Obesity is a risk factor for poor response to treatment in early rheumatoid arthritis: a NORD-STAR study.

OBJECTIVE: This report from the NORD-STAR (Nordic Rheumatic Diseases Strategy Trials and Registries) trial aimed to determine if obesity is associated with response to conventional and biological antirheumatic treatment in early rheumatoid arthritis (RA). METHODS: This report included 793 participants with untreated early RA from the randomised, longitudinal NORD-STAR trial, all of whom had their body mass index (BMI) assessed at baseline. Obesity was defined as BMI ≥30 kg/m2. All participants were randomised 1:1:1:1 to one of four treatment arms: active conventional treatment, certolizumab-pegol, abatacept and tocilizumab. Clinical and laboratory measurements were performed at baseline and at 8, 12, 24 and 48-week follow-up. The primary endpoint for this report was response to treatment based on Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) remission and Disease Activity Score with 28 joints using C-reactive protein (DAS28-CRP) <2.6 stratified by BMI. RESULTS: Out of 793 people included in the present report, 161 (20%) had obesity at baseline. During follow-up, participants with baseline obesity had higher disease activity compared with those with lower BMI, despite having similar disease activity at baseline. In survival analyses, obesity was associated with a lower likelihood of achieving response to treatment during follow-up for up to 48 weeks (CDAI remission, HR 0.84, 95% CI 0.67 to 1.05; SDAI, HR 0.77, 95% CI 0.62 to 0.97; DAS28-CRP <2.6, HR 0.78, 95% CI 0.64 to 0.95). The effect of obesity on response to treatment was not influenced by the treatment arms. CONCLUSION: In people with untreated early RA followed up for up to 48 weeks, obesity was associated with a lower likelihood of good treatment response, irrespective of the type of randomised treatment received. TRIAL REGISTRATION NUMBER: NCT01491815.

DEVELOPMENT OF THE PUBLIC HEALTH SYSTEM IN THE CONDITIONS OF CURRENT CHALLENGES AND THREATS.

OBJECTIVE: The aim: Analysis of the development and optimization of the public health system in the face of current challenges and threats. PATIENTS AND METHODS: Materials and methods: Bibliographic, information-analytical, statistical methods and content analysis were used in the study. An analysis of the regulatory framework for the development of the public health system, including WHO strategic documents and national legislation was conducted. A critical assessment of the pre-existing public health system under the Semashko model was provided. The main stages of development of the new public health system of Ukraine, it's structural, financial and economic, organizational and managerial, scientific and educational, information and communication aspects are described. Reporting materials of the Public Health Center of the Ministry of Health of Ukraine and regional health centers, the state institution «Center for Medical Statistics of the Ministry of Health of Ukraine¼ and state institutions «Laboratory Centers of Ukraine¼ were analyzed. RESULTS: Results: The development of the national public health system in Ukraine is carried out in accordance with the main directions of state policy, recommendations of the WHO and other international organizations in health care and aims to ensure health and well-being, prevent and minimize the negative consequences of current challenges and threats to population health. The public health development strategy is defined and enshrined in the legal framework. Structural development includes the creation of a national, 23 regional public health centers, a network of local structures, their staffing, the formation of a network of training institutions and their continuous development. The organizational and managerial strategy provides coordination of activities, intersectoral and intersectoral cooperation, improvement of technological and resource provision of institutions and institutions of the public health system. Financial and economic activities include multi-channel financing of structures and public health activities. Information and analytical activities provide effective monitoring of health and well-being, obtaining organizational and managerial and government structures objective information for making sound management decisions. CONCLUSION: Conclusions: Development of the national public health system in Ukraine and its optimization is carried out in accordance with the main directions of state policy, recommendations of the WHO and other international organizations in health care and aims to ensure health and well-being, prevent and minimize the negative consequences of modern challenges and threats to population health. Optimization of the public health system includes a number of measures of functional-structural, organizational-administrative, regulatory, financial-economic, scientific-educational, information-analytical nature, aimed at ensuring the implementation of the main operational functions of public health.

HEALTH OF THE TEACHER OF HIGHER EDUCATION INSTITUTIONS (EFFICIENCY - DEVELOPMENT).

OBJECTIVE: The aim: Of the work is to find a scientifically based approach to improve the health of teachers on the basis of a comprehensive socio-hygienic analysis of the factors that affect the state of their health. Identify the main aspects of psychological work with teachers to support the mechanisms of self-regulation of their psychological health. PATIENTS AND METHODS: Materials and methods: Theoretical and methodological analysis of psychological and pedagogical literature; сomparison; generalization; systematization. The article presents the current problem of modernity - the mental health of teachers of higher education. Criteria, quality categories, levels, principles of ensuring the mental health of the teacher as a person are analyzed. The components of mental health are compared. CONCLUSION: Conclusions: The concept of professional psychological health as a process of scientific understanding of the teachers practice involves the development of a comprehensive program for teacher's health care, which will include all areas: informational, preventional, diagnostical, rehabilitational and treatment. Higher education teachers are active participants in the preservation and promotion of health at the state, social and personal levels. They should form the concept of health in students during the process of their professional activities. Teachers use various forms of organizational, educational, volunteer work and different new technologies to preserve their own health and create the environment with the appropriate social conditions, where students can take responsibility for their own actions, deeds, work, leading a healthy lifestyle.