Репозиторий Университета

© 2020 Elsevier B.V. Introduction: Vaginal birth after caesarean delivery is associated with better outcomes compared to repeat caesarean section. Accurate antenatal risk stratification of women undergoing a trial of labor after caesarean section is crucial in order to maximize perinatal and maternal outcomes. The primary aim of this study was to explore the role of antepartum ultrasound in predicting the probability of vaginal birth in women attempting trial of labor; the secondary aim was to build a multiparametric prediction model including pregnancy and ultrasound characteristics able to predict vaginal birth and compare its diagnostic performance with previously developed models based exclusively upon clinical and pregnancy characteristics. Methods: Prospective study of consecutive singleton pregnancies scheduled for trial of labor undergoing a dedicated antepartum ultrasound assessment at 36–38 weeks of gestation. Head circumference, estimated fetal weight cervical length, sub-pubic angle were recorded before the onset of labour. The obstetricians and midwives attending the delivery suite were blinded to the ultrasound findings. Multivariate logistic regression and area under the curve analyses were used to explore the strength of association and test the diagnostic accuracy of different maternal and ultrasound characteristics in predicting vaginal birth. Comparison with previously reported clinical models developed by the Maternal-Fetal Medicine Unit Network (Grobman's models) was performed using De Long analysis. Results: A total of 161women who underwent trial of labor were included in the study. Among them 114 (70.8 %) women had successful vaginal birth. At multivariable logistic regression analysis maternal height (adjusted odds ratio (aOR):1.24;9 5% Confidence Interval (CI)1.17−1.33), previous C-section for arrest labor (aOR:0.77; 95 %CI0.66−0.93), cervical dilation at admission (aOR:1.35; 95 %CI1.12−1.74), fetal head circumference (aOR:0.77; 5%CI0.43−0.89), subpubic angle (aOR:1.39 95 %CI1.11−1.99) and cervical length (aOR:0.82 95 % CI0.54−0.98) were independently associated with VBAC. A model integrating these variables had an area under curve of 0.839(95 % CI 0.710−0.727) for the prediction of vaginal birth, significantly higher than those achieved with intake (0.694; 95 %CI0.549−0.815; p = 0.01) and admission (0.732: 95 % CI 0.590−0.84; p = 0.04) models reported by Grobman. Conclusion: Antepartum prediction of vaginal birth after a caesarean section is feasible. Fetal head circumference, subpubic angle and cervical length are independently associated and predictive of vaginal birth. Adding these variables to a multiparametric model including maternal parameters improves the diagnostic accuracy of vaginal birth compared to those based only on maternal characteristic.

© 2020 Elsevier B.V. Introduction: Vaginal birth after caesarean delivery is associated with better outcomes compared to repeat caesarean section. Accurate antenatal risk stratification of women undergoing a trial of labor after caesarean section is crucial in order to maximize perinatal and maternal outcomes. The primary aim of this study was to explore the role of antepartum ultrasound in predicting the probability of vaginal birth in women attempting trial of labor; the secondary aim was to build a multiparametric prediction model including pregnancy and ultrasound characteristics able to predict vaginal birth and compare its diagnostic performance with previously developed models based exclusively upon clinical and pregnancy characteristics. Methods: Prospective study of consecutive singleton pregnancies scheduled for trial of labor undergoing a dedicated antepartum ultrasound assessment at 36–38 weeks of gestation. Head circumference, estimated fetal weight cervical length, sub-pubic angle were recorded before the onset of labour. The obstetricians and midwives attending the delivery suite were blinded to the ultrasound findings. Multivariate logistic regression and area under the curve analyses were used to explore the strength of association and test the diagnostic accuracy of different maternal and ultrasound characteristics in predicting vaginal birth. Comparison with previously reported clinical models developed by the Maternal-Fetal Medicine Unit Network (Grobman's models) was performed using De Long analysis. Results: A total of 161women who underwent trial of labor were included in the study. Among them 114 (70.8 %) women had successful vaginal birth. At multivariable logistic regression analysis maternal height (adjusted odds ratio (aOR):1.24;9 5% Confidence Interval (CI)1.17−1.33), previous C-section for arrest labor (aOR:0.77; 95 %CI0.66−0.93), cervical dilation at admission (aOR:1.35; 95 %CI1.12−1.74), fetal head circumference (aOR:0.77; 5%CI0.43−0.89), subpubic angle (aOR:1.39 95 %CI1.11−1.99) and cervical length (aOR:0.82 95 % CI0.54−0.98) were independently associated with VBAC. A model integrating these variables had an area under curve of 0.839(95 % CI 0.710−0.727) for the prediction of vaginal birth, significantly higher than those achieved with intake (0.694; 95 %CI0.549−0.815; p = 0.01) and admission (0.732: 95 % CI 0.590−0.84; p = 0.04) models reported by Grobman. Conclusion: Antepartum prediction of vaginal birth after a caesarean section is feasible. Fetal head circumference, subpubic angle and cervical length are independently associated and predictive of vaginal birth. Adding these variables to a multiparametric model including maternal parameters improves the diagnostic accuracy of vaginal birth compared to those based only on maternal characteristic.

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. Neurovirulent enterovirus 71 (EV-A71) caused a massive epidemic in China in 2008-2011. While subgenotype C4 was the major causative agent, a few isolates were almost identical to the prototype EV-A71 strain and belonged to genotype A. This variant was allegedly extinct since 1970, and its identification in this epidemic suggests reintroduction of the archive virus. Regression analysis of genetic distances (TempEst software) was of moderate utility due to the low resolution of classical phylogenetic methods. Bayesian phylogenetic analysis (BEAST software) suggested artificial introduction event based on highly aberrant phylogenetic tree branch rates that differed by over three standard deviations from the mean substitution rate for EV71. Manual nucleotide-level analysis was used to further explore the virus spread pattern after introduction into circulation. Upon reintroduction, the virus accumulated up to seven substitutions in VP1, most of them non-synonymous and located within the capsid's canyon or at its rims, compatible with readaptation of a lab strain to natural circulation.

The publication presents the definition of key terms in pricing, sets out pricing methods, lists the current legal documents on cost indicators in health care. Methodical approaches to the calculation of remuneration, as one of the components of the cost of medical care, involve the use of labor standards of medical workers, differentiated by their participation in the therapeutic and diagnostic process. The analysis of the regulatory framework for labor in health made the need for its revision.

© 2019, Pleiades Publishing, Ltd. Preterm birth is not only medical, but also a social problem. The global goal of medicine is prevention of preterm labor and identification of risk factors leading to preterm birth. The objective of our study was to find the association between polymorphic markers in the cytokine IL-β, TNF-α, IL-1Ra, and IL-4 genes and development of preterm labor. The prospective study was conducted in 108 pregnant women with the risk of preterm birth. The main group consisted of 66 women whose pregnancy ended with preterm delivery despite the ongoing therapy. The comparison group included 42 women with the full-term delivery. The dominant T allele of the cytokine IL-1β gene polymorphism rs1143634 (3953C→T) was 7.6 times more common in women with preterm delivery vs. the comparison group (36.4 and 4.8%, respectively; RR, 1.802; 95% CI, 1.420–2.288; p < 0.05); its homozygous form was detected only in women with preterm delivery at the very early gestation age (less than 26 weeks). The dominant proinflammatory allele 2R of the IL-1 receptor antagonist gene (IL-1Ra) was 1.5 times more common in women with preterm delivery than in the comparison group (63.6 and 42.8%, respectively; RR, 1.400; 95% CI, 1.009–1.943; p < 0.05), which makes the 2R allele the risk factor for preterm birth. The 2R/2R and 2R/4R genotypes led to a very early and early preterm delivery, respectively. The combination of three or four proinflammatory genotypes was detected only in women with a very early preterm delivery, which confirms that the combination of several proinflammatory genotypes is an extremely unfavorable factor for the full-term pregnancy. Identification of genetic polymorphisms in the interleukin genes at the periconceptional stage will help to prevent the risk of preterm delivery, which will reduce the incidence of preterm births, as well as perinatal morbidity and mortality.

© 2019 John Wiley  &  Sons Ltd Aims and objectives: To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. Background: Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. Design: The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. Methods: A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February–May 2015. The “STROBE” EQUATOR checklist was used. Results: Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. Conclusion: Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. Relevance to clinical practice: Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To offer a clinical and laboratory characteristic of coronavirus infection in hospitalised children. Patients and methods. The group of study included 50 children, who were diagnosed with coronavirus infection by polymerase chain reaction (PCR). Mono-coronavirus infection was found in 40 children (80%), mixed virus infection conditioned by a combination of two or three viruses - in 10 children (20%). Results. In all examined children with coronavirus infection disease had an acute onset and took a mild or moderate course. In general, the clinical picture of disease was manifested by cough, signs of rhinitis (stuffy nose, mucus discharge from the nose), febrile fever (in 52.5% of patients with mono-infection and in 80% of children with mixed infection), laryngotracheitis with laryngeal stenosis grade 1 (in 52.5% with mono-infection and in 80% with mixed infection). In 10% of children with monoinfection and in 50% of children with mixed infection gastrointestinal dysfunction was noted in the form of repeated vomiting to 2-6 times, diarrhoea to 1-4 times daily without pathological admixtures. Haematological parameters did not show any characteristic specificities in any child in both mono-infection and mixed infection. Cclusionon. Catarrhal inflammation is the leading clinical syndrome in mono- and mixed coronavirus infection; disease was manifested by cough, often - elevated body temperature, signs of stenosing laryngitis; part of children developed gastrointestinal dysfunction.

© Bukhtiyarov I.V., Yushkova O.I., Fesenko M.A., Merkulova A.G., 2018. The papers dwells on the results obtained during fatigue risk assessment as per subjective and objective parameters in civil aviation crew members. Our research goal was to assess fatigue and overfatigue risks as per subjective and objective cardiovascular system parameters and central nervous system parameters in workers with morning and evening biorhythms under neuro-emotional workloads and shift work performed by planes crew members, air traffic controllers, and operators. Our examined workers were mostly people aged 35-45 with working period equal to 5-15 years. Fatigue which occurred during flights was assessed subjectively by crew members questioning as per Epworth Sleep Scale, Karolinska Sleepiness Scale, and crew state control as per Samn-Perelli. Working efficiency was studied via PVT test (psychomotor vigilance test), sleep monitoring, and actigraphy. Circadian rhythms dynamics was examined as per changes in minimal body temperature which aircrew members had. We applied Ostberg's questionnaires to assess biorhythmologic activity type. Workers' functional reserves were assessed via stress testing. We calculated functional changes index to assess functional abilities of the circulatory system and adaptation state during a working shift in workers with various biorhythmologic types. The paper outlines the examination results for physiological reactions appearing in the cardiovascular system and central nervous system of workers with morning and evening biorhythms. We revealed that functional state peculiarities in operators when they performed their work tasks in a shift regime were closely connected with their biorhythmologic activity type. "Early risers" had more adverse physiological reactions during their work activities. We developed ways to lower risks related to fatigue and overfatigue caused by shift work. It was shown that regulatory mechanisms stress occurring in the circulatory system, lower labor motivation, and poorer health in people with the morning biorhythmologic type made it necessary to correct the body functional state during shift work, especially when labor was very intense.

© Izdatel'stvo Meditsina. All rights reserved. The professional standard is the basis of education and training. It should meet modern requirements to ensure the sanitary and epidemiological wellbeing of the country's population, the labor market. The current professional standard does not fully take into account the various types of economic activity in which young professionals of the medical and preventive profile will work. The main task of a specialist in the medical and prophylactic profile is to carry out activities aimed ensuring the sanitary and epidemiological wellbeing of the population (informing the control subject concerning mandatory sanitary and epidemiological requirements, implementation, assessing the effectiveness and effectiveness of their implementation, implementing production control, expert control, sanitary-epidemiological audit). The main employers for these young professionals are organizations of the sanitary and epidemiological services; hospitals, sanatorium, spa and resort organizations; organization of disinfection and deratization, organizations of industrial equipment, testing and analysis of the composition and purity of materials and substances; testing and analysis in the field of food hygiene; testing and analysis of physical and mechanical properties of materials and substances; examination of design documentation and engineering survey results; monitoring of environmental pollution. The professional standard of the young professionals in the hygiene profile has a particular set of qualities, skills, and behaviors that ensure the success of the career. There is a set of standards for education and training of professionals in the hygiene profile. There are sanitary and epidemiological diagnostic - activities to establish compliance (inconsistency) with the requirements of the legislation of the Russian Federation in the field of public health. Also, there is the support of the sanitary and epidemiological wellbeing of the population, technical regulation, labor protection, various activities concerning and preventive measures; organization of monitoring and sanitary-epidemiological assessment of the risk of environmental factors affecting health. The education and training of students of medical-prophylactic faculties should be carried out taking into account modern approaches to the professional standard for the specialist of the hygienic profile and the educational standard developed on the basis of it.

© 2011–2018 NSPU Bulletin All rights reserved  Introduction. The authors investigate the problem of effective use of distance technologies in the educational process. The purpose of the article is to identify the potential of the Moodle electronic distance learning platform as a source for improving the quality of technical education. Materials and Methods. The authors used a set of research methods, including: 1) analysis of scientific literature on the topic of the article; 2) proposition of a hypothesis about the possibility of expanding the didactic functions of the Moodle distance learning platform by integrating interactive content into it; 3) constructing a methodological model which includes innovative educational content, characterized by an interactive format; 4) experimental approbation of teaching methods with elements of statistical analysis of the results of the control and experimental groups of students using the Pearson criteria – χ 2 . Results. As a result of the research, the following statements were identified: 1) determining factors for the realization of the capabilities of the Moodle platform in the educational process for the disciplines of physical, mathematical and technical fields; 2) the authors developed an algorithm for evaluating students’ work and showed the possibilities of placing models in a distance learning system to perform laboratory work necessary for the qualitative studying these disciplines; 3) the statistical analysis showed a positive result in terms of improving the quality of mastering basic knowledge elements. Conclusions. The authors summarize the characteristic features of the potential of the Moodle e-learning platform as a source for improving the quality of technical education.

© Bionika Media Ltd. Different factors caused by both equipment and the course of surgery (conditions under which the operation is performed, the location of incision, the characteristics of suture material, the type of surgical suture, and the amount of blood loss), by the course of the postoperative period, and the peculiarities of repair of damaged tissues influence wound healing of the uterus during cesarean section. Objective. To establish the value of premature amniorrhea and uterine inertia as predictors of impaired myometrial repair after cesarean section, by using clinical and morphological analyses. Subjects and methods. The investigation enrolled 129 patients who had given birth via cesarean section. Of them, 44 patients had delivery before birth activity, 85 during the first stage of labor. 49 and 80 women delivered before and after amniorrhea, respectively. During cesarean section, uterine tissue was taken from the upper edge of the wound after uterine incision. The myometrial biopsy specimens obtained during cesarean section were morphologically and immunohistochemically examined. The patients were divided into 4 groups according to the level of birth activity and the preservation of amniotic fluid at the time of cesarean section. Group 1 included patients with regular labor activity and amniorrhea at the time of caesarean section; Group 2 consisted of those with labor activity in the presence of whole amniotic fluid; Group 3 comprised those without birth activity in the presence of whole amniotic fluid; Group 4 included patients with premature amniorrhea without uterine contractions. 36 cases (9 in each group) were selected by random sampling for morphological and immunohistochemical examinations. The biopsy specimens were fixed in 10% neutral formalin and embedded in paraffin. The serial paraffin-embedded sections underwent histological examination and immunohistochemical tests for the following markers: TGF-β, VEGF, MMP2, TIMP1, types I and III collagen, TNF, and PDGF. Results. The morphological and immunohistochemical analyses revealed the most pronounced signs of myometrial damage during cesarean section in Group 4 patients having premature amniorrhea without uterine contractions. There were decreased VEGF, PDGF, MMP2, and TIMP levels and simultaneously increased TNF-α expression in leiomyocytes, vascular endothelium, and myometrial stromal cells. The findings may indicate the relatively lower reparative potential of the myometrium and the increased readiness for an inflammatory response in the group of women undergoing cesarean section in the presence of premature amniorrhea without uterine contractions. Conclusion. Clinical, morphological, and immunohistochemical analyses have revealed differences in the myometrial status in relation to typical clinical factors, such as amniorrhea and birth activity. Wound healing occurs under the influence of growth factors and the ratio of expression levels for growth factors can vary in different pathological conditions. The reduced expression of VEGF, MMP2, TIMP, and PDGF and the increased expression of TNF in the group having amniorrhea without uterine contractions (P-B+) suggest that there are pronounced inflammatory processes and impaired myometrial repair with the longer latency period in the absence of labor activity, which may refer these women to a group at risk for incompetent scar formation.

© Bionika Media Ltd. Objective. To evaluate the efficiency of methodological approaches to optimizing the care of pregnant women with gestational diabetes mellitus (GDM) under the present-day conditions of a progressive increase in the incidence of this disease in case of a specialized obstetric hospital. Materials and methods. The statistical data on the 2015–2016 activities of the Outpatient Department and the Maternity Department, Moscow City Clinical Hospital Twenty-Nine, were retrospectively analyzed. Results. GDM was diagnosed in two thirds of the pregnant women at more than 30 weeks’ gestation in primary outpatient care services. In the management of pregnant women with untimely detected GDM, the sensitivity of ultrasound fetometry using the specific markers of diabetic fetopathy (DF) was 65.5%. Programmed labor (PL) was one of the leading methods during childbirth. Conclusion. Ultrasound fetometry using specific markers for DF and the strict continuity of outpatient and inpatient care permitted the frequency of DF to be reduced about 1.5-fold. The use of PL methods in GDM contributed to a two-fold decrease in the cesarean delivery rate without deteriorating the perinatal outcomes of labor.

© 2018 Media Sphera Publishing Group. All rights reserved. The All-Russian physical culture-sports set «Ready for Labour and Defense» (RLD) is a system that is aimed at health improvement and patriotic education of the nation. This system consists of strength, speed, endurance, agility, and flexibility tests. Statutory requirements for each discipline have been developed taking into account the age and gender characteristics of an organism. The main aim of the RLD set is to improve the population's health; therefore much attention is focussed on the issues of medical support. The medical support of the RLD set can be arbitrarily divided into several stages: to make preliminary medical examination and to gain access to RLD tests; to check whether medical access is available and complies with the health status of their participant at the time of the tests; to render medical care when the RLD standards are fulfilled. This paper proposes to consider the stepwise medical support of the RLD set in accordance with actual normative legal acts.

© 2018, Modestum Ltd.. All rights reserved. Objective: The relevance of this study is due to the mass accreditation of health professionals that is developing in Russia, which requires innovative measurement tools and opens new opportunities for a well-founded cross-analysis of specialists’ professional readiness quality. Purpose of the study: The purpose of this article is to present approved methodical approaches to the transformation of accreditation data into a format suitable for secondary analysis of medical schools graduates quality based on the requirements of Professional Standards. Method: The leading methods of secondary data analysis are: a) codification of indicators in the primary data accumulation array; b) statistical processing of study results (evaluation of the relationships between the arrays of primary data accumulation and instrumental data, the correlation of test scores obtained by accreditation results with the labor functions of Professional Standards); c) the creation of representative samples for data analysis. The implementation of methods is carried out in the mode of working with arrays of big data, which also uses the method of cross-analysis to identify additional factors that affect to specialists’ professional readiness quality. Results: As a results of the research, there were: 1) approaches to the codification of data in the array and their secondary analysis were developed; 2) three samples were constructed with an estimation of representativeness for different strata, including subjects, assignments and corresponding labor functions; 3) the matrix of primary data in the specialty “Pediatrics” was verified using the example of the results of students from 50 medical universities in Russia. Conclusion: Approbation of methods of secondary data analysis conducted on representative samples of the subjects showed the effectiveness of the developed approaches that should be used when analyzing large data sets in the procedures of certification or accreditation. The materials of the article can be useful for specialists in the field of assessing the quality of education or assessing the professional readiness of health professionals, managers, professors and pedagogical staff of medical schools, specialists of centers for independent assessment of qualifications.