Background. Adequate intake of vitamin D and its concentration in serum is important for the health of bones and calcium-phosphorus metabolism and for the optimal functioning of many organs and tissues. Most epidemiological studies have shown that vitamin D deficiency is widespread among the population in Russian Federation.Material and methods. We reviewed relevant literature on the epidemiology of insufficiency and deficiency, skeletal and extraskeletal effects of vitamin D and summarized recommendations for the diagnosis, prevention and treatment of vitamin D deficiency in the general population, which were subsequently discussed and amended in conjunction with leading endocrinologists of the Russian Federation who are experts in this subject.Results. The optimal concentration of 25(OH)D in the serum as the best indicator of vitamin D body stores is recognized as 30—100 ng/ml (75—250 nmol/l), insufficiency — from 20 to 30 ng/ml (50 to 75 nmol/l), deficiency — less than 20 ng/ml (less than 50 nmol/l). In prevention and treatment it is recommended to stick to the target serum levels of 25(OH)D in the range of 30—60 ng/ml (75—150 nmol/l). We’ve developed a general practice recommendations for the prevention, diagnosis and treatment of vitamin D deficiency in adults, including pregnant and lactating women, persons over 50 years old and subjects suffering from various diseases affecting the metabolism of vitamin D.Conclusions. Increased sufficiency of vitamin D in the population should be included as one of the priorities of modern healthcare due to proven preventive health effects on the musculoskeletal system and the potential positive impact on many socially significant diseases. This publication is a detailed version of the Federal Guideline.

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Young patients with CS have a low TBS. However, the only predictor of low traumatic fracture is the severity of the disease itself, indicated by high 24hUFC levels.

Primary hyperparathyroidism (PHT) is the third most common endocrine disorder in men and women after diabetes mellitus and thyroid disease and one of the most frequent causes of osteoporosis and fractures among the secondary osteopathy. PHT refers to socially significant problems in connection with involvement in the pathological process of the majority of organs and system In recent years, the conception of epidemiology, clinic and tactics of management of patients with PHT has changed due to significant increase of morbidity at the expense of identification of mild forms of disease. The modern management concept tactics depends on clinical manifestations. Bearing in mind the importance of the problem under consideration, the working group was set up for the development of federal recommendations on the treatment of PHT based on the principles of evidence-based medicine. The experience accumulated by the domestic and international experts was summarized in the federal clinical guidelines on PHT.

Comparing lipid levels and hemostatic variables as a function of glycosylated hemoglobin level, we conclude that diabetes control has greater influence on these parameters than the type and dose of steroids involved in the contraceptive devices.

В статье представлена попытка выявить основные характеристики детской информационной среды и показать их влияние на особенности психологии современных детей. На материале анализа рынка современных игрушек, книжек и фильмов, автор констатирует некоторые парадоксы современной социокультурной ситуации. Один из них заключается в том, что большая часть информационной продукции для детей не рассчитана на возрастные особенности своего адресата. Другой парадокс заключается в том, что повы-шенные требования к умственному развитию детей сочетаются с чрезмерно бережным отношением к их физической безопасности и самостоятельности. Стремление облегчить жизнь ребенка, обезопасить его от всяких рисков, усилий и трудностей является доминирующей тенденцией воспитания. В ре-зультате у детей складывается установка на потребление, которая усиливает-ся экспансией современных СМИ и видеопродукции для детей. Во второй части статьи обсуждаются проблемы современных детей в связи с характе-ристиками детской субкультуры. Среди них недоразвитие моторной сферы, нарушения речевого развития, дефицит воображения, коммуникативные трудности, отсутствие самостоятельности и самоорганизации. Автор делает вывод о том, что установка взрослых на раннее развитие, которое понимается как «обученность», тормозит развитие целостной личности ребенка и ведет к дефициту мотивационной сферы. Культурные средства, транслируемые взрослыми, не опираются на возрастные особенности мотивационной сферы детей, а их собственные смыслы отсутствуют или лежат вне традиционного культурного контекста. Ключевые слова: детская субкультура, информационная продукция для детей, игрушки, мультфильмы, компьютерные игры и программы, самостоятель-ность, самоорганизация, личность. В последние десятилетия существенно изменились условия жизни и взросления детей. Стремительный переход к постиндустриальному, ин-формационному обществу, который переживаем мы все, с особой остро-той коснулся современного детства. С первых месяцев ребенок сталки-вается с благами цивилизации, о которых не подозревали его сверстники 20-30 лет назад. Памперсы, радио-няни, электронные игры, компью

This study estimates diagnostic performance of late-night salivary cortisol (LNSC) as measured by automated electrochemiluminescence immunoassay (ECLIA), evaluates the clinical implication of two consecutive LNSC measurements, and compares its accuracy with enzyme-linked immunosorbent assay (ELISA) and serum cortisol after low-dose dexamethasone suppression test (DST) in obese and overweight patients referred for suspected Cushing's syndrome (CS). One hundred twenty three consecutive obese and overweight referred patients and 98 healthy volunteers provided two saliva samples collected at 23:00 using a Salivette (Sarstedt, Germany), assayed by ECLIA (Cobas e601) and ELISA. The patients underwent DST and were further evaluated until CS was pathologically confirmed (n = 45) or excluded. Diagnostic performance of LNSC was evaluated by receiver operating characteristic (ROC) analysis. The total areas under the curve (AUC) were calculated to compare the different tests. We found that a cut-off value of 9.4 nmol/l can differentiate CS among obese and overweight patients with sensitivity of 84.4 % (95% CI 71.2-92.2), specificity of 92.3 % (95% CI 84.2-96.4), and diagnostic odds ratio of 65.1 (95% CI 20.4-207.6). No difference was found between AUCs from the first, second, and the mean from the two LNSC measurements (ECLIA), LNSC (ELISA), or DST. The single LNSC (ECLIA) and DST improved the sensitivity and specificity for concordant results up to 100 and 97.4 %, respectively. In conclusion, due to its automation and its comparable diagnostic performance, ECLIA is preferable as a first-line LNSC screening test for CS. The initial use of single LNSC followed by DST provides better diagnostic performance for concordant results.

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