ANALYSIS OF THE RESULTS OF A MEDICAL AND SOCIOLOGICAL SURVEY OF HEALTHCARE PROVIDERS ON MOTIVATIONAL COMPONENT OF ENSURING THE HEALTHCARE QUALITY.

OBJECTIVE: The aim: To identify the main motivational components of improving the healthcare quality in health care providers in Sumy. PATIENTS AND METHODS: Materials and methods: The study involved data obtained from 187 doctors working in primary health care institutions, inpatient and outpatient departments of health care institutions in Sumy, during September-November 2020. The study used systematic, bibliosemantic approaches, comparative and statistical analysis, and logical generalization. The obtained data were processed and statistically analyzed with Google Forms and Microsoft Excel 2010 Windows. RESULTS: Results: The analysis of data received from the surveyed group of respondents showed that 83 doctors (44.39%) have 11-15 years' work experience, 51 people (27.27%) - 6-10 years, 40 people (21.39%) have up to 5 years of work experience and 13 people (6.95%) - more than 15 years. Most doctors (114 people (60.96%)) work for one position, 39 people (20.86%) work for less than one, while 34 people (18.18%) work for more than one position. The number of doctors who indicated that they were mostly overworked during the working day was 123 (65.77%), another 46 (24.60%) indicated that they were overworked during the working day correspondingly to their workload at occupied position, and 18 respondents (9.63%) answered that they were not fully loaded. At the same time, 91.98% of people indicated that the actual amount of their salary does not correspond to the workload, and there is no financial stimulation system for medical care quality increasing (87.70% of responses). CONCLUSION: Conclusions: The study showed that the healthcare facilities where the respondents work do not have an effective system of staff motivation for work quality (79.14% of responses). It was found that doctors are ready to work harder and better for additional pay, despite the high level of workload (88.24% of responses), and consider it necessary to introduce an effective stimulation system to improve the quality of medical services (96.79% of responses).

DIAGNOSTIC OF THE ATHLETE'S HEART AND FACTORS AFFECTING ITS DEVELOPING.

OBJECTIVE: The aim: Studying the features of the structure and function of the heart in athletes and identifying the factors that influence the development of these changes. PATIENTS AND METHODS: Materials and methods: The study included 54 athletes, 29 men and 25 women. The ultrasound study was performed according to standard methods with determining the size of the main structures of the heart, indicators normalized to body surface area, height. RESULTS: Results: The heart of dilatation and hypertrophy of the left ventricular myocardium were found in 25.93% of the athletes. When comparing the diameter of the left ventricle of individual athletes with the average values of the norm, their excess was found in 94.44% of athletes. The Odds ratio (OR) of the relationship between left ventricle diameter (LVd) and time of the exercise less than 10 y was 16.13, time of the exercise less than 5 y - 0.17 (p <0.05). OR of increase LVd to age less than 20 years was 3.56 units (p <0.05). The ejection fraction was above the normative mean in 75.93%, as well as the ratio of the periods of filling of the ventricles. CONCLUSION: Conclusions: The most common sign of an athlete's heart development was left ventricular dilatation, which occurred at a rate of 25 percent. Age less than 20 years and the duration of sports activities from 5 to 10 years is associated with a higher frequency of the athlete's heart.

Influence of magnesium on the state of the cardiovascular system in children with chronic tonsilitis.

OBJECTIVE: The aim of the study was to evaluate the condition of the cardiovascular system and the effect of the combined preparation of magnesium and vitamin B6 in children with secondary cardiomyopathy on the background of chronic tonsillitis. PATIENTS AND METHODS: Materials and methods: 100 children at the aged of 13-17 years were surveyed, including 60 patients with secondary cardiomyopathy with chronic tonsillitis. And the group I consisted of 45 children receiving standard treatment, group II - 15 patients who, along with standard treatment, received the drug magnesium. The control group consisted of 40 healthy children. To assess the condition of the cardiovascular system and vegetative regulation, we performed electrocardiographic examination (ECG), exercise test and ECG control, cardiointervalography with clinoortostatic test. The concentration of magnesium in the serum was determined by atomic absorption spectrophotometry. Also, we have provided the requirements of the principles of bioethics and drafted a protocol in accordance with the basic principles of the Helsinki Declaration. RESULTS: Results: In addition to the standard treatment of children with magnesium drug, there was a significant decrease in the frequency of sinus arrhythmias, disorders of the intraventricular conduction, and the processes of repolarization, extrasystole, sinus suchchardia were not observed in any of the patients. The normalization of magnesium in the serum of patients was observed. CONCLUSION: Conclusions: Supplementation of combination therapy with magnesium and B6 helped to improve myocardial electrophysiology and cardiac output, as well as to normalize the serum magnesium in children with secondary cardiomyopathy.

Crystallographic investigation of urine in newborn with renal disturbance due to asphyxia.

OBJECTIVE: The aim is to increase the efficiency of diagnosis of renal injury in neonates with asphyxia by identifying of structural markers according to research facies of urine in newborns of different gestational ages. PATIENTS AND METHODS: Materials and methods: The study involved 150 full-term with signs of kidney damage due to asphyxia: 75 babies with severe asphyxia, and 75 children with moderate asphyxia and 100 preterm infants: 50 children with severe asphyxia and 50 children with moderate. Comparison groups: group 1 consisted of 20 full-term infants, group 2 which included 20 preterm neonates. Material for the study - morning portion of urine, which was collected at 8-10 a.m. on 1-2 and 7-8 days of life. RESULTS: Results: morphological picture of facies of newborns with asphyxia depends on the severity of pathological changes in the urine (proteinuria) and urine output. Structure of facies in babies with renal distorbance due to severe asphyxia indicates a significant loss of organic and mineral substances in the urine. The width of the peripheral zone facies, the amount of solid particles transferred depends on the severity of asphyxia, the difference in morphology facies is maintained even at the end of the early neonatal period. CONCLUSION: Conclusions: Analysis of dried drops of urine in infants with renal impairment on the background of asphyxia can be used as one of the criteria for assessing kidney function and have prognostic value.

Laboratory criteria of perinatal damage of central nervous system at premature newborns

Introduction: Fetal and neonatal hypoxia takes a special place among the damaging factors of central nervous system (CNS). All forms of oxygen deficiency are accompanied by the development of bioenergetic hypoxia, which leads to tension of metabolic processes of the organism. Metabolic effect of hypoxia includes stark reduce of mitochondrial activity due to a significant inhibition enzymes of the Krebs cycle: succinate dehydrogenase (SDH) and lactate dehydrogenase (LDH). In newborn babies is not always possible to objectively assess the condition of the CNS defeat, because very often the severity of lesions does not correspond to clinical symptoms, especially in premature newborns. So far determination the severity of hypoxic-ischemic CNS lesions is still very actual in modern medicine. More objective method of such an assessment is determine the activity of neurospecific enolase (NSE). The aim of the paper is to increase the efficiency of diagnosis of hypoxic CNS lesions in premature infants by determining the activity of NSE and study energy supply during the neonatal period. Material and methods: The concentration of NSE, SDH and LDH were determined in 15 conventionally healthy preterm infants (CHPI), which made the comparison group, and 64 premature babies with hypoxic-ischemic CNS lesions, which were divided into three groups: I group ­ 26 premature children with mild CNS lesions; II group ­ 20 premature children with severe hypoxic lesions and low birth weight; III group ­ 18 premature newborns with severe damage of central nervous system and extremely low birth weight. NSE activity was determined by enzyme immunoassay using reagents of the company «Fujirebio¼ (Sweden) on an automatic analyzer «Multiscan Plus¼ company «Labsystems¼ (Finland). Material for investigation was peripheral venous blood of newborns, which collected by vein punction at morning on an empty stomach. Results and conclusions: Metabolic effect of hypoxia in premature infants manifested by severe inhibition of mitochondrial respiratory activity, which appears in the reduction of aerobic enzyme activity of SDH and activation serum LDH. During the neonatal period in infants with perinatal hypoxic- ischemic lesions of the CNS levels of the of NSE, SDH and LDG aren't normalized, that indicated on energy deficiency and requires the development of effective methods of correcting this condition. Perinatal hypoxia in premature neonates causes significant alteration of neuronal membranes and increase concentration in blood such neurospecific protein as NSE, whose concentration correlates with the degree of severity of CNS injury.

DYNAMICS OF CONTENT OF SOME MINERALS IN TEENAGERS WITH CARDIOVASCULAR SYSTEM PATHOLOGY AGAINST THE BACKGROUND OF CHRONIC TONSILLITIS ZMIANY ZAWARTOSCI NIEKTÓRYCH SKLADNIKÓW MINERALNYCH U MLODZIEZY Z CHOROBAMI UKLADU SERCOWO-NACZYNIOWEGO JAKO PODLOZE ROZWOJU PRZEWLEKLEGO ZAPALENIA MIGDALKÓW PODNIEBIENNYCH.

OBJECTIVE: Introduction: Chronic diseases of the upper respiratory tract in children and teenagers, such as chronic tonsillitis is quite common in pediatric populations, accompanied by changes in reactivity, causing a risk of complications. Due to the fact that the child's body resistance to acute infectious diseases depends on the sufficiency of trace elements, then at present stage greatly increased interest in deeper study of exchange of macro- and microelements in the human body in normal and pathological conditions. The aim: To study the dynamics of zinc, iron, potassium and magnesium in adolescents with disorders of the cardiovascular system with chronic tonsillitis. PATIENTS AND METHODS: Materials and methods: It was examined 63 patients with chronic tonsillitis, among them- 31 children suffer from chronic tonsillitis off-damage to the cardiovascular system (I group), 32 patients with disorders of the cardiovascular system against the background of chronic tonsillitis (II group). The content of trace elements zinc, iron, minerals potassium and magnesium was analyzed. The measurement and calculation were done according to AAS-SPECTR program. Analysis and statistics treatment was done on using application programs STATISTICA 7.0 and MS Excel XP. RESULTS: Results: In result of investigation it was found a violation of trace element composition in the blood serum. Thus, in patients with chronic tonsillitis without cardiovascular system damage during hospitalization was observed a significant decrease in the concentration of iron to (15,47 ± 1,12) mmol/l. Similar changes were observed with the concentration of zinc in the blood serum. In patients with chronic tonsillitis without cardiovascular system damage during hospitalization was observed a significant decrease in the concentration of iron to (15,47 ± 1,12) mmol/l. Similar changes were observed with the concentration of zinc in the blood serum of patients of I groups during hospitalization (10,89 ± 0,57mmol/l) and was significantly lower compared with the data of healthy children (18,40 ± 0,71 mmol/l (p <0.05)). CONCLUSION: Сonclusions: It should be noted that children with tonsillogene cardiac lesions during hospitalization have a significant decreasing in the level of magnesium compared with indicators of children without pathology of the cardiovascular system. After treatment, the normalization of trace elements iron, zinc, magnesium did not happen, moreover, significant changes were observed in patients with heart disease against the background of chronic tonsillitis.