Medical perspectives (Medicni perspektivi)

12-18

Authors: Vysochina I.L., Valchuk S.I.,Vasilevskaya I.V.

The first global palliative care resolution WHA 67.19 has been developed recently, in 2014, where the need to improve access to palliative care around the world is first declared. In the article, the authors analyzed the change trends and the state of the medical care delivery system for incurable patients in the world and Ukraine. As the civilization of the state and the humanity of society as a whole is assessed by the level of PHC provision in today's world, this problem has attracted the attention of central (Ukraine) and regional (Dnipro city) government bodies, which was reflected in the search for new medical and educational initiatives. The need of the time is the need to focus the attention of family doctors on the issue that palliative care is a qualification component of their daily work, which will help to remove incurable patients from the periphery of attention of their multicomponent work, and will also help to clearly build the interaction between the primary and secondary link, in particular, with hospice departments of specialized hospitals. In particular, the experience of implementing a joint project of a new format for training family doctors on palliative care issues, realized by the Department of Family Medicine of the SE “DMA” and the Municipal non-commercial enterprise "City Clinical Hospital No. 2” of Dnipro City Council is described. In­novative forms of conducting classes help to expand the boundaries of the possibilities of teaching problematic issues of palliative medicine, which account for only 0.6% of instructional time in the existing program of training family doctors of secondary specialization, and the multicomponent format for studying palliative care issues, implemented, inter alia, with support of Director of the Municipal non-commercial enterprise "City Clinical Hospital No. 2” of Dnipro City Council (visiting hospice and palliative departments delivering secondary level of medical care assistance, a structured regulatory unit for the provision of PHC in Ukraine, working out of patients’ routing issues, interactive teaching methods, etc.) leaves in the memory of physician-trainees not only the essential content, but also a deep emotional trace, which helps to increase the motivation of the physician trainees, improves coordination between primary and secondary palliative care and improves the quality of training.

25-29

Authors: Kuryta O.V., Karapetian K.H., Frolova Ye.O., Kushnir Yu.S.

Modern requirements for training of high-skilled specialists require the implementation of international medical and educational standards in the educational and integrative process. Formation of cognitive activity, pursuance of professional development, the necessity to correspond to world standards medical students’ of gained knowledge. Medical students’ individual work is very important for medical students’ education because it helps to systematize and use knowledge that was gained in practical classes. The aim of the work – to analyze the forms of students’ individual work, used at in the Department of Internal Medicine 2 and Phthisiology, in order to improve the educational process and to form the future doctor’s medical judgment, their ability to self-improvement and self-education. The recommended hours attempted for students’ individual work is 90 out of the total of 240 hours assigned to the discipline in teaching the module “internal diseases” for the 5th year students at the Depertment of Internal Medicine 2 and Phthisiology. In studying the discipline of "internal diseases" in the 5th year one of the main tasks of medical student’s occupation training is mastering ability of assimilation on his own, of knowledge and refresh it, and then to use knowledge effectively in the future career. The difference of the individual work lies in the fact that students can study individually choosing the necessary kind of extracurricular activity according to their interests. In addition, the lack of strict grading by the teacher has more advantages compared to practical classes. The curriculum, the teacher’s tasks and methodological materials determine the content of the individual work. The article presents the three main directions of students’ individual work in teaching discipline of "internal diseases" for students of the 5th year as: students’ individual work in classroom learning, students’ individual work individual work under the teacher’s supervision. When discussing the results of individual work, students learn to think critically, communicate with each other, and make their own well-thought-out (educated) decision. Well-structured process of the individual work encourages medical students to its qualitative fulfillment and it is a significant motivation for further professional growth. Significant reserves to increase its efficiency inherent in the use of modern computer technology. Medical students’ individual work should be considered as one of the necessary stages of a modern doctor training. The latest information technologies and individual scientific projects adoption into the educational process leads to efficiency improvement and it forms new future doctor’s professional competences.

37-43

Authors: Shevchenko M.V., Yurochko T.P., Skrypnikova O.S.

Ensuring that the local population has access to medicines is one of the functions of a modern democratic state and an important element of social policy. The question of the affordability of medicines to the public is extremely important. This is also due to the fact that, unlike in European countries, Ukraine did not have a system of medicines reimbursement. To date, the reimbursement Affordable Medicines Programme has been in effect since April 2017 and is applicable to patients with cardiovascular disease, bronchial asthma, and type II diabetes. In total, 258 medicines are included in the Programme, 64 of which can be obtained free of charge and the others with a small extra payment. The respondents' perceptions of the Programme were conducted through a secondary analysis based on the third wave of the «Health Index. Ukraine» which was held in 2018 by the International Renaissance Foundation, the School of Public Health of the National University of Kyiv Mohyla Academy, and the Kyiv International Institute of Sociology. This study aims to present the results of the research of the attitude of Ukrainians to the government Affordable Medicines Programme and their perception of its implementation. The total number of respondents to this survey totaled more than 10,000 household rep­resentatives. The results of the research indicate a positive assessment of the respondents who participated in the survey «Health Index. Ukraine» (76% in 2018), which is confirmed by other research of the Kyiv International Institute of Sociology (63% in 2019) and by international experts. The results of the survey do not allow us to draw any official conclusions about the impact of the Programme on the health of Ukrainians, but during the interview 60.6% of the respondents said that the Programme «helped improve health»; in addition, positive changes in health were indicated by the most financially vulne­rable categories of the population. It is also noted that 80–82% of prescriptions were reimbursed to Programme participants.

48-54

Authors: Volosovets O.P., Bolbot Y.K., Volosovets A.O., Trachuk L.E., Kryvopustov S.P., Beketova G.V., Kuzmenko A.Ya.

Disorders of the psyche and behavior among children is an urgent problem of modern pediatric science and medical practice. The high prevalence of this pathology may be a result of the unfavorable psychological state of society, aggressive effects of the unfiltered information and negative influence of the environment (including radiatioactive factors) on the mind and body of the child. We have studied a 25-years’ trends in morbidity of mental illneses and behavior disorders among children of Ukraine in order to determine the impact of environmental factors (in particular - radioactivity after Chernobyl disaster in 1986) on their development. We have performed an analysis of the incidence and prevalence of psychiatric and behavioral disorders (PBD) among children from different regions of Ukraine, including radioactive regions, contaminated after Chernobyl disaster. We used methods of statistical evaluation and epidemiological analysis of statistical data about the mental health of children of the country, aquired from the Ministry of Health of Ukraine. Over the past 25 years, we have observed trend of reducing the incidence of PBD among children of Ukraine to 3.77 cases per 1,000 children (p<0.01) with prevalence of this pathology among children from large industrial and agricultural regions of the country. We have connected this trend with significant toxic influence of environmental factors on the child's organism. The incidence of PBD in the last 25 years among children from the regions of the country contaminated by the Chernobyl accident in 1986 (especially in Chernihiv and Zhytomyr regions) has exceeded the national incidence rates of PBD and its incidence among children from regions without territories of radiological control. In early 1990s the incidence of mental and behavioral disorders was high among children affected by Chornobyl accident. But over the last 25 years the incidence of PBD has become lower and now its level is even lower than among children who permanently lived in areas contaminated by radiation after the Chernobyl accident and the national incidence rate of PBD among children. The results of our 25-years’ follow-up of PBD morbidity among Ukrainian children have shown that children with prolonged exposure to ecotoxic factors, including radiation, have higher levels of prevalence and incidence of mental and behavioral disorders compared with other children. All this testify that there is a need of a proper correction programs and special attention to this cohort of children.

60-65

Authors: Volkogon A.D., Harbuzova V.Yu., Ataman A.V.

ANRIL (Antisense Non-coding RNA in the INK4 Locus, also known as CDKN2B-AS1) – 3.8-kb long non-coding RNA transcribed from the antisense strand of INK4b-ARF-INK4a gene cluster. It is known that ANRIL overexpression is associated with development of oncological pathologies of different localization. In addition, there are a number of studies devoted to role of ANRIL genetic polymorphism in emergence and progression of tumors, including tumors of genitourinary system. The aim of the study was to check the possible association between ANRIL gene polymorphism rs4977574 and kidney cancer development in representatives of Ukrainian population. Whole venous blood of 101 patients with clear cell renal cell carcinoma (CCRCC) (42 women and 59 men) and 100 patients without oncology history (34 women and 66 men) was used in the study. DNA from blood white cells was extracted using GeneJET Whole Blood Genomic DNA Purification Mini Kit (Thermo Fisher Scientific, USA). Genotyping of rs4977574 ANRIL gene polymorphic locus was performed using real-time polymerase chain reaction (real-time PCR) method in the presence of TaqMan assay C_31720978_30. The mathematical data were processed using the SPSS software package (version 17.0). P values <0.05 were considered as statistically significant. It was found that difference in rs4977574-genotype distribution between patients with CCRCC and control persons was absent in general group (P=0.216). At the same time, the statistical analysis stratified by gender showed that both in female and male subjects rs4977574-genotypes frequency also did not differ significantly between comparison groups (P=0.526 and P=0.160, respectively). However, after adjusting for age, body mass index, and smoking habits statistically significant association between rs4977574 ANRIL gene polymorphism and risk of kidney cancer development was detected in male subjects under superdominant inheritance model (P=0.049). It was revealed that heterozygotes (AG-genotype) have 2.17-fold higher risk of CCRCC development (95% CI=1.005-4.695) compared to patients with AA- and GG-genotypes. In summary, this is the first report about ANRIL gene polymorphisms association with kidney cancer. Obtained results revealed that rs4977574 is related to kidney cancer risk only in Ukrainian men. Male individuals with AG-genotype have higher risk of CCRCC development compared to AA- and GG-genotypes carriers.

71-77

Authors: Basanets A.V., Andrusyshyna I.N., Lashko О.N.

The problem of diagnosis in the early and preclinical stages of diseases is important in the prevention of occupational diseases and their complications, because this is the key to the timely initiation of treatment, the implementation of preventive measures. Chronic lumbosacral radiculopathy (CLSR) or low back pain (LBP) is one of the most common diseases in the structure of occupational pathology in Ukraine, which usually develops in those of working professions associated with physical activity, forced work posture, effect of high levels of general vibration, etc. The highest levels of occupational morbidity are recorded in the coal industry, which accounts for about 80% of occupational pathology in Ukraine. Above 1600 cases of CLRS are diagnosed annually in the country. A risk factor for the development of the CLSR is osteoporosis, which arises due to the impairment of quantitative and qualitative characteristics of bone tissue and is characterized by a decrease in its strength, an impairment of microarchitecture with a further increase in risk of fractures. One of the modern methods of assessing condition of bone tissue is determination of the content of macro- and trace elements (MaE and ME) in the biological environments of patients. Ca, Al, Mg, B, P are the most important in the formation and development of bone and connective tissue. To date, studies of bone tissue status in patients with CLSR of professional etiology have not been conducted (small in numbers). Goal – to determine the role of essential elements Ca, Al, Mg, B, P in serum and urine in the formation of occupational CLSR in miners. The research was conducted in 20 miners with CLRS (slaughterer, mining worker of a clearing face (MWCF), drifter) of coal mining industry of Donbass and Lviv-Volyn basins. The results were analyzed in two groups: І group consisted of patients with 10-15 years of work experience (n=10), II group with 16-32 years of work experience (n=10). The control group included 22 patients without pathology of the musculoskeletal system and connective tissue. The inductively coupled plasma atomic emission spectroscopy method (ICPAE) was used to determine the MaE and ME concentrations. The study revealed that the average serum aluminum (Al) concentration in miners with occupational CLSR (115.07 μmol/l) exceeded control group level (3.3 μmol/l) by almost 30 times (p<0.05). Serum boron (B) concentration in both age groups (25.90 μMol/l and 19.43 μMol/l, respectively) were lower than in the control (62.90 μMol/l), (p<0.05). The average serum calcium (Ca) concentration in patients with occupational CLSR (2.82 mmol/l) was 1.3 times higher than the same indicator in the control group (2.16 mmol/l), with a significant difference between the two age groups (p<0.05). It was revealed that the average level of phosphorus (P) in the urine of patients with occupational CLSR (19.0 mmol/l) significantly exceeded its content in patients of control group (11.96 mmol/l) (p<0.05). The concentration of Al in the urine of patients with CLSR in both age groups (1.26 μMol/l and 1.334 μMol/l, respectively) was higher that in control (0.85 μMol/l), (p<0.05). Reduction of Ca and Mg levels in the serum of miners in increasing work experience in harmful working conditions, exceeding average concentration of aluminum in patients' blood compared to the normative value and indicators of the control group patients was established.

86-92

Authors: Grigoruk S.P., Zorin M.O., Dudukina S.O.

The quality of life of patients after surgical interventions in those of with combined atherosclerotic lesions of the cerebral and coronary arteries remains a topical issue of modern medicine. The purpose of the study: to analyze the results of treatment of patients with combined atherosclerotic lesions of the cerebral and coronary arteries in the temporal aspect, who underwent carotid endarterectomy as the first stage of treatment. The results of treatment of 112 patients were analyzed. All patients underwent simultaneous cerebral and coronary angiography. After the operation, if new neurological symptoms appeared or a cardiological pathology progressed, the angiographic study was performed again, and the results of this study were used to decide on further tactics. Treatment results were evaluated 30 days, 5 and 10 years after ACBS. With the revealed indications for ACBS, hemodynamically significant stenoses of the operated carotid artery were found in 10.7% of patients. Stenoses of other cerebral vessels that required surgical correction (opposite ICA, VA) in 7.1%. These patients had cerebral artery stenting before ACBS. In 9.8% of patients, indications were found for stenting of cerebral and coronary arteries, which were performed in one session. In 5.4%, only coronary artery stenting was performed. In the remaining 75 patients without indicated surgical correction of cerebral arteries ACBS was performed. So, in 3-5 years after CEE, ACBS was performed in 35 patients, later than in 5 years – in 40 patients. In the postoperative period, ACBS TIA was registered only in 4%, ischemic stroke – in 5.3%. The total lethality rate is 4%. The 10-year survival rate after myocardial revascularization was 46% [CI 95% 58%; 34%]. the most intensive decrease in survival function was registered during the first 5 years of follow-up (5-year survival rate 60% [71%; 48%]. Carotid endarterectomy is an effective method of treating atherosclerotic stenosis of the ICA and a method of preventing neurological complications in patients with combined atherosclerotic lesions of the cerebral and coronary arteries with the progression of cardiac pathology.

98-103

Authors: Shydlovska T.A., Zemliak T.B.

Treatment of patients with bilateral vocal fold paralyses remains a complicated task. Study of central mechanisms of realization of larynx functions in case of stenosis is of interest. By electro­encephalography method (EEG) patients with bilateral vocal fold paralysis were examined: 55 patients without surgical treatment (group I), and 51 patients who had unilateral chordoarytenoidotomy (group II). All the patients showed changes in percentage content of the α - and β-rhythms and Δ- and θ-rhythms ("slow" waves). The group II patients demonstrated more pronounced rhythms, as compared with the control group. During the background recording, in group I the increase in the percentage content of the Δ-rhythms in frontal and parietal directions up to 28.2±2.3 and 29.2±2.4%, was seen, the group II patients showed the increase in Δ-activity up to 32.2±2.8 and 35.4±2.9% in frontal, temporal and parietal directions accordingly. Besides, the group II patients proved to have an increasing of β-rhythms activity in all the directions, as compared to the control group, as well as an increasing of θ-rhythms in temporal and parietal directions. Herewith, the increase of θ-rhythms in temporal directions up to 21.4±2.2%, was much higher as compared to group I data 16.5±1.3%. Besides, all the patients showed decrease in α-rhythms amplitude. So, the redistribution of electroencephalography rhythms in the way of α-range fluctuation decrease and increase of slow wave activity (θ- и Δ- waves), as well as α-rhythms amplitude decrease in patients having vocal fold motor disorders testify to the prevailing influence of subcortical structures on the bioelectrical brain activity and facts of nervous processes depletion in brain, including chronic hypoxia of patients suffering from larynx stenosis of paralytic origin.

108-118

Authors: Shifris I.M., Dudar I.O., Driyanska V.E., Shymova А.U.

The aim of the work was to determine the blood serum pro-inflammatory cytokine profile and to study their relationship with comorbidity and mortality in end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). Ninety three ESRD patients treated with CAPD during 2012-2019 were included in the cohort prospective open study. The study was conducted in two stages. At the first stage, the determination of TNF-α and IL-6 levels was conducted and study of comorbidity, its quantitative assessment, baseline clinical and laboratory parameters was made. A modified polymorbidity index (MPI) which determined the quantitative assessment of comorbidity was calculated as the number of diseases per one patient excluding ESRD and its reasons. At the second stage, considering the baseline values of the studied cytokines, a prospective study of the dynamics of the prevalence of comorbid pathology, the value of MPI and mortality rate was carried out. The average duration of prospective follow-up was 26.4±6.8 months. Serum cytokines levels were determined by ELISA. Statistical analysis was performed by using "MedCalc", version 19.1.7. (Ostend, Belgium). Serum levels of TNF-α and IL-6 were significantly higher in PD-patients with 5 or more comorbid diseases. Levels of TNF-α>13.0 pg/ml have a negative effect on the dynamics of prevalence of heart failure (HF) and coronary heart disease (CHD), number of comorbid conditions in CAPD-patients. The proportion of the dead with a level of TNF-α>13.0 pg/ml was by three times higher, and deaths from cardiovascular events are almost by 10 times higher than patients who had a level of TNF-α≤13.0 pg/ml. Serum levels of IL-6>23.4 pg/ml are associated with a significant increase in number of comorbid conditions, prevalence of bacterial infections and overall and infectious mortality. Independent predictors of comorbidity and overall mortality in patients with ESRD who are treated with CAPD are serum levels of TNF-α, IL-6 and albumin. Serum levels of TNF-α and albumin are predictors of fatal cardiovascular events, and serum levels of IL-6 are predictors of fatal infectious events.

124-129

Authors: Kolosovych I.V., Bezrodnyi B.H., Hanol I.V., Cherepenko I.V.

The article deals with the problem of diagnosis and treatment of acute pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity with a high risk of complications, the mortality rate of which reaches 5.5%, and in acute pancreatitis it varies within 40-70%. The purpose of this work is to improve the results of surgical treatment of patients with acute pancreatitis. The results of treatment of 112 patients with acute pancreatitis, who were hospitalized in the procedure of ambulance in the Department of Surgery No. 2 of the Bogomolets National Medical University in 2009-2019 period are analyzed. Severe disease course was observed in 83 (74.1%) patients, moderate – in 29 (25.9%) patients. In the early phase of the disease, endoscopic operations were performed in 44 (39.3%) patients, and laparotomy was performed in 12 (10.7%) patients with advanced purulent peritonitis. In the late phase 15 (13.4%) patients underwent laparotomy, necrsequestrectomy, abdominization of the pancreas, drainage of the abdominal cavity and retroperitoneal space, 36 (32.1%) patients were treated with ultrasound-guided puncture treatments. In the case of progression of the disease and ineffective drainage under ultrasound control, 5 (4.5%) patients were treated with retroperitoneoscopically assisted necrsequestrectomy, combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy was performed in 3 (2.7%) patients, and in 2 (1.8%) patients – open laparotomy, abdominization, necrsequestrectomy, drainage of the abdominal cavity and retroperitoneal space. The surgical intervention in the late phase of the disease was 21±4.2 days from the onset of the disease. A stage approach in the treatment of acute pancreatitis was applied to 80 (71.4%) patients in the main group. The comparison group consisted of 32 (28.6%) patients who underwent laparotomy and laparoscopic interventions in the early and late periods of the disease without prior use of endoscopic interventions or drainage operations under ultrasound control. In the main group the length of stay in the hospital was 21,3±4,2 days, in the comparison group – 48.2±5.3 days respectively. In 42 (95.5%) patients who underwent endoscopic surgery, a positive clinical effect, rapid regression of symptoms of acute pancreatitis was achieved. In two (4.5%) patients who underwent endoscopic interventions, the disease progressed with the development of an abscess of the omental pouch, they underwent puncture drainage under ultrasound control. When using puncture drainage operations under ultrasound control in 26 (72.2%) patients, a positive result was achieved, the abscess cavity decreased by 63±6.2% within 7 days. In 10 (27.8%) patients due to the progression of the disease, the following stage of treatment was performed: retroperitoneoscopically assisted necrsequestrectomy (5 (13.9%) patients), combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy (3 (8.3%) patients), and open laparotomy, abdominization, necrosequestrectomy, drainage of the abdominal cavity and retroperitoneal space (2 (5.6%) patients). Complications in the main group developed in two (2.5%) patients, the mortality rate was 2.5% (two patients). In the comparison group, complications developed in 8 (25%) patients, the mortality rate was 18.8% (6 patients). The use of minimally invasive endoscopic interventions, draining surgeries under ultrasound control followed by combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy or open laparotomy reduces the length of hospital stay of patients from 48.2±5.3 days (comparison group) to 21.3±4.2 days (main group) (p<0.0001, t=28.346) and the number of complications by 22.5% (p=0.0002, χ2=14.104, CI 9.2333-39.7022). The use of a stage approach in the surgical treatment of acute pancreatitis reduces mortality by 16.3% (p=0.0026, χ2 =9.058, CI 4.6571-32.9639).

137-144

Authors: Gudaryan O.O., Іdashkіna N.G., Nekhanevich Zh.M.

Objective – improving the effectiveness of treatment of patients with retention and dystopia of the third molars of the lower jaw in their horizontal or inverse position by developing an integrated approach using photodynamic therapy and drugs that enhance osteogenesis (platelet autoplasma enriched with i-PRF fibrin and recombinant morphogenetic protein (rhBMP-2). 82 patients with difficult eruption of third molars of the lower jaw aged 19 to 37 were included in research: 40 (48.8%) men and 42 (51.2%) women. The standard approach to performing operations of atypical removal of retined third molars causes a significant number of complications (large bone defects, inflammatory contracture, post-traumatic neuritis, etc.). Treatment process was provided in two stages. During the first (preoperative) stage sanitation was done to eliminate or stabilize an acute infection which is inflammatory process in the area of impacted third molar. The second stage provides abscessed tooth extraction, wound sanitation, formed defect filling with osseo-inductive medications under the collagen membrane and complete closure. The developed surgical method for treating retention and dystopia of the lower third molars using biomaterial based on demineralized bone matrix (BCP) saturated with recombinant morphogenetic protein of bone rhBMP-2 can reduce the occurrence of postoperative inflammatory complications by 35.4%, and also reduce the time for their elimination as well.

149-155

Authors: Ryabukha O.I.

Despite the available information on the interaction between the thyroid gland activity and that of the adrenal glands, and the liver involvement in their hormones metabolism, the study of the connection existing between these organs in hyperthyroidism is still incomplete. Changes in the weight indices values of the thyroid and adrenal glands and the liver of 90 non-linear white male rats were studied. Animals received histologically verified minimally active (21 μg iodine per kg body weight), moderate (50 μg iodine per kg body weight), and significant (100 μg iodine per kg body weight) doses of organic and inorganic iodine during 30 days under the model hyperthyroidism conditions. It was found that consumption of organic and inorganic iodine at a minimal dose approximates the digital values of adrenal gland and those of the liver of the intact animals. Consumption of a moderate organic iodine dose is accompanied by a decrease in the previously achieved values of the thyroid weight index by 17.28%, and the increase in the liver weight index by 19.66%. When consuming a moderate amount of inorganic iodine, the largest change in the values achieved was the liver weight index which increased by 13.76%. Consumption of organic and inorganic iodine compounds in a significant dose is accompanied by further changing in the studied parameters. When consuming organic iodine the thyroid weight index grows by 10.44%, that of the adrenal glands – by 13.33%, the liver – by 34.52%. Сonsuming of inorganic iodine is accompanied by a rapid increase in the thyroid glands weight index by 21.25%, that of the liver – by 34.31%. The established indicates the existence of functional communication between the studied organs; the effect depends on the chemical nature and dose of iodine consumed. The existing functional dependence gives grounds to apply changes in the weight index of the thyroid gland, adrenal glands and the liver as screening-markers to determine the body’s condition in hyperthyroidism.

163-167

Authors: Shevchenko О.А., Burlakova I.A., Sheviakov О.V., Agarkov O.A., Shramko I.A.

A theoretical and methodological approach to the study of the process of professional health of specialists in the economic sphere was developed, which allowed to distinguish professionally important qualities of a specialist influencing his professional health, as well as to predict their transformation in changing social conditions. The peculiarities of the dynamics of the process of occupational health of specialists in the economic sphere (the stage of "primary formation" and undefined attitude to the profession; "personal-activity" stage - realization of social status at the level of the professional community; "professional-ethical" stage – values-based attitude to the profession) are revealed. Types of values-based attitude relation (neutral; pragmatic-realistic; values-based) to professional activity and peculiarities of their manifestations in specialists of economic sphere having different experience of such activity are determined. It is shown that the dynamics of professional becoming of specialists in the economic sphere is associated with the activation of changes in the internal and external environment of the subject of activity. The conceptual model of formation and preservation of professional health of specialists of the economic sphere is offered, implemented as a theoretical and methodological strategy of the systemic and holistic process in the direction of ensuring its effectiveness, presented in the form of an image of a healthy person, responsibly managing his own health and realizing himself in society, and an image of a specialist who independently sets the goals of formation and preservation of professional health, chooses the best ways and means and achievements. The developed model provides a qualitatively new level of personal, physical, professional and social readiness of the person for self-realization in the professional economic sphere of activity and successful integration into society.