Sphere Of Patients Research Articles

Features of damage to the central nervous system and mental sphere in patients with comorbid post-COVID syndrome

The prevalence of post-COVID syndrome in patients treated on an outpatient basis ranges from 10 to 35 %; it can reach 80 % in patients with severe coronavirus infection. It is currently hypothesized that long-COVID may be due to both the direct effects of the SARS-CoV-2 virus and the biopsychosocial effects of COVID-19.The aim. To study the characteristics of damage to the central nervous system and mental sphere in patients with comorbid post-COVID syndrome.Materials and methods. To study the clinical features of the course of post-COVID syndrome, 98 patients who had suffered COVID-19 were examined. Of these, 18 (18.4 %) were men, 80 (81.6 %) were women. The mean age in the group was 56.05 ± 1.27 years. The examination program included a questionnaire, clinical examination, pulse oximetry, and assessment of exercise tolerance using the Borg scale. Statistical processing was carried out using the Statistica software package, version 6 (StatSoft Inc., USA). The results of the study are presented as a median, upper and lower quartiles. After analyzing the compliance of the studied indicators with the law of normal distribution (Shapiro – Wilk test), the groups were compared using the Wilcoxon test for pairwise comparison of related samples. Differences were considered statistically significant at p < 0.05.Results. Our studies of comorbidity and complications after COVID-19 infection revealed the most frequent involvement of three systems in the pathological process: cardiovascular, nervous and endocrine. Metabolic syndrome was detected in 67 % and involvement of the cardiovascular system was detected in 48.8 % of those examined.One of the main manifestations of post-COVID syndrome is damage to the central nervous system and mental sphere in the form of mild cognitive and emotional-volitional disorders with asthenodepressive and anxiety-depressive disorders.Conclusion. The health status of patients after COVID-19 is significantly lower than that of the general population. The study results indicate an urgent need to study the pathogenesis of long COVID and develop effective interventions to reduce the risk of its development.

LYMPH-Q translation, cultural adaptation and validation in Italian language: A prospective PROMs-based study on breast cancer-related arm lymphedema for patients’ education

BackgroundUpper Extremity Lymphedema following oncological breast surgery affects not only the patient's physique, but also the patient's psychological sphere. One of the best known PROMs-based questionnaires for investigating the condition is the LYMPH-Q. The study aimed to perform the Italian translation and cultural adaptation of the LYMPH-Q and to assess if, independently from disease evolution, arm sleeve improves QoL in these patients. Materials and methodsTranslation included 4 steps: Forward translation, Back translation, Back translation review and Patient interviews. The questionnaire was administered to 50 female patients older than 18 years of age with UEL who received a prescription for daily use of a compression sheath. A second administration took place 30 days after. Forty-four patients completed the study (Group 1: 26 patients with indication to use compression sleeve who wore it; Group 2:18 patients who despite the prescription did not want to wear it. A descriptive statistical analysis was performed with Prism 9 software. ResultsT-tests showed statistical significance for changes in “Symptoms,” “Function,” “Appearance” and “Psychological” scales. There were no statistically significant changes for “Information scale” in Group 1 and for all scales in Group 2. ConclusionData from this observational study show that HR-QOL analyzed from the patients' perspective also tends to improve in terms of symptoms, function, appearance, and psychological sphere in patients with BCRL when using a compression sheath. The Lymph-Q has proven to be a valuable ally of the physician attempting to improve treatment approaches for BCRL based not only on scientific evidence but also on PROMs.

Peculiarities of the affective sphere in patients with different forms of diffuse alopecia

Background. To determine the peculiarities of the affective sphere in patients with different forms of diffuse alopecia, in order to develop personalized approaches to treatment and rehabilitation for this contingent of patients in the future. Purpose. To determine the features of the affective sphere in patients with different forms of diffuse alopecia, for the development, subsequently, personalized approaches to treatment and rehabilitation for this contingent of patients. Materials and Methods. Our examination involved 153 women aged 25 to 45 with diffuse alopecia. By means of a structured interview according to the criteria of International Classification of Diseases, 10th Revision (ICD-10) and the psychodiagnostic method, three groups were distinguished among female patients at the first stage of the work: without signs of mental maladjustment (MM) numbering 45 people (group 1 – G1); with separate signs of maladjustment, numbering 73 people (group 2 – G2); and with the adjustment disorders according to the ICD-10 criteria, numbering 35 people (group 3 – G3). Taking into account the genesis of alopecia within each of these groups the following two subgroups were distinguished: metabolic (45 patients) or mixed (108 patients). Further study of the affective sphere of the examinees, which was conducted at the second stage of the work, was carried out by clinical-psychopathological and psychometric methods (using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) and The Beck Depression Inventory). Results. The mental state of patients with diffuse alopecia of both metabolic and mixed genesis is characterized by diversity and clinical-psychopathological heterogeneity along the axis «mental health – adjustment disorders F43.2». Among this contingent there are mentally healthy individuals (a total of 29.4%, 66.7% of them with metabolic alopecia, 13.9% with mixed alopecia), patients with mosaic signs of mental maladjustment (MM), the variability and intensity of which do not reach the nosologically defined level (only 47.7%, 20.0% of them with metabolic alopecia and 59.3% with mixed alopecia), and patients with adjustment disorders of cluster F43.2 (total 22.9%, 13.3% of them with metabolic form of alopecia and 26.8% with a mixed form of alopecia). Thus, the majority of female patients with diffuse alopecia are in a state of mental maladjustment (47.7%), having individual symptoms of different, but not very significant severity, while the quantitative difference of both mentally healthy people and persons with stress-associated adjustment disorders (29.4% and 22.9%, accordingly), is not statistically significant. In the structure of mental pathology in patients with diffuse alopecia, there are relevant differences depending on the genesis of the dermatological disease: mentally healthy people predominate (66.7%) among patients with metabolic alopecia, while among people with a mixed form of alopecia, the majority have signs of mental maladjustment (MM) (59.3%), and a little less than a third (26.8%) – clinically formed adjustment disorders. Clinical variability and intensity of psychopathological affective anxiety-depressive symptoms also varies depending on the genesis of alopecia, having significant differences in expressiveness in patients with a mixed form, in contrast to the metabolic one. This applies to both the leading depressive and anxiety clinical-psychopathological phenomena. Conclusion. The revealed regularities should be taken into account when developing a strategy of personalized treatment of patients with diffuse alopecia.

Features of the pathodynamics of psychosomatic pathology (based on the psoriasis model) under the influence of large-scale social crises

Background. Psychoemotional stress is a relevant factor in the recurrence of psoriasis. In recent years, the population of Ukraine has been experiencing strong social stress related to the COVID-19 pandemic and the war. Studying the influence of social stress on the recurrence of psoriasis allows for the personalization of therapeutic and preventive measures aimed at normalizing the psycho-emotional sphere in patients with psoriasis. Purpose – to investigate the relationship between the influence of stress and the pathodynamics of psychosomatic pathology (on the model of psoriasis) during periods of social upheavals, to determine, in the future, targets of medical and psychological support of the population during large-scale social crises. Objectives of the study: to determine the frequency of recurrence of psoriasis during the action of powerful social stress, their connection with social stress, and features of psychopathological manifestations during exacerbations taking into account the scale. Materials and Methods. 39 men and 44 women with psoriasis were examined using a specially developed online questionnaire. Results. It was found that 36.1% of patients had an exacerbation of psoriasis in the first year of the COVID-19 pandemic (38.6% of women and 33.3% of men), and the majority (63.3% of patients) associated this exacerbation with stress pandemic Exacerbation occurred insignificantly more often in refugees: 38.9% vs. 34.0% (p>0.05); among local residents, the impact of stress was more often noted by women (66.7% vs. 57.1%, p>0.05), and among refugees by men (66.7% vs. 62.5%, p>0.05). The structure of psychopathological manifestations during an exacerbation during the COVID-19 pandemic was dominated by fear and anxiety (80.0%), low mood (66.7%), dyssomnias (50%), manifestations of asthenia (36.7%), emotional lability and irritability (33.3%), with the prevalence of all psychopathological symptoms being slightly higher among women. It was found that the stress of war was associated with a higher frequency of psoriasis exacerbations (49.4%) and a higher association with social stress (82.9%), more significantly in refugees (55.6% vs. 44.7%, p>0, 05), and among men (51.3% vs. 47.7%, p>0.05). This is a significant (p<0.01) more than during the Covid-19 pandemic, the same differences are detected for men (p<0.01) and women (p <0.05). Statistically significant exacerbation occurred after the start of the war compared to the Covid-19 pandemic in IDPs in general (p <0.05) and in men-IVPO (p <0.05). Affected by psychopathological symptoms during exacerbations during wartime was also higher than the pandemic period: fear, anxiety – 97.6%, reduced mood – 92.7%, asthenisation – 51.2%, irritability – 39.0%. Moreover, men were greater than the prevalence of low mood and emotional lability. Conclusion. The determining factor of exacerbation of psychosomatic pathology (on the model of excerbation of psoriasis) is the content of stress factor and features of individual response to stress, while gender differences of response, and even the fact of forced resettle during large-scale social crises, are less significant. The prospects for further research are to study the role of large-scale social crises with the recurrence of psychosomatic pathology, and to develop on the basis of these personalized medical and psychological support measures.

Characteristics of the affective sphere in patients with negative symptoms in schizophrenia

Introduction. The prevalence of schizophrenia in the world reaches 1.4 %, and the number of patients with negative disorders in this group is 90.0 %. Negative symptoms (NS) can be considered the main category symptoms of schizophrenia. They are described as a change in the patient’s usual behavior, which is usually caused by a decrease or lack of motivation, interest, and a violation of the emotional component. Currently five signs are considered key manifestations of schizophrenia NS: flattened affect, alogia, anhedonia, asociality and abulia. The leading manifestation of NS is a flattened affect, characteristic with the weakness of emotional reactions, emotional blunting with a decrease in the brightness of feelings, empathy, indifference to others, misunderstanding of the subtleties of human communication, formality, superficiality of interpersonal relations, low expressiveness of gestures and facial expressions, modulation of voice, posture and emotions. All these manifestations have negative social consequences. At the moment, understanding disorders of the affective sphere manifestations in patients with NS in schizophrenia is far from complete; subsequently the development of innovative treatment of this particular condition has been far too slow, being considered an unsolved problem in modern psychiatry. Therefore, the investigation of the features of the affective sphere in patients with NS in schizophrenia is relevant and requires further careful studies. The aim of the study – to determine the peculiarities of the dynamics of the clinical-psychopathological structure and the severity of affective flattening in patients with NS in schizophrenia in order to improve the diagnosis and correction of the affective sphere in schizophrenia. Materials and methods. Clinical-psychopathological, psychometric (SANS scale) and statistical research methods were used to study the dynamics of the characteristics of the affective sphere in patients with negative symptoms in schizophrenia. In total 252 patients with NS of schizophrenia took part in the investigation, including: 83 patients with a first psychotic episode; 88 patients with schizophrenia in a state of exacerbation; and 81 patients with schizophrenia in a state of remission. Results. Verification of negative violations was carried out using the SANS scale. Affective flattening or blunting prevailed in 34.67 % of patients with a first psychotic episode, in 49.18 % of patients with schizophrenia in a state of exacerbation, and in 68.21 % of patients with schizophrenia in a state of remission. The main manifestation included impoverished expressiveness of reactions and emotional sensitivity. Weakening of emotional reactions, mental coldness, indifference, monotony were also observed. On this background, many patients lost all feelings for relatives and loved ones, and showed complete indifference to themselves and their condition. It was found that the most affected components in patients with a first psychotic episode were reduced expressiveness of speech, avoidance of eye contact, subjective feeling of loss of emotions, and inadequacy of affect. In patients with schizophrenia in a state of exacerbation, intensification of affect was added to the listed symptoms, and in patients with schizophrenia in a state of remission, indicators of intensification of affect increased and symptoms of impoverished motor expressiveness, decreased spontaneous mobility, and impoverished facial expressions were added. Conclusions. The peculiarities of the dynamics of the characteristics of the affective sphere in patients with negative symptoms in schizophrenia were established: a) patients with the first psychotic episode (group I) were characterized mainly by minimal disturbances of emotional reactions and minimal manifestations of impoverished facial expressions; lack of reduced mobility; minimum and average levels of motor expression disorders; a slight level of inadequacy of affect, a subjective feeling of loss of emotions and eye contact disorders; mainly a moderate level of speech intonation deficiency; b) patients with negative symptoms of schizophrenia in an acute state (group II) were characterized mainly by mild and minimal levels of facial expression impoverishment; minimal decrease in spontaneous mobility; mainly minimal and average levels of expressive motor disorders; pronounced and severe levels of eye contact avoidance; a slight decrease in emotional reactions; moderate level of inadequacy of affect, lack of language intonations and subjective feeling of loss of emotions; c) patients with negative symptoms of schizophrenia in a remission (III group) were characterized mainly by moderate and pronounced levels of impoverishment of facial expressions, spontaneous mobility, motor expressiveness, avoidance of eye contact, reduction of emotional reactions; moderate inadequacy of affect; lack of language intonations of pronounced and severe levels; expressed subjective feeling of loss of emotions. The obtained data can be used to establish diagnostic criteria among patients with negative symptoms in schizophrenia, depending on the dynamics of the disease.

Identifying barriers and utility of obtaining ambulatory blood pressure monitoring in a pediatric chronic kidney disease population

BackgroundHypertension is a prevalent complication of Chronic Kidney Disease (CKD) and Ambulatory Blood Pressure Monitoring (ABPM) is the gold standard for diagnosis. The aim of our study was to assess the usefulness of obtaining ABPM and to identify barriers to ABPM in this pediatric patient population.MethodIn this retrospective analysis of patients with CKD stage 3–5 who were seen in one academic medical center’s outpatient Pediatric Nephrology clinics between 2018 and 2021, we performed logistic regression to evaluate for associations between demographic factors and odds of having an ABPM.ResultAmong 96 patients included in the study, 48 patients carried a diagnosis of hypertension. 31 patients had ABPM performed with usable data. In those who had ABPM done, 21 had normotension and 10 had undertreated hypertension. Our study also showed 1 had masked hypertension and 5 had white coat hypertension or effect. We did not find a statistically significant difference in those who did or did not undergo ABPM evaluation based on gender, previous diagnosis of hypertension, distance from clinic, language preference, or racial or ethnic identity.ConclusionABPM is a useful tool in our CKD population for the diagnosis and management of hypertension. We did not identify specific barriers to ABPM in our CKD population, and there were no differences in patients who obtained ABPM when looking at specific demographic and disease characteristics. Given these findings, we recommend focusing on areas of future improvement in spheres of patient and provider education as well as better quantification using surveys to further illuminate barriers.

Evaluation of the sexual sphere in patients with psoriatic arthritis

IntroductionPsoriatic arthritis (PsA) is a chronic inflammatory disorder that primarily affects the joints and entheses. In addition, it is associated with depressive syndrome (DS), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), obesity and psoriasis (Pso). There are few studies aimed to analyze the association of the involvement of the musculoskeletal system with sexual function (SF). MethodsA cross-sectional observational study was proposed in patients diagnosed with PsA, to whom self-administered validated questionnaires were applied to determine alterations in SF: MGH-SFQ and CSFQ-14, which assess the 4 domains of sexual function; Qualisex and DLQI designed for joint and dermatological pathology respectively, which explore sexual aspects. The objective was to describe the existence of altered sexual function in patients with PsA; analyze the association between sociodemographic characteristics, comorbidities (Pso, DS, cardiovascular risk factors) and the treatments of patients on SF; and describe differences of SF according to gender. Results72 patients were evaluated. It was observed that the variables of patients with PsA that were associated with lower scores in SF were gender and age in the CSFQ-14 and MGH-SFQ; annual incomes, treatment with NSAIDs, DL and depression were associated with worse results in some domains of the sexual sphere. ConclusionsPatients with PsA had impaired SF, especially women, elder patiens, those with low annual incomes, DL and emotional disorders. Anti-inflammatory treatments were associated with better SF. Globally, the chronic disease and the psychological burden behaved as factors associated with sexual dysfunction.

Prevalence of Anxiety and Depression Symptoms in Patients Diagnosed with Atopic Dermatitis in Mexico: A Cross-Sectional Study

Introduction: Atopic Dermatitis (AD) is one of the most common inflammatory skin diseases affecting individuals of all ages. It is proposed that intense pruritus, sleep cycle disturbances, stigmatization, and social isolation due to the visual nature of the disease, along with the poor quality of life and the presence of neuroinflammation, contribute to the development of anxiety and depression. According to recent systematic reviews and meta-analyses evaluating the relationship between AD, anxiety, and depression, there is a higher likelihood of developing depression during the disease, predominantly in children and both disorders in adults. However, no Mexican studies have determined the prevalence of anxiety and depression symptoms in children, adolescents, and adults diagnosed with AD. Objective: To determine the prevalence of anxiety and depression symptoms in patients diagnosed with AD. Material and Methods: This is an observational, cross-sectional, and comparative study. We included forty-eight patients who met the inclusion criteria and applied two self-administered screening questionnaires for anxiety and depression symptoms. Results: A prevalence rate of depression symptoms of 4.5% and 16.7% were found in children and adolescents, respectively, and 27.3% and 16.6% for anxiety symptoms, respectively. On the other hand, in the group of adults, the presence of clinically significant symptoms of anxiety and depression was present at 40% and 45%, respectively. Conclusion: It is crucial that allergists evaluate the psycho-emotional sphere in patients with AD with the available screening tools with the aim to identify and refer in a timely manner.

FEATURES OF THE PSYCHO-EMOTIONAL SPHERE IN PATIENTS WITH HEMISPHERIC ISCHEMIC STROKE DEPENDING ON THE PRESENCE OF COVID-19 IN HISTORY

This article discusses the features of the psycho-emotional sphere in patients with hemispheric ischemic stroke depending on the presence of COVID-19 in history. The hemodynamic subtype was excluded from the study due to the small number of patients, IS of unspecified etiology - due to the possibly heterogeneous structure of the pathogenesis of IS.

Evaluation of the Effectiveness of Neurocognitive Rehabilitation of Patients with Mild Cognitive Decline under Restrictions during the COVID-19 Pandemic

Background: the development of programs for the correction of cognitive impairment in elderly patients with various types of mild cognitive decline is an urgent task of geriatric medicine and clinical psychology. The aim of the study was to conduct neuropsychological and psychometric evaluation of the results of a modified neurorehabilitation program (combination of full time and part time studies) in patients of the “Memory Clinic”. Patients and methods: a total of 114 patients (mean age 73 years) with mild cognitive impairment was studied. Neuropsychological and psychometric evaluation of the dynamics of the cognitive sphere in patients with mild cognitive decline (MCI) before and after participation (week 6) in the full-time/part-time neurorehabilitation program at the “Memory Clinic” was carried out. For psychometric assessment, the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were used. The neuropsychological study was carried out using the “Express Method for the Study of Cognitive Functions at a Late Age” (N.K. Korsakova et al.). For psychometric assessment, the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were used. The neuropsychological study was carried out using the “Express Method for the Study of Cognitive Functions at a Late Age” (N.K. Korsakova, E.Yu. Balashova, I.F. Roshchina). Results: using the method of multivariate analysis of variance (MANOVA), a statistically significant effect (p < 0.05) of the neurorehabilitation program on psychometric tests (MMSE, MoCA) and on the total score of the “Express Methods for the Study of Cognitive Functions at a Late Age”, as well as on its subscales —verbal memory, visual memory, semantic memory, dynamic, spatial and regulatory praxis was detected. Conclusions: a psychometric and neuropsychological study showed the effectiveness of a full time/part-time neurocognitive rehabilitation program for patients with mild cognitive decline under conditions of limited visits to the Memory Clinic during the COVID-19 pandemic.

Diagnosis of channelopathies affects quality of life and psychological status in patients and relatives

Abstract Background Cardiac channelopathies are a group of inherited cardiovascular diseases with increased risk of sudden cardiac death in structurally normal hearts. The psychological status after their diagnosis has not been thoroughly studied. Purpose To establish health-related quality of life (QOL) and emotional response to the diagnosis of channelopathies in a cohort of patients and their families. Methods Adult patients with diagnosis of channelopathies and their relatives were eligible. After enrolment they were divided in 3 groups, according to the time of psychological evaluation: At diagnosis (T0), one year (T1), and 2 years after diagnosis (T2). Psychological evaluation was conducted through self-report questionnaires on QOL (SF-12), general anxiety (BAI), depression (BDI-II), perceived stress (PSS-10), post-traumatic stress (IES-R), and protective resilience resources (RSA). Results From August 2020 to April 2021, 64 patients (95% Brugada syndrome, 3% long QT syndrome, and 2% catecholaminergic polymorphic ventricular tachycardia) and 41 relatives were enrolled. A control group of 105 healthy subjects, matched to the study group regarding age, gender and level of education, was also enrolled. Patients at T0 showed increased physical and reduced mental QOL; at T1, reduction of RSA; and at T2, reduction of RSA and increased BAI. A significant percentage of patients referred the occurrence of a traumatic event during their lifetime at T0, T1 and T2 (Figure 1). At T0 relatives presented high PSS-10 and a high proportion of them reported experiencing a traumatic episode during their lifetime. BAI score was high among relatives at T0, T1 and T2, reaching levels of concern 2 years after the diagnosis (Figure 2). Female gender independently predicted MCS-12 in patients at T0. Conclusions Diagnosis of channelopathies impact different areas of QOL and the psychological sphere in patients (QOL, resilience, anxiety and occurrence of traumatic events during lifetime) and relatives (anxiety, stress, and occurrence of traumatic events during lifetime), and at different moments after the diagnosis. Female gender was an independent predictor of worse mental QOL in patients at T0. Patients and their families should be involved in psychological counselling and psychoeducational interventions, taking into account their differences and the timing of psychological responses, in order to better support them in adjusting to their new life circumstances. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Regione Autonoma della Sardegna

Assessment of Sexual Dysfunction in Cervical Cancer Patients after Different Treatment Modality: A Systematic Review.

Background and Objectives: Cervical cancer is a leading cause of mortality among women. Chemo-radiation followed by interventional radiotherapy (IRT) is the standard of care for stage IB–IVA FIGO. Several studies have shown that image-guided adaptive IRT resulted in excellent local and pelvic control, but it is associated with vaginal toxicity and intercourse problems. The purpose of this review is to evaluate the dysfunctions of the sexual sphere in patients with cervical cancer undergoing different cervix cancer treatments. Materials and Methods: We performed a comprehensive literature search using Pub med, Scopus and Cochrane to identify all the full articles evaluating the dysfunctions of the sexual sphere. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results: One thousand three hundred fifty-six women included in five studies published from 2016 to 2022 were analyzed. The median age was 50 years (range 46–56 years). The median follow-up was 12 months (range 0–60). Cervical cancer diagnosis and treatment (radiotherapy, chemotherapy and surgery) negatively affected sexual intercourse. Sexual symptoms such as fibrosis, strictures, decreased elasticity and depth and mucosal atrophy promote sexual dysfunction by causing frigidity, lack of lubrication, arousal, orgasm and libido and dyspareunia. Conclusions: Physical, physiological and social factors all contribute to the modification of the sexual sphere. Cervical cancer survivors who were irradiated have lower sexual and vaginal function than the normal population. Although there are cures for reducing discomfort, effective communication about sexual dysfunctions following treatment is essential.

Phenomenology of ideas of gender change in patients with schizotypic disorder

Objective: a psychopathological analysis of the ideas of sex change and a description of the state of the sexual sphere in patients with schizotypal disorder. Materials and methods: we examined 38 patients who applied with a request to change their passport sex and were diagnosed with schizotypal disorder, 27 of them were women, 9 were men. Methods: clinical-psychopathological, sexological. To assess the sexual sphere and identify the motivation for changing sex and plans for the future a specially designed questionnaire was used. Results: variants of the ideas of gender reassignment were identified: obsessive, fixed, dominant, overvalued, delusional, their features specific to schizotypal disorder were described. For each variant, varying degrees of severity of violations of criticality and features of sexual behavior are described. An analysis of the characteristics of the sexual sphere of the studied groups showed the predominance of delays in psychosexual development and the associated deactualization of this sphere. In order to characterize the ability to adequately assess one's state, it is necessary to assess criticality as a variant of capacity, the issue of its methodology needs to be developed. Conclusions: the selected options differ in the degree of violation of criticality, which should be taken into account when deciding whether to change the passport gender.

Functional Capaсities of Limb Muscles in Patients with Partial Damage to the Cervical Spinal Cord

INTRODUCTION: In the long-term course of traumatic spinal cord disease (TSCD), neuroplastic adaptive and maladaptive changes occurred on different structural levels of the nervous system, which leads to a shift in the activation and strength characteristics of the limb muscles. The standard neurological assessment is approximate; therefore, objective instrumental studies of the motor sphere of patients with partial damage to the cervical spinal cord have not lost their significance.
 AIM: To study the activation and strength characteristics of the limb muscles of patients with partial injury of the cervical spinal cord in the long-term course of the disease (type B on the American Spinal Cord Injury Association (ASIA) scale).
 MATERIALS AND METHODS: The study enrolled 28 patients with fractures of the cervical spinal cord vertebrae in the late period of the TSCD of ASIA type B. The amplitude of motor responses (M-responses) of the upper and lower limbs was assessed using electroneuromyography. The strength of the upper limb muscles was evaluated using manual dynamometers.
 RESULTS: M-responses were absent in 9% and 64% in the upper and lower limbs, respectively. The amplitude of the most recorded M-responses of the upper and lower limb muscles was reduced relative to the norm. The reduction was not uniform, with significant differences in different leads. The average values of the amplitude asymmetry of M-responses did not exceed the norm. Moreover, 61% of the patients could perform hand-grip functions and hold the wrist dynamometer. Only 59% of the patients could make an effort and the results of strength measurement were obtained, whereas in 41% of cases, zero values were obtained. Statistical analyses revealed a clear relationship between the motor deficiency index of the upper limb and hand-grip strength.
 CONCLUSION: The degree of preservation of M-responses and evident asymmetry of evoked electrical activities of the upper and lower limb muscles indicate the existence of a certain level of neurotrophic interaction in the muscle fibermotor neuron system. The level of reduction of the hand-grip strength and its relationship with the motor deficiency index allows discussion about the partial preservation of the voluntary control of the motor function of the upper limbs.

Quality of life after surgical operations

The aim of the work is to study the quality of life in patients who underwent gastric plication for morbid obesity. A prospective study of 37 patients aged 28 to 59 years, who underwent gastroplication according to the original technique, was conducted on the basis of the Clinic of the Bashkir State Medical University. The indication for surgery was morbid obesity (body mass index 40 kg/m² or more). The quality of life of patients who underwent laparoscopic gastric plication for morbid obesity was studied by comparing the results of questionnaires and special research methods. Weight loss achieved as a result of laparoscopic gastric plication, correction of concomitant disorders in organs and systems, and normalization of metabolic parameters allow us to consider the intervention effective, and the results obtained good. Long-term results of treatment were monitored for up to 2 years. The assessment of the parameters of the quality of life of patients indicates that after bariatric interventions, positive changes are more related to the physical indicators of the quality of life and health status in general. At the same time, changes in mental health indicators, such as vitality, social and emotional functioning, were not statistically significant. In addition to the ongoing surgical correction, obviously essential in achieving stabilization of the psycho-emotional sphere of patients should be given a multidisciplinary approach using developed diets snd psychotherapeutic techniques. The study highlights the features of the regimen and structure of nutrition in patients after bariatric surgery, which can improve long-term results and improve the quality of life in patients with morbid obesity.

Somatoform disorders. Models of personification oriented therapy

IntroductionContemporary in Ukraine the special priority has been the somatoform disorders increase. The most significant complications belong to the patient’s self-evaluation of the influence of the disease on their social functioning, influence essential part of the self-evaluation of the disease and the important point of therapeutic personality accomodate intervention.ObjectivesDevelop the stages of personalized models of psychotherapyMethodsOn the basis of the examined 270 somatoform disorders patients and 190 ischemic cardial disease patients we have elaborated a formal test that allows to evaluate quantitatively the influents of the disease on various spheres of patients´ social status.ResultsIt was absolutely unrespectable the common for ischemic cardial and somatoform disorders patients rise of significance of personal individual, common life factors in cases of aggravation of the main disease course. We created the personification accomodate psychotherapy system consist with CBT, suggestive and autosuggestive implementations. Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of psychotherapy system, consulting, psychological support for patients with high-effectiveness 1,5 - 3 years catamnes in 85% patients.ConclusionsThe retrospective results showed the necessity the personification oriented models of psychotherapy, parted on stages. On the first stage - sedative-adapting the receptions of CBT and suggestive psychotherapy are used. There is group therapy on second stage. On the third stage-supportive elements of the autogenic training mastered.DisclosureNo significant relationships.

PECULIARITIES OF OBESITY EFFECTS ON THE QUALITY OF LIFE AND PSYCHOEMOTIONAL STATE OF PATIENTS WITH BRONCHIAL ASTHMA.

The aim: To study the effect of concomitant obesity in patients with bronchial asthma on quality of life and psychoemotional state depending on the phase of the disease. Materials and methods: 176 patients with bronchial asthma in different phases of the disease with normal weight, pre-obesity and obesity were examined. The quality of life and psycho-emotional state of the patients was determined by the «Sent George Respiratory Question» and the Spielberger-Hanin and Beck tests. Results: All studied patients, showed significant violations of the psychoemotional sphere, a decrease in quality of life compared to healthy individuals (p<0.05). The remission phase revealed a deterioration in the quality of life of patients with overweight and obesity compared to patients with normal weight (p<0.05), in the exacerbation phase - with obesity and normal body weight (p < 0.05). Exacerbation negatively affected the psycho-emotional sphere in patients with normal body weight and obesity (p<0.05). Conclusions: The quality of life was reduced in all studied patients, regardless of body mass index(p<0.05), and the exacerbation of the disease worsened it (p < 0.05), increased depressive tendencies in patients with normal body weight and obesity (p<0.05). In patients with obesity, the worst quality of life indicators were found in the remission phase (p<0.05) and more pronounced depressive tendencies in the exacerbation phase than in the pre-obesity group (p<0.05). The most important indicators determining the course of bronchial asthma are quality of life and body mass index.

Personally - emotional sphere in patients with mild traumatic brain injury

One of the earliest and most significant disorders in traumatic brain injury (TBI) is a violation of the emotional and personal sphere. To study the degree of anxiety and depression in patients with mild traumatic brain injury

English

BACKGROUND Chronic kidney disease (CKD) is a major health issue around the globe. The illness and its treatment affect both the patients and care givers life. Care giving can have varying effects on the caregiver’s life. It can disrupt the family routines, can contribute to occupational and financial problems and can affect the physical and psychological health of the carer. The purpose of this study was to assess the caregiver burden and resilience of the caregivers of patients undergoing maintenance haemodialysis. METHODS This is a cross-sectional study. The sample of the study consisted of caregivers of 180 patients with chronic kidney disease undergoing maintenance haemodialysis. Specially designed pro-forma, Burden Scale for Family Caregivers (BSFC), Brief Resilience Scale (BRS) are the tools used for the study. RESULTS The mean age of patients in bystanders with significant caregiver burden was 47.36 years and those with low burden was 48.12 years respectively. Among the 180 care givers, 8.9 % had low burden and 91.1 % had significant burden. Resilience was low in 27.2 % of caregivers, medium in 72.2 % and high in 0.6 % of caregivers. The mean BRS score was 3.81 + 0.473 in low burden group against a BRS score of 3.15 + 0.543 in significant burden group. There was a significant association between caregiver resilience and caregiver burden. CONCLUSIONS Chronic kidney disease, due to its long course and prolonged treatment, affects the physical, psychological and social spheres of patient and family. This may result in the feeling of burden among caregivers and affects the various aspects of carer’s life. Burden was high and resilience was low among the caregivers of patients with CKD. Attention should be given to the strategies to support the caregivers. KEYWORDS Care Giver Burden, Resilience, Chronic Kidney Disease

Core competencies of clinical nurse specialists: A comparison across three Nordic countries.

To describe and compare the clinical nurse specialist core competency use in Finland, Denmark and Iceland. Clinical nurse specialist roles were first developed more than 60years ago in the United States. Within the Nordic countries, the clinical nurse specialist role emerged around 2000. There is scarcity of clinical nurse specialist competency descriptions outside of North America, and research has been limited to examine or validate established competencies across different countries. A descriptive correlational study. An online survey was conducted from May to September 2019. A population sample of clinical nurse specialists in Finland, Denmark and Iceland was recruited. A validated self-report questionnaire of clinical nurse specialist competencies was used. The data were analysed using descriptive and inferential statistics, and the STROBE checklist was used as the reporting guideline. A total sample of 184clinical nurse specialists, 52 from Finland, 95 from Denmark and 37 from Iceland, participated in the study (response rate=72%, 35% and 48%, respectively). Overall, clinical nurse specialists utilised the organisational competency most frequently followed by the patient, clinical nursing leadership and scholarship competency. Univariate analysis of variance test between-country effects showed statistically significant difference in patient competency (p=.000) and in organisational competency (p<.05). There were no statistically significant differences between counties in the utilisation of clinical nursing leadership and scholarship competency. A small variability was found in the comparison of the clinical nurse specialist use of core competency in the spheres of patient, nursing, organisation and scholarship within three Nordic countries. The CNS competency scale may be utilised in benchmarking clinical nurse specialist roles and practice within and across countries. The long-term goal for the competency descriptions is to enhance the clinical nurse specialist role clarity, integration and evaluation as well as inform post-graduate education.