First- and Second-generation Health Condition Affected by Radiation

Research relevance: article presents the incidence of children and grandchildren for 2018–2019 of liquidator workers who took part in cleaning up the contaminated area around the Chernobyl nuclear power plant, as well as residents evacuated from the city of Pripyat and other settlements within a radius of 70 km from the station. The consequences of radiation exposure of Chernobyl accident remain a topical issue. Research objectives: in order to study health status of children and grandchildren of liquidators, outpatient cards and reporting forms no. 15-zdrav “On medical care for people affected by radiation and included in the Kyrgyz State Medical and Dosimetric Register” examined. Research materials and methods: diseases of the endocrine and nervous systems, nutritional disorders, metabolic disorders, mental disorders, diseases of the eye and its adnexa, ear diseases of and mastoid process were studied. Circulatory and respiratory system diseases were analyzed. Research results: animal and cell culture studies show that high doses of ionizing radiation can lead to mutations in offspring. However, there have not been sufficiently large-scale studies on humans that would allow assessing the effect of radiation on the health of offspring. The exposure provokes mutations and incurable diseases, but it is still unclear how it might affect the children affected. It is known that exposure to ionizing radiation increases DNA mutagenesis compared to background values. Conclusions: obtained data substantiate the need for further monitoring of their health, organization of differentiated dispensary observation of this contingent and timely implementation of medical, rehabilitation and preventive measures in order to preserve health of “children and grandchildren of Chernobyl” at all subsequent stages of their life.

Barriers to applying for medical rehabilitation: a time-to-event analysis of employees with severe back pain in Germany

Objective: Longitudinal studies on barriers to applying for rehabilitation in Germany are lacking in light of the suspected underutilization of rehabilitation services. The aim of this study was to examine application behaviour in persons with disabling back pain and to identify relevant predictors for making an application. Design: A prospective cohort study with randomized sampling of insurants in the German Pension Insurance, using a questionnaire at baseline and follow-up with linked administrative data for 1.5 years. Subjects/patients: Employed persons (age range 45–59 years) with a high degree of limitations due to back pain and a self-reported risk of permanent work disability (not applied for disability pension, no medical rehabilitation within the last 4 years). Methods: Multivariable Cox regression was used to examine the influence of pre-selected variables on making an application in the follow-up period. Results: Of 690 persons, only 12% applied for rehabilitation. Predictors for making an application were: support from physicians (hazard ratio (HR)=2.24; 95% confidence interval (95% CI) 1.32–3.80), family, and friends (HR=1.67; 95% CI 1.02–2.73), more pain-related disability days (HR=1.02; 95% CI 1.01–1.03), and worse work ability (HR=0.86; 95% CI 0.75–0.97). An intention to apply at baseline mediated the effect of family and physician support on the application. Conclusion: The low number of applications for rehabilitation despite disabling back pain indicates access barriers to, and underuse of, medical rehabilitation.

Physical Fitness Differences, Amenable to Hypoxia-Driven and Sarcopenia Pathophysiology, between Sleep Apnea and COVID-19

Handgrip strength is an indirect indicator of physical fitness that is used in medical rehabilitation for its potential prognostic value. An increasing number of studies indicate that COVID-19 survivors experience impaired physical fitness for months following hospitalization. The aim of our study was to assess physical fitness indicator differences with another prevalent and hypoxia-driven disease, Obstructive Sleep Apnea Syndrome (OSAS). Our findings showed differences between post-COVID-19 and OSAS groups in cardiovascular responses, with post-COVID-19 patients exhibiting higher values for heart rate and in mean arterial blood pressure. Oxygen saturation (SpO2) was lower in post-COVID-19 patients during a six-minute walking test (6MWT), whereas the ΔSpO2 (the difference between the baseline to end of the 6MWT) was higher compared to OSAS patients. In patients of both groups, statistically significant correlations were detected between handgrip strength and distance during the 6MWT, anthropometric characteristics, and body composition parameters. In our study, COVID-19 survivors demonstrated a long-term reduction in muscle strength compared to OSAS patients. Lower handgrip strength has been independently associated with a prior COVID-19 hospitalization. The differences in muscle strength and oxygenation could be attributed to the abrupt onset of the disorder, which does not allow compensatory mechanisms to act effectively. Targeted rehabilitation focusing on such residual impairments may thus be indispensable within the setting of post-COVID-19 syndrome.

AUTONOMIC NERVOUS SYSTEM DYSFUNCTION IN BREAST CANCER PATIENTS

When studying oncology diseases, it is necessary not only to assess their nature, progress and outcome depending on the local disease process, but also to take into account overall health, since multiple organ damage has a prognostic value and determines the disease outcome. All mechanisms and structures that have an integrative and homeostatic effect on the overall health should be considered. One of these structures is the autonomic nervous system. Traditionally, the autonomic nervous system has been considered in terms of 3 components: sympathetic, parasympathetic and intestinal. However, in recent years, ideas about neuroendocrine and neuroimmune systems have come to the fore, justifying the expansion of the concept "autonomy of the nervous system." In case of autonomous dysfunction, dysregulation of the involuntary body functions occurs, and autonomic neuropathy develops. There are cardiovascular, gastrointestinal, urogenital, and sudomotor forms of autonomic neuropathy, which are characterized by certain changes in various pathological states, especially in malignant processes. We pay attention to breast cancer, which ranks first in the structure of oncology diseases in the Russian Federation. Nowadays, there are only a few studies devoted to the changes in the autonomic nervous system in patients with breast cancer during anticancer drug therapy, taking into account the disease progress and clinical features, as well as methods for dysfunction remodeling. The article analyzes a number of scientific information sources that can help to study various forms of autonomic neuropathy in patients with breast cancer and allow assessing the use of medical rehabilitation for such patients. Key words: autonomic nervous system, autonomic neuropathy, breast cancer, antitumor drug therapy. При изучении онкологического заболевания необходимо не только оценивать его характер, течение и исход в зависимости от локального процесса, но и учитывать общее состояние организма, так как множественное поражение органов имеет прогностическое значение и определяет исход заболевания. Следует рассматривать все механизмы и структуры, которые оказывают интегративное и гомеостатическое действие на организм в целом. Одной из таких структур является вегетативная нервная система. Традиционно вегетативная нервная система рассматривалась в аспекте 3 составляющих: симпатической, парасимпатической и кишечной. Однако в последнее время на первый план вышли представления о нейроэндокринных и нейроиммунных системах, обосновывающие расширение значения понятия «автономность нервной системы». При поражении автономной нервной системы возникает дисрегуляция непроизвольных функций организма, развивается автономная нейропатия. Выделяют кардиоваскулярную, гастроинтестинальную, урогенитальную, судомоторную формы автономной нейропатии, которые характеризуются определенными изменениями при различных патологических состояниях организма, особенно при злокачественных процессах. Фокус нашего научного внимания был направлен на рак молочной железы, который занимает первое место в структуре онкологических заболеваний в Российской Федерации. В литературе представлены немногочисленные исследования, отражающие изменения состояния вегетативной нервной системы у больных раком молочной железы в процессе противоопухолевой лекарственной терапии с учётом характера течения и клинических особенностей болезни, а также методы рациональной коррекции её дисфункции. В статье приведен анализ ряда научных источников, которые могут помочь в исследовании различных форм автономной нейропатии у больных раком молочной железы и позволят оценить возможность применения медицинской реабилитации для данной категории пациентов. Ключевые слова: вегетативная (автономная) нервная система, автономная нейропатия, рак молочной железы, противоопухолевая лекарственная терапия.

Online Adaptive PID Control for a Multi-Joint Lower Extremity Exoskeleton System Using Improved Particle Swarm Optimization

Robotic exoskeletons have great potential in the medical rehabilitation and augmentation of human performance in a variety of tasks. Proposing effective and adaptive control strategies is one of the most challenging issues for exoskeleton systems to work interactively with the user in dynamic environments and variable tasks. This research, therefore, aims to advance the state of the art of the exoskeleton adaptive control by integrating the excellent search capability of metaheuristic algorithms with the PID feedback mechanism. Specifically, this paper proposes an online adaptive PID controller for a multi-joint lower extremity exoskeleton system by making use of the particle swarm optimization (PSO) algorithm. Significant improvements, including a ‘leaving and re-searching mechanism’, are introduced into the PSO algorithm for better and faster update of the solution and to prevent premature convergence. In this research, a 9-DOF lower extremity exoskeleton with seven controllable joints is adopted as a test-bench, whose first-principle dynamic model is developed, which includes as many uncertain factors as possible for generality, including human–exoskeleton interactions, environmental forces, and joint unilateral constraint forces. Based upon this, to illustrate the effectiveness of the proposed controller, the human–exoskeleton coupled system is simulated in four characteristic scenarios, in which the following factors are considered: exoskeleton parameter perturbations, human effects, walking terrain switches, and walking speed variations. The results indicate that the proposed controller is superior to the standard PSO algorithm and the conventional PID controller in achieving rapid convergence, suppressing the undesired chattering of PID gains, adaptively adjusting PID coefficients when internal or external disturbances are encountered, and improving tracking accuracy in both position and velocity. We also demonstrate that the proposed controller could be used to switch the working mode of the exoskeleton for either performance or an energy-saving consideration. Overall, aiming at a multi-joint lower extremity exoskeleton system, this research proposes a PSO-based online adaptive PID controller that can be easily implemented in applications. Through rich and practical case studies, the excellent anti-interference capability and environment/task adaptivity of the controller are exemplified.

Health Status Stability of Patients in a Medical Rehabilitation Program: What Are the Roles of Time, Physical Fitness Level, and Self-efficacy?

Background Individuals’ physical and mental health, as well as their chances of returning to work after their ability to work is damaged, can be addressed by medical rehabilitation. Aim This study investigated the developmental trends of mental and physical health among patients in medical rehabilitation and the roles of self-efficacy and physical fitness in the development of mental and physical health. Design A longitudinal design that included four time-point measurements across 15 months. Setting A medical rehabilitation center in Germany. Population Participants included 201 patients who were recruited from a medical rehabilitation center. Methods To objectively measure physical fitness (lung functioning), oxygen reabsorption at anaerobic threshold (VO2AT) was used, along with several self-report scales. Results We found a nonlinear change in mental health among medical rehabilitation patients. The results underscored the importance of medical rehabilitation for patients’ mental health over time. In addition, patients’ physical health was stable over time. The initial level of physical fitness (VO2AT) positively predicted their mental health and kept the trend more stable. Self-efficacy appeared to have a positive relationship with mental health after rehabilitation treatment. Conclusions This study revealed a nonlinear change in mental health among medical rehabilitation patients. Self-efficacy was positively related to mental health, and the initial level of physical fitness positively predicted the level of mental health after rehabilitation treatment. Clinical Rehabilitation More attention could be given to physical capacity and self-efficacy for improving and maintaining rehabilitants’ mental health.

Application of the International Classification of Functioning, Disabilities and Health in the Rehabilitation Process

With the development of high technologies in medicine, the diagnostic process is improving, the methods of treating patients are refining, the percentage of patients who survived after serious injuries, diseases and/or conditions is increasing. The issue of the patients` quality of life that received primary medical, specialized, including high-tech medical care is becoming a priority for health care. Rehabilitation is defined as one of the critical interventions “enabling people with disabilities to achieve and maintain maximum independence, full physical, mental, social and professional ability and full inclusion and participation in all aspects of life”. The problems and prospects of rehabilitation medicine for the future arise due to critical changes in demographics, life expectancy, a variation in approaches to assessing disability, an increase in the prevalence of long-term health disorders, especially in connection with the new coronavirus infection, technological progress, as well as changes in health care costs and changes in society’s requirements for well-being and quality of life, including health. The object of the study is the process of organizing medical rehabilitation of patients with cerebral stroke at the second phase of rehabilitation process in a 24-hour inpatient medical rehabilitation department for patients with impaired function, structures, limited activity and participation due to damage to the central nervous system based on the application of the International Classification of Functioning, Disabilities and Health (ICF) for the rehabilitation diagnosis description (the degree of disturbance of structure, function, limitation of activity and participation, the degree of influence of environmental factors) and the formation of the medical rehabilitation program on its basis.

ABOUT REHABILITATION OF PATIENTS WITH LONG-TERM CONSEQUENCES OF COVID-19

Новая коронавирусная инфекция и ее отдаленные последствия занимают особое место в научной медицине и практическом здравоохранении. Появление COVID-19, распространение его среди населения земного шара, появление все новых штаммов поставило перед специалистами здравоохранения задачи, связанные с быстрой диагностикой инфекции, вызванной новым коронавирусом, оказанием специализированной медицинской помощи, включая диагностику, лечение, первичную и вторичную профилактику, медицинскую реабилитацию. Реабилитация пациентов, перенесших COVID-19, имеет важнейшее значение для восстановления трудоспособности и сохранения здоровья этой категории граждан. Эффективная организация и полноценная реализация реабилитационных мероприятий, достижение целей и задач медицинской и социальной реабилитации определяют социальные последствия пандемии как для конкретного индивида, так и для общества и государства в целом. Статья посвящена изучению и анализу возможностей применения рефлексотерапии в комплексе реабилитационных мероприятий пациентов с отдаленными последствиями новой коронавирусной инфекции COVID - 19. Дальнейшее совершенствование системы реабилитации, включая расширение и оптимизацию применения средств и методов реабилитационных мероприятий, будет способствовать повышению качества и эффективности оказания медицинской помощи, преодолению негативных последствий перенесенной новой коронавирусной инфекции COVID-19 The new coronavirus infection and its long-term consequences occupy a special place in scientific medicine and practical healthcare. The emergence of COVID-19, its spread among the world's population, and the emergence of new strains have set health professionals tasks related to the rapid diagnosis of infection caused by the new coronavirus, the provision of specialized medical assistance, including diagnosis, treatment, primary and secondary prevention, and medical rehabilitation. Rehabilitation of patients who have undergone COVID-19 is of crucial importance for the restoration of working capacity and the preservation of the health of this category of citizens. Effective organization and full implementation of rehabilitation measures, achievement of goals and objectives of medical and social rehabilitation determines the social consequences of the pandemic both for a particular individual and for society and the state as a whole. The article is devoted to the study and analysis of the possibilities of using refloxotherapy in a complex of rehabilitation measures for patients with long-term consequences of a new coronavirus infection COVID - 19. Further improvement of the rehabilitation system, including the expansion and optimization of the use of means and methods of rehabilitation measures, will contribute to improving the quality and effectiveness of medical care, overcoming the negative consequences of the new coronavirus infection COVID-19

Assessment of the effectiveness of medical rehabilitation after COVID-19 based on the functional capacity of the cardiovascular and respiratory systems

Aim. To assess the effectiveness of medical rehabilitation after pneumonia associated with the novel coronavirus infection (COVID-19), based on the study of functional capacity of the cardiovascular system and the external respiratory system.Methods. The study included 70 patients who had COVID-19 pneumonia and underwent a medical rehabilitation program from September to December 2020. Before being included in the rehabilitation program, all patients underwent pulmonary function tests (PFT), including an assessment of the lungs diffusion capacity, cardiopulmonary exercise testing, multispiral computed tomography (MSCT) of the chest, echocardiography, an evaluation of the quality of life according to the SF-36 questionnaire and the severity of shortness of breath on the mMRC scale. The effectiveness of rehabilitation was evaluated against the changes in PFT parameters, exercise tolerance, and quality of life.Results. At the enrollment, 46% of patients retained lung tissue lesions shown by MSCT and accompanied by a decrease in the lung diffusion capacity (67 (55 - 79%) of predicted value), dyspnea of 1.6 (1.0 - 3.0) points according to mMRC scale, moderate level of exercise tolerance and quality of life. Complex cardiopulmonary rehabilitation for 12 - 14 days in a specialized hospital led to a significant improvement in the parameters of pulmonary gas exchange and ventilation, peak oxygen consumption, and an increase in the reserve capacity of the cardiorespiratory system. The factors limiting the improvement of pulmonary gas exchange were the older age of the patients and the increased pressure in the pulmonary artery system. The positive influence of rehabilitation on both the physical and psycho-emotional components of the quality of life was noted.Conclusion. Complex cardiopulmonary rehabilitation with the assessment of changes in the oxygen metabolism parameters and functional capacity of the cardiovascular and respiratory systems has shown to be safe and highly effective in the studied group of patients who have had COVID-19 pneumonia.