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The SBIM (biomedical sciences) program appeared in Belgium as early as 1997 in a lot of universities in order to offer an alternative to medical studies. That year corresponds with the introduction of federal quotas from the INAMI (National Institute for Health and Disability Insurance) and admission procedures to medical and dentistry studies. In the framework of a reflection on the role of biomedical sciences graduates in the Belgian health system, given their sometimes close proximity with the health care professions, an investigation was conducted among the graduates of the past five years (classes 2011 to 2015) but also the first- and final-year students in biomedical sciences of the academic year 2015-2016, so as to achieve a detailed description of the current situation. The aim of this exploratory study was to get an overall vision of the training, experience and daily practice of the graduates as Master in biomedical sciences issued by the Belgian universities. In 2016, the Master in biomedical sciences no longer attracts only students leaving medical studies leave. It is now organized by 10 Belgian universities, offering altogether 44 specific orientations in 25 different areas and awarding 350 diplomas per year. The lack of training standards and the diversity of available orientations do not allow us to have a precise idea of the competency profiles and professions of those graduates. All this creates ambiguities in terms of professional practice, competencies identification and profession. Our enquiries unveiled an orientation with multiple paradoxes which, given this legislative gap sometimes lead the SBIMs to work illegally. This work thus gives an overview of the present situation, providing potential solutions to the future place of the SBIMs in the Belgian health system of tomorrow, so they would not be performing medicine illegally anymore. ; En Belgique, la filière en sciences biomédicales (SBIM) est apparue dès 1997 dans nombres d'universités en vue de proposer une alternative aux études en médecine. Cette date coïncide avec l'instauration des quotas fédéraux INAMI et une sélection pour l'accès aux études de médecine et dentisterie. Dans le cadre d'une réflexion au sujet de la place des diplômés en sciences biomédicales au sein du système de santé belge au vu de leur proximité parfois étroite avec les professions de soins de santé, une enquête a été réalisée afin d'avoir une description détaillée de la situation actuelle auprès des diplômés de ces cinq dernières années (promotions 2011 à 2015) mais également auprès des étudiants en sciences biomédicales en première et dernière année de l'année académique 2015-2016. L'objectif de cette étude exploratoire était d'avoir une vision d'ensemble sur la formation, l'expérience et la pratique quotidienne des détenteurs du master en sciences biomédicales délivré par les universités belges. En 2016, le master en sciences biomédicales n'attire plus uniquement les déchus de la médecine et est organisé par 10 universités belges proposant en tout et pour tout 44 finalités dans 25 domaines différents et délivrant 350 diplômes par an. L'absence de standards de formation et la diversité des finalités proposées ne permettent pas d'avoir une idée précise des profils de compétences et métiers de ces diplômés. Ce qui crée des ambiguïtés en termes de pratique professionnelle, identification des compétences et du métier. Les résultats de l'enquête nous ont montré que 53 % des diplômés SBIM de ces cinq dernières années étaient doctorants et que 77 % des diplômés en sciences biomédicales réalisaient plus ou moins régulièrement dans leurs pratiques professionnelles au moins un acte réservé aux professionnels de soins de santé. Or les diplômés en sciences biomédicales ne sont reconnus en tant que tels ni par la loi relative à l'exercice des professions de soins de santé ni dans le droit biomédical belge ou international. Nos recherches ont dévoilé une filière aux multiples paradoxes qui au vu de ce vide législatif mène parfois les SBIMs à travailler dans l'illégalité. Ce travail donne donc un aperçu de la situation actuelle en proposant des pistes de solutions concernant la place future des SBIMs dans le système de santé belge de demain afin qu'ils n'exercent plus illégalement la médecine. ; De richting biomedische wetenschappen (BMW) wordt vanaf 1997 in vele universiteiten in België aangeboden als alternatief voor de studie geneeskunde. Die datum valt samen met de invoering van de federale quota van het RIZIV en een selectie om toegang te krijgen tot de studies geneeskunde en tandheelkunde. In het kader van overleg over de plaats van de afgestudeerden in de biomedische wetenschappen binnen het Belgische gezondheidssysteem, omdat ze soms zeer dicht bij de gezondheidszorgbeoefenaars staan, werd een enquête gehouden om een gedetailleerde beschrijving te hebben van de huidige situatie van de afgestudeerden van de laatste vijf jaar (lichtingen van 2011 tot 2015) maar ook van de studenten biomedische wetenschappen uit het eerste en het laatste academiejaar 2015-2016. Het doel van die verkennende studie was om een totaalbeeld te krijgen van de opleiding, de ervaring en de dagelijkse praktijk van de houders van de master in de biomedische wetenschappen die de Belgische universiteiten afleveren. In 2016 trekt de master in de biomedische wetenschappen niet meer alleen studenten aan die niet toegelaten werden tot de studie geneeskunde en wordt die master door 10 Belgische universiteiten georganiseerd die alles bij elkaar 44 finaliteiten in 25 verschillende domeinen aanbieden en worden er jaarlijks 350 diploma's uitgereikt. Door het gebrek aan opleidingsstandaarden en de diversiteit van de aangeboden finaliteiten heeft men geen duidelijk beeld van de competentieprofielen en beroepen van die gediplomeerden. Dat creëert onduidelijkheid op het vlak van beroepspraktijk en de identificatie van de competenties en het beroep. De resultaten van de enquête hebben ons aangetoond dat 53% van de afgestudeerden in de BMW van de laatste vijf jaar aan het doctoreren zijn en dat 77 % van de afgestudeerden in de BMW min of meer regelmatig in hun beroepspraktijk minstens één handeling stellen die voorbehouden is aan gezondheidszorgbeoefenaars. Gediplomeerden in de biomedische wetenschappen zijn daar echter niet voor erkend, noch door de wet betreffende de uitoefening van de gezondheidszorgberoepen, noch in het Belgische of internationale biomedische recht. Ons onderzoek bracht aan het licht dat het hier gaat om een richting met vele paradoxen, die er door de hiaten in de wetgeving soms voor zorgt dat de BMW'ers in de illegaliteit werken. Dit werk geeft dus een overzicht van de huidige situatie en stelt tegelijkertijd mogelijke oplossingen voor in verband met de toekomstige plaats van de BMW'ers in het Belgische gezondheidssysteem van morgen zodat zij niet meer illegaal de geneeskunde zouden uitoefenen.

Vergiftungen mit flüssigen Kohlenwasserstoffen beim Menschen sind seit Anfang des letzten Jahrhunderts bekannt. In den 1950er Jahren waren diese Vergiftungen die Hauptursache für Klinikaufnahmen bei Vergiftungen mit Haushaltschemikalien im Kindesalter in den USA. Erste Hinweise auf eine Gefährdung durch dünnflüssige Lampenöle auf Petroleumdestillat- und Paraffinbasis, die Brennstoffe in Öl- oder Zierlampen waren, kamen aus Skandinavien. Hinweise auf ein besonderes Risiko für Kleinkinder ergaben sich 1989 aus dem ersten Jahresbericht der Beratungsstelle für Vergiftungserscheinungen und Embryonaltoxikologie, Berlin in Deutschland. Aus den Ergebnissen eines Forschungsvorhabens des Bundesministeriums für Umwelt, Naturschutz und Reaktorsicherheit zur harmonisierten Dokumentation von Vergiftungsfällen konnte 1993 abgeschätzt werden, dass von allen Haushaltschemikalien speziell die attraktiven, gefärbten und parfümierten Lampenöle das höchste Gefährdungspotenzial für Kinder zwischen 1 und 3 Jahren in Deutschland hatten. Systematische Risiko-Abschätzungen für das Jahr 1995 ergaben, dass bei etwa 1.000 Anfragen zu Lampenölingestionen in den deutschen Giftinformationszentren im Zeitraum 1992-1994, jährlich mit etwa 250 bis 300 chemisch bedingten Pneumonien bei Kleinkindern zu rechnen war. Im Zeitraum 1989-2013 waren insgesamt 5 Todesfälle zu beklagen. Trotz verschiedener Risikominimierungsmaßnahmen, wie kindergesicherte Verschlüsse (ab 1992), spezielle Warnhinweise (ab 1996), einem neu geschaffenen R-Satz R 65 (ab 1996), war ein relevanter Rückgang der Fallzahlen erst zeitgleich mit einem Verbot der aspirationsgefährlichen flüssigen gefärbten und parfümierten Petroleumdestillat- und Paraffin-haltigen Lampenöle ab 01.01.1999 in Deutschland, später dann auch ab 1.07.2000 auch in der Europäischen Union (EU) zu sehen. Entgegen deutschen EU-Vorschlägen wurden die ungefärbten aspirationsgefährlichen flüssigen Petroleumdestillat und Paraffin-haltigen Lampenöle und Brennstoffe durch die Intervention der Industrie nicht verboten. Wachsende Marktanteile dieser ebenso gefährlichen Stoffe, besonders über die vermehrte Vermarktung von flüssigen Grillanzündern nach 2000, haben eine schnelle und nachhaltige Risikoverminderung in der EU zunächst verhindert. In der Folge mussten dann die aspirationsgefährlichen flüssigen Petroleumdestillate und Paraffine in ihrer Gesamtheit sowohl als Lampenöle, als auch als flüssige Grillanzünder im Rahmen von REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) erneut reguliert werden. Seit 1. Juni 2014 kann eine vollständige Risikominimierung erreicht werden, letztlich, durch ein vollständiges Verbot der aspirationsgefährlichen flüssigen Kohlenwasserstoffe im Verbraucherbereich. Unter Public Health Gesichtspunkten wird in der Dissertation der gesamte regulatorisch-toxikologische Prozess aufgezeigt, durch dessen Verlauf die neuen Erkenntnisse über die Epidemiologie der aspirationsgefährlichen flüssigen Kohlenwasserstoffe, den genauen Unfallmechanismus, die speziellen gefährlichen physikalisch-chemischen Eigenschaften und die pathophysiologischen Mechanismen der Aspiration und der Aspirationspneumonie gewonnen worden. Der Erfolg der initiierten Risikominimierungsmaßnahmen konnte über ein in den Einzelheiten verbessertes Monitoring in Deutschland gemessen werden. Ein besonderer wissenschaftlicher Aspekt der Untersuchungen beim Menschen war, dass sich die frühere Einschätzung des Risikos und der Toxizität der aspirationsgefährlichen flüssigen Petroleumdestillate und Paraffine durch Tierversuche letzten Endes als falsch herausgestellt hat. Das Risiko im Standardtierversuch wurde absolut unterschätzt. Eine derartige Fehlvorhersage muss bei zukünftigen Risikoabschätzungen von Stoffen mittels Tierversuchen oder Alternativen zu Tierversuchen unbedingt vermieden werden. Im wissenschaftlichen Kontext werden in dieser Arbeit Fragen aufgeworfen, die Zielsetzungen im Sinne der neuen fünf Public Health Kerndisziplinen entsprechen. Dabei werden die Maßnahmen und Wirkungen der Regulationsmechanismen beleuchtet. Die Arbeit beschreibt den gesamten wissenschaftlichen Prozess, in dem die verschiedenen wissenschaftlichen Disziplinen der Medizin, wie Toxikologie, Physiologie und Pathophysiologie, klinische Chemie und Statistik und physikalisch-chemische Untersuchungen zu neuen Erkenntnissen geführt haben. Im Einzelnen kann mit den Ergebnissen der Arbeit wissenschaftlich klar nachgewiesen werden, dass 1) die früheren Tierversuche und deren Bewertung unter einem falschen Versuchsansatz durchgeführt wurden, weil der Pathomechanismus der Aspiration von Flüssigkeiten bis dahin nicht ausreichend verstanden und nicht als relevanter toxikologischer Expositionsweg erkannt wurde, 2) die Todesursachen- bzw. die Krankheitsartenstatistik des Statistischen Bundesamtes aufgrund der unzureichenden ICD-Codierung das spezielle Risiko für den Menschen nicht aufdecken konnte und 3) ein ausreichendes Monitoring über Vergiftungsunfälle beim Menschen in der Bundesrepublik Deutschland, welches neuartige Risiken oder Trends entdecken könnte, bisher weder etabliert noch im öffentlichen Gesundheitsbereich vorgesehen ist. Erst die Zusammenführung aller dieser Fakten in der Arbeit in Zusammenarbeit mit zahlreichen Akteuren hat erstmalig eine wissenschaftliche Sicht auf die Gesamtproblematik und -prozess der aspirationsgefährlichen flüssigen Kohlenwasserstoffe gegeben und geholfen diese Stoffgruppe einer wirksamen Risikominimierung im Sinne der Public Health Wissenschaften zuzuführen. ; Cases of poisoning involving liquid hydrocarbons in humans have become known since the beginning of the last century. In the 1950s, poisoning of this type constituted the main cause of hospitalization of cases of poisoning in children involving household chemicals in the USA. Scandinavia was the first region to draw attention to a risk arising from low-viscosity lamp oils based on petroleum distillates and paraffins that were used as fuels in oil lamps including ornamental lamps. For the first time in 1989, confirmed indications of a special risk for young children resulted from the first annual report of the Berlin poison emergency centre (information centre for poisoning symptoms and embryonic toxicology) in Germany. Based on the results of a research project conducted by the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU) and aiming at a harmonized documentation of cases of poisoning, it was possible to identify in 1993 the attractively coloured and scented lamp oils being those posing the highest risk for children aged between 1 and 3 years, among all household chemicals. The results of systematic risk assessments for 1995 suggested that for about 1000 enquiries on lamp oil ingestion recorded at the German poison information centres in the 1992-1994 period, it had to be assumed that annually, there had been between 250 and 300 cases of chemical pneumonia in young children. In the 1989-2013 period, altogether five deaths had to be deplored. In spite of a number of different risk minimization measures implemented, such as child-resistant closures (from 1992), special warnings (from 1996) and a newly established R phrase (R 65, from 1996), a relevant decrease in case numbers was only achieved after a ban on coloured and scented lamp oils containing liquid petroleum distillates and paraffins and posing an aspiration hazard had taken effect on 1 January 1999 in Germany, and on 1 July 2000 in the entire European Union (EU). Due to intervention by industry, and contrary to the German EU proposals, the ban did not include uncoloured lamp oils and fuels containing liquid petroleum distillates and paraffins posing an aspiration hazard. At first, a rapid and sustainable risk minimization within the EU was constrained by growing market shares of these similarly dangerous substances, particularly an increased marketing of grill lighter fluids from 2000. This is why liquid petroleum distillates and paraffins involving an aspiration hazard had to undergo a fresh regulation procedure both as lamp oils and as grill lighter fluids in the context of the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH). Since 1 June 2014, a complete risk minimization has eventually been achieved by a complete ban on liquid hydrocarbons involving an aspiration hazard for use in consumer products. From the angle of public health aspects, the doctoral thesis demonstrates the entire regulatory toxicological process which has resulted in new knowledge about the epidemiology of health risks from hydrocarbons posing an aspiration hazard, the accident mechanism, the special dangerous physicochemical properties and the pathophysiological mechanisms of aspiration and aspiration pneumonia. The success of the risk minimization measures implemented could be measured by means of an enhanced monitoring system in Germany. A special scientific aspect of the studies in humans consisted in the fact that the former assessment of the risk and the toxicity of liquid petroleum distillates and paraffins posing an aspiration hazard that had been made on the basis of animal experiments was eventually found to be incorrect. The risk had been absolutely underestimated in standard animal experiments. For the future, it is absolutely essential to avoid similar wrong predictions in the risk assessment of substances based on animal experiments or their alternatives. In a scientific context, this thesis has raised questions related to the objectives of the new five core disciplines of public health. In this framework, the measures and effects of regulatory mechanisms are elucidated. The thesis provides a description of the entire scientific process in which the different scientific disciplines of medicine such as toxicology, physiology and pathophysiology, clinical chemistry and statistics, as well as physicochemical studies have led to new findings. Based on the present results of this thesis, it can be clearly demonstrated in scientific terms that 1) Earlier animal studies and their evaluation had been performed with a wrong experimental approach because until then, the pathomechanism of fluid aspiration had not been sufficiently understood and not been identified as a relevant toxicological route of exposure; 2) The statistics on causes of death and the statistics on types of disease kept by the Federal Statistical Office did not permit the detection of an existing special risk due to the inadequate ICD encoding; and 3) A sufficient monitoring of cases of poisoning in humans in the Federal Republic of Germany that would have been appropriate to identify new risks or trends has neither been established nor envisaged in the public health sector so far. It was the combination and compilation of all these facts in this thesis, in collaboration with numerous actors that, for the first time, has provided a scientific perspective on the overall problem and process of liquid hydrocarbons posing an aspiration hazard and helped to subject this group of substances to an effective risk minimization in the sense of the public health sciences.

Background. The unfavorable medical and demographic situation in Ukraine requires an affordable, high-quality and efficient Palliative and Hospice Care (PHC) System substantiation, creation and development that requiring of Primary Health Care (PMC) providers (GPs) and health specialists involvement in PHC, such as Health Facilities (HF) of various Ministries and Departments, different forms of ownership Health Facilities (HF) work coordination. The purpose was to substantiate the optimal PHC System in Ukraine at the PMC level the modern conceptual model. Materials and methods. Medical statistics data, national and international literary sources, results of sociological research, bibliosemantic, statistical and sociological research methods, methods of systemic and structural-functional analysis were used in this work. Results. The optimal PHC System in Ukraine at the PMC level conceptual model is substantiated, in particular, the PHC involved institutions are substantiated: 1) PMC HF; 2) Multi-disciplinary PHC teams; 3) Licensed Pharmacy Facilities; 4) Social Care Facilities. At the PMC level it provides: 1) Identification, organization of status determination and registration of palliative patients (PP); 2) Providing palliative medical care, organization of PP hospitalization to stationary PHC HF, according to testimony; 3) PP and their families members of psychological, social and religious/spiritual support organization; 4) PP and their families members counseling, information and education; 5) Co-ordination and cooperation with a PHC multi-disciplinary team, or PHC HF stationary, health specialist according to the PP's nosology, social care institutions, NGOs, charitable foundations, volunteers. Conclusions. The medical and social analysis of demographic indicators, morbidity and mortality in Ukraine indicates a rapid decline in population and population aging, a high mortality rate from malignant neoplasms and chronic non-communicable diseases (HNCD) severe complications, which determine the high need of the population in PHC and require the affordable, high-quality, and efficient PHC System creation and development. The existing stationary PHC HF network and capacity is extremely inadequate, which results in a signi­ficant need for PHC at the PMC level with the PMC HF specialists involvement. The PHC System conceptual model that based on a patient-family-oriented, multidisciplinary, inter-departmental and multisectoral approach at all health care levels, with an emphasis on PMC, which is consistent with modern international standards and norms, in order to integrate PHC into the Health Care System is substantiated. The proposed optimal PHC System conceptual model is a highly professional component of Health Care System that requires modern high-tech equipment and effective medicines, personnel special training and motivation, a relevant regulatory framework and, of course, adequate the Government of Ukraine, regional and local authorities financial and political support and the interest and support of the whole society. ; Актуальность. Неблагоприятная медико-демографическая ситуация в Украине определяет необходимость обоснования, создания и развития доступной, качественной и эффективной системы паллиативной и хосписной помощи (ПХП), что требует привлечения к оказанию ПХП медицинских работников учреждений здравоохранения (УЗ) первичной медицинской помощи (ПМП) и специализированных УЗ, координации работы учреждений, подчиненных различным министерствам и ведомствам, различных форм собственности. Цель работы: обосновать современную концептуальную модель оптимальной системы оказания ПХП населению Украины на уровне ПМП. Материалы и методы. В работе были использованы данные медицинской статистики, национальные и международные литературные источники, результаты социологического исследования, библиосемантические, статистические и социологические методы исследования, методы системного и структурно-функционального анализа. Результаты. Обоснована концептуальная модель оптимальной системы оказания ПХП на уровне ПМП, в частности, определены учреждения, которых привлекают к оказанию ПХП: 1) УЗ ПМП; 2) Выездные мультидисциплинарные бригады ПХП; 3) Лицензированные аптечные учреждения; 4) Учреждения социальной защиты населения. На уровне ПТП обеспечивается: 1) Выявление, организация определения статуса и учет паллиативных пациентов (ПП); 2) Оказание паллиативной медицинской помощи, организация госпитализации ПП в стационарные УЗ ПХП, по показаниям; 3) Организация психологической, социальной и религиозной/духовной поддержки и сопровождения ПП и членов их семей; 4) Консультирование, информирование и обучение ПП и членов их семей; 5) Координация и сотрудничество с выездной мультидисциплинарной бригадой ПХП или стационарными УЗ ПХП, врачами-специалистами, соответственно нозологии ПП, учреждениями социальной защиты населения, НПО, благотворительными фондами, волонтерами. Выводы. Медико-социальный анализ демографических показателей, заболеваемости и смертности в Украине свидетельствует о быстром сокращении численности и старении населения, высоком уровне смертности от злокачественных новообразований (ЗН) и тяжелых осложнений хронических неинфекционных заболеваний (ХНИЗ), определяющих высокую потребность населения в ПХП и требуют создания и развития доступной, качественной и эффективной системы ПХП. Существующая сеть и мощность стационарных УЗ ПХП – крайне недостаточна, что обусловливает значительную потребность оказания ПХП и паллиативного ухода на уровне ПМП с привлечением медицинских работников УЗ ПМП. Обоснована, разработана и апробирована на уровне отдельных инновационных составляющих концептуальная модель системы ПХП, основой которой является пациент-семья-ориентированный, мультидисциплинарный, межведомственный и межсекторальный подход на всех уровнях оказания медицинской помощи, с акцентом на ПМП, что соответствует современным международным стандартам и нормам, с целью интеграции ПХП в систему здравоохранения, которая обеспечит ее непрерывность и преемственность и обратную связь. Предложенная концептуальная модель оптимальной системы ПХП представляет собой высокопрофессиональную составляющую здравоохранения, требует современного высокотехнологичного оборудования и эффективных лекарственных средств, специальной профессиональной подготовки и мотивации кадров, соответствующей нормативно-правовой базы и, безусловно, надлежащего финансового обеспечения и политической поддержке Правительства Украина, региональных и местных органов власти, заинтересованности и поддержки всего общества. ; Актуальність. Несприятлива медико-демографічна ситуація в Україні вимагає обґрунтування, створення і розвитку доступної, якісної і ефективної системи паліативної та хоспісної допомоги (ПХД), що потребує залучення до надання ПХД медичних працівників закладів охорони здоров'я (ЗОЗ) первинної медичної допомоги (ПМД) і спеціалізованих ЗОЗ, координації роботи закладів і установ, підпорядкованих різним міністерствам і відомствам, різних форм власності. Мета роботи: обґрунтувати сучасну концептуальну модель оптимальної системи надання ПХД населенню України на рівні ПМД. Матеріали та методи. У роботі були використані дані медичної статистики, національні та міжнародні літературні джерела, результати соціологічного дослідження, бібліосемантичні, статистичні і соціологічні методи дослідження, методи системного та структурно-функціонального аналізу. Результати. Обґрунтована концептуальна модель оптимальної системи надання ПХД на рівні ПМД, зокрема визначені заклади, що залучаються до надання ПХД: 1) ЗОЗ ПМД; 2) Виїзні мультидисциплінарні бригади ПХД; 3) Ліцензовані аптечні заклади; 4) Заклади соціального захисту населення. На рівні ПМД забезпечується: 1) Виявлення, організація визначення статусу та облік паліативних пацієнтів (ПП); 2) Надання паліативної медичної допомоги, організація госпіталізації ПП до стаціонарних ЗОЗ ПХД, за показаннями; 3) Організація психологічної, соціальної і релігійної/духовної підтримки і супроводу ПП і членів його сім'ї; 4) Консультування, інформування та навчання ПП і членів його сім'ї; 5) Координація та співпраця з виїзною мультидисциплінарною бригадою ПХД або стаціонарним ЗОЗ ПХД, лікарями-спеціалістами відповідно нозології ПП, закладами соціального захисту населення, НДО, благодійними фондами, волонтерами. Висновки. Медико-соціальний аналіз демографічних показників, захворюваності і смертності в Україні свідчить про швидке скорочення чисельності та постаріння населення, високий рівень смертності від злоякісних новоутворень (ЗН) і тяжких ускладнень хронічних неінфекційних захворювання (ХНІЗ), що визначають високу потребу населення у ПХД та вимагають створення і розвитку доступної, якісної і ефективної системи ПХД. Існуюча мережа та потужність стаціонарних ЗОЗ ПХД – вкрай недостатня, що зумовлює значну потребу надання ПХД та паліативного догляду на рівні ПМД із залученням медичних працівників ЗОЗ ПМД. Обґрунтовано, розроблено та апробовано на рівні окремих інноваційних складових концептуальну модель системи ПХД, основою якої є пацієнт-сім'я-орієнтований, мультидисциплінарний, міжвідомчий і міжсекторальний підхід на усіх рівнях надання медичної допомоги, з акцентом на ПМД, що відповідає сучасним міжнародним стандартам і нормам, з метою інтеграції ПХД в систему охорони здоров'я, що забезпечить безперервність та наступність її надання і зворотний зв'язок. Запропонована концептуальна модель оптимальної системи ПХД являє собою високопрофесійну складову охорони здоров'я, що потребує сучасного високотехнологічного обладнання та ефективних лікарських засобів, спеціальної професійної підготовки і мотивації кадрів, відповідної нормативно-правової бази і, безумовно, належного фінансового забезпечення і політичної підтримки Уряду України, регіональних і місцевих органів влади та зацікавленості і підтримки усього суспільства.

Актуальность. Неблагоприятная медико-демографическая ситуация в Украине определяет необходимость обоснования, создания и развития доступной, качественной и эффективной системы паллиативной и хосписной помощи (ПХП), что требует привлечения к оказанию ПХП медицинских работников учреждений здравоохранения (УЗ) первичной медицинской помощи (ПМП) и специализированных УЗ, координации работы учреждений, подчиненных различным министерствам и ведомствам, различных форм собственности. Цель работы: обосновать современную концептуальную модель оптимальной системы оказания ПХП населению Украины на уровне ПМП. Материалы и методы. В работе были использованы данные медицинской статистики, национальные и международные литературные источники, результаты социологического исследования, библиосемантические, статистические и социологические методы исследования, методы системного и структурно-функционального анализа. Результаты. Обоснована концептуальная модель оптимальной системы оказания ПХП на уровне ПМП, в частности, определены учреждения, которых привлекают к оказанию ПХП: 1) УЗ ПМП; 2) Выездные мультидисциплинарные бригады ПХП; 3) Лицензированные аптечные учреждения; 4) Учреждения социальной защиты населения. На уровне ПТП обеспечивается: 1) Выявление, организация определения статуса и учет паллиативных пациентов (ПП); 2) Оказание паллиативной медицинской помощи, организация госпитализации ПП в стационарные УЗ ПХП, по показаниям; 3) Организация психологической, социальной и религиозной/духовной поддержки и сопровождения ПП и членов их семей; 4) Консультирование, информирование и обучение ПП и членов их семей; 5) Координация и сотрудничество с выездной мультидисциплинарной бригадой ПХП или стационарными УЗ ПХП, врачами-специалистами, соответственно нозологии ПП, учреждениями социальной защиты населения, НПО, благотворительными фондами, волонтерами. Выводы. Медико-социальный анализ демографических показателей, заболеваемости и смертности в Украине свидетельствует о быстром сокращении численности и старении населения, высоком уровне смертности от злокачественных новообразований (ЗН) и тяжелых осложнений хронических неинфекционных заболеваний (ХНИЗ), определяющих высокую потребность населения в ПХП и требуют создания и развития доступной, качественной и эффективной системы ПХП. Существующая сеть и мощность стационарных УЗ ПХП – крайне недостаточна, что обусловливает значительную потребность оказания ПХП и паллиативного ухода на уровне ПМП с привлечением медицинских работников УЗ ПМП. Обоснована, разработана и апробирована на уровне отдельных инновационных составляющих концептуальная модель системы ПХП, основой которой является пациент-семья-ориентированный, мультидисциплинарный, межведомственный и межсекторальный подход на всех уровнях оказания медицинской помощи, с акцентом на ПМП, что соответствует современным международным стандартам и нормам, с целью интеграции ПХП в систему здравоохранения, которая обеспечит ее непрерывность и преемственность и обратную связь. Предложенная концептуальная модель оптимальной системы ПХП представляет собой высокопрофессиональную составляющую здравоохранения, требует современного высокотехнологичного оборудования и эффективных лекарственных средств, специальной профессиональной подготовки и мотивации кадров, соответствующей нормативно-правовой базы и, безусловно, надлежащего финансового обеспечения и политической поддержке Правительства Украина, региональных и местных органов власти, заинтересованности и поддержки всего общества. ; Background. The unfavorable medical and demographic situation in Ukraine requires an affordable, high-quality and efficient Palliative and Hospice Care (PHC) System substantiation, creation and development that requiring of Primary Health Care (PMC) providers (GPs) and health specialists involvement in PHC, such as Health Facilities (HF) of various Ministries and Departments, different forms of ownership Health Facilities (HF) work coordination. The purpose was to substantiate the optimal PHC System in Ukraine at the PMC level the modern conceptual model. Materials and methods. Medical statistics data, national and international literary sources, results of sociological research, bibliosemantic, statistical and sociological research methods, methods of systemic and structural-functional analysis were used in this work. Results. The optimal PHC System in Ukraine at the PMC level conceptual model is substantiated, in particular, the PHC involved institutions are substantiated: 1) PMC HF; 2) Multi-disciplinary PHC teams; 3) Licensed Pharmacy Facilities; 4) Social Care Facilities. At the PMC level it provides: 1) Identification, organization of status determination and registration of palliative patients (PP); 2) Providing palliative medical care, organization of PP hospitalization to stationary PHC HF, according to testimony; 3) PP and their families members of psychological, social and religious/spiritual support organization; 4) PP and their families members counseling, information and education; 5) Co-ordination and cooperation with a PHC multi-disciplinary team, or PHC HF stationary, health specialist according to the PP's nosology, social care institutions, NGOs, charitable foundations, volunteers. Conclusions. The medical and social analysis of demographic indicators, morbidity and mortality in Ukraine indicates a rapid decline in population and population aging, a high mortality rate from malignant neoplasms and chronic non-communicable diseases (HNCD) severe complications, which determine the high need of the population in PHC and require the affordable, high-quality, and efficient PHC System creation and development. The existing stationary PHC HF network and capacity is extremely inadequate, which results in a signi­ficant need for PHC at the PMC level with the PMC HF specialists involvement. The PHC System conceptual model that based on a patient-family-oriented, multidisciplinary, inter-departmental and multisectoral approach at all health care levels, with an emphasis on PMC, which is consistent with modern international standards and norms, in order to integrate PHC into the Health Care System is substantiated. The proposed optimal PHC System conceptual model is a highly professional component of Health Care System that requires modern high-tech equipment and effective medicines, personnel special training and motivation, a relevant regulatory framework and, of course, adequate the Government of Ukraine, regional and local authorities financial and political support and the interest and support of the whole society. ; Актуальність. Несприятлива медико-демографічна ситуація в Україні вимагає обґрунтування, створення і розвитку доступної, якісної і ефективної системи паліативної та хоспісної допомоги (ПХД), що потребує залучення до надання ПХД медичних працівників закладів охорони здоров'я (ЗОЗ) первинної медичної допомоги (ПМД) і спеціалізованих ЗОЗ, координації роботи закладів і установ, підпорядкованих різним міністерствам і відомствам, різних форм власності. Мета роботи: обґрунтувати сучасну концептуальну модель оптимальної системи надання ПХД населенню України на рівні ПМД. Матеріали та методи. У роботі були використані дані медичної статистики, національні та міжнародні літературні джерела, результати соціологічного дослідження, бібліосемантичні, статистичні і соціологічні методи дослідження, методи системного та структурно-функціонального аналізу. Результати. Обґрунтована концептуальна модель оптимальної системи надання ПХД на рівні ПМД, зокрема визначені заклади, що залучаються до надання ПХД: 1) ЗОЗ ПМД; 2) Виїзні мультидисциплінарні бригади ПХД; 3) Ліцензовані аптечні заклади; 4) Заклади соціального захисту населення. На рівні ПМД забезпечується: 1) Виявлення, організація визначення статусу та облік паліативних пацієнтів (ПП); 2) Надання паліативної медичної допомоги, організація госпіталізації ПП до стаціонарних ЗОЗ ПХД, за показаннями; 3) Організація психологічної, соціальної і релігійної/духовної підтримки і супроводу ПП і членів його сім'ї; 4) Консультування, інформування та навчання ПП і членів його сім'ї; 5) Координація та співпраця з виїзною мультидисциплінарною бригадою ПХД або стаціонарним ЗОЗ ПХД, лікарями-спеціалістами відповідно нозології ПП, закладами соціального захисту населення, НДО, благодійними фондами, волонтерами. Висновки. Медико-соціальний аналіз демографічних показників, захворюваності і смертності в Україні свідчить про швидке скорочення чисельності та постаріння населення, високий рівень смертності від злоякісних новоутворень (ЗН) і тяжких ускладнень хронічних неінфекційних захворювання (ХНІЗ), що визначають високу потребу населення у ПХД та вимагають створення і розвитку доступної, якісної і ефективної системи ПХД. Існуюча мережа та потужність стаціонарних ЗОЗ ПХД – вкрай недостатня, що зумовлює значну потребу надання ПХД та паліативного догляду на рівні ПМД із залученням медичних працівників ЗОЗ ПМД. Обґрунтовано, розроблено та апробовано на рівні окремих інноваційних складових концептуальну модель системи ПХД, основою якої є пацієнт-сім'я-орієнтований, мультидисциплінарний, міжвідомчий і міжсекторальний підхід на усіх рівнях надання медичної допомоги, з акцентом на ПМД, що відповідає сучасним міжнародним стандартам і нормам, з метою інтеграції ПХД в систему охорони здоров'я, що забезпечить безперервність та наступність її надання і зворотний зв'язок. Запропонована концептуальна модель оптимальної системи ПХД являє собою високопрофесійну складову охорони здоров'я, що потребує сучасного високотехнологічного обладнання та ефективних лікарських засобів, спеціальної професійної підготовки і мотивації кадрів, відповідної нормативно-правової бази і, безумовно, належного фінансового забезпечення і політичної підтримки Уряду України, регіональних і місцевих органів влади та зацікавленості і підтримки усього суспільства.

Актуальность. Неблагоприятная медико-демографическая ситуация в Украине определяет необходимость обоснования, создания и развития доступной, качественной и эффективной системы паллиативной и хосписной помощи (ПХП), что требует привлечения к оказанию ПХП медицинских работников учреждений здравоохранения (УЗ) первичной медицинской помощи (ПМП) и специализированных УЗ, координации работы учреждений, подчиненных различным министерствам и ведомствам, различных форм собственности. Цель работы: обосновать современную концептуальную модель оптимальной системы оказания ПХП населению Украины на уровне ПМП. Материалы и методы. В работе были использованы данные медицинской статистики, национальные и международные литературные источники, результаты социологического исследования, библиосемантические, статистические и социологические методы исследования, методы системного и структурно-функционального анализа. Результаты. Обоснована концептуальная модель оптимальной системы оказания ПХП на уровне ПМП, в частности, определены учреждения, которых привлекают к оказанию ПХП: 1) УЗ ПМП; 2) Выездные мультидисциплинарные бригады ПХП; 3) Лицензированные аптечные учреждения; 4) Учреждения социальной защиты населения. На уровне ПТП обеспечивается: 1) Выявление, организация определения статуса и учет паллиативных пациентов (ПП); 2) Оказание паллиативной медицинской помощи, организация госпитализации ПП в стационарные УЗ ПХП, по показаниям; 3) Организация психологической, социальной и религиозной/духовной поддержки и сопровождения ПП и членов их семей; 4) Консультирование, информирование и обучение ПП и членов их семей; 5) Координация и сотрудничество с выездной мультидисциплинарной бригадой ПХП или стационарными УЗ ПХП, врачами-специалистами, соответственно нозологии ПП, учреждениями социальной защиты населения, НПО, благотворительными фондами, волонтерами. Выводы. Медико-социальный анализ демографических показателей, заболеваемости и смертности в Украине свидетельствует о быстром сокращении численности и старении населения, высоком уровне смертности от злокачественных новообразований (ЗН) и тяжелых осложнений хронических неинфекционных заболеваний (ХНИЗ), определяющих высокую потребность населения в ПХП и требуют создания и развития доступной, качественной и эффективной системы ПХП. Существующая сеть и мощность стационарных УЗ ПХП – крайне недостаточна, что обусловливает значительную потребность оказания ПХП и паллиативного ухода на уровне ПМП с привлечением медицинских работников УЗ ПМП. Обоснована, разработана и апробирована на уровне отдельных инновационных составляющих концептуальная модель системы ПХП, основой которой является пациент-семья-ориентированный, мультидисциплинарный, межведомственный и межсекторальный подход на всех уровнях оказания медицинской помощи, с акцентом на ПМП, что соответствует современным международным стандартам и нормам, с целью интеграции ПХП в систему здравоохранения, которая обеспечит ее непрерывность и преемственность и обратную связь. Предложенная концептуальная модель оптимальной системы ПХП представляет собой высокопрофессиональную составляющую здравоохранения, требует современного высокотехнологичного оборудования и эффективных лекарственных средств, специальной профессиональной подготовки и мотивации кадров, соответствующей нормативно-правовой базы и, безусловно, надлежащего финансового обеспечения и политической поддержке Правительства Украина, региональных и местных органов власти, заинтересованности и поддержки всего общества. ; Background. The unfavorable medical and demographic situation in Ukraine requires an affordable, high-quality and efficient Palliative and Hospice Care (PHC) System substantiation, creation and development that requiring of Primary Health Care (PMC) providers (GPs) and health specialists involvement in PHC, such as Health Facilities (HF) of various Ministries and Departments, different forms of ownership Health Facilities (HF) work coordination. The purpose was to substantiate the optimal PHC System in Ukraine at the PMC level the modern conceptual model. Materials and methods. Medical statistics data, national and international literary sources, results of sociological research, bibliosemantic, statistical and sociological research methods, methods of systemic and structural-functional analysis were used in this work. Results. The optimal PHC System in Ukraine at the PMC level conceptual model is substantiated, in particular, the PHC involved institutions are substantiated: 1) PMC HF; 2) Multi-disciplinary PHC teams; 3) Licensed Pharmacy Facilities; 4) Social Care Facilities. At the PMC level it provides: 1) Identification, organization of status determination and registration of palliative patients (PP); 2) Providing palliative medical care, organization of PP hospitalization to stationary PHC HF, according to testimony; 3) PP and their families members of psychological, social and religious/spiritual support organization; 4) PP and their families members counseling, information and education; 5) Co-ordination and cooperation with a PHC multi-disciplinary team, or PHC HF stationary, health specialist according to the PP's nosology, social care institutions, NGOs, charitable foundations, volunteers. Conclusions. The medical and social analysis of demographic indicators, morbidity and mortality in Ukraine indicates a rapid decline in population and population aging, a high mortality rate from malignant neoplasms and chronic non-communicable diseases (HNCD) severe complications, which determine the high need of the population in PHC and require the affordable, high-quality, and efficient PHC System creation and development. The existing stationary PHC HF network and capacity is extremely inadequate, which results in a signi­ficant need for PHC at the PMC level with the PMC HF specialists involvement. The PHC System conceptual model that based on a patient-family-oriented, multidisciplinary, inter-departmental and multisectoral approach at all health care levels, with an emphasis on PMC, which is consistent with modern international standards and norms, in order to integrate PHC into the Health Care System is substantiated. The proposed optimal PHC System conceptual model is a highly professional component of Health Care System that requires modern high-tech equipment and effective medicines, personnel special training and motivation, a relevant regulatory framework and, of course, adequate the Government of Ukraine, regional and local authorities financial and political support and the interest and support of the whole society. ; Актуальність. Несприятлива медико-демографічна ситуація в Україні вимагає обґрунтування, створення і розвитку доступної, якісної і ефективної системи паліативної та хоспісної допомоги (ПХД), що потребує залучення до надання ПХД медичних працівників закладів охорони здоров'я (ЗОЗ) первинної медичної допомоги (ПМД) і спеціалізованих ЗОЗ, координації роботи закладів і установ, підпорядкованих різним міністерствам і відомствам, різних форм власності. Мета роботи: обґрунтувати сучасну концептуальну модель оптимальної системи надання ПХД населенню України на рівні ПМД. Матеріали та методи. У роботі були використані дані медичної статистики, національні та міжнародні літературні джерела, результати соціологічного дослідження, бібліосемантичні, статистичні і соціологічні методи дослідження, методи системного та структурно-функціонального аналізу. Результати. Обґрунтована концептуальна модель оптимальної системи надання ПХД на рівні ПМД, зокрема визначені заклади, що залучаються до надання ПХД: 1) ЗОЗ ПМД; 2) Виїзні мультидисциплінарні бригади ПХД; 3) Ліцензовані аптечні заклади; 4) Заклади соціального захисту населення. На рівні ПМД забезпечується: 1) Виявлення, організація визначення статусу та облік паліативних пацієнтів (ПП); 2) Надання паліативної медичної допомоги, організація госпіталізації ПП до стаціонарних ЗОЗ ПХД, за показаннями; 3) Організація психологічної, соціальної і релігійної/духовної підтримки і супроводу ПП і членів його сім'ї; 4) Консультування, інформування та навчання ПП і членів його сім'ї; 5) Координація та співпраця з виїзною мультидисциплінарною бригадою ПХД або стаціонарним ЗОЗ ПХД, лікарями-спеціалістами відповідно нозології ПП, закладами соціального захисту населення, НДО, благодійними фондами, волонтерами. Висновки. Медико-соціальний аналіз демографічних показників, захворюваності і смертності в Україні свідчить про швидке скорочення чисельності та постаріння населення, високий рівень смертності від злоякісних новоутворень (ЗН) і тяжких ускладнень хронічних неінфекційних захворювання (ХНІЗ), що визначають високу потребу населення у ПХД та вимагають створення і розвитку доступної, якісної і ефективної системи ПХД. Існуюча мережа та потужність стаціонарних ЗОЗ ПХД – вкрай недостатня, що зумовлює значну потребу надання ПХД та паліативного догляду на рівні ПМД із залученням медичних працівників ЗОЗ ПМД. Обґрунтовано, розроблено та апробовано на рівні окремих інноваційних складових концептуальну модель системи ПХД, основою якої є пацієнт-сім'я-орієнтований, мультидисциплінарний, міжвідомчий і міжсекторальний підхід на усіх рівнях надання медичної допомоги, з акцентом на ПМД, що відповідає сучасним міжнародним стандартам і нормам, з метою інтеграції ПХД в систему охорони здоров'я, що забезпечить безперервність та наступність її надання і зворотний зв'язок. Запропонована концептуальна модель оптимальної системи ПХД являє собою високопрофесійну складову охорони здоров'я, що потребує сучасного високотехнологічного обладнання та ефективних лікарських засобів, спеціальної професійної підготовки і мотивації кадрів, відповідної нормативно-правової бази і, безумовно, належного фінансового забезпечення і політичної підтримки Уряду України, регіональних і місцевих органів влади та зацікавленості і підтримки усього суспільства.

This dissertation argues that the psychic force that Freud named "the death drive" would more precisely be termed "the disability drive." Freud's concept of the death drive emerged from his efforts to account for feelings, desires, and actions that seemed not to accord with rational self-interest or the desire for pleasure. Positing that human subjectivity was intrinsically divided against itself, Freud suggested that the ego's instincts for pleasure and survival were undermined by a competing component of mental life, which he called the death drive. But the death drive does not primarily refer to biological death, and the term has consequently provoked confusion. By distancing Freud's theory from physical death and highlighting its imbrication with disability, I revise this important psychoanalytic concept and reveal its utility to disability studies. While Freud envisaged a human subject that is drawn, despite itself, toward something like death, I propose that this "something" can productively be understood as disability. In addition, I contend that our culture's repression of the disability drive, and its resultant projection of the drive onto stigmatized minorities, is a root cause of multiple forms of oppression."The Disability Drive" opens with a question: "What makes disability so sexy?" This is a counterintuitive query; after all, the dominant culture usually depicts disability as decidedly unsexy. But by performing a critical disability studies analysis of Freud's writings about sexuality and the death drive, I theorize sex as an intrinsically disabling experience and suggest that fantasies of disability may have an unrecognized sexual appeal. These possibilities lead me to introduce a new interpretive framework, "the sexual model of disability," which I posit as an alternative to disability studies' prevailing analytic paradigm, the social model of disability. While the social model defines disability as a system of oppression that isolates and excludes disabled people, the sexual model of disability goes deeper than this, locating the impetus for these exclusions in our culture's repression of the disability drive. Because disability may provoke an erotic excitement that the ego cannot bear to acknowledge, ableist culture is often torn between an urge to witness disability (e.g., by staring at disabled people) and an impulse to hide disability from view (e.g., by confining disabled people to institutions). The sexual model of disability has the potential to make interventions not only in disability studies but also in a range of other disciplines. In Chapter 1, I bring my account of the disability drive to bear on signal texts in queer theory. In doing so, I proffer an answer to a question that has long troubled disability scholars: given the many similarities between ableism and homophobia, why have queer theorists often been reluctant to engage with disability studies? Observing that founding texts in queer theory repudiate "feminist identity politics" and liken this discourse to madness and to figurative states of blindness and paralysis, I argue that these texts project the disability drive onto feminism, thus allowing queer theory to portray its own erotics as mobile, playful, and physically and mentally able. In Chapter 2, I show that the sexual model of disability can subvert a foundational concept in psychoanalysis: the disease category "hysteria." Analyzing Freud's case history Dora, which was published in 1905, in conjunction with Beyond the Pleasure Principle, which was published in 1920, I argue that Freud's notion of hysteria adumbrates his later theorization of the drive. The diagnostic category of hysteria, I contend, constitutes a projection of the disability drive onto people with what I call "undocumented disabilities," that is, nonapparent impairments for which mainstream western medicine cannot identify biological causes. One effect of this projection is that people with undocumented disabilities are figured as epistemologically disabled; that is, we are seen as distinctively lacking in the capacity to know ourselves.The social position of people with undocumented disabilities differs from that of the paradigmatic subject of disability studies: while people with undocumented impairments are often denied recognition of the disabling suffering that shapes our lives, people with disabilities that are visible and/or documented are frequently subjected to unwanted displays of pity. For this reason, "no pity" has long been a rallying cry of the disability rights movement. But is it possible to proscribe pity? In Chapter 3, I argue that instead of seeking to banish the affect of pity, disability scholars might do better to attend to the complex ways in which this affect can be incited and expressed. Toward this end, I propose a distinction between what I call "primary pity" and "secondary pity." The term "secondary pity" accords with the everyday understanding of pity, in which a person who feels pity is assumed to occupy a position of superiority in relation to a person who is pitied. Primary pity refers to a very different affective process, which is profoundly destabilizing to the ego of the person who feels pity. Derived in part from Freud's notion of "primary narcissism," my concept of primary pity occupies a liminal position between the erasure of the ego that primary narcissism entails and the buttressing of the ego involved in secondary narcissism. Because primary pity involves a complex process of identification, in which the subject and the object of pity risk becoming fantasmatically indistinguishable, this emotion threatens the ego's belief in its self-sufficiency and autonomy. I argue that primary pity's threat to the ego can be understood as a manifestation of the disability drive, and I suggest that the "no pity" position taken up by disability activists and scholars may be invested in a fantasy of overcoming the disability drive.This dissertation argues that rather than seeking to overcome the disability drive, cultural critics and activists should work to acknowledge the myriad ways in which the drive determines us. It is important to recognize and acknowledge one's determination by the disability drive because denying or repressing the ways in which this psychic force governs us will inevitably lead to the drive's being abjected onto groups of stigmatized others. In Chapter 4, I argue that in contemporary US American culture fat people constitute one such group. This chapter focuses on the drive to eat, a compulsion that I define as inseparable from the disability drive. Dependence, (on food), loss of mastery (over the intensities of the pleasures of eating), and failures of control (over what, and how much, one eats) combine to make hunger a fundamentally disabling drive. But instead of acknowledging that we are all disabled by the drive to eat, our culture abjects this drive onto fat people, whom it depicts as being driven, in ways that thin people are assumed not to be, by an out-of-control compulsion to eat. US American culture's projection of the disability drive onto fat people is intensified by racially inflected assumptions about "primitive" versus "civilized" forms of embodiment and by heteronormative constructions of "perversion." Resisting fatphobia therefore necessitates an intersectional analysis of the disability drive, an approach that takes measure of the ways in which repressing the drive reinforces multiple forms of prejudice.The central aim of this thesis is to show that the disability drive is a force that we must understand if we are to effectively challenge the many intersecting and overlapping modalities of oppression that define present-day cultural and social relations. "The Disability Drive" offers an invitation, to scholars and activists in a variety of cultural locations, to consider the ways in which our own beliefs and practices may be implicated in a hegemonic cultural endeavor whose goal is to overcome the disability drive. Because denying the drive results in the reentrenchment of oppressive social structures, I maintain that it is imperative to develop political strategies that resist the impulse to overcome the disability drive.

In the new issue, our scientific journal offers you thirteen scientific articles. As always, we try to offer a wide variety of topics and areas and follow current trends in the history of science and technology. In the article by Olha Chumachenko, оn the basis of a wide base of sources, the article highlights and analyzes the development of research work of aircraft engine companies in Zaporizhzhia during the 1970s. The existence of a single system of functioning of the Zaporizhzhia production association "Motorobudivnyk" (now the Public Joint Stock Company "Motor Sich") and the Zaporizhzhia Machine-Building Design Bureau "Progress" (now the State Enterprise "Ivchenko – Progress") has been taken into account. Leonid Griffen and Nadiia Ryzheva present their vision of the essence of technology as a socio-historical phenomenon. The article reveals the authors' vision of the essence of the technology as a sociohistorical phenomenon. It is based on the idea that technology is not only a set of technical devices but a segment of the general system – a society – located between a social medium and its natural surroundings in the form of a peculiar social technosphere, which simultaneously separates and connects them. Definitely the article by Denis Kislov, which examines the period from the end of the XVII century to the beginning of the XIX century, is also of interest, when on the basis of deep philosophical concepts, a new vision of the development of statehood and human values raised. At this time, a certain re-thinking of the management and communication ideas of Antiquity and the Renaissance took place, which outlined the main promising trends in the statehood evolution, which to one degree or another were embodied in practice in the 19th and 20th centuries. A systematic approach and a comparative analysis of the causes and consequences of those years' achievements for the present and the immediate future of the 21st century served as the methodological basis for a comprehensive review of the studies of that period. The article by Serhii Paliienko is devoted to an exploration of archaeological theory issues at the Institute of archaeology AS UkrSSR in the 1960s. This period is one of the worst studied in the history of Soviet archaeology. But it was the time when in the USSR archaeological researches reached the summit, quantitative methods and methods of natural sciences were applied and interest in theoretical issues had grown in archaeology. Now there are a lot of publications dedicated to theoretical discussions between archaeologists from Leningrad but the same researches about Kyiv scholars are still unknown The legacy of St.Luke in medical science, authors from Greece - this study aims to highlight key elements of the life of Valentyn Feliksovych Voino-Yasenetskyi and his scientific contribution to medicine. Among the scientists of European greatness, who at the turn of the XIX and XX centuries showed interest to the folklore of Galicia (Halychyna) and Galician Ukrainians, contributed to their national and cultural revival, one of the leading places is occupied by the outstanding Ukrainian scientist Ivan Verkhratskyi. He was both naturalist and philologist, as well as folklorist and ethnographer, organizer of scientific work, publisher and popularizer of Ukrainian literature, translator, publicist and famous public figure. I.H.Verkhratskyi was also an outstanding researcher of plants and animals of Eastern Galicia, a connoisseur of insects, especially butterflies, the author of the first school textbooks on natural science written in Ukrainian. A new emerging field that has seen the application of the drone technology is the healthcare sector. Over the years, the health sector has increasingly relied on the device for timely transportation of essential articles across the globe. Since its introduction in health, scholars have attempted to address the impact of drones on healthcare across Africa and the world at large. Among other things, it has been reported by scholars that the device has the ability to overcome the menace of weather constraints, inadequate personnel and inaccessible roads within the healthcare sector. This notwithstanding, data on drones and drone application in Ghana and her healthcare sector in particular appears to be little within the drone literature. Also, little attempt has been made by scholars to highlight the use of drones in African countries. By using a narrative review approach, the current study attempts to address the gap above. By this approach, a thorough literature search was performed to locate and assess scientific materials involving the application of drones in the military field and in the medical systems of Africans and Ghanaians in particular. The paper by Artemii Bernatskyi and Vladyslav Khaskin is devoted to the analysis of the history of the laser creation as one of the greatest technical inventions of the 20th century. This paper focuses on establishing a relation between the periodization of the stages of creation and implementation of certain types of lasers, with their influence on the invention of certain types of equipment and industrial technologies for processing the materials, the development of certain branches of the economy, and scientific-technological progress as a whole. The paper discusses the stages of: invention of the first laser; creation of the first commercial lasers; development of the first applications of lasers in industrial technologies for processing the materials. Special attention is paid to the "patent wars" that accompanied different stages of the creation of lasers. A comparative analysis of the market development for laser technology from the stage of creation to the present has been carried out. Nineteenth-century world exhibitions were platforms to demonstrate technical and technological changes that witnessed the modernization and industrialization of the world. World exhibitions have contributed to the promotion of new inventions and the popularization of already known, as well as the emergence of art objects of world importance. One of the most important world events at the turn of the century was the 1900 World's Fair in Paris. Thus, the author has tried to analyze the participation of representatives of the sugar industry in the World's Fair in 1900 and to define the role of exhibitions as indicators of economic development, to show the importance and influence of private entrepreneurs, especially from Ukraine, on the sugar industry and international contacts. The article by Viktor Verhunov highlights the life and creative path of the outstanding domestic scientist, theorist, methodologist and practitioner of agricultural engineering K.G.Schindler, associated with the formation of agricultural mechanics in Ukraine. The methodological foundation of the research is the principles of historicism, scientific nature and objectivity in reproducing the phenomena of the past based on the complex use of general scientific, special, interdisciplinary methods. For the first time a number of documents from Russian and Ukrainian archives, which reflect some facts of the professional biography of the scientist, were introduced into scientific circulation. The authors from Kremenchuk National University named after Mykhailo Ostrohradskyi presented a fascinating study of a bayonet fragment with severe damages of metal found in the city Kremenchuk (Ukraine) in one of the canals on the outskirts of the city, near the Dnipro River. Theoretical research to study blade weapons of the World War I period and the typology of the bayonets of that period, which made it possible to put forward an assumption about the possible identification of the object as a modified bayonet to the Mauser rifle has been carried out. Metal science expert examination was based on X-ray fluorescence spectrometry to determine the concentration of elements in the sample from the cleaned part of the blade. In the article by Mykola Ruban and Vadym Ponomarenko on the basis of the complex analysis of sources and scientific literature the attempt to investigate historical circumstances of development and construction of shunting electric locomotives at the Dnipropetrovsk electric locomotive plant has been made. The next scientific article continues the series of publications devoted to the assessment of activities of the heads of the Ministry of Railways of the Russian Empire. In this article, the authors have attempted to systematize and analyze historical data on the activities of Klavdii Semyonovych Nemeshaev as the Minister of Railways of the Russian Empire. The article also assesses the development and construction of railway network in the Russian Empire during Nemeshaev's office, in particular, of the Amur Line and Moscow Encircle Railway, as well as the increase in the capacity of the Trans-Siberian Railway. The article discusses K.S.Nemeshaev's contribution to the development of technology and the introduction of a new type of freight steam locomotive for state-owned railways. We hope that everyone will find interesting useful information in the new issue. And, of course, we welcome your new submissions. ; In the new issue, our scientific journal offers you thirteen scientific articles. As always, we try to offer a wide variety of topics and areas and follow current trends in the history of science and technology. In the article by Olha Chumachenko, оn the basis of a wide base of sources, the article highlights and analyzes the development of research work of aircraft engine companies in Zaporizhzhia during the 1970s. The existence of a single system of functioning of the Zaporizhzhia production association "Motorobudivnyk" (now the Public Joint Stock Company "Motor Sich") and the Zaporizhzhia Machine-Building Design Bureau "Progress" (now the State Enterprise "Ivchenko – Progress") has been taken into account. Leonid Griffen and Nadiia Ryzheva present their vision of the essence of technology as a socio-historical phenomenon. The article reveals the authors' vision of the essence of the technology as a sociohistorical phenomenon. It is based on the idea that technology is not only a set of technical devices but a segment of the general system – a society – located between a social medium and its natural surroundings in the form of a peculiar social technosphere, which simultaneously separates and connects them. Definitely the article by Denis Kislov, which examines the period from the end of the XVII century to the beginning of the XIX century, is also of interest, when on the basis of deep philosophical concepts, a new vision of the development of statehood and human values raised. At this time, a certain re-thinking of the management and communication ideas of Antiquity and the Renaissance took place, which outlined the main promising trends in the statehood evolution, which to one degree or another were embodied in practice in the 19th and 20th centuries. A systematic approach and a comparative analysis of the causes and consequences of those years' achievements for the present and the immediate future of the 21st century served as the methodological basis for a comprehensive review of the studies of that period. The article by Serhii Paliienko is devoted to an exploration of archaeological theory issues at the Institute of archaeology AS UkrSSR in the 1960s. This period is one of the worst studied in the history of Soviet archaeology. But it was the time when in the USSR archaeological researches reached the summit, quantitative methods and methods of natural sciences were applied and interest in theoretical issues had grown in archaeology. Now there are a lot of publications dedicated to theoretical discussions between archaeologists from Leningrad but the same researches about Kyiv scholars are still unknown The legacy of St.Luke in medical science, authors from Greece - this study aims to highlight key elements of the life of Valentyn Feliksovych Voino-Yasenetskyi and his scientific contribution to medicine. Among the scientists of European greatness, who at the turn of the XIX and XX centuries showed interest to the folklore of Galicia (Halychyna) and Galician Ukrainians, contributed to their national and cultural revival, one of the leading places is occupied by the outstanding Ukrainian scientist Ivan Verkhratskyi. He was both naturalist and philologist, as well as folklorist and ethnographer, organizer of scientific work, publisher and popularizer of Ukrainian literature, translator, publicist and famous public figure. I.H.Verkhratskyi was also an outstanding researcher of plants and animals of Eastern Galicia, a connoisseur of insects, especially butterflies, the author of the first school textbooks on natural science written in Ukrainian. A new emerging field that has seen the application of the drone technology is the healthcare sector. Over the years, the health sector has increasingly relied on the device for timely transportation of essential articles across the globe. Since its introduction in health, scholars have attempted to address the impact of drones on healthcare across Africa and the world at large. Among other things, it has been reported by scholars that the device has the ability to overcome the menace of weather constraints, inadequate personnel and inaccessible roads within the healthcare sector. This notwithstanding, data on drones and drone application in Ghana and her healthcare sector in particular appears to be little within the drone literature. Also, little attempt has been made by scholars to highlight the use of drones in African countries. By using a narrative review approach, the current study attempts to address the gap above. By this approach, a thorough literature search was performed to locate and assess scientific materials involving the application of drones in the military field and in the medical systems of Africans and Ghanaians in particular. The paper by Artemii Bernatskyi and Vladyslav Khaskin is devoted to the analysis of the history of the laser creation as one of the greatest technical inventions of the 20th century. This paper focuses on establishing a relation between the periodization of the stages of creation and implementation of certain types of lasers, with their influence on the invention of certain types of equipment and industrial technologies for processing the materials, the development of certain branches of the economy, and scientific-technological progress as a whole. The paper discusses the stages of: invention of the first laser; creation of the first commercial lasers; development of the first applications of lasers in industrial technologies for processing the materials. Special attention is paid to the "patent wars" that accompanied different stages of the creation of lasers. A comparative analysis of the market development for laser technology from the stage of creation to the present has been carried out. Nineteenth-century world exhibitions were platforms to demonstrate technical and technological changes that witnessed the modernization and industrialization of the world. World exhibitions have contributed to the promotion of new inventions and the popularization of already known, as well as the emergence of art objects of world importance. One of the most important world events at the turn of the century was the 1900 World's Fair in Paris. Thus, the author has tried to analyze the participation of representatives of the sugar industry in the World's Fair in 1900 and to define the role of exhibitions as indicators of economic development, to show the importance and influence of private entrepreneurs, especially from Ukraine, on the sugar industry and international contacts. The article by Viktor Verhunov highlights the life and creative path of the outstanding domestic scientist, theorist, methodologist and practitioner of agricultural engineering K.G.Schindler, associated with the formation of agricultural mechanics in Ukraine. The methodological foundation of the research is the principles of historicism, scientific nature and objectivity in reproducing the phenomena of the past based on the complex use of general scientific, special, interdisciplinary methods. For the first time a number of documents from Russian and Ukrainian archives, which reflect some facts of the professional biography of the scientist, were introduced into scientific circulation. The authors from Kremenchuk National University named after Mykhailo Ostrohradskyi presented a fascinating study of a bayonet fragment with severe damages of metal found in the city Kremenchuk (Ukraine) in one of the canals on the outskirts of the city, near the Dnipro River. Theoretical research to study blade weapons of the World War I period and the typology of the bayonets of that period, which made it possible to put forward an assumption about the possible identification of the object as a modified bayonet to the Mauser rifle has been carried out. Metal science expert examination was based on X-ray fluorescence spectrometry to determine the concentration of elements in the sample from the cleaned part of the blade. In the article by Mykola Ruban and Vadym Ponomarenko on the basis of the complex analysis of sources and scientific literature the attempt to investigate historical circumstances of development and construction of shunting electric locomotives at the Dnipropetrovsk electric locomotive plant has been made. The next scientific article continues the series of publications devoted to the assessment of activities of the heads of the Ministry of Railways of the Russian Empire. In this article, the authors have attempted to systematize and analyze historical data on the activities of Klavdii Semyonovych Nemeshaev as the Minister of Railways of the Russian Empire. The article also assesses the development and construction of railway network in the Russian Empire during Nemeshaev's office, in particular, of the Amur Line and Moscow Encircle Railway, as well as the increase in the capacity of the Trans-Siberian Railway. The article discusses K.S.Nemeshaev's contribution to the development of technology and the introduction of a new type of freight steam locomotive for state-owned railways. We hope that everyone will find interesting useful information in the new issue. And, of course, we welcome your new submissions. ; In the new issue, our scientific journal offers you thirteen scientific articles. As always, we try to offer a wide variety of topics and areas and follow current trends in the history of science and technology. In the article by Olha Chumachenko, оn the basis of a wide base of sources, the article highlights and analyzes the development of research work of aircraft engine companies in Zaporizhzhia during the 1970s. The existence of a single system of functioning of the Zaporizhzhia production association "Motorobudivnyk" (now the Public Joint Stock Company "Motor Sich") and the Zaporizhzhia Machine-Building Design Bureau "Progress" (now the State Enterprise "Ivchenko – Progress") has been taken into account. Leonid Griffen and Nadiia Ryzheva present their vision of the essence of technology as a socio-historical phenomenon. The article reveals the authors' vision of the essence of the technology as a sociohistorical phenomenon. It is based on the idea that technology is not only a set of technical devices but a segment of the general system – a society – located between a social medium and its natural surroundings in the form of a peculiar social technosphere, which simultaneously separates and connects them. Definitely the article by Denis Kislov, which examines the period from the end of the XVII century to the beginning of the XIX century, is also of interest, when on the basis of deep philosophical concepts, a new vision of the development of statehood and human values raised. At this time, a certain re-thinking of the management and communication ideas of Antiquity and the Renaissance took place, which outlined the main promising trends in the statehood evolution, which to one degree or another were embodied in practice in the 19th and 20th centuries. A systematic approach and a comparative analysis of the causes and consequences of those years' achievements for the present and the immediate future of the 21st century served as the methodological basis for a comprehensive review of the studies of that period. The article by Serhii Paliienko is devoted to an exploration of archaeological theory issues at the Institute of archaeology AS UkrSSR in the 1960s. This period is one of the worst studied in the history of Soviet archaeology. But it was the time when in the USSR archaeological researches reached the summit, quantitative methods and methods of natural sciences were applied and interest in theoretical issues had grown in archaeology. Now there are a lot of publications dedicated to theoretical discussions between archaeologists from Leningrad but the same researches about Kyiv scholars are still unknown The legacy of St.Luke in medical science, authors from Greece - this study aims to highlight key elements of the life of Valentyn Feliksovych Voino-Yasenetskyi and his scientific contribution to medicine. Among the scientists of European greatness, who at the turn of the XIX and XX centuries showed interest to the folklore of Galicia (Halychyna) and Galician Ukrainians, contributed to their national and cultural revival, one of the leading places is occupied by the outstanding Ukrainian scientist Ivan Verkhratskyi. He was both naturalist and philologist, as well as folklorist and ethnographer, organizer of scientific work, publisher and popularizer of Ukrainian literature, translator, publicist and famous public figure. I.H.Verkhratskyi was also an outstanding researcher of plants and animals of Eastern Galicia, a connoisseur of insects, especially butterflies, the author of the first school textbooks on natural science written in Ukrainian. A new emerging field that has seen the application of the drone technology is the healthcare sector. Over the years, the health sector has increasingly relied on the device for timely transportation of essential articles across the globe. Since its introduction in health, scholars have attempted to address the impact of drones on healthcare across Africa and the world at large. Among other things, it has been reported by scholars that the device has the ability to overcome the menace of weather constraints, inadequate personnel and inaccessible roads within the healthcare sector. This notwithstanding, data on drones and drone application in Ghana and her healthcare sector in particular appears to be little within the drone literature. Also, little attempt has been made by scholars to highlight the use of drones in African countries. By using a narrative review approach, the current study attempts to address the gap above. By this approach, a thorough literature search was performed to locate and assess scientific materials involving the application of drones in the military field and in the medical systems of Africans and Ghanaians in particular. The paper by Artemii Bernatskyi and Vladyslav Khaskin is devoted to the analysis of the history of the laser creation as one of the greatest technical inventions of the 20th century. This paper focuses on establishing a relation between the periodization of the stages of creation and implementation of certain types of lasers, with their influence on the invention of certain types of equipment and industrial technologies for processing the materials, the development of certain branches of the economy, and scientific-technological progress as a whole. The paper discusses the stages of: invention of the first laser; creation of the first commercial lasers; development of the first applications of lasers in industrial technologies for processing the materials. Special attention is paid to the "patent wars" that accompanied different stages of the creation of lasers. A comparative analysis of the market development for laser technology from the stage of creation to the present has been carried out. Nineteenth-century world exhibitions were platforms to demonstrate technical and technological changes that witnessed the modernization and industrialization of the world. World exhibitions have contributed to the promotion of new inventions and the popularization of already known, as well as the emergence of art objects of world importance. One of the most important world events at the turn of the century was the 1900 World's Fair in Paris. Thus, the author has tried to analyze the participation of representatives of the sugar industry in the World's Fair in 1900 and to define the role of exhibitions as indicators of economic development, to show the importance and influence of private entrepreneurs, especially from Ukraine, on the sugar industry and international contacts. The article by Viktor Verhunov highlights the life and creative path of the outstanding domestic scientist, theorist, methodologist and practitioner of agricultural engineering K.G.Schindler, associated with the formation of agricultural mechanics in Ukraine. The methodological foundation of the research is the principles of historicism, scientific nature and objectivity in reproducing the phenomena of the past based on the complex use of general scientific, special, interdisciplinary methods. For the first time a number of documents from Russian and Ukrainian archives, which reflect some facts of the professional biography of the scientist, were introduced into scientific circulation. The authors from Kremenchuk National University named after Mykhailo Ostrohradskyi presented a fascinating study of a bayonet fragment with severe damages of metal found in the city Kremenchuk (Ukraine) in one of the canals on the outskirts of the city, near the Dnipro River. Theoretical research to study blade weapons of the World War I period and the typology of the bayonets of that period, which made it possible to put forward an assumption about the possible identification of the object as a modified bayonet to the Mauser rifle has been carried out. Metal science expert examination was based on X-ray fluorescence spectrometry to determine the concentration of elements in the sample from the cleaned part of the blade. In the article by Mykola Ruban and Vadym Ponomarenko on the basis of the complex analysis of sources and scientific literature the attempt to investigate historical circumstances of development and construction of shunting electric locomotives at the Dnipropetrovsk electric locomotive plant has been made. The next scientific article continues the series of publications devoted to the assessment of activities of the heads of the Ministry of Railways of the Russian Empire. In this article, the authors have attempted to systematize and analyze historical data on the activities of Klavdii Semyonovych Nemeshaev as the Minister of Railways of the Russian Empire. The article also assesses the development and construction of railway network in the Russian Empire during Nemeshaev's office, in particular, of the Amur Line and Moscow Encircle Railway, as well as the increase in the capacity of the Trans-Siberian Railway. The article discusses K.S.Nemeshaev's contribution to the development of technology and the introduction of a new type of freight steam locomotive for state-owned railways. We hope that everyone will find interesting useful information in the new issue. And, of course, we welcome your new submissions.

Background In armed conflicts, civilian health care struggles to cope. Understanding the relationship between demographics, injury mechanism, and injury patterns to predict what surgical resources are needed is therefore vital. In the 1990s the International Committee of the Red Cross (ICRC) implemented the Red Cross Wound Score (RCWS) for the assessment of penetrating injuries. It is unknown to what extent RCWS can be used to predict surgical resource consumption and in-hospital mortality. A substantial portion of surgical resources in conflicts are used in the treatment of infected wounds, which entails antibiotics, debridements, and change of dressings. Many health care providers advocate for the use of honey as an adjunct due to its bactericidal and hyperosmotic properties. However, the scientific evidence to support this notion is insufficient. If efficacy for honey could be demonstrated, the need for repeated debridements and antibiotics could potentially be reduced, subsequently allowing for more efficient use of surgical resources. Objectives To increase knowledge regarding the relationship between demographics, injury mechanism, injury patterns, treatment received (Paper I), treatment trends (Paper II), and surgical resources consumption (Paper III). To identify predictive methods (Paper III) and practices (Paper IV) that can improve how surgical resources are used in resource-constrained conflict settings. Materials and Methods In Papers I – III routine clinical data from patients treated at three ICRC hospitals were used. The patients had weapon-related injuries from either the conflict around the Afghanistan – Pakistan border or the conflict in the Kivu region in the Democratic Republic of the Congo (DRC). In Paper I, the relationships between gender, injury mechanism, injury patterns, and treatment received were examined with univariate statistics. In Paper II, differences in treatment practices between 1992 – 1995 and 2009 – 2012 for extremity injuries were analysed with univariate statistics and logistic regression to adjust for differences in injury mechanism and severity. In Paper III, univariate statistics, logistic regression, receiver operating characteristics curves, and goodness of fit were used to determine the predictive ability of RCWS and commonly used trauma scores for surgical resource consumption. In Paper IV, 50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topical honey or intramuscular gentamicin to determine if topical honey is non-inferior to systemic gentamicin treatment. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological and immunohistochemical assays, as well as assessment of inflammatory response. Main findings In both conflicts, most of the patients were males in their mid-twenties with injuries to the extremities. Injuries from indiscriminate weapons (such as bombs, missiles, and explosives) were more predominant in the Afghanistan – Pakistan border conflict, and gunshot injuries were more frequent in the Kivu conflict. Soft tissue procedures were the most common type of surgery. Less than 20% of the patients were subjected to major surgery, and in-hospital mortality was under 5% (Papers I – III). Females were more frequently injured by indiscriminate weapons, had more severely affected vital parameters, received more blood transfusions, and were subjected to more extensive surgery than the males (Paper I). During the last decades, the risk for amputation remained unchanged, while the use of external fixation and split skin grafts decreased (Paper II). RCWS predicted high surgical resource consumption better than and in-hospital mortality at least equal to commonly used trauma scores (Paper III). Wound size was unchanged with topical honey and decreased with intramuscular gentamicin. However, there was no difference in bacterial count between honey and gentamicin at the end of treatment (Paper IV). Conclusions Females were more frequently injured by indiscriminate weapons, had more severe injuries, and had greater surgical treatment needs than the males (Paper I). Even though injuries to the extremities remain common in armed conflicts, the use of limb-preserving treatment techniques seems to have decreased during the last decades (Paper II). RCWS demonstrated a better predictive ability for surgical resource consumption compared to commonly used trauma scores (Paper III). Topical honey may be non-inferior to gentamicin in reducing S. aureus colonization on the wound's surface, but not in reducing wound size (Paper IV). ; Väpnade konflikter leder till kollaps av existerande hälso-och sjukvårdssystem, vilket snabbt begränsar eller omöjliggör kirurgisk vård för patienter med potentiellt livshotande skador. Dessutom är skador i väpnade konflikter ofta mer komplexa och resurskrävande än skador som förekommer i fredstid. För vårdgivare behövs därför kunskap om vad som påverkar det kirurgiska resursbehovet i konflikter, men även metoder för att kunna följa och förutsäga det samma. Internationella Rödakorskommittén (ICRC) har sedan 1990-talet använt ett system för sårklassificering (RCWS) för att hjälpa kirurger att bedöma och prioritera penetrerande sårskador. Det är okänt i vilken utsträckning RCWS eller andra klassificeringssystem som används i civil traumasjukvård kan användas för att förutsäga kirurgiskt resursbehov och dödlighet i resursknappa konfliktmiljöer. En betydande del av kirurgiska resurser i konflikter används för behandling av infekterade sår. Många vårdgivare förespråkar användande av honung som del i denna behandling. Detta på grund av honungs bakteriedödande och uttorkande egenskaper. Det saknas dock vetenskapligt stöd för denna uppfattning. Om honung kan påvisas vara effektivt som behandling för infekterade sår skulle behovet av antibiotika och upprepade kirurgiska behandlingar kunna minskas. Detta skulle möjliggöra mer effektivt användande av kirurgiska resurser. Denna avhandling syftar till att öka kunskapen kring hur kirurgiska resurser används i resursknappa konfliktmiljöer. Detta med målsättningen att identifiera metoder för att förutsäga och mäta det kirurgiska resursbehovet och göra användandet av det samma mera effektivt. I tre av de studier som ingår i avhandlingen har rutinmässigt insamlade journaluppgifter från patienter som behandlats vid tre ICRC sjukhus använts. Patienterna hade vapen-orsakade skador från konflikten vid gränsen mellan Afghanistan och Pakistan eller konflikten i Kivu-regionen i Demokratiska republiken Kongo (DRC). I den första studien undersöktes förhållandet mellan kön, skademekanism, uppkomna skador och erhållen kirurgisk behandling för patienter som behandlats vid ICRC sjukhuset i Peshawar, Pakistan. I den andra studien undersöktes hur behandlingen av vapen-orsakade extremitetsskador skilde sig mellan perioderna 1992 – 1995 och 2009 – 2012 vid ICRC sjukhus i Quetta och Peshawar, Pakistan. I den tredje studien prövades hur väl RCWS samt poängssystem som används i civil traumasjukvård kunde förutsäga det kirurgiska behandlingsbehovet hos patienter vid ICRC sjukhus i Peshawar, Pakistan, och Goma, DRC. I den sista studien jämfördes honung och antibiotika som behandling av infekterade sår i en försöksdjursmodell. De båda behandlingarna utvärderades och jämfördes genom bakterieodlingar, mätningar av såryta, histologiska och immunhistokemiska analyser samt inflammatoriskt svar. På de studerade ICRC sjukhusen var de flesta patienterna män i tjugoårsåldern med skador på armar eller ben. Skador från urskillningslösa vapen, som granater, missiler och bomber, var mer frekvent förekommande i gränskonflikten mellan Afghanistan och Pakistan, medan skottskador var vanligare i Kivu-konflikten. Behandling av mjukdelsskador var den vanligaste typen av kirurgi. Mindre än 20% av patienterna genomgick större operationer och dödligheten under sjukhusvistelsen var mindre än 5%. Kvinnor skadades i större omfattning av urskillningslösa vapen, hade allvarligare skador, fick oftare blodtransfusioner och behandlades med mera omfattande kirurgi än männen. Trots att skador på armar och ben är vanligt förekommande i väpnande konflikter så hade användandet av frakturstabiliserande åtgärder och hudtransplantationer minskat under de senaste årtiondena, medan risken för amputation var oförändrad. RCWS var bättre på att förutsäga kirurgisk resursförbrukning än de poängsystem som används i civil traumasjukvård. Slutligen visade den sista studien i avhandlingen att varken honung eller antibiotika minskar antalet bakterier i sår efter avslutad behandling. Däremot minskade sårens storlek med antibiotika, men var oförändrade med honung. Möjligen skulle därför honung kunna vara effektivt för att förhindra bakterieväxt på sårytan. Det finns därför anledning att undersöka om honung kan vara ett värdefullt tillägg till antibiotika och kirurgisk behandling. Detta skulle kunna förbättra användandet av de begränsade kirurgiska resurser som finns tillgängliga i väpnade konflikter. ; Funding agencies: • Elsa and Sigurd Golje Foundation • Linköping Society of Medicine • RALF and ALF grants, Region Östergötland • Kamprad Family Foundation

Schmerzen sind nur schwer in Sprache zu fassen, indessen sind sie präverbal kommunizierbar wie kaum ein anderes Erleben. Chronische Schmerzsyndrome bei Migranten fordern die Fachleute heraus. Die psychoanalytische Literatur zur Psychosomatik kann aber wenig Erhellendes über die spezifischen Gesundheitsprobleme dieses Bevölkerungsanteiles aussagen. Es stellt sich sogar die Frage, inwiefern die Diagnose der Psychosomatik als Restkategorie der somatischen Medizin überhaupt auf eine einheitliche Psychodynamik verweisen kann. Schmerzen spielen bei den Phänomenen Krankheit und Verletzung, bei Folter und Krieg, aber auch für das ganz normale Lernen eine wesentliche Rolle. Im Hinblick auf das Lernen wird eine These des französischen Ethnopsy-choanalytikers Tobie Nathan vorgestellt, nach der in Ritualen vorkommenden Traumatisierungen - und damit dem absichtsvollen Zufügen von Schmerzen -eine wichtige Rolle zukomme. Ein Vergleich zwischen den in den letzten Jahren vielfach rezipierten, nichtpsychoanalytischen Theorien zum Trauma und dem Freud'schen Traumabegriff führt zur Frage, wie die Kluft zwischen Sprechen und körperlichem Erleben therapeutisch angegangen werden kann. Die Fallvignette eines Mannes, dessen Lebensgeschichte von bedeutenden Einschnitten und Schritten fast zu voll ist, zeigt, dass die Schwierigkeit der Deutungsarbeit hier nicht im Inhaltlichen liegt. Bei Patienten, denen der Weg der Psychotherapie sehr fremd ist und deren unbewusste Konflikte sich durch somatische Symptome oder im Ausagieren zeigen, liegt die Herausforderung an die Therapeutin darin, wie eine verständliche Sprache gefunden werden kann, bei der der Patient unmittelbar - körperlich quasi - berührt wird.Schlüsselwörter:Chronische Schmerzsyndrome bei Migranten; Lernprozess; Traumatheorie ; Pain is hard to express in words but it communicates itself in a nonverbal way. Chronic pain is often found within the migrant population. These syndromes are a challenge for experts. Meanwhile the psychoanalytic specialized literature about psychoso-matics does not contribute a great deal to the clarification of the health problems of this section of the population. We even have to ask if the diagnosis of psychosomatic as a remnant category of somatic medicine refers after all to homogenous psychic dynamics. Pain is important to the phenomena of illness and injury, torture and war, but it also plays an important part in the normal process of learning.A hypothesis of the French ethno-psychoanalyst Tobie Nathan concerning processes of learning will be presented. This author claims that traumatism fulfils an important function in rituals of archaic cultures. A comparison of the, nowadays, often cited nonpsychoanalyt-ic theories of trauma with the Freudian one leads us to the issue of how to bridge the gap between language and bodily sensations in the course of therapies. The vignette of a patient whose life history is full of meaningful turning points shows that the difficulty of interpreting is not to be found in the content. The challenge for the therapist with patients whose cultural background is foreign to therapeutic thinking lies in finding an adequate language, capable of touching the patient immediately, as it were bodily, especially when unconscious conflicts show themselves through bodily symptoms or a tendency towards acting out.Keywords:Chronic pain; Migrant population; Learning process; Trauma ; L'auteur considère la douleur comme un vécu subjectif. Elle constate qu'il est difficile de la traduire en mots, alors qu'elle peut être communiquée au niveau pré-verbal plus facilement que d'autres vécus. L'article a pour thème central la manière dont des patients originaires d'autres cultures gèrent les phénomènes associés à des douleurs chroniques. On se rend compte que les psychanalystes s'intéressant à la psychosomatique ont publié peu de travaux utiles sur les problèmes de santé spécifiques aux immigrés. L'auteur présente des ouvrages issus de l'ethnologie de la médecine ; il y est indiqué que, sur un plan culturel comme à un niveau interculturel, les douleurs expriment beaucoup plus et quelque chose d'autre que des conflits inconscients. Ces travaux montrent également qu'il ne faut pas interpréter avec trop de précipitation le comportement d'immigrés qui entreprennent une thérapie d'orientation psychanalytique ; il ne faut pas leur appliquer trop vite des schémas développés en psychosomatique car, du fait des attentes qui existent dans leur propre culture, ces patients peuvent avoir de nombreuses raisons de ne pas révéler à l'analyste leurs réflexions et/ou fantaisies intimes. L'auteur se pose aussi la question de savoir si le diagnostic d'un trouble psychosomatique n'est pas une sorte de catégorie secondaire de la médecine somatique, n'incluant pas une conception globale des processus psychodynamiques.Du point de vue de la culture, les douleurs accompagnent certains événements (maladie et blessure, torture et guerre) mais jouent aussi un rôle essentiel au niveau de l'apprentissage normal. Concernant ce dernier aspect, elle présente une thèse élaborée par l'ethno-psychanalyste français Tobie Nathan ; selon lui, les traumatismes - donc les douleurs - infligés volontairement jouent un rôle important dans le contexte des rituels pratiqués au sein des cultures archaïques. Mais ils ont aussi une fonction dans le cadre de l'apprentissage effectué par l'enfant en bas âge - voir le «apprendre par l'expérience » de W.R. Bion.Selon l'auteur, les théories des traumatismes - comme d'ailleurs celles des troubles psychosomatiques - soulignent que les patients souffrent d'un déficit de la capacité à symboliser. Elle compare les théories non-psychanalytiques souvent citées ces dernières années avec la théorie des traumatismes développée par Freud. Elle montre que la manière dont Freud conçoit le dépassement de la faille séparant le non-symbolique de l'expression symbolique (par le langage) peut être utile et que les théories plus récentes ne tiennent pas compte de l'interaction entre protection contre les stimulations et traumatisme, ni d'ailleurs de la manière dont l'expérience d'un traumatisme influe sur la formation de structures psychiques.L'auteur présente ensuite une brève analyse devant permettre de définir comment les immigrés souffrant de troubles psychosomatiques peuvent être provisoirement répartis en différentes catégories, dont certaines pour lesquelles il pourrait être utile d'appliquer cette notion de manque de capacité à symboliser. Elle présente ensuite le cas d'un jeune Irakien et montre comment ce patient, dont la biographie comptait un surplus de vécus lourds à porter, rendait le travail d'interprétation difficile - mais pas tellement au niveau du contenu. Lorsque les thérapeutes travaillent avec des patients pour lesquels la psychothérapie est quelque chose de totalement inconnu et dont les conflits inconscients s'expriment avant tout par des symptômes somati-ques et par l'extériorisation, le défi consiste surtout à trouver un langage intelligible qui les touchera directement - quasiment au niveau du corps.

A ARABIANS, p. 4, 30. Abortion, case of, 61. Author, anecdote of, 121, 124, 127,402. Alderman an, comparative view of, 191. Animal Magnetifm, 253. Alteratives, 269. Agriculture Society, Odiham, 270. Aliment, its procefs, 207. Adventurer, legerdemain, 355. Anecdotes, 367. Afcot, plate won, 61. Aliment, of different kinds, 93. Authors, a review of, 135 B Breeding, p. 1. Blood Horfes, 4, 316. Breeders, northern, 7. ———, inconfiftent, ir. , penurious, 49. Bowdrow, 18. Bloodftock, current price of, 24. Bracken, remark upon, 31, 213, 219, 253, 255. Breaking, 105- Breakers, intoxication of, 109. --- , qualifications, 113. Barrier, 157, 161, 182, 213. Bleeding, adverted to, 216. Blind Stallions, 7, 36, 40. Blood, the flute of, 217, 272, 299. Bone, confidered, 314. «' Black Legs,"" who fo called, 387. Blindnefs, by hard running, 4 c. — —'—, by too frequent covering, 41. Bar Shoes, remarks upon, 183. c Cumberland, former duke of, p. 17, 65. Cantharides, dangerous ufe of, 44. Carrots, great utility of, 95. Clergyman, anecdote of, i)^ Country Farriers, 120. Cripples, by flioeing, 155. Corns, caufe of, 171, 173. —., cure, 174- Cutting, caufe of, 176. Cleanlinefs, neceffity of, 194, 202. Clarke, Mr. remark upon, 217, 272, 341. Cafes, of difeafed eyes, 233. Chafe, of flag or fox, 292, 320, 325. Chambermaid, liberality to, 372. Courts, of law, 379. Colts, improvement of, 69. D. Draft Horfe, Englifli, p. 10, 26. Dungannon, 18. Dealers practice of, 107. Difpofal, proper mode of, 38;,Eclipfe, dam of, p. 17. ■ , get of, j 8, 20. Evergreen, 20. Equeftrians, Juvenile, 193. Exercife, 203, 344. —, comparative view of, 245* — -—, in the metropolis, 25a. Eyes, defeats in, 144, 295, 348, ———, lofs of, 193. Enemies, to improvement, 99, F Foaling, proper time of, p. 47, jr. Foal, time of mares going with, 55. ——, brought up by hand, 65. Feet, different kinds of, 158. Flefliy, footed horfes, 181. Feet, attended to when young, 183. Fundaments, artificial, 257. Figure, in the Field, 291, 323. Feeding, 337, 339, 356. Farmer, a ftory of, 358, Fortunes, annihilated, 386. "" Family the,"" defcribed, 387. Fired horfes, the caufe of fo many, 109. Farriers, ability of, 168. G Gunpowder, p. 18. Gibfon, 135, 157- Gentlemen, advice to, 139,Gamblers, 387. Generofity, of Sportfmen, 140. H Hunters, Englifh, p. 5. Herod, King, 20. Highflyer, 20, 102. Hamilton, Lord Spencer, 40. Horfes, ftarting, 115. Humours, the erFeft of repletion, 208, 212, 223. Hunters, 289. ■ --- , condition of, 291, choice of, 313* Heroes, on horfeback, 188, 327. Harriers, mentioned, 319. Hunter, management of, 321. • —, in the chace, 325. ———, after the chace, 328. Hard Riders, mentioned, 367. Horfes, fele&ion of, 350. J Jupiter, p. 18, Jerry Sneak, 40. Ignorance, of grooms, 239, 294. Juvenile Equeftrians, 193. Inns, defcribed, 351. --- , their figns emblematic, 354. Ill ufage in fhoeing, 143. K King's T. the Hon. blind ftallion, p. 39. L Lelcefterfhire, p. 5, 26. Lincolnflilre, 5, 26. Lewenhock, upon Male Semen, 41. La Fofle, 160, 182. Livery Stables, 190, 203. Light, advantages of, 20 r. Labour, probable, 251. Landlords, defcription of, 35Z. * Lets go,"" its utility, 360. Lottery Office Keepers, 383. Lamenefs from fhoeing, 166, 169. M Mare, fpider legged, p. 7. Marfk, 16, 21. Mercury, 18. Meteor, 18. Milkfop, reafon why fo called, 65. Mare, management of, after foaling, 65. ■ --- , when taken to horfe, 83. Medical ftudent, anecdote of, 362. Mare, compulfively covered, 54. — --- , her time of going with foal, 55. Major O'Flaherty quoted, 190. Medicines, author's, follow Index. Matches, of the author, 401, 403. N Newmarket, p. 4. 394. Northamptonfhire, 5, 26. Nutrition, effect of, 8, 75. Nitre, its ufe, 241. --- , its abufe, 243. Noble Lord, anecdote of, 384.Ofmer, quoted, p. 148. ___'s felf-contradi&ion, 161. Oftler's, defcription of, 329, 354, 357. ———, reward to, 372. Obligation, mutual, 142, P Perfpiration, explained, p. 210. —, its obftru£tion, 248, Purging, the confiftency of, 296, 301^ __ --- j difference of action, 308. Purges, mercurial, 311. Parliament, petition to, 353. Pofthorfes, 373. Pawnbrokers, 383. Perfevere and conquer, 128. Quackery, danger of, p. 239 Quixotes, equeftrian, 189. R ReftifFhorfes, ill ufage of, p. Ill, 127, 129, 14c. Rowelling, 253, explained, 256. • --- , anecdote of, 235, 263. ————, investigated, 277. --- 1—, conclufion drawn, 283, &c. Repletion, and its effects, 189, 191, 208, 338. Racing, in the chace, 327.Road horfes, 349. Road horfes, management of, 365. , on a journey, 369. Repofitory, local law of, 377. Running horfes, number of, 387. Riders, alias jockies, 388, 395, 397* s Stallions, blind, p. 7, 36, 40. --- , of falhion, 16, 35, 39. ———, Shakespear, 17, --- , Marfk, 17. Soldier, 18. Sweetbriar, 20. Sulphur, anecdote of, 60. Shoeing, 130. Sportfmen, liberality of, 140. Smiths, ill ufage of horfes, 143. Stabling, 187. Stimulus, cathartic, 305. Sound, its meaning, (in law) 379* Sporting, bankrupts, 383. Swampy, four grafs, 68. T Turf, p. 19, refinement of, 107. Tradefman, Manchester, 188. Tony Lumpkin, 293. Twitch, its ufe confidered, 348. Turf, the, 382, villainy of, 388. Trainers, 388. Tax, minifterial, 387-Training, expenfive, p. 385. Turf, integrity, 405. U Unions, heterogeneous, p. 6, 10. V Verturruius, p. 18. Ventilators, recommended, 201. Veterinarian education. 270- W Woodpecker, p. 20. Woodcock, 54* Weaning foals, 85, ici. Writers, difFerent, review of, 135. Water and its efFecb, 248, 330, 339, 342, 357, 370, 373 Warm Arables, 356. Wignell, anecdote of, 363. Waiter, reward to, 372. Weftminfter Hall, 380. Y Yorkfhire breeders, p. 5, 26, "

Problem setting. The status of the state and private partnership in Ukraine and the prospects of its development under conditions of the healthcare reform were examined. The cooperation of the state and private sector becomes increasingly important in a social sense, however the existing practice does not demonstrate the efficiency of the fulfillment of the assigned tasks. The conducted analysis allowed to determine the risks and problems of the implementation of the state and private partnership in the sphere of healthcare under current conditions in Ukraine. It was substantiated that the fulfillment of the concept of the state and private partnership in the healthcare system of Ukraine is one of the key issues of the state policy. Recent research and publications analysis. The involvement of a private partner in the field of healthcare is highly common in many countries of the world. The effectiveness of such cooperation is confirmed and described in a number of various studies. At the same time, authors' publications fail to mention the aspects of involving the private sector in the activities of municipal and state healthcare facilities, including under conditions of healthcare reform in Ukraine. Highlighting previously unsettled parts of the general problem. At the modern stage of reforming of the healthcare system which is an integral part of socioeconomic transformations in Ukraine, the problem of the state regulation of investment support for the development of healthcare sector is becoming ever more important. The main goal of the reform is to build such a model of the healthcare system which would ensure equal and fair access of all members of society to necessary medical services, their high quality and cost-effectiveness while maintaining socially expected volume of state guarantees. The purpose of this article is to reveal the prospects of the state and private partnership under conditions of implementation of the healthcare reform. Paper main body. Ministry of Economic Development and Trade of Ukraine continues to play a key role in the institutional support of the state and private partnership in Ukraine. According to the regulatory document (Decree on the Ministry) it is entrusted with various functions related to the implementation of the state policy in this sector, and namely: monitoring the efficiency of the central, regional and municipal authorities in the field of the state and private partnership; verification of the fulfilment of the signed contracts on the state and private partnership; preparation and provision of information on the results of the state and private partnership to the public; monitoring and evaluation of various types of risks (and namely, general risk) of state partners within the framework of the contracts on the state and private partnership; accounting of contracts on the state and private partnership; organizing and conducting training in order to form and implement the contracts on the state and private partnership; monitoring of compliance with the requirements of current laws on the state and private partnership with respect to existing and new contracts. As of today, the development of the concept of the state and private partnership in the field of healthcare of Ukraine, unfortunately, is not a matter of priority of the state policy and modern budgeting system creates high financial risks for the state and private partnership which are related to short-term (yearly) budget cycles of planning and their annual approval procedures which are sometimes unnecessarily prolonged. Joint activities, distribution of products etc. may be forms of implementation of the projects of the state and private partnership and they may be financed from the funds of the state and local budgets, financial resources of the private partner, loaned funds and other sources which are not prohibited by laws. In this case, the legislation foresees the provision of support to projects of the state and private partnership through state guarantees, provision of funds from state and local budgets and other sources within the framework of the state-wide and local programmes. There are also preconditions for organizing high-tech centres for treating various types of diseases while using financial instruments of investors and staff capacity of the state healthcare facilities. However, presently there are certain doubts on the side of potential private partners regarding the possibility of implementation of long-term mutually beneficial cooperation. It resulted in the absence of transparency and clarity in the normative and legal regulation of the state and private partnership in Ukraine. Therefore, state and private partnership must ensure: The use of the mechanism for planning and funding projects of the state and private partnership because it contributes significantly to the interest of private domestic and foreign investors in participating in the state and private partnership. Normative and legal regulation of implementation of projects of the state and private partnership. Successful introduction of infrastructure projects of the state and private partnership into the activities of healthcare facilities. Construction of high-tech centres for treatment of various types of diseases. Increasing the accessibility of health services for the population and supporting the development of the private sector. Conclusions of the research and prospects for further studies. The majority of projects were implemented in order to reduce the expenses incurred by state and municipal healthcare facilities and neither to increase the quality of provision of health services nor to optimize the expenditure for upgrading material and technical equipment. As a result, the efficiency of such state and private cooperation is one-sided and, as a rule, it has a positive impact solely on the private partner or a short-term result for a healthcare facility where such cooperation is implemented. In this case, the primary task laid as part of implementation of the state policy within the framework of healthcare reform, and namely improving the quality and accessibility of health services for the population of Ukraine, remains uncompleted on the side of the state and municipal healthcare facilities. However, there is a positive experience of involvement of private business in the process of introduction of infrastructure projects of the state and private partnership into the activities of healthcare facilities; confirmation of the relevance of the development for practical introduction of infrastructural projects of the state and private partners into the activities of facilities of the system of emergency medical care of Ukraine. Introduction of the mentioned infrastructural forms of the state and private partnership into the activities of emergency medical care facilities in Ukraine may be an effective instrument for reducing the share of the non-market sector in the field of healthcare while simultaneously increasing the efficiency of the state management. The involvement of the private sector helps to resolve several issues at once: Involvement of personnel oriented towards the provision of services which will contribute significantly to the competitive ability of the state and municipal facilities. Management which reacts quickly to changes on the market of health services which is somewhat restricted under conditions of budgetary legislation on the side of the state and municipal healthcare facilities and is sufficiently important for constantly adapting the needs of the population to the modern global requirements. Raising funds from partners for upgrading material and technical equipment, on the one hand, may significantly reduce financial losses with the involvement of the most up-to-date technologies or give the facilities an opportunity to receive modern services and equipment with the use of the funds of private partners. Reducing financial burden of expenses on local authorities and the state budget of Ukraine in general while keeping a healthcare facility in a satisfactory condition and corresponding level of provision of health services. Improvement of socioeconomic standard of living on account of an increase in accessibility of healthcare to the population of Ukraine in accordance with global requirements. All of this will finally result in a change of the situation in the healthcare sector, will help to build trust in the domestic medicine and increase the health of the nation in the overall perspective. Further research prospects in this direction should include the study of successful foreign experience for strengthening the state and private partnership and determining the feasibility of implementation of the best foreign practices under current conditions in Ukraine on account of development, adaptation and introduction of changes into the legal framework. ; Розглянуто стан державно-приватного партнерства в Україні та перспективи його розвитку в умовах реформи охорони здоров'я. Зауважено, що співпраця державного та приватного сектору набуває все більшого соціального значення, проте існуюча практика не демонструє ефективність у реалізації визначених цілей. На основі проведеного аналізу визначено ризики та проблеми в реалізації державно-приватного партнерства у сфері охорони здоров'я у сучасних умовах в Україні. Обґрунтовано, що реалізація концепції державно-приватного партнерства у системі охорони здоров'я України є одним із ключових питань державної політики.

Problem setting. The status of the state and private partnership in Ukraine and the prospects of its development under conditions of the healthcare reform were examined. The cooperation of the state and private sector becomes increasingly important in a social sense, however the existing practice does not demonstrate the efficiency of the fulfillment of the assigned tasks. The conducted analysis allowed to determine the risks and problems of the implementation of the state and private partnership in the sphere of healthcare under current conditions in Ukraine. It was substantiated that the fulfillment of the concept of the state and private partnership in the healthcare system of Ukraine is one of the key issues of the state policy. Recent research and publications analysis. The involvement of a private partner in the field of healthcare is highly common in many countries of the world. The effectiveness of such cooperation is confirmed and described in a number of various studies. At the same time, authors' publications fail to mention the aspects of involving the private sector in the activities of municipal and state healthcare facilities, including under conditions of healthcare reform in Ukraine. Highlighting previously unsettled parts of the general problem. At the modern stage of reforming of the healthcare system which is an integral part of socioeconomic transformations in Ukraine, the problem of the state regulation of investment support for the development of healthcare sector is becoming ever more important. The main goal of the reform is to build such a model of the healthcare system which would ensure equal and fair access of all members of society to necessary medical services, their high quality and cost-effectiveness while maintaining socially expected volume of state guarantees. The purpose of this article is to reveal the prospects of the state and private partnership under conditions of implementation of the healthcare reform. Paper main body. Ministry of Economic Development and Trade of Ukraine continues to play a key role in the institutional support of the state and private partnership in Ukraine. According to the regulatory document (Decree on the Ministry) it is entrusted with various functions related to the implementation of the state policy in this sector, and namely: monitoring the efficiency of the central, regional and municipal authorities in the field of the state and private partnership; verification of the fulfilment of the signed contracts on the state and private partnership; preparation and provision of information on the results of the state and private partnership to the public; monitoring and evaluation of various types of risks (and namely, general risk) of state partners within the framework of the contracts on the state and private partnership; accounting of contracts on the state and private partnership; organizing and conducting training in order to form and implement the contracts on the state and private partnership; monitoring of compliance with the requirements of current laws on the state and private partnership with respect to existing and new contracts. As of today, the development of the concept of the state and private partnership in the field of healthcare of Ukraine, unfortunately, is not a matter of priority of the state policy and modern budgeting system creates high financial risks for the state and private partnership which are related to short-term (yearly) budget cycles of planning and their annual approval procedures which are sometimes unnecessarily prolonged. Joint activities, distribution of products etc. may be forms of implementation of the projects of the state and private partnership and they may be financed from the funds of the state and local budgets, financial resources of the private partner, loaned funds and other sources which are not prohibited by laws. In this case, the legislation foresees the provision of support to projects of the state and private partnership through state guarantees, provision of funds from state and local budgets and other sources within the framework of the state-wide and local programmes. There are also preconditions for organizing high-tech centres for treating various types of diseases while using financial instruments of investors and staff capacity of the state healthcare facilities. However, presently there are certain doubts on the side of potential private partners regarding the possibility of implementation of long-term mutually beneficial cooperation. It resulted in the absence of transparency and clarity in the normative and legal regulation of the state and private partnership in Ukraine. Therefore, state and private partnership must ensure: The use of the mechanism for planning and funding projects of the state and private partnership because it contributes significantly to the interest of private domestic and foreign investors in participating in the state and private partnership. Normative and legal regulation of implementation of projects of the state and private partnership. Successful introduction of infrastructure projects of the state and private partnership into the activities of healthcare facilities. Construction of high-tech centres for treatment of various types of diseases. Increasing the accessibility of health services for the population and supporting the development of the private sector. Conclusions of the research and prospects for further studies. The majority of projects were implemented in order to reduce the expenses incurred by state and municipal healthcare facilities and neither to increase the quality of provision of health services nor to optimize the expenditure for upgrading material and technical equipment. As a result, the efficiency of such state and private cooperation is one-sided and, as a rule, it has a positive impact solely on the private partner or a short-term result for a healthcare facility where such cooperation is implemented. In this case, the primary task laid as part of implementation of the state policy within the framework of healthcare reform, and namely improving the quality and accessibility of health services for the population of Ukraine, remains uncompleted on the side of the state and municipal healthcare facilities. However, there is a positive experience of involvement of private business in the process of introduction of infrastructure projects of the state and private partnership into the activities of healthcare facilities; confirmation of the relevance of the development for practical introduction of infrastructural projects of the state and private partners into the activities of facilities of the system of emergency medical care of Ukraine. Introduction of the mentioned infrastructural forms of the state and private partnership into the activities of emergency medical care facilities in Ukraine may be an effective instrument for reducing the share of the non-market sector in the field of healthcare while simultaneously increasing the efficiency of the state management. The involvement of the private sector helps to resolve several issues at once: Involvement of personnel oriented towards the provision of services which will contribute significantly to the competitive ability of the state and municipal facilities. Management which reacts quickly to changes on the market of health services which is somewhat restricted under conditions of budgetary legislation on the side of the state and municipal healthcare facilities and is sufficiently important for constantly adapting the needs of the population to the modern global requirements. Raising funds from partners for upgrading material and technical equipment, on the one hand, may significantly reduce financial losses with the involvement of the most up-to-date technologies or give the facilities an opportunity to receive modern services and equipment with the use of the funds of private partners. Reducing financial burden of expenses on local authorities and the state budget of Ukraine in general while keeping a healthcare facility in a satisfactory condition and corresponding level of provision of health services. Improvement of socioeconomic standard of living on account of an increase in accessibility of healthcare to the population of Ukraine in accordance with global requirements. All of this will finally result in a change of the situation in the healthcare sector, will help to build trust in the domestic medicine and increase the health of the nation in the overall perspective. Further research prospects in this direction should include the study of successful foreign experience for strengthening the state and private partnership and determining the feasibility of implementation of the best foreign practices under current conditions in Ukraine on account of development, adaptation and introduction of changes into the legal framework. ; Розглянуто стан державно-приватного партнерства в Україні та перспективи його розвитку в умовах реформи охорони здоров'я. Зауважено, що співпраця державного та приватного сектору набуває все більшого соціального значення, проте існуюча практика не демонструє ефективність у реалізації визначених цілей. На основі проведеного аналізу визначено ризики та проблеми в реалізації державно-приватного партнерства у сфері охорони здоров'я у сучасних умовах в Україні. Обґрунтовано, що реалізація концепції державно-приватного партнерства у системі охорони здоров'я України є одним із ключових питань державної політики.

ABSTRAKPenelitian ini bertujuan untuk mengetahui apakah burnout dan stress kerja berpengaruh secara signifikan terhadap Perawat Rumah Sakit Umum Daerah Dr. Soedarso Provinsi Kalimantan Barat. Penelitian ini termasuk asosiatif kausal dan menggunakan kuesioner yang disebar kepada Perawat Rumah Sakit Umum Daerah Dr. Soedarso Provinsi Kalimantan Barat. Jumlah responden 75 orang, dipilih dengan metode random sampling. Metode analisis yang digunakan adalah analisis regresi linear berganda.Hasil penelitian ini menunjukan bahwa burnout dan stress kerja berpengaruh signifikan terhadap kinerja Perawat Rumah Sakit Umum Daerah Dr. Soedarso Provinsi Kalimantan Barat dikarenakan hasil uji pada penelitian ini menunjukkan variabel tersebut signifikan kurang dari 0,05 .Kata kunci: Burnout, Stress Kerja, Kinerja DAFTAR PUSTAKAAsi, S.P. (2013). Pengaruh Iklim Organisasi dan Burnout terhadap Kinerja Perawat RSUD Dr. Doris Sylvanus Palangka Raya. Jurnal Aplikasi Manajemen, 11(3).Ahirudin. (2011). 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Penelitian ini bertujuan untuk mengetahui apakah burnout dan stress kerja berpengaruh secara signifikan terhadap Perawat Rumah Sakit Umum Daerah Dr. Soedarso Provinsi Kalimantan Barat. Penelitian ini termasuk asosiatif kausal dan menggunakan kuesioner yang disebar kepada Perawat Rumah Sakit Umum Daerah Dr. Soedarso Provinsi Kalimantan Barat. Jumlah responden 75 orang, dipilih dengan metode random sampling. Metode analisis yang digunakan adalah analisis regresi linear berganda.Hasil penelitian ini menunjukan bahwa burnout dan stress kerja berpengaruh signifikan terhadap kinerja Perawat Rumah Sakit Umum Daerah Dr. Soedarso Provinsi Kalimantan Barat dikarenakan hasil uji pada penelitian ini menunjukkan variabel tersebut signifikan kurang dari 0,05 .Kata kunci: Burnout, Stress Kerja, KinerjaDAFTAR PUSTAKAAsi, S.P. (2013). Pengaruh Iklim Organisasi dan Burnout terhadap Kinerja Perawat RSUD Dr. Doris Sylvanus Palangka Raya. Jurnal Aplikasi Manajemen, 11(3).Ahirudin. (2011). 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Access to reliable and quality health information and appropriate medical advice can contribute to a dramatic reduction in the mortality figures of countries. The governments of the Americas are faced with the opportunity to continue working on this challenge, and their institutional presence on their websites should play a key role in this task. In a setting where the access to information is essential to both health professionals and citizens, it is relevant to analyze the role of national health authorities. Given that search engines play such a key role in the access to health information, it is important to specifically know - in connection to national health authorities - whether health information offered is easily available to the population, and whether this information is well-ranked in search engines. Quantitative methods were used to gather data on the institutional presence of national health authorities on the web. An exploratory and descriptive research served to analyze and interpret data and information obtained quantitatively from different perspectives, including an analysis by country, and also by leading causes of death. A total of 18 web pages were analyzed. Information on leading causes of death was searched on websites of national health authorities in the week of August 10-14, 2015. The probability of finding information of national health authorities on the 10 leading causes of death in a country, among the top 10 results on Google, is 6.66%. Additionally, ten out the 18 countries under study (55%) do not have information ranked among the top results in Google when searching for the selected terms. Additionally, a total of 33 websites represent the sources of information with the highest visibility for all the search strategies in each country on Google for the ten leading causes of death in a country. Two websites, the National Library of Medicine and Wikipedia, occur as a result with visibility in the total of eighteen countries of the sample. Taking into consideration that providing reliable and quality information on these topics to the population should be one of the priorities of national health authorities, these results suggest that national health authorities need to take measures to try to better position their contents. ; El acceso a información médica confiable y de calidad y el asesoramiento médico adecuado pueden contribuir a una reducción drástica en las cifras de mortalidad de los países. Los gobiernos de las Américas se enfrentan a la oportunidad de continuar trabajando en este desafío, y la presencia institucional en sus sitios web debe jugar un papel clave en esta tarea. En un entorno donde el acceso a la información es esencial tanto para los profesionales de la salud como para los ciudadanos, es relevante analizar el papel de las autoridades sanitarias nacionales. Dado que los motores de búsqueda desempeñan un papel tan importante en el acceso a la información de salud, es importante saber específicamente, en relación con las autoridades sanitarias nacionales, si la información de salud que se ofrece está fácilmente disponible para la población y si esta información está bien clasificada en los motores de búsqueda. Se han utilizado métodos cuantitativos para recopilar datos sobre la presencia institucional de las autoridades sanitarias nacionales en la web. Una investigación exploratoria y descriptiva ha servido para analizar e interpretar datos e información obtenidos cuantitativamente desde diferentes perspectivas, incluido un análisis por país y también por las principales causas de muerte. Se han analizado un total de 18 páginas web. Se buscó información sobre las principales causas de muerte en los sitios web de las autoridades nacionales de salud en la semana del 10 al 14 de agosto de 2015. La probabilidad de encontrar información de las autoridades sanitarias nacionales sobre las 10 principales causas de muerte en un país, entre los 10 primeros resultados en Google, es del 6,66%. Además, diez de los 18 países estudiados (55%) no tienen información clasificada entre los mejores resultados en Google al buscar los términos seleccionados. Además, un total de 33 sitios web representan las fuentes de información con la mayor visibilidad para todas las estrategias de búsqueda en cada país en Google para las diez principales causas de muerte en un país. Dos sitios web, la Biblioteca Nacional de Medicina y Wikipedia, aparecen como resultado con visibilidad en el total de dieciocho países de la muestra. Teniendo en cuenta que brindar información confiable y de calidad sobre estos temas a la población debería ser una de las prioridades de las autoridades sanitarias nacionales, estos resultados sugieren que las autoridades sanitarias nacionales deben tomar medidas para tratar de posicionar mejor sus contenidos. ; L'accés a informació mèdica confiable i de qualitat i l'assessorament mèdic adequat poden contribuir a una reducció drástica en les dades de mortalitat dels països. Els governs de les Amèriques s'enfronten a l'oportunitat de continuar treballant en aquest desafiament, i la presència institucional en els seus llocs web ha de jugar un paper clau en aquesta tasca. En un entorn on l'accés a la informació és essencial tant per als professionals de la salut com per als ciutadans, és rellevant analitzar el paper de les autoritats sanitàries nacionals. Donat que els motors de recerca tenen un paper tan important en l'accés a la informació de salut, és important saber específicament, en relació amb les autoritats sanitàries nacionals, si la informació de salut que s'ofereix és fàcilment disponible per a la població i si aquesta informació està ben classificada en els motors de cerca. S'han utilitzat mètodes quantitatius per recopilar dades sobre la presència institucional de les autoritats sanitàries nacionals a la web. Una investigació exploratòria i descriptiva ha servit per analitzar i interpretar dades i informació obtingudes quantitativament des de diferents perspectives, inclosa una anàlisi per país i també per les principals causes de mort. S'han analitzat un total de 18 pàgines web. Es va buscar informació sobre les principals causes de mort en els llocs web de les autoritats nacionals de salut en la setmana del 10 al 14 d'agost de 2015. La probabilitat de trobar informació de les autoritats sanitàries nacionals sobre les 10 principals causes de mort en un país, entre els 10 primers resultats a Google, és del 6,66%. A més, deu dels 18 països estudiats (55%) no tenen informació classificada entre els millors resultats a Google en cercar els termes seleccionats. A més, un total de 33 llocs web representen les fonts d'informació amb la major visibilitat per a totes les estratègies de cerca a cada país a Google per les deu principals causes de mort en un país. Dos llocs web, la Biblioteca Nacional de Medicina i Wikipedia, apareixen com a resultat amb visibilitat en el total de 18 països de la mostra. Tenint en compte que oferir informació confiable i de qualitat sobre aquests temes a la població hauria de ser una de les prioritats de les autoritats sanitàries nacionals, aquests resultats suggereixen que les autoritats sanitàries nacionals han de prendre mesures per tractar de posicionar millor els seus continguts.