[On the issue of evaluation of quality and efficiency of intersectorial interaction under palliative medical care support].

The article presents the original system of indices for comprehensive assessment of level of intersectorial collaboration in palliative medical care support of population. The system was developed on the basis of and considering requirements of normative legal acts of the Russian Federation. The proposed indices can be applied in analysis of functioning and subsequent optimization of medical institutions network and social service institutions in the subjects of the Russian Federation, including involvement of non-profit organizations and public associations.

[Humoral regulation of nutritional status in children].

The purpose of the research was the investigation of the characteristics of insulin resistance, levels of adipokines, myokines and collagen metabolites type I in children in orphanages and social rehabilitation centers (SRC). The study involved 69 children aged 7-12 years. The first group consisted of 20 children from SRC, the second - 16 children living in orphanages, control group included 33 children (1-2 health groups) from wealthy families. The average length of stay of children in SRP was 1.0 (0.5-2.5) month, in orphanages - 38 (22-44) months. The groups were comparable in age and sex. Anthropometric indices were determined, in blood serum glucose concentration was measured by glucose oxidase method, blood serum level of insulin, cortisol, leptin, adiponectin, resistin, apelin, myostatin, collagen metabolites were determined by ELISA. Children from orphanages and SRC had significantly lower anthropometric indices in comparison with the control group. Particularly low parameters were observed in children from SRP, which in growth, body weight, chest circumference and body mass index significantly lagged behind the control group peers. The children from SRP as compared with the control group revealed higher insulin resistance index (3.33±0.49 vs 2.29±0.29, p<0.05) and cortisol level (405.21±38.21 vs 313.08±25.97 nmol/l, p>0.05). There were changes (p<0.05) in blood serum content of adipokines - reduced leptin level (5.35±1.55 vs 14.00±3.10 ng/ml) and increased apelin level (4.07±0.82 vs 2.19±0.41 ng/ml), as well as higher levels (p<0.05) of myostatin (183.95±16.3 vs 116.4±9.4 ng/ml) and C-terminal telopeptide of type I collagen (1.11±0.11 vs 0.72±0.08 ng/ml). The children in orphanages compared with the control group had lower levels of insulin (5.04±0.69 vs 11.3±1.12 µIU/ml), high insulin sensitivity - HOMA-IR was 1.01±0.16. The children in orphanages have even more pronounced reduction in leptin concentration (2.69±0.4 ng/ml), a decrease of resistin (4.99±0.32 vs 7.16±0.70 ng/ml, p<0.05), increased concentration (p<0.05) of apelin (3.53±0.67 ng/ml), myostatin (181.17±10.2 ng/ml) and C-terminal telopeptide of type I collagen (2.70±0.22 ng/ml). Features of hormone and cytokine regulation of metabolism make it particularly urgent to prevent disorders of eating behavior and to promote a healthy lifestyle among children left without parental care.