bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study of Clinical and Paraclinical Findings of Elderly and Non-Elderly Patients With Acute Pneumonia and Pneumosepsis
Authors: Majzoobi Mohammad Mahdi , Jalalvand Zahra , Khanlarzadeh Elham , Moradi Abbas
Published: February 2020

Accurate diagnosis and timely treatment of pneumonia, as one of the most common infectious diseases in elderly patients, require careful attention to the clinical and paraclinical findings, which may be different between the elderly and non-elderly patients. The aim of the present study was to compare the clinical, laboratory, and radiological findings of elderly and non-elderly patients with pneumonia and pneumosepsis. This cross-sectional study was performed on 97 elderly and 93 non-elderly patients with pneumonia, admitted to Sina hospital in Hamadan, west of Iran, in 2017. Patients in both groups were also compared in terms of the underlying diseases, sepsis rate, electrolyte disturbances and CURB-65 criteria. All underlying diseases, except for HIV infection, in addition to clinical findings such as tachypnea, lethargy, decreased consciousness, hypotension, and respiratory alkalosis were significantly more common in the elderly, compared to the non-elderly group. In the elderly group, the average length of hospital stay, sepsis rate, and mortality rate were 9.4 days, 74.2%, and 21.7%, respectively versus 6.2 days, 46.3%, and 3.2%, respectively in the non-elderly group. Patients in the two groups were significantly different in terms of CkkURB-65 criteria and radiological findings. For the timely diagnosis of pneumonia and pneumosepsis in the elderly, it is necessary to consider any alteration in respiratory rate and consciousness status. Also, for proper treatment, the clinicians should pay attention to the existence of any comorbidities and electrolyte disturbances.
© 2019 Tehran University of Medical Sciences. All rights reserved.
Acta Med Iran 2019;57(8):503-509.
Jinekoloji Polikliniğine Başvuran Geriatrik Hastalardaki Problemlerin Premenapozal Dönemdeki Hastalarla Kıyaslanması
Authors: GÜVEY Huri
Published: February 2020

Amaç:
Premenapozal
ve postmenapozal geritrik hasta gruplarının jinekoloji polikiniğine başvuru
nedenlerini inceleyip karşılaştırmak.Yöntem: Sakarya Özel Konak Hastanesi Kadın Doğum
Polikliniğine başvuran 25 premenapozal ve 25 postmenapozal geriatrik yaş
grubunda hasta retrospektif olarak başvuru tanıları, gravida, parite durumları,
cerrahi operasyon ve sistemik hastalık bulunma öyküsü, ultrasonografi ile
endometrium kalınlığı ölçümü incelendi ve karşılaştırıldı. Araştırma verisi
SPSS 23.0 istatistik paket programı aracılığıyla değerlendirilmiştir.

Bulgular: Katılımcıların
en sık başvuru sebepleri; %20 ile vajinit, %16 düzensiz menstrüal kanama, %14
postmenapozal kanama şeklindedir. Hastaların %76’sında sistemik hastalık öyküsü
yoktur. Hastaların %18’inde hipertansiyon, %6’sında diyabetes mellitus
bulunmaktadır. Premenapozal grupta sistemik hastalık bulunma oranı %4 iken
postmenapozal grupta bu oran %44 olarak bulunmuştur. Bulgularımıza göre postmenapozal
grupta uterin prolapsus (%12), sistosel ( %24) , üriner inkontinans (20), vazomotor
semptomlar(%4), vajinit (%12) ve postmenapozal kanama (28) görülürken,
premenapozal grupta vajinit (%28), myoma uteri (%16), düzensiz menstruasyon
(%32), dismenore (%8), over kisti (%12) ve cilt altı endometriozis (%4)  tespit edilmiştir. Postmenapozal kanama
şikayetiyle  gelen hastalara yapılan
endometrial örneklemede 2 hastada endometriod adenokanser saptanmıştır,
hastalar jinekolojik onkoloji kliniğine yönlendirilmiştir.Sonuç:
Tüm
jinekolojik problemlerin geriatrik yaş grubunda görülebilmesine karşın
hipoöstrojenemiye bağlı atrofik semptomlar, vazomotor semptomlar,  pelvik organ prolapsusu, üriner
inkontinas  gibi hastalıklar bu yaş grubu
kadınlarda daha sık görülmektedir. Hem kadın sağlığı hem de geriatrik yaş grubu
bakımı açısından bunlar da göz önüne alınarak jinekolojik değerlendirme yapmak
hastalıkların erken tanı ve tedavisi açısından yararlı olacaktır.
Hemşirelerde Tükenmişlik Düzeyinin Çeşitli Değişkenlere Göre İncelenmesi: Bir Üniversite Hastanesi Örneği
Authors: UZUN Lütfiye Nur , MAYDA Atilla Senih
Published: February 2020

Amaç:
Bu araştırma bir üniversite hastanesinde çalışan hemşirelerde tükenmişlik
düzeyini belirlemek ve tükenmişliğin sosyo-demografik değişkenlerle ilişkisini
incelemek amacıyla yapıldı. Yöntem: Çalışma, araştırmaya katılmayı kabul eden 192 hemşire ile yapıldı. Veriler
31 sorudan oluşan sosyodemografik veri formu ve 22 sorudan oluşan Maslach
Tükenmişlik Ölçeği (MTÖ) ile toplandı. Bulgular:
Hemşirelerin MTÖ duygusal tükenme alt boyutu puan ortalamaları 20.3±7.0,
duyarsızlaşma alt boyutu puan ortalamaları 6.0±3.2 ve kişisel başarı alt boyutu
puan ortalamaları 19.3±4.1 olarak belirlendi. Hemşirelerde cinsiyet, algılanan gelir
düzeyi , kronik hastalık varlığı, psikiyatrik yardım alma öyküsü, klinikteki
toplam hizmet süresi, yıllık izin alırken problem yaşama durumu, mesleki
uygunluk, mesleğe bağlılık, mesleğini sevme ve kurumun mesleki gelişim imkanı sağlamasının
tükenmişliği etkilediği saptandı (p<0.05) Sonuç: Hemşirelerin duygusal tükenme düzeyi yüksek, duyarsızlaşma
düzeyi orta ve kişisel başarı düzeyi ters orantılı olacak şekilde düşük olduğu
belirlendi. Tükenmişlik sendromu hemşirelerin kişisel özellikleri ile iş yeri
ve mesleki özelliklerinin etkileşimleri sonucunda yaşanabilmektedir. Tüm bu
değişkenler tükenme düzeylerini etkilemektedir. Hemşirelerde ki tükenmişlik hem bireysel hem de örgütsel açıdan
değerlendirilmelidir.
Sıçan İnce Barsak İskemi/Reperfüzyon Hasarında İleum ve Akciğer Dokusunda Görülen Damar Dışına Protein Kaçışının, Kanabinoid 2 Reseptör Agonisti (Am-1241) ile Kontrolü
Authors: HANCI Mustafa , PARLAR Ali , ARSLAN Seyfullah Oktay
Published: February 2020

Amaç: Kanabinoid 2 reseptör agonistinin İskemi/Reperfüzyon (İ/R) hasarı modelinde anti-inflamatuvar etkisinin olup olmadığını kanıtlamaktır.Yöntem: Araştırmada; sıçanlarda barsak iskemi ve reperfüzyon modeli oluşturuldu. Kanabinoid 2 reseptör agonisti (AM-1241), iskemi ve reperfüzyon oluşturmadan hemen önce abdominal venden (iv) verildi. Sonrasında evans mavisi iv olarak uygulandı. Dokulara evans mavisinin geçişi çıplak gözle görüldü. Bu aşamadan hemen sonra sıçanın göğüs kafesi açıldı ve sistemik kan dolaşım havuzu usulüne uygun olarak boşaltıldı. Dokular tartıldıktan sonra 48 saat formamidde inkübasyona bırakıldı ve spektrofotometrede 620 nm dalgaboyunda ölçüm yapıldı.Bulgular: İ/R grubu şam kontrol grubunu göre yaklaşık % 803 evans mavisi kaçışı izlendi. İ/R ve İ/R+CB2 agonist arasındaki fark ise agonistin proteinleri tutup, protein ve evans mavisinin doku sıvısına geçişini azalttığı görülür.Sonuç: Kanabinoid 2 reseptör agonistinin, hem ileum dokusunda ve hem de uzak organda (akciğer) kılcal damarlardan dokuya protein kaçışını engellediği ve dolayısıyla ileum İ/R hasarında antiinflamatuar etki gösterdiği bulundu.
Ursodeoksikolik Asit, Diyabetik Olmayan, Alkol Dışı Karaciğer Yağlanması Tedavisinde Yer Almalı Mı?
Authors: BEKTAS Atilla , ULUSOY Meltem , DAĞALP Kemal
Published: February 2020

Amaç: Diyabetik olmayan nonalkolik steatohepatitli (NASH) hastalarda Ursodeoksikolik asidin (UDKA) tedavi edici etkisini araştırıldı. Gereç ve Yöntem: Diyabetik olmayan ve NASH tanısı konulan 28 hastaya (4 kadın, 24 erkek), herhangi bir diyet uygulamaksızın, 12 ay süreyle 12-15 mg/kg/gün dozda UDKA verilerek; histopatolojik, biyokimyasal ve ultrasonografik yönden değerlendirildi.Bulgular: Alanin aminotransferaz (ALT) ve aspartat aminotransferaz (AST) değerlerinde istatistiksel olarak anlamlı azalma oldu. Dokuzuncu aydan sonra, istatistiksel olarak anlamlı olmayan ancak iyi yönde ultrasonografik değişiklikler izlendi. Hiçbir hastada normal karaciğer histopatolojisine dönüş olmamakla beraber, hafif olgularda istatiksel olarak anlamlı gerileme oldu (P < 0.008).Sonuç: Çalışmamızda UDKA kullanımıyla nondiyabetik NASH’lı hastaların, serum transaminaz değerlerinde düşüş ile birlikte fibrozis dışındaki karaciğerlerindeki histolopatolojik bulgularında gerileme sağlanmıştır. UDKA, NASH tedavisinde bazı kılavuzda yer almamaktadır. Ancak yan etki potansiyeli düşük UDKA’nın, nondiyabetik gibi seçilmiş olgularda ve özel bir kombinasyon tedavisinde yer alması NASH’da fayda sağlayabilir.
Nöropskiyatrik Bozukluklarda Fonksiyonel Yakın-Kızılötesi (İnfrared) Spektroskopisine (fNIRS)- Dayalı Nörofeedback (NF) Eğitim Uygulamaları
Authors: BAHADIR Anzel
Published: February 2020

Fonksiyonel yakın-kızılötesi (infrared) spektrokopisi nöropsikiyatrik araştırmalarda, bilişsel (kognitif) bir aktivite ile ilişkili olarak beyin oksijenizasyonundaki hemodinamik değişiklikleri (oksihemoglobin ve deoksihemoglobin) ölçmeye dayanan ve beyin aktivitesinin gerçek zamanlı değerlendirilmesini sağlayan girişimsel olmayan optiksel bir görüntüleme tekniğidir. Fonksiyonel yakın-kızılötesi (infrared) spektrokopisine dayalı nörofeedback, görsel/işitsel/dokunma uyaranları ile birlikte eğitim seanslarının uygulanması sonucu nöropsikiyatrik bozukluklarda beynin etkin bölgelerindeki hemodinamik değişiklerin, edimsel (operant) koşullanma yolu ile kendi-kendine düzenlenmesini sağlamaktadır. Bu derlemenin amacı, güncel literatür verilerine göre sosyal anksiyete bozukluğu, dikkat eksikliği-hiperaktivite bozukluğu, yeme bozukluğu, şizofreni ve otizm spektrum bozukluğunu içeren nöropsikiyatrik rahatsızlıklarda, fonksiyonel yakın-kızılötesi (infrared) spektrokopisi- nörofeedback eğitimi uygulamaları ve bu eğitimin olası gelişiminin kapsamlı olarak değerlendirilmesidir. Bu doğrultuda, derlemede Pubmed/MEDLINE, ScienceDirect, Web of Knowledge/Web of Science, EMBASE, EBSCOhost ve Scopus veri tabanlarında taratılan konu ile ilgili güncel literatür verileri incelenmiştir. Bu inceleme sonucuna göre, nöropsikiyatrik bozukluklarda, etkilenmiş olan özellikle prefrontal korteks, dorsolateral prefrontal korteks, posterior-superior temporal girus, inferior frontal girus hedef beyin bölgelerindeki hemodinamik değişiklere bağlı bilişsel ve davranışsal temelli fonksiyonel aktivitelerin farklı uyaranlar ile kendi kendine düzenlenmesine dayalı fonksiyonel yakın-kızılötesi (infrared) spektrokopisi- nörofeedback eğitim protokollerinin bozukluk/semptom ve bireye özgün olarak uygulanmasının, gelecekte bu hastalıkların tedavilerinde umut verici alternatif bir yöntem olabileceği öngörülmektedir. Bu nedenle, nöropsikiyatrik bozukluklarda etkin nörofeedback tedavi uygulayabilmek için fonksiyonel yakın-kızılötesi (infrared) spektrokopisi- nörofeedback’in klinik etkilerine ek olarak, farklı beyin ağlarındaki (networks) etkilerinin altında yatan mekanizmalara ve aktivite değişikliklerine odaklı çalışmalara ihtiyaç duyulmaktadır.
Comparıson The Effect Of Antıadhesıve Materıals After Abdomınal Surgery
Authors: DOĞAN Sami , ÇETİN Mehmet , GÜNAL Ömer , ERDEM Havva
Published: February 2020

Objective: We aimed to evaluate and compare the effects of anti-adhesion materials, Seprafilm, Suprofilm, olive oil, and olive oil containing Vitamin E by measuring tension forces.Method: 60 male Wistar-Albino rats were divided into six groups. The front side of the cecum and right abdominal parietal peritoneal wall were abrased. The rats were euthanized on the 14th postoperative day. Adhesions between intestines, omentum, other abdominal organs, cecum, incisionsites, and abdominal anterior wall peritoneum were all evaluated. Adhesion strength was measured with dynamometer. Histopathological evaluations of the adhesion area was performed.Results: Stage-I (0.43Newton) in Group-I, stage-IV (1.0540N) in Group-II, stage-II (0.6370N) in Group-III, stage-II in Group-IV (0, 5230N), stage-III (0.7620N) in Group-V, stage-IV (1.3560N) in Group-VI, were detected. A significant difference was found between these findings. P = 0.001, (p <0.05). Histopathological examination: It was found that GroupV-VI reduced inflammation, increased collagen production, fibroblastic activity and vascular proliferation.Conclusion: More objective evaluation can be made by measuring the tension force of the adhesions. Suprafilm can also be effectively used as an antiadhesive, such as Seprafilm. Olive oil and vitamin E require more studies to be used as antiadhesives.
Stylistic fronting and verb placement in main clauses in Insular Scandinavian / Stílførsla og sagnorðspláss í høvuðssetningum í íslendskum og føroyskum
Authors: Angantýsson Ásgrímur
Published: February 2020

AbstractThe goal of this paper is twofold. On the one hand, it provides an overview of V1 (verb-first), V2 (verb-second), and V3 (verb-third) constructions in main clauses in Icelandic and Faroese, and it seeks to explore to what extent the two closely related languages behave the same way in that resepect. The data presented here support the idea that Icelandic and Faroese have similar conditions with respect to the possibility of V1 and V3. However, some interesting exceptions are pointed out, in particular regarding the fronting of negative objects in Faroese (V3). On the other hand, special attention is given to the possibility of Stylistic Fronting (SF) as a matrix V2-phenomenon in the Insular Scandinavian languages. It has been claimed that SF is more restricted in embedded clauses in Faroese than it is in Icelandic, suggesting that Faroese is evolving in the direction of the Mainland Scandinavian languages, where SF has all but disappeared. Based on that, one might expect that SF is also on itsway out in main clauses. The comparison of stylistically fronted elements of various kinds conducted in this study shows that both languages obey similar restrictions. However, certain SF-constructions are much more restricted in Faroese than in Icelandic. ÚrtakEndamálið við hesi grein er tvíbýtt. Øðrumegin er tað at útvega eitt yvirlit yvir setningsgerðir við S1 (sagnorð-eitt), S2 (sagnorð-tvey) og S3 (sagnorð-trý) í høvuðssetningum í íslendskum og føroyskum, og roynt verður at kanna, í hvussu stóran mun tey bæði nær skyldu málini bera seg at á sama hátt í hesum sambandi. Dáturnar, ið verða lagdar fram her, stuðla hugsanini, at íslendskt og føroyskt hava líkar setningsgerðir við atliti at møguleikumfyri S1 og S3. Hinvegin verður víst á nøkur áhugaverd undantøk, serliga í sambandi við at hava negativ ávirki fremst í føroyskum (S3). Hinumegin verður serliga hugt at møguleikum fyri stílførslu sum S2-fyribrigdi í høvuðssetningumí íslendskum og føroyskum. Ført hevur verið fram, at stílførsla er meira avmarkað í eykasetningum í føroyskum enn hon er í íslendskum. Tað skuldi tí bent á, at føroyskt mennir seg sama veg sum danskt, norskt og svenskt, har ið stílførsla er um at vera púra burtur. Við støði í tí skuldi væntast, at stílførslaeisini er á veg út í høvuðssetningum. Samanberingar av stílførdum eindum av ymsum slag fremst í setningi, sum eru gjørdar í hesi kanning, vísa, at bæði málini geva seg undir avmarkingar av sama slag. Tó eru ávísar setningsgerðirvið stílførslu munandi meira avmarkaðar í føroyskum enn í íslendskum.
Evaluation of sleep quality and perceived stress of nursing students who are engaged in clinical practice based on their sleeping habits
Authors: TOKUR KESGİN Makbule , ÇAĞLAR Songül
Published: February 2020

Objectives: Sleep quality and perceived stress of nursing students affects both their personal health and nursing care. The aim of this study is to identify nursing students' sleep quality and perceived stress and the sleeping habits affecting them. Methods: This descriptive cross-sectional study was carried out with 446 nursing students. The data were collected through a questionnaire involving some questions aiming to identify sleeping habits and perceived stress, Pittsburgh Sleep Quality Index (PSQI) and Perceived Stress Scale for Nursing Students (PSSNS). Results: The average score of PSQI was 7.71 ± 3.27 while scale of PSSNS was 63.50 ± 26.65. According to PSSNS, female students perceived stress level more than males (p = 0.005). However, there was no statistically significant difference between female students and male students in terms of total PSQI scores (p = 0.113). Students with poor sleeping quality showed some signs of sleep deprivation during the day. There was a weak relationship between sleeping quality and perceived stress (p = 0.01). Nevertheless, delaying sleep due to academic workload affects students' perceived stress. Conclusions: Nursing students should be encouraged to develop healthy sleeping habits and skills to deal with stress.
The impact of transcutaneous posterior tibial nerve stimulation in patients with premature ejaculation
Authors: AYDOS Mustafa Murat , NAS İdris , ÖNEN Efe
Published: February 2020

Objectives: Approximately 30-40% of men worldwide are affected by premature ejaculation. Despite much research on this subject, there is still little information about the cause and treatment of premature ejaculation. The aim of this study was to evaluate the therapeutic aspect of transcutaneous posterior tibial nerve stimulation (PTNS) in patients with premature ejaculation. Methods: The study included 60 PE patients, aged 20-50 years, divided into 2 groups as the treatment group (n = 30) and the control group (n = 30). Transcutaneous PTNS was applied to patients in the treatment group for 30 minutes once a week for 12 weeks. In the control group, a stimulation probe was placed on the posterior tibial nerve without giving any stimulation, to provide a placebo effect. The Arabic Index of Premature Ejaculation (AIPE) scale and Intravaginal Ejaculation Latency Time (IELT) measurements were used before and after the procedure. Results: In both groups, the mean IELT duration and AIPE scale scores were statistically significantly increased after the procedure (p < 0.05). The percentage change in the AIPE scale scores after the procedure was found to be higher in the treatment group than in the control group (p = 0.007). Conclusions: The results of the study showed a statistically significant increase in the duration of the time to ejaculation with PTNS, and a significant improvement was obtained in the post-treatment AIPE scale scores. There is a need for further research to achieve more robust results to contribute to premature ejaculation treatment.
Safe use of vascular stapling devices during laparoscopic cholecystectomy in cases with enlarged cystic canal
Authors: FIRAT Yurdakul Deniz , EROL Mehmet Fatih
Published: February 2020

Objectives: Bile duct injuries and fistulas due to bile leakage are observed at certain rates in laparoscopic cholecystectomy. In complicated cases, in patients with cholelithiasis cystic duct edema, the cystic canal may be enlarged to the extent that it cannot be closed with a clip in a standard operation. In this study we evaluated the eficiency of stapler closure of cystic canal. Methods: In this retrospective study the cases who had laparoscopic cholecystectomy and cystic canal was closed with stapler between August 2016 and December 2018 were reviewed. Patients' hospital stay and complications were noted. Results: Thirty-three patients who were electively operated and cystic canal closure was performed with vascular staples because of a wide cystic canal during the operation were included in this study. Low bile drainage was observed in only one case and this patient had spontaneous regression with conservative follow-up. Mean duration of hospital stay was 3.7 days. Patients were followed up from 2 months to 28 months postoperatively.Conclusions: Endo-vasculer stapler can be used safely during laparoscopic cholecystectomy with a history of stones in the main bile duct. In this group of patients, it is advisable to make preparations in this direction before the operation.
A scientific explanation and understanding of epistemological issues in tourism research (a study based on the theories of Kurt Lewin and John Tribe)
Authors: Alejziak Wiesław
Published: February 2020

The article presents the essence as well as various models of academic explanation and the explanatory value of understanding, indicating their usability and limitations as regards understanding why and how tourism functions. Particular attention has been paid to the epistemological dimension of tourism research, as well as its new directions. The author has referred to two models concerning the epistemological aspects of tourism research where the focal point is the category of ‘truth about tourism’. These have been presented in two articles by John Tribe.
Controversial types of travel and the position of Polish tourism service providers: Experience tourism
Authors: Godlewski Grzegorz
Published: February 2020

The aim of this study is to investigate the potential of the Polish market for the development of the supply-side of controversial forms of tourism, based on the opinions and products offered by tour operators and retail travel agents. Analytical data were collected using desk research and CATI (N=107) methods. The most common controversial types of tourism include drug and sex tourism, followed by disaster tourism, medical tourism, slum tourism, fan tourism and poverty tourism. The expectations of customers regarding tourism offers usually focus on party tourism and extreme travel, and the providers highlight that this market segment will continue to develop.
Identification and evaluation of factors influencing sports fan attendance at international events: volleyball case study
Authors: Ryśnik Jakub
Published: February 2020

The article presents unpublished results of research conducted among fans at the 2014 FIVB Volleyball Men’s World Championship (1618 respondents to a direct questionnaire survey). Its aim is to describe selected motives and barriers to attendance at international sports events. The analysis attempts to obtain information about the importance of particular factors and barriers for respondents, their relative importance and to derive a model from the correlation between these variables to explain the attendance of fans at international sports events.
Ekonomia współdzielenia i zarządzanie zrównoważonym rozwojem środowiska w sektorze turystycznym w skali globalnej
Authors: Genç Ruhet
Published: February 2020

W artykule zostanie omówiony wpływ rozwoju ekonomii współdzielenia na równowagę ekologiczną w sektorze turystycznym, w skali globalnej, jako że w literaturze jak dotąd nacisk jest kładziony głównie na konsekwencje ekonomiczne i społeczne. Zaprezentowano model matematyczny w celu oceny wpływu ekonomii współdzielenia na dobrobyt jednostek, które uczestniczą w działaniach z tego zakresu w konkretnych miejscowościach turystycznych. Autor opisuje też korzyść odnoszoną przez inne jednostki w postaci ich pozytywnego wizerunku zewnętrznego. Rozwój modelu będzie zależał od wyników przyszłych badań. Z pewnością wykażą one, że ekonomia współdzielenia wraz ze konsumpcją kolaboratywną w sektorze turystycznym stanowią rosnący trend w ekonomii światowej, który również przyczynia się do zrównoważonego rozwoju. Współdzieląc środki produkcji transportu, komunikacji itd., zarówno turyści, jak i usługodawcy są w stanie ograniczyć swój negatywny wpływ na środowisko. Artykuł wypełnia lukę w badaniach nad związkiem pomiędzy rozwojem zrównoważonym a ekonomią współdzielenia w sektorze turystycznym.
Zmiany w strukturze funkcji turystycznej w uzdrowiskach kujawskich (na podstawie wielkości i struktury ruchu turystycznego)
Authors: Matczak Andrzej
Published: February 2020

Celem opracowania jest identyfikacja zmian zachodzących w strukturze funkcji turystycznej w uzdrowiskach kujawskich prowadząca do przekształcania się ich w ośrodki turystyczno-uzdrowiskowe. Wykonano ją na podstawie danych o ruchu turystycznym w latach 2000–2017, poprzez określenie relacji między ruchem kuracyjnym a pozostałymi formami ruchu turystycznego. Wykorzystano szeroki zakres zastanych danych statystycznych oraz pochodzących z badań ankietowych. Informacje te umożliwiły przeprowadzenie wnioskowania na podstawie analizy dynamiki wyrażonej gradientem pozytywnych zmian zachodzących w ruchu turystycznym. W analizie wykorzystano statystyczne wskaźniki dynamiki, natężenia i struktury. Przeprowadzone badania wskazują na zaawansowany proces transformacji uzdrowisk kujawskich. Potwierdzają to wskaźniki dynamiki ruchu kuracyjnego i pozakuracyjnego oraz cele przyjazdów do uzdrowisk. Dynamika poziomu zmian zachodzących w strukturze funkcji turystycznej była zróżnicowana w poszczególnych uzdrowiskach. Najbardziej zaawansowana w Ciechocinku, szybko postępująca w Wieńcu-Zdroju, natomiast opóźniona w Inowrocławiu. Prowadzi ona do stopniowego oraz charakteryzującego się zróżnicowaną dynamiką przekształcania się ich w ośrodki turystyczno-uzdrowiskowe.
Wykorzystanie technologii informacyjno-komunikacyjnych w dostępie do informacji i usług turystycznych w świetle wyników badań przeprowadzonych wśród polskich turystów w województwie małopolskim
Authors: Pawłowska-Legwand Aneta
Published: February 2020

Technologie informacyjno-komunikacyjne znalazły szerokie zastosowanie w dostępie do informacji i usług turystycznych, a korzystanie z tego typu rozwiązań oddziałuje na zachowania turystyczne. Celem autorki artykułu było scharakteryzowanie na podstawie wyników przeprowadzonych badań zachowań i opinii turystów w zakresie korzystania z tych technologii przed planowaną podróżą. Wyniki te, w tym ocena użyteczności narzędzi cyfrowych, wskazują, że turyści są zainteresowani korzystaniem z technologii informacyjno-komunikacyjnych. Najbardziej aktywnymi użytkownikami byli respondenci w wieku poniżej 35 lat, mieszkający w miastach i mający wykształcenie średnie lub wyższe. Strony internetowe, aplikacje mobilne i inne rozwiązania utworzone z zastosowaniem omawianych technologii były traktowane przez nich przede wszystkim jako źródło szeroko rozumianej informacji turystycznej oraz narzędzie ułatwiające planowanie trasy przemieszczania się, a także kupowanie usług turystycznych. Dla podróżnych miały również znaczenie media społecznościowe, umożliwiające dzielenie się w Internecie treściami związanymi z wyjazdem turystycznym.
THE RELATIONSHIP BETWEEN LESIONS IN GASTROESOPHAGEAL REFLUX DISEASE AND EROSIVE ULCER OF THE GASTRODUODENAL ZONE IN SCHOOLCHILDREN OF SIBERIA
Authors: Polivanova T. V. , Vshivkov V. A.
Published: February 2020

The aim of the study. To study the association between lesions in gastroesophageal reflux disease (GERD) and erosive ulcer in schoolchildren of Siberia (Russia). Materials and Methods. We performed the cross-section survey for the schoolchildren aged from 7 to 17 in the cities of Tyva Republic, Evenkia and Buryatia (Russia) using the questionnaires in order to reveal gastric intestinal complaints. We have examined 1535 schoolchildren in Tyva, 1369 in Evenkia and 790 in Buryatia. GERD had been diagnosed when heartburn was marked in accordance with international consensus for pediatric populations. In each region, we performed esophageogastroduodenoscopy in schoolchildren with gastric intestinal complaints picked up by random (283 in Tyva, 205 in Evenkia and 110 in Buryatia). Results. In Siberia schoolchildren GERD prevalence amounted to 6.4%. This index in Tyva Republic was 9.5%, being higher than in Buryatia (4.1%; p=0,0001) and Evenkia (4.2%; p=0,0001). In Tyva Republic, GERD erosive variant was found to show the tendency to increase. The destructive process in stomach mucosa and duodenum in the examined schoolchildren had been diagnosed in 10.7% subjects (in 15.5% schoolchildren of Tyva Republic as compared to 7.3% in children of Buryatia (p=0,0297) and 5.9% in Evenkia (p=0,0009)). In children with erosive ulcer lesions of the gastroduodenal area, the comorbidity of esophageal lesions was revealed more frequently. Conclusion. There is the association between GERD and erosive ulcer lesions in the mucosa of the gastric duodenal area in Siberia schoolchildren. Its severity shows territorial distinctions.
HIGH-TECH DIAGNOSTIC METHODS AND AN ENTEROSCOPIC TREATMENT OF CHILDREN WITH PEUTZ-JEGHERS SYNDROME
Authors: Kirakosyan E. V. , Lokhmatov M. M. , Dyakonova E. Yu.
Published: February 2020

Peutz-Jeghers syndrome (PJS) is an autosomal dominant hereditary hamartomatous polyposis with predominant localization in the jejunum and ileum. Because of PJS polyps differ from adenomatous ones, the performing polypectomy is associated with a high risk of bowel perforation. During 2015-2017 18 PJS children were comprehensively examined including esophagogastroduodenoscopy, colonoscopy, and video capsule endoscopy There was developed a step-by-step procedure for the removal of polyps common in all parts of the small intestine, including the creation of a “persistent pillow”; electroexcision of a polyp and application of a clip to the region of the womb of a removed polyp. Polyps more than 7 mm detected in the stomach and duodenum, were removed during endogastroduodenoscopy, and in the colon - under a colonoscopy. During video capsular endoscopy, polyps with a diameter of 2 mm to 2.5 cm were detected in the deep parts of the small intestine. For their surgical removal, during a therapeutic single-balloon enteroscopy, an electroscission of all polyps was performed. The postoperative period was uneventful. The combination of a single balloon enteroscopy with an electroexcision of polyps is suggested by the authors as the optimal method for the diagnosis and treatment of PJS in children, which allows avoiding delayed perforations of the small intestine in the postoperative period. Thanks to this technique, enteroscopy becomes the only possible alternative to bowel resection in PJS children.
THE USE OF INTRAVENOUS IMMUNOGLOBULIN PENTAGLOBIN IN THE COMPLEX TREATMENT OF SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN
Authors: Arslanova A. Yu. , Aliskandiev A. M. , Izrailov M. I. , Aliskandieva Z. A. , Ismailova F. E.
Published: February 2020

There are presented data from a comprehensive examination and treatment of 30 children with community-acquired pneumonia (CAP). For the treatment of young children with focal-confluent forms of CAP and the clinical manifestations of infectious-septic shock, Pentaglobin preparations containing IgM were used. Severe CAP with a tendency to destruction was more often observed in cases with the dominance of gram-negative flora in the etiological structure, most often detected in the foothill zone (18.2% of children), in the middle mountain zone - in- 13.3%, in the low-grade zone - in 5% of children. Pseudomonas aeruginosae was more commonly seeded in children in the foothill zone (12.5%), while in children living in the lowland and middle mountain zone in 2.5% and 6.6% correspondingly. The authors showed the preparation of intravenous immunoglobulin Pentoglobin is a safe, effective, easily tolerated means of etiotropic and pathogenetic therapy of severe CAP, caused more often by gram-negative and gram-positive bacterial microbiota.
DIAGNOSTIC AND TREATMENT OF COMBINED DAMAGES OF LARGE BONES OF THE LIMBS AND ORGANS OF THE ABDOMINAL CAVITY IN CHILDREN
Authors: Yahyaev Y. M. , Izrailov M. I. , Aliyev I. A. , Magomedov M. -A. , Aliskandiev A. M.
Published: February 2020

The experience of the management of 141 victim cases aged from 1 year to 15 years with fractures of the large bones of the extremities associated with injuries of the abdominal organs is presented. The cause of injury in 56% of cases was a traffic accident with boys to prevalent to suffer. In 141 victims, 184 injuries of the abdominal organs were diagnosed with predominant damage in isolated injuries of the spleen (40%), in case of multiple injuries, a combination of damage to the spleen and liver (41.9%). In 47.6% of patients, fractures of the lower limbs were observed, fractures of the bones of the upper extremities were found in 41.8%, with predominant damage to the bones of the lower extremities with open fractures (65%). The use of the developed algorithm for diagnosis and treatment, providing for a differentiated approach to diagnosis and treatment at different periods of combined trauma, allowed obtaining more beneficial results in the main group (97.4%) compared with the control group (93.9%) with an economic effect of 28%.
ORGANIZATION OF MEASURES FOR THE PREVENTION AND EARLY DIAGNOSIS OF GYNECOLOGICAL DISEASES IN CHILDREN AND ADOLESCENTS
Authors: Sharkov S. M. , Sibirskaya E. V. , Tarbaya N. O. , Shchukina N. D.
Published: February 2020

The current demographic situation in Russia is characterized by a high frequency of male and female infertility, high childhood morbidity, an increased frequency of birth of children with genetic diseases, hereditary and congenital malformations. All this explains the need to protect the reproductive health of the younger generation. A significant number of organic and functional diseases of the female genital organs has been established to originate from childhood. In turn, the gynecological morbidity of girls and adolescent girls has a significant impact on the course of future pregnancies, childbirth, as well as fertility and the health of the offspring as a whole. There are obvious shortcomings in the provision of specialized care to girls, there are no regular gynecological examinations, despite the clinical examination of the population, most pediatricians, as well as parents, are not sufficiently aware of the features of the course in different forms of gynecological pathology in girls, which, together with the low appealability of girls to a pediatric gynecologist, fails to allow prevention, timely identify and treat disorders of the reproductive system in childhood and adolescence. The article presents the main forms of organization of activities for the prevention and early diagnosis of gynecological diseases of children and adolescents.
MOLECULAR DIAGNOSIS OF FIBROSIS IN DIFFUSE LIVER DISEASES
Authors: Fisenko Andrey P. , Smirnov I. E.
Published: February 2020

Chronic liver diseases (CLD) held an important place in the structure of pediatric hepatology including viral and autoimmune hepatitis, various forms of liver pathology caused by metabolic disorders. They are characterized by a variety of clinical manifestations, a progressive course with the formation of fibrosis and the possibility of its outcome in liver cirrhosis (LC). Liver puncture biopsy with morphological examination of its tissue is the leading method for determining the stage of liver fibrosis (LF) in CLD children. However, it is not always safe for the patient. Using non-invasive imaging methods, it is impossible to detect intermediate stages of fibrosis and it is not always possible to detect signs of CL. Therefore, non-invasive markers of LF, based on the identification of various molecular compounds involved in the formation of components of the extracellular matrix (ECM) or acting as activators of fibrogenesis, are necessary. Hyaluronic acid, collagen type IV, matrix metalloproteinases-2 and -9, a tissue inhibitor of matrix metalloproteinases-1, transforming growth factor beta1, showing diagnostic value for non-invasive monitoring of the development of LF, are well studied among them.
RATIONALE FOR EXPANDING THE LIST OF SPECIALIZED SPECIALISTS PROVIDING SPECIALIZED ASSISTANCE TO CHILDREN WITH CEREBRAL PALSY
Authors: Pak Lale A. , Fisenko A. P. , Kuzenkova L. M. , Makarova S. G.
Published: February 2020

In the article, the authors present results of their own clinical study, on the basis of which the need to involve doctors of various specialties to accompany children with cerebral palsy is scientifically justified.
THE POSSIBILITIES OF USING THE DOMESTIC MIXTURE FOR ENTERAL NUTRITION IN THE CORRECTION OF THE UNDERNUTRITION IN CYSTIC FIBROSIS CHILDREN
Authors: Roslavtseva Elena A. , Bushueva T. V. , Borovik T. E. , Simonova O. I. , Burkina N. I. , Lokhmatov M. M.
Published: February 2020

The article presents the results of clinical observation of cystic fibrosis (CF) patients received the enteral nutrition product Nutrient Standard (Russia) as nutritional support. The high efficiency of this product has been shown for the correction of malnutrition in СF children.
WAYS OF MODERNIZATION OF MEDICAL AND SOCIAL ASSISTANCE IN CHILDREN’S HOMES
Authors: Lazurenko Svetlana B. , Fisenko A. P. , Konova S. R.
Published: February 2020

Results of the analysis and comparison of official statistics and selective studies of the health status of young children brought up in children’s homes and in the children’s population over the past decade are presented. It has been established that The state of health of charity-children of children’s homes by the nature and structure of disorders was established to differ from the state of health of children in the population. The authors propose to implement a number of measures to ensure the improvement of the quality of medical and psychological-pedagogical assistance to children with combined forms of pathology; to introduce in the child’s homes modern medical-psychological-pedagogical assistance to a severe contingent of children based on interdisciplinary interaction, to improve the system of gradual rehabilitation treatment and comprehensive medical rehabilitation of children of the first year of life, taking into account the structure of health disorders.
ESTIMATION BY PARENTS OF ACCESSIBILITY AND QUALITY OF MEDICAL AID PROVIDED TO CHILDREN IN OUT-PATIENT CONDITIONS
Authors: Yuriev V. K. , Moiseeva Karina E. , Alekseeva A. V. , Kharbedia Sh. D. , Glushchenko V. A.
Published: February 2020

Introduction. In modern conditions, the population’s satisfaction with medical care, including the urban and rural population, is one of the main criteria for the quality and accessibility of medical care. The goal. Subjective assessment of the organization of medical care for children in the conditions of the children’s polyclinical department of a medical ambulatory. Materials and methods. The study was conducted by random sampling using an anonymous questionnaire of 312 parents of children receiving medical care on an outpatient basis in the children’s department of the New Devyatkino village clinic in the Vsevolozhsky district of the Leningrad Region. Results. Preventive examinations, treating acute diseases, and testing when being under observation were established to be the main reasons for contacting the pediatric ward of a polyclinic are. Most of the parents spent an average of 24.5 ± 0.07 minutes on the way to the medical organization. Most often, parents choose to make an appointment with a doctor through a call center, the Internet and through an electronic record. The majority of parents (73.6%) believe the schedule of work of doctors to be convenient. More than half of parents (53.6%) believe that in the children’s outpatient department there are no specialists of the profile they need. In the opinion of parents, the most difficult is to arrange a visit to an ophthalmologist, otolaryngologist, and surgeon. In general, 65.3% of parents were satisfied with the organization of the children’s outpatient department, 28.9% were not completely satisfied, 2.3% were not completely satisfied. The main reasons for parents dissatisfaction are long queues at the registry (20.5 ± 0.08 minutes), to the pediatrician (average 22.7 ± 0.09 minutes) and highly specialized doctors (average 23.5 ± 0.09 minutes), difficulties in obtaining expert advice, and passing the examination. Conclusion There is a need to improve the availability and quality of medical care for children provided on an outpatient basis.
LASER SURGERY FOR SKIN VASCULAR TUMORS IN INFANTS
Authors: Shakina L. D. , Ponomarev Igor V. , Smirnov I. E.
Published: February 2020

In young children, benign vascular tumors (VT) are most often manifested as congenital hemangioma and infantile hemangioma. There are considered clinical variants, pathogenesis, evaluation of severity and approaches to assessing the effectiveness of laser surgical treatment for VT in infants. For the first time, there are presented numerical criteria for selecting the optimal laser system to provide the relevant photo-obstruction of the pathological vascular bed, reducing the risk for the development of side effects in the early and remote period after the laser radiation exposure. Comparison of the values of the coefficients of complete absorption of oxyhemoglobin and hemoglobin at different stages of vascular tumor development shows the optimal laser treatment of vascular tumors can be realized by the laser radiation with a wavelength of 578 nm, since it is absorbed to the maximum extent by the main vascular photothermophores - oxyhemoglobin and hemoglobin. Taking into account the features of the angioarchitecture of the pathological vascular bed of the papillary dermis, to prevent the occurrence of petechial hemorrhages (purpura) immediately after the procedure, laser irradiation should be carried out in a pulsed mode with a pulse duration of 15-20 ns. To prevent thermal damage to the reticular layer of the dermis, it is advisable to use a laser pen with a diameter of 0.6-1 mm. The choice of optimal conditions for radiation exposure ensures high efficiency of the laser treatment of vascular tumors, which have been becoming one of the most promising directions in modern hospital-replacing technologies in pediatric laser surgery.
IMMUNIZATION AGAINST ROTAVIRUS INFECTION AS AN APPROACH TO PROPHYLAXIS OF ACUTE GASTROENTERITIS IN CHILDREN
Authors: Fisenko A. P. , Kaliuzhnaia Tatiana A. , Makarova S. G. , Shakhtakhtinskaya F. Ch. , Kurdup M. K. , Tkachenko N. E. , Fedoseenko M. V. , Yasakov D. S. , Orlova Y. O. , Ivardava M. I.
Published: February 2020

Introduction. The only effective method of controlling rotavirus infection is vaccination, which has been mandatory in the Moscow Vaccination Schedule since 2014 and in the Epidemic Vaccinations Schedule. To evaluate the efficacy and safety of pentavalent vaccine immunization for the prevention of rotavirus infection in healthy children and children with chronic diseases there were comprehensively examined 182 children, including 83 healthy and 99 cases with problems of health. Vaccination was performed at the age of 6-32 weeks. All adverse events occurred within 42 days after vaccine administration were recorded. There was analyzed the incidence of intestinal infections within the next year since the moment of the first vaccination. There were no revealed any statistically significant differences in the frequency of adverse events between the group of healthy children and the group of cases with different chronic diseases. The most common post-vaccination adverse effects were diarrhea and subfebrile and febrile temperature. During a year follow-up period, a group of patients (n=9) did not have any symptoms of the disease after contacting patients with cases with acute intestinal infections. Conclusion The study shows the safety of rotavirus infection immunization in healthy children and children with chronic diseases. Rotavirus infection vaccination is effective in patients who have had contact with persons suffering from acute intestinal infections. Vaccination against rotavirus infection should be recommended not only for healthy infants but for those with chronic diseases also.
ADIPOKINES AND HORMONES IN CHILDREN OF PRIMARY SCHOOL AGE WITH NORMAL AND EXCESS BODY WEIGHT
Authors: Skvortsova Vera A. , Khodzhieva M. V. , Borovik T. E. , Bushueva T. V. , Smirnov I. E. , Mayanskiy N. A. , Filyanskaya E. G. , Melnichuk O. S.
Published: February 2020

Prevention and early diagnosis of obesity in children is an urgent task. For this, biologically active peptides and hormones regulating the metabolism of adipose tissue can be used. The authors evaluated the nutritional status of 652 children aged 7-10 years living in Moscow and attending general education schools. Among these children, the case-control method was used to select 40 patients with overweight / obesity and 38 schoolchildren with normal weight and height (comparison group). Blood was taken from all children to quantify hormones and adipokines. Serum concentrations of hormones (ghrelin, insulin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1 and glucagon), C-peptide and adipokines (adiponectin, adipsin, leptin, tissue plasminogen-activator inhibitor-1, resin, visfatin) in the blood sample were evaluated with the use of method of flow cytometry. There was found a significant increase in adipokine and hormone blood concentrations, depending on the degree of the disorder of the nutritional status of children. In makes them to consider as early biomarkers of obesity with diagnostic and prognostic significance.
MODERN APPROACHES TO THE ASSESSMENT OF THE DISORDER OF FUNCTIONING IN DISABLED CHILDREN IN TERMS OF THE QUALITY OF LIFE
Authors: Vinyarskaya Irina V. , Terletskaya R. N. , Chernikov V. V. , Antonova E. V. , Alekseeva E. I. , Fetisova A. N. , Basargina E. N. , Simonova O. I. , Gorinova Yu. B. , Savva N. N.
Published: February 2020

Introduction. Currently, there are still problems in the rehabilitation of children with chronic diseases and children with disabilities, as well as in the establishment of the disability itself, which is primarily due to the lack of common criteria for describing the health, functioning of the child’s body, their disorders at different ages and assessing the effectiveness of rehabilitation measures. Purpose. To develop criteria of functioning disturbance in children suffered from various chronic disabling diseases in terms of quality of life. Materials and methods. By means of the developed Russian-language version of the standardized international questionnaire (HUI) applicable for children’s age, 832 children at the age of 5-17 years were examined (healthy children, children with chronic disabling diseases and the children in need of palliative care). Results. For the first time, domestic pediatrics profiles of functioning disturbance with the use of HUI questionnaire in healthy and sick children are developed. Indices of healthy children can be used as standard criteria. Juvenile idiopathic arthritis patients were revealed to have functioning disturbances in almost all aspects, except sight, hearing, and speech. In children with the heart diseases followed by chronic heart failure, the capability to move, cognitive abilities are disturbed, emotional violations and a pain syndrome were noted. Patients with cystic fibrosis had functioning disturbance concerned emotions and pain. The most expressed disturbances on all aspects included in the HUI questionnaire, except hearing, are noted in disabled children needing palliative care. Conclusion. The data can be used for obtaining information of impact of the disease on the activity of a child, extent of functioning disturbance on this or that aspect of quality of life, for development and assessment of efficiency of individual rehabilitation programs.
STRATEGIES AND VECTORS OF THE DEVELOPMENT OF NURSING INVESTIGATIONS
Authors: Modestov Arseny A. , Fisenko A. P. , Nevolin Yu. S. , Golubchenko A. V.
Published: February 2020

The development of nursing largely associated with the expansion of the functions of nurses is a response to the challenges of professional activity due to the development of technology, improvement of diagnostic and treatment and rehabilitation work, both in primary health care and in medical institutions of the second and third levels. However, the system of training and professional development, the management of medical institutions does not fully take into account these new challenges. To determine the strategies influencing the formation of research competencies among nurses and their development vectors, the authors conducted a survey of 486 nurses and a sociological survey of 80 nurses, reflecting the need for mastering digital skills. Professional competencies of nurses have been established to be in demand, and the management of medical institutions is not focused on motivating them to participate in clinical nursing research. The participation of nurses in clinical research was shown to expand the range of knowledge, contributes to the formation of their communicative and digital competencies, forms leadership skills