnel: psychophysiological stabilization – adjustment of emotional balance – restoration of cognitive processes and acquisition of constructive coping strategies – formation of life meanings that provide an opportunity to survive the crisis period of life. In the article, the author also notes the importance of providing psychological first aid to victims of extreme situations in a timely manner, which helps reduce the intensity of symptoms of acute stress disorder and reduces the likelihood of posttraumatic stress disorder.

ABOUT AUTISM

Autism is a neurodevelopmental disorder with an increasing prevalence. It comprises an entire spectrum of characteristics with two core manifestations: a defi cit în social communication and the presence of repetitive behaviours and interests. The primary medical care personnel has an important role in the identifi cation of children with suggestive signs and their redirectioning towards specialized services and also in the long term management of their overall health.

Перспективи впровадження навчання по удосконаленню знань, умінь та практичних навиків за фахом «Стоматологія» у сімейних лікарів на кафедрі ортопедичної стоматології НУОЗ України імені П. Л. Шупика

Relevance. Dental diseases, including dentoalveolar anomalies, have a significant prevalence and occupy a leading place in the structure of the general morbidity of the population of Ukraine. In the context of a pandemic and a state of war, the effectiveness of preventive measures has fallen sharply, which negatively affects the dental health of the population. An important role in solving this problem should be taken by family doctors, who are representatives of the primary level of health care. A family doctor should take a leading place in the prevention and detection of diseases, including dental diseases, pay special attention to hygiene education and education of the population, health education. Therefore, much attention has recently been paid to an interdisciplinary approach in dentistry, which will significantly improve the effectiveness of patient treatment. Purpose – scientific and methodological substantiation of the need for continuous professional development of general practitioners in dental care for the population at the dental departments of the National University of Health of Ukraine named after P.L. Shupyk. Results. Priority areas for training general practitioners in the preservation of dental health have been identified. Conclusions. Awareness of the family doctor with preventive dental measures will make it possible to bring primary medical care closer to the population, ensure its quality and accessibility, prevent the development of severe pathology and conduct appropriate comprehensive, including orthopedic treatment. Keywords: family doctor, prevention of dental diseases, primary health care.