DISORDERS OF ADAPTATION OF COMBATANTS AND THEIR MEDICAL AND PSYCHOLOGICAL REHABILITATION AT THE SANATORIUM STAGE OF TREATMENT.

OBJECTIVE: The aim of the study was on the basis of the study of clinical manifestations and mechanisms of the formation of disorders of psychological adaptation among the combatants, to develop the principles and program of their medical and psychological rehabilitation. PATIENTS AND METHODS: Materials and methods: The study was attended by 153 people at the sanatorium and resort stage of treatment, of which 98 people were combatants and 55 people were civilians. The study used a set of methods aimed at the study of emotional disorders (HDRS, BDI, Spielberger Scale, "Asthenic state scale"), individual psychological features (Multilevel personal questionnaire "Adaptability," Test questionnaire G. Shmishek, K. Leonhard), features of psychosocial functioning (Mississippian scale of PTSD-military version) and quality of life (WHOQOL-BREF). RESULTS: Results: At the stage of sanatorium treatment of combatants is important readaptation to peaceful living conditions. A clinical and psychological analysis of combatants showed that the presence of experienced state of subjective distress and emotional disorder leads to a decrease in the productivity of adaptation to a stressful event. The stress factor disrupted the integrity of the micro-social network of combatants and their system of social support and social values, with the prevailing sense of inability to overcome problems and build plans. A detailed analysis of the nature of depressive and anxiety manifestations was carried out, which allowed to determine the predictors of the violation of adaptation in combatants. Thus, on the basis of the study of clinical manifestations and mechanisms of the formation of disorders of psychological adaptation among the participants of hostilities, the principles of their medical and psychological rehabilitation at the sanatorium and resort stage of treatment are developed. CONCLUSION: Conclusions: The peculiarities of stress response in combatants as a component of personal potential play a role in the formation of predictors of psychological adaptation disorders among combatants. Psychological intervention at the tertiary stage of rehabilitation (sanatorium-resort) should be targeted, taking into account individual-psychological characteristics (preventors) and psychosocial factors (predictors).

THE EFFECT OF NOS3 AND AGTR1 GENOTYPES ON THE COURSE OF THE ARTERIAL HYPERTENSION FOR THE OVERWEIGHT OR OBESE PATIENTS.

OBJECTIVE: The aim: Objective of the research is to determine the effect of NOS3 and AGTR1 genotypes of patients with arterial hypertension and high body mass index in the course of the disease. PATIENTS AND METHODS: Materials and methods: 58 patients (22 men and 36 women) with AH and high BMI were examined. The average age of the examined patients was 53.6±8.7 years. The analysis of rs1799983 polymorphisms of the NOS3 gene (localization 7q36.1; 7:150999023) and AGTR1 (type 1 receptor for angiotensin 2 1166 A>C) was performed using TaqMan assay (Thermo Fisher Scientific, USA) by real-time PCR (Applied Biosystems, USA) using TaqMan probe amplification products. Genomic DNA samples were isolated from stabilized blood using a Genomic DNA Mini Kit reagent (Invitrogen, USA). The Statistica 10 program (StatSoft Inc.) was used for statistical processing of the obtained data, USA). The independent samples were compared using the Mann-Whitney (U) criterion. In all cases of statistical evaluation, the reliability of differences was taken into account at a value of p<0.05. CONCLUSION: Results and conclusions: Polymorphism of the NOS3 and AGTR1 genes is associated with early development and complicated course of cardiovascular pathology. The combination of NOS3 and AGTR1 gene polymorphism in patients with the high body mass index increases the risk of complications in hypertension. Using a mathematical model to predict the probability (95%) of genetic mutations in two genes (NOS3 and AGTR1) increases the effectiveness of diagnosis for patients with the high risk of developing cardiovascular complications.

PHENOMENOLOGICAL ANALYSIS OF SUICIDAL BEHAVIOR IN PATIENTS WITH COGNITIVE IMPAIRMENT IN RECURRENT DEPRESSIVE DISORDER.

OBJECTIVE: The aim of the study was to determine the characteristics of suicidal behaviour (SB) in patients with cognitive impairment in recurrent depressive disorder (RDD). PATIENTS AND METHODS: Materials and methods: The article presents a phenomenological analysis of suicidal behavior in 123 patients with recurrent depressive disorder. The study of cognitive dysfunctions in patients with recurrent depressive disorder included an analysis of the severity of cognitive impairment and the characteristics of cognitive processes, executive functions, and the specifics of social functioning. The study of the features of suicidal behavior included an analysis of the severity of suicidal risk, diagnosis of symptoms, stress level, suicidal behavior in the past, communication capabilities, reactions of significant others, and the severity of autoaggressive predictors. A complex of research methods was used: clinical-psychopathological, psychometrical, psychodiagnostical and statistical. RESULTS: Results: It was determined that patients with recurrent depressive disorder have specific characteristics of suicidal behavior, which included: a moderate to low level of suicidal risk; the severity of symptoms of depression, tension, anxiety, guilt, hopelessness and exhaustion; repeated visits to doctors for help; presence and recurrence of stress factors; anamnestic burden; violation of communications; the presence of autoaggressive predictors. CONCLUSION: Conclusions: It was found that a weak level of cognitive deficit, a tendency to catastrophisation and self-blame, low switchability and increased focus on negative stimuli in patients with recurrent depressive disorder was associated with a high risk of their suicidal behavior.

Theoretical substantiation of the ways of increasing the efficiency of specialized medical aid in patients with lung cancer.

OBJECTIVE: Introduction: Organizational changes in the context of the transformation of the health system in Ukraine are based on deep and consistent structural and functional transformations and directed to the providing of specialized care of appropriate quality and efficiency, which are the main target function and a prominent criterion for the functioning of the national health system. The aim: Theoretical substantiation of the ways of increasing the efficiency of specialized medical aid in patients with lung cancer. PATIENTS AND METHODS: Materials and methods: Accounting medical records were the main source for the investigation, along with that the results of sociological researches in oncological patients with lung cancer and the results of expert estimation of the ways of increasing the efficiency of specialized aid for such kind of patients. Some methods were also used, such as system approach and analysis, sociological method, methods of conceptual modeling and expert values. RESULTS: Results: An increase of integral efficiency of a specialized medical aid for cancer patients in Ukraine could be reached by expected medical one (introduction of preventive, diagnostic and therapeutic technologies); social one (healthy way of life; satisfaction by the quality and availability as primary as specialized medical aid) and economic efficiency (reduction of economic losses because of disability; shortening of inpatient medical aid financing because of less number of patients with neglected stages of the disease). All of that is grounded on the development and introduction of organizational medical technologies, directed on the early detection of lung cancer and provides justification and development of an optimized model for the early detection of this disease. CONCLUSION: Conclusions: The disadvantages and lack of efficiency of the existing system of specialized cancer care in Ukraine have identified the necessity of a systematic and integrated solution of the problem of early detection of lung cancer based on the optimization of its model, based on the principles of systemicity and complexity, the use of modern science and practice achievements in the management and organization of specialized medical care, application between sector interaction and improvement of its information and communication and organizational-economic components.

[Theoretical grounds of a structural and functional model for quality assurance of radiation diagnostics under conditions of development of the modern health care system in Ukraine].

OBJECTIVE: Introduction: Modern changes in the health care system of Ukraine are focused on financial support in providing medical and diagnostic care to the population and are based on deep and consistent structural and functional transformations. They are aimed at providing adequate quality care, which is the main target function and a principal criterion for operation of health care system. The urgency of this problem is increasing in the context of reforming the health care system and global changes in the governmental financial guarantees for the provision of medical services to the population. The aim of the work is to provide theoretical grounds for a structural and functional model of quality assurance of radiation diagnostics at all levels of medical care given to the population under the current health care reform in Ukraine. PATIENTS AND METHODS: Materials and methods: The object of the study is organizing the operation of the radiation diagnostic service; the information is based on the actual data on the characteristics of radiation diagnosis at different levels of medical care provision. Methods of systematic approach, system analysis and structural and functional analysis of the operating system of radiation diagnostics are used. RESULTS: Review: The basis of the quality assurance model is the cyclical process, which includes the stages of the problem identifition, planning of its solution, organization of the system for implementation of decisions, monitoring the quality management process of the radiation diagnostics, and factors influencing the quality of the radiation diagnostics service. These factors include the quality of the structure, process, results, organization of management and control of current processes and the results of radiation diagnostics management. CONCLUSION: Conclusions: The advantages of the proposed model for ensuring the quality of the radiation diagnostics service are its systemacy and complexity, elimination of identified defects and deficiencies, and achievement of profitability through modern redistribution and use of existing resources of the health care system. The results of adequate service quality management activities in radiation diagnostics are the improvement of organizational and economic principles along with legislative regulation, the implementation of a modern system of radiation diagnostics in the state health care at the national and regional levels, the increase of the accessibility, quality and efficiency of the radiation diagnostics service.