journey primary care

DPC Frontier

Journey Direct Primary Care (FreedomDOC)

Direct primary care in hoover, al.

Accepting new patients

Family Medicine

Meet the doctor

John shugrue, md, prices and fees.

Membership prices

$240/MONTH Family max (for Family of 5 and over)

Additional fees

Enrollment fee

What is Direct Primary Care?

Direct Primary Care, or DPC, is a new way of providing primary care that's already helped a quarter million people stay healthier and spend less on healthcare. Patients at DPC practices often receive ongoing primary care from their doctor with zero copays, convenient online scheduling options, near-wholesale prices on medications and blood tests, and even their doctor's personal cell number. It's like having a doctor in the family.

So how is this possible? Easy: direct primary care practices cut out middlemen like insurance companies, freeing themselves to provide great care at fair prices. Unlike traditional third party practices that serve the needs of insurance companies, direct primary care is for everybody; most DPC memberships cost less than your monthly cell phone or cable bill, for great care whenever you need it.

If you're tired of high copays, insane wait times, rushed 8-minute doctor visits, join 250,000 other Americans that have already benefited from direct primary care. Search on the DPC Mapper to find a practice near you.

Founded by Phil Eskew. Copyright © 2018 by DPC Frontier, LLC All rights reserved.

now accepting new patients! *Same day, late evening, & saturday appointments!

NOW ACCEPTING NEW PATIENTS!

*walk-in/same day, late evening & saturday appointments available.

Now Offering On Site Echocardiogram, Non-Invasive Cardiovascular Wellness Scan, Arterial/Doppler and Ultrasound services!

Here to leave a review? Scroll down to the "Review" section and click the Google hyperlink.

"on your journey to becoming your whole self, we're here beside you every step of the way...", our philosophy.

At JourneyCare Family Medicine, we believe in treating the whole person-not just their symptoms. We take a holistic approach to healthcare, focusing on the physical, mental, and emotional well-being of our patients. With our unique mixture of Family Medicine, Holistic Medicine, Mental Health services and extended hours (we're even open on Saturday), we are not just a primary care clinic; we are a "patient centered medical home" which prioritizes the needs of our patients above all. 

Affordable, High-Quality Healthcare for Your Entire Family!

*LATE EVENING & SATURDAY APPOINTMENTS AVAILABLE*

A Personal Approach

Experienced medical professionals.

 Whether you need medical care for acute illnesses, chronic diseases, or disease prevention, our team has the professional experience to realize that there is no such thing as "one-size-fits-all". When it comes to your treatment plan, our approach is individualized to your meet your specific needs.  

Our team is highly skilled, knowledgeable, and compassionate, and is dedicated to improving and maintaining your overall health by empowering you to understand and manage your health conditions and wellness plan. 

The Latest Treatments

 We provide both a high-quality and personalized health experience by offering a broad array of medical care services. We offer the latest evidence-based treatments and technology to address common illnesses and injuries. We are dedicated to improving your health through preventative care and management of chronic diseases. 

most commercial insurance plans, Medicaid, and MEdicare accepted!

Patient-centered care.

At JourneyCare Family Medicine, we pride ourselves on providing patient-centered care. We listen to your concerns, answer your questions, and work with you to develop a treatment plan that meets your specific needs. We are dedicated to ensuring your satisfaction with the care you receive.

New Patients

We are happily accepting new patients at JourneyCare Family Medicine! We offer late evening, * same and/or next day , and Saturday appointments! If you're looking for a new healthcare provider, we would be honored to serve you and your family. Contact us today to schedule your first appointment! *Same and/or next day appointments are based on scheduling availability.  

Chronic Disease Management

If you're living with a chronic condition, we can help you manage it and improve your quality of life. Find out how we can support you.

Pediatric Care

We provide comprehensive pediatric care for children starting from 2 weeks of age and older! Our provider is dedicated to ensuring your child receives the best possible care and treatment. We offer well-child visits, immunizations, sick and minor injury visits to keep your child healthy.

Senior Care

As we age, our healthcare needs change. We offer specialized care for seniors, including geriatric assessments and chronic disease management.

Behavioral Health

At JourneyCare Family Medicine Family, we understand that mental health is just as important as physical health ! Learn about our behavioral health services.

Laboratory and Diagnostic Imaging

As your "medical home" we are dedicated to making healthcare easier and more convenient for you by providing comprehensive healthcare services "under one roof"! We offer laboratory and diagnostic imaging in-house. Learn more about our laboratory and diagnostic imaging services. 

Ready to schedule an appointment? Have questions about our services or insurance? Give us a call and our friendly staff will be happy to assist you! *Please review our cancellation and no-show policy which can be found in the "services" or "contact us" sections of this website. 

We value your feedback! Please click the Google link below to rate your experience with us!

Veteran owned small business.

Here at JCFM, we are proud to be of service for our heroes who proudly served, and we thank you for your sacrifice and service! 

LGBTQ+ Health Partner

JourneyCare Family Medicine is a proud advocate for healthcare diversity and inclusion, and welcomes everyone to be cared for in a warm, professional setting that is free from 

bias, judgment, and prejudice. 

journeycare family medicine

126 N Park drive Fayetteville, ga 30214

Office: (470) 278-2618 Fax: (678) 519-2736

Copyright © 2023 JourneyCare Family Medicine - All Rights Reserved.

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

News & Announcements

Journey Family Medicine pre-registration is open!

By Dr. Pilar Bradshaw, Owner

Published September 7, 2022

It’s been a dream of mine to create a clinic that’s similar to Eugene Pediatric Associates —a clinic for adults that’s locally owned, family-focused and provides integrated healthcare at every chapter of life—and that dream is now a reality!

I’m excited to introduce Journey Family Medicine, offering primary care for adults by applying our amazing model of integrating medical providers, behavioral health specialists and social workers to help adults achieve optimal health. Pre-registration is now open on the Journey Family Medicine website, JourneyFamilyMedicine.com . Most insurances are accepted. Opening day is Monday, October 3.

The new clinic is located right next to Eugene Pediatrics, in the same building, at 995 Willagillespie Road. Journey Family Medicine will be a welcoming spot for our older pediatric patients who want to graduate to a grown-up primary care clinic, as well as their parents and grandparents.

As owner of Journey Family Medicine, I will not be seeing patients at my new clinic. I will, however, continue to care for infants, children and young adults as a pediatrician at Eugene Pediatric Associates.

Our talented team will walk alongside you

I’ve hand-picked a talented team of clinicians for Journey Family Medicine—professionals who I trust to care for my own family and me, personally. They share my belief that each of us walk a unique path in life. It’s important that our individual healthcare journeys are in the company of clinicians who know us well and provide the personalized service that only a small, local clinic can deliver.  Through all the twists and turns and ups and downs, your medical, behavioral health and social work experts at Journey Family Medicine will walk alongside you. Let me introduce them to you!

Meg Hamilton, FNP-C , and I have spent the past 20 years talking about how wonderful it would be to work together “someday.” Well, that “someday” is finally here. Meg, who I’m proud to say is my personal primary care provider, is an attentive listener, deeply compassionate, wicked smart and driven to provide the best-possible care for her patients. I have always trusted her implicitly with my own health and the health of my family members. If you or a friend or family member needs a primary care provider or is looking to make a change, I highly recommend Meg.

Lindsey Adkisson, DNP, FNP-C , was hand-picked by Meg to be her partner at Journey Family Medicine. Over the course of many months of planning this new venture, I have come to adore Lindsey and value her medical and philosophical insights. She is caring, well-rounded, highly educated and has a passion for equity in healthcare.

Tamara Hughes, LCSW , and I have known each other for years, in a variety of ways. Most recently, I have watched her work closely and successfully as a behavioral health expert at my other clinic, Thrive Behavioral Health , caring for moms with perinatal mood issues. Before that, she was a phenomenal social worker at Sacred Heart Medical Center at RiverBend. Here’s a fun fact: Tamara and her husband purchased my former house, which is proof that Eugene really is a small town! Tamara is a deep listener, kind soul and thrives on helping people. -->

Tell others, spread the word far and wide

It’s a challenging time to start a small business, so every person who chooses Journey Family Medicine is helping to make this dream a reality.

Please consider Journey Family Medicine for your primary care and tell your Eugene-Springfield family and friends. I pledge that you’ll feel loved and cared for by my amazing team throughout your healthcare journey.

Thank you for spreading the word!

– Dr. Pilar Bradshaw, Owner & Pediatrician

DISCLAIMER: No content on this website, regardless of date, should be used as a substitute for direct medical advice from your primary care provider.

Website by Turell Group © 2024

• Neurology Specialists
• Pediatricians

Sheila's Weight Loss Journey

At 350 pounds, Sheila Briggs was experiencing a lot of pain and discomfort. Pre-diabetic and suffering from severe sleep apnea, she dreamed of an active life, but didn't have the energy to do much more than sit on the couch. 

When you’re ready to leave pain, illness and mobility issues behind ...

Sheila was referred to MaineHealth Weight Management - Kennebunk by her endocrinologist at MaineHealth Maine Medical Center. She chose to begin her weight loss journey at oue practice because it's closer to her home in Wells and she liked the feel of a smaller program with more personalized attention.

 ... step out of your comfort zone and start living the life that you deserve. 

From the very first meeting, Sheila felt an immediate connection to the MaineHealth Weight Management - Kennebunk team. They took the time to educate her whole family about the process - making sure everyone felt comfortable and prepared. And when they day came, her surgery was a success with zero complications.

We'll be with you for every step of your weight loss journey.

Sixteen months after her surgery, Shelia has lost 135 pounds, continues to keep the weight off, and has set a goal to lose even more weight. She’s able to do yard work, kayak, and take the family dog for a walk on Wells Beach. She is no longer pre-diabetic and no longer needs to use a CPAP machine to sleep at night. She exercises five to six times a week and meets with a trainer in Sanford once a week.

She continues to see her dietitian and attends support team meetings with her husband twice each month. She says this long-term support by the MaineHealth Weight Management - Kennebunk team has helped her stay accountable and motivated. Her husband has also been a big supporter and is thrilled with the positive impact this program has had on their family.

You’re worth it. 

The best part of all? Sheila and her husband have booked their dream vacation. While in Hawaii, they plan to slide on a zip line and go horseback riding - activities Sheila could never do before, because of her weight. Sheila chose to share her story to help other people who are struggling with obesity to understand that they are valued, important, and that their life is worth living.

Want to learn more about weight loss surgery?

Join a free info session. Just complete this short form and a member of our team will contact you with more details.

Is weight loss surgery right for you?

Use our interactive decision tool to find out more.

• Visit Our Blog about Russia to know more about Russian sights, history
• Check out our Russian cities and regions guides
• Follow us on Twitter and Facebook to better understand Russia
• Info about getting Russian visa , the main airports , how to rent an apartment
• Our Expert answers your questions about Russia, some tips about sending flowers

Russian regions

• Amur oblast
• Buryat republic
• Chukotka okrug
• Jewish autonomous oblast
• Kamchatka krai
• Khabarovsk krai
• Komsomolsk-on-Amur
• Magadan oblast
• Primorye krai
• Sakha republic
• Sakhalin oblast
• Zabaikalsky krai
• Map of Russia
• All cities and regions
• Blog about Russia
• News from Russia
• How to get a visa
• Flights to Russia
• Russian hotels
• Renting apartments
• Russian currency
• FIFA World Cup 2018
• Submit an article
• Flowers to Russia
• Ask our Expert

Khabarovsk Krai, Russia

The capital city of Khabarovsk krai: Khabarovsk .

Khabarovsk Krai - Overview

Khabarovsk Krai is a federal subject of Russia located in the center of the Russian Far East, part of the Far Eastern Federal District. Khabarovsk is the capital city of the region.

The population of Khabarovsk Krai is about 1,299,000 (2022), the area - 787,633 sq. km.

Khabarovsk krai flag

Khabarovsk krai coat of arms.

Khabarovsk krai map, Russia

Khabarovsk krai latest news and posts from our blog:.

25 August, 2017 / Russian banknotes and the sights depicted on them .

1 August, 2017 / Khabarovsk - the view from above .

21 December, 2016 / Flying over diverse Russia .

21 April, 2013 / Khabarovsk - the center of the Russian Far East .

16 January, 2011 / Siberian tiger walking the highway .

More posts..

History of Khabarovsk Krai

In the Middle Ages, the territory of today’s Khabarovsk Krai was inhabited mainly by the peoples of the Tungus-Manchu language group, as well as Nivkhs. In China they were known collectively as “wild Jurchen”. In the 13th-14th centuries, the Mongol rulers of China repeatedly organized expeditions to the lower Amur.

Russians began the development of the Far East in the 17th century. In 1639, a Cossack troop headed by Ivan Moskvitin reached the coast of the Sea of Okhotsk. The first stockade town was built in the mouth of the Ulya River. Later, Vasily Danilovich Poyarkov and Yerofei Pavlovich Khabarov were the first who started joining the Amur lands to Russia. Before Russians came here, the tribes of Daurs, Evenks, Natks, Gilyaks and others lived in this area (only about 30 thousand people).

The area was quickly populated by Russian settlers; new stockade towns were founded. But the process was interrupted due to a conflict with the Qing Dynasty. From the 1680s, Manchus started to fight against the Russian state.

More Historical Facts…

Russia could not move significant military forces to the Amur region and had to sign the Treaty of Nerchinsk (1689). According to it, Russians had to leave the left bank of the Amur River but managed to uphold its rights for the area behind Lake Baikal and the Sea of Okhotsk coast.

In the 18th century, Okhotsk became the main Pacific port of the Russian Empire. Development of the northern coast of the Pacific, exploration of the Kuril Islands and Sakhalin prepared the basis for the return of the Amur region.

In 1847, Nikolai Nikolayevich Muravyov was appointed a governor-general of Eastern Siberia. He did his best to return the Amur area to the Russian Empire. The number of Russians in the region began to grow. In 1858, the town of Khabarovsk was founded.

As a result of the weakening of China during the Opium Wars, two agreements were signed - the Aigun Treaty in 1858 and the Beijing Treaty in 1860. The Russian-Chinese border was established on the Amur and Ussuri rivers.

In 1884, Zabaikalskaya, Amurskaya and Primorskaya regions were united into Priamurskoye region with the center in Khabarovsk. Until the late 19th century, the Amur area was settled slowly. The situation changed in the early 20th century. In 1900, the Trans-Baikal Railway was opened, in 1902 - the Chinese Eastern Railway.

As a result, the number of settlers grew rapidly. In 1900-1913, about 300,000 peasants from other regions of the Russian Empire came to the Amur area. There were three towns (Khabarovsk, Nikolayevsk-on-Amur and Okhotsk) on the territory, which makes Khabarovsk krai today. By 1915, there were more than six thousand settlements with a total population of 316,300 people in Primorskaya oblast.

The Civil War lead to a great number of deaths and economic collapse in Russia. The restoration of pre-war level of economy was achieved by 1926. New cities were built in the region - Komsomolsk-on-Amur, Birobidzhan. October 20, 1938, Dalnevostochny region was divided into Khabarovsky and Primorsky regions.

In 1947-1948, Sakhalin and Amur regions were separated from Dalnevostochny region. In 1953, Magadan region was formed and separated from Dalnevostochny region. In 1956, Kamchatka region became independent too. In 1991, the Jewish autonomous region was separated from Dalnevostochny region.

Nature of Khabarovsk Krai

Khabarovsk Krai scenery

Author: Alexander Semyonov

Khabarovsk Krai landscape

Author: Alexander Makharov

Lake in Khabarovsk Krai

Author: Ezerskiy Feliks

Khabarovsk Krai - Features

Khabarovsk Krai is one of the largest administrative-territorial units of the Russian Federation. The territory of the region stretches for about 1,800 kilometers from north to south, and for 125-750 km from west to east. The distance from Khabarovsk to Moscow is 8,533 km by rail, 8,385 by roads and 6,075 km by air.

Part of the southern boundary of the Khabarovsk region is the state border of Russia with China. The province is washed by the Sea of Okhotsk and the Sea of Japan. The coastline extension is 3,390 km, including islands, the largest of them are Shantarsky Islands. The highest point is Berill Mountain (2,933 meters).

The climate of the region changes from north to south. Winters are long and snowy. The average temperature in January is in the range of minus 22-40 degrees Celsius, on the coast - minus 18-24 degrees Celsius. Summers are hot and humid. The average temperature in July is about plus 15-20 degrees Celsius.

In general, Khabarovsk Krai is one of the most sparsely populated regions of Russia, which is due, firstly, the general economic decline of the post-Soviet time, and secondly - the severity of the local climate, comparable with the regions of the Far North.

The largest cities and towns are Khabarovsk (613,500), Komsomolsk-on-Amur (239,400) Amursk (38,200), Sovetskaya Gavan (22,900), Nikolaevsk-on-Amur (17,400), Bikin (15,900).

Khabarovsk Krai - Economy and Transport

The main branches of the local economy are mechanical engineering and metalworking, ferrous metallurgy, mining, fishing, food, light and timber industries. The mineral resources of the region include gold, tin, aluminum, iron, coal and lignite, graphite.

The main highways of Khabarovsk Krai are M60 “Ussuri” (Khabarovsk - Ussuriysk - Vladivostok) and M58 “Amur” (Chita - Never - Svobodny - Arkhara - Birobidzhan - Khabarovsk). The railway station “Khabarovsk-2” is a large railway hub. The directions are as follows: to the south (to Vladivostok and Port Vostochny), to the west (to Moscow) and to the north (to Komsomolsk-on-Amur).

The river port in Khabarovsk is the largest on the Amur River. The other river ports of the region are located in Komsomolsk and Nikolayevsk. The sea ports of the region are Okhotsk, Ayan, Nikolayevsk-on-Amur, Vanino, Sovetskaya Gavan.

Tourism in Khabarovsk Krai

The rich natural potential of the region provides endless opportunities for the development of ecological tourism. You can see reindeer, brown and Himalayan bears, bighorn sheep and even the Siberian tigers on the territory of Khabarovsk krai.

The Amur River is the main attraction of the region. Most of natural, cultural and historical tourist sites are concentrated in the valley of this river.

Shantarsky Islands, one of the most beautiful and unique places of unspoiled nature, are another natural attraction of this region. The inaccessibility of the islands allowed to preserve pristine nature. Shantarsky Islands are a habitat of whales, seals, killer whales. It is a great place for fishing.

If you prefer ethnographic tourism, you may be interested in cave paintings located near the Nanai village of Sikachi-Alyan and Lake Bolon, which is a large bird sanctuary. In the past, there were a Buddhist temple and ancient settlements in the vicinity of the lake.

Lovers of adventure tourism may be interested in rafting, fishing tours, caving and winter recreation.

The best time for tourism in Khabarovsk krai: “late spring - early summer”, “end of summer - early fall.”

The largest international airport in the region is located in Khabarovsk. The flights to Moscow, Vladivostok, Yuzhno-Sakhalinsk, Novosibirsk, Yakutsk, Krasnoyarsk, Irkutsk, Bangkok, Seoul, Harbin are available.

Khabarovsk krai of Russia photos

Pictures of khabarovsk krai.

Author: Sergey Kotelnikov

Author: Evgeniy Lopatin

Forest in Khabarovsk Krai

Winter in Khabarovsk Krai

Author: Volman Michail

The questions of our visitors

The comments of our visitors.

• Currently 2.88/5

Rating: 2.9 /5 (161 votes cast)

Sponsored Links:

Browse Econ Literature

• Working papers
• Software components
• Book chapters
• JEL classification

More features

• Subscribe to new research

RePEc Biblio

Author registration.

• Economics Virtual Seminar Calendar NEW!

The Socio-Economic Profile of the Khabarovsky Krai – 2020

• Author & abstract
• Related works & more

Corrections

• Ruslan Gulidov

(Federal Autonomous Scientific Institution «Eastern State Planning Center»)

Suggested Citation

Download full text from publisher.

Follow serials, authors, keywords & more

Public profiles for Economics researchers

Various research rankings in Economics

RePEc Genealogy

Who was a student of whom, using RePEc

Curated articles & papers on economics topics

Upload your paper to be listed on RePEc and IDEAS

New papers by email

Subscribe to new additions to RePEc

EconAcademics

Blog aggregator for economics research

Cases of plagiarism in Economics

About RePEc

Initiative for open bibliographies in Economics

News about RePEc

Questions about IDEAS and RePEc

RePEc volunteers

Participating archives

Publishers indexing in RePEc

Privacy statement

Found an error or omission?

Opportunities to help RePEc

Get papers listed

Have your research listed on RePEc

Open a RePEc archive

Have your institution's/publisher's output listed on RePEc

Get RePEc data

Use data assembled by RePEc

The Potential of the Khabarovsk Krai, Jewish Autonomous Region and the Amur Oblast for Fluorite Mineralization

• Published: 02 August 2023
• Volume 17 , pages 364–376, ( 2023 )

Cite this article

• A. A. Cherepanov 1 &
• N. V. Berdnikov 1  

30 Accesses

Explore all metrics

The available data on the fluorite potential of the Khabarovsk krai, the Jewish Autonomous Region and Amur oblast have been synthesized. Fluorite deposits and occurrences were ascribed to the rare-earth–fluorite, beryllium–fluorite, fluorite–tin-ore, base-metal–fluorite, and fluorite mineralization types. Fluorite also occurs in the ore and phosphorite deposits of the fluorite-bearing mineralization type. The features of their localization in different tectono-stratigraphic areas of the region are shown. Fluorite-bearing districts were identified and their economic potential was assessed. Most promising fluorite occurrences are located along the periphery of the Siberian platform and in the southern part of the Bureya massif. Inferred fluorite resources were calculated and the prospects for their industrial development were estimated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA) Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Fluorite Deposits

Geochemical characteristics of the qahr-abad fluorite deposit, southeast of saqqez, western iran.

Mineralogical-Technological Characteristics of the South-Western Lupikko Fluorite Occurrences, Republic of Karelia

N. V. Gorelikova, B. I. Semenyak, P. G. Korostelev, V. I. Taskaev, F. V. Balashov and V. A. Rassulov, “Rare earth minerals in the rare-metal greisens of the Verkhnee Deposit in the Khingan–Olonoisky District of the Amur Region, Russia,” Russ. J. Pac. Geol. 16 (6) 608–623 (2022).

V. A. Gur’yanov, Geology and Metallogeny of the Ulkan District (Aldan–Stanovoy Shield) (Dal’nauka, Vladivostok, 2007) [in Russian].

Google Scholar  

I. I. Egorov, I. P. Ovchinnikov, and K. A. Nikiforov, “New type of fluorite ores,” Razved. Okhr. Nedr, No. 9, 13–18 (1966).

A. A. Ivanova, “Prediction of fluorite mineralization based on formation classification,” Razved. Okhr. Nedr, No. 7, 12–18 (1977).

A. A. Ivanova, Yu. I. Mikhailova, and S. A. Novolinskaya, “Fluorite,” Criteria for Forecasting Assessment for Solid Minerals (Nedra, Leningrad, 1986), pp. 610–628.

A. V. Koplus, “Fluorspar,” Methodical Guide on the Assessment of Predictin Resources of Solid Minerals (Moscow, 1989), Vol. 4, pp. 119–151 [in Russian].

A. V. Koplus, “Mineral-Raw Base of the World and Russia: state, development, and prospects. Fluorspar,” Mineral Raw Material. Geological-Economic Series (VIMS, Moscow, 2000), No. 5.

A. V. Koplus and A. G. Romanov, “State, problems, and prospects of mineral-raw base of fluorspar in Russia,” Razved. Okhr. Nedr, No. 6, 36–42 (2012).

P. G. Korostelev, B. I. Semenyak, S. B. Demashov, et al., “Some compositional features of ores of the Khingan–Olonoy area,” Ore Deposits of Continental Margin (Dal’nauka, Moscow, 2000), Vol. 1, pp. 202–225 [in Russian].

I. I. Kupriyanova and E. P. Shpanov, Beryllium Deposits of Russia (GEOS, Moscow, 2011) [in Russian].

M. V. Martynyuk, A. F. Vas’kin, A. S. Vol’skii, et al., Geological Map of the Khabarovsk Krai and Amur Region. 1 : 500 000: Explanatory Note (Khabarovsk, 1988) [in Russian].

Methodical Guidebook on Assessment of Prediction Resources of Solid Minerals. Fluorspar , (Kazan’, 1986), Vyp. A, pp. 134–151 [in Russian].

M. I. Novikova and N. N. Zabolotnaya, “Beryllium-bearing feldspathic metasomatites of the Mesozoic activation zones,” Sov. Geologiya, No. 12, 92–100 (1988).

D. O. Ontoev, Geology of Complex Rare-Earth Deposits (Nedra, Moscow, 1984) [in Russian].

D. O. Ontoev, “Complex rare-earth deposits as new sources of barium, strontium, and fluorine,” Sov. Geologiya, No. 4, 33–42 (1988).

M. D. Ryazantseva, “Fluorite deposits of the Khanka median massif,” Geology and Genesis of Fluorite Deposits (Vladivostok, 1986), pp. 98–107 [in Russian].

L. V. Tausov, Geochemical Types and Ore Potential of Granitoids (Nauka, Moscow, 1977) [in Russian].

A. A. Frolov and Yu. A. Bogdasarov, “Carbonatites as a new genetic type of fluorite deposits,” Razved. Okhr. Nedr, No. 7, 6–8 (1968).

A. A. Cherepanov, N. K. Krutov, M. D. Ryazantseva, and G. G. Arkhipov, “Fluorite mineralization of the Far East and USSE Norteast, Tr. Assots. Dal’nedra (Khabarovsk, 1991), Vol. 1, pp. 170–189.

A. A. Cherepanov and N. V. Berdnikov, Stratiform Fluorite Mineralization in the Surrounding of the Siberian Platform and Russian East (Khabarovsk, 2022) [in Russian].

Download references

Author information

Authors and affiliations.

Kosygin Institute of Tectonics and Geophysics, Far Eastern Branch, Russian Academy of Sciences, 680000, Khabarovsk, Russia

A. A. Cherepanov & N. V. Berdnikov

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to N. V. Berdnikov .

Ethics declarations

The authors declare that they have no conflicts of interest.

Additional information

Recommended for publishing by A.P. Sorokin

Translated by M. Bogina

Rights and permissions

Reprints and permissions

About this article

Cherepanov, A.A., Berdnikov, N.V. The Potential of the Khabarovsk Krai, Jewish Autonomous Region and the Amur Oblast for Fluorite Mineralization. Russ. J. of Pac. Geol. 17 , 364–376 (2023). https://doi.org/10.1134/S1819714023040024

Download citation

Received : 12 January 2023

Revised : 10 March 2023

Accepted : 24 March 2023

Published : 02 August 2023

Issue Date : August 2023

DOI : https://doi.org/10.1134/S1819714023040024

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• metallogenic provinces
• fluorite-bearing mineralization types
• fluorite deposits
• Amur oblast
• Jewish Autonomous Region
• Find a journal
• Publish with us
• Track your research

• Places - Siberia and the Russian Far East

Russian Far East

The Russian Far East is a region in eastern Russia that includes the territories that run along the Pacific coast and the Amur River, the Kamchatka Peninsula, Sakhalin island and the Kuril Islands. It is a cold, inhospitable and sparsely populated area with stunning scenery, rich fisheries, virgin forest, remote towns, Siberian tigers and Aumur leopards. Sometimes the Russian Far East is regarded as part of Siberia.

Rachel Dickinson wrote in The Atlantic: Russia’s Far Eastern Federal District is huge — 2.4 million square miles, roughly twice the size of India — and takes up one-third of the country, but only 6.7 million people populate that vast space. (The district’s biggest city is Vladivostok — best known for being the last stop on the Trans-Siberian Railroad and home to the Russian Pacific fleet.) Provideniya was once a thriving military town with a population as high as 10,000; today the population is about 2,000. Most of the ethnic Russians have left, ceding the city to the region’s indigenous people. Now the government is struggling to stem the tide of people leaving the desolate Far East. [Source: Rachel Dickinson, The Atlantic, July/August 2009]

The entire Russian Pacific coastline extends for almost 16,000 kilometers (10,000 miles). The formal dividing line between Siberia and the Far East are the borders of the Khabarovsk territory and Magadan region, which extends between 160 kilometers (100 miles) to 1,600 kilometers (1,000 miles) inland from the Russia's east coast. Siberia, the Russian Far East and Kamchatka were largely covered by glaciers during the last Ice Age, which ended about 10,000 years ago. In the Soviet era, the Far East had its share of gulags and labor camps, Maksim Gorky called it " land of chains and ice." Since the break up of the Soviet Union, its people have largely been forgotten. The whole region would probably be forgotten if it weren't so rich in resources.

The Far East only has 6.7 million people and its population is falling. There used to be around 8 million people there. Eighty percent of the people live in the cities but have a strong ties to the land: hunting, fishing or picking berries and mushrooms whenever they get the chance. Some places only exist because the government subsidizes them, providing the people with shipped-in food and cheap energy for heat. In the early 2000s, the government has decided it has spent too much supporting these people and told them they have to move. In some places the people refused to move and the government cut off their water and heat and they still stayed. In recent years thing have stabilized somewhat as more money has flowed in from oil, natural gas, minerals, fishing and timber.

What the Russian Far East lacks in historical sites, old cities and museums — compared to the European parts of Russia and even Siberia — it makes up for with a wide variety of beautiful scenery and adventures. The Amur Rive boast sturgeons the size of whales. In the Primorskiy territory you can find rocky islands, steep cliffs, Siberian tigers and Amur leopards. There are isolated beaches on rivers and the see. If you like taiga, there lots of that along with wild mountains and many places to go hiking, fishing, hunting and camping. On Kamchatka there are dozens of very active 's volcanoes. Further north are some of the best places in the world to see walruses, polar bears and whales. Khabarovsk and Vladivostok are two major cities that define the eastern end of the Trans-Siberian Railway and have plenty of urban activities.

The Far Eastern Federal District is the largest of the eight federal districts of Russia but the least populated. The 11 federal subjects are: 1) Amur Oblast: 361,900 square kilometers, 830,103 people, capital: Blagoveshchensk 2) Republic of Buryatia: 351,300 square kilometers,, 971,021 people, capital: Ulan-Ude 3) Jewish Autonomous Oblast: 36,300 square kilometers, 176,558 people, capital: Birobidzhan 4) Zabaykalsky Krai: 431,900 square kilometers, 1,107,107 people, capital: Chita 5) Kamchatka Krai: 464,300 square kilometers, 322,079 people, capital: Petropavlovsk-Kamchatsky 6) Magadan Oblast: 462,500 square kilometers, 156,996 people, capital: Magadan 7) Primorsky Krai: 164,700 square kilometers, 1,956,497 people, capital: Vladivostok 8) Sakha Republic: 3,083,500 square kilometers, 958,528, people capital: Yakutsk 9) Sakhalin Oblast: 87,100 square kilometers, 497,973 people, capital: Yuzhno-Sakhalinsk 10) Khabarovsk Krai: 787,600 square kilometers, 1,343,869 people, capital: Khabarovsk 11) Chukotka Autonomous Okrug: 721,500 square kilometers, 50,526 people, capital: Anadyr

Traveling in the Far East is troublesome. There are few roads, and they are in poor conditions. Many places can’t be reached by road anyway. Rivers are frozen much of the year. Helicopters can cost as much as US$500 an hour to rent. Corruption is rampant and it seems like everyone wants a cut. Even if paperwork is in order customs officials, police an other authorities demand, sometimes, huge outrageous "fees."

Economics of the Far East

The Far East is rich in gold, diamonds, oil, natural gas, minerals, timber and fish. It accounts for more than 60 percent of Russia's total sea harvest and fishing is the region’s leading industry, providing jobs for more than 150,000 people. People in the Far East should be rich from the wealth generated from fishing, timber and minerals but that is not necessarily the case. In the case of timber, in the early 2000s, local communities were supposed to get 30 percent of the profits but in reality Moscow took 80 percent and local officials took the rest.

In the early 2000s, gas and oil companies could not pay their workers and utility companies couldn’t pay the oil and gas companies and as a result electricity was only on for a few hours a day. Workers were among the last to receive their wages, factories were cannibalized of scrap metal and parts, students studied in sub-freezing classrooms, and people died at early ages. Those that could afford it moved away.

Many foreign companies were equally frustrated. The U.S. wood product giant Weyerhaueser, Korea's Hyundai conglomerate and Australian mining companies arrived in east Russia with high hopes but after some time there either packed up and left or scaled down their staff down to a skeletal crew.

Ussuri River

The Ussuri River forms the border between Russia and China in southern Khabarovsk Krai and . Primorsky Karia. A right tributary of the Amur, it is 897 kilometers long, with a basin area of more than 193,000 square kilometers. The Ussuri River originates in the spurs of the central Sikhote-Alin. Once it descends into it the valley, the river becomes flat and gentle but has a steep rocky coast. In many area there are meandering channels.

Among the tributaries of the Ussuri are: 1) the upper river: Izvilinka, Sokolovka, Matveyevka and Pavlivka. 2) the left tributaries: Arsen'evka, Muling, Naoli River and Songacha River; 3) and the right tributaries: Pavlovka, Zhuravlovka, Big Ussurka, Bikin and Khor.

In Khabarovsk Krai, near the village of Kazakevichevo, Ussuri River flows into the shallow Kazakevichevo channel and after that the confluence of the Ussuri is called the Amur channel. The Amur channel empties into the Amur River in the center of the city of Khabarovsk. The Ussuri is a full-flowing river from May to August. In the summer and when the ice breaks there are frequent floods. Ice on the Ussuri breaks up in April and forms in November. The water is used for water supply. Above Lesozavodsk the river is navigable. Previously it was widely used for timber floating.

The Ussuri River is good for fishing and rich in fish. Gudgeon, crucian carp, common carp, trout, burbot, pike, catfish, flax and grayling are all caught as are Kaluga sturgeon, which can reach a huge size (eight meters recorded in the Amur River). The river is a spawning ground for salmon and chum salmon. In the waters of the Ussuri fish mountain rivers are found near the bottom fish. Mountain fish comes to the Ussuri in the spring to spawn.

Ussuri Taiga and Dersu Uzala

The Ussuri taiga is a forest different from the normal Russian taiga. Located between the Ussuri and Amur Rivers in the Far East and dominated by the Sikhot Alim Mountains, it is a monsoon forest filled with plants and animals found nowhere else in Siberia or Russia and instead are similar to those found in China, Korea and even the Himalayas. In the forest there is s lush undergrowth, with lianas and ferns. Wildlife include Siberian tigers, Asian black bears, Amur leopards and even tree frogs. The Siberian Tiger Project is located here. The 1970 Akira Kurosawa Oscar-winning film “Dersu Uzala,” and the book it was based on, about a Tungus trapper, was set here.

Ian Frazier wrote in The New Yorker: ““Dersu Uzala,” the memoir and narrative of exploration by Vladimir K. Arsenyev, begins in 1902, when Arsenyev is a young Army officer assigned the job of exploring and mapping the almost unknown regions east and northeast of Vladivostok, including Lake Khanka and the upper watershed of the Ussuri River. The name for the whole area is the Primorskii Krai—the By-the-Sea Region. It and much of the Khabarovskii Krai, just to the north of it, consist of a unique kind of Pacific forest in which tall hardwoods hung with vines grow beside conifers almost equally high, and the lushness of the foliage, especially along the watercourses, often becomes quite jungly. [Source: Ian Frazier, The New Yorker, August 10 and 17, 2009, Frazier is author of “Travels in Siberia” (2010) ]

“In Arsenyev’s time, this jungle-taiga was full of wildlife, with species ranging from the flying squirrel and the wild boar to the Siberian tiger. Back then (and even recently) tigers could also be seen on the outskirts of Vladivostok, where they sometimes made forays to kill and carry off dogs. Arsenyev describes how tigers in the forest sometimes bellowed like red deer to attract the deer during mating season; the tiger’s imitation betrayed itself only at the end of the bellow, when it trailed off into a purr.

“The humans one was likely to meet in this nearly trackless forest were Chinese medicine hunters, bandits, inhabitants of little Korean settlements, and hunter-trappers of wild game. Dersu Uzala, a trapper whom Arsenyev and his men come upon early in their 1902 journey, is a Siberian native of the Nanai tribe whose wife and children have died of smallpox and who now is alone. After their meeting, Dersu becomes the party’s guide. The book is about Arsenyev’s adventures with Dersu on this journey and others, their friendship, and Dersu’s decline and end.

“In the nineteen-seventies, a Soviet film studio produced a movie of “Dersu Uzala,” directed by Akira Kurosawa. It won the Academy Award for Best Foreign Film of 1975. The movie is long and slow-paced, like a passage through the forest, and wonderfully evokes the Primorskii country. I own a cassette of the movie and in my many viewings of it even picked up some useful fractured Russian from the distinctive way Dersu talks.

Udegeh: People Who Live with Siberian Tigers

The Udegeh live around the Sikhotealin Mountains in the Far East, also home to many Siberian tigers, and traditionally survived by hunting in the forest. Their ancestors were farmers and members of the Zhurdzhen empire, which ruled parts of what is now China, Mongolia and Russia. In the 13th century, Zhurdzhen was defeated by Genghis Khan and the Mongols and survived in scattered communities in the forest, where they became nomadic hunters to survive and formed their own language and culture, called Udegeh. There are only about 2,000 Udegeh left. The largest group lives in a village called Krasnyr, about 175 miles southeast of Khabarovsk.

The Udegeh live in wooden houses that often have painted gables with images of bears, dogs, devils and pagan goddesses. Their villages are surrounded by forests, and in the winter deep snow. They primarily live on animals they hunt such as sable, mink, squirrel, deer and boar. They often earn what little money they have by collecting wild ginseng in the forest or selling furs.

About 80 Siberian tigers live in the Udegeh hunting grounds. The Udegeh worship tigers, which are considered sinful to kill. One Udegeh hunter told the Washington Post, "The tiger and the Udegeh people are the same."

In the 1920s, the Udegeh were organized into hunting cooperatives by the Soviets. They sold furs to the Soviets and were able to keep their culture alive even though the Communists frowned upon their pagan beliefs and shaman practices. Today most young Udegeh wear Russian clothes and few of them speak the old language. Intermarriage is common and there are few pure blood Udegeh left. In the early 1990s, the Udegeh were involved in a dispute with the South Korean conglomerate Hyundai, who wanted to log the Udegeh's hunting ground.

See Separate Article PEOPLE OF THE RUSSIAN FAR EAST factsanddetails.com

Ussuriisk (kilometer 9177 on the Trans-Siberian, an hour and a half drive from Vladivostok) contains a "Chinese Bazaar" that is more like a separate town. The market operates all night and approximately 2,000 Chinese traders live semi-permanently in metal freight containers near their stalls.

The Museum of History and Local Lore and the famous 800-year-old stone turtle will introduce you to the history of this city. At the end of summer, tourists come to see the city's blooming lotuses. In the winter, you can enjoy a swim in an outdoor pool, surrounded by snowy fir trees. There is a historical park of everyday life and customs of the Russian people called “Emerald Valley” located five kilometers away from the city . Various events are held here, including the celebration of Kupala Night, jousting tournaments, Christmas and Maslenitsa festivities.

Ussuriisk is located near the border with China and North Korea and stands at the confluence of the Komarovka, Rakovka and Razdolnaya. The city was founded in 1866 by Russians from Voronezh and Astrakhan province in East Russia and the Capian Sea area. The town began to grow when the construction of the Trans-Siberian Railway began in the area.

Places Where the Siberian Tigers Live

Siberian tigers today are confined primarily to the Ussuri Taiga, a forest different from the normal Russian taiga. Located between the Ussuri and Amur Rivers in the Far East and dominated by the Sikhot Alim Mountains, it is a monsoon forest filled with plants and animals found nowhere else in Siberia or Russia and instead are similar to those found in China, Korea and even the Himalayas. In the forest there is s lush undergrowth, with lianas and ferns. Wildlife include Siberian tigers, Asian black bears, Amur leopards and even tree frogs. The Siberian Tiger Project is located here. The 1970 Akira Kurosawa film Dersu Uzala, about a Tungus trapper, was set here.

Sikhot Alin Reserve and Kedrovaya Pad Reserve within the Ussuri Taiga are the last homes of the Siberian tiger. The largest wildlife sanctuaries in the Far East, they embrace 1,350 square miles of forested mountains, coastline and clear rivers. Other animals found in Sikhot Alin reserve and Kedrovaya Pad reserve include brown bears, Amur leopard (of which only 20 to 30 remain), the Manchurian deer, roe deer, goral (a rare mountain goat), Asian black bears, salmon, lynx, wolf and squirrels with tassels on their ears, azure winged magpies and the emerald-colored papilio bianor maackii butterfly. Over 350 different species of bird have been sen here.

Dunishenko and Kulikov wrote: “In the 19th century, aside from the Sikhote-Alin and Malyi Khingan portions of Russia, tigers were found in southeastern Transcaucasia, in the Balkhash basin, in Iran, China and Korea. Now the Amur tiger is found only in Russia’s Primorskii and southern Khabarovskii Krais. This is all that remains of an enormous tiger population that formerly numbered in the thousands and that lived mostly in China. In the spring of 1998, one of the authors of this booklet took part in an international scientific study investigating the best tiger habitat remaining in the Chinese province of Jilin. We found three to five tigers there, mostly along the Russian border. Our general impression is that there are no more than twenty or thirty Amur tigers in all of China. [Source: “The Amur Tiger” by Yury Dunishenko and Alexander Kulikov, The Wildlife Foundation, 1999 ~~]

The general area where Siberian tigers lives is called the Primorskii or Primorye, a region of the southeast Russian Far East that embraces Vladivistok. John Vaillant wrote in “The Tiger: A True Story of Vengeance and Survival”: “Primorye, which is also known as the Maritime Territory, is about the size of Washington state. Tucked into the southeast corner of Russia by the Sea of Japan, it is a thickly forested and mountainous region that combines the backwoods claustrophobia of Appalachia with the frontier roughness of the Yukon. Industry here is of the crudest kind: logging, mining, fishing, and hunting, all of which are complicated by poor wages, corrupt officials, thriving black markets — and some of the world's largest cats.” [Source: John Vaillant. “The Tiger: A True Story of Vengeance and Survival” (Knopf, 2010)]

Nezhino (100 kilometers north of Vladivostok, 20 kilometers east of the Chinese border) is used as a base for people who track Siberian tigers. They are particularly easy to track in the winter, if you can initially locate some tracks, when they leave big paw prints in the snow. Tigers tracking tours began being offered in 2005.

See Separate Articles: SIBERIAN TIGERS factsanddetails.com ; PLACES WHERE THE SIBERIAN TIGERS LIVE factsanddetails.com ; HUMANS, SCIENTISTS, CENSUSES AND SIBERIAN TIGERS factsanddetails.com ; ENDANGERED SIBERIAN TIGERS factsanddetails.com ; SIBERIAN TIGERS CONSERVATION factsanddetails.com ; SIBERIAN TIGER ATTACKS factsanddetails.com .

Ussuri Nature Reserve and Lake Khanka

Ussuri Nature Reserve (100 kilometers north of Vladivostok) is specially protected natural area located in the southern Sikhote-Alina range, It is rich in virgin liana conifer-deciduous forests, which have been cut down in other parts of the Russian Far East and the neighboring countries. The reserve is named after Academician Vladimir L. Komarov, a Russian botanist who studied the flora of East Asia. He first gave a description of the area, visiting her in 1913.

The reserve was created in 1932 and since then has significantly increased its area, which now amounts to 4,040 square kilometers. The reserve embraces lowlands and mountains and foot hools formed by the the southern spurs of the Sikhote-Alin (Przewalski Mountains). The average elevation is 300-400 meters above sea level. The highest peaks are 650-700 meters high. There are also mountain rivers in canyon-like narrow valleys and small waterfalls. Summers are warm and humid. Winters are moderately severe with little snow. The coldest month is January (average temperature of -17.9 degrees C). The warmest month is August 19.7 degrees).

The flora of the reserve is composed almost entirely of forest species, mainly those found in cedar-broadleaf forests, which are are characterized by high species diversity and different from ecosystems found in Russia and elsewhere in the former U.S.S.R. A typical plot of pine forests, contains trees, shrubs and vines from 50-60 species. Among the many rare plants and ginseng, hard juniper, mountain peony and Chinese Prinsep

The fauna of the reserve is typical of coniferous and deciduous forests: wild boar, red deer, musk deer, and black bear. Among the birds are common warblers, blue nightingale, nuthatch and grouse. The reserve is home to the largest beetle fauna of Russia: It is interesting that several attempts to "diversify" the species composition of fauna — through the the introduction of sika deer and Barguzin sable — did not work as hoped. Most of the reserve is off limits to visitors. Among the places that one can visit are the rehabilitation center for the education of orphaned bear cubs. Reserve staff tell the story of each bear and describe it character and habits. There is also a nature trail and small museum.

Lake Khanka (200 kilometers from Vladivostok) has an average depth of 4.5 meters and is home to more than 300 species of bird and 75 species of fish. Trips to the lake includes stops at the villages of Kamen-Rybolov and Troitskoye on the west side of the lake and a trip to Gaivoron, near the town of Spassk-Dalniy, where there is a 10,000 square meter open air cage with a family of Siberian tigers. The cage is made of a transparent metallic net. The enclose incorporates the surrounding forest so you can see the tiger is a pretty close facsimile to how they lin nature.

Biodiversity of the Ussuriskii Taiga Forest

Siberian tigers inhabits the Ussuriskii taiga forest, a coniferous broadleaf forest that specifically favors the so-called Manchurian forest type. The Manchurian forests are located in riparian areas and are particularly high in biodiversity. John Goodrich of NPR wrote: “The most bio-diverse region in all of Russia lies on a chunk of land sandwiched between China and the Pacific Ocean. There, in Russia's Far East, subarctic animals — such as caribou and wolves — mingle with tigers and other species of the subtropics. It was very nearly a perfect habitat for the tigers — until humans showed up. The tigers that populate this region are commonly referred to as Siberian tigers, but they are more accurately known as the Amur tiger. "Imagine a creature that has the agility and appetite of the cat and the mass of an industrial refrigerator," Vaillant tells NPR's Linda Wertheimer. "The Amur tiger can weigh over 500 pounds and can be more than 10 feet long nose to tail." [Source: John Goodrich, NPR, September 14, 2010]

Dunishenko and Kulikov wrote: "The range of biodiversity experienced by the early explorers in the Ussuriskii taiga forest is hard to imagine. Read Vladimir Arsenev and Nikolai Przhevalskii and you’ll realize that the region’s present-day richness is but a sad remnant of what was once found here. The fact is, that not all that long ago there was a lot more to be found in our taiga. Old-timers can still vividly recall the herds of deer, numbering in the hundreds, that migrated the lightly snow covered regions of China, the incessant moan in the taiga when red Manchurian deer were mating, the endless waves of birds, the rivers boiling with salmon. [Source: “The Amur Tiger” by Yury Dunishenko and Alexander Kulikov, The Wildlife Foundation, 1999 ~~]

"And my lord, how many wild boar there used to be in the taiga! All winter long, the southern exposures of oak-covered hills were dug up by droves of wild pigs. Snow under the crowns of Korean pine forests was trampled to ground level as wild boar gathered pine cones throughout the winter. A symphony of squeal and moan! Mud caked wild boar racing around the taiga, rattling around in coats of frozen icycles after taking mud baths to cool passion-heated bodies. Horrible, blood caked wounds, chattering tusks, snorting, bear-like grunting, squawky squeaking, oh the life of a piglet.~~

"This was an earlier image of the Ussuriskii taiga. Just 30 years ago a professional hunter could take 60 to 80 wild boar in a season! There was more than enough game for the tiger out there among the riotous forest “swine.” Tigers strolled lazily, baron-like and important. They avoided the thick forests: why waste energy with all the boar trails around — you could roll along them sideways! It was only later on that the tigers took to following human trails.~~

"How many tigers there used to be in the wild can only be conjectured. Southern Khabarovskii Krai is a natural edge of their habitat; at one point in history there was a substantial tiger population that spilled over into surrounding regions. The tiger’s range coincided, for the most part, with Korean pine and wild boar distribution, and the number of tigers in the Russian Far East in the last century was at least one thousand. Tigers densely settled the Malyi Khingan and the Korean pine, broad leaf deciduous forests typical of southern Amurskaya Oblast. Lone animals wandered out as far as Lake Baikal and Yakutiya."~~

Sikhote Alin Reserve

Sikhote Alin Reserve (400 kilometers northeast of Vladivostok) and Kedrovaya Pad Reserve are the last homes of the Amur (Siberian) tiger. The largest wildlife sanctuary in the Far East. It embraces 3,500square kilometers (1,350 square miles) of forested mountains, coastline and clear rivers. Other animals found in reserves include brown bears, Amur leopard (of which only 40 to 50 remain), the Manchurian deer, roe deer, goral (a rare mountain goat), Asian black bears, salmon, lynx, wolf and squirrels with tassels on their ears, azure winged magpies and the emerald-colored papilio bianor maackii butterfly. Over 350 different species of bird have been seen here.

Central Sikhote-Alin was designated a UNESCO World Heritage Site in 2001. According to UNESCO: “The Sikhote-Alin mountain range contains one of the richest and most unusual temperate forests of the world. In this mixed zone between taiga and subtropics, southern species such as the tiger and Himalayan bear cohabit with northern species such as the brown bear and lynx. After its extension in 2018, the property includes the Bikin River Valley, located about 100 kilometers to the north of the existing site. It encompasses the South-Okhotsk dark coniferous forests and the East-Asian coniferous broadleaf forests. The fauna includes species of the taiga alongside southern Manchurian species. It includes notable mammals such as the Amur Tiger, Siberian Musk Deer, Wolverine and Sable. [Source: UNESCO]

Founded in 1935, Sikhote-Alin Nature Reserve covers an area of 3,902 square kilometers, plus and 2.9 square kilometers offshore. The reserve is located in the northern part of Primorsky Krai and includes the eastern slope of the Sikhote-Alin mountain range from its watershed to the coast (including one kilometer of shoreline), as well as a part of the western slope of the mountain range. The maximum elevation in the reserve is 1598 meters.

The reserve was originally established to protect sable populations that were on the verge of extinction. V.K. Arsenyev was one of the initiators of the reserve. K.G. Abramov and Y.A. Salmin substantiated the need to create the reserve. In our age when there are fewer and fewer untouched corners of nature on the globe, The profusion and diversity of the reserve’s ecosystems are attributable to the fact that the park includes different slopes of the Sikhote-Alin, range which differ in natural conditions and elevation. Availability of direct access to the sea is another important factor.

The reserve includes parts of three landscape areas: 1) Terney (cedar broad-leaved forests), 2) Samargino-Dalnegorsky (in the subzone of broad-leaved and coniferous forests) and 3) Mid-Sikhote-Alin (fir and spruce forests) in a boreal coniferous forest subzone. The flora and fauna in the reserve are strongly influenced by the presence of the Sea of Okhotsk: dark boreal coniferous forests are more strongly represented here than in other reserve in Primorye Krai. At the same time, conditions exist for the development of the Manchuria-like ecosystems. A distinctive feature of the flora and fauna in the reserve is the combination of heat-loving and cold-loving natural species. For its long-term research program and achievements in the conservation of the Amur tiger, the reserve was awarded with a CATS international certificate in 2015, becoming the only reserve in Russia (and the second in the world) to receive such recognition.

Traveling by Road Around Sikhote Alin Reserve

Ian Frazier wrote in The New Yorker: ““Rather than continue south, directly to Vladivostok, our ultimate destination, we had decided to turn east again, cross the Sikhote-Alin Mountains, and arrive at the Pacific (technically the Sea of Japan) in a less inhabited place on the mountains’ other side. The Sikhote-Alins, once we were among them, seemed more like hills, and not very forbidding, but the depth and silence of their forest made up for that. Arsenyev had described the taiga here as “virginal, primeval timberland.” From the altitude of the trees and the venerable length of the vines depending from them, I would guess that the taiga we saw was still original growth. That night, we camped above the small gorge of a river named for Arsenyev—the Arsenyevka. The sound of it was pleasant to sit beside; this was our first genuinely rushing stream. I stayed up for a while after Sergei and Volodya had gone to bed, listening to it and looking up at the stars and at the satellites tracking past. [Source: Ian Frazier, The New Yorker, August 10 and 17, 2009, Frazier is author of “Travels in Siberia” (2010) ]

“The next day, we continued winding generally eastward through the mountains. I noted villages called Uborka (Harvest), Shumnyi (Noisy), and Rudnyi (Oreville). Now we were in Arsenyev’s very footsteps. A little beyond Rudnyi, we crossed a mountain pass that hardly looked like one. This was the divide between the waters that flow roundabout to the Pacific via the Ussuri and the Amur, and those which drain down the front of the Sikhote-Alins and into the Pacific directly. At the crest of the divide, back among the roadside weeds, stood a cement obelisk on which was inscribed: “crossed over this pass: m. i. venyukov 1858*; N. M. PREZHEVALSKII* 1887*; V. K. ARSENYEV* 1906.”

Arsenyev’s passage across this divide happened during a mapping expedition guided by Dersu and described in detail in the book. The party continued from here until they came to the Pacific and the port village of Olga, where they were resupplied. Sergei said that we would also aim for Olga and camp near there.

“Often the taiga stood so close to the road that the vines almost touched the side of the car, and on the upgrades we were looking into the canopy. At one point in the movie “Dersu Uzala,” a tiger stalks Arsenyev’s party, and the Siberian tiger used for the scene was a splendid animal, all liquid motion and snarling growls. Though near extinction, the Siberian tiger has not yet been wiped out, and the thought that this Pacific forest—reminiscent in some ways of the American and Canadian Northwest—had tigers in it gave the shadows far back among the trees a new level of authority. I had been in a few forests that held grizzly bears, but a forest with tigers in it seemed even more mysterious and honorable.”

Kedrovaya Pad Reserve

Kedrovaya Pad Reserve (400 kilometers northeast of Vladivostok) is the oldest reserve in the Far East and the southernmost reserve of Primorye. Sikhote Alin Reserve and Kedrovaya Pad Reserve are the last homes of the Amur (Siberian) tiger. The largest wildlife sanctuary in the Far East. Kedrovaya (Cedar) Pad Reserve embraces 178.97 square kilometers (69.10 square miles) of forested mountains, coastline and clear rivers. Other animals found in reserves include brown bears, Amur leopard (of which only 40 to 50 remain), the Manchurian deer, roe deer, goral (a rare mountain goat), Asian black bears, salmon, lynx, wolf and squirrels with tassels on their ears, azure winged magpies and the emerald-colored papilio bianor maackii butterfly. Over 350 different species of bird have been seen here.

Kedrovaya (Cedar) Pad Reserve was one of the first officially organized reserves in Russia. The idea for establishing was raised at the beginning of the 20th century after the Trans-Siberian railway and built nearby and intensive development of the Ussuri region was accompanied by indiscriminate logging, forest fires, uncontrolled hunting. In 1908, the region created the first forest reserves, one of which was on Cedar River. Kedrovaya Pad Reserve, founded in 1916 close to the western shore of Amur Bay. Over time that status of the reserve was improved and the reserve was enlarged. In 2004 UNESCO designated the reserve as a biosphere.

Kedrovaya (Cedar) Pad Reserve is located in the Khasan district of Primorye Territory. The villages of Seaside, Perevoznaya, Cedar, Bezverkhova and Barabash located within a few kilometers of the reserve. . The reserve was established for the preservation and study of natural systems there of liana deciduous and mixed forests with hornbeam and black fir-broad-leaved forests and their animals and plants. The reserve provides shelter for two adult Amur leopard females and their offspring and one male. Among the rare species of insects found there are the excellent marshmallow beetle and Jankowski beetle.

The territory of the reserve is occupied by by two major low mountain ranges — the Gakkelevskaya and Suhorechensky — representing the extreme northeastern foothills of the Black (Changbai) Mountains, which are mainly in China and Korea. The length of the main Cedar River within the reserve is about 15 kilometers. The largest number of tributaries originating from Suhorechenskogo ridge flows into the forest, where many wild boars live. About 73.1 percent of the entire reserve is occupied by forests. The remaining area is occupied by scrub and secondary meadows resulting from logging in the past and especially forest fires.

The forest reserve contains numerous species of trees. The underbrush is represented by various bushes, that often blossom beautifully, such as early-flowering honeysuckle and Weigel, which produces fine-leaved mock orange flowers. Vines entwine tree trunks rising to a height of 30-35 meters. The diameter of the winding vines of wild grapes and the Amur Actinidia Argut reaches 10-15 centimeters. They are like giant snakes crawling from the ground and entangling shrubs and trees.

In places the reserve resembles a rainforest and it does have parallels with the temperate rain forests in coast British Columbia, Alaska and Washington state. Among the many plant species are Manchurian walnut, dimorfanta and aralia, with and velvet, spiny trunks, and several types of ferns. In the crevices of bark and crotches of trees attract epiphyte and small fern called Ussuri centipede.

Zov Tigra (“Roar of the Tiger”) National Park

Zov Tigra National Park(Near Lazo, 150 kilometers northeast of Vladivostok is a mountainous refuge for the Amur (Siberian) Tiger. Established in 2008, the park encompasses an area of 834 square difficult (322 square miles) on the southeast coast of Primorsky Krai. The park lies on both the eastern and western slopes of the southern Sikhote-Alin mountain range.,The relatively warm waters of the Sea of Japan are to the east, the Korean peninsula to the south, and China to the West. The terrain in rugged and difficult to access, with heavily forested taiga coexisting with tropical species of animals and birds. The park is relatively isolated from human development, and functions as a conservation reserve. Tourists may visit the portions of the park marked for recreation, but entry to the protected zones is only possible in the company of park rangers. The park’s name in English means "Call of the Tiger” or "Roar of the Tiger".

Zov Tigra National Park is occupied by Ussuri taiga and is located at the junction of Lazovsky, Chuguevsky, and Olginsky districts. The park covers 1,854-meter-high Oblachnaya mountain, the upper half of the Milogradovka's river basin, and sources of the Kievka River. There are more than 50 mountains more than 1000 meters high. The forest feature giant cedars, specimen trees, slender spruces entwined with gaily-coloured actinidia's lianas, emerald-green clusters of Amur grape and Schizandra brushwood.

Zov tigra was established in part as as a "source habitat" for the recovery of the Amur Tiger and its prey base. A survey in 2012 identified four Amur tigers resident in the park, and four more that visited the protected areas frequently. The base of prey consisted of 1,200 Manchurian deer, 800 Roe deer, and 99 Sika deer and 189 wild boars. These species make up some 85% of the Amur tiger's diet. Brown bears and lynx are relatively common in area. The Far Eastern Forest Cat is found in the broad-leaf and oak valleys. The critically endangered Amur Leopard has not been resident since the 1970s.

Amur Leopards

The Amur leopard inhabits an 800-mile long stretch of evergreen forest in the eastern Siberian taiga near the North Korean border. Named after the river that forms the border between Russia and China, they live in a narrow mountain chain that extends from Hanka Lake in the Russian Far East south to the borders of China and North Korea. It ranges further north than any leopard species, even the snow leopard.

Amur leopards weighs between 40 and 60 kilograms (90 and 140 pounds). They are reclusive, solitary creatures. They eat sitka deer and wild boars. Their numbers have declined as the numbers of their main food source, roe deer, have declined. They also suffer from declining numbers of sitka deer and wild boars. Leopards eat dogs of villagers to survive. Sometimes they are forced to make a single meal last for two weeks. Other times they reduced to scavenging for carrion. It’s winter coat has large spots.

Only 38 to 46 Amur leopard are believed to remain. Twenty to twenty-four in Russia. Fifteen in China and an unknown number in North Korea. They have been hurt by loss of habitat, loss of prey and poaching. Around 30 Amur leopards live in an area which borders China and is 150 kilometers long and 30 kilometers wide. At least 16 live in Nezhinkoye game reserve. This area contains many villages and is crisscrossed by roads, making survival problematic

Environmentalists have trouble securing funds to study the leopards. Most of what is known about them is based on studies conducted at Kedrovaya pad nature Reserve near Vladivostok. The Russian Academy of Science, the University of California and the International Wildlife Congress are studying the leopards using “phototraps”— motion sensitive cameras.

Land of Leopard National Park

Land of Leopard The National Park (200 kilometers west of Vladivostok) occupies 2,620 square kilometers and is located in the Khasansky, Nadezdinsky, Ussuriysky districts of Primorsky Krai as well as in the small area of Frunzenskiy district in Vladivostok. Kedrovaya Pad and Leopardovy reserves and number of other territories, with total area exceeding 2,800 square kilometers are as compounds of the National Park. The national park’s buffer zone covers about 800 square kilometers.

About 30 individual Amur leopards are thought to be living in the southwest area of Primorsky Krai. “Land of the Leopard” national park covers about 60 percent of the natural habitat occupied by the leopards and the main reason the park was set up was to preserve them. Many surviving Amur leopards live In the Nezhinkoye game reserve that is under partial protection of the Russian Pacific fleet. Hunting with dogs and hunting for fur animals is banned in the reserve. Deer and wild boars are fed. Some leopards used to follow hunters in hopes of snatching an easy meal. Work on the world’s longest pipeline — between Siberia and the Sea of Japan — was suspended in 2005 due to ecological concerns, among them the fate of the Amur leopard, whose territory would be bisected by the pipeline.

The “Land of Leopard” is divided into several zones, the smallest of which is a 230-square-kilometer conservation zone that you can’t visit without special permission. Other zones have a simplified visiting regime. Guided trips are allowed in the “specially protected” zone. The 7950-square-kilometer recreational zone allows more touristic activity. The “Leopard Trail” is the first tourist route, developed in the National Park. The 770-square-kilometer administrative zone accommodates villagers and interests of other people living in the territory of the National Park.

Leopardovy Sanctuary

Leopardovy Sanctuary (200 kilometers west of Vladivostok) embraces 1,694.29 square kilometers of the “Barsovy” and “Borisovskoe Plato” sanctuaries in the Khasansky, Ussuriysky, and Nadezhdinskiy districts. The state biological sanctuary “Barsovy” was founded in 1979 to preserve and restore not only the endangered animal species such as Siberian Tiger and Amur Leopard but also their natural habitat. The animal sanctuary “Borisovskoe Plato” was created in 1996 to conserve and increase the population number of Amur leopard; Siberian tiger and other threatened animals.

The sanctuary's natural environment is highly favorable for the forest faun's inhabitation. The low-level mountain ranges deeply dissected with the river valleys, extended rock masses, and plateau-like mountains create mosaic of forest, tree and shrubbery vegetation. Secondary broadleaved forests prevail here. Primary forests with fir trees, cedars and khingam fir remain in the west and northwest part of the sanctuary. The plateau-like mountains are covered with the leafed forest.

Amur leopard is the main protected species here.Siberian tiger, Asian black bear, leopard cat and other animals are also placed under special protection. There are six ungulates species such as Amur goral, Manchurian wapiti, wild boar, musk deer, roe deer, and deer in the sanctuary. Lot of rare vascular plants grows here, some of them such as water caltrop, stipa baicalensis, nepeta manchuriensis are not presented even in the neighboring “Kedrovaya Pad” reserve. More than 150 species of birds nest in the sanctuary and around 100 species traverse its territory or make stopover here during the migration period. It must be stressed that “Leopardovy” sanctuary is the only place of nesting for some bird species in this part of Primorsky krai. 15 of these species are threatened with extinction. Over 40 IUCN Red List insect species inhabit here, what is more some of them occur exceptionally at the sanctuary's territory.

This district has a monsoon climate. Its specific trait is the variability of the airstreams direction in the summer and winter seasons. Plenty of rivers and streams run at the sanctuary’s territory. There are no large lakes. The biggest one, Krivoe lake, covers 11 hectares. All types of hunting, commercial fishery, timber felling, resource development, ploughing the ground, and application of chemicals are prohibited here. Beyond that, public visiting, amateur fishery, and gathering wild harvest are brought under regulation. The sanctuary contains some populated places such as Barabash settlement and military firing range with total area in 3,490 squate kilometers A considerable part of the territory is the border territory separated from the rest of area by the plowed strip.

Image Sources: Wikimedia Commons

Text Sources: Federal Agency for Tourism of the Russian Federation (official Russia tourism website russiatourism.ru ), Russian government websites, UNESCO, Wikipedia, Lonely Planet guides, New York Times, Washington Post, Los Angeles Times, National Geographic, The New Yorker, Bloomberg, Reuters, Associated Press, AFP, Yomiuri Shimbun and various books and other publications.

Updated in September 2020

•  Facebook
•  Twitter
•  Google+
•  e-mail

 Page Top

This site contains copyrighted material the use of which has not always been authorized by the copyright owner. Such material is made available in an effort to advance understanding of country or topic discussed in the article. This constitutes 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner. If you are the copyright owner and would like this content removed from factsanddetails.com, please contact me.

• Open access
• Published: 03 June 2024

Integrated care model for patients with functional somatic symptom disorder – a co-produced stakeholder exploration with recommendations for best practice

• Frank Röhricht 1 , 2 ,
• Carole Green 3 ,
• Maria Filippidou 4 ,
• Simon Lowe 5 ,
• Nicki Power 1 , 2 ,
• Sara Rassool 6 ,
• Katherine Rothman 7 ,
• Meera Shah 8 &
• Nina Papadopoulos 1  

BMC Health Services Research volume  24 , Article number:  698 ( 2024 ) Cite this article

71 Accesses

5 Altmetric

Metrics details

Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals’ understanding of the nature of the symptoms. New service models are urgently needed to address patients’ needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body–mind dichotomy.

A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice.

The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment.

We propose a novel, integrated care pathway for patients with ‘functional somatic disorder’, which delivers care according to and working with patients’ explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient’s complaints and provide flexible access points to the care pathway.

Peer Review reports

Healthcare systems globally struggle to provide for patients who present with functional somatic symptoms. Burton et al. [ 1 , p. 1], on behalf of the EURONET-Soma group, acknowledge that “functional somatic symptoms and disorders are common and complex phenomena…they pose major challenges across medical specialities”. Accordingly, the National Health Service (NHS) in the United Kingdom emphasises on its website that “many people have persistent physical complaints”. Although Burton et al. proposed “a new classification, ‘functional somatic disorder’, which is neither purely somatic nor purely mental” (p. 1), the frequently used term “Medically Unexplained Symptoms” (MUS) carries the assumption that they “…don’t appear to be symptoms of a medical condition…” [ 2 ]. This notion is out of date with respect to developments in the understanding of functional somatic symptom disorders; the new versions of the two main international diagnostic classification systems – DSM-V and ICD-11 [ 3 , 4 ] – no longer differentiate between medically un/explained somatic disorders; instead, they refer to the ongoing presence of somatic symptoms that are distressing and result in excessive attention under the new terms somatic symptom disorder/bodily distress disorder (SSD/BDD). In fact, a large proportion of patients with long-term medical conditions suffer from bodily distress symptoms, and the criterion of ‘no physical basis’ has consequently dropped in line with new findings regarding the aetiology of the disorder, updating the biopsychosocial model [ 5 , 6 ]. On that basis we decided to choose “functional somatic symptom disorder” as umbrella term whilst reporting findings from the literature according to the terms used in the primary literature. The incidence reported under the terms MUS or persistent physical symptoms (PPS) suggests that at least 20% of primary care presentations account for these conditions, approximately 50% in secondary medical outpatient clinics [ 7 , 8 ] and that patients with MUS/PPS have disproportionately high rates of healthcare utilisation [ 9 ]. An estimated 10% of the annual expenditure working-age population in the NHS in England (at least three billion £ each year) is used to diagnose and treat MUS/PPS, resulting in appr. £1.2k per patient annually on average [ 9 , 10 ]. The total societal costs are estimated to be approximately £18 billion [ 11 ]. The Kings Fund [ 12 ] analysed the situation across the NHS and concluded, “Much of this expenditure currently delivers limited value to patients; at worst, it can be counterproductive or even harmful” (p. 10). It has been estimated that 70% of people with MUS/PPS will also experience comorbid depression or anxiety disorders [ 2 ]; hence, there is a compelling case for delivering care in an integrated way to ensure that a person’s psychosocial and physical health and needs are met. Despite the enormous impact on service, pressures on health economies and poor treatment outcomes, there is currently no dedicated/specific integrated care pathway at the primary or secondary care level in the NHS for patients with functional somatic disorders. The standard talking therapy offered within NHS talking therapy services (formerly known as ‘Improving Access to Psychological Therapy’/IAPT services) for patients with MUS and Long-Term-conditions (LTC) delivers psychological (“talking”) therapy through a separate provider entity, and the treatment offered is not accepted by a large proportion of referred patients; drop-out rates are 50%, and a recent estimate of only 17% recovery rates [ 13 , 14 ] indicates the need for a more efficient and acceptable treatment. Existing care models for patients with functional somatic syndromes do not adequately address the needs of these patients. New and innovative intervention strategies are necessary to achieve better health and corresponding economic outcomes. Therefore, experts have suggested that research into new, effective, and favourable service models and treatments that are acceptable to patients according to their preferences and specific explanatory beliefs is urgently needed [ 15 ].

The East London Foundation Trust (ELFT) provides mental, community and primary health services across the Luton and Bedfordshire geographical footprint (Bedford, Luton, Milton Keynes / BLMK Integrated Care System). Between 2010 and 2020, ELFT clinicians developed and evaluated a novel care pathway package [ 16 , 17 , 18 ] and a manualised body-oriented group therapy intervention [ 19 ] for patients with MUS disorders, which is now implemented in East London. The service demonstrated that this novel, embedded care package benefited patients and contributed to reductions in health care utilisation, therefore reducing the overall cost associated with MUS [ 17 ]. Based on those experiences, this study aimed to develop recommendations for commissioners with respect to an evidence-based and clinically desired integrated service model for patients with FSS.

A multidisciplinary expert group was established in Bedfordshire in 2020 by the Medical Director for Research & Innovation from ELFT, inviting representatives from all healthcare provider organisations with relevance for the treatment of patients with functional somatic syndromes in the community (see authors list, in addition staff from the Bedfordshire Chronic Fatigue Syndrome Service and the Improving Access to Psychological Therapy Service).

This expert group aimed to map existing services, to review examples of services where elements of care are provided in a holistic, integrative fashion and to centrally consider the views of people with lived experience of functional somatic symptoms.

Service mapping

The clinical expert group conducted a mapping exercise of all services that provide elements of healthcare for this particular patient cohort. This was carried out to understand the existing service elements and problems in care delivery, to discover underlying interrelationships and structures as a basis for a shared model of the clinically desired system, and to understand how the system structure creates observable outcomes. Team members from the respective providers were also asked to identify their vision for an updated service model. The expert group defined the main questions and started with the construction of a visual map of the current complex system of care; in the second step, the group reflected on this service map, described current referral/treatment pathways, and identified strengths and weaknesses with those services operating separately. The group considered this in the context of the available evidence base and the recommendations obtained from the service user lived experience focus group. Third, the group strived to achieve consensus and to develop a vision for the future.

Focus group with service users

To better understand the experience of the healthcare journey by patients who had been managing functional somatic symptoms and to develop lived experience recommendations to improve the service pathway within Bedfordshire, we conducted a focus group with patients. Recruitment to the focus group used convenience sampling, through staff within the expert group who work with this patient population. They were asked to identify potential participants for the focus group. In addition, the lead GP from Leighton Road Surgery in Bedfordshire was asked to identify potential participants from the surgery caseload. Willing participants were then contacted via telephone by the ELFT People Participation Lead for Bedfordshire Community Health Services (CG), who provided information about the purpose of the focus group, the logistics of the day, the need for confidentiality, and reward and recognition for taking part. This was also an opportunity for all potential participants to ask any questions and feel prepared before deciding to take part in the focus group.

The semi-structured online focus group format followed a topic guide specifically developed for this study (see supplementary file); the topic guide was not pilot tested. Based upon discussions within the expert group, we hypothesised that the following themes may arise: belief, information, length of journey, diagnosis, pathway (care and treatment/processes), and communication (including language and terminology). These hypotheses formed the basis of the questions chosen for the interview topic guide, shown below.

To better understand the existing pathway, we asked:

What has been good about your experience of services/care and treatment to date?

What has not been good about your experience of services/care and treatment to date?

Where or who did you first go to for help when your symptoms started?

What happened when you first went to your GP?

To better understand the impact of people’s experiences, we asked:

What impact has good experiences had on you?

What impact has bad experiences had on you?

To guide improvements and shape the future pathway, we asked:

What would you have liked to have happened?

What should the pathway look like?

CG contacted the participants prior to the focus group and explained her involvement and personal interest in the study as an expert by experience. All participants provided informed consent; the focus group was delivered online on a singular occasion and lasted for two hours (including a 15-minute break). It was facilitated by author CG with a staff member supporting any technical issues and offering support around navigating the chosen virtual platform.

The discussion of the focus group was audio-recorded and transcribed for thematic analysis by author CG (female); transcripts were not returned to participants for comments. Ethical approval for this service evaluation was obtained from the East London NHS Trust Governance and Ethics Committee for Studies and Evaluations (GECSE).

A realist epistemology, grounded in the pragmatism of service improvement within the NHS was adopted as the theoretical stance during analysis. Thematic analysis [ 20 ] was conducted on a question-by-question basis (by CG), this allowed for an inductive approach (per question) which was set within a wider theoretical or deductive frame (i.e. the question format of the whole focus group). This method ensured that the identified themes remained strongly linked to the data and that the lived experience of the focus group members was privileged. Furthermore, interpretation was minimised and themes remained at a semantic level. Analysis began with data familiarisation through reading and re-reading the transcript, line by line coding and initial theme development followed, and then, reviewing the themes for completeness through connecting back to the primary data in the transcript. For each question and answer pair, a thematic map was developed, which showed the hierarchy of themes and relational factors between themes. The prevalence of identified codes was noted, but not used to weight the themes. Using the thematic maps enabled clear identification of themes additional to those hypothesised by the expert group; though these were not integrated in the overall analysis. A further stage of synthesis of all themes from each thematic map resulted in meta-themes which represent this group’s core lived experiences.

Service mapping (the Central Bedfordshire population 294,200 according to the 2021 census) to identify care options available for patients with functional somatic symptoms :

Existing treatment for people with medically unexplained persistent symptoms/ Bodily Distress Disorder involved six different (at times overlapping) services across the county, as follows:

Primary care services consisted of 11 primary care networks with 43 surgeries. GP surgeries were often the first point of access for patients with somatic symptoms, although surgeries varied in their approach to dealing with patients who presented with FSS (or diagnosis of MUS/PPS), and no surgery provided a dedicated service for these patients.

Luton & Bedford Liaison Psychiatry Services provided assessments, treatment recommendations and general management plans for inpatients at Luton & Dunstable and Bedford hospitals who presented with a combination of mental and physical health problems. The service provides signposting and connecting with other services, and optional brief psychosocial interventions are offered. Although the Service was not specifically commissioned to provide for patients with FSS, psychiatrists contributed to multidisciplinary team meetings at Bedford Hospital where very complex cases with chronic pain, eating disorder issues, substance misuse issues, recurrent admissions, etc., were discussed.

The Pain Psychology/Pain Management Team at Circle Integrated Care (Bedfordshire), in partnership with the Essex Partnership University NHS Foundation Trust (EPUT), provided patients with musculoskeletal (MSK) conditions with outreach to various settings, including outpatient clinics, GP surgeries, and community venues. It also included a pain management service for patients where other physical/medical interventions have been tried or were not considered appropriate and where the pain has been manifesting for three to six months or longer. A clear emphasis was placed on ‘management’ and not on ‘cure’. Additionally, the Pain Psychology Service offered a one-to-one assessment, psychoeducation and brief psychological therapy (on average, six sessions with a range from one to twelve sessions) for some patients based on cognitive behaviour therapy (CBT). There was also a group-based pain management programme (PMP, based on CBT) with six sessions of PMP (two to three hours per session) and one three-month follow-up session. This was led by the psychologist and specialist pain physiotherapist, with the pain nurse also involved in one or two sessions.

Bedfordshire Chronic Fatigue Syndrome (CFS) Service  The CFS service of Bedfordshire Community Health Services provided specialist multidisciplinary team (MDT) care for patients with at least four months of chronic and significant fatigue, where the fatigue was persistent or relapsing and was present for at least 50% of the time (as per 2016 guidance). Patients presented with associated symptoms such as joint/muscle pain, reduced memory and concentration, and fatigue substantially impacted daily activities. The small MDT of psychologists, physiotherapists, and occupational therapists provided MDT assessment, collaborative diagnosis and treatment, self-management education, graded exercise therapy, CBT and occupational therapy inputs (service treatment has since changed to ‘Energy Management Principles’).

Improving Access to Psychological Therapy Service (IAPT; now: Talking Therapy Service)

Bedfordshire Talking Therapies provide mainly CBT and a range of different therapy modalities through individual or group sessions. The service aims to help people aged 17 and over who are experiencing common mental health problems such as depression and anxiety disorders. In addition, the service also offers help to foster living well with long-term physical health conditions, recognising that mental health can play a role in physical health in relation to the symptoms experienced and the impact this has on people’s lives. Talking therapy services are now also offering treatment to patients with MUS according to the expansion of the remit of the previous “IAPT” service.

Secondary Care Mental Health Services : There was no secondary care mental health service in Bedfordshire dedicated to offering treatments for individuals with functional disorders. Only patients with a significant degree of psychiatric comorbidity are accepted by community mental health teams with a focus on providing care for mental health problems. Patients were predominantly seen by liaison psychiatry teams, if referred. Some patients with more severe symptoms and corresponding disability were referred to one of the tertiary neuropsychiatry centres in the country.

Following the visual mapping exercise and sorting of identified themes, a co-created outline for an integrated Functional Somatic Symptom Disorder Care Pathway, which we termed ‘Staff Vision’, was developed as follows:

Time : Significantly reduced waiting times lead to patients receiving the right service in a timely manner. Patient reports of being ‘bounced’ between several services and not receiving any targeted intervention to address their needs were reduced. This is also related to early intervention, which has the potential to prevent patients from becoming chronic.

Communication : The provision of seamless referral pathways between different service providers, built on improved communication within teams and across services, particularly between primary and secondary care, as well as with community psychology services. At the beginning of the pathway, good-quality MDT assessment with individual collaborative formulations was ensured. During treatment, regular MDT meetings were provided across services to present and discuss cases.

Barrier-free Care : For patients to experience seamless integrated service without referral processes between service providers. Ideally, there is no waiting time for patients, which could be addressed using signposting to where patients can receive care more rapidly if one service has no capacity. Accessible and straightforward referral routes and clarity in terms of what each service is offering so that there is no overlap. The implementation of more joint up-working between services, particularly where gaps have been identified in service provision and patients do not meet the criteria for CMHT, Bedfordshire Wellbeing Service/IAPT or specialist pain management/chronic fatigue services.

Choice : A range of therapeutic interventions are offered through a range of professional modalities. This includes the introduction of more virtual therapy groups, which have been successful since the COVID-19 pandemic. In addition, a mixture of group and individual therapy provisions was provided, with adequate group therapy space. The expansion of the workforce to routinely include physiotherapists and occupational therapists. Formalising pathways for liaison with specialties such as gastroenterologists and neurologists.

Continued Professional Development, Evaluation & Research : Initially, further education of primary care practitioners to identify suitable patients, support positive engagement and refer appropriately. Then, a system of training and development on this subject across all disciplines ensures that best practices are shared with all parts of the healthcare system. The provision of professional forums to discuss complex cases that use all levels of healthcare. Ongoing evaluation of services and patient experiences has the potential for large-scale research to demonstrate impact.

Clinical Governance : Within this barrier-free model of care, which spans traditional healthcare boundaries, there are clear operational policies for services, meaning that staff members have a clear remit and that patient expectations can be effectively managed.

Focus group of people with lived experience

All five participants who expressed an interest were included: four participants were female, and one was male. One participant described their ethnicity as mixed and four stated that they were white. The participants’ age range was from 21 to 60 years old. There was a range in employment status and level of educational attainment amongst the participants.

For brevity within this paper, the full findings will not be reported. An overview of the four meta-themes identified by people with lived experience of a functional somatic symptom condition are shown below:

Patient perceptions of being both believed and understood by healthcare professionals supported a more positive experience of care. The focus group linked this to effective communication on the part of the professional and highlighted the skill of listening.

The professional and personal attributes of healthcare professionals, as perceived by patients, also affected the healthcare journey. The GPs, as the first point of contact for patients, played a pivotal role in determining whether these patients had a positive experience and healthcare journey. The focus group linked more positive experiences of care to greater knowledge and understanding of FSS and of potential treatment pathways by healthcare professionals. Furthermore, the group highlighted that their perception of the professional’s attitudes toward FSS directly affected their wellbeing.

The length of the journey from initial assessment to diagnosis affected health outcomes and experience for these patients, with longer healthcare journeys linked to more negative experiences by focus group members.

Understanding and accepting their condition was an important aspect of these patients’ healthcare journeys. The focus group considered that being supported by healthcare professionals, both to understand and to accept FSS, was an important part of their experience.

Recommendations

Following a review of the findings from both the service mapping and from the focus group the following recommendations were suggested. Furthermore, the expert group suggested setting up a county-wide steering group with representatives from all healthcare organisations to provide a context for continuing engagement with commissioners and people with lived experience.

Transparent communication, accountability and coproduction : Engagement with service users should be sought and achieved through Focus Groups, Surveys, Personal interviews, Open Forum events, Patient Representation on the Steering Group, and direct participation in service-level Quality Improvement projects. The steering group should regularly provide feedback to people’s participation groups about how their contributions have helped shape the project towards an integrated care offer.

The importance of primary care services and empathic/trustful communication for the patient journey and experience : Reports from patients and professionals indicate that the success of the interactions between these patients and their GPs early on and during the healthcare journey plays a pivotal role in determining how patients judge their experience of care and treatment within this pathway and may impact the length of their health journey and ultimately their health and wellbeing. A training package for all primary care health care workers should address the importance of developing trustful relationships and a shared explanatory model that no longer carries simplified and dichotomic assumptions about the nature of the physical complaints (as being psychological in nature). Instead, the training must provide an up-to-date account of bodily distress disorder symptoms in the context of a contemporary biopsychosocial model. A new service model should consider the positive impact that individual health care professionals can have on the experience of patients on this pathway. Participants in the focus group cited particular healthcare professionals and their ability to listen and ‘believe’ the patient and their support for the patient to understand and accept a diagnosis as key moments in their journey. People with lived experience refer to a predominant model among professionals, suggesting “it’s all in the mind”. Taking a holistic approach and knowledge and understanding the nature of FSS seemed to be the defining characteristics of the HCPs that were mentioned positively. The Focus Group discussions suggested that communication (language and terminology) between healthcare professionals and patients may be pivotal to this population feeling believed and understood. It may also play a role in how patients feel about their diagnosis. Team-based training should emphasise the importance of empathic acceptance and the relevance of the initial consultation, the chosen language to label somatic complaints. The training package must encompass practical steps to foster therapeutic relationships at all levels, including an awareness of key “Do’s and Don’ts according to the literature (Table  1 ):

Updating knowledge through continuous professional development (CPD) and Curricula amendments : The focus group findings suggested that knowledge and understanding from healthcare professionals (particularly GPs) may be an area that could significantly impact the healthcare journey of this patient group. GPs should be adequately trained to make a provisional diagnosis of bodily distress disorder according to new criteria in the ICD-11 or the equivalent “somatic symptom disorder” in the DSM-V. Healthcare professionals should be able to understand contemporary biopsychosocial care models and the overlap of functional symptom disorders with conditions such as complex posttraumatic stress disorder.

Systemic issues/the provider collaborative : Commissioners should consider the inadequate current length of time from first presenting with symptoms to the point of diagnosis; it was strongly emphasised that this gap needs to be reduced for patients on this pathway. The focus group discussions suggested that the length of time to diagnosis may have a negative impact on both patients’ experience and their health and wellbeing (course and prognosis). Service-level interventions must be provided in a seamless, coordinated manner, allowing real-time monitoring and timely communication of all care elements provided. Patients should be given a main point of contact (ideally their primary care practitioner) and communicated clearly to the patients as a comprehensive care plan (akin to the principle of long-term condition management). Integrated care and continuity are key components for patients to feel adequately supported, and service users stressed the fact that repetitive accounts of their symptoms induce a sense of chaos and a feeling of being misunderstood. Information sharing between professionals is crucially important to reduce the need for patients to retell their stories to multiple HCPs. This is of particular importance within primary care if patients are not able to see the same GP.

Treatment and support options : Developing a shared understanding, mutually acceptable and valid conceptualisation of patients’ somatic complaints is the first and foremost objective in the treatment of FSS conditions. This requires a timely and skilled provision of psychoeducation, utilising established new explanatory frameworks that enable patients to explore the inseparable and situative (embedded) nature of all experiences across the spectrum of mental, somatic and interpersonal phenomena. Reference should be given to the importance and process of patients’ understanding of their condition and the potential this may have in improving both experience and health outcomes. Some patients went on to say that understanding their condition improved their ability to self-manage.

Based upon a clearly communicated working diagnosis, treatment should be offered according to the principles of informed choices, acknowledging that patients have different preferences and characteristics that impact the effectiveness of treatment options. According to the findings of this study, treatment options included in a portfolio for an integrated service, delivered by a multidisciplinary group of health care professionals and for patient’s choice: self-help (sensible literature web sites, handouts); problem solving for social/interpersonal problems; psychoeducation; reattribution approaches, psychological treatment: CBT, psychodynamic psychotherapy, mindfulness/mindfulness-based stress reduction, body-oriented psychological therapy, exercising; progressive muscle relaxation and related techniques; Yoga/Pilates courses; and drug treatments: herbal remedies and antidepressants.

This project enabled a stock-taking analysis of services provided for patients with FSS disorders in the county of Bedfordshire, bringing together people with lived experience (patients) and experts from various services currently involved in the provision of care elements for this patient population: the MSK service, A&E Psychiatric liaison services, Primary Care, Community Health Services, Secondary Care Psychology, Liaison Psychiatry, and IAPT. The network aimed to develop a system proposal for service reconfiguration to create a seamless service with multiple access points and flexible care delivery. The recommendations developed by the FSS care provider network in Bedfordshire are broadly consistent with the recently published national guidance by the National Neurosciences Advisory Group in February 2023 [ 24 ] for integrated care of patients with functional neurological disorder (FND). The guidance highlights the importance of peer-support, psychoeducation, multidisciplinary planning of personalised care and integration of health services through pooling of resources from different providers.

Some important variations are required for the provision of an integrated care pathway for FSS patients. Most patients present at the primary care level initially, and the GP is often referred to as the most trusted clinician for these patients, as highlighted by focus group members. The current primary context is, however, significantly compromised in its capacity to provide comprehensive care for long-term conditions. Most GPs receive no specific training in managing medically unexplained symptoms [ 25 ] and may lack confidence in exploring the complex holistic nature of functional somatic symptom disorders and the relevant psychological issues potentially involved. The needs of people with FSS vary greatly and often require multidisciplinary input from various therapists. The primary care organisational framework (mostly ten-minute consultation slots) and the large increase in demand in recent years have posed significant challenges. Capitalising on the effective therapeutic relationship patients have established with their GPs, it seems nevertheless advisable if not necessary to provide FSS services at the primary care level. One way of achieving that is the creation of specific clinics with initial assessments and therapeutic elements provided at primary care premises. In many parts of the United Kingdom, newly configured primary care networks and neighbourhood teams can be utilised to identify practices with large enough rooms for group therapy. The recommendations established through the coproduced work of clinical experts and experts by experience suggest a clinical model that operates a single point of access care provided by a team of clinicians working according to a biopsychosocial model and a paradigm of embodied engagement. Integration of care elements involves crucially also transdisciplinary co-creative cooperation and integrated approaches such as psychologically informed physiotherapy or movement therapy.

More specifically, the FSS disorder care pathway can be provided at the primary care level based upon pooled and integrated resources or as specific FSS clinics; either way, the specific health care agenda of patients with a range of functional somatic symptoms makes it necessary for an experienced doctor to provide clinical leadership to provide assurance to both patients and wider systems about concerns that “something serious of medical nature may be missed” (e.g., GPs, pain/MSK specialists or psychiatrists with specific expertise in psychological medicine/liaison psychiatry). The multidisciplinary team needs to integrate the expertise of allied health professionals (physiotherapists, arts therapists and occupational/speech and language therapists) while continuing to operate with a degree of diagnostic uncertainty. The patient’s predominant explanatory belief (“it’s caused by a physical illness not yet detected”) inevitably results in repeated negotiations regarding the necessity for further medical investigations. The input from a senior doctor in the MDT is therefore crucially important in representing the evidence base and medical facts: it has been demonstrated that family physicians demonstrate a high level of accuracy in subjectively recognising functional somatic symptom disorders without the aid of standardised assessments [ 26 ]. A systematic review and meta-analysis conducted by Eikelboom et al. [ 27 ] identified 16 follow-up studies (1980–2014), and the rate of revised diagnoses for functional somatic symptoms (pain, fatigue, IBS bowel, multiple bodily symptoms) was very low at 0.5%. However, this evidence is of course based on rational and systematic diagnostic testing before a diagnosis of functional disorder is made. The advantage of a primary care-based/aligned service model is therefore the reliable assurance provided to FSS sufferers that medical oversight remains with their GPs/doctors who will respond to any significant change in their presentation, assuring continuity of care and clinical oversight. Anecdotal clinical evidence suggests that doctors tend to avoid assigning diagnostic codes related to the range of functional disorders, which makes it difficult to determine the real scale of the problem in research. Holding care responsibilities for these patients at the team level with distributed and defined roles may make it easier to record FSS conditions in the future. Another important success factor for an FSS service is the continuity of care aspect. Patients with somatic complaints tend to present at various service-level access points at times of subjective crises. An integrated care model should ensure the coordination of care between various provider points, providing seamless and timely information sharing with an identified point of care within the service model so that patients can develop trustful and reliable therapeutic relationships.

Figure  1 summarises an integrated, desired care pathway model.

Care pathway illustration

Considering the results of a systematic review and metaanalysis for the psychological treatment of somatoform disorders and medically unexplained physical symptoms, it appears increasingly questionable as to whether a standard talking therapy approach is as effective as claimed. For CBT, the standard and most widely applied modality of psychological therapy, moderate improvements in symptom reduction have been reported [ 28 ]. Summarising the evidence base for IAPT talking therapies, Geraghty & Scott conclude that “this is not a strong evidence base for IAPT to treat MUS” [ 14 , p. 3]. Recovery rates recorded at IAPT services and the degree of engagement following initial referral both indicate that patient acceptance of this treatment modality remains poor and has suboptimal effects [ 14 ]. Based upon developments in cognitive sciences, the embodied nature of thought processes has increasingly been emphasised [ 29 ]. Focusing on the most prevalent persistent physical symptom of pain, an updated version of the biopsychosocial model [ 6 , 30 ] and associated recommendations for holistic treatments therefore refer to new understandings of somatization. Furthermore, according to an empirical study [ 31 ], body image is an important feature in patients with somatoform disorders. New treatments have been proposed accordingly, with interventions that operate at the level of the lived body (body/sensory awareness, body cathexis/affect regulation, movement behaviour [ 29 , 30 ]. One major advantage of these approaches is a better match with the patient perspective and a shared language; current descriptors of complaints presuppose body and mind dualism, whereas the notion of the extended mind [ 32 ] asserts that mind is neither body nor brain but rather a complex interplay of those with the environment. A holistic healthcare offer must address binary/Cartesian misconceptions of the nature of functional disorders at the heart of the therapeutic offer. An explanatory model can be communicated to patients in such a way that it validates their experiences (i.e., problems occurring on physical levels in the context of distress). Somatic complaints are not exclusively psychogenic or somatogenic but rather ‘psychosomatic’ in nature. The professional formulation operates comprehensively across domains, allowing for an individualised understanding of the constellation of presenting complaints; this will take into account biological vulnerabilities, biographical factors such as childhood adversity or significant life events, and cognitive and illness behaviour models with corresponding reinforcement of acquired beliefs. A service model that applies a radical embodiment paradigm allows us to focus the therapeutic strategy on important key somatic facts, centring on the sensitisation theory [ 33 ]: predisposing biological vulnerability, low pain thresholds, hyperarousal reactions, an amplifying somatic style of coping, alexithymia and focused attention towards distressing bodily sensations (hypervigilance) have been described in the literature [ 5 ]. Body-oriented psychological therapies explicitly operate on the level of the ‘lived body’, intrinsically relating to the observation that distress can be expressed through nonverbal (somatic) communication (“body language”, postures, gestures, movements”).

An informal scoping literature review conducted in the context of this study revealed a paucity of primary care-embedded and integrated FSS services, mostly restricted to psychiatric consultation models. Edwards et al. [ 34 ] concluded that “GPs’ beliefs about the lack of treatment guidance are consistent with the literature: there are few MUS treatment studies based in primary care” (p. 211). Examples identified as providing integrated care at the primary care level through informal reports refer to an emphasis on self-management, psychoeducation [ 35 ] and consultation with experts. Increasingly, multidisciplinary rehabilitation approaches emphasise the important contributions of Allied Health Professionals (see above), with an emphasis on capabilities, physical resilience, stress resistance and autonomic regulation [ 36 ]. Few studies have reported the outcomes of integrated service models. The “City & Hackney Primary Care Psychotherapy Consultation Service/PCPCS” report, published by the Centre for Mental Health [ 37 ], presented findings from a sample of 282 patients with MUS (49%), personality disorder (51%) or chronic mental health problems (52%). The evaluation demonstrated significant clinical improvements and reductions in NHS service use costs in the 2 years after the start of treatment; however, they calculated the average cost per patient as £1.348 (at the level of cost established for routine care [ 10 ]. This is likely related to the fact that the service included mainly patients with high morbidity and severe mental illness. Another holistic care intervention study [ 38 ] explored the efficacy of involving relaxation response and resiliency training and showed a significant reduction in healthcare utilisation across clinical services. Röhricht & Elanjithara [ 16 ] conducted an analysis of a cohort of MUS patients who were treated with body-oriented psychological therapy (BOPT) in a specialist liaison psychiatry outpatient clinic. Service utilisation in the year following BOPT (A&E attendance and referrals to specialist services) was reported to have significantly decreased by nearly 50%. Similarly, a subsequent cohort study evaluating a novel care pathway for patients with MUS indicated that care pathway implementation at the primary care level results in significant reductions in somatic symptom levels and associated improvements in health-related subjective quality of life [ 17 , 18 ]. The study demonstrated net savings within the wider care system, particularly within acute care, due to a reduction in unnecessary service utilisation; the calculations suggest that each one pound invested in the care pathway can result in two-three pounds savings elsewhere in the system. Based upon healthcare cost estimations for the study period, the cost per patient treatment was estimated at £228. A corresponding systematic review regarding the cost-effectiveness of interventions for MUS [ 39 ] emphasised that group interventions might be more cost effective than individual interventions. Overall, these figures are very encouraging and point towards a highly cost- and clinically effective opportunity for service development across geographic footprints in the context of Integrated Care Systems. These systems allow for sector-based commissioning through provider collaboratives, which is crucial for patients with FSS who have traditionally been neglected in the wider system due to disputes about the nature of their conditions (unsuitable dichotomy of mental versus physical health problems).

Subject to added expertise and resources, those service models might extend to other specific diagnostic groups, such as ‘Chronic Fatigue Syndrome’ and ‘Functional Neurological Disorders’, as well as, to some extent, ‘Long-Covid’ conditions, as they pose significant challenges to health care providers given the diagnostic and aetiological uncertainty. The body-oriented nature of the novel primary care pathway can be an important way to lower the threshold for patients’ acceptance of a holistic care offer because it does not imply psychological causality in the same way as the IAPT/talking therapy model. Instead, an embodied therapeutic experience of contextualising symptoms, exploring their situational nature and the way body and mind operate as a holistic organism, can also become an enabler for subsequent psychotherapeutic exploration of more specific aetiological factors.

In summary, the expert group concluded that the proposed integrated primary care FSS disorder pathway can complement the existing care elements and address a significant gap within the current provider systems with the additional benefit of a promising impact on health economies. Whilst this study aimed to explore healthcare support and treatment offers for patients with functional somatic disorders, pathway development should crucially consider also the importance of promoting resilience, self-efficacy and recovery.

There are however methodological limitations to consider for conclusions drawn: due to the fact that this was an unfunded study, only a relatively small group of five patients was recruited through the trust’s people participation team; patients reported to have included collateral information from other patients in their responses, but it remains questionable to what extent their views are representative of the entire patient population across the county. Subsequent research in larger patient samples should capture patient views about service provisions prospectively, utilising the findings of this study to determine hypotheses. The qualitative methods could have been strengthened through initial piloting of the questionnaire to assess suitability, using a team to conduct analysis to enable inter-rater reliability, returning to participants after analysis for member checking and a final stage of integration of findings from both the professional and people with lived experience.

More systematic research is required, guided by people with lived experience, with a view to test the recommendations of this study and their corresponding hypotheses regarding anticipated clinical benefits and cost-effectiveness of delivering an integrated care model for patients with functional somatic symptom disorder.

Data availability

Available from the corresponding author on reasonable request.

Burton C, Fink P, Henningsen P, Löwe B, Rief W, Euronet-Soma Group. Functional somatic disorders: discussion paper for a new common classification for research and clinical use. BMC Med. 2020;18:1–7.

Article   Google Scholar  

NHS England. https://www.nhs.uk/conditions/medically-unexplained-symptoms/ last accessed 19/01/24.

American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5™. 5th ed. American Psychiatric Publishing, Inc.; 2013. https://doi.org/10.1176/appi.books.9780890425596 .

World Health Organisation. (2022). ICD-11: International classification of diseases (11th revision). https://icd.who.int/ last accessed 19/01/24.

Henningsen P, Gundel H, Kop WJ, Lowe B, Martin A, Rief W, et al. Persistent physical symptoms as perceptual dysregulation: a neuropsychobehavioral model and its clinical implications. Psychosom Med. 2018;80:422–31.

Article   PubMed   Google Scholar  

Zipfel S, Löwe B, Giel K, Friederich HC, Henningsen P. Implementing the biopsychosocial model in clinical medicine: a tribute to Giovanni Fava. Psychother Psychosom. 2023;92(1):21–6.

Husain M, Chalder T. Medically unexplained symptoms: assessment and management. Clin Med (Lond). 2021;21(1):13–8.

Jadhakhan F, Lindner OC, Blakemore A, Guthrie E. Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol. BMJ open. 2019;9(7).

Lee K, Johnson MH, Harris J, Sundram F. The resource utilisation of medically unexplained physical symptoms. SAGE Open Med. 2016;4:2050312116666217.

Article   PubMed   PubMed Central   Google Scholar  

Konnopka A, Schaefert R, Heinrich S, et al. Economics of medically unexplained symptoms: a systematic review of the literature. Psychother Psychosom. 2012;81(5):265–75.

Bermingham SL, Cohen A, Hague J, Parsonage M. The cost of somatisation among the working-age population in England for the year 2008–2009. Ment Health Fam Med. 2010;7:71.

PubMed   PubMed Central   Google Scholar  

Naylor C, Das P, Ross S, Honeyman M, Thompson J, Gilburt H. Bringing together physical and mental health. King’s Fund. 2016;109(10):364–6.

Google Scholar  

Chew-Graham CA, Heyland S, Kingstone T, Shepherd T, Buszewicz M, Burroughs H, et al. Medically unexplained symptoms: continuing challenges for primary care. Br J Gen Pract. 2017;67(656):106–7.

Geraghty K, Scott MJ. Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified. BMC Psychol. 2020;8(1):1–1.

Van der Feltz-Cornelis CM, Elfeddali I, Werneke U, Malt UF, Van den Bergh O, Schaefert R, Kop WJ, Lobo A, Sharpe M, Söllner W, Löwe B. A European research agenda for somatic symptom disorders, bodily distress disorders, and functional disorders: results of an estimate-talk-estimate Delphi expert study. Front Psychiatry. 2018;9:151.

Röhricht F, Elanjithara T. Management of medically unexplained symptoms: outcomes of a specialist liaison clinic. Psychiatr Bull. 2014;38:102–7.

Röhricht F, Zammit I, Papadopoulos N. Novel primary care treatment package for patients with medically unexplained symptoms: a cohort intervention study. Br J Gen Pract Open. 2017;1(4):1–11.

Papadopoulos N, Burrell C, Smith L, Röhricht F. Therapeutic processes and personalised care in body oriented psychological therapy for patients with medically unexplained symptoms (MUS). Eur J Person Centered Healthc. 2017;5(4):449–53.

Röhricht F, Sattel H, Kuhn C, Lahmann C. Group body psychotherapy for the treatment of somatoform disorder-a partly randomised-controlled feasibility pilot study. BMC Psychiatry. 2019;19:1–9.

Braun V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101.

Rosendal M, Fink P, Bro F, Olesen F. Somatization, heartsink patients, or functional somatic symptoms? Towards a clinical useful classification in primary health care. Scand J Prim Health Care. 2005;23(1):3–10.

Morriss R, Dowrick C, Salmon P, Peters S, Dunn G, Rogers A, Lewis B, Charles-Jones H, Hogg J, Clifford R, Rigby C. Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms. Br J Psychiatry. 2007;191(6):536–42.

Guthrie E. Medically unexplained symptoms in primary care. Adv Psychiatr Treat. 2008;14(6):432–40.

National Neurosciences Advisory Group (NNAG), February. 2023; https://www.nnag.org.uk/optimal-clinical-pathway-adults-fnd-functional-neurological-disorder ; last accessed 19/01/24.

Chitnis A, Dowrick C, Byng R, Turner PD, Shiers D. Guidance for health professionals on medically unexplained symptoms. Guidance for health professionals on medically unexplained symptoms. 2011.

Rasmussen NH, Agerter DC, Colligan RC, Baird MA, Yunghans CE, Cha SS. Somatisation and alexithymia in patients with high use of medical care and medically unexplained symptoms. Mental Health Family Med. 2008;5(3):139.

Eikelboom EM, Tak LM, Roest AM, Rosmalen JG. A systematic review and meta-analysis of the percentage of revised diagnoses in functional somatic symptoms. J Psychosom Res. 2016;88:60–7.

Article   CAS   PubMed   Google Scholar  

van Dessel N, den Boeft M, van der Wouden JC et al. Non pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev 2014:CD011142.

Gallagher S. Embodied and enactive approaches to cognition. Cambridge University Press; 2023. Jul 31.

Henningsen P. Allgemeine Psychosomatische Medizin: Krankheiten Des verkörperten Selbst Im 21. Jahrhundert [General Psychosomatic Medicine. Disorders of the embodied self in the 21st century]. Heidelberg: Springer; 2021.

Book   Google Scholar  

Scheffers M, Kalisvaart H, Van Busschbach JT, Bosscher RJ, Van Duijn MA, van Broeckhuysen-Kloth SA, Schoevers RA, Geenen R. Body image in patients with somatoform disorder. BMC Psychiatry. 2018;18(1):1–8.

Fuchs T. The circularity of the embodied mind. Front Psychol. 2020;11:1707.

van Ravenzwaaij J, Olde Hartman TC, Van Ravesteijn H, Eveleigh R, Van Rijswijk E, Lucassen PL. Explanatory models of medically unexplained symptoms: a qualitative analysis of the literature. Mental Health Family Med. 2010;7(4):223.

Edwards TM, Stern A, Clarke DD, Ivbijaro G, Kasney LM. The treatment of patients with medically unexplained symptoms in primary care: a review of the literature. Ment Health Fam Med. 2010;7(4):209–21.

Pedersen HF, Holsting A, Frostholm L, Rask C, Jensen JS, Høeg MD, Schröder A. Understand your illness and your needs: assessment-informed patient education for people with multiple functional somatic syndromes. Patient Educ Counselling. 2019;102(9):1662–71.

Vassilopoulos A, Mohammad S, Dure L, Kozlowska K, Fobian AD. Treatment approaches for functional neurological disorders in children. Curr Treat Options Neurol. 2022;24(2):77–97.

Parsonage M, Hard E, Rock B. Managing Patients with Complex Needs: Evaluation of the City and Hackney Primary Care Psychotherapy Consultation Service. 2014. https://repository.tavistockandportman.ac.uk/880/1/Managing_patients_complex_needs.pdf ; last accessed 19/01/2024.

Stahl J, Dossett M, Lajoie A, et al. Relaxation response and resiliency training and its effect on healthcare resource utilization. PLoS ONE. 2015;10(10):e0140212.

Wortman MS, Lokkerbol J, van der Wouden JC, Visser B, van der Horst HE, Olde Hartman TC. Cost-effectiveness of interventions for medically unexplained symptoms: a systematic review. PLoS ONE. 2018;13(10):e0205278.

Download references

Acknowledgements

None. Publication processing fees were contributed through the budgets of the ELFT Research & Innovation Department.

Author information

Authors and affiliations.

East London NHS Foundation Trust (ELFT), London, United Kingdom

Frank Röhricht, Nicki Power & Nina Papadopoulos

Queen Mary University of London, London, United Kingdom

Frank Röhricht & Nicki Power

Bedfordshire Community Health Services (BCHS), Bedford, United Kingdom

Carole Green

Bedford Liaison Psychiatry Service, ELFT, Bedford, United Kingdom

Maria Filippidou

Circle Bedfordshire Integrated Care Musculoskeletal Service, Bedford, United Kingdom

Clinical Health Psychology Services Bedfordshire & Luton, ELFT, Dunstable, United Kingdom

Sara Rassool

Bedfordshire & Luton Community Adult Mental Health & Learning Disability Services , ELFT, Clapham, United Kingdom

Katherine Rothman

Clinical Health Psychology Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

You can also search for this author in PubMed   Google Scholar

Contributions

Authors’ contributions: All authors (FR, CG, MF, SL, SR, KR, MS, NPa and NPo) participated as clinical experts or experts by experience (CG) in developing the study design and in meetings to explore findings for recommendations. CG conducted the lived-experience focus group and conducted the qualitative analysis. NPo prepared the service mapping tools for analysis. FR drafted the manuscript; FR and NPo edited the final version, and all co-authors (CG, MF, SL, NPo, SR, KR, MS and NP) proofread and contributed to the final version.

Corresponding author

Correspondence to Frank Röhricht .

Ethics declarations

Ethics approval and consent to participate.

All members provided informed consent, and the discussion of the focus group was recorded and transcribed for thematic analysis. Ethical approval for this service evaluation study was obtained from the East London NHS Trust Governance and Ethics Committee for Studies and Evaluations (GECSE).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary material 2, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Röhricht, F., Green, C., Filippidou, M. et al. Integrated care model for patients with functional somatic symptom disorder – a co-produced stakeholder exploration with recommendations for best practice. BMC Health Serv Res 24 , 698 (2024). https://doi.org/10.1186/s12913-024-11130-9

Download citation

Received : 08 February 2024

Accepted : 21 May 2024

Published : 03 June 2024

DOI : https://doi.org/10.1186/s12913-024-11130-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Functional somatic symptoms and disorders
• Medically unexplained symptoms
• Psychosomatic medicine
• Somatoform disorders
• Somatic symptom disorder
• Bodily distress disorder
• Body-oriented psychological therapy

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

Patient Forms

Click a link to download the form.

Patient History Form

Record Release Form

Record Request Form

Patient Portal – please click here to access the patient payment portal.

Contact Us Today

Monday-Thursday: 8am-5pm Friday: 8am-12pm

2341 John Hawkins Pkwy Suite 133 Hoover, AL 35244

Khabarovsk Krai

Administrative divisions, heavy industry, demographics, ethnic groups, settlements, sister relations, external links.

Being dominated by the Siberian High winter cold, the continental climates of the krai see extreme freezing for an area adjacent to the sea near the mid-latitudes, but also warm summers in the interior. The southern region lies mostly in the basin of the lower Amur River , with the mouth of the river located at Nikolaevsk-on-Amur draining into the Strait of Tartary , which separates Khabarovsk Krai from the island of Sakhalin . The north occupies a vast mountainous area along the coastline of the Sea of Okhotsk , a marginal sea of the Pacific Ocean . Khabarovsk Krai is bordered by Magadan Oblast to the north; Amur Oblast , Jewish Autonomous Oblast , and the Sakha Republic to the west; Primorsky Krai to the south; and Sakhalin Oblast to the east.

The population consists of mostly ethnic Russians , but indigenous people of the area are numerous, such as the Tungusic peoples ( Evenks , Negidals , Ulchs , Nanai , Oroch , Udege ), Amur Nivkhs , and Ainu . [10]

Khabarovsk Krai shares its borders with Magadan Oblast in the north; with the Sakha Republic and Amur Oblast in the west; with the Jewish Autonomous Oblast , China ( Heilongjiang ), and Primorsky Krai in the south; and is limited by the Sea of Okhotsk in the east. In terms of area, it is the fourth-largest federal subject within Russia. Major islands include the Shantar Islands .

Taiga and tundra in the north, swampy forest in the central depression, and deciduous forest in the south are the natural vegetation in the area. The main rivers are the Amur , Amgun , Uda , and Tugur , among others. There are also lakes such as Bokon , Bolon , Chukchagir , Evoron , Kizi , Khummi , Orel , and Udyl , among others. [11]

Khabarovsk Krai has a severely continental climate with its northern areas being subarctic with stronger maritime summer moderation in the north. In its southerly areas, especially inland, annual swings are extremely strong, with Khabarovsk itself having hot, wet, and humid summers which rapidly transform into severely cold and long winters, where temperatures hardly ever go above freezing. This is because of the influence of the East Asian monsoon in summer and the bitterly cold Siberian High in winter. The second-largest city of Komsomolsk-on-Amur has even more violent temperature swings than Khabarovsk, with winter average lows below −30   °C (−22   °F) , but in spite of this, avoiding being subarctic because of the significant heat in summer.

The main mountain ranges in the region are the Bureya Range , the Badzhal Range (highest point 2,221 metres (7,287   ft) high, the Gora Ulun ), the Yam-Alin , the Dusse-Alin , the Sikhote-Alin , the Dzhugdzhur Mountains , the Kondyor Massif , as well as a small section of the Suntar-Khayata Range , the Yudoma-Maya Highlands , and the Sette-Daban in the western border regions. The highest point is 2,933 metres (9,623   ft) high, Berill Mountain . [12] [13]

There are a number of peninsulas along the krai's extensive coast, the main ones being (north to south) the Lisyansky Peninsula , Nurki Peninsula , Tugurskiy Peninsula , and the Tokhareu Peninsula .

The main islands of Khabarovsk Krai (north to south) are Malminskiye Island , the Shantar Islands , Menshikov Island , Reyneke Island (Sea of Okhotsk) , Chkalov Island , Baydukov Island , and the Chastye Islands . The island of Sakhalin (Russia's largest) is administered separately as Sakhalin Oblast , along with the Kuril Islands .

The charts below detail climate averages from various locations in the krai. Khabarovsk is set near the Chinese border at a lower latitude far inland, while Komsomolsk-on-Amur being further downstream on the Amur river at a higher latitude. Sovetskaya Gavan and Okhotsk are coastal settlements in the deep south and far north, respectively.

According to various Chinese and Korean records, the southern part of Khabarovsk Krai was originally occupied by one of the five semi-nomadic Shiwei , the Bo Shiwei tribes, and the Black Water Mohe tribes living, respectively, on the west and the east of the Bureya and the Lesser Khingan ranges.

In 1643, Vassili Poyarkov 's boats descended the Amur , returning to Yakutsk by the Sea of Okhotsk and the Aldan River , and in 1649–1650, Yerofey Khabarov occupied the banks of the Amur. The resistance of the Chinese, however, obliged the Cossacks to quit their forts, and by the Treaty of Nerchinsk (1689), Russia abandoned its advance into the basin of the river.

Although the Russians were thus deprived of the right to navigate the Amur River, the territorial claim over the lower courses of the river was not settled in the Treaty of Nerchinsk of 1689. The area between the Uda River and the Greater Khingan mountain range (i.e. most of Lower Amuria) was left undemarcated and the Sino-Russian border was allowed to fluctuate. [20] [21]

Later in the nineteenth century, Nikolay Muravyov conducted an aggressive policy with China by claiming that the lower reaches of the Amur River belonged to Russia . In 1852, a Russian military expedition under Muravyov explored the Amur, and by 1857, a chain of Russian Cossacks and peasants had been settled along the whole course of the river. In 1858, in the Treaty of Aigun , China recognized the Amur River downstream as far as the Ussuri River as the boundary between Russia and the Qing Empire, and granted Russia free access to the Pacific Ocean. [22] The Sino-Russian border was later further delineated in the Treaty of Peking of 1860 when the Ussuri Territory (the Maritime Territory ), which was previously a joint possession, became Russian. [23]

Khabarovsk Krai was established on 20 October 1938, when the Far Eastern Krai was split into the Khabarovsk and Primorsky Krais . [24] Kamchatka Oblast , which was originally subordinated to the Far Eastern Krai, fell under the Jurisdiction of Khabarovsk Krai, along with its two National Okrugs, Chukotka and Koryak . In 1947, the northern part of Sakhalin was removed from the Krai to join the southern part and form Sakhalin Oblast . In 1948, parts of its southwestern territories were removed from the Krai to form Amur Oblast . In 1953, Magadan Oblast was established from the northern parts of the Krai and was given jurisdiction over Chukotka National Okrug, which was originally under the jurisdiction of Kamchatka oblast. In 1956, Kamchatka Oblast became its own region and took Koryak National Okrug with it. The Krai took its modern form in 1991, just before the USSR's collapse when the Jewish Autonomous Oblast was created within its territory. On 24 April 1996, Khabarovsk signed a power-sharing agreement with the federal government, granting it autonomy. [25] This agreement would be abolished on 12 August 2002. [26]

During the Soviet period, the high authority in the oblast was shared between three persons: The first secretary of the Khabarovsk CPSU Committee (who, in reality, had the biggest authority), the chairman of the oblast Soviet (legislative power), and the Chairman of the oblast Executive Committee (executive power). Since 1991, CPSU lost all the power, and the head of the Oblast administration, and eventually the governor, was appointed/elected alongside elected regional parliament .

The Charter of Khabarovsk Krai is the fundamental law of the krai. The Legislative Duma of Khabarovsk Krai is the regional standing legislative (representative) body. The Legislative Duma exercises its authority by passing laws, resolutions, and other legal acts and by supervising the implementation and observance of the laws and other legal acts passed by it. The highest executive body is the Krai Government, which includes territorial executive bodies, such as district administrations, committees, and commissions that facilitate development and run the day to day matters of the province. The Krai Administration supports the activities of the Governor , who is the highest official and acts as guarantor of the observance of the Charter in accordance with the Constitution of Russia .

On 9 July 2020, the governor of the region, Sergei Furgal , was arrested and flown to Moscow. The 2020 Khabarovsk Krai protests began on 11 July 2020, in support of Furgal. [27]

Khabarovsk Krai is the most industrialized territory of the Far East of Russia, producing 30% of the total industrial products in the Far Eastern Economic Region.

The machine construction industry consists primarily of a highly developed military–industrial complex of large-scale aircraft- and shipbuilding enterprises. [28] The Komsomolsk-on-Amur Aircraft Production Association is currently among the krai's most successful enterprises, and for years has been the largest taxpayer of the territory. [28] Other major industries include timber-working and fishing , along with metallurgy in the main cities. Komsomolsk-on-Amur is the iron and steel centre of the Far East; a pipeline from northern Sakhalin supplies the petroleum-refining industry in the city of Khabarovsk . In the Amur basin, there is also some cultivation of wheat and soybeans . The administrative centre , Khabarovsk, is at the junction of the Amur River and the Trans-Siberian Railway .

The region's mineral resources are relatively underdeveloped. Khabarovsk Krai contains large gold mining operations (Highland Gold, Polus Gold), a major but low-grade copper deposit being explored by IG Integro Group , and a world-class tin district which was a major contributor to the Soviet industrial complex and is currently being revitalised by Far Eastern Tin (Festivalnoye mine) and by Sable Tin Resources Archived March 13, 2017, at the Wayback Machine , which is developing the Sable Tin Deposit (Sobolinoye) , a large high-grade deposit, 25   km from Solnechny town.

Population : 1,292,944   ( 2021 Census ) ; [29] 1,343,869   ( 2010 Russian census ) ; [9] 1,436,570   ( 2002 Census ) ; [30] 1,824,506   ( 1989 Soviet census ) . [31]

Vital statistics for 2022: [33] [34]

• Births: 12,404 (9.6 per 1,000)
• Deaths: 18,209 (14.0 per 1,000)

Total fertility rate (2022): [35] 1.50 children per woman

Life expectancy (2021): [36] Total — 67.85 years (male   — 62.91, female   — 72.94)

According to a 2012 survey, [37] 26.2% of the population of Khabarovsk Krai adheres to the Russian Orthodox Church , 4% are unaffiliated generic Christians , 1% adhere to other Orthodox churches or are believers in Orthodox Christianity who do not belong to any church, while 1% are adherents of Islam . In addition, 28% of the population declared to be "spiritual but not religious", 23% are atheist , and 16.8% follow other religions or did not give an answer to the question. [37]

There are the following institutions of higher education in Khabarovsk Krai. [39] [40]

• Pacific National University
• Far Eastern State University of Humanities
• Far Eastern State Medical University
• Khabarovsk State Academy of Economics and Law   [ ru ]
• Far Eastern State Transport University
• Far Eastern Academy of Government Services
• Far Eastern State Physical Education University
• Khabarovsk State Institute of Arts and Culture
• Komsomolsk-on-Amur State Technical University
• Komsomolsk-on-Amur State Pedagogical institute

• Amur Khabarovsk , a professional hockey club of the international Kontinental Hockey League and plays its home games at the Platinum Arena .
• FC SKA-Energiya Khabarovsk is a professional association football team playing in the Russian Football National League , the second tier of Russian association football.
• SKA-Neftyanik is a professional bandy club which plays in the top-tier Russian Bandy Super League at its own indoor venue Arena Yerofey . In the 2016–17 season , the club became Russian champion for the first time. [41]

The city was a host to the 1981 Bandy World Championship as well as to the 2015 Bandy World Championship . For the 2015 games, twenty-one teams originally were expected, which would have been four more than the record-making seventeen from the 2014 tournament , but eventually, only sixteen teams came. The A Division of the 2018 Bandy World Championship was again to be played in Khabarovsk. [42]

• List of Chairmen of the Legislative Duma of Khabarovsk Krai
• Tourism in Khabarovsk Krai

Related Research Articles

Khabarovsk is the largest city and the administrative centre of Khabarovsk Krai, Russia, located 30 kilometers (19 mi) from the China–Russia border, at the confluence of the Amur and Ussuri Rivers, about 800 kilometers (500 mi) north of Vladivostok. As of the 2021 Russian census, it had a population of 617,441. The city was the administrative center of the Far Eastern Federal District of Russia from 2002 until December 2018, when the status was given to Vladivostok. It is the largest city in the Russian Far East, having overtaken Vladivostok in 2015. It was known as Khabarovka until 1893. As is typical of the interior of the Russian Far East, Khabarovsk has an extreme climate with strong seasonal swings resulting in strong, cold winters and relatively hot and humid summers.

Amur Oblast is a federal subject of Russia, located on the banks of the Amur and Zeya rivers in the Russian Far East. Amur Oblast borders Heilongjiang province of the People's Republic of China (PRC) to the south.

Okha is a town and the administrative center of Okhinsky District of Sakhalin Oblast, Russia. Population: 23,008 (2010 Russian census) ; 27,963 (2002 Census) ; 36,104 (1989 Soviet census) .

Sakhalin Oblast is a federal subject of Russia comprising the island of Sakhalin and the Kuril Islands in the Russian Far East. The oblast has an area of 87,100 square kilometers (33,600 sq mi). Its administrative center and largest city is Yuzhno-Sakhalinsk. As of the 2021 Census, the oblast has a population of roughly 500,000.

Komsomolsk-on-Amur is a city in Khabarovsk Krai, Russia, located on the west bank of the Amur River in the Russian Far East. It is located on the Baikal-Amur Mainline, 356 kilometers (221 mi) northeast of Khabarovsk. Population: 238,505 (2021 Census) ; 263,906 (2010 Russian census) ; 281,035 (2002 Census) ; 315,325 (1989 Soviet census) .

Nikolayevsk-on-Amur is a town in Khabarovsk Krai, Russia located on the Amur River close to its liman in the Pacific Ocean. Population: 22,752 (2010 Russian census) ; 28,492 (2002 Census) ; 36,296 (1989 Soviet census) .

Sovetskaya Gavan is a town in Khabarovsk Krai, Russia, and a port on the Strait of Tartary which connects the Sea of Okhotsk in the north with the Sea of Japan in the south. Population: 27,712 (2010 Russian census) ; 30,480 (2002 Census) ; 34,915 (1989 Soviet census) .

Dolinsk is a town and the administrative center of Dolinsky District of Sakhalin Oblast, Russia, located in the southeast of the Sakhalin Island in the valley of the Naiba River and its tributaries, about 45 kilometers (28 mi) north of Yuzhno-Sakhalinsk and 10 kilometers (6.2 mi) from the coast of the Terpeniye Bay of the Sea of Okhotsk. Population: 12,200 (2010 Russian census) ; 12,555 (2002 Census) ; 15,653 (1989 Soviet census) .

Kamchatka Krai is a federal subject of Russia, situated in the Russian Far East. It is administratively part of the Far Eastern Federal District. Its administrative center and largest city is Petropavlovsk-Kamchatsky, home to over half of its population of 291,705.

Amursk is a town in Khabarovsk Krai, Russia, located on the left bank of the Amur River 45 kilometers (28 mi) south of Komsomolsk-on-Amur. Population: 42,970 (2010 Russian census) ; 47,759 (2002 Census) ; 58,395 (1989 Soviet census) .

Lesozavodsk is a town in Primorsky Krai, Russia, located on the Ussuri River, 10 kilometers (6.2 mi) from the Sino–Russian border and about 300 kilometers (190 mi) north of Vladivostok, the administrative center of the krai. Population: 37,034 (2010 Russian census) ; 42,185 (2002 Census) ; 44,065 (1989 Soviet census) ; 37,000 (1972).

Poronaysk is a town and the administrative center of Poronaysky District of Sakhalin Oblast, Russia, located on the Poronay River 288 kilometers (179 mi) north of Yuzhno-Sakhalinsk. Population: 16,120 (2010 Russian census) ; 17,954 (2002 Census) ; 25,971 (1989 Soviet census) .

Ayano-Maysky District is an administrative and municipal district (raion), one of the seventeen in Khabarovsk Krai, Russia. It is located in the north of the krai. The area of the district is 167,200 square kilometers (64,600 sq mi). Its administrative center is the rural locality of Ayan. Population: 2,292 (2010 Russian census) ; 3,271 (2002 Census) ; 4,802 (1989 Soviet census) . The population of Ayan accounts for 42.2% of the district's total population.

Novy Urgal is an urban locality in Verkhnebureinsky District of Khabarovsk Krai, Russia, located in the valley of the Bureya River, close to its confluence with the Urgal River, about 340 kilometers (210 mi) northwest of the krai's administrative center of Khabarovsk and 28 kilometers (17 mi) west of the district's administrative center of Chegdomyn. Population: 6,803 (2010 Russian census) ; 7,274 (2002 Census) ; 9,126 (1989 Soviet census) .

Nogliki is an urban locality and the administrative center of Nogliksky District of Sakhalin Oblast, Russia, located near the eastern coast of Sakhalin Island, about 6 kilometers (3.7 mi) inland from the Sea of Okhotsk shoreline and about 600 kilometers (370 mi) north of Yuzhno-Sakhalinsk. Population: 10,231 (2010 Russian census) ; 10,729 (2002 Census) ; 11,546 (1989 Soviet census) .

Komsomolsky District is an administrative and municipal district (raion), one of the seventeen in Khabarovsk Krai, Russia. It is located in the southern central part of the krai. The area of the district is 25,167 square kilometers (9,717 sq mi). Its administrative center is the city of Komsomolsk-on-Amur. Population: 29,072 (2010 Russian census) ; 31,563 (2002 Census) ; 33,649 (1989 Soviet census) .

Nikolayevsky District is an administrative and municipal district (raion), one of the seventeen in Khabarovsk Krai, Russia. It is located in the east of the krai. The area of the district is 17,188 square kilometers (6,636 sq mi). Its administrative center is the town of Nikolayevsk-on-Amur. Population: 9,942 (2010 Russian census) ; 13,850 (2002 Census) ; 19,683 (1989 Soviet census) .

Okhotsky District is an administrative and municipal district (raion), one of the seventeen in Khabarovsk Krai, Russia. It is located in the north of the krai. The area of the district is 158,517.8 square kilometers (61,204.1 sq mi). Its administrative center is the urban locality of Okhotsk. Population: 8,197 (2010 Russian census) ; 12,017 (2002 Census) ; 19,183 (1989 Soviet census) . The population of Okhotsk accounts for 51.4% of the district's total population.

Tuguro-Chumikansky District is an administrative and municipal district (raion), one of the seventeen in Khabarovsk Krai, Russia. It is located in the center of the krai. The area of the district is 96,069 square kilometers (37,092 sq mi). Its administrative center is the rural locality of Chumikan. Population: 2,255 (2010 Russian census) ; 2,860 (2002 Census) ; 3,610 (1989 Soviet census) . The population of Chumikan accounts for 47.0% of the district's total population.

Selikhino is a rural locality in Komsomolsky District of Khabarovsk Krai, Russia. Population: 4,255 (2010 Russian census) ; 4,865 (2002 Census) .

• ↑ Президент Российской Федерации.   Указ   №849   от   13 мая 2000 г. «О полномочном представителе Президента Российской Федерации в федеральном округе». Вступил в силу   13 мая 2000 г. Опубликован: "Собрание законодательства РФ", No.   20, ст. 2112, 15 мая 2000 г. (President of the Russian Federation.   Decree   # 849   of   May 13, 2000 On the Plenipotentiary Representative of the President of the Russian Federation in a Federal District . Effective as of   May 13, 2000.).
• ↑ Госстандарт Российской Федерации.   №ОК 024-95   27 декабря 1995 г. «Общероссийский классификатор экономических регионов. 2.   Экономические районы», в ред. Изменения №5/2001 ОКЭР. ( Gosstandart of the Russian Federation.   # OK 024-95   December 27, 1995 Russian Classification of Economic Regions. 2.   Economic Regions , as amended by the Amendment   # 5/2001 OKER. ).
• 1 2 Charter of Khabarovsk Krai, Article   4
• ↑ "Оценка численности постоянного населения по субъектам Российской Федерации" . Federal State Statistics Service . Retrieved September 1, 2022 .
• ↑ "26. Численность постоянного населения Российской Федерации по муниципальным образованиям на 1 января 2018 года" . Federal State Statistics Service . Retrieved January 23, 2019 .
• ↑ "Об исчислении времени" . Официальный интернет-портал правовой информации (in Russian). June 3, 2011 . Retrieved January 19, 2019 .
• ↑ Official throughout the Russian Federation according to Article   68.1 of the Constitution of Russia .
• 1 2 Russian Federal State Statistics Service (2011). Всероссийская перепись населения 2010 года. Том   1 [ 2010 All-Russian Population Census, vol.   1 ] . Всероссийская перепись населения 2010   года [2010 All-Russia Population Census] (in Russian). Federal State Statistics Service .
• ↑ Chaussonnet, p.109
• ↑ Topographic map N-53; M 1: 1,000,00
• ↑ Khabarovsk Krai Mountains - PeakVisor
• ↑ Google Earth
• ↑ "Pogoda.ru.net" (in Russian) . Retrieved November 8, 2021 .
• ↑ "Habarovsk/Novy (Khabarovsk) Climate Normals 1961–1990" . National Oceanic and Atmospheric Administration . Retrieved November 2, 2021 .
• ↑ "climatebase.ru (1948-2011)" . Retrieved April 28, 2012 .
• ↑ "Weatherbase: Historical Weather for Komsomolsk-on-Amur, Russia" . Weatherbase. 2012. Retrieved on November 24, 2011.
• ↑ "Weather and Climate-The Climate of Okhotsk" (in Russian). Weather and Climate (Погода и климат). Archived from the original on December 3, 2019 . Retrieved December 3, 2019 .
• ↑ "Ohotsk (Okhotsk) Climate Normals 1961–1990" . National Oceanic and Atmospheric Administration . Retrieved December 3, 2019 .
• ↑ "1689, Nerchinsk – Russia" . China's External Relations .
• ↑ Alexei D. Voskressenski (2002). Russia and China: A Theory of Inter-State Relations . Routledge. pp.   107–108. ISBN   978-0700714957 .
• ↑ "1858, Aigun – Russia" . China's External Relations .
• ↑ Alexei D. Voskressenski (2002). Russia and China: A Theory of Inter-State Relations . Routledge. pp.   112–113. ISBN   978-0700714957 .
• ↑ Decree of October   20, 1938
• ↑ Solnick, Steven (May 29, 1996). "Asymmetries in Russian Federation Bargaining" (PDF) . The National Council for Soviet and East European Research : 12. Archived (PDF) from the original on October 9, 2022.
• ↑ Chuman, Mizuki. "The Rise and Fall of Power-Sharing Treaties Between Center and Regions in Post-Soviet Russia" (PDF) . Demokratizatsiya : 146. Archived (PDF) from the original on October 9, 2022.
• ↑ "Anger at Kremlin Grows in Latest Massive Russian Far East Protest" . The Moscow Times . July 25, 2020.
• 1 2 "KNAAPO Komsomolsk na Amure Aviation Industrial Association named after Gagarin - Russian" . www.globalsecurity.org .
• ↑ Russian Federal State Statistics Service. Всероссийская перепись населения 2020 года. Том 1 [ 2020 All-Russian Population Census, vol. 1 ] (XLS) (in Russian). Federal State Statistics Service .
• ↑ Federal State Statistics Service (May 21, 2004). Численность населения России, субъектов Российской Федерации в составе федеральных округов, районов, городских поселений, сельских населённых пунктов   – районных центров и сельских населённых пунктов с населением 3   тысячи и более человек [ Population of Russia, Its Federal Districts, Federal Subjects, Districts, Urban Localities, Rural Localities—Administrative Centers, and Rural Localities with Population of Over 3,000 ] (XLS) . Всероссийская перепись населения 2002   года [All-Russia Population Census of 2002] (in Russian).
• ↑ Всесоюзная перепись населения 1989   г. Численность наличного населения союзных и автономных республик, автономных областей и округов, краёв, областей, районов, городских поселений и сёл-райцентров [ All Union Population Census of 1989: Present Population of Union and Autonomous Republics, Autonomous Oblasts and Okrugs, Krais, Oblasts, Districts, Urban Settlements, and Villages Serving as District Administrative Centers ] . Всесоюзная перепись населения 1989   года [All-Union Population Census of 1989] (in Russian). Институт демографии Национального исследовательского университета: Высшая школа экономики [Institute of Demography at the National Research University: Higher School of Economics]. 1989 – via Demoscope Weekly .
• ↑ "Национальный состав населения" . Federal State Statistics Service . Retrieved December 30, 2022 .
• ↑ "Information on the number of registered births, deaths, marriages and divorces for January to December 2022" . ROSSTAT . Archived from the original on March 2, 2023 . Retrieved February 21, 2023 .
• ↑ "Birth rate, mortality rate, natural increase, marriage rate, divorce rate for January to December 2022" . ROSSTAT . Archived from the original on March 2, 2023 . Retrieved February 21, 2023 .
• ↑ Суммарный коэффициент рождаемости [ Total fertility rate ] . Russian Federal State Statistics Service (in Russian). Archived from the original (XLSX) on August 10, 2023 . Retrieved August 10, 2023 .
• ↑ "Демографический ежегодник России" [ The Demographic Yearbook of Russia ] (in Russian). Federal State Statistics Service of Russia (Rosstat) . Retrieved June 1, 2022 .
• 1 2 3 "Arena: Atlas of Religions and Nationalities in Russia" . Sreda, 2012.
• ↑ 2012 Arena Atlas Religion Maps . "Ogonek", № 34 (5243), 27/08/2012. Retrieved 21/04/2017. Archived .
• ↑ The Institutions of Higher Education in Khabarovsk Krai Archived December 28, 2005, at the Wayback Machine
• ↑ "Independent Russian and Ukrainian Interpreters" . RusMoose.com .
• ↑ "Google Translate" . translate.google.co.uk .
• ↑ "Annual Congress in Sandviken, Sweden on Jan 30 2017 2017-01-28" (PDF) . Archived from the original (PDF) on December 4, 2017 . Retrieved February 23, 2017 .
• ↑ Gyeongsangnam-do official website English Archived September 21, 2008, at the Wayback Machine
• ↑ "Sister cities of the Hyogo Prefecture" . Archived from the original on October 29, 2007 . Retrieved January 10, 2009 .
• Хабаровская краевая Дума.   Постановление   №150   от   30 ноября 1995 г. «Устав Хабаровского края», в ред. Закона №152 от   23 декабря 2015 г.   «О внесении изменений в статьи   26 и   34 Устава Хабаровского края». Вступил в силу   16 января 1996 г. Опубликован: "Тихоокеанская звезда", №№7–8, 13 и 16 января 1996 г. (Khabarovsk Krai Duma.   Resolution   # 150   of   November   30, 1995 Charter of Khabarovsk Krai , as amended by the Law   # 152 of   December   23, 2015 On Amending Articles   26 and   34 of the Charter of Khabarovsk Krai . Effective as of   January   16, 1996.).
• Президиум Верховного Совета СССР.   Указ   от   20 октября 1938 г. «О разделении Дальневосточного края на Приморский и Хабаровский края». ( Presidium of the Supreme Soviet of the USSR .   Decree   of   October   20, 1938 On Splitting Far Eastern Krai into Primorsky and Khabarovsk Krais . ).
• Chaussonnet, Valerie (1995) Native Cultures of Alaska and Siberia . Arctic Studies Center. Washington, D.C. 112p. ISBN   1-56098-661-1
• (in Russian) — Official website of Khabarovsk Krai
• Information concerning the Shiwei tribes and their relationship with the Khitans
• (in Russian) — Brief history of Khabaovsk Krai
• Cities and towns
• Far Eastern Federal District
• Far Eastern economic region
• Far Eastern Republic
• Indigenous peoples of Siberia
• Eastern Military District
• Amur Oblast

• Fundraisers
• GoFundMe Heroes
• Success Stories
• Social Impact Funds
• Celebrate Black Joy
• How GoFundMe Works
• What is crowdfunding?
• Team fundraising
• The Donate Button
• Fundraising tips
• Fundraising ideas
• Help center
• Your fundraisers
• Donations you've made
• Account settings
• Start a new fundraiser
• Success stories
• GoFundMe Causes
• How GoFundMe works
• For charities
• Start a GoFundMe
• Charity activity
• GoFundMe Community
• Your Fundraisers
• Account Settings

Start an Education Fundraiser on GoFundMe

Teachers, students, parents, clubs, and more use GoFundMe as a trusted and easy way to raise money for education needs. Education fundraising is available for your classroom, tuition assistance, after school program, or school supplies.

Everything you need to help your fundraiser succeed is here. Start fundraising on GoFundMe today

Start fundraising on GoFundMe

Help with tuition

Classroom supplies

Teacher power

Resources for education fundraising, questions about education fundraising on gofundme, can i start a gofundme for help with tuition.

Yes, GoFundMe has been used by many students to help them in their education journey. We recommend listing how the funds you raise will be used to help potential donors understand how they are helping. 

I’m a teacher. Can I start a GoFundMe for my classroom expenses?

Yes, you can fundraise for your classroom needs on GoFundMe. You can also nominate your fundraiser to receive a grant from GoFundMe.org’s Learning and Education fund here . 

How do I set up a fundraiser so that someone else receives the money?

We recommend you first ask if the person you are fundraising for is comfortable with you starting the fundraiser. Once you set up the fundraiser, you can invite them to set up bank transfers so they will receive the money directly. Learn more about inviting the person you are fundraising for to receive funds .

How long will it take to receive the money?

The process of setting up and verifying transfers can take 3-7 business days or longer to complete. Then, once your first transfer is sent, it will take on average 2-5 business days for the funds to safely be deposited into the bank account on file.

Can I upload videos to my fundraiser?

Yes, one way you can consider using photos or videos is by adding one to a fundraiser update to easily thank everyone or engage with a progress update. Try these tips for using video in your fundraiser .

How much of the money will I keep?

One small transaction fee (2.9% + $0.30) is automatically deducted per donation—that’s it. Everything else goes directly to your cause. For more information and to estimate what you will receive, check out the GoFundMe pricing calculator.

What details should I include in an education fundraiser?

In your fundraiser, we recommend including as many details as you can about what you are fundraising for and how much you need to raise. For example, if you need help covering the cost of your textbooks, you can add up the average or projected costs of your books and include that in your fundraiser description. 

How do I invite team members to help me?

If you are fundraising as part of a club or organization, adding team members can be a great way to help reach your goal. You can add team members to help you run the fundraiser after the fundraiser is set up. Visit this tips article for advice on using team members help your GoFundMe reach its goal .

Why start an education fundraiser on GoFundMe?

When people come together on GoFundMe to fund the potential of education, they are serving as a powerful ally for students, teachers, and communities in pursuit of academic goals and improvements. Whether you’re a student looking for help covering educational expenses, a teacher enriching your classroom with resources and development opportunities, or enabling communities to fund scholarships and school projects, GoFundMe harnesses the collective power of its community and technology. People care deeply about education, let them show how much they care by starting a fundraiser and providing a way for them to help you.

Main navigation

• Continuing Nursing Education
• News & Events

Celebrating first graduating cohort of Nurse Practitioner Program's Adult Care Concentration

• Add to calendar
• Tweet Widget

Held at the Ingram School of Nursing (ISoN) on May 28 th , our Sip, Sip, Hurray reception honoured our convocation prize winners as well as the first graduating cohort of the Adult Care Concentration of the Nurse Practitioner Program. Launched in the fall of 2021, the Adult Care Concentration offers comprehensive theoretical and clinical training in the care of individuals aged 14 and over with complex, acute, chronic or critical care issues. As noted by Associate Dean and ISoN Director Anita Gagnon, RN, PHD, at the reception, “Using a nursing lens, Adult Care Nurse Practitioners consider the impacts of illness on the whole person and the family, and help to identify strengths and resources that enable optimal conditions for health and healing.”

With the addition of the Adult Care concentration, the ISoN became the first – and, to the best of our knowledge, only - nursing school in Quebec to offer all five NP concentrations, including Primary Care, Neonatal, Pediatrics and Mental Health.

As advanced practice nurses with graduate nursing preparation and specialized nursing knowledge and expertise, NPS can perform eight additional reserved activities including diagnosing illnesses, prescribing medications and diagnostic tests, determining medical treatment plans, using invasive medical techniques or treatments, and providing pregnancy care. They work autonomously in the context of interprofessional collaboration with physicians, nurses and other healthcare professionals, serving as educators who advocate for their patients, and taking leading roles in optimizing our healthcare system through research and policy development.

Speaking on behalf of the first graduating Adult Care cohort, newly minted Nurse Practitioner Lori Rousseau expressed profound gratitude to her peers, to the program’s educators, and to the ISoN. “Our time in this program has taught us invaluable lessons, some of which came as surprises. We were reminded about how fundamental empathy and compassion are in caring for patients and their families. We re-discovered the power of teamwork, realizing that our peers can often become our greatest allies and sources of strength. We also learned the importance of being able to adapt to unexpected situations.” 

In particular, she praised Nurse Director Shannon McNamara, and Assistant Nurse Director Sheena Heslip for serving as educators, role models and mentors who challenged students to think critically and creatively at every turn. She concluded her remarks with these inspirational words, “As we step back into the challengingly beautiful world of healthcare in our new roles, let us carry forward the knowledge, skills, and values we have gained along the way. Let us hold closely the memories we have made, the lessons we have learned, and the people who have shaped our journey. Together, I truly believe we can have a profound impact on our healthcare system.”

Department and University Information

Ingram school of nursing.

Our Associated Organizations

Our usefull links.

World Wildlife Fund

Baikal Environmental Wave