Intermedical journal

INTENSITY OF DENTAL CARIES, SALIVARY FUNCTIONAL PARAMETERS AND SOMATIC PATHOLOGY IN WOMEN-NUNS OF DIFFERENT AGE GROUPS

Hanna Oleksandrivna Babenia — 2026-04-03

Introduction. The intensity of dental caries in adults is determined by a combination of age-related, behavioral, biological and social factors. Women living in monastic communities represent a socially and behaviorally homogeneous group, which minimizes external influences and allows for an objective assessment of age-related patterns of oral health. The study of salivary functional characteristics and systemic health conditions in this cohort provides an opportunity to clarify the role of local and systemic determinants in caries development. The aim of the study was to assess the intensity of dental caries and its age-related features in women-nuns, and to evaluate the relationship of the DMFT index with basal salivation rate, saliva microcrystallization patterns, and somatic comorbidities. Materials and methods. Twenty-nine women-nuns aged 25–75 years were examined and stratified into three age groups (25–44 years, n = 15; 45–59 years, n = 10; 60–75 years, n = 4). Caries intensity was assessed using the DMFT index (D – decayed, M – missing, F – filled teeth). Basal salivation rate was measured using the unstimulated saliva collection method over 5 minutes; the remineralizing potential of saliva was evaluated using the microcrystallization test with morphological classification (types IIA, IIB, IIC, IIIA, IIIB). Somatic pathology was determined by structured interviewing. Statistical analysis included ANOVA or Kruskal–Wallis tests for group comparisons and Spearman correlation for assessing associations (p < 0.05). Results. A clear age-related increase in caries intensity was observed: mean DMFT values rose from 17.0 ± 3.9 in the 25–44 age group to 28.8 ± 3.8 in women aged 60–75 years (p < 0.01). The main contributor to between-group differences was the “M” component (missing teeth), whereas active caries (“D”) remained low across all groups. All participants demonstrated high values of the “F” component, indicating a generally treated dental status. Basal salivation rate and saliva microcrystallization types showed no significant association with DMFT values (p > 0.2). Endocrine (37.9 %), cardiovascular (34.5 %) and musculoskeletal disorders (31.0 %) were the most common systemic conditions, but none were associated with DMFT level (p = 0.96). Conclusions. Women-nuns demonstrated a pronounced age-related increase in dental caries intensity, mainly due to cumulative tooth loss. Salivary functional characteristics (basal salivation and microcrystallization) and somatic comorbidities did not influence caries intensity. The social homogeneity of this cohort makes the findings valuable for understanding age-related patterns of oral health and for developing targeted preventive strategies.

СLASSIFICATION APPROACHES OF ENDODONTIC INSTRUMENTS’ FRACTURES CASES: PROPOSALS FOR THE FORMATION OF PREDICTORS AND PROGNOSTIC MODEL SCHEME REGARDING COMPLICATION DEVELOPMENT

Anastasia Mykhaylivna Biley — 2026-04-03

Introduction. Literature sources describe approaches for the success prediction of fractured endodontic instrument retrieval, which facilitate the selection of appropriate management strategies for such clinical cases. However, existing models aimed at predicting the risk of occurrence for such complication itself are still primarily based on regression analyses of heterogeneous datasets, which limits the generalizability of the obtained conclusions. Objective of the research. To analyze existing approaches for the classification of endodontic file fracture cases with the consideration of significance levels among key influencing factors, and to identify categories and determinants that could potentially be used as predictors within prognostic model of such complication development. Materials and methods. Selected data was processed using multilevel analytical approach that included: comparative analysis of various classification systems with respect to their discriminatory capacity and prognostic value; grouping process of risk factors according to their origin (clinical conditions, instrument properties and treatment parameters); assessment of potential role of individual variables as regressors in multiparametric prognostic models; analysis of the feasibility for using dynamic reassessment of instrument fracture risk during treatment. Proposed prognostic model for assessing the risk of endodontic instrument fracture was developed through a stepwise analytical process aimed at transforming descriptive and associative factors into formalized prognostic variables suitable for further mathematical and algorithmic modeling, including processing using machine learning computational capabilities. Results and discussion. Provided analysis demonstrated the expediency of shifting from static criteria for instrument wear assessment (such as the number of uses) toward dynamic parameters that reflect actual loading conditions, duration of functional use, and the degree of interaction with dentinal walls under specific anatomical conditions, which may serve as elements of prognostic model. The most consistently reproducible risk factors for endodontic file fracture include the severity and localization of root canal curvature, type and kinematics of instrument motion, rotational speed, geometric characteristics and metallurgical properties of NiTi files, as well as operator experience and specific clinical instrumentation techniques. Generalization of the obtained data allowed to identify three basic groups of determinants for endodontic instrument fracture risk: factors related to initial clinical conditions; factors determined by instrument properties and conditions; and factors associated with the treatment process and the operator. Such structuring approach represents methodologically appropriate basis for constructing a multiparametric prognostic model for this type of complication. Conclusions. The analysis of contemporary scientific sources revealed the absence of unified, prognostically oriented classification of endodontic instrument fracture cases, as most existing approaches are primarily focused on describing fragment localization, while also at selecting complication management strategies rather than estimating the probability of its occurrence. Existing classifications of endodontic instrument damage and deformation (including morphological and kinematic classifications) demonstrate potential for using certain categories as predictors of fracture risk; however, their prognostic value remains insufficiently validated under conditions of multifactorial analysis.

ANALYSIS OF LYSOZYME LEVELS IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE DEPENDING ON THE PRESENCE OF PERIODONTAL PATHOLOGY

Petro Anatoliyovych Hasiuk — 2026-04-03

Introduction. Muramidase is a component of saliva that coats the mucous membranes of the mouth, providing the protective function of saliva and aiding the food bolus in passing through the gastrointestinal tract from the external environment. The structure of lysozyme, in addition to the oral cavity, is found in various sections of the small intestine, where it contributes to the protection of this part of the human body. Based on the specific mechanism of action of the studied enzyme on the peptidoglycan (murein) layer of bacteria, it can be concluded that it indirectly participates in the formation of the immune response. Objective – to determine and analyze possible changes in lysozyme levels in saliva depending on the form of gastroesophageal reflux disease, taking into account the condition of the oral mucosa and periodontal tissues. Materials and Methods. To determine lysozyme activity in saliva, test tubes were filled with 4.0 ml of a 0.5% NaCl solution and 1 ml of the studied material. To the mixture, a suspension of 1 billion M. lyzodecticus cells was added, mixed, and incubated in a thermostat at 37 °C for 3 hours. The optical density of the samples was measured before and after incubation using a photoelectrocolorimeter (FEC-M) at a wavelength of 540 nm. The enzyme activity in saliva was calculated using the formula: L=Do - D1/ Do × 100%, where: L – lysozyme activity (in %), Do – optical density before incubation, D1 – optical density after incubation. Results. Comparing the concentrations of the mucolytic enzyme in saliva, a significant decrease in lysozyme levels was observed, accompanied by changes in periodontal tissues. Specifically, in the group with gingivitis on the background of erosive gastroesophageal reflux disease, the indicator was significantly lower than in the groups with gingivitis in the non-erosive form (p < 0.05) and with intact periodontium (p < 0.05). As destructive-inflammatory processes in the periodontal tissues became more active, the numerical indicator of enzyme activity increased compared to that in gingivitis (p < 0.05). Conclusions. The progression of the inflammatory process in the esophageal tissues leads to a decrease in the activity of nonspecific protective factors, which is manifested by a reduction in lysozyme activity in the oral cavity and, subsequently, contributes to the progression of destructive-inflammatory processes in the periodontium. Evidence for this statement is the compensatory increase of 5.1% in enzyme activity in saliva (p < 0.05).

PERMANENT TOOTH IMPACTION IN CHILDREN: CURRENT CONCEPTS AND FUTURE PERSPECTIVES

Oksana Ivanіvna Godovanets — 2026-04-03

This article provides a detailed analysis of current views on the problem of permanent tooth impaction in children. The main etiological factors and the pathogenesis of disturbed tooth eruption is described in detail, with particular attention to the guidance theory. The clinical features, modern diagnostic methods (CBCT), and possible complications, such as root resorption, are highlighted. Special attention is paid to preventive approaches and the effectiveness of interceptive treatment during the mixed dentition period. Objective. To determine the current state of knowledge regarding the etiology, pathogenetic mechanisms, and clinical features of permanent tooth impaction in children. Materials and Methods. To achieve the stated objective, an information search and analysis of scientific publications were conducted in international scientometric databases, including PubMed, Scopus, Google Scholar, and ScienceDirect. Results. Depending on the depth of tooth position and the nature of the overlying tissues, bone, soft-tissue, and mixed forms of impaction are distinguished, which is of fundamental importance for the selection of surgical – orthodontic treatment strategies. Impaction of the maxillary canines is of particular clinical significance, as the treatment prognosis is closely associated with the spatial position of the tooth crown according to the Ericson–Kurol classification. The etiology of tooth impaction is multifactorial. The prolonged asymptomatic course of this condition complicates early clinical diagnosis and increases the risk of complications, particularly root resorption of adjacent teeth. In this context, radiological methods play a key role in the diagnostic algorithm, with cone-beam computed tomography. Conclusion.Tooth impaction is a complex multifactorial condition that requires early detection and a comprehensive diagnostic and therapeutic approach.

PAIN SYNDROME IN PATIENTS DURING ORTHODONTIC TREATMENT WITH FIXED STRUCTURES AND METHODS FOR ITS ASSESSMENT

Oksana Vasylivna Klitynska — 2026-04-03

Introduction. Pain during orthodontic treatment is a common reaction in children and adults, which can increase dental anxiety and affect treatment outcomes. Both malocclusion and orthodontic pain negatively affect patients’ quality of life. The purpose of conducting an analysis of sources of evidence-based scientific literature and meta-analyses regarding the causes of pain syndrome in patients during orthodontic treatment with fixed structures and methods of its assessment and correction. Materials and methods. Comprehensive search of bibliographic sources in the international databases PubMed, EMBASE, AMED, ProQuest, CINAHL for keywords related to pain syndrome in patients during orthodontic treatment with a bracket system, methods for assessing pain and anxiety, and mechanisms of occurrence. Results. Modern orthodontic science is gradually moving away from a purely biomedical paradigm and integrating elements of a biopsychosocial model, which focuses not only on the clinical condition but also on the patient’s psychological profile. This expansion of the theoretical basis necessitates the study of motivational factors, the emotional and social impact of dentofacial anomalies, as well as personal characteristics that may determine the perception of one’s own appearance and readiness for long-term treatment. Conclusions. Current evidence suggests that pain sensitivity in response to orthodontic intervention is a predominantly psychologically driven phenomenon with a key role for pain catastrophizing, while the influence of demographic factors and common genetic markers is minimal or absent.

ORTHODONTIC CARE DELIVERY IN UKRAINE DURING MARTIAL LAW: CHALLENGES, CLINICAL RISKS, AND ADAPTATION STRATEGIES

Larisa Vasylivna Korniienko — 2026-04-03

Introduction. The imposition of martial law in Ukraine has led to systemic transformations in the organization of healthcare delivery, resulting in reduced accessibility of the population to planned medical services, including dental care. Orthodontic treatment is inherently prolonged, multi-stage, and dependent on regular monitoring. Consequently, disruptions in scheduled visits due to patient displacement, resource constraints, and elevated psycho-emotional stress may adversely affect treatment outcomes and increase the risk of complications. Objective. To synthesize contemporary evidence regarding the prevalence of dentofacial anomalies in Ukraine with particular emphasis on regional data; to characterize the organizational and economic mechanisms of orthodontic care delivery under wartime conditions; to analyze the clinical consequences associated with interruptions of orthodontic treatment; and to identify potential strategies for adapting clinical practice through the implementation of telemonitoring, digital technologies, and crisis-resilient protocols. Materials and Methods. A narrative literature review was conducted using searches in PubMed, Scopus, and relevant national sources. Publications in the fields of orthodontics, public health, crisis medicine, and the organization of dental care were included. Evidence was synthesized concerning the epidemiology of dentofacial anomalies in Ukraine, the impact of war on healthcare accessibility, and adaptive modifications of clinical protocols. Results and Discussion. Findings from regional studies in Ukraine confirm a high prevalence of dentofacial anomalies among children and adolescents, generating a substantial demand for orthodontic treatment. The ongoing war has been accompanied by documented attacks on the healthcare system and disruptions in access to medical services, directly affecting the provision of planned orthodontic care. The principal clinical risks associated with treatment interruption include loss of biomechanical control over tooth movement, increased risk of enamel demineralization and periodontal complications, as well as reduced patient compliance. Promising adaptive approaches involve patient risk stratification, protocol simplification, extension of follow-up intervals with safety monitoring, and the integration of telemonitoring and digital tools. Conclusions. Under conditions of martial law, the orthodontic service in Ukraine requires the integration of clinical and systemic strategies, including ensuring continuity of treatment, standardization of management during forced interruptions, implementation of digital support systems, and consideration of psychosocial determinants.

COMPARATIVE ANALYSIS OF THE EFFECT OF PIEZOSURGICAL AND ROTATIONAL PROTOCOLS ON THE REGENERATION OF THE JAW BONE DEFECT IN THE SURGICAL TREATMENT OF RETENTION AND DYSTOPIA OF THE LOWER THIRD MOLARS

Nataliya Bohdanivna Kuzniak — 2026-04-03

Introduction. The traditional technique of atypical extraction involves the use of rotary instruments with carbide or diamond burs. An alternative is piezoelectric surgery, which uses ultrasonic microvibrations (24–36 kHz). Despite the above positive characteristics inherent in piezosurgery, at present, in our opinion, the literature remains insufficiently covered the issues of long-term results of reparative regeneration of the mandibular bone tissue in the defect area according to densitometry data (Hounsfield units), especially in complex extractions under retention conditions and medial or horizontal position of the lower third molars. Purpose of the study. To conduct a comparative analysis of the results of the use of rotary and piezosurgical methods of atypical extraction of the impacted lower third molar. Materials and Methods. The study involved 100 patients who sought elective surgical care for the removal of lower third molars. All patients were randomly divided into two clinical groups. Group 1 (control, n=50) – osteotomy was performed using rotational systems. Group 2 (main, n=50) – a piezosurgical device was used to perform osteotomy. Analysis of intraoperative parameters. The average duration of tooth extraction in the first group was 22.4±4.1 min, whereas in the second group it was significantly higher — 28.6±5.3 min (p≤0.05). The increase in time by 18–22% is associated with the technical features of the piezotome, which requires slower, reciprocating movements without excessive pressure to maintain the amplitude of the nozzle oscillations. When analyzing the severity of the pain syndrome (as measured by the VAS visual analog scale), piezosurgery showed a significant advantage. Probing of the distal surface of the second molar after 6 months showed that the average pocket depth in the control group, under the conditions of using rotational systems, was 4.5±0.7 mm, which could be considered signs of a pathological periodontal pocket, while in the main group, where tooth extraction was performed using a piezotome, it was 2.8±0.3 mm, which was a sign of the physiological norm. Conclusions. Atypical removal of the lower third molar using piezoelectric technology is a gentler method than the traditional rotational technique, despite an average increase in surgical duration of 6 minutes. The use of ultrasound during surgical intervention significantly reduces the risk of postoperative complications: pain intensity decreases by 40%, edema regresses more quickly, and the risk of alveolitis is minimized.

DETERMINATION OF THE RETENTION STRENGTH OF A REMOVABLE DENTAL PROSTHESIS SUPPORTED BY A VARIOUS NUMBER OF MINI-IMPLANTS

Bohdan Hryhorovych Mykhajlychenko — 2026-04-03

Introduction. Retention is one of the most important factors in the successful use of removable dentures supported on dental implants, as well as conditionally removable dentures. In the context of using mini-implants as supporting elements, the number of implants has been proposed as the primary variable affecting denture retention, mechanical stability, durability of use, and patient satisfaction. Methodology and methods of the study. The study aimed to investigate the retention force of retainers for complete removable dentures with fixation on dental mini-implants in different design variants in laboratory conditions. Jaw models with four parallel installed miniimplants were used. O-ring matrix sleeves were fixed to the acrylic plate of the prosthesis. The retention force was determined using a strain gauge, with the maximum load upon detachment recorded in Newtons. For each configuration (1, 2 side by side, 2 opposite, 3 and 4 supports) 10 measurements were performed. Summary of the primary study material. A gradual increase in retention force with increasing number of mini-implants was established: 5.31±1.15 N (1 support), 9.72±1.81 N (2 side by side), 11.90±3.17 N (2 opposite), 18.45±3.31 N (3 supports) and 21.73±2.95 N (4 supports). The ANOVA test revealed statistically significant differences between groups (p<0.001). Paired comparisons showed significant differences between all groups, except for two configurations with 2 implants (p=0.14). The effect size was large (η² = 0.846), indicating a strong association between the number of implants and retention. The obtained data confirm a linear relationship between the number of supports and the prosthesis's fixation force and are consistent with the current literature. An increase in the number of mini-implants significantly increases retention, although the increase between three and four supports is less pronounced. The limitations of the study include the model's laboratory nature and the absence of clinical factors, so the results require further clinical verification. Conclusions. The use of two, three, and four supports progressively increases the retention force of a removable denture supported by dental implants. The location of implants in non-adjacent segments of the dentition in a two-support design also increases retention force compared to when the supports are adjacent.

SOCIOECONOMIC BURDEN OF OPHTHALMIC INJURIES: METHODOLOGY FOR ASSESSING DIRECT AND INDIRECT COSTS IN THE HEALTHCARE SYSTEM

Valeriy Dmytrovych Beliaiev — 2026-04-03

Introduction. Traumatic eye injuries represent a significant medical and social problem due to the high risk of disability among the working-age population and substantial economic losses for society. More than 55 million eye injury cases of varying severity are registered worldwide annually. Assessment of the economic burden of traumatic eye injuries requires a comprehensive approach accounting not only for the direct medical costs of treatment but also for the indirect costs associated with loss of working capacity, decreased quality of life, and social adaptation of victims. Purpose: to develop a methodology for a comprehensive assessment of the socioeconomic burden of ophthalmic injuries with the determination of direct and indirect costs in the Ukrainian healthcare system. Methods: systematic literature analysis for 2015-2024 conducted, international methodological approaches to economic burden of disease assessment studied, statistical data from the Center for Medical Statistics of the Ministry of Health of Ukraine and the Ministry of Internal Affairs analyzed for 2020-2023. Economic analysis, modeling, and expert assessment methods are used. Results: established that approximately 45-50 thousand ophthalmic injury cases are registered annually in Ukraine, 18-22% leading to persistent vision loss or blindness. A methodological approach to calculating the economic burden has been developed, encompassing direct medical costs (outpatient and inpatient treatment, medications, rehabilitation), direct non-medical costs (transportation, care, social support), and indirect costs (productivity loss, premature mortality, reduction in quality of life). Preliminary calculations show the total economic burden of ophthalmic injuries in Ukraine exceeds 2.5 billion UAH annually. Conclusions: The proposed methodology enables a comprehensive assessment of the socioeconomic burden of ophthalmic injuries and justification of investments in prevention programs. Implementation of an economic monitoring system for ophthalmic injuries will facilitate the optimization of vision care resource allocation and reduce society’s economic losses.

DESIGNING A PUBLIC HEALTH COURSE: COMPETENCY-BASED APPROACH, ACTIVE LEARNING METHODS, AND DIGITAL ASSESSMENT

Valeriya Volodymyrivna Brych — 2026-04-03

Introduction. Public health as an interdisciplinary field of knowledge and professional practice requires modernization of specialist training to ensure readiness for work under conditions of complexity and uncertainty, the ability to apply evidence-based approaches, communicate effectively with stakeholders, and implement preventive and health promotion interventions at the community level. In these circumstances, traditional didactics focused mainly on reproductive learning does not provide the formation of the necessary competencies. The purpose of the study. To substantiate and present a model of a public health training course that integrates the competency-based approach, active learning methods, and digital assessment tools. Materials and methods. The study was conducted in the format of a descriptive and methodological analysis and pedagogical design of an academic discipline. The methods included an analysis of regulatory and methodological documents and scientific sources, as well as a systematization of approaches to learning tools and assessment methods. Results and discussion. A framework of the educational component “Strategies and Methods of Teaching Public Health” was proposed, including blocks of modern didactics, competency-based approach, instructional design, active and interactive learning, problem-based learning and case method, project-based learning and community work, digital pedagogy, and academic integrity. A key element of summative assessment is defined as a modular test in the format of a digital portfolio implemented through the creation by the learner of a Google Classroom with a modular structure, assignments, testing, rubrics, and academic integrity policies. Conclusions. The presented course model ensures the development of pedagogical and professional competencies of Master’s students in public health through the integration of active learning, practice-oriented tasks, and digital assessment tools, and can be recommended for implementation in Master’s level public health educational programmes.

THE RELATIONSHIP BETWEEN COVID-19 AND THE LONG-TERM DEVELOPMENT OF AUTOIMMUNE DISEASES AND POST-COVID-19 CONDITION (LONG COVID). REHABILITATION AND PREVENTION GUIDELINES

Roman Yulianovych Grytsko — 2026-04-03

Introduction. The transition of the COVID-19 pandemic to an endemic phase has not removed from the agenda the problem of the longterm consequences of SARS-CoV-2 infection. A significant medical and social burden on healthcare systems worldwide is formed by Post- COVID-19 Condition (Long COVID) and the potential increase in the risk of debut or progression of autoimmune diseases. Aim of the Study. This review study synthesizes current interdisciplinary knowledge on the immunopathogenetic mechanisms mediating the link between past coronavirus infection and the development of long-term pathological conditions. Materials and Methods. The study is based on a critical analysis of current scientific literature, data from international clinical studies, and the results of the author’s own research. Results and Discussion. Key Pathogenetic Mechanisms: The role of persistence of viral antigens, the formation of a wide range of functional autoantibodies, the phenomenon of molecular mimicry, as well as the state of chronic systemic inflammation and endothelial dysfunction. Assessment and Rehabilitation Concept: Based on the analysis, a concept for a multidimensional assessment of patients with Long COVID has been formulated. A structured, multidisciplinary, and personalized program of step-by-step rehabilitation is proposed, integrating neurological, cardiorespiratory, musculoskeletal, and psychological support with mandatory consideration of the risk of post-exertional malaise development. Organizational Measures: Key organizational measures for the healthcare system aimed at creating effective infrastructure for diagnosis, rehabilitation, and dynamic monitoring are outlined. Prevention Prospects: The prospects for the application of innovative technologies, in particular nano-adjuvants, for modulating the immune response and preventing long-term complications are separately considered. Conclusions. The necessity of continuous monitoring of the circulation of new SARS-CoV-2 variants and evaluation of the effectiveness of existing and developing preventive and therapeutic interventions to overcome the long-term consequence of the pandemic is emphasized. In summary, the critical need for a multidisciplinary approach to managing patients with Long COVID and adapting the healthcare system to the long-term challenges of the post-pandemic era is highlighted.

OPTIMIZATION OF LOGISTICAL AND CLINICAL ASPECTS OF THE REHABILITATION ROUTE FOR PREMATURE INFANTS

Maria Vladyslavivna Dnistryanska — 2026-04-03

Introduction. The relevance of this topic is driven by the fact that the survival of deeply premature infants presents new challenges regarding the minimization of disability and the improvement of their quality of life. The main problem is the lack of clear logistical coordination between the stages of nursing care and rehabilitation, which leads to the loss of «golden time» and a gap in the provision of care. Parents often find themselves in an «information vacuum,» and rehabilitation begins with a delay. The aim of the study is to substantiate and develop an optimized model of the rehabilitation route that combines logistical efficiency (rapid and safe transfer) with clinical expediency (early initiation of intervention). Materials and Methods. The study was based at the CNPE “Vinnytsia Regional Children’s Clinical Hospital of the Vinnytsia Regional Council.” The sample consisted of 100 prematurely born infants (gestational age 28–34 weeks, weight <1500 g), divided into a study group (50 children) and a control group (50 children). A three-level logistics system was implemented (NICU – transitional stage – outpatient followup), along with specific clinical solutions: positioning («nesting»), sensory protection (noise/light control), and parent education («School of Parents»). Results. In the study group, interventions began on the 5th day of life, whereas in the control group, they began on the 14th day (a difference of 9 days, which is statistically significant). The duration of hospitalization was reduced by an average of 8 days due to faster stabilization and the establishment of the sucking reflex. In children of the study group, the frequency of pronounced motor impairments at the age of 1 year was 18% lower, and cognitive development according to the Bayley scale was within normal limits. The level of maternal anxiety decreased by 25% due to their involvement in the care process. Conclusions. The implementation of the optimized model confirmed the effectiveness of early intervention starting at the resuscitation stage. Utilizing the «golden window» of neuroplasticity improves the neurosensory prognosis and reduces the risk of disability. In addition to the clinical effect, the model provides economic benefits for the hospital (reduction of bed-days) and ensures the successful integration of parents into the rehabilitation process.

CHARACTERISTICS OF THE MANAGEMENT SYSTEM OF OPHTHALMOLOGICAL CARE FOR CHILDREN

Andriy Vasyliovych Ilko — 2026-04-03

Introduction. The article is devoted to the topical problem of the modern health care system in Ukraine at this stage of the management system for ophthalmological care for children. The aim of the article is to present and characterize the developed system for managing ophthalmological care for children. In the methodological part, a systematic approach and structural and logical analysis were applied, which provided for the generalization and systematization of modern approaches to the organization of ophthalmological care for children. The main material presents a description of the modern system of ophthalmological care for children, based on Ukraine's current legislative framework and the World Health Organization's recommendations. The presented system includes an object and a subject of management, as well as a regulatory framework. Conclusions emphasize the need for a systematic approach to the organization and management of ophthalmological care for children to ensure its availability and quality.

COMPETENCY PROFILE OF A PUBLIC HEALTH PROFESSIONAL: INTERNATIONAL EXPERIENCE AND UKRAINIAN PERSPECTIVES

Ivanna Ivanivna Kornash — 2026-04-03

Introduction. The modern transformation of the public health system in Ukraine and other countries is accompanied by increasing requirements for the professional preparedness of the public health workforce. At the same time, a gap persists between competency frameworks and the actual needs of practice, particularly in leadership, communication, and systems thinking. In this context, the development of a comprehensive competency profile of a public health professional is considered a tool for aligning education, professional activity, and the needs of the public health system. The aim of the study is to analyze international experience in developing competency frameworks for public health professionals and to assess the current state of this issue in Ukraine. Materials and methods. A systems approach was applied in the study using content analysis and comparative analysis of international and national regulatory documents, as well as the synthesis of contemporary scientific publications on workforce training for the public health system. Results. The main material presents a generalization of international and Ukrainian experience in developing competency frameworks for specialists in public health and characterizes the key competency domains of a public health professional. The study demonstrates gaps between competency frameworks and the practical needs of the system, particularly in leadership, communication, and systems thinking. Conclusions. The application of the competency-based approach in shaping the profile of a public health professional helps bridge the gap between competency frameworks and the practical needs of the system. The analysis of international experience demonstrates the importance of adapting models to the national context as a prerequisite for strengthening the public health system’s workforce capacity.

SOCIO-BEHAVIORAL PATTERNS OF THE POPULATION AS PREDICTORS OF TRAUMATIC EYE INJURIES: RESULTS OF A COMPARATIVE ANALYSIS OF UKRAINIAN REGIONS

Nataliia Volodymyrivna Medvedovska — 2026-04-03

Introduction. About 200 thousand cases of eye injuries are registered annually, of which more than 15% lead to persistent vision loss or complete blindness. Behavioral factors play a leading role in the occurrence of eye injuries; however, their regional characteristics and prognostic significance in Ukraine remain poorly understood. Purpose: to determine regional differences in socio-behavioral patterns of the Ukrainian population and identify their prognostic significance for the occurrence of traumatic eye injuries. The study aimed to identify key behavioral predictors of ocular trauma and establish evidence-based recommendations for regional prevention programs. Materials and methods: A study was conducted in thirteen regions of Ukraine, representing five geographical macroregions: Western, Eastern, Central, Northern, and Southern. Data from official statistics of the Ministry of Health of Ukraine on 187,452 cases of eye injuries for 2020-2023 were used. A survey of 3,456 respondents aged 18-65 was conducted using a random sampling method. 1,587 medical records of patients with eye injuries in specialized hospitals were analyzed. The questionnaire included 45 questions about educational level, professional activity, frequency of use of personal protective equipment, alcohol consumption habits, self-assessment of the level of awareness of safety rules. Pearson correlation analysis, logistic regression to determine predictors, and cluster analysis using the k-means method were applied. Statistical processing was performed in IBM SPSS Statistics version 29. The study was conducted in compliance with the principles of the Declaration of Helsinki. Results: significant inter-regional differences in the frequency of eye injuries were found (from 16.2 to 30.8 per 10 thousand population). Lack of higher education increases the chances of injury by 2.4 times (OR=2.41; p<0.001), irregular use of protective equipment by 3.8 times (OR=3.79; p<0.001), and alcohol consumption by 3.2 times (OR=3.24; p<0.001). Cluster analysis identified two groups of regions with different behavioral patterns. The use of personal protective equipment in cases of occupational injuries was reported in only 23.8% of cases, with a variation ranging from 41.4% in the Lviv region to 10.9% in the Kherson region. Conclusions. Socio-behavioral characteristics of the population are key predictors of eye injuries. The identified clustering of regions enables the development of targeted prevention strategies for specific regions of Ukraine, thereby enhancing the effectiveness of interventions.

ORGANIZATION OF MEDICAL ASSISTANCE TO MILITARY SERVANTS WITH COMBAT DAMAGES TO THE VISUAL APPARATUS

Borys Ivanovych Palamar — 2026-04-03

Purpose: to analyze modern approaches to organizing staged medical care for military personnel with traumatic eye injuries and to develop an optimal system for providing specialized ophthalmological care in wartime conditions. Materials and methods. A systematic analysis of domestic and foreign publications from 2019 to 2024, focusing on the organization of medical care for combat eye injuries, was conducted. Bibliosemantic, system-analytical methods, and the method of expert assessments were used. Statistical data on the structure and nature of eye injuries during military conflicts in Ukraine for the period 2022-2024 were analyzed. Results. It was established that the frequency of traumatic eye injuries in the structure of combat injuries is 8-12%. The main stages of care are determined: pre-hospital (first medical aid), hospital (qualified and specialized medical aid), and rehabilitation. An algorithm for sorting victims depending on the nature of the injury has been developed: penetrating wounds with leakage of intraocular contents, contusions with intraocular hemorrhage, chemical burns, and closed injuries without violation of the integrity of the eyeball. The need for a multidisciplinary approach to combined injuries is substantiated. An optimized system of staged care, utilizing telemedical consultations, mobile ophthalmological teams, and specialized eye microsurgery centers, is proposed. Conclusions. Effective organization of medical care for military personnel with traumatic eye injuries requires clear coordination at all stages of evacuation. The implementation of modern triage protocols, early specialized treatment, and comprehensive rehabilitation enables the preservation of vision in 65-70% of cases of penetrating wounds and in 85-90% of cases of eye contusions. The proposed system of organizing medical care contributes to reducing the level of disability and increasing the percentage of servicemen returning to duty.

THE ROLE OF PUBLIC HEALTH INSTITUTIONS IN THE FORMATION OF REGIONAL STRATEGIES FOR THE PREVENTION OF OPHTHALMIC INJURIES

Renata Yuriivna Pohoriliak — 2026-04-03

Introduction. In the current context of healthcare reform, the role of public health institutions, which shape policy, coordinate interagency interaction, and provide an evidence-based basis for making management decisions, is of particular importance. Purpose. The purpose of the study was to assess the institutional determinants that influence the formation and effectiveness of regional ocular trauma prevention strategies. Specifically, the study aimed to identify which organizational, regulatory, and collaborative mechanisms within public health institutions contribute most significantly to decreasing ocular trauma incidence and enhancing the sustainability of preventive activities. Materials and methods. A modeling of the functioning of the public health system in five regions of Ukraine, which differed in the level of institutional capacity, was conducted. Epidemiological analysis, content analysis of regulatory documents, and assessment of the human and organizational potential of public health centers were used. Statistical analysis was performed using descriptive statistics, correlation analysis, and clustering techniques. The study was conducted on generalized data in compliance with ethical requirements. Statistical modeling confirmed the significance of integrated approaches in forming strategies for preventing ophthalmic trauma, as recommended by the WHO. Results. It has been established that individual regions with high institutional capacity demonstrate 27% lower rates of ophthalmic trauma. The effectiveness of prevention is attributed to the presence of regional programs that provide specialized medical care, systematic monitoring of eye injury risks, and intersectoral collaboration among education, labor protection, and local government bodies. and the corresponding human resources potential of public health centers. Conclusions. Public health institutions play a crucial role in developing regional strategies for preventing eye injuries. Strengthening their institutional capacity and fostering intersectoral cooperation aims to ensure the sustainability of preventive measures and reduce the level of injuries.

METABOLIC DYSFUNCTION–ASSOCIATED STEATOTIC LIVER DISEASE WITHIN THE NONCOMMUNICABLE DISEASE FRAMEWORK: CHALLENGES FOR PUBLIC HEALTH IN UKRAINE

Snizhana Vasylivna Feysa — 2026-04-03

Introduction. Metabolically–dysfunctional–associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease and a substantial contributor to the global burden of noncommunicable diseases. The high prevalence of obesity, type 2 diabetes mellitus, cardiovascular diseases, and harmful alcohol consumption makes MASLD a particularly relevant challenge for the health-care system of Ukraine. Aim. To analyze MASLD as a component of noncommunicable diseases in Ukraine from medical and public health perspectives, taking into account the MASLD-2024 recommendations and the European context. Materials and methods. An analytical review of national strategic and epidemiological sources (STEPS-2019, the Health-Care Development Strategy of Ukraine up to 2030) and current international clinical guidelines and recommendations (EASL–EASD–EASO, WHO, ESC) was conducted. Comparative analysis, synthesis, and data generalization methods were applied. Results and discussion. Ukraine is characterized by a high prevalence of overweight and obesity, a pronounced cardiometabolic risk profile, and a significant contribution of alcohol consumption, which together create unfavorable conditions for the development and progression of MASLD. Compared to European countries, these risk factors are similarly pronounced, while the preventive capacity of primary healthcare remains insufficiently implemented. The MASLD-2024 concept emphasizes the need for an integrated approach, focusing on early detection and fibrosis risk stratification. Conclusions. MASLD should be regarded as a systemic noncommunicable disease and a priority public health issue in Ukraine. Strengthening prevention strategies, early detection, and interdisciplinary management at the primary care level is essential to reduce the overall disease burden.

THE ROLE OF THE FAMILY FACTOR IN SHAPING PHYSICAL ACTIVITY OF RURAL SCHOOLCHILDREN: RESULTS OF THE PARENTAL SURVEY

Greta Lajosovna Shepella — 2026-04-03

Introduction. The global decline in children’s physical activity levels is one of the pressing public health problems, exacerbated by socioeconomic and security-related factors. The family environment is considered a key determinant in shaping a child’s movement behavior and motivation for the physical activity. The purpose of the study. To investigate the role of the family factor in the formation of physical activity among schoolchildren living in rural areas and the methods used by parents to motivate their children. The materials and the methods. The study was conducted among parents of schoolchildren in grades 5–9 from schools in rural settlements of the Zakarpattia region through an online survey (Google Forms). Participation was voluntary and anonymous. Bibliographicsemantic, sociological, statistical, and graphical methods were applied. The total number of respondents was 867 (96% women, 4% men). The results and discussion. Almost half of the parents (47.9%) assessed their child’s physical activity as sufficient, 34.5% as partial; 15.5% of parents believed that their children need an increased level of activity, and 2.2% stated that their child is not physically active at all. Only 25.6% of respondents correctly indicated the recommended level of physical activity (“at least 60 minutes / day”), while 28.8% reported that there is no minimum standard. The main barriers to supporting children’s physical activity identified by parents were lack of time (35.4%), a busy work schedule (33.7%), lack of interest (31.9%), and health problems (27.7%). The majority of respondents (76.7%) consider the family to be primarily responsible for a child’s physical activity; however, 70.8% of parents do not engage in sports, and only 27% practice physical activity together with their children. The most common motivational methods are support and encouragement (72.5%) and discussions about the importance of physical activity for health (55.6%). The conclusions. The obtained results confirm the leading role of the family in shaping children’s physical activity, while simultaneously revealing a lack of parental awareness of current recommendations and insufficient regularity of joint activities. This substantiates the need for family-oriented educational and motivational interventions.

SANITARY AND HYGIENIC STATE OF SOIL BY MICROBIOLOGICAL INDICATORS: DATA FROM METAGENOMIC AND CULTURAL ANALYSES

Nadiіa Yuriivna Bobryk — 2026-04-03

Introduction. Under conditions of increased technogenic load and enterprise relocation, monitoring the sanitary and hygienic state of soils is critical for the region’s environmental safety. Current regulatory gaps and the limitations of classical analytical methods necessitate the implementation of modern molecular genetic approaches for an objective assessment of territories. Objective. The work aims to evaluate the sanitary and hygienic state of technogenically modified soils in Transcarpathia using traditional cultural and modern metagenomic methods. Materials and Methods. The study focused on soil samples from the zones influenced by a timber chemical plant and railway transport, collected in June 2025. The methodology included classical plating on selective media and metagenomic sequencing of 16S rRNA gene regions, followed by functional prediction using the FAPROTAX database. Results. It was established that the total microbial count in technogenic zones significantly exceeds the control, although no direct signs of recent fecal contamination were found (coli-index <1000 CFU/kg). Metagenomic analysis recorded a twofold higher content of nitrifiers in technogenic soils, indicating intensive self-purification processes, and identified functional groups of potential pathogens (Burkholderiales, Aquabacterium, C. perfringens) that indicate potential epidemic hazards and long-term contamination. Conclusions. The combination of classical and metagenomic methods ensures high accuracy in hygienic assessment, revealing hidden changes in the microbial community structure of technogenic areas. The findings emphasize the need to modernize the monitoring system and include genetic indicators in the protocols for sanitary-epidemiological soil control.

SCIENTIFIC AND CLINICAL RATIONALE FOR MULTIDISCIPLINARY REHABILITATION IN INFLAMMATORY BOWEL DISEASES: SYNERGY OF PHYSICAL ACTIVITY, KINESIOTERАPY, AND BALNEOTHERAPY

Olena Anatolyivna Dulo — 2026-04-03

Introduction. The current strategy for managing patients with inflammatory bowel disease (IBD) is shifting toward a multidisciplinary approach, where non-pharmacological methods become an integral part of therapy. Physical rehabilitation is considered not merely an auxiliary tool but an instrument of pathogenetic influence on disease activity and patients’ quality of life. The purpose. To systematize scientific evidence regarding the effectiveness of physical exercise, kinesioterаpy, and balneotherapy in the complex treatment of IBD, as well as to reveal the biomedical mechanisms of their action at the systemic and molecular levels. Results and discussion. The article provides a detailed analysis of the key therapeutic pathways of physical activity. It describes the immunomodulatory effect resulting from the secretion of anti-inflammatory myokines (IL-6, IL-10) by skeletal muscles, which shifts the balance toward classical anti-inflammatory signaling. A significant impact on barrier function is observed through the restoration of intestinal epithelial integrity and the strengthening of tight junctions, leading to a 30–40% reduction in systemic endotoxemia (LPS) levels. Furthermore, there is an increase in microbiota biodiversity and stimulation of the growth of butyrate-producing bacteria that synthesize short-chain fatty acids. Changes in psycho-emotional status occur through a reduction in cortisol levels and the activation of endorphin synthesis, resulting in a 30–45% decrease in manifestations of depression and anxiety. Systematic reviews and RCTs confirm that regular structured exercise contributes to a 25–40% reduction in disease activity and a 15–25% increase in bone mineral density, which is critical for the prevention of osteoporosis in IBD. Balneotherapy and specific forms of kinesioterаpy allow for the effective correction of intestinal dyskinetic disorders and a reduction in pain syndrome. Conclusions. The integration of individualized physical activity programs and balneotherapy into clinical protocols is an evidence-based method for achieving stable remission and preventing systemic complications. The rehabilitation program must be adapted to the phase of the disease (remission, mild, or active flare-up).