Dynamics of quality of life indicators in patients with gastroesophageal reflux disease comorbid with connective tissue dysplasia under the influence of complex treatment

Introduction. In the case of gastroesophageal reflux disease (GERD) on the background of undifferentiated connective tissue dysplasia (UCTD) causes an even more significant deterioration in the QOL, including sleep disturbances and the onset of excessive daytime sleepiness (EDS). Thus, the study of the peculiarities of GERD on the background of connective tissue dysplasia and determining the impact of comorbid pathology on the QOL of patients with GERD is a topical issue in internal medicine. It has significant socio-economic significance. We believe that monitoring the most important variables that affect the quality of life of patients with GERD can help raise public awareness in this regard. In addition, it can guide the health care system to address these issues. Purpose. The purpose of the work is to increase the awareness of medical workers about the scale of the problem and ways to solve it. to study the features of the dynamics of quality of life in patients with gastroesophageal reflux disease comorbid with connective tissue dysplasia under the influence of the proposed complex therapy. Methodology. 120 patients were included: 65 men and 55 women. In 75 of them (Study Group) GERD was in the background of UCTD, in 45 (?omparison Group ) - developed as an independent disease. The Study Group was divided into three groups. ?omparison Group - 45 patients with GERD without UCTD, received basic standard therapy, which included PPI "Panocid" 40 mg once a day and alginate-antacid formulation (Gaviscon Double Action Liquid) 20 ml, 3 times per day after meals and before bedtime. I Group - 25 patients with GERD +UCTD, which to the standard basic therapy was added "Magne-B6" for 2 tablets 3 times per day. II Group - 25 patients with GERD +UCTD, which to the standard basic therapy was added "Calcium-D3 Nicomed" 1 tablet 3 times per day. III  Group - 25 patients with GERD +UCTD, who used the drug "Magne-B6" 2 tablets 3 times per day and "Calcium-D3 Nicomed" 1 tablet 3 times per day on the background of standard basic therapy. The Medical Outcomes Study 36-Item Short-Form Health Status (SF-36), the Gastrointestinal Symptom Rating Scale (GSRS), and the scale of "Personal and social performance" (PSP) - were used to study patients in detail. A comprehensive examination of patients was performed twice: before and after 30 days of comprehensive treatment. Results and Discussion. Under the influence of the basic therapy in Comparison Group the General Health (GH) improved by 33.03%. While in the groups on the background of complex treatment is increased by 42.52% in patients of the I Group, by 13.10%  in patients of the II Group, and 46.28% in patients of the III Group (p1, p2, p3 <0.05).Physical Functiong Scale (PF) improved by 17.9% in patients of the Comparison Group (p <0.05) and by 30.38%; 27.47%, 29.17%, respectively (p1, p2, p3 <0.05). Role Physical Scale (RP) scores improved by 25.14% in Comparison Group (p <0.05) and by 33.6 %, 22.58%  and 40.20% respectively (p1, p2, p3 <0.05). Dynamics of data in Body Pain (BP) scale improved by 21.84%  in patients of the Comparison Group (p <0.05) and by 37.28%, 25.46%, 35.92% (p1, p2, p3 <0.05).As can be seen from it, under the influence of complex therapy, the values of the Vitality (VT) increased by 17.18% in patients of Group I, by 21.93% – in Group II, by 37.87%– in Group III (p1, p2, p3 <0.05). Among patients of the Comparison Group, the influx of strength and energy felt 9.50% (p <0.05). Data of Social Functioning Scale (SF) improved by 8.8% in patients of the Comparison Group (p <0 , 05) and by 22.7%,  29.6%, 29.31%, respectively(p1, p2, p3 <0.05). Mental Health Scale (MH) improved by 17.23% in patients of Group I, by 22.41%  – in Group II, by 21.96% – in Group III (p1, p2, p3 <0.05) and 14.22% - in the Comparison Group (p <0.05). Also in patients were positive dynamics of the Role Emotional functioning scale (RE): by 27.37% in patients of Group I, by 12.36%– in Group II, by 15.7%  – in the Group III (p1, p2, p3 <0.05) and 9.05% - in patients of the Comparison Group (p < 0.05). Conclusions. Thus, the inclusion in the standard therapy of gastroesophageal reflux disease in patients with its development on the background of undifferentiated connective tissue dysplasia of magnesium lactate dihydrate in combination with pyridoxine hydrochloride ("Magne -B6 ") and calcium carbonate in combination with cholecalciferol ("Calcium-D3 Nicomed") contributed to a significant improvement in their quality of lif

Psychological, ethical and deontological needs of the patients

Introduction. We live in time of rapid technical development. And this in turn contributes to the formation of a technical approach to the doctor-patient relationship. The rapid and easily accessible flow of information, excessive awareness of patients sometimes complicates compliance - the cooperation of the doctor with the patient (Mandal, J., et.al., 2016 ). In world practice, compliance is considered excellent when the patient follows 75% of the doctor's instructions. In addition patient safety is a persistent issue in public health that has taken a new connotation in the contemporary sanitary context (Façanha, T. R.et.al., 2019). Purpose. The purpose of the paper is to investigate what qualities a doctor of the 21st century should have from the point of view of a modern patient in order to improve compliance, cooperation of the doctor with the patient.Methodology. The survey was completely anonymous and voluntary. If the answer is yes, the patient had to choose from the proposed options the one that would most fully reflect his needs. In order to exclude subjectivity and systematic errors, the survey was conducted in various medical institutions of Ivano-Frankivsk. We interviewed 120 patients: 75 (group I) were hospitalized, 45 (group II) - outpatient. The special questionnaire developed by us consists of 30 questions, which are grouped into groups, each of which reflects certain qualities: competence and personal experience of the doctor; review features; the ability to explain to the patient the essence of the disease; appearance.Some items of the questionnaire were: "Does age or gender of the doctor matter to you?"; "Did you have problems with" doctor's handwriting "? Did it in any way affect your cooperation with the doctor on the way to better health? ? ».Results and Discussion. The study found that among the main qualities of the doctor, 88% of patients of group I and 80% of group II distinguish competence and professionalism; 42.66% vs 46.5% - attention; 60.0% vs 53.2% - patience and kindness; 90.6% vs 80.0% - the ability to easily and informatively answer questions of concern to the patient. The distribution of the qualities of the doctor and the manifestation of the need for them among the studied patients are shown in Figure 1.Significantly fewer patients focused on the doctor's appearance or age. Significantly fewer patients focused on the doctor's appearance or age. However, there has been a trend: most respondents prefer middle-aged female doctors.Causal analysis of the problem of poor handwriting of doctors showed the following data: 42.6% of patients of group I and 53.2% of group II complained of poor handwriting of doctors. And 6.6% and 2.2%, respectively, consider it illegible. According to the patients, they had the experience of buying and even using drugs issued incorrectly in the pharmacy due to the "medical handwriting" of 5 patients of group I and 1 patient of group II. However in the conditions of inpatient treatment this problem was quickly solved thanks to good cooperation of the doctor-nurse. It is almost impossible to control the same problem in the conditions of outpatient reception. Practical value. The results of our study were successfully implemented in the educational and scientific process of the Department of Propaedeutics of Internal Medicine and the Department of Psychiatry, Narcology and Medical Psychology at Ivano-Frankivsk National Medical University and can be used in lectures and workshops on occupational therapy and rehabilitation, medical psychology, the psychology of creativity, general, pedagogical psychology, pedagogy, sociology, philosophy, etc. Conclusion. The results of the study are statistically processed and allow to develop a model of the relationship between doctor and patient. It is possible that this study will promote better collaboration between physicians and patients. And medical students to think about what qualities should be nurtured in themselves for successful wor

Covid-19: severe lockdowns, joint fiscal response, and coronabonds

A panel of European economists discusses economic policy alternatives for the coronavirus crisis, writes Romesh Vaitilinga

Analysis of current approaches to the treatment and quality of life improvement in patients with gastroesophageal reflux disease in case of its combination with the syndrome of undifferentiated connective tissue dysplasia

When the structure of the connective tissue is disturbed, the probability of developing pathology of the internal organs increases. The gastrointestinal tract is one of the systems that is most often involved in the pathological process in the case of such disorders. Due to its mesenchymal origin, the esophagus is one of the first to suffer. Normalization of mineral metabolism, correction of immunological and bioenergetic status are the main tasks in the treatment of such patients. Therapy with magnesium drugs, vitamins, anabolic drugs, ?-blockers, aldosterone antagonists, and amino acid drugs should also be used for this purpose. Patients in this group should also take drugs that contain vitamin D

The nature of the manifestation of procrastination, level of anxiety and depression in medical students in a period of altered psycho-emotional state during forced social distancing because of pandemic COVID-19 and its impact on academic performance

Introduction: The fact that learning is moving online is probably a disappointment to most medical students.  This is especially true for middle and senior students, in whom most disciplines are clinical and focus on practical work with patients. During the period of forced social distancing and online learning in connection with the COVID-19 pandemic, such a common way of learning became impossible. All these changes obviously affect the mental health of medical students, who are already at risk for such phenomenon as procrastination and disorders as anxiety and depression. Purpose: Investigate and evaluate the level of anxiety, depression, and the nature of the manifestation of procrastination in medical students Faculty of Medicine and the Faculty of Training Foreign Citizens (FTFC) of Ivano-Frankivsk National Medical University (IFNMU) in a period of altered psycho-emotional state during the period of forced social distancing and its impact on academic performance. Methodology: 212 medical students were interviewed. The survey was voluntary and anonymous. We used two clinical test methods to identify emotional disturbances: the Hospital Anxiety and Depression Scale (HADS) and the Montgomery-Asberg Depression Rating Scale (MADRS) (Zigmond A.S. et.al.,1983; Svanborg P., 2001). In order to assess the propensity of students to procrastinate, we also used the "Questionnaire to study the propensity of the individual to procrastination" (Shivari ,O.A., 2015), which is a modification of the "General Procrastination Scale" (Lay, C., 1986) and consists of two scales: "Personally conditioned procrastination scale" (Scale I) and "Situationally conditioned procrastination scale" (Scale II). The statistical analysis of the results was performed using STATISTICA 7.0 software packages and the package of statistical functions of Microsoft Excel. Results and Discussion: During the testing, students note that the most important problem for them is time management. The analysis of the results survey by "Personally conditioned procrastination scale" (Scale I) "showed that 15% of the students have a low, 47.5% - medium, 37.5% - high level of personal propensity to procrastination. The analysis of the results "Situationally conditioned procrastination scale" (Scale II) showed that 25% of students have a low level of situational procrastination, 37.5% - medium and 37.5% - high, respectively. The study of the relationship between the level of propensity to procrastination (Scale I) and academic performance in medical students showed that in the group with low procrastination the success rate is higher than in groups with medium and high procrastination (r = -0.58; p <0.05). We also established a direct correlation between the Scale II indicators and the average academic performance indicators. After the survey and analysis of the results on the HADS and MADRS scales, we found a clear relationship between increased learning during the period of altered psychoemotional state and the severity of anxiety-depressive symptoms in medical students, which manifested itself in an increase in the level of anxiety and mood disorders of varying degrees. Conclusions: Thus, procrastination that occurs in the surveyed medical students in the period of altered psycho-emotional state during forced social distancing because of pandemic COVID-19 has had "situational" situational nature. Besides, the study confirmed that the pandemic of COVID-19, as a stressful moment of the external test of identity, caused the emergence of protective mechanisms in medical students in the form of emotional and behavioral changes and disorders. The results obtained indicate the presence of adjustment disorders in the period of the altered psychoemotional state during forced social distancing because of pandemic COVID-19 in all the studied groups. Medical students also need to be made aware that depression is not a cause for shame. Future doctors should be able to maintain their mental and emotional health, as well as know, how to deal with classmates who suffer from mental illnes

The role of metformin hydrochloride in complex therapy of disorders of carbohydrate metabolism in patients with paranoid schizophrenia treated with atypical antipsychotics

Introduction. According to the literature, mortality among patients with schizophrenia is 1.5 -2 times higher than in the healthy population. One explanation for this is the complication of neuroleptic therapy, which, according to various authors, occurs in 2 to 100% of cases. Purpose. We aimed to study some indicators of carbohydrate metabolism disorders in patients with paranoid schizophrenia who have been taking neuroleptics for a long time, to correct the established changes by adding metformin hydrochloride to the standard regimen and to monitor its effectiveness. Methodology. The study was conducted based on Municipal non-commercial enterprise "Precarpathian regional clinical center of mental health of Ivano-Frankivsk regional council. This study included patients diagnosed with paranoid schizophrenia according to the criteria of ICD-10 (F20.0). As a result of our studies in 63 patients, we found a violation of carbohydrate metabolism, which accounted for 52% of all examined. Among them, 55 patients with prediabetes: 12 (19.04%) patients with impaired glucose tolerance (IGT), 43 (68%) with impaired fasting glycemia (IFG), and 8 patients (12.7%) with type 2 diabetes mellitus (T2D). Subsequently, all these 63 patients were prescribed corrective therapy with a drug from the group of biguanides - metformin hydrochloride at a dose from 500 to 1000 mg/day: in violation of IFG at a dose of 500 mg/day; in case of IGT - 850 mg/day; in the case of T2D- 1000 mg/day. All studies were performed before and after 3 months of metformin correction. These included fasting glucose, postprandial hyperglycemia (PPG) (two hours after a meal), glycosylated hemoglobin (HbAIc), immunoreactive insulin (IRI), and, if necessary, an oral glucose tolerance test (OGTT). Fasting plasma glucose (FPG) was measured by the glucose oxidase method. HbAIc values were determined by ion-exchange high-performance liquid chromatography (HPLC). The determination of the IRI level was performed by enzyme-linked immunosorbent assay (ELISA) Results and Discussion. The results of the research showed that 52% of all surveyed found disorders of carbohydrate metabolism. They were prescribed corrective therapy with a drug from the group of biguanides - metformin hydrochloride at a dose of 500 to 1000 mg/day. As a result of the research, we found that in all groups of examined patients revealed a positive dynamics of carbohydrate metabolism under the influence of this drug. A significantly higher therapeutic effect of the treatment of carbohydrate metabolism disorders with metformin was found in patients receiving the latter in combination with haloperidol. The combination of metformin with risperidone and quetiapine showed a slightly lower clinical effect. Conclusion. Our own clinical experience gives grounds to recommend metformin hydrochloride as a medium for the correction of carbohydrate metabolism disorders in patients with a paranoid form of schizophrenia in the treatment of this category of patients with neuroleptic

Disorders of social functioning and quality of life in patients with gastroesophageal reflux disease while combined with undifferentiated connective tissue dysplasia

Introduction. It has been scientifically confirmed that the risk of developing gastroesophageal reflux disease (GERD) increases especially with generalized or regional disruption of connective tissue structure, which is widespread among the population. Patients with such comorbid pathology may have a wide range of symptoms that may go beyond the general symptoms of heartburn and regurgitation. The symptoms and complications of GERD affect general health, daily and social functioning, physical and emotional activity. It also affects the quality of life (QoL) associated with health through frequent breaks during sleep, work and social activities. Purpose. study the dynamics of the level of quality of life and social functioning in patients with gastroesophageal reflux disease in combination with the syndrome of undifferentiated connective tissue dysplasia. Methodology. A total of 120 patients were included in the study: 65 men and 55 women: in 75 of them (Group II) GERD occurred on the background of UCTD, in 45 (Group I) as an independent disease. The control group consisted of 12 healthy individuals. The study was comprehensive. The Medical Outcomes Study 36-Item Short-Form Health Status (SF-36),the Gastrointestinal Symptom Rating Scale (GSRS) and the scale of "Personal and social performance" (PSP) -  were used to study patients in detail. Results and Discussion. Analyzing the results obtained on the basis of the GSRS questionnaire (Table 1), in patients with GERD on the background of UCTD, compared with patients of group I and the control group, there is a significant increase in three and four from the five scales. QoL in patients of Group II on the scale "Abdominal pain" were 14.3 ± 0.4 points, in Group I - 5.6 ± 1.3 points, in the Control Group - 2.4 ± 0.8 points, on the scale "Reflux syndrome": 13.7 ± 0.9, 10.5 ± 1.3 and 3.1 ± 0.9, respectively. "Dyspeptic syndrome" - 15.3 ± 0.4 points in Group II, 12.2 ± 0.6- in Group I and 6.1 ± 0.3- in the control group. "Constipation syndrome" 9.5 ± 0.8, 5.6 ± 1.03 and 5.7 ± 0.4, respectively (p <0,05). Conclusions: In this research we investigated the effect of comorbid pathology on QoL in patients with GERD, which developed against the background of UCTD. The results confirm that patients with such combined pathology have a lower level of quality of life and social functioning, and the tactics of treatment of such patients should take into account these change

Experience in correcting eating disorders in the clinic of mental illness

Introduction: Eating disorders - a class of psychogenic behavioral syndromes associated with eating disorders. The class of these disorders includes anorexia nervosa, bulimia nervosa, compulsive overeating, as well as several other disorders, which are included in the international classification, to section F 50-F 59. Purpose: The purpose of our study is to trace the dynamics of individual eating disorders in patients with various mental illnesses under the influence of corrective therapy. Methodology: Were examined 77 patients with various mental diseases who have had eating disorders. The first (I) group included 33 patients. They have added Metoclopramide at a dose of 20 mg/day to the main treatment. The second group (II) - 44 patients who received the drug Ondansetron at a dose of 4 mg/day, respectively. The condition of all patients was assessed according to the following scales: Eating Attitudes Test (EAT-26), 36-Item Short-Form Health Status (SF-36). Body mass index (BMI) was calculated to study the dynamics of weight. All examinations of patients were performed at the beginning and after 14 days of treatment. Results: According to the EAT-26 scale the average score in the I group was 29 ± 2.8 points, and in the II - 30.1 ± 2.4, respectively. According to the SF-36 questionnaire, the average total score in the I group was - 69.5 ± 1.8 before treatment, 79.5 ± 1.6 - after treatment improved by 12.5% (p <0,05). In group II - 70.8 ± 1.2 and 89.4 ± 1.5, improving by 20.8%, respectively (p <0.05). Under the influence of the therapy, the patients' manifestations of eating behavior decreased, which contributed to the growth of BMI: in group I - by 2.1 ± 1.3 kg, in group II - by 3.5 ± 2.3 kg, which is 1.6 times more. Conclusions: The drug Ondansetron, intended for the correction of eating disorders, in combination with therapy of the underlying pathology, was likely to be more effective than Metoclopramide hydrochloride, which should be considered in practical psychiatr

The Beacon Community Centers Middle School Initiative: Final Report on Implementation and Youth Experience in the Initiative

The report evaluates New York City's Beacon Middle School Initiative, which was launched to increase services to middle-grades youth through programs in academics, life skills, career awareness, civic engagement, physical health, and arts and culture. The report describes youth characteristics and participation, program features, connections to school and communities, youth reports of their experiences, and relationships between program characteristics and youth outcomes

Leaving STEM: An Examination of the STEM to Non-STEM Major Change and How the STEM Curriculum Relates to Academic Achievement in Non-STEM Fields

The lack of student persistence in the Science, Technology, Engineering and Mathematics (STEM) fields has been widely researched in recent years. Due to the high attrition rates in STEM fields and the shortage of STEM workers in the United States, research on STEM attrition has focused on identifying factors that cause STEM attrition and ways to increase STEM persistence. While these studies are helpful to understand STEM attrition, researchers have ignored what happens to the students who fail to persist in the STEM fields. Instead of focusing on the causes of STEM attrition, this study focused on the STEM to non-STEM major change by examining how STEM course enrollment and STEM course performance relates to various forms of academic achievement (first year retention, graduation, time to degree, cumulative GPA). The analytical sample for this study was drawn from the 2004/2009 Beginning Postsecondary Students Longitudinal Study (BPS:04/09) and the associated 2009 Postsecondary Education Transcript Study (PETS:09) datasets with the final sample used for analysis representing students who initially enrolled in a STEM bachelor’s degree program and changed to a non-STEM field or left the institution entirely. As such, the results were reflective of this group of students, and not all students in college in general. Results of the study revealed three general findings about the relationship between STEM course enrollment and STEM course academic performance and academic achievement. First, STEM credits attempted is negatively associated with first year retention. Each unit increase in STEM credits attempted reduced the odds of persistence past the first year. Secondly, performance in college level math, introductory laboratory science and STEM courses plays an important role in determining students’ level of academic achievement in non-STEM fields. Lastly, females reach higher levels of academic achievement after leaving the STEM fields when compared to males