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Дослідження задоволеності працею та синдром вигорання у медичних працівників
Get PDFAim. Determination of burnout syndrome formation features in healthcare workers “satisfied” and “not satisfied” with their job for the further development of recommendations to prevent it.Methods. The study of employee satisfaction in 164 healthcare workers of Kherson city clinical hospital named after E. E. Karabelesh (Kherson, Ukraine) by questionnaire (response was 87 %). The responders answered the question: "Are you satisfied with your job at the hospital?". The answers were evaluated by 7-point scale. The responders were divided in two groups according their answers: the first group (n=120) consisted of the satisfied with job (7, 6, 5 points), the second group (n=34) consisted of the not satisfied with job (3, 2, 1 points). The responders (n=10) answered “can not decide” (4 points) were removed from the further analysis.Results. It was found that the share of people having burnout syndrome among the “not satisfied” (65.0 %) is significantly higher (р<0,05) comparing to the “satisfied” group (40.0 %). In the responders from the “not satisfied” group, the symptoms of “stressful circumstances experiencing" (46 %), “professional duties reduction” (38 %), “depersonalization” (35 %), “expansion the scope of keeping emotions” (30 %), “inadequate selective emotional response” (27 %) manifested the most often. In the “satisfied” group, the symptoms of “expansion the scope of keeping emotions” (15 %) and “stressful circumstances experiencing" (14 %) were the most frequent manifestation of burnout syndrome. There is a negative relationship between employee satisfaction and the level of severity of burnout syndrome (Р<0,001).Conclusion. The probability of burnout syndrome is higher in healthcare workers unsatisfied with their job. In these workers the syndrome leads to deterioration professional capacity and decrease in quality of medical care by “professional duties reduction” and “depersonalization” symptoms. In the “satisfied” workers it leads to quality of communication and their health deterioration by “expansion the scope of keeping emotions” and “psychosomatic and psycho-vegetative violations” symptoms. Employee satisfaction is a factor for burnout syndrome preventionВ дослідженні представлено особливості формування синдрому вигорання у «задоволених» та «невдоволених» працею медичних працівників. Встановлено, що ймовірність розвитку синдрому вища у «невдоволених», ніж у «задоволених» працею медичних працівників. У «невдоволених» синдром частіше проявляється симптомами «редукція професійних обов’язків» та «деперсоналізація», у «задоволених» – «розширення сфери економії емоцій» та «психосоматичні та психовегетативні порушення
Дослідження патоперсонологічних розшарувань у хворих на цукровий діабет 2-го типу важкого ступеня тяжкості
Get PDFAim. To study the pathopersonological features of patients with severe DM type 2 for improvement of diagnostics and treatment of patients with DM type 2.Materials and methods. On the bases of MI “Zaporizhzhya city hospital № 1” and MI “Regional clinical endocrinology dispensary” of Zaporizhzhya region council were examined 174 patients with severe diabetes mellitus type 2, who underwent stationary treatment; average age in group was (61,8±0,85) years old.Methods of research: anamnestic, clinical-psychopathological, psychodiagnostic.Results of research. As a result of research, the pathopersonological features of patients with severe diabetes mellitus type 2 were established. There were separated five types of pathopersonological stratifications in patients with severe diabetes mellitus type 2: psycho-organic (deficit and affective-labile variants), astheno-neurotic, psychastheno-depressive, ergo-hypersthenic and hypochondriac types. The influence of each established type of pathopersonological stratifications in patients with severe diabetes mellitus type 2 on their compliance to the therapy was studied. The dominant types of of pathopersonological stratifications in patients with severe diabetes mellitus type 2 were established. Conclusions. The established types of pathopersonological stratifications in patients with severe diabetes mellitus type 2 can be a base of diabetic pathopersonology that improves the quality of differentiated diagnostics and approaches to the therapy and psychoprophylaxis of DM type 2, including in the context of correction of compliance to the therapy of DM type 2 at the expanse of dyscompliant personal features levelingВстановлено патоперсонологічні особливості хворих на цукровий діабет 2-го типу важкого ступеня тяжкості. Виділено п’ять типів патоперсонологічних розшарувань у хворих на цукровий діабет 2-го типу важкого ступеня тяжкості, що розширює уявлення про діабетичну патоперсонологію. Встановлено домінуючі типи патоперсонологічних розшарувань та їх вплив на комплаєнс хворих до терапі
Сравнительный анализ накопления ацетата свинца в плазме крови, моче и гомогенатах твердых тканей зубов крыс
Get PDFAim. A comparative analysis of lead acetate concentration in blood plasma, urine and homogenates of hard dental tissues in rats for determination of the informative value of indicators to estimate condition of lead acetate accumulation and metabolism depending on its accumulation degree. Methods. The studies were carried out using 36 white mongrel male rats weighing 200–250 g. The animals were divided into two groups: the first (12 rats) – the control group, receiving ordinary water, the second group (24 rats) – the animals received lead acetate in a dose of 10 mg / kg of the the animal weight of in the form of a one-percent intragastric solution with drinking water daily during one, two and three months.Results. In result of research devoted to determination of lead acetate in blood plasma, urine and homogenates of hard dental tissues in rats, its increase depending on the poisoning period duration was found, and the highest indices were marked after 3 months period.Conclusion. A comparative analysis of the accumulation of lead acetate in blood plasma, urine and homogenates of hard dental tissues in rats using atomic absorption spectrometry was carried out. In result of the study we can conclude about the degree of lead acetate accumulation in homogenates of hard dental tissues and about the presence of subchronic lead intoxication (blood plasma, urine)Актуальным остается изучение токсического действия соединений свинца на твердые ткани зубов, поскольку свинец отнесен ВОЗ к глобальным загрязнителям окружающей среды. В исследовании методом атомно-абсорбционной спектрометрии проведен сравнительный анализ накопления ацетата свинца в плазме крови, моче и гомогенатах твердых тканей зубов контрольной группы крыс и в группе крыс получавших ацетат свинца в течении 1,2 и 3 месяцев и выявлена наибольшая концентрация спустя три месяц
Оцінка якості життя хворих на хронічне обструктивне захворювання легень за супутніх розладів психоемоційної сфери
Get PDFAim – to study quality of life (QOL) indicators in patients with chronic obstructive pulmonary disease (COPD) at different types and expressiveness of concomitant psycho-emotional disorders.Materials and methods. There were examined 206 patients with COPD (158 (76,7 %) men and 48 (23,3 %) women, whose mean age was 64,4±0,8 years, mean disease duration – 8,8±0,4 years) using clinical-functional and questionnaire methods of research. The psychic status of respondents was determined using the complex of standardized questionnaire methods. QOL was assessed using the Ukrainian version of the international questionnaire on QOL MOS SF-36. The statistical processing of data was realized using the package of statistical programs SPSS 20.0 for Windows by parametric and non-parametric methods according to the type of variables distribution.Results. It was established, that patients with COPD had statistically reliably higher mean values than practically healthy persons by scales of neurotization ((44,97±1,27) %, р=0,005), state anxiety ((42,82±0,64) points, р<0,001), trait anxiety ((44,95±0,63) points, р <0,001) and depressive states ((41,00±0,65) points, р<0,001). There were established the prevalence of psycho-emotional disorders in patients with COPD: neurotization (26,2 %), state anxiety (37,9 %), traitanxiety (49,5 %), depressive states (16,5 %).It was revealed that patients with COPD have reliably lower mean values than practically healthy persons by all indicators of physical, psychic and general statuses of QOL and change health comparing with the previous year.It was established, that each separate psycho-emotional disorder essentially influences QOL indicators of patients with COPD that is manifested in the reliable decrease of mean values by all scales of MOS SF-36 form.Conclusions. In the result of the study there were assessed QOL indicators of patients with COPD and also established their dependence on the type and expressiveness of concomitant psycho-emotional disordersУ хворих на хронічне обструктивне захворювання легень одними з найбільш частих коморбідних станів є розлади психоемоційної сфери. Досліджено показники якості життя хворих в залежності від виду та виразності психоемоційних розладів. Встановлено, що клінічно значимі синдроми невротизації, тривожності та депресивні стани посилюють негативний вплив захворювання на показники якості життя пацієнті
Малярія vivax на Буковині: клінічний випадок безконтрольного самолікування
Get PDFMaterials and methods. There were used clinical, general laboratory, parasitological (microscopy of a smear and thick drop of blood), instrumental, epidemiological research methods. The descriptive analysis of the medical documentation (outpatient and stationary card of a patient) was realized, clinical-epidemiological data of a patient were analyzed. Results of research and their discussion. At the admission of a patient of the infectious stationary of MCI “Regional clinical hospital of Chernyvtsi city” it was elucidated that he has been suffering from malaria attacks (ague-fever-perspiration) since 2013 after staying in Venezuela. He has the distinctly expressed positive epidemiological anamnesis, connected with a contract work. In the presented clinical case the patient was aware as to the malaria symptoms, because worked as a ship doctor. The uncontrolled self-treatment at the absence of the “gold standard” of laboratory diagnostics of malaria led to the long parasite-spreading in the liver tissue as “dormant forms”.Conclusions. 1. At the positive epidemic anamnesis all cases of fever of unexplained genesis must be diagnosed for the most socially important tropic disease of 21 century in the world scale – malaria.2. It is obligatory to establish the type of a malaria plasmodium by the repeated parasitoscopy of blood by the methods of thin smear, stained according to Gimza-Romanovsky and thick drop taking into account the predicted sensitivity to anti-malaria chemopreparations.3. The attentive attitude of family doctors of the first link of family medicine to malaria allows to avoid complicated forms and remote relapses of this inoculable infection, caused by different types of plasmodiaОписано клінічний випадок завізної малярії на Буковині, спричиненої Pl. vivax в трудового мігранта. Безконтрольне самолікування за відсутності «золотого стандарту» діагностики малярії призвело до тривалого паразитоносійства в тканині печінки у вигляді «дормантних форм». Насторожене відношення сімейних лікарів щодо малярії дозволить уникнути ускладнених форм і віддалених рецидивів цієї трансмісивної інфекці
Анализ репаративного остеогенеза при диафизарных переломах костей голени по данным рентгенографии
Get PDFAim of research. To study the features of reparative osteogenesis at diaphysial tibia fractures in patients of a young and middle age.Material and methods. There was presented the analysis of x-ray photographs of 122 patients with diaphysial tibia fractures 18 - 60 years old (men - 54,2%, women - 45,8%) in sanitary projections at the dynamic observation from 8 months to 3 years.Research results. It was established that the full accretion of fractures in terms up to 4 months was detected only in 28,7% of cases (35 patients), in terms up to 6 months -in 33,6% (41 patients), up to 8 months - in 16, 4% (20 patients). In 26 patients (21,3%) the accretion of diaphysial tibia fractures was forming during 1,5-2 years. Most often at fractures accretion was observed a periosteal callus (83,6%), less often – intermediary one (11,4%) and paraossale (4,9%). Complication at fractures accretion were detected in 46 (37,7%) of traumatized persons.Conclusions. In most cases diaphysial fractures of tibia accreted longer than 4 months with complications in each third patientНа основании анализа рентгенограмм 122 пациентов с диафизарными переломами костей голени в возрасте от 18 до 60 лет при динамическом наблюдении на протяжении от 8 мес. до 3-х лет установлены сроки сращения, виды костной мозоли и частоту осложнений репаративного остеогенеза. Осложнения при заживлении переломов отмечены у 46 (37,7 %) травмированны
Дослідження показників, що впливають на клінічний прогноз та ремоделювання серця у віддаленому періоді у хворих на інфаркт міокарду з елевацією сегменту ST
Get PDFAim. To determine factors, connected with the unfavorable prognosis of patients with myocardium infarction (MI) with ST element elevation, who underwent the thrombolytic therapy (TLT).Materials and methods. There were examined 100 patients with MI with ST segment elevation, who underwent TLT, admitted at hospital during the first 6 hours of the disease. The average time of TLT was 154±75,56 minutes, TLT was realized at the pre-hospital stage in 35(38,5 %) patients.Blood samples for determining biochemical parameters, especially asymmetric dimethylarginine (ADMA) and high-sensitive C-reactive protein (CRP), were taken at admission at hospital. ADMA level was determined using the high-effective liquid chromatography, the level of high-sensitive CRP – by the immunoturbdiametric analysis. For determining the allele condition of T786C polymorphism of the gene of endothelial NO synthase (eNOS), there was used polymerase chain reaction. All patients underwent echocardioscopy (EchoCS). Patients were examined repeatedly in 1 year. The information as to undesirable clinical events was accessible in 91 persons, 60 patients underwent the repeated EchoCS.Results. Undesirable clinical events took part in 13 (14,3 %) of 91 patients. Among patients, who underwent undesirable events, reliably more patients had the previous localization of MI (39,7 % and 76,9 %, respectively, р=0,03). They had also the more heart rate for the second day of the disease (71,01±12,38 st/min and 77,36±7,84 st/min, respectively, p=0,045). The reliably more part of patients from this group had angina before the development of the current MI - 1 (1,3 %) and 3 ( 23,1 %), respectively, р=0,009. Patients, who had undergone undesirable events, had the reliably higher level of the high-sensitive CRP at admission to hospital (37,47±28,08 against 11,70±12,21in І group, р=0,006). The regression analysis established that the increase of the risk of undesirable events by 9,9 % is connected with angina before MI, by 7,3 % with the previous MI localization, by 5,6 % with the decrease of the emission fraction (EF) in the acute period of MI, by 5,1 % with the increase of the level of the high-sensitive CRP, by 5,1 % with the decrease of smoking length, and by 5,1 % with female sex.The left ventricle (LV) remodeling (increment of the end diastolic volume (EDV) over 20 % comparing with the results of the first EchCS) was observed in 13 (21,7 %) of 60 examined persons. It was revealed, that patients with the further development of LV remodeling had better parameters of the intracardiac hemodynamics in the acute period of MI – less values of LV EDV (р=0,028), LV end systolic volume (ESV) (р=0,049), LV myocardium mass (р=0,031). At the analysis of laboratory data, it was revealed, that these patients had the reliably higher level of the high-sensitive CRP and ADMA. The method of regression analysis demonstrated that the increase of the risk of LV remodeling is connected with the less size of the left atrium by 12,5 % and by 9,1 % - with the less MMLV in the acute MI period, by 5,9 % with smoking at the moment of MI, by 5,1 % with the increase of the level of high-sensitive CRP, by 4,7 % with angina before MI, by 4,6 % with the previous MI localization.Conclusions. The risk of clinical undesirable events and LV remodeling in patients with MI with ST segment elevation depends on their anamnesis, infarction localization and clinical course of the disease and also on several biochemical indicesДослідження присвячене актуальному питанню кардіології – визначенню прогнозу хворих після перенесеного гострого інфаркту міокарду. Автори розглядають показники, що впливають на ризик розвитку небажаних клінічних подій та ремоделювання серця, яке є підґрунтям серцевої недостатності - частого і важкого ускладнення інфаркту міокарду. Урахування цих чинників в процесі лікування сприятиме покращенню прогнозу хворих, що перенесли інфаркт міокард
Визначення ролі біомаркерів сигнального шляху кальціневрину у розвитку ранніх змін в міокарді у дітей з двостулковим аортальним клапаном серця
Get PDFAim of research: determination of the diagnostic value of serum concentration of biomarkers of calcineurin signal pathway (calcineurin, protein S100, interleukin-2) in children with the bicuspid aortic valve at absence of heart failure signs and influence of revealed changes on the early remodeling and hypertrophy of myocardium.Materials and methods: 38 children with the bicuspid aortic valve (SAV), diagnosed by doppleroechocardiography, and 28 children of the control group underwent the measuring of concentrations of calcineurin, protein S100, interleukin-2 and general calcium by the immune-enzyme method with the further estimation of the influence of these changes on morphofunctional hearth parameters by the method of correlation analysis.Results: children with SAV demonstrated the reliable thickening of the back wall of the left ventricle and interventricular septum at the correspondent increase of the blood velocity and pressure gradient on the aortic valve. Serum concentrations of calcineurin and calcium in children with SAV were reliably decreased, and protein S100 correspondingly increased comparing with the control group. At that the SAV group, as opposite to the control one, demonstrated reliable negative correlations between the calcineurin level and right ventricle sizes, protein S100 and left and right atria sizes interleukin-2 and left ventricle systolic size at the reliable positive correlation between levels of calcineurin and general calcium.Conclusions: Children with SAV demonstrated the moderately expressed left ventricle myocardium hypertrophy, decrease of calcineurin serum concentrations that have a negative influence on the geometry of right heart parts and serum calcium level at the correspondent increase of protein S100. The revealed changes allowed to establish the predicative role of calcineurin in the development of early morphofunctional changes of myocardium in children with SAVВ результаті дослідження вмісту сироваткових концентрацій кальціневрину, білка S100, інтерлейкіну-2, у дітей з двостулковим аортальним клапаном встановлена наявність помірної гіпертрофії міокарду, збільшення градієнту тиску та швидкості кровотоку на аортальному клапані, зниження рівнів кальціневрину та загального кальцію, збільшення концентрації білка S100 при негативному впливі цих показників на геометрію правих відділів серц
Обґрунтування та базові засади медико-психологічного супроводу у сфері дитячої нейрохірургії
Get PDFAim: Comprehensive study of the features of emotional disorders in the parents of a child of the first year of life with severe craniocerebral trauma.Materials and methods. To achieve this aim, in compliance with the principles of bioethics and medical deontology was conducted a comprehensive clinical-anamnestic, clinical-psychological and psychodiagnostic examination of 137 families (mother and father) of children of the first year of life who received a craniocerebral trauma. All the examined families were full (mother and father), the average age of their parents was 27.0 ± 3.0 years.The main group consisted of 97 families who took part in the program of medical and psychological support using psycho education. Control group - 40 families who did not receive psychological support.The following survey methods were used in the study: clinical and anamnestic; clinical and psychological; psychodiagnostic using a questionnaire of nervous-psychic stress, clinical scale of anxiety and depression of Hamilton, adapted to MKH-10; scale of situational and personal anxiety Ch.D. Spielberger, methods of studying the styles of stress-breaking behavior "Methods of coping", methodology "Determination of ways to resolve conflicts" by K. Thomas in adaptation by N.V. Grishina.Results of the research. The child's illness is a traumatic situation for all parents, which leads to the development of anxiety-depressive reactions and conditions. Distributed anxiety-depressive, astheno-depressive, depressive-apatitic and dysphoric variants of emotional disorders in the parents of infants with severe craniocerebral trauma and described their clinical features.For parents of infants with severe craniocerebral trauma are characterized as ones with high levels of emotional stress, a sharp increase of negative emotions, a feeling of anxiety, depressive manifestations.The obtained results allowed to substantiate expediency of medical-psychological support of the family with the first year child with severe craniocerebral trauma, which includes methods of differentiated psychotherapy and psycho-educational programs.Conclusions The structure of psycho-emotional disorders in the parents of infants with severe craniocerebral trauma is represented by anxiety-depressive (40.9%), asthenoid-depressive (22.5%), depression-apathy (20.5%) and dysphoric (16.1%) variants.The efficiency of the system of medical and psychological support of the family with the first year child with severe craniocerebral trauma, which includes methods of differentiated psychotherapy and psycho-educational programs is provedУ роботі проведено вивчення особливостей емоційних розладів у батьків дитини першого року життя з важкою черепно-мозковою травмою.Структура тривожно-депресивних станів обстежених батьків представлена тривожно-депресивним, астено-депресивним, депресивно-апатичним і дисфоричним варіантами.Отримані результати дозволили обґрунтувати доцільність медико-психологічного супроводу родини немовляти з важкою черепно-мозковою травмою, яка включає методи диференційованої психотерапії та психоосвіт
Содержание макро- и микроэлементов в волосах у детей с эпилептическими припадками, перенесшими перинатальную патологию центральной нервной системы. Клинико-лабораторные корреляции
Get PDFAim of research. Identify the features of the content of trace elements and minerals in hair in children with epileptic seizures that have undergone perinatal pathology of the central nervous system. To determine the specificity of elemental status in patients whose seizures could be stopped, and in patients resistant to pharmacotherapy.Methods. Twenty children with epileptic seizures underwent perinatal pathology of the central nervous system, aged from 3 months to 8 years (an average of 3.04±2.9 years) were controlled. Population is divided into two groups: I group (10 people) - children with epileptic seizures, managed to be stopped. Group II (10 people) - children with epileptic seizures, resistant to therapy. The control group consisted of 10 practically healthy children of the corresponding sex and age. The content of 25 chemical elements: Al, As, Be, Cd, Hg, Li, Ni. Pb, Sn, B, V, I, Ca, Co, Cr, Cu, Fe, K, Mg, Mn, Na, P, Se, Si, Zn, μg / g was determined in hair by atomic-emission spectrometry with inductively coupled argon plasma and mass spectrometry.Results. The children with epileptic seizures showed a statistically significant increase in the content of Ca, Mg, Mn, Pb, a decrease in Sn concentration when comparing the content of elements in the group II and the control group (p <0.05). The increase in the concentration of the toxic element Pb in the group of seriously ill children with pharmacoresistant persisting epileptic seizures is 3.5 times higher than in the control group (p <0.05). The amount of Ca, Mg, Mn, Pb (ƿ from 0.42 to 0.67) in hair directly correlated (according to Spearman) with the severity of the condition and the propensity to resistance to therapy, in feedback - Sn (ƿ -0, 53). The largest number of direct average and strong links with the severity of clinical evidence and the character of structural changes in the brain was noted in Mg.Conclusions. The revealed changes in elemental status may indicate a possible pathogenetic mechanism in the development of clinical symptoms in the patients examined, the formation of pharmaco-resistance to therapy due to a disturbance of the metal-ligand homeostasis. More studies are needed to clarify the importance of the exchange of micro- and macroelements in the development of the diseaseЦелью работы являлось выявление особенностей содержания микро- и макроэлементов в волосах у детей с эпилептическими припадками, перенесших перинатальную патологию центральной нервной системы. По результатам исследования у детей с фармакорезистентными эпилептическими припадками выявлено статистически значимое по сравнению с контролем повышение содержания в волосах Ca, Mg, Mn, Pb, уменьшение концентрации Sn (p<0,05