[Review of methodological approaches for the assessment of social and medical rehabilitation in the cardio-respiratory system diseases at the post-COVID period]. / Obzor metodologicheskikh podkhodov otsenki sotsial'no-meditsinskoi reabilitatsii pri zabolevaniyakh kardiorespiratornoi sistemy v postkovidnyi period.

There is currently no systematic relationship between the quantification of funding for the treatment and rehabilitation of cardio-respiratory diseases and the length of a citizen's working life. The development of a universal evaluation methodology that can be used for qualitative and quantitative evaluation of the effectiveness of social and medical rehabilitation is a relevant area of research. The survey contains an analysis of the scientific approaches used in research on social and medical rehabilitation, as well as the development of medical and social rehabilitation and health resort and spa treatment, and to assess the impact of medical rehabilitation on restoration of ability to work. On the basis of the data obtained, a set of indicators for the assessment of the socio-medical rehabilitation of diseases of the cardio-respiratory system at the post-COVID period is proposed, which in the future will serve as a methodological tool in the field of medical and social rehabilitation, health resort and spa activities and at all stages of rehabilitation and preventive medicine.

[Weather and climatic factors at the resort of the Southern coast of Crimea in the medical rehabilitation of patients with hypertension]. / Pogodno-klimaticheskie faktory na kurorte Yuzhnogo berega Kryma v meditsinskoi reabilitatsii patsientov s gipertonicheskoi bolezn'yu.

OBJECTIVE: To evaluate the effect of weather and climatic factors of the South Coast of Crimea (SCC) on the effectiveness of health resort medical rehabilitation (MR) of patients with arterial hypertension (AH). MATERIAL AND METHODS: One hundred and thirty-four patients with AH were examined. The effect of weather and climatic factors of the SCC was assessed using the methods of Modified Clinical Weather Pathogenicity Index (CWPI-M, developed at the I.M. Sechenov Institute) and assessment of medical rehabilitation according to International Classification of Functioning, Disability and Health (ICF) criteria. RESULTS: The regression equations for the change of ICF domains b2401, b420, b4301, b4552, d240 and the change of mean values of all domains depending on air temperature and humidity, wind velocity, amount of clouds, variability of air temperature, and atmospheric pressure were developed. The equations permit the generation of reliable rehabilitation prognosis for patients with AH for all terms of health resort care at the SCC. CONCLUSIONS: The use of CWPI-M makes it possible to form a rehabilitation prognosis for patients with AH based on certain ICF domains. The best rehabilitation prognosis for the SCC resorts is for the warm period of the year.

[Phenotypes of bronchial asthma during the health resort period and personalized programs of medical rehabilitation]. / Fenotipy bronkhial'noi astmy na sanatorno-kurortnom étape i personalizirovannye programmy meditsinskoi reabilitatsii.

INTRODUCTION: Bronchial asthma (BA) is a relevant social and medical problem in our country and around the world. Currently, phenotypes of the disease are distinguished. One of the original decisions in phenotypes distinguishing is the use of cluster analysis. However, the concept of BA phenotypes at the health resort period of rehabilitation has not yet been formed. AIM: To determine the BA phenotypes upon admission of patients to a health resort medical rehabilitation (HRMR) using cluster analysis and to offer personalized rehabilitation programs. MATERIAL AND METHODS: 518 patients with asthma who underwent HRMR on the southern coast of Crimea were examined. Each patient received clinical, functional and laboratory examination. HRMR included correction of long-term treatment according to the severity of asthma, climate therapy, respiratory therapy, educational programs, and physiotherapeutic procedures. We applied cluster analysis in order to identify BA phenotypes. Description statistics methods were used for phenotype-cluster characterization, comparative analysis - for determination of reliable phenotypic characteristics and relation of the effectiveness of HRMR and phenotypes. RESULTS: A model of three phenotype-clusters was developed. The first cluster included patients with BA of moderate severity, uncontrolled course, frequent exacerbations, history of atopy, a tendency to obesity, moderately reduced external respiration function, fixed airway obstruction, high adherence to long-term therapy with medium doses of inhaled glucocorticoids (ICS) combined with long-acting ß-2 agonists (LABA). Cluster 2 included patients with mild asthma, controlled or partially controlled course of the disease, with rare short exacerbations, late onset, preserved external respiration function and exercise tolerance, but low adherence to long-term therapy with medium and low doses of ICS. Cluster 3 included patients with moderate to severe BA, uncontrolled course, with early onset, frequent and prolonged exacerbations, severe symptoms, significantly reduced external respiration function with fixed obstruction, decreased exercise tolerance, but low adherence to long-term therapy (4th stage) with high doses of ICS in combination with LABA and long-acting anticholinergics. A close relationship was found between phenotypes-clusters and the achieved effects: a significant increase in the control of BA and a high efficiency of rehabilitation in patients of the 1st and especially 3rd clusters and low in the 2nd cluster. The optimal rehabilitation programs for each of the selected cluster phenotypes were determined. CONCLUSION: The cluster model developed with the help of artificial intelligence has demonstrated high prognostic value in the determination of the effectiveness and change of control over the course of asthma as a result of HRMR. Personalized HRMR programs are suggested.

[The modular strategy for the informational support of medical activities based at the spa and health resort facilities under conditions of infrastructure deficit].

The Crimean peninsula, by virtue of its unique geographical conditions, has a variety of natural resources providing a basis for the maintenance of the health resort activities in the region. However, most local health centers suffer from the chronic and difficultly avoidable in the short term problems with logistical support, including the shortage of computers and the lack of modern network infrastructure. This circumstance limits the deployment capabilities of high-grade medical information systems for the automation of all components of the activity of health resorts and the significant improvement of the performance of other aspects of their work, such as efficient patient routing, workflow optimization, limiting the opportunities for the realization of certain corruption schemes by the staff. We have studied the routing of patients and the associated document flow in a number of Crimean spa and health resort facilities (sanatoriums). As a result, the basic work places at which information contained in the documents is undergoing changes were identified. Based on these data, the basic (modular) concept of the development of medical information system was formulated. According to the principle of modularity, the structure of the information system has been modified and optimized. The stages of implementation of this approach at various levels of logistic facilities were described, defined and justified. The key feature of the proposed system consists in that even the minimal equipment of computing infrastructure units (starting from a single workplace, such as a «medical receptionist¼) may be sufficient to achieve the significant degree of automation in the workflow, provide monitoring and analysis of the medical records of the spa and health resort facilities. By gradually increasing the number of related automated workplaces and modules, it is possible to expand the capabilities of the system up to the full automation of a given health resort facility.

[The development of the medical information system for the improvement of the quality of work of the Crimean spa and health resorts].

The Crimea has the enormous potential for the health promotion activities. However, neither the profile of these activities nor the demand for the socio-medical services is clearly defined for the majority of the local spa and health resort facilities. The possibilities of modern information technology are not used in the full measure either. The objective of the present work was to elaborate the new medical information system and demonstrate its effectiveness. In addition, the article describes the main advantages of the system for the optimization of healthcare in the Crimean spa and health resort facilities. We reviewed and analyzed various literature publications, legal framework, standards, regulations, guidelines, and questionnaire survey data obtain at 50 spa and health resort facilities of the Crimea. The results of the assessment indicate the necessity of the systematic approach to the analysis of the quality of medical care and the process of its further development. Statistical and mathematical methods were used to elaborate the medical information system for the optimization of the activities of the Crimean spa and health resorts. The distinctive features of the proposed information system are modularity and the possibility of flexible adjustment to the conditions of individual settings, one-step data loading with the subsequent multiple application for the formulation of documents, automated filling of records in compliance with the medical standards, and taking into consideration the possible changes in or amendments to the form of the documents. The data obtained in the course of project implementation were used for the first time in the Republic of Crimea to design, substantiate, and recommend for the practical application the algorithm for the comprehensive estimation of the results of treatment of the patients based at the spa and health resort facilities with due regard for the specific regional conditions.

[Protective effect of grape wines in nitrosative stress caused by experimental diabetes mellitus].

It was found that under the diabetes-induced oxidative-nitrosative stress, red and white wines, which polyphenols are considered to be the main active components, decrease the level of nitrotyrosine-modified proteins toward the control level in sciatic nerve, dorsal root ganglia and spinal cord of animals with diabetes mellitus. A decrease of the activity of poly(ADP-ribose)polymerase-1 to the control level in the sciatic nerve of diabetic rats with red wine consumption was also shown. During the experiment the body weight of the control group and diabetic groups of rats with consumption of red wine was significantly increased by 52% and 19% accordingly. The present results allow us to assume an important role of red wine and possibility of production of its preparations for prevention and treatment of diabetic neuropathy.

[The energy characteristics of cardiorespiratory system function in patients with chronic bronchitis under graded physical loads]. / Energeticheskie kharakteristiki funktsii kardiorespiratornoi sistemy bol'nykh khronicheskim bronkhitom pri dozirovannykh fizicheskikh nagruzkakh.

On the basis of 38 spiroveloergometries performed in 20 patients with chronic bronchitis (ChB) there have been calculated energy characteristics of the function of the cardiorespiratory system (power of the heart, respiratory muscles and erythron, effectiveness of capturing of oxygen in the cardiac, pulmonary, erythron links and in the oxygen transport system as a whole) while they were doing their graded exercise. Mathematical simulation (factor analysis) permitted identification of two levels of work load (> and < 80 Wt) differing widely in their physiological and energy maintenance. A conclusion is substantiated and validated that loads under 80 Wt appear to be preferable, corresponding to the area of optimal, in terms of energy maintenance, functioning of the cardiorespiratory system of ChB patients (strategy of increasing the oxygen consumption at the expense of the predominant augmentation of the adequate volume in proportion to enlargement of the stroke volume).

[Energy metabolic changes in the cardiorespiratory system of patients with chronic bronchitis under the action of galvanization and dalargin electrophoresis on the area of the chest cavity]. / Izmenenie énergoobmena kardiorespiratornoi sistemy bol'nykh khronicheskim bronkhitom pod vozdeistviem gal'vanizatsii i élektroforezom dalargina na oblast' grudnoi kletki.

Galvanization and dalargin electrophoresis were examined for effects on external respiration, hemodynamics and oxygen-related energy metabolism of cardiorespiratory system of chronic bronchitis patients. Universal stress-limiting mechanism of these procedures, correcting cardiorespiratory function is based on more effective utilization of energy resources for support of self-cleaning activity of the body.