СУЧАСНА МОДЕЛЬ ПРОФЕСІЙНОЇ ПІДГОТОВКИ МАГІСТРІВ- СТОМАТОЛОГІВ

The article reveals that the system of masters’ in dentistry professional training in Ukraine does not sufficiently meet the international requirements and education levels regulated by the National Qualifications Framework. At the same time, the updated field standard of higher education in the specialty “Dentistry” (2019) contains a number of contradictory conditions, in particular: the availability of educational-professional training program and educational-scientific (optional for universities) one with different number of credits (300 and 360 correspondingly). The necessity to implement the levels of junior bachelor (dentist’s assistant) and bachelor (odontologist-hygienist) into the model of masters’ in dentistry professional training process was substantiated. This allows students of higher dental education institutions to start practical activity from the first year of studying, which can encourage them to increase the level of their professional competence and restore the preventive component of dental care to the population of Ukraine. It has been proved the expediency to prolong the period of masters’ in dentistry professional training to 6 years with the last year of practically oriented study to ensure compliance of dental education in Ukraine with the requirements of the World Federation for Medical Education in terms of the amount of academic load and the need to strengthen its practical component. A modern model of masters’ in dentisry professional training has been developed in accordance with the National Qualifications Framework and the requirements of the World Federation of Medical Education.У статті доведено, що система професійної підготовки магістрів-стоматологів в Україні не відповідає достатньою мірою міжнародним вимогам і регламентованим Національною рамкою кваліфікацій рівням освіти. Водночас оновлений галузевий стандарт вищої освіти за спеціальністю «Стоматологія» (2019) містить низку суперечливих положень, зокрема: наявність освітньо-професійної і освітньо-наукової (на вибір ЗВО) програм підготовки з різним об’ємом кредитів (300 і 360 відповідно). Обґрунтовано необхідність імплементації у модель процесу професійної підготовки магістрів-стоматологів рівнів молодшого бакалавра – асистента стоматолога, бакалавра – одонтолога-гігієніста і магістра – лікаря-стоматолога. Це дасть змогу студентам закладів вищої стоматологічної освіти розпочати практичну діяльність з молодших курсів, що сприятиме підвищенню рівня їх професійної компетентності і відновленню профілактичної складової стоматологічної допомоги населенню України. Для забезпечення відповідності стоматологічної освіти в Україні вимогам ВФМО у частині обсягу навчального навантаження і необхідності посилити її практичну складову доведено доцільність продовжити термін професійної підготовки магістрів до 6 років з останнім – практично-орієнтованим роком навчання. Розроблена модель професійної підготовки магістрів-стоматологів відповідно до Національної рамки кваліфікацій і вимог Всесвітньої федерації медичної освіти

ПРОФЕСІЙНА ПІДГОТОВКА МАГІСТРІВ ІЗ СТОМАТОЛОГІЇ У МЕДИЧНИХ ЗАКЛАДАХ ВИЩОЇ ОСВІТИ УКРАЇНИ І КРАЇНАХ ЄВРОПЕЙСЬКОГО СОЮЗУ В КОНТЕКСТІ ГАРМОНІЗАЦІЇ ОСВІТНІХ ПРОГРАМ ТА НАВЧАЛЬНИХ ПЛАНІВ

The article analyzes, compares and summarizes the curricula for masters in dentistry used in medical universities of the EU countries and O. Bohomolets National Medical University. A comparative analysis of European and national universities’ curricula revealed that the professional training of masters in dentistry in medical universities of Ukraine and in European countries has significant differences in both content and organizational context. Curricula for professional training of future dentists in European universities differ in the number of disciplines and ECTS credits allocated for their study. Comparing of syllabi in NMU and EU countries allowed to state that the main differences consists in their intensity. It is established that the workload of students of national medical universities is very high on account of the large number of humanities and socio-economic disciplines, while European students have only two socio-economic disciplines in the program. Comparative analysis of curricula of national and European universities made it possible to determine the main tasks of reforming the system of dental education, particularly: improving the quality of medical education, ensuring its conti­nuity and consistency throughout the period of professional activity; reducing the workload on students; providing the optimal ratio of theoretical and practical training with increasing emphasis on clinical and practical training.У статті проаналізовано, порівняно й узагальнено навчальні плани підготовки магістрів у галузі стоматології медичних університетів країн ЄС і Національного медичного університету імені О. О. Богомольця. Порівняльний аналіз навчальних програм європейських та вітчизняних ЗВО виявив, що професійна підготовка магістрів із стоматології у медичних ЗВО України і у європейських країнах має суттєві відмінності як у змістовому, так і організаційному контексті. Навчальні плани підготовки стоматологів європейських ЗВО принципово різняться кількістю дисциплін та, відведених на їх вивчення, ECTS-кредитів. Порівняння навчальних планів підготовки стоматологів у НМУ та країнах ЄС дало змогу констатувати, що основні відмінності полягають у їх насиченості. Встановлено, що завантаженість студентів вітчизняних ЗВО дуже висока через велику кількість гуманітарних та соціально-економічних дисциплін, у той час як європейські студенти мають у програмі лише дві соціально-економічні дисципліни. Порівняльний аналіз навчальних програм вітчизняних та європейських ЗВО дав змогу визначити основні завдання реформування системи стоматологічної освіти, а саме: підвищення якості медичної освіти, забезпечення її безперервності і послідовності протягом усього періоду професійної діяльності; зменшення навчального навантаження на студентів; забезпечення оптимального співвідношення теоретичної та практичної підготовки із посиленням акценту на клінічно-практичній підготовці

Features of the functional composition of goat's milk and its importance as the basis for infant formula

Goat milk has a long history of use in human nutrition. There are currently many studies examining the functional characteristics and nutritional value of goat milk and its importance in the production of various dairy products. Before, native goat milk was widely used for feeding young children if the breastfeeding was impossible. To date, however, the practice of feeding unmodified goat milk, as well as cow milk, to infants under 12 months of age is strongly discouraged, as this leaves them exposed to the risk of electrolyte imbalance, as well as iron, folic acid, and vitamin B12 deficiencies. Commercial production of formulas based on goat milk began in the 1980s, and since then there have been many studies which show the safety and effectiveness of these formulas. The review provides the latest evidenced-based information on the composition and functional properties of individual components of the goat milk and goat milk formulas. The protein and amino acid composition of goat milk, as well as the features of its effects on the formation of the infant's intestinal microbiota, are described in detail. The studies investigating goat milk oligosaccharides and their similarity to human milk oligosaccharides are presented. The characteristics of the goat milk fat profile have been demonstrated. As an example of an adapted goat milk formula, a formula designed to meet all standards is presented. The fat profile of the presented formula is modified by introducing a patented lipid complex consisting of β-palmitate in its composition. In addition, the presented formula composition includes such oligosaccharides as galacto- and fructo-oligosaccharides, which availability ensure the formation of an optimal intestinal microbiota

Anabar Region of Yakutia in the XX — Early XXI Centuries: Characteristics of the Local Cultural Landscape

The features of the ethnocultural landscape of the Anabar national (Dolgan-Evenk) ulus of the Republic of Sakha (Yakutia) are considered. Attention is paid to the main components of cultural landscapes: local communities and traditional economy. In the study area, the retrospective analysis made it possible to identify the dynamics of the  number and settlement of residents, to state the modern functioning of two rural local communities: Saskylakh  and Yuryung-khainsky. It is argued that the sustainability and preservation of traditional sectors of the economy are due to the adaptation of the local population to natural landscapes. It is noted that during the XX — early XXI centuries, the traditional economic activities of the indigenous population, represented by different ethnic groups  that originally inhabited the territory of the ulus, remained unchanged and, despite all the socio-economic transformations, remain vital and common for the Anabarians. The article presents the results of the analysis of a sociological survey and an associative experiment, which revealed the features of the linguistic landscape of the area under consideration, depending on different layers of self-awareness: external, with a predominance of Russian-language text in the linguistic appearance of the settlements under study; individual, with a predominance of the Yakut language in intergroup communication; and the subconscious, which revealed the dominance of the Dolgan cultural codes. It has been established that the cultural landscape of the Anabar ulus is the result of  centuries-old interaction of indigenous ethnic groups inhabiting this area: Dolgans, Evenks, Yakuts and Russians

CLINICAL PSYCHIATRIC INTERVIEW (LECTURE)

Aim. To reflect the theoretical foundations and create a minimum set of practical skills of diagnostic and treatment interviewing in psychiatry.Materials and methods. To achieve this goal a thematic selection of scientific literature sources of both classical and modern domestic and foreign authors was carried out. In addition, the authors focused on the rich personal experience of interviewing, which allowed choosing and describing the most effective, practically significant methods and methods of clinical diagnosis in psychiatry in the form of psychiatric interviewing.Results. The factors that determine the nature and content of the interview: place, time, participants of the interview – doctor and patient have been described and analyzed. The analytical description of the main psychotechnologies which are used by the psychiatrist (psychotherapist) in the course of interview is given: establishment of contact, technology of hearing of and listening to the patient, technology of asking questions, technology of a pause and silence, technology of tactile contact, technology of using humour, advice, recommendation, interpretation, technology of finishing the interview and its structuring.Conclusion. Clinical interview is the main diagnostic and psychotherapeutic tool of a psychiatrist, and especially of a psychotherapist. The diagnostic effectiveness of a psychiatric interview is determined by the extent to which the information obtained in the course of it is structured into a diagnostic concept, the therapeutic effectiveness is determined by the extent to which the patient accepts the concept of understanding by the doctor of his painful condition (achieved compliance)

Analysis of vitamin D availability of premature infants in the south of Russia

Introduction. Inadequate vitamin D supply worldwide is a public health problem. Low vitamin D levels during pregnancy can lead to abnormal placentation, placental insufficiency and abnormal fetal development, which contributes to poor health after birth.Objective of the study is to analyze the vitamin D status of premature infants born in the south of Russia.Materials and methods. A total of 141 premature infants were examined. Extremely low birth weight was found in 19 (13.4%) newborns, very low birth weight in 35 (24.8%), and low birth weight in 75 (53.2%).Results and discussion. Premature infants had vitamin D deficiency in the majority of cases (51%), with a median of 16.9 [11.7; 22.9] ng/mL. Correlation analysis demonstrated a positive association between 25(OH)D levels and body weight in very low birth weight infants (r = 0.34, p = 0.043). Serum vitamin D concentrations were 1.6 times lower in infants whose mothers did not receive multivitamins than in those whose mothers received multivitamins, 13.8 [9.7; 20.9] and 21.6 [16.9; 28.6] ng/mL, respectively (p = 0.001). Infants with an Apgar score of 7-10 had higher vitamin D levels, 17.8 [11.9; 22.7] ng/mL, than infants with severe asphyxia, 13.8 [9.9; 16.8] ng/mL (p = 0.036). Premature infants with congenital infection had lower 25(OH)D levels than infants without an infectious process, 15.6 [10.8; 22.9] and 18.4 [14.2; 22.7] ng/mL, respectively. Children with an infectious process that subsequently ended in death had lower 25(OH)D levels than children without an infectious process (p = 0.001). Children with cerebral ischemia had lower 25(OH)D concentrations than children without cerebral ischemia (p = 0.001).Conclusions. Premature infants born in the south of Russia have vitamin D deficiency in more than half of the cases. Administration of preparations containing cholecalciferol reduces the proportion of newborns with severe vitamin D deficiency, but does not ensure optimal serum levels. Initially low levels of 25(OH)D can be considered as an unfavorable prognostic sign against the background of the development of congenital infection

Differential diagnosis of myopathy and multiple epiphysal dysplasia caused by mutations in the <i>COMP</i> gene in children

Background. Multiple epiphysal dysplasia (MED) type 1 (OMIM: 132400) is one of 7 genetic variants of this group of skeletal dysplasias described to date. The disease is caused by mutations in the COMP gene located on chromosome 19p13.1. The presence of muscle hypotonia and ligamentous laxity, as well as a moderate increase in the level of creatinephosphokinase activity, can lead to misdiagnosis of myopathy.Objective: to analyze the clinical and genetic characteristics of type 1 MED caused by mutations in the COMP gene in a series of Russian patients. Differential diagnosis was focused on the distinctive features of the disorder and hereditary myopathies.Materials and methods. We observed 8 patients from 7 families aged 7 to 15 years with MED type 1 caused by heterozygous mutations in the COMP gene. To confirm the diagnosis, the following methods were used: genealogical analysis, clinical examination, neurological examination with psycho-emotional testing, radiography and targeted sequencing of a panel consisting of 166 genes responsible for the development of inherited skeletal pathology.Results. Case history, clinical, radiological and genetic characteristics of 8 patients with MED type 1 caused by mutations in the COMP gene were analyzed. The first clinical manifestations of the disease were recorded from the age of 2–3 years and were characterized by gait disturbances, muscle weakness, difficulties with climbing stairs, frequent falls when walking, the inability to get up from the floor and from a squatting position and hypermobility of the joints. Electroneuromyographic study did not reveal the signs of miopathy. In two patients, a moderate increase in the creatinekinase level of up to 250–360 u / l was found. All patients were surveyed by neurologists for several years with a clinical diagnosis of congenital myopathy. At the age of 5–6 years patients COMPlained knee and ankle pain, which was assumed as rheumatic arthropathy. X-ray examination revealed typical signs of deficient ossification of the epiphyses. The next-generation sequencing analysis revealed seven single nucleotide variants in the COMP gene that lead to MED type 1. Three of the found variants here identified for the first time. As previously described, the majority of nucleotide variants (six out of seven) were localized in the 8–14 exons of the COMP gene and led to amino acid substitutions in calmodulin-like protein domain repeats, and only one substitution was localized in the C-terminal region of the protein molecule.Conclusion. In most patients with MED caused by mutations in the COMP gene, the first symptoms of the disease are gait disturbance, muscle weakness, and Gowers» maneuvers. The presence of these symptoms, along with a moderate increase in the level of creatinephosphokinase activity, often precedes the onset of clinical manifestations of skeletal dysplasia, leading to a misdiagnosis with myopathies. Accession of expressive arthralgias to these symptoms was mistakenly identified as reactive arthritis. X-ray examination of patients’ long bones helps to suspect the presence of MED. This X-ray imaging shows specific signs of epiphyses damage. A molecular-genetic analysis needs to be done to diagnose the genetic variant, caused by mutations in gene COMP

Дифференциальная диагностика миопатии и множественной эпифизарной дисплазии, обусловленной мутациями в гене COMP, в детском возрасте

Background. Multiple epiphysal dysplasia (MED) type 1 (OMIM: 132400) is one of 7 genetic variants of this group of skeletal dysplasias described to date. The disease is caused by mutations in the COMP gene located on chromosome 19p13.1. The presence of muscle hypotonia and ligamentous laxity, as well as a moderate increase in the level of creatinephosphokinase activity, can lead to misdiagnosis of myopathy.Objective: to analyze the clinical and genetic characteristics of type 1 MED caused by mutations in the COMP gene in a series of Russian patients. Differential diagnosis was focused on the distinctive features of the disorder and hereditary myopathies.Materials and methods. We observed 8 patients from 7 families aged 7 to 15 years with MED type 1 caused by heterozygous mutations in the COMP gene. To confirm the diagnosis, the following methods were used: genealogical analysis, clinical examination, neurological examination with psycho-emotional testing, radiography and targeted sequencing of a panel consisting of 166 genes responsible for the development of inherited skeletal pathology.Results. Case history, clinical, radiological and genetic characteristics of 8 patients with MED type 1 caused by mutations in the COMP gene were analyzed. The first clinical manifestations of the disease were recorded from the age of 2–3 years and were characterized by gait disturbances, muscle weakness, difficulties with climbing stairs, frequent falls when walking, the inability to get up from the floor and from a squatting position and hypermobility of the joints. Electroneuromyographic study did not reveal the signs of miopathy. In two patients, a moderate increase in the creatinekinase level of up to 250–360 u / l was found. All patients were surveyed by neurologists for several years with a clinical diagnosis of congenital myopathy. At the age of 5–6 years patients COMPlained knee and ankle pain, which was assumed as rheumatic arthropathy. X-ray examination revealed typical signs of deficient ossification of the epiphyses. The next-generation sequencing analysis revealed seven single nucleotide variants in the COMP gene that lead to MED type 1. Three of the found variants here identified for the first time. As previously described, the majority of nucleotide variants (six out of seven) were localized in the 8–14 exons of the COMP gene and led to amino acid substitutions in calmodulin-like protein domain repeats, and only one substitution was localized in the C-terminal region of the protein molecule.Conclusion. In most patients with MED caused by mutations in the COMP gene, the first symptoms of the disease are gait disturbance, muscle weakness, and Gowers» maneuvers. The presence of these symptoms, along with a moderate increase in the level of creatinephosphokinase activity, often precedes the onset of clinical manifestations of skeletal dysplasia, leading to a misdiagnosis with myopathies. Accession of expressive arthralgias to these symptoms was mistakenly identified as reactive arthritis. X-ray examination of patients’ long bones helps to suspect the presence of MED. This X-ray imaging shows specific signs of epiphyses damage. A molecular-genetic analysis needs to be done to diagnose the genetic variant, caused by mutations in gene COMP.Введение. Множественная эпифизарная дисплазия (МЭД) 1‑го типа (OMIM: 132400) – один из семи описанных к настоящему времени генетических вариантов этой группы скелетных дисплазий. Заболевание обусловлено мутациями в гене COMP, локализованном на хромосоме 19р13.1. Наличие мышечной гипотонии и слабости связочного аппарата суставов, а также умеренное повышение уровня активности креатинфосфокиназы часто приводят к ошибочной диагностике миопатии.Цель исследования – анализ клинико‑генетических характеристик МЭД 1‑го типа, обусловленной мутациями в гене COMP, в выборке российских пациентов и формирование принципов дифференциальной диагностики заболевания с наследственными миопатиями.Материалы и методы. Под нашим наблюдением находилось 8 пациентов из 7 семей в возрасте от 7 до 15 лет с МЭД 1‑го типа, обусловленной гетерозиготными мутациями в гене COMP. Для уточнения диагноза использовались генеалогический анализ, клиническое обследование, неврологический осмотр по стандартной методике с оценкой психоэмоциональной сферы, рентгенография и таргетное секвенирование панели, состоящей из 166 генов, ответственных за развитие наследственной скелетной патологии.Результаты. Проведен анализ анамнестических данных, клинико‑рентгенологических и молекулярно‑генетических характеристик 8 пациентов с МЭД 1‑го типа, обусловленной мутациями в гене COMP. Первые клинические проявления заболевания регистрировались с 2–3‑летнего возраста и характеризовались изменением походки, быстрой утомляемостью, трудностью подъема по лестнице, частыми падениями при ходьбе, отсутствием возможности самостоятельно встать с пола и из положения на корточках, выраженной гипермобильностью в суставах. В результате проведения электронейромиографического исследования не отмечалось признаков первично‑мышечного поражения. У 2 пациентов обнаружено умеренное повышение уровня активности креатинфосфокиназы в плазме крови до 250–360 Ед/л. Все пациенты в течение нескольких лет наблюдались у неврологов с диагнозом врожденной миопатии. В возрасте 5–6 лет у пациентов возникали боли в коленных и голеностопных суставах, которые расценивались как реактивные, чаще всего ревматические, артропатии. При проведении рентгенологического обследования выявлены типичные признаки поражения эпифизов длинных трубчатых костей, что позволило диагностировать МЭД. В результате анализа секвенирования нового поколения выявлено 7 нуклеотидных вариантов в гене COMP, ответственном за возникновение 1‑го типа этой группы заболеваний. Три из выявленных вариантов зарегистрированы впервые. Как и в ранее описанных выборках, в анализируемой выборке пациентов большинство нуклеотидных вариантов (6 из 7) локализовались в области 8–14‑го экзонов гена COMP и приводили к аминокислотным заменам в повторах кальмодулиноподобного домена белка, и лишь 1 замена была локализована в С‑концевом участке белковой молекулы.Заключение. МЭД 1‑го типа – генетический вариант скелетных дисплазий, не сопровождающийся значимым снижением роста. У большинства пациентов первыми симптомами заболевания, отмеченными в возрасте 2–3 лет, были нарушение походки, повышенная мышечная утомляемость и приемы Говерса. Наличие этих симптомов наряду с умеренным повышением уровня активности креатинфосфокиназы предшествовало возникновению клинических проявлений скелетной дисплазии, приводя к ошибочной диагностике у пациентов нервно‑мышечного заболевания из группы миопатий. Присоединение к этим симптомам выраженных артралгий приводило к ошибочному диагнозу реактивных артритов. Заподозрить наличие МЭД у пациентов позволяет рентгенологическое исследование длинных трубчатых костей, в результате которого выявляются специфические признаки поражения эпифизов. Для диагностики генетического варианта, обусловленного мутациями в гене COMP, необходимо проведение молекулярно‑генетического анализа