Despite significant progress in the treatment of T1DM in children, achieving target levels of carbohydrate metabolism in children remains one of the most difficult tasks. The influence of the psychosocial state of the family on the ability to achieve metabolic compensation is becoming increasingly clear. However, the study of social risk factors in families with children with T1DM and their impact on metabolic control remains clearly insufficient.The purpose of the study is to determine social risk factors (SR) that are most typical for families of children with type 1 diabetes mellitus (T1DM) in our country and to analyze their relationship with compensation for T1DM based on a survey of parents.MATERIALS AND METHODS: The study was conducted in endocrinology departments of children’s hospitals and departments of medical and social care of children’s clinics in 4 regions - Vologda, Tyumen, Chelyabinsk regions and Khanty-Mansi Autonomous Okrug.A total of 325 respondents took part in the study. 1 group — experience of T1DM in children >1 year and poor metabolic control (level of glycated hemoglobin ((HbA1c) >7.5%) — 195 hours; 2 gr. — experience of T1DM in children >1 year and good metabolic control (HbA1c <7.5%) — 60 people. An additional group consisted of 73 patients with <1 year of experience of T1DM in children, regardless of metabolic control, in order to analyze the prevalence of social risk factors already in the 1st year of diabetes.RESULTS: In the overall group, HbA1c was 9.1% (4.9–17%). The five most common SR factors were a low level of parental education (lack of higher or secondary education), lack of a permanent job, raising a child alone, lack of support from loved ones, and income below the subsistence level.1 group (192 people). Average HbA1c level 9.8% (7.5–17%). Among the HR factors that significantly influence HbA1c levels, the level of education of parents, single parenting of a child, low family income and the number of children in the family were identified. The number of influencing social risk factors also has a negative impact on metabolic control.2nd group. (60 people). HbA1с — 6.6% (5.3%–7.3%). The prevalence of SR factors was significantly lower than in the previous group. The differences were significant for lack of higher education, single parenting, and low family income.3 gr. (73 people). HbA1c — 9.3% (4.9–15.1%, which may be due to the duration of diabetes less than 3 months in some children. After 3 months, the HbA1c level was 7.9% (4.8–13.4%). The list of SR factors practically coincides in composition and frequency with those in families of group 1. Thus, social difficulties that are not resolved in a timely manner aggravate the situation of the family and negatively affect the compensation of carbohydrate metabolism.CONCLUSION. We have identified the most significant factors of SR in families with children with T1DM in the Russian Federation. The deterioration of social conditions in the family is a factor that negatively affects the level of control of T1DM and the development of complications in the future. As a result, families with children with T1DM, especially with chronic decompensation, need assessment of SD factors and support from social services.

Telemedicine technologies in pediatric patients with type 1 diabetes mellitus (T1D) is an effective approach that have begun to be used recently. The purpose of this research was to evaluate the possibility and effectiveness of remote observation and training of children with newly diagnosed T1D in selected Russia regions. Materials and methods used: a multicenter prospective open uncontrolled experimental clinical study involved 92 children aged 1 to 18 y/o with T1D receiving intensified insulin therapy who were divided into two groups: G1 of 60 patients with T1D manifestation of less than 12 weeks prior to the inclusion in the study, and G2 of 32 children with T1D manifestation lasting over 12 weeks prior to the inclusion with poor disease control (glycated hemoglobin at 8% and above) from troubled families. The main indicator for evaluating the effectiveness was the glycated hemoglobin (HbA1c) level. Results: median age was 9.2 (6.2-11.2) y/o, 47 boys/45 girls. A total of 401 remote consultations had been carried out in various forms. The HbA1c level decreased statistically significantly by the end of the study by 3.5% and 0.6% (p<0.001) in G1 and G2, respectively. Statistically significant (p<0.001) increase in the number of patients with HbA1c at the level of less than 7% was reached, with most of them (52%) reaching the target glycemic control parameters. Telemedicine technologies therefore represent the effective (in terms of glycemic control) addition to the traditional dispensary observation, which in its turn increases the availability of medical care for children with endocrine diseases.

Effective control of type 1 diabetes mellitus (DM1) is a difficult and burdensome task for the patient and/or his/her parents/caretakers as well as healthcare professionals. Another approach to improve glycemic control could be the use of telemedicine. The purpose of this study was to evaluate the possibility and effectiveness of remote monitoring and education of children with newly diagnosed DM1. Materials and methods of the research: a multicenter prospective open uncontrolled experimental clinical study was conducted between Oct. 2020 and Feb. 2022. The study was conducted in the two clinical centers as follows: Endocrinology Research Centre of the Ministry of Healthcare of Russia; and M.F. Vladimirsky Moscow Oblast Regional Scientific and Research Clinical Institute (MONIKI), both located in Moscow, Russia. Children aged 1 to 18 years old diagnosed with DM1 within 12 weeks prior to inclusion in the study and receiving intensified insulin therapy were invited to participate in the study. Results: the study included 220 children with DM1 living overall the Moscow Oblast region aged 1 to 18 years old (median age 8.1 (5.1–10.9) years old), of which 48% were male and 52% female. During the period of remote monitoring 1062 remote consultations were concluded as follows: 12% via videoconferencing, 64% via audio, and 34% via specialized mobile app. The duration of consultations averaged as follows: 14.9, 20.7 and 14.8 minutes for consultations via videoconferencing, audio and mobile app, respectively. Glycated hemoglobin (HbA1c) level was one of the main indicators for evaluating the effectiveness of participation of children with DM1 in the program of remote observation and education. HbA1c values decreased statistically significantly by the end of the study by –5.0% (p<0.001). As a result, there was a statistically significant (p<0.001) (+55%) increase in the number of children with HbA1c level of less than 7%, thus, most of the children reached the target indicators of glycemic control. In addition to indicators of glycemic control, indicators of the quality of life and the level of distress in parents of children with DM1 were analyzed using specialized questionnaires as supplemental criteria reflecting the clinical effectiveness of remote monitoring. After the first month of participation parents/caretakers showed a statistically significant decrease in the level of stress associated with DM1 in their children (p=0.033), while at the same time the level returned to baseline values (p=0.201) by the end of the project. Conclusion: the outpatient monitoring of children with newly diagnosed DM1 using telemedicine and specialized mobile products (“niche apps”) is an effective (in terms of glycemic control) addition to traditional dispensary monitoring which increases the accessibility of medical care and its convenience to the patients and the quality of life for pediatric patients and their parents/caretakers.

The aim was to compare effects of salmeterol/fluticasone propionate 50/100 μg bd (FSL) via Discus™ device with fluticasone propionate (FP) 100 pg bd via Dischaler or beclomethasone dipropionate (BDP 200 pg bid) via Dischaler in 12-week multtcentre randomised controlled trial involved 250 symptomatic children aged 4 to 10 yrs with moderate to severe asthma who had previosly received beclomethasone dipropionate less than 400 pg daily or cromones. The treatment effectiveness was assessed using a dairy card including measurement of asthma symptoms, peak expiratory flow (PEF), need in short-acting β 2 -agonists, and a patient's consideration of treatment. The patients receiving FSL had significantly more symptom-free days (64.8 ± 21.8) versus the patients receiving FP (55 ± 23.9, p < 0,05) or BDP (52 ± 24.8, p < 0.05). The FSL patients had fewer days with rescue medication (10.2 ± 12.6) in comparison with the FP (24.9 ± 21.7, p < 0.001) and the BD patients (23.8 ±20.1 p < 0.001). During first 4 weeks of the treatment the morning PEF rates were slightly higher in the FSL patients (114 ±7 % pred.) versus the FP ones (107 ± 8 %) and BDP (106 ± 8 %). Significantly more FSL children and their parents were satisfied with the treatment (97 %) compared with 82 % of the FP and 68 % of the BDP patients ( p < 0.001). Children did not have problems using the dry powder inhalers Discus and Dischaler. Adverse events were found in 4 FSL, 7 FP and 12 BDP patients (cold, cough after inhalation, sore throat). These effects were not severe. Thus, the combined treatment with low-dose FP and SL was more effective than two-fold higher dose BDP and the single therapy with low-dose FP in pediatric asthma patients.

Background: The prevalence of type 1 diabetes mellitus (T1DM) in childhood is increasing every year. Adolescence is the most challenging age for achieving optimal metabolic control of T1DM. Telemedicine has already been shown to be ­effective in children with the condition, but there are not enough studies in adolescents. The use of mobile apps may be associated with better glycemic control in patients with type 1 diabetes. Aims: To assess the effectiveness and safety of a model of medical care for adolescents with type 1 diabetes using remote counseling and a mobile application. Materials and methods : Were included adolescents aged ≥14 and 18 years with a T1DM duration> 3 months, a glycated hemoglobin level (HbA 1c )> 7%. The duration of the study was 26 weeks. There were 3 face-to-face and at least 4 remote visits using a mobile application. All patients underwent standard examination and anthropometry, study of HbA 1c , registration and analysis of indicators, assessment and correction of the treatment. The quality of life of adolescents was assessed at baseline and at the end of the study. Adolescents and physicians were interviewed about program evaluation. Results: 56 patients were included, 7 adolescents withdrew. HbA 1c significantly decreased by the 12th week of the study (–0.3%; p = 0.005), by the end of the study the change in HbA1c was –0.5% (p <0.001). There was an increase in the percentage of glucose measurements in the target range (+5.3 pp; p = 0.016) and a decrease in blood glucose variability (-3.1 pp; p = 0.015). There was a significant improvement in both the total assessment of the quality of life by patients (+2.9 points; p = 0.008) and individual components of its indicators: attitude to diabetes (+3.0 points; p = 0.049), attitude to treatment (+4.6 points; p = 0.010) and communication with others (+4.5 points; p = 0.015). The majority of doctors and patients assessed their participation in the study positively. The incidence of adverse events did not change significantly during the study from baseline. Conclusion: Remote counseling using a mobile app is a safe and effective approach for adolescents with T1DM in terms of glycemic control and quality of life, and provides convenience and speed of interaction.

A randomized open study was performed to compare bronchodilating activity of fomroterol (Foradyl) and salbutamol in 48 children aged 5 to 12 yrs with exacerbation of moderate bronchial asthma. The efficacy was evaluated within first 30 min and subsequent 8 to 10 hrs using FVC, FEV 1 , PEF values and bronchophonographic parameters. Formoterol was found to possess the bronchodilating effect rising equally but keeping longer than that of salbutamol. This fact allows to use formoterol as urgent therapy in mild and moderate bronchial obstruction.

3512-13 июня 2021 г. РЕЗУЛЬТАТЫ ВНЕДРЕНИЯ ВОЛОНТЕРСКОЙ ПРОГРАММЫ «РАВНЫЙ-РАВНОМУ» В СЕМЬЯХ ДЕТЕЙ C САХАРНЫМ

Charity program to help children with endocrine diseases «Alpha-Endo” is aiming to improve quality of medical care for children with endocrine pathology. The main directions of the Program include: molecular-genetic and immunological testing of hereditary endocrine diseases; improvement of health and social care for children; and obesity prevention. The best evidence-based Russian and international managerial strategies, and clinical practices of diagnostics, prevention and treatment of endocrine diseases are reviewed by experts and implemented within the Program. The synergistic cooperation involving the highly qualified Endocrinology Research Centre staff, significant financial resources “Alfa Group” and organizational support of CAF Foundation helps to solve difficult problems in pediatric endocrinology and improve welfare of children with endocrine diseases.

This paper reports the results of the study designed to estimate the quality of medical aid provided to the children with type 1 diabetes mellitus in six regions of the Russian Federation. The primary objective of the study was to improve the quality and to enhance the availability of the medical assistance for the children suffering from endocrine diseases in the framework of the “Alpha-Endo” program

Clinical and population research is an important part of health care improvement and development. Quality and coordination as well as integration in medical practice are among priorities in modern research agenda. The article discusses modern approaches to design, quality and ethical issues in health care research.

Для снижения заболеваемости ВИЧ-инфекцией у детей грудного и младшего возраста необходим комплексный подход, сочетающий первичную профилактику ВИЧ-инфекции, предупреждение нежелательных беременностей у ВИЧ-инфицированных женщин, профилактику ПМР; предоставление помощи, лечения и поддержки ВИЧ-инфицированным женщинам, их детям и семьям. Профилактика ПМР (вертикальная или перинатальная передача) – широко используемый термин для программ и мероприятий, направленных на снижение риска ПМР. ПМР может произойти во время беременности, родов и кормления грудью. К мероприятиям по снижению риска ПМР относятся консультирование и тестирование на ВИЧ, антиретровирусная (АРВ) профилактика и терапия, безопасные родовспоможение и вскармливание.

Prevention of HIV transmission from mother to child is actual question of Russian health service. Modern methods of prevetion of HIV transmission from mother to child are included: antiretroviral medication of HIV-positive women during pregnancy and the infants; cesarean section before onset of labor; artifi cial infant feeding. Investigations of offi cial statistics, to medical documents and women examination with HIV are show that the main problems are insuffi ciently range of antiretroviral prevention and medical control of women during pregnancy and aft er labor. It is necessity to perfect the integration of prevention of perinatal transmission of HIV infection to mother and child care service.

Results of complex research aimed at the study of dynamics of incidence and mortality caused by human immunodeficiency virus (HIV) among children, their medical and social characteristics, problems of social adaptation of rejected children, are presented. It is shown that in the dynamics of HIV incidence among children a steady growth trend is observed, mostly due to children born by HIV positive mothers. The number of HIV positive children due to perinatal transmission, increased by 9 times in 2000–2006. 43,6 per cent of children born by HIV positive mothers had significant deviations in the health status, 21,6 percent of infants were transferred to the 2nd stage of nursing. High level of stillbirths, perinatal and early neonatal mortality of infants born by HIV positive mothers, was observed. Though there is a certain trend of decreasing the number of rejected children both in the general population and among HIV positive mothers, the absolute number of such cases is increasing in the latter group. Children abandoned by their parents in most cases are isolated and do not receive the necessary social and psychological aid.Key words: HIV infection, children, perinatal mortality, social adaptation.