Gender hormones and non-specificbronchial hypersensitivity in children with bronchial asthma

Bronchial asthma continues to occupy a leading place in thestructure of chronic respiratory diseases in adults and children. Therefore,bronchial asthma remains an actual scientific problem today.One of the main links in the pathogenesis of bronchial asthma is bronchialhyperreactivity (non-specific bronchial hypersensitivity). On the other hand,among the etiological and pathogenetic factors of the development of bronchial asthma,a certain role belongs to violations of the neuroendocrine regulation of the body, whichis performed by the hypothalamic-pituitary-adrenal system. The hormonal defensemechanism of the body is triggered due to a state of stress reaction, which causesincreased activity of the pituitary gland, which in turn activates the adrenal cortex. Themain hormones of the adenohypophysis play a key role in the process of physiologicalmaturation of the body and the establishment of reproductive function. Theendocrine status of children and adolescents is characterized by the immaturity of the"hypothalamus - pituitary gland - gonads and target organs" system. In suchconditions, the negative impact of exo- and endogenous factors during the formationof the reproductive system can cause its functional immaturity. It is a well-known factthat sex hormones are included in the mechanisms of adaptation reactions.It is from the age of 12 that there is a significant restructuring of the functionalactivity of the pituitary-adrenal-gonadal status and a qualitative change in thehypothalamic-pituitary-gonadal relationship in the system of negative and positivefeedback.The purpose of the study: to study the relationship between puberty and the stateof non-specific bronchial sensitivity in children suffering from bronchial asthma

Polypharmacy problem in treatment of children in outpatient practice

The drug load that children receive is often superfluous and unreasonable. A typical example is the appointment of antibacterial drugs and immunomodulators in acute respiratory infections (ARI). In this work, there were analyzed 714 appeals to primary care physicians due to ARI in children under five years of age. The morbidity structure and frequency of use of drugs of various groups in this age period are presented. Unjustified use of antibacterial drugs has been noted in 59 % of cases. The average total number of drugs received by a child due to ARIs in his first five years of life was 44, some of which did not have proven effectiveness and safety

Sensitivity of bronchial receptors under the effect of tobacco smoke in the conditions of various activityof the thyroid gland in children

Остаточно не визначена роль вихідних порушень гормонального профілю системи «гіпофіз - щитоподібна залоза» у виникненні бронхоспазму у відповідь на екзогенні стимули. Метою нашого дослідження було вивчення характеру і вираженості взаємозв'язку між бронхіальною гіперчутливістю в дітей, які зазнають впливу куріння, і функціональною активністю щитоподібної залози. У дослідженні взяли участь 74 дитини у віці від 10 до 17 років. Серед обстежених дітей було 16 дітей, які не зазнавали впливу тютюнового диму, 50 дітей були пасивними курцями, і 8 обстежених дітей активно курили. Для дослідження рівня бронхіальної чутливості проводилися інгаляційні бронхопровокаційні тести з неспецифічним подразником – бронхоконстрикторами з ацетилхоліном. Функціональний стан щитоподібної залози оцінювали за рівнем у сироватці крові тиреотропного гормона (ТТГ), тироксину (Т4) і трийодтироніну (Т3). Для більшості обстежених дітей типовими були показники гормонів щитоподібної залози, які не відрізняються від нормативних показників для здорових дітей. Аналіз результатів інгаляційного бронхопровокаційного тесту з ацетилхоліном показав, що стан неспецифічної бронхіальної гіперчутливості мав місце в 2 активних курців, в одного пасивного курця і в одного, який не палить (χ2=15,4> χ201=9,21 або р0,05). Згідно з нашими даними, зміни у функціональному стані чутливих рецепторів бронхів (холінорецепторов) у дітей, які зазнають впливу тютюнового диму, активно або пасивно, не залежать від функціонального стану щитоподібної залози (Рχ2>0,05).The role of the initial hormonal profile disorders of the system “pituitary – thyroid” in the emergence of a bronchospasm in response to exogenic stimuli has not been finally determined. The aim of our research was to investigate the character and degree of the relationship between bronchial hypersensitivity in children exposed to smoking and the functional activity of the thyroid gland. The research involved 74 patients aged 10 to 17 years. Sixteen children were not exposed to tobacco smoke, 50 children were passive smokers, and 8 of the children surveyed smoked actively. To investigate the level of bronchial sensitivity, a bronchial provocation test with a non-specific stimulus – bronchoconstrictor acetylcholine was carried out. We assayed the functional state of the thyroid gland by the level of free triiodothyronine (FT3), free thyroxin 4 (FT4) and thyroid stimulating hormone (TSH), identified by Enzyme-linked Immunosorbent Assay (ELISA) (Alkor Bio, Russia). Indicators of hormones of a thyroid gland in most of the examined children did not differ from standard values for healthy children. Analysis of the results of the inhaled bronchial provocation test with acetylcholin showed that the state of nonspecific bronchial hypersensitivity was observed in 2 active smokers and in none of the passive smokers and nonsmokers (χ2=15,4>χ201=9,21 або р0.05). According to our data, changes in the functional status of sensitive bronchial receptors (cholinergic receptors) resulting from exposure to tobacco smoke in children exposed to tobacco smoke, active or passive, do not depend on the functional state of the thyroid gland (Рχ2>0,05)

The health status of children and youth depending on tobacco smoking status

Abstract. Electronic nicotine delivery devices (e-cigarettes) have been thesubject of research and debate among scientists and the public over the past decades.This innovative alternative to traditional smoking has gained widespread popularity,promoting itself as a less harmful or even safe alternative to tobacco. However, thequestion of the impact of electronic cigarettes on the human body remainsincomplete in knowledge and requires further study. Objective: to assess the impactof tobacco smoking on the health of children and adolescents. Materials andMethods: The study involved 2,202 children from grades 5 to 11 in six schools inthe city of Dnipro, with 115 of them participating in the second part. All childrenhad their smoking status and exposure to tobacco smoke determined, and somerespondents underwent spirometry, a test for hidden bronchospasm, and abronchoprovocation test with physical exertion.Results and Discussion. Of the 2,202 children aged 10-17, 2,039 (92.6%)experienced some degree of negative impact from tobacco smoke. There were 652(29.6%) active smokers, 1,387 (63.0%) passive smokers, and only 163 children(7.4%) were non-smokers. Chronic pathologies were found in 71 (61.7%) of thecomprehensively examined children. Among those with chronic pathologies,chronic tonsillitis was registered in 36 (50.7%), allergic rhinitis in 7 (9.8%), nondysfunctionalthyroid gland hyperplasia (euthyroid state) in 7 (9.8%), vegetativevasculardysfunction syndrome in 53 children (74.7%), and chronic gastritis andduodenitis in 9 (21.7%) children. No significant difference in the presence of"hidden bronchospasm" between groups of children with different smoking statuseswas found. Conclusions: Among older school-age children, 92.6% are affected bytobacco smoking. 29.6% of schoolchildren are active smokers, while 63.0% arepassive smokers. Chronic gastritis and duodenitis are significantly more common in children exposed to tobacco smoke (p < 0.01). The vegetative dysfunction syndromecontributes to the disruption of the functional state of β2-adrenoceptors in thebronchi of children exposed to tobacco smoke. The negative impact of tobaccosmoke in childhood manifests as a regulation disorder of bronchial patency by theautonomic nervous system: bronchospasm during physical exertion was three timesmore common in smoking children compared to non-smokers. Анотація. Електронні засоби доставки нікотину (електронні сигарети)стали предметом досліджень та суперечок науковців та громадськостіпротягом останніх десятиліть. Ця інноваційна альтернатива традиційномукурінню здобула широку популярність, пропагуючи себе менш шкідливою абонавіть безпечною альтернативою тютюну. Проте, питання про впливелектронних сигарет на організм людини залишається містить багато пробілівв знаннях і потребує подальшого вивчення. Мета: оцінити впливтютюнопаління на здоров’я дітей та молоді. Матеріали і методи. Участь удійсному дослідженні взяло 2202 дитини 5 – 11 класів шести шкіл м. Дніпро,115 із них були залучені у другу частину. Всім дітям проводилось визначеннястатусу курця і рівня навантаження тютюновим димом, частині респондентівбуло проведено спірометрію з проведенням тесту на прихований бронхоспазмта бронхопровокаційний тест з фізичним навантаженням. Результати таобговорення. Негативного впливу тютюнового диму тією чи іншою міроюзазнає 2039 із 2202 дітей (92,6%) віком 10-17 років. Активними курцями були652 (29,6%) дитини, пасивними курцями - 1387 (63,0%) і некурцями лише163 дитини (7,4%). Хронічна патологія була виявлена у 71 (61,7%) комплекснообстежених дітей. Серед всіх, що мали хронічну патологію дітей хронічнийтонзиліт реєструвався у 36 (50,7 %), алергічний риніт - у 7 (9,8%), гіперплазія щитовидної залози без порушення функції (еутериоїдний стан) - у 7 (9,8%),синдром вегето-судинної дисфункції - 53 дитини (74,7%), хронічнийгастродуоденіт – 9 (21,7%) дітей. Вірогідної різниці у наявності «прихованогобронхоспазму» між групами дітей з різним статусом курця виявлено не було.Висновки. Серед дітей старшого шкільного віку впливу тютюнопаліннязазнають 92,6%. Активно палять 29,6% школярів, пасивно - 63,0%. Хронічнийгастродуоденіт зустрічається достовірно частіше в дітей, які зазнають впливутютюнового диму (р<0,01). Синдром вегетативної дисфункції сприяє порушенню функціонального стану β2-адренорецепторів бронхів у дітей, щозазнають впливу тютюнового диму. Негативний вплив тютюнового диму вдитячому віці проявляється порушенням регуляції бронхіальної прохідності збоку вегетативної нервової системи: у дітей-курців бронхоспазм фізичного навантаження виявлявся в 3 рази частіше порівняно з некурц

Experience of organizing training on motivativecounseling for primary care physicians

In the modern model of training medical students, the leading role belongs to the formation of standardized skills, which are practiced according to unified algorithms, i.e. - hard skills. The advantage of this approach is the ability to test and control acquired skills and knowledge. However, further training of physicians cannot be rigidly tied to soulless algorithms and requires improved communication skills, especially in family medicine. After all, it is the primary level of medical care based on trusting and long-term relationships with the patient, establishing stable, healthy communication. In preventive medicine, you can often hear about compliance, although in the literal sense it is only a direct implementation of the patient's instructions. In recent years, more and more attention has been paid to the doctor's ability to motivate the patient to make lifestyle changes in order to maintain and strengthen the health of community members. At present, it is impossible to imagine a family doctor who does not use motivational counseling in his daily practice. At this stage, some doctors experience some gaps in their training and want to improve their communication skills (so-called soft skills). Motivational counseling trainings are constantly held at the Department of Family Medicine FPE of Dnipro State Medical University. The article describes the experience of teaching this topic to primary care physicians and confirms the effectiveness of our approach. The four-day intensive training allows you to immediately practice the acquired knowledge in a safe environment among your colleagues and clearly see its effectiveness. The participatory approach helps to attract invaluable experience of participants to solve clinical cases and situational problems. Based on Bloom's taxonomy of educational goals, our training provides a clear pursuit of the goal and consistent assimilation of the material to the highest level - the synthesis of new ideas. Thus, we managed to create a quality educational product for the formation of the necessary competencies in the communicative field of "patient-doctor", taking into account ethical and deontological professional principles

Peculiarities of the assessment of thefunctional reserve of the heart in childrenof all ages

An analysis of the literature on the topic showed that three quarters of adolescents do not follow the recommendations for physical activity, and insufficient physical activity, according to the WHO, is one of the main risk factors for non-infectious diseases such as cardiovascular disease, cancer and diabetes [1, 2]. In Ukraine government provides medical and pedagogical control (MPC) of health according to the Order of the Ministry of Health of Ukraine from 20.07.2009 №518 / 674 "On ensuring medical and pedagogical control over physical education of students in secondary schools". MPC is conducted at the level of primary care. The purpose of MPC is to determine the level of health, functional capabilities of the body and the level of development of motor skills of the child, to identify functional disorders and early symptoms of the disease that occur during exercise [3, 4, 5]. The main component of the MPC is the estimation of the functional reserve of the heart (FRH) as the main indicator of the cardiovascular system in children of different ages and their division into groups of physical education in accordance with the FRH. Ruffier's functional test as a representative, inexpensive and simple method is a tool for determining the FRH in our country and many countries around the worl

The academic self-efficacy of general practitioners – family doctors

Abstract: Education, for many specialties, especially for doctors, is a continuing process. It becomes not only a reflection of socio-cultural norms, personal values, but also plays an important role in unlocking personal potential, creates a need for effective learning, self-education, self-development.Self-efficacy means a sense of competence and efficiency, as well as the confidence to realize their own abilities and rebuild behavior that corresponds to a specific task or situation. People with a high level of self-efficacy are more interested in education and vocational training. Learning becomes a part of their lives and provides them with a major source of personal growth.In the literature, many scholars have studied this issue by studying the educational effectiveness of students of different specialties, teachers, adults of different specialties, however, there is little work on the characteristics of health professionals.Purpose of the article: To study the level of academic self-efficacy among doctors in the specialty "General Practice-Family Medicine". The study was attended by 51 trainee physicians in "General Practice - Family Medicine", who were trained in cycles of thematic improvement. The study of the peculiarities of academic self-efficacy of doctors was conducted using the questionnaire "Academic self-efficacy of adults".The results of the study showed that most doctors are aware of the meaning of their training. When evaluating the results of the component "Confidence in one's own learning ability", no doctor had a high score. These results show that most students are not confident in their own learning ability, in the ability to improve professional skills, which provides an opportunity to conduct psychological training to strengthen faith in the possibility of learning at any age. Evaluation of the data of the scale "Motivational-targeted orientation in learning" showed that most doctors had an adequate ability to set goals for their own development and perseverance in achieving them. The study of the component "Prognostic-reflexive ability to learn" found that most physicians-students can make predictions in learning, analyze and evaluate internal and external opportunities for successful achievement of the educational goal. Assessment on the scale of personal responsibility for learning and development showed that most doctors are ready to take responsibility for learning outcomes and personal development. The overall rate of learning self-efficacy was high at 18%, mid-level 76% and low-level 6% of trainee physicians.Conclusions: Thus, the results suggest that most general practitioners in family medicine have an average level of general self-efficacy (76%), feel the need to constantly review their competence, focusing on self-improvement and self-development, but are afraid of other assessments of these changes. This indicates a significant contingent of possible influence in order to increase the number of doctors with a high level of academic self-efficacy, which will improveprofessional and personal self-realization, will promote competitiveness in today's labor market

Experience of organizing training on motivative counseling for primary care physicians

In the modern model of training medical students, the leading role belongs to the formation of standardized skills, which are practiced according to unified algorithms, i.e. - hard skills. The advantage of this approach is the ability to test and control acquired skills and knowledge. However, further training of physicians cannot be rigidly tied to soulless algorithms and requires improved communication skills, especially in family medicine. After all, it is the primary level of medical care based on trusting and long-term relationships with the patient, establishing stable, healthy communication. In preventive medicine, you can often hear about compliance, although in the literal sense it is only a direct implementation of the patient's instructions. In recent years, more and more attention has been paid to the doctor's ability to motivate the patient to make lifestyle changes in order to maintain and strengthen the health of community members. At present, it is impossible to imagine a family doctor who does not use motivational counseling in his daily practice. At this stage, some doctors experience some gaps in their training and want to improve their communication skills (so-called soft skills). Motivational counseling trainings are constantly held at the Department of Family Medicine FPE of Dnipro State Medical University. The article describes the experience of teaching this topic to primary care physicians and confirms the effectiveness of our approach. The four-day intensive training allows you to immediately practice the acquired knowledge in a safe environment among your colleagues and clearly see its effectiveness. The participatory approach helps to attract invaluable experience of participants to solve clinical cases and situational problems. Based on Bloom's taxonomy of educational goals, our training provides a clear pursuit of the goal and consistent assimilation of the material to the highest level - the synthesis of new ideas. Thus, we managed to create a quality educational product for the formation of the necessary competencies in the communicative field of "patient-doctor", taking into account ethical and deontological professional principles. В сучасній моделі підготовки студентів-медиків провідна роль належить формуванню стандартизованих навичок, які відпрацьовуються згідно уніфікованих алгоритмів, тобто - hard skills. Перевагою такою підходу залишається можливість перевірки та контролю напрацьованих навиків та знань. Проте подальша підготовка лікаря не може бути жорстко прив’язаною до бездушних алгоритмів та потребує вдосконалення комунікативних здібностей, особливо це важливо в сімейній медицині. Адже саме первинна ланка медичної допомоги заснована на довірливих та тривалих взаємовідносинах з пацієнтом, налагодженні стабільної, здорової комунікації. В профілактичній медицині дуже часто можна почути про комплаєнс, хоча в прямому розумінні це лише безпосереднє виконання пацієнтом вказівок лікаря. Останніми роками, все більше уваги приділяється вмінню лікаря мотивувати пацієнта до змін образу життя задля збереження та зміцнення здоров’я членів громади. Наразі неможливо собі уявити сімейного лікаря, який не використовує в своїй повсякденній практиці мотиваційне консультування. На цьому етапі деякі лікарі відчувають певні пробіли в своїй професійній підготовці та бажають покращити свої навички спілкування (так звані - м’які навички). На кафедрі сімейної медицини Дніпровського державного медичного університету постійно проводяться тренінги з мотиваційного консультування. В статті описано досвід викладання цієї теми для лікарів первинної ланки медичної допомоги та приводиться підтвердження ефективності напрацьованого нами підходу. Чотириденний інтенсивний тренінг дає змогу відразу відпрацьовувати набуті знання в безпечному середовищі серед своїх колег та наочно переконатись в його ефективності. Партисипативний підхід допомагає залучати безцінний досвід учасників для вирішення клінічних кейсів та ситуаційних завдань. Базуючись на Блумівській таксономії освітніх цілей, наш тренінг забезпечує чітке слідування поставленій меті та послідовне засвоєння матеріалу аж до найвищого рівня – синтезу нових ідей. Таким чином, нам вдалося створити якісний навчальний продукт задля формування необхідних компетенцій в комунікативному полі «пацієнт-лікар» з урахуванням етичних принципів та деонтологічних професійних засад

Тreatment of patients with the constipation by a general practitioner - family doctor at the ambulatory stage

In the context of professional competence, the management of constipation syndrome (self-diagnosis, self-treatment and provision of preventive measures for constipation in patients of different ages) is a function of doctors of a general practice medicine - family medicine. The authors developed and proposed an algorithm of treatment and management of a patient with constipation syndrome at the ambulatory stage