Содержание и эффективность системы медико-психологической помощи в клинике детской онкологии

Проведено комплексное исследование в области детской психоонкологии, которое включало изучение психоэмоционального состояния, личностных и поведенческих особенностей онкобольных детей и их родителей, связанных с реагированием на онкологическое заболевание, семейное функционирование. Определены факторы профессионального дистресса медицинских работников и волонтеров. На основе полученных результатов разработана целостная система медико−психологической помощи и проведена оценка ее эффективности.Проведено комплексне дослідження в галузі дитячої онкології, що містило вивчення психоемоційного стану, особистісних і поведінкових особливостей онкохворих дітей та їхніх батьків, пов'язаних із реагуванням на онкологічне захворювання, сімейне функціонування. Визначено чинники професійного дистресу медичних працівників та волонтерів. На основі отриманих результатів розроблено цілісну систему медико−психологічної допомоги і проведено оцінку її ефективності.A complex investigation in the area of pediatric psychooncology including investigation of the psychoemotional state, personality and behavior peculiarities of cancer children and their parents, associated with reaction to cancer and family function, was performed. The factors of professional distress of medical staff and volunteers were determined. The obtained findings were used to work out a comprehensive system of medical psychological aid and to assess its efficacy

Increased maternal TSH and decreased maternal FT4 are associated with a higher operative delivery rate in low-risk pregnancies:A prospective cohort study

Background:  The increasing number of operative deliveries is a topic of major concern in modern obstetrics. Maternal thyroid function is of known influence on many obstetric parameters. Our objective was to investigate a possible relation between maternal thyroid function, and operative deliveries. Secondary aim was to explore whether thyroid function was related to specific reasons for operative deliveries. Methods:  In this prospective cohort study, low-risk Caucasian women, pregnant of a single cephalic fetus were included. Women with known auto-immune disease, a pre-labour Caesarean section, induction of labour, breech presentation or preterm delivery were excluded. In all trimesters of pregnancy the thyroid function was assessed. Differences in mean TSH and FT4 were assessed using t-test. Mean TSH and FT4 levels for operative deliveries were determined by one way ANOVA. Repeated measurement analyses were performed (ANOVA), adjusting for BMI, partiy, maternal age and gestational age at delivery. Results:  In total 872 women were included, of which 699 (80.2 %) had a spontaneous delivery. At 36 weeks gestation women who had an operative delivery had a significantly higher mean TSH (1.63mIU/L versus 1.46mIU/L, p = 0.025) and lower mean FT4 (12.9pmol/L versus 13.3pmol/L, p = 0.007)) compared to women who had a spontaneous delivery. Mean TSH was significantly higher (p = 0.026) and mean FT4 significantly lower (p = 0.030) throughout pregnancy for women with an operative delivery due to failure to progress in second stage of labour, compared to women with a spontaneous delivery or operative delivery for other reasons. Conclusion:  Increased TSH and decreased FT4 seem to be associated with more operative vaginal deliveries and Caesarean sections. After adjusting for several confounders the association remained for operative deliveries due to failure to progress in second stage of labour, possibly to be explained by less efficient uterine action