Влияние взаимодействия в системе «Врач – Пациент» на состояние больных

The study focuses on the search for ways to solve the problem of improving the quality of medical care for heart disease patients; the effectiveness of patients’ treatment is determined by the science-oriented medicine achievements and the general psycho-emotional states arising in various situations of doctor-patient interaction. The aim of the study is to identify the types of doctors and their impacts on patients’ psycho-emotional states and attitudes toward the disease. The study was conducted in a number of clinical hospitals in Moscow (Russia). It involved 167 doctors and 1,248 patients with arterial hypertension, coronary heart disease, and arrhythmias, aged 43 to 82 years. The study was carried out using valid psychodiagnostic techniques. There were statistically significant differences in the characteristics of the response to the disease in heart disease patients, whose physicians established with them collaborative, caring, directive, authoritarian and alienated relationships.El estudio se centra en la búsqueda de formas de resolución el problema de mejorar la calidad de la asistencia médica a los pacientes con enfermedades cardiovasculares, cuya eficacia del tratamiento se determina por los logros de la medicina naturalmente orientada a la ciencia y la condición psique-emocional general que se produce en situaciones diversas de su interacción con el médico tratante. El observatorio del estudio es identificación de los tipos de médicos tratantes y sus efectos sobre la condición psique-emocional y la actitud hacia la enfermedad de los pacientes.  El estudio se llevó a cabo sobre la base de la serie de hospitales clínicos en Moscú (Rusia). En el estudio participaron 167 médicos y 1248 pacientes con hipertensión arterial, enfermedad isquémica coronaria y arritmias, de 43 a 82 años. El estudio se realizó con la ayuda de técnicas psiquediagnósticas validas. Se han obtenido las diferencias estadísticamente fidedignas en los indicadores de la respuesta a la enfermedad en pacientes con enfermedades cardiovasculares, cuyos médicos tratantes establecen relaciones cooperativas, de tutela, directivas, autoritarias y suspendidas con ellos.Исследование ориентировано на поиск способов решения проблемы повышения качества оказания медицинской помощи пациентам с сердечно-сосудистыми заболеваниями, эффективность лечения которых определяется как достижениями естественно-научно ориентированной медицины, так и общим психоэмоциональным состоянием, возникающим в различных ситуациях его взаимодействия с лечащим врачом. Цель исследования – выявление типов лечащих врачей и их влияния на психоэмоциональное состояние и отношение к болезни пациентов.  Исследование проводилось на базе ряда клинических больниц г. Москвы (Россия). В исследовании приняли участие 167 врачей и 1248 пациентов с артериальной гипертонией, ишемической болезнью сердца и аритмиями, в возрасте от 43 до 82 лет. Исследование осуществлялось с помощью валидных психодиагностических методик. Были получены статистически достоверны различия в показателях особенностей реагирования на болезнь у пациентов с сердечно-сосудистыми заболеваниями, лечащие врачи которых устанавливают с ними сотруднические, опекающие, директивные, авторитарные и отстраненные отношения

Factors of the Development of Fear of Disease Progression in Patients with Breast Cancer

BACKGROUND: The issue of the influence of psychics on somatic diseases, including cancer, becomes more and more relevant. In cases with cancer, patients face a vital threat, which, in its turn, is manifested as a range of biopsychosocial consequences. AIM: The aim of the study was to reveal the factors of the formation of fear of cancer progression or recurrence in breast cancer patients. METHODS: The sampling included patients from clinical hospitals of Moscow and Saint Petersburg (Russia). The study involved 690 patients aged 30–79 years old. The study was performed with specially selected diagnostic tools that allowed the authors to evaluate the intensity and reveal peculiarities of the development of fear of cancer progression. Statistical analysis was performed by the calculation of the mean arithmetic of the general sampling, the rate, and the ratio distribution by the intensity of fear of cancer progression, and Spearman correlation. RESULTS: Statistically significant associations were revealed between the parameters of intensity and peculiarities of fear of cancer progression and such characteristics of personality as viability, integrated personality, and experiences in a close relationship. CONCLUSION: The obtained results were used to develop methodical recommendations on the improvement of a psychoemotional condition of women diagnosed with breast cancer

Индивидуально-психологические детерминанты пищевого поведения студентов высших учебных заведений

The article is devoted to the problem of eating disorders of young people. The study focuses on the identification of psychological factors that determine the styles of eating behavior. The empirical results of the survey are presented, in which 937 students aged 18 to 25 took part. The aim of the study was to identify the relationship between the characteristics of the self-structure of students' personality, reflecting the state of their identity, and the characteristics of their eating behavior. As a result, it was revealed that constructive, destructive, and deficit self-functions (as unconscious personality constructs) find their expression not only in behavior and interpersonal social relations, but also in the style of eating behavior, tendencies to eating disorders and deviations.El artículo se centra en el problema del trastorno del comportamiento alimentario de las personas jóvenes. El estudio se centra en la detección de los factores psicológicos que determinan los estilos del comportamiento alimentario. Se presentaron los resultados empíricos de la encuesta, en la que participaron 937 estudiantes de 18 a 25 años. El observatorio del estudio fue identificación de la relación entre las características de la estructura del autoconcepto de la personalidad de los estudiantes, que reflejan el estado de su identidad, y las características de su comportamiento alimentario. Como resultado, se reveló que las funciones constructivas, destructivas y deficientes del autoconcepto, (como los diseños de personalidad inconscientes), encuentran su expresión no solo en el comportamiento y las relaciones sociales interpersonales, sino también en el estilo del comportamiento alimentario, las inclinaciones a los desarreglos alimentarios y los trastornos.Статья посвящена проблеме нарушения пищевого поведения людей молодого возраста. В исследовании акцентируется внимание на выявлении психологических факторов, детерминирующих стили пищевого поведения. Представлены эмпирические результаты опроса, в котором приняли участие 937 студентов в возрасте от 18 до 25 лет. Целью исследования стало выявление взаимосвязи между особенностями Я-структуры личности студентов, отражающими состояние их идентичности, и особенностями их пищевого поведения. В результате было выявлено, что конструктивные, деструктивные и дефицитарные Я-функции, (как неосознаваемые конструкты личности), находят свое выражение не только в поведении и межличностных социальных отношениях, но и в стиле пищевого поведения, склонностях к пищевым расстройствам и нарушениям

Immunological aspects of vaccination in HIV-infected patients

Until recently, HIV infection does not lose its relevance. In 2022, 630 000 people died and 1.3 million people became infected with the human immunodeficiency virus (HIV). HIV-positive persons develop more infectious diseases than healthy people do; the causative agents are mainly opportunistic microorganisms. Streptococcus pneumoniae is the main causative agent of infection in the lungs in HIV-infected persons. In order to prevent the development of severe pneumococcal infections and to overcome antibiotic resistance, vaccines have been developed. There are polysaccharide (PPV) and conjugate (PCV) vaccines. According to clinical recommendations, vaccination of previously unvaccinated HIV-infected patients is carried out regardless of T-helper cell level. However, no data were found on the effect of PCV13 on immunological memory cells. The purpose of this study is to assess an effect of PCV13 vaccination on the immune system in HIV-infected subjects. Materials and methods. The study included 200 patients with HIV infection, which were divided into two groups: I — received a dose of PCV13 (n = 100) and control group (n = 100). During the first visit, immunological and microbiological studies were carried out. On the second visit, a PCV13 was injected into the deltoid muscle. The third visit was made a year later, where immunological and microbiological studies were repeated. Participants were divided into 4 subgroups depending on CD4+ T cell level. The microbial study was done using a swab collected from the back of the throat. Results. During the immunological examination at visit 1, abnormalities were detected in all examined populations and immune cell subsets. At 12 months post-vaccination, the median levels of CD3+CD4+ and CD45RO+ T lymphocytes in the immunized group were higher than pre-vaccination levels compared to control group, in which the values changed insignificantly. Our data confirm the immunological effectiveness of PCV13 administration in HIV-infected patients. In patients with peripheral blood CD19+ lymphocyte deficiency, had increased microbial detection rate (p = 0.003). Conclusion. As a result, due to the high risk of pneumococcal pneumonia, HIV-infected patients should be immunized with a 13-valent pneumococcal conjugate vaccine

Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes

publisher: Elsevier articletitle: Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes journaltitle: Cell articlelink: https://doi.org/10.1016/j.cell.2018.05.046 content_type: article copyright: © 2018 Elsevier Inc

Severe Tuberculosis in Humans Correlates Best with Neutrophil Abundance and Lymphocyte Deficiency and Does Not Correlate with Antigen-Specific CD4 T-Cell Response

It is generally thought that Mycobacterium tuberculosis (Mtb)-specific CD4+ Th1 cells producing IFN-γ are essential for protection against tuberculosis (TB). In some studies, protection has recently been associated with polyfunctional subpopulation of Mtb-specific Th1 cells, i.e., with cells able to simultaneously secrete several type 1 cytokines. However, the role for Mtb-specific Th1 cells and their polyfunctional subpopulations during established TB disease is not fully defined. Pulmonary TB is characterized by a great variability of disease manifestations. To address the role for Mtb-specific Th1 responses during TB, we investigated how Th1 and other immune cells correlated with particular TB manifestations, such as the degree of pulmonary destruction, TB extent, the level of bacteria excretion, clinical disease severity, clinical TB forms, and “Timika X-ray score,” an integrative parameter of pulmonary TB pathology. In comparison with healthy Mtb-exposed controls, TB patients (TBP) did not exhibit deficiency in Mtb-specific cytokine-producing CD4+ cells circulating in the blood and differed by a polyfunctional profile of these cells, which was biased toward the accumulation of bifunctional TNF-α+IFN-γ+IL-2− lymphocytes. Importantly, however, severity of different TB manifestations was not associated with Mtb-specific cytokine-producing cells or their polyfunctional profile. In contrast, several TB manifestations were strongly correlated with leukocyte numbers, the percent or the absolute number of lymphocytes, segmented or band neutrophils. In multiple alternative statistical analyses, band neutrophils appeared as the strongest positive correlate of pulmonary destruction, bacteria excretion, and “Timika X-ray score.” In contrast, clinical TB severity was primarily and inversely correlated with the number of lymphocytes in the blood. The results suggest that: (i) different TB manifestations may be driven by distinct mechanisms; (ii) quantitative parameters and polyfunctional profile of circulating Mtb-specific CD4+ cells play a minor role in determining TB severity; and (iii) general shifts in production/removal of granulocytic and lymphocytic lineages represent an important factor of TB pathogenesis. Mechanisms leading to these shifts and their specific role during TB are yet to be determined but are likely to involve changes in human hematopoietic system

Compound phenotype in a girl with r(22), concomitant microdeletion 22q13.32-q13.33 and mosaic monosomy 22

Abstract Background Ring chromosome instability may influence a patient’s phenotype and challenge its interpretation. Results Here, we report a 4-year-old girl with a compound phenotype. Cytogenetic analysis revealed her karyotype to be 46,XX,r(22). aCGH identified a 180 kb 22q13.32 duplication, a de novo 2.024 Mb subtelomeric 22q13.32-q13.33 deletion, which is associated with Phelan-McDermid syndrome, and a maternal single gene 382-kb TUSC7 deletion of uncertain clinical significance located in the region of the 3q13.31 deletion syndrome. All chromosomal aberrations were confirmed by real-time PCR in lymphocytes and detected in skin fibroblasts. The deletions were also found in the buccal epithelium. According to FISH analysis, 8% and 24% of the patient’s lymphocytes and skin fibroblasts, respectively, had monosomy 22. Conclusions We believe that a combination of 22q13.32-q13.33 deletion and monosomy 22 in a portion of cells can better define the clinical phenotype of the patient. Importantly, the in vivo presence of monosomic cells indicates ring chromosome instability, which may favor karyotype correction that is significant for the development of chromosomal therapy protocols