Unfavorable Social Conditions Research Articles

Maternal social deprivation and preterm birth: The PreCARE cohort study

AbstractBackgroundMaternal exposure to unfavourable social conditions is associated with a higher rate of perinatal complications, such as placental vascular pathologies. A higher risk of preterm birth (PTB) has also been reported, and variations across studies and settings suggest that different patterns may be involved in this association.ObjectiveTo assess the association between maternal social deprivation and PTB (overall and by phenotype).MethodsWe analysed 9365 patients included in the PreCARE cohort study. Four dimensions (social isolation, insecure housing, no income from work and absence of standard health insurance) defined maternal social deprivation (exposure). They were considered separately and combined into a social deprivation index (SDI). The associations between social deprivation and PTB <37 weeks (primary outcome) were analysed with univariable and multivariable log‐binomial models (adjusted for maternal age, parity, education level and birthplace). Then we used multinomial analysis to examine the association with preterm birth phenotypes (secondary outcome): spontaneous labour, preterm prelabour rupture of membranes (PPROM) and placental vascular pathologies.ResultsIn all, 66.3%, 17.8%, 8.9% and 7.0% of patients had an SDI of 0, 1, 2 and 3, respectively. Social isolation affected 4.5% of the patients, insecure housing 15.5%, no income from work 15.6% and no standard health insurance 22.4%. Preterm birth complicated 7.0% of pregnancies (39.8% spontaneous labour, 28.3% PPROM, 21.8% placental vascular pathologies and 10.1% other phenotypes). Neither the univariable nor multivariable analyses found any association between social deprivation and the risk of preterm birth overall (SDI 1 versus 0: aRR 1.02, 95% confidence interval [CI] 0.83, 1.26; 2 versus 0: aRR 1.05, 95% CI 0.80, 1.38; 3 versus 0: aRR 0.92, 95% CI 0.66, 1.29) or its different phenotypes.ConclusionsIn the French PreCARE cohort, we observed no association between markers of social deprivation and the risk of preterm birth, regardless of phenotype.

The Burden of Hereditary Angioedema in a Large Family in Brazil

Introduction: Hereditary angioedema (HAE) is a rare genetic disease characterized by submucosal and subcutaneous edema with high morbidity and possibility of mortality. This study presents the sociodemographic characteristics of a large Brazilian family with HAE. Methods: Descriptive cross-sectional study with patients from two family branches coming from the same city and HAE diagnosis was carried out. Clinical, laboratory, and treatment data of patients have been collected. Genetic testing was performed on some individuals. Correlation tests and comparisons between variables were applied using IBM SPSS Statistics® 2.0 program. Results: We provide a detailed characterization of two families affected by HAE due to C1-INH deficiency, residing in a small town in southern Brazil. These families harbor an identified mutation in the SERPING1 gene (c.1104del, p.Asp369ThrfsTer2). The mean age at HAE diagnosis was 16.7 (±14.0) years, with the mean onset of symptoms at 6.0 (±6.1) years of age. A correlation was observed between patients’ current age and age at HAE diagnosis, with older patients being diagnosed later than younger individuals (p < 0.0001). On average, there were 16.8 emergency visits in the past year (±24.8), and 53.5% of patients reported at least one lifetime hospitalization. Notably, treatment modalities often diverged from consensus recommendations regarding optimal prophylaxis and management of HAE attacks. Conclusions: This study describes one of the largest known families with HAE in Brazil and highlights the significant impact of unfavorable social conditions on disease control.

(Why) did it turn wrong? Wholeness or totality of the Internet.

The Internet was created as a space and a structure to share knowledge, information, and opinions for the sake of science and progression of humanity. Today, the Internet is co-created and modified by its users networking from all over the world. It is a representation of humankind, a social structure reactive to local and global societal processes. For the youngest generations the Internet is an integral part of their social milieu influencing both normal and pathological development from their very first year of life. Discussing the roots of totalitarianism, Erik H. Erikson distinguished between wholeness and totality in personal and social development and provided a wonderful metaphor of productive and pathogenic functioning for the impact of the Internet. Conceived as a fruitful association and organization for the development of wholeness in individuals and a future humanity, it largely keeps this promise. But under unfavorable social conditions and/or pathogenic individual predispositions, it can take a totalitarian structure and mode of action.

Iron and vitamin D intake on a diet are able to modify the in vitro immune response to Mycobacterium leprae.

The impact of nutrient availability on the survival of Mycobacterium leprae and the development of leprosy remains largely unknown. Iron is essential for the survival and replication of pathogens, while vitamin D has been involved with pathogen elimination and immunoregulation. We evaluated the influence of dietary iron and vitamin D supplementation and restriction on the inflammatory response of mouse immune cells in vitro. After 30 days of standard or modified diets, peritoneal cells and splenocytes were stimulated with the alive microorganisms and sonicated antigens of M. leprae, respectively. The production of inflammatory cytokines, reactive oxygen species, and cell proliferation were evaluated. In peritoneal cells, vitamin D supplementation and iron restriction reduced the production of IL-6 and TNF in response to M. leprae, while splenocytes presented a reduction in TNF production under the same conditions. Lower levels of IFN-γ and TNF were observed in both iron-supplemented and iron-deficient splenocytes. Besides, iron supplementation also reduced the production of IL-6 and IL-10. No changes in the production of reactive oxygen species or in cell proliferation were observed related to different diets. Taken together, these data point to an interference of the status of these nutrients on the interaction between the host and M. leprae, with the potential to interfere with the progression of leprosy. Our results highlight the impact of nutritional aspects on this neglected disease, which is significantly associated with unfavourable social conditions.

Unfavorable transcriptome profiles and social disadvantage in hematopoietic cell transplantation: a CIBMTR analysis

AbstractPatient-reported outcomes (PROs) capture subjective social determinants of health (SDOHs), which can affect health outcomes through the stress response pathway. The conserved transcriptional response to adversity (CTRA) is a stress-mediated proinflammatory transcriptomic pattern that has been linked to adverse hematopoietic cell transplant (HCT) outcomes. This study examined the association of pretransplant CTRA with patient-reported SDOHs in allogeneic HCT recipients. In this cross-sectional study, pre-HCT SDOH-related PROs included the 36-Item Short Form Health Survey and the Functional Assessment of Cancer Therapy–Bone Marrow Transplant (FACT-BMT). CTRA was assessed by RNA sequencing of whole blood specimens, with mixed effects linear regression models relating CTRA expression to PRO scores while controlling for age, sex, race, disease, and performance status. Among 121 patients, the median age was 54 years, 42% were female, and 91% were White. CTRA was elevated in participants reporting lower scores on the FACT-BMT (P = .003), including the general (P = .003) and BMT-specific (P = .014) components. Effects were driven by the social well-being domain (P = .0001). This corresponded to an 8% to 15% difference in CTRA RNA expression across a 4 standard deviation range in patient-reported SDOHs. Ancillary bioinformatics analyses confirmed the association of well-being with reduced proinflammatory transcription pathway activity [cyclic AMP response element-binding protein, (CREB), NF-κB, and activating protein-1 (AP-1)]. In conclusion, HCT-treated patients who experience unfavorable social conditions show elevated CTRA expression in pretransplant blood samples. These data highlight the biologic sequelae of social well-being and community context and suggest a potential molecular mechanism for the impact of social gradients in HCT outcomes. Targeting this pathway could optimize outcomes in this high-risk population.

Migrasi Muslim India ke Barus Tapanuli Tengah di Abad ke-20 M: Sebuah Tinjauan Sejarah

This study explores the 20th-century entry of Indian-Muslim ethnic groups into Barus, Central Tapanuli, aiming to understand the historical context. It focuses on three key aspects: 1) the migration factors driving Indian-Muslims to Barus, encompassing both push and pull factors; 2) the responses of the Barus residents towards Indian-Muslim newcomers; and 3) the professions pursued by the Indian-Muslim community in Barus. Employing qualitative and library-based research methods, data was collected through interviews, observations, and documentation, subsequently verified and analyzed. The findings highlight the influence of various push factors, primarily the unfavorable social and economic conditions in their hometowns, and the pull factors include economic opportunities and the religious significance of the Barus region. The indigenous people of Barus generally welcome Indian-Muslim newcomers, fostering integration through social and economic interactions, as well as cross-cultural marriages and the granting of Batak clan names to Indian-Muslim ethnic groups. Notably, Indian-Muslims predominantly engage in professions akin to the local Barus population, such as agriculture, fishing, trading, and various services.

"The Periphery – the Keystone of Rehousing in Algeria. The Case of Constantine City "

Rehousing is a practical measure to reduce the housing crisis in metropolitan areas that do not have land resources. The periphery corresponds to the spaces dependent on the center, which the Algerian public authorities have used to build collective housing estates. According to the townspeople of Constantine, these processes were followed by many social effects. This study presents the survey results with the heads of households in Boudhraà Saleh precarious neighbourhood, near Constantine city center in eastern Algeria, who were rehoused from the precarious housing towards the new city Massinissa at the periphery of Constantine. Using a descriptive approach, we analyze the effects of rehousing operations and the periphery’s choice as a transfer place. Our survey results show the social effects of rehousing and the reflections of relocated households related to their social environment, whereas the periphery has become uninhabitable. The difficulty in obtaining a habitat forced them to face these difficult circumstances. Given the unfavorable social and environmental conditions prevailing in the new city of Massinissa, prompt intervention is imperative to identify and implement drastic measures to address the harsh realities experienced by its rehousing households and provide them with suitable habitats and outdoor spaces in compliance with the fundamental tenets of sustainable development.

Peculiarities of Military Values of Combatants with Signs of Post-traumatic Stress Reactions and Moral Traumas

According to the results of the study, there were determined the peculiarities of military values of servicemen who participated in hostilities and had signs of PTSD and moral trauma. The study included 397 servicemen (aged 20 to 55 years) with combat experience. The study showed that PTSD and violation of moral normativity were closely related to unfavorable social conditions of performing combat tasks. Unlike PTSD, the moral normativity indicator was less tightly related to the immediate threat to life. The structure of values of the servicemen had no signs of PTSD as well as no violation of moral normativity consisted of factors that indicated the value of teamwork, responsibilities for decisions and actions made based on ideas related to loyalty to the oath and the Motherland, resistance, and professionalism. For the servicemen who participated in hostilities who had violations of moral normativity, it was more important to have the ability to act following their conscience, not to lose dignity, and to remain honest in the faces of their brothers than to have professionalism, loyalty to the oath and the Motherland.

Causes and legal consequences of deviant behavior

The essence of deviant behavior, the factors leading to it, its varieties and legal consequences are considered. Illegal behavior, immoral acts, various addictions, suicides are all realities of today. Abnormality and deviance become a typical and widespread phenomenon, especially dangerous is the fairly widespread delinquent behavior, as a result of which society gradually sinks into a state of anomie, which is a companion of any crises and social upheavals. This determines the topicality of the topic. Currently, the spread of deviant forms of behavior is facilitated by the crisis state of society, corruption, the war waged by Russia against Ukraine, legal nihilism, and social injustice. Deviant behavior affected the criminalization of society, an increase in crime rates and a change in its structure in the direction of expanding the social base at the expense of deviants, a decrease in public interest in moral issues, an increase in immorality and hypocrisy, and deformation of legal consciousness. Deviance is a relative characteristic associated with the changing standards and social expectations of a community that change in space and time. Social factors are not the only determinants of deviations. Personal factors also lead to deviant behavior, including criminal behavior. The essential determinants of deviant behavior are antisocial personality development, unfavorable social conditions and psychological characteristics of the individual. Marginality is both a prerequisite and a consequence of deviance. Characteristic features of the process of marginalization are a value vacuum, social maladaptation, and social disintegration, manifested in deviation. Marginalization can be a source of social conflicts, delinquent behavior and criminalization of society. The theoretical provisions and conclusions of the article develop and complement a number of sections of the general theory of law, criminology, will contribute to more effective implementation of rights and freedoms, crime prevention and prevention of individual crimes. This is the practical significance of this article.

#5268 PREGNANCY OUTCOMES IN DIALYSIS PATIENTS: A TEN-YEAR SERIES FROM A TERTIARY CENTER

Abstract Background and Aims Pregnancy in dialysis patients was almost prohibited a decade ago, as fetal and maternal outcomes were very poor. In the last years, there has been a paradigm shift, as the introduction of intensive hemodialysis (HD) schedules has been associated with an impressive improvement on fetal outcomes, making motherhood a possibility in these women. Nevertheless, pregnancy in women on dialysis remains associated with a high incidence of complications and is extremely demanding for both patients and clinicians. We describe the maternal, obstetric, and perinatal outcomes of pregnancies in women on dialysis followed at the Nephro-Obstetric Clinic at Centro Hospitalar Universitário Lisboa Norte (CHULN). Method Retrospective analysis of pregnancies in women on dialysis and surveilled at the Nephro-Obstetric Clinic at CHULN from 2011 to 2022. Results We considered 17 pregnancies from 16 women. One of the women accounted was submitted to voluntary termination of pregnancy. Mean age was 31.5 ± 6.1 years; 70.6% were Black (n = 11) and 29.4% (n = 5) Caucasian; 58.8% were nulliparous (n = 10). All patients had chronic hypertension (HTN), although only 75.0% were under therapy (12/16). Additionally, 3/16 patients had diabetes and 2/16 hyperthyroidism. The mean of overall renal replacement therapy (RRT) duration was 9.1 ± 8.2 years (dialysis and renal transplantation time), being on dialysis program 43.7 ± 37.5 months before gestation. One patient was on peritoneal dialysis (PD) and two patients started HD during pregnancy. Five patients (31.2%) were exposed to teratogenic drugs during gestation. Pregnancy diagnosis occurred at 13.4 ± 5.6 weeks; 70.6% of the patients were on low dose acetylsalicylic acid (n = 12). HD mean time per week according to each trimester was 13.7 ± 2.8 hours/week, 24.5 ± 7.3 hours/week and 28.0 ± 8.0 hours/week during the 1st/2nd/3rd respectively. Mean pre-dialysis urea was 62.1 ± 28.0 mg/dL during gestation. Regarding maternal outcomes, worsening HTN occurred in 62.5% (n = 10) of patients during the 1st (4/10) and 2nd trimester (7/10) and pre- eclampsia (PE) occurred in 6/16 patients (1 with HELLP syndrome). One patient developed polyhydramnios and another one cholestasis of pregnancy. Premature rupture of membranes (PRM) occurred in 3 patients (at 17, 25 and 36 weeks); One patient asked for medical termination of pregnancy due to severe growth restriction and oligohydramnios at 20 weeks. Stillbirth occurred in 4 gestations (cervical insufficiency in a twin pregnancy, severe congenital fetal cardiopathy in a patient with PE, severe growth restriction and premature rupture of membranes (PRM). In the 2 patients with early PRM, the neonates died in the following week due to severe prematurity complications. Labor was induced in 9 patients, mainly due to PE (7/9). Cesarean was performed in 10/17 patients and mean gestation age at delivery was 29.8 ± 6.6 weeks. Extreme prematurity (&amp;lt;28 weeks) occurred in 3 pregnancies and there were three term babies. Mean birth weight was 1554.0±613.6 grams with 4 newborns having extremely low birth weight (&amp;lt;1000g) and 6 requiring neonatal care. Conclusion Our study reveals that pregnancy in women on dialysis is challenging and still associated with significant maternal, obstetric and perinatal complications. This population was highly heterogenous, with a significant number of patients living under unfavorable social conditions, and with significant comorbidities. The diagnosis of pregnancy took place mainly during the 2nd trimester, preventing early initiation of intensive dialysis schedules which could have significantly improved outcomes. Pregnancy planning, early diagnosis and management by a multidisciplinary experienced team are of paramount importance to improve outcomes and reduce complications.

Influence of Educational Level and Healthy Habits on the Prevalence of Diabesity in a Spanish Working Population.

Background: Diabesity is a growing problem internationally. Taking into account the importance of physical activity and diet in its prevention and treatment, the objective of this study was to delve into the impact of healthy habits on diabesity. Methods: A descriptive, cross-sectional study was carried out in 386,924 Spanish adult workers. Obesity was determined according to eleven different formulas. Life habits were also valued; sociodemographic variables; and educational level; as well as analytical and clinical variables such as blood pressure and blood glucose levels. The association between the different variables was performed using the chi-square and the Student’s t-tests when the samples were independent. A multivariate analysis was performed using the multinomial logistic regression test by calculating the odds ratio and a 95% confidence interval. The Hosmer–Lemeshow goodness-of-fit test was also performed. Results: The overall prevalence of diabesity ranged between 0.3% (95% CI 0.3–0.4) when obesity was assessed according to the abdominal volume index and 8.3% (95% CI 8.2–8.4) when evaluated according to the CUN-BAE (Clínica Universitaria de Navarra Body Adiposity Estimator) formula. The prevalence of diabesity was also higher in workers with a non-heart-healthy diet and in those who did not exercise regularly. Conclusions: The most disadvantaged socioeconomic classes are those with the highest prevalence of diabesity. It is important to prioritise prevention in populations and communities with the most unfavourable social and environmental conditions to reduce the burden of diabesity.

Head circumference as an epigenetic risk factor for maternal nutrition.

Nutrition indicators for malnutrition can be screened by many signs such as stunting, underweight or obesity, muscle wasting, and low caloric and nutrients intake. Those deficiencies are also associated with low socioeconomic status. Anthropometry can assess nutritional status by maternal weight measurements during pregnancy. However, most studies have focused primarily on identifying changes in weight or Body Mass Index (BMI), and their effects on neonatal measures at present time. Whereas head circumference (HC) has been associated with nutrition in the past. When the mother was exposed to poor nutrition and unfavorable social conditions during fetal life, it was hypothesized that the intergenerational cycle was potentially mediated by epigenetic mechanisms. To investigate this theory, maternal head circumference (MHC) was associated with neonatal head circumference (NHC) in pregnant women without preexisting chronic conditions, differentiated by sociodemographic characteristics. A multiple linear regression model showed that each 1 cm-increase in MHC correlated with a 0.11 cm increase in NHC (β95% CI 0.07 to 0.15). Notwithstanding, associations between maternal and neonatal anthropometrics according to gestational age at birth have been extensively explained. Path analysis showed the influence of social status and the latent variable was socioeconomic status. A model of maternal height and head circumference was tested with effects on neonatal HC. The social variable lacked significance to predict neonatal HC in the total sample (p = 0.212) and in the South/Southeast (p = 0.095), in contrast to the Northeast (p = 0.047). This study highlights the potential intergenerational influence of maternal nutrition on HC, suggesting that maternal nutrition may be more relevant in families with major social vulnerability.

Multidimensional analysis of frailty in older people of a Brazilian community: a cross-sectional study

In Brazil, the aging process takes place under unfavorable economic, social and health conditions. Therefore, a better understanding of the functionality patterns of different elderly populations becomes essential, especially in times of Covid-19. The objective of study is to assess the functionality of institutionalized and community older people. Cross-sectional study with 51 older people, divided into two groups: Institutionalized Older People Group (GII) and Community Older People Group (GIC), assessed by the Mini Mental State Examination, Clinical Functional Vulnerability Index-20 (IVCF-20), Barthel Scale, Lawton Scale and Tinneti Scale, descriptive analysis, multivariate multiple correspondence technique, multinomial and binomial logistic regression, with the R software were performed. The results showed: the quartiles: robust GIC (IVCF-20=6.75), independent (Lawton=21/Barthel=100). The fragile GII (IVCF-20=18), partially dependent (Lawton=13/Barthel=100). In GII association of frail older people and high risk of falls. In the GIC there is no association. The GIC showed more chances compared to the GII: 198.34 cognitively normal; 5.48 robust; more than 100,000 independents; and 14 low risk of falls. In this way, it is concluded that older people in the community have better functional performance than older people living in the two Long Term Care Institutions.

Altered neural processing of social reward in male heroin abstainers

Individuals who are addicted to drugs often face unfavourable social conditions and difficulty with social adaptation. Both may be closely related to impaired social cognitive ability. This study posits that social cognitive impairments likely arise from blunted social reward processing in drug users. This study aimed to explore the electrophysiological mechanism of social reward processing in people who abstain from using heroin (heroin abstainers). Twenty-eight male heroin abstainers and 27 matched controls completed the social incentive delay task. At the same time, their corresponding behaviour and electroencephalography data were recorded. The feedback-related negativity (FRN) elicited by positive outcomes was significantly more positive than that elicited by negative outcomes for the healthy controls. However, no significant difference in FRN was found between negative and positive outcomes among the heroin abstainers. There was no significant difference in P3 (a positive event-related potential component after FRN) elicited by negative and neutral outcomes in the heroin abstainers. Meanwhile, negative outcomes elicited greater P3 than neutral outcomes in the healthy controls. In addition, this study also found that withdrawal time was negatively correlated with the difference wave of FRN for the heroin abstainers. Heroin abstainers may be hyposensitive to the processing of social reward outcomes. In other words, they may have insufficient motivation to acquire social rewards. Abnormal social reward processing found in heroin abstainers can be improved with an increase in abstinence time. These results deepen our understanding of the social reward impairments associated with chronic drug use.

Percepção da população sobre a atuação das autoridades e das comunidades no controle das arboviroses

ABSTRACT The environmental control for prevention of arboviruses depends both on the actions of public authorities and the involvement of communities. The present study analyzed the perception of 385 citizens of 17 municipalities from the 5 regions of Brazil regarding the actions of the authorities and the community itself in relation to the control and prevention of dengue. The participants acknowledged that actions such as basic sanitation, regular waste collection, inspection of vacant lots and closed homes have often been neglected by the authorities. There was a tendency to hold the community accountable, through the example of neighbors who do not carry out prevention procedures. It was also noteworthy the silencing around unfavorable social conditions that can hinder the implementation of prevention procedures. We also reflected on the damage that the COVID-19 pandemic has caused to preventive practices and its possible future impacts.

Social Vulnerability Predicts Frailty: Towards a Distinction between Fragility and Frailty?

All definitions of frailty converge in two aspects: the notion of loss or decline and the ability to predict negative health outcomes. Numerous factors were reported to be associated with frailty among which biological, psychological, economic and social factors. Whether the latter contribute at the same level is a relevant question, as social vulnerability does not refer to an ongoing process of decline leading a person to become frail but rather to a relativity stable state making the person fragile. Thus, social vulnerability should increase the risk of frailty. This study aims at assessing whether social vulnerability increases the risk of incident frailty. 1531 participants aged 65 or older from the PAQUID cohort study were included. Cox regression models tested the association between social vulnerability index (SVI, based on 28 social items) and frailty index (FI, based on 25 health-related items) over the 27 years of follow-up. Adjusted for age and sex, higher SVI was associated with increased risk of incident frailty (HR=3.85, 95% CI=1.87-7.94, p<.001). After additional control for IADL disability and comorbidities, higher SVI was associated with increased risk of frailty (HR=3.40, 95% CI=1.63-7.07, p<.05). The association remained significant after controlling for MMSE (HR=2.34, 95% CI=1.08-5.07, p<.05). Poor social status is a risk factor of frailty. From a conceptual point of view, our results claim for a distinction between the concepts of frailty and fragility, the first one being the consequence of an ongoing decline, the other one related to a relatively stable condition of fragility, mainly explained by unfavorable social conditions.

Personality of the Convict in the Penitentiary Process

The article examines the ways of normative response to criminal behavior from the point of view of historical retrospect and the current level of empirical knowledge. The author focuses on some controversial issues of criminal motivation. It is argued that criminal behavior has not only social determinants, but is also based on the existence of psychophysiological features of the individual formed in unfavorable social conditions. The article analyzes the importance of a person-oriented penitentiary process for ensuring the effectiveness of correctional influence on convicts and state coercion. Special attention is paid to educational work in the process of implementing correction tools. It is shown that the criminal law impact has the potential to comprehensively regulate the behavior of convicts in the process of applying a sentence of imprisonment.

Marginalised identities between fatalism and desperation – experiences of low-level cannabis street dealers in Frankfurt

Purpose This paper aims to research people who sell cannabis in public spaces known as “drug places” in Frankfurt, Germany. A particular focus is set to the relations of identity formation, relations to other dealers and law enforcement, taking into account the concept of “street capital” as social and cultural capital accumulated in the practice of drug dealing in public. Design/methodology/approach Nine biographically oriented qualitative interviews were conducted directly within the respective “drug places” in the inner city and the margins of the local open drug scene with exclusively male subjects. Interviews were conducted in German, audio-recorded and transcribed. Data was analysed with structured qualitative content analysis. Findings All respondents had some degree of migration background, ranging from German citizens up to refugees with illegal residence permit status. Social deprivation, socio-cultural conflicts with parents, combined with often early own drug use (mainly cannabis and cocaine) and stigma had contributed to a precarious existence. Experiences of criminalisation did not discourage the respondents from the continuation of their selling activity. Violence in these settings was likely but assessed in highly different ways depending on attitudes and experiences. The same is true for diverging experiences with police, however, the threat of being criminalised is always present. Originality/value As mostly independent and solitary dealers, this study researched a rarely investigated group. While these respondents have developed skills or street capital to survive in the respective setting, they are caught between unfavourable social conditions, social exclusion, violence, law enforcement and own drug use, leading to a desperate and fatalistic mindset. Somewhat paradoxically, this fatalism may be regarded as a result of keeping control over their own actions.

Type 1 diabetes mellitus in chronic insulin deficiency conditions

Mauriac syndrome is a severe complication of type 1 diabetes mellitus, manifested by growth retardation, impaired formation of secondary sexual characteristics, lack of libido, and hepatomegaly. Currently, the presented syndrome is quite rare. This is more related to the emergence of intensive insulin therapy, which keeps the level of daily glycemia within the tolerance of type 1 for diabetes mellitus. The article describes a clinical case of the development of Mauriac syndrome in a 21-year-old patient with decompensated diabetes mellitus and multiple complications. The patient was deprived of proper control over the condition of daily glycemia and full-fledged insulin replacement therapy for a long because of unfavorable social and material conditions in the family, which contributed to the development of chronic insulin insufficiency and complications.

MANAGEMENT OF THE ACTIVITIES OF EDUCATIONAL INSTITUTIONS WORKING IN HARD SOCIAL CONDITIONS

The article reveals the features of managing the activities of schools operating in unfavorable social conditions, gives a characteristic of educational institutions that show low academic results, presents a qualitative assessment of the resources and factors that affect the students’ performance and the efficiency of schools, proposes a program for managing the activities of educational institutions in order to transfer them to the effective mode of operation, the results of its implementation are described.