Vol 27, No 6 (2019)

Full Issue

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Articles
The trends of population general morbidity in the subjects of the Central Federal Okrug of the Russian Federation
Starodubov V.I., Leonov S.A., Savina A.A., Feyginova S.I., Alekseeva V.M., Zimina E.V.
Abstract
The article presents the results of analysis of indices of total morbidity of population of the Central Federal Okrug (CFD) of the Russian Federation in 2010-2017. The significant differences in indices of total morbidity between the CFD subjects in certain ICD-10 classes were established. The indices of total morbidity of population during study period (8 years) in the Central Federal District factually didn't altered, while dynamics of indices in other subjects was characterized by multidirectionality. The gap in levels of total morbidity of population in the subjects was significant: from 115,123.6 per 100,000 of population in the Kursk Oblast to 194,404.1 per 100,000 of population in the Orel Oblast. The significant difference in rates of increase/ decrease of indices is noted. Thus, in Moscow decrease rate made up to 10%, while in the Orel Oblast morbidity increased up to 13.1%. Besides, in 2017, the Orel Region took a leadership in rate of increasing of total morbidity in such classes of diseases as infectious and parasitic diseases (39.3%), diseases of blood and blood-forming organs (49.1%), diseases of endocrine system (59,1%), diseases of nervous system (26.8%), diseases of respiratory system (28.2%), diseases of musculoskeletal system (16%), malformations (56%). It is very likely that this trend developed under influence of demographic situation in the subject due to significant increasing of percentage of people older than able-bodied age.The city of Moscow occupies leading position in decreasing of rate of prevalence of diseases and last but one place in level of total morbidity being inferior only to the Kursk Oblast. Thus, in Moscow was noted the most significant decreasing of morbidity in classes of infectious and parasitic diseases (26%) and diseases of digestive system (20.6%). The diseases of blood and blood-forming organs (235.2 per 100,000 population) and mental disorders (2353.5 per 100,000 population) were registered the less.The main contribution into trends of increasing or decreasing of indices is made by persons aged 18 years and older (74.1%).
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):947-952
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The public-private partnership in medical services market
Abubakirov A.S., Zudin A.B., Snegireva Y.Y.
Abstract
The article considers the types of public-private partnership in the medical services market. Nowadays, health care is recognized all over the world as one of the most investment attractive platform for development of public-private partnership. The investments of private capital into medical services sector represent global trend conditioned by implementation of innovative treatment methods, technique support of medical clinics, improvement of quality of medical services, formation of new institutional structure in health care. The alterations like that make it necessary to attract financial resources, including at the expense of private investments entry. Thus, in modern economic conditions, issues of considering possibilities of public-private partnership projects in medical services market are actual in Russia.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):953-958
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The children morbidity of bronchial asthma in municipal and rural districts of the Belgorod oblast
Agarkov N.M., Kicha D.I., Poshibaylova A.V.
Abstract
The bronchial asthma is a common pathology among children of different countries, Russia included. However, comparative studies of the incidence of bronchial asthma in children in urban and rural areas are factually absent.The purpose of study is to analyze children morbidity of bronchial asthma in urban and rural areas of the Belgorod Oblast.The official statistics data was used to analyze primary and total morbidity of children with bronchial asthma in cities and rural areas of the Belgorod Oblast in 2012-2017. The continuous retrospective technique was applied.The level of primary morbidity of bronchial asthma in children is factually the same in urban and rural areas (P>0.05). However, total morbidity of bronchial asthma in children population is significantly higher in cities of the Oblast.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):959-961
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The role of ADRB1 genes polymorphism in examined patients with chronic rheumatic heart disease
Petrov V.S., Smirnova E.A.
Abstract
The study purpose is to evaluate effect of ADRB1 gene polymorphism on echocardiography indices and endothelial function in patients with chronic rheumatic heart disease. The sampling consisted of 128 patients with chronic rheumatic heart disease. The echocardiography was performed on Philips Affinity 50 device and evaluation of endothelial function was implemented on “AngioScan01” device. The genetic typing was carried out according polymorphic markers Gly49Ser and Gly389Arg. The nucleotide replacement of glycine with serine resulted in increasing of left sections of heart both at Ser49Ser (left atrium 5.65±0.09 cm; LVED 5.61±0.27 cm; LVES 3.76±0.16 cm), and Gly49Ser (left atrium 5.65±0.09 cm; LVED 5.61±0.27 cm; LVES 3.76±0.16 cm), The similar situation occurred when glycine was replaced with arginine: for Arg389Arg homozygotes (left atrium 5.63±0.12 cm; LVED 5.97±0.20 cm; LVES 3.97±0.16 cm); and heterozygotes Gly389Arg (LVED 5.60±0.08 cm; LVES 3.78±0.07 cm). Homozygosity of Ser49Ser in endothelial function led to low values of index augmentation (5.83±0.80%) and indicators reflecting function of small resistive arteries were the worst (1.30±0.07). Arg389Arg homozygotes had the worst endothelial function in system of large arteries (-20.40±0.68 ms). highest severity of arterial stiffness (23.00±0.68%) as compared with Gly389Gly homozygotes (8.92±0.99% and 62.67±1.41 years). ADRB1 gene polymorphism in subjects with HRBS leads to dilatation of left heart. The effect on endothelial dysfunction is multidirectional: Ser49Ser homozygosity leads to minimal arterial stiffness and changes in small resistive arteries; homozygosity of Arg389Arg leads to maximum changes in large conducting arteries and the highest rates of vascular stiffness.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):962-966
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The factors associated with development of professional burning-out in physicians
Kobiakova O.S., Deev I.A., Kulikov E.S., Khomiakov K.V., Tiufilin D.S., Zagromova T.A., Balaganskaia M.A.
Abstract
The professional burnout of physicians is a common world problem that has significant negative impact on quality of medical care and decreases effectiveness of human resources policy in health care. The first step in solving the burnout problem is to identify the most common provoking and protective factors (predictors) of this phenomenon. The study was targeted to determine and categorize the key factors associated with burnout of physicians and to provide prevention and treatment of the condition in the future. The participants of the study completed a questionnaire targeted to evaluating professional burnout levels and establishing key factors of its development and prevention. The sampling of 1668 physicians from the Tomsk Oblast participated in the study. The moderate or high levels of professional burnout were found in more than half of respondents and only 1% of them had no predictors of this syndrome. The correlation and multiple regression analysis were applied to classify various factors impacting on professional burnout as negative (resulting in professional burnout) or protective (preventing development of professional burnout). The results of the study demonstrated the importance of integrated approach in effective solving of the problem of professional burnout in Russia. The study will assist in finding practical applications of its results in preventing and reducing the risk of development of professional burnout.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):967-971
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The effect of advertising activity on patients' choice of medical organization
Komarova A.A., Dianina E.V., Moreeva E.V.
Abstract
The article presents theoretical propositions concerning placement and dissemination of information about medical organization and practical recommendations of the advertising campaign of medical services. The analysis of the advertising activities’ influence on the patient choice of the medical organization out of top annual revenue medical institutions in Russia was carried out. In economically developed countries, the support of possibility of choosing particular medical organization and physician in economic theory and in practice of organization of health care system is targeted to improving medical care quality and health care efficiency. The process of expanding possibilities of choice is officially declared as one of the priorities of development of Russian health care. However, the influence of consumer choice of patient of medical organization while addressing for medical care is still to be an object of research study in Russia.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):972-977
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The specificity of moral aspects of activity of medical workers in Health Care of Russia
Petrakova A.S., Martseva T.G., Voblaya I.N.
Abstract
The transformation of values and dissemination of consumerism ideology, associated with active implementation of market mechanisms of functioning in the Russian health care system, significantly affected processes of implementing moral aspects of activities of medical workers. The transition of physician and patient to buying and selling relationships initiated the situation when the life and health maintenance is considered not as an ultimate purpose of medical profession, but as a service supplied for particular fee. Moreover, quality of medical care supplied is considered as directly proportional to its cost. This fact results, from one hand, in corruption in health care system initiated by patients themselves because unofficial fee is significantly lower than the established one. From the other hand, it results in the fact that service supplied to patient for free in state polyclinics is provided untimely and not always is has needed quality due to lacking of necessary resources. As a result, the moral purpose of medical profession becomes minor, yielding to commercial relationships. However, these occurrences do not disprove the fact that the patient, in case of visiting physician, remains completely dependent on one's professionalism and responsibility, despite the abundance of private medical institutions and the formal freedom of choosing type of medical service and medical specialist providing it. The high moral culture was and continue to be an obligatory characteristic of successfulness and professionalism of physician. In the new economic conditions, it can become a competitive advantage, since every patient wishes to see in physician not only competent specialist, but also a person capable to empathize and responsibly treat with responsibility another life that was trusted to him.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):978-982
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The modern characteristics of quality of ambulatory polyclinic medical care of patients of elderly age
Popov V.V., Novikova I.A.
Abstract
The organization of out-patient care of elderly people has its own clinical and organizational characteristics.The study was carried out to establish quality factors of ambulatory polyclinic medical care of elderly people from the position of attending physician. The sampling consisted of 80 physicians interviewed. Out of them 70 were females (87.5%), 50 local therapists and general practitioners and 30 physicians of various specialties. The genuinely elaborated questionnaire was applied. Results and discussion. It is established that most physicians are aware of the need of improving quality of medical care of elderly patients and developing geriatric care. The percentage of elderly patients in ambulatory polyclinic network makes up to 50%, and in particular cases up to 60-70%. The majority of elderly patients visit their physician 1-2 times per month. More than 50% of physicians consider elderly patients have to be observed by physicians of geriatric profile that confirms actual need in this medical specialty. The social and organizational factors of quality of medical care are identified: insufficient duration of physician admission, low level of preferential medications support, lacking of cash resources in patients to purchase prescribed medications, difficulties in making an appointment to medical specialist and district physician, difficult access of medical organization. The orientation of doctors in provision of care to elderly patients only to medication therapy is established. Conclusion. The specific characteristics of identified factors of quality of medical care of elderly patients are to be considered in developing directions of optimizing medical care for this contingent.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):983-987
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The evaluation of inter-departmental interaction in ensuring sanitary hygienic security under realization of mass events
Zamalieva M.A., Balabanova L.A.
Abstract
The article presents results of assessment of the algorithm of interdepartmental interaction related to complex security during mass events as exemplified by experience of the Department of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) in the Republic of Tatarstan (Tatarstan) during the preparation and holding of matches of the FIFA world Cup 2018 and the FIFA Confederations Cup 2017 in Kazan. The structure of management and interaction concerning security issues included three levels: the Federal level, the subject regional level and the regional departmental level. The vertical interaction was carried out on the departmental level as well as between the interdepartmental operational headquarters and regional interdepartmental operational headquarters through their heads. The horizontal interaction was carried out between departments at the subject regional level. The parallel transmission of information on the horizontal and vertical levels of interaction between the headquarters was previously worked out in Kazan conditions of mass events in 2013 and 2015. The model of interdepartmental horizontal interaction at the level of the constituent entity of the Russian Federation provided algorithm of coordination of activities of security on the part of responsible Agency. For operational prevention of possible security menaces and implementation of planned tasks ensuring comprehensive security directly during the mass events the operational interdepartmental management centers composed of representatives of all interested departments in the subject of the city-participant were created. The key areas of activities ensuring security during preparation and holding of the matches of the FIFA World Cup 2018 and the FIFA Confederations Cup 2017 in Kazan were included into interdepartmental plans of actions since the establishment of the coordinating body and at the end of the event, as well as in the minutes of meetings of the established interdepartmental body. The regulations of activities of interdepartmental operational bodies allowed to implement effective interaction in reaching objectives of safety in the subject of the Russian Federation.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):988-991
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The organizational aspects of health care of students of institutions of higher professional education
Kazantseva A.V., Anufrieva E.V.
Abstract
In recent decades, both in the Russian Federation and in the Sverdlovsk oblast decreasing of population size of adolescents and deterioration of their physical development and health status were established. In Russia, the organization of medical care of college students is insufficiently organized and requires additional improvements. The selective assessment of activities of medical offices in six colleges in Yekaterinburg was implemented. The sociological surveys were organized on the basis of the international HBSC questionnaire to study opinions of the minors about organization of medical care in colleges (653 students interviewed) and prevalence of health risk factors among students (1142 students were interviewed). In the Sverdlovsk region in 2018, only 53.6% of colleges were licensed for carrying out medical activities. According to the study, medical care in colleges was provided by medical assistant of medical office. This condition resulted in that not all the students underwent preventive examinations or underwent them not in required fullness. The medical personnel of colleges provided no analysis of health status of adolescents and health education is insufficient. The analysis of the data of sociological surveys established high prevalence of behavioral risk factors among underage students. Almost half of respondents noted the presence of harmful habits and only quarter of respondents paid attention to healthy diet. The percentage of respondents claimed that they tasted and consumed “spices” and “surfactants” was high against the background of low awareness of dangers of these habits. To amend this situation, it is necessary to organize auditing of quality of medical care of students in colleges, to analyze quality of preventive examinations, to develop a set of preventive measures of promoting health of students of colleges, based on their motivation and psychological characteristics, involving students themselves in the process, applying interactive forms.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):992-996
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The trans-dermal therapeutic systems as a convenient alternative of traditional medicinal forms
Gildeeva G.N., Ejova E.A., Zakaliukina E.V., Ivanova A.A.
Abstract
The development of new medications increasing bio-availability and efficacy of existing pharmaceuticals is considered as an alternative to implementation of new medications that can significantly reduce time-frame and costs of bringing medication to the market, acquired in recent decades high practical and scientific importance.The new effective medications include trans-dermal therapeutic systems (TTS) that are capable of providing a controlled release of the active pharmaceutical ingredient (API) through the skin into the bloodstream at a therapeutically optimal rate for a long time. The application of TTS is painless and convenient. It eliminates losses associated with metabolism in the gastrointestinal tract and liver and allows wide variation of dosage and to discontinue treatment at any moment.The key problem of trans-dermal delivery is difficulty in penetrating API through the skin, which has complex multilayer structure. The understanding of all aspects affecting permeability of API through the skin is crucial for the development of new TTS and is a subject of special research interest in modern pharmacological science.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):997-1002
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The modern characteristics of occupational morbidity of agriculture workers
Bezrukova G.A., Danilov A.N., Spirin V.F., Novikova T.A.
Abstract
On the basis of updated data from 82 subjects of the Russian Federation multivariate analysis of occupational diseases of agricultural workers was implemented. It is established that in unhealthy work conditions are characteristic for 30% of workers in the agricultural sector. In the enterprises of agriculture, the percentage of workplaces not meeting sanitary hygienic standards made up to 35%. The high etiologic pathogenic relationship between nosological form of disease and working conditions in the profession is established. Most often, the occupational pathology was developed in agricultural workers in case of conditions of physical overload (37.2%), effecting of physical factors (26.8%) and contact with infected animals (14.6%). In nosological structure of accumulated occupational diseases the first place took radiculopathy of cervical and lumbar sacral levels (23%), the second - vibration disease (15.3%), followed by brucellosis (14.6%), the fourth - neuro-sensory deafness (11.5%).The regions of the Russian Federation are characterized by pronounced heterogeneity both related to general level of registered occupational diseases and its nosological spectrum. In the whole, in Russia during 2011-2015 persistent trend of decreasing of occupational diseases morbidity of agricultural workers was marked.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1003-1007
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The review and evaluation of possibilities, financial economical and medical social effects of development of medical services export in the Russian Federation
Khalfin R.A., Orlov S.A., Madianova V.V., Stolbov A.P., Kachkova O.E.
Abstract
The global health care market demonstrates a steady annual development. According to VISA study, in 2016 the market size was 100 billion US dollars, by 2025 it will reach 3 trillion US dollars and up to 4% of the world's population will receive medical care outside their countries of permanent residence. Exports of medical services are becoming part of government programs. The obvious advantages of developing export of medical services are, first of all, in improving medical infrastructure and quality of patient medical care and organizing additional jobs in many related sectors of national economics as well. The purpose of the study is to identify opportunities and to assess the socio-economic effects of the development of medical services exports in the Russian Federation. As a result of the study, the possibilities of the health care system for more efficient use of available resources, increasing the volume of medical care, as well as the formation of additional financial revenues for solving organizational and managerial tasks of providing material incentives for medical workers, updating the material and technical base, and introducing new medical technologies were revealed.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1008-1014
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The characteristics of medical demographic development of the Republic of Dagestan
Mingazova E.N., Schepin V.O., Gasaynieva M.M.
Abstract
The issues of assessing medical and demographic processes and improving public health are very actual in Russia. The article analyzes the current state and regional characteristics of medical and demographic development using the example of the Republic of Dagestan. The positive tendency of the main fertility indicators was determined, including the analysis of the age structure of the population and population size alterations.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1015-1021
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The satisfaction of parents with ambulatory polyclinic care of children in conditions of the region
Alikova Z.R., Anayeva L.A., Kozyreva F.U.
Abstract
To identify the most effective areas of out-patient care of children, an in-depth sociological study was carried out in the Kabardino-Balkaria Republic. The questionnaire allowed to get answers on satisfaction of parents with the quality, volume and availability of out-patient care, as well as to study the social status of respondents. The survey included 495 mothers aged of 18-45 years. Out of them, 70.0% had 1-2 children, 30.0% had 3 or more children. The orientation of the majority of families to the birth of 1-2 children formed one of the lowest in the republics of the North Caucasus total fertility rate of 1.61. The results of the study of parental satisfaction with the level of medical care of children in out-patient settings established that the main problem is sufficiently correlated with the data of similar studies in different regions of Russia. According to the data obtained, 61.0% of the respondents were satisfied with the overall health care in the clinic, and only 12.0% of the respondents were fully satisfied. At the same time, a quarter of the respondents expressed their dissatisfaction with various aspects of medical care. The main reasons for dissatisfaction are the low level of examination, organizational issues that need to be addressed, a significant workload of doctors, often the lack of doctors of narrow specialties. According to parents opinion, the clinic is lacking continuity in the work and dynamic monitoring of a sick child, as well as awareness of patients about the ongoing therapeutic and preventive measures. The low efficiency of preventive work is established. The dissatisfaction with the availability and quality of medical care of children is the basis for the necessary measures to improve functioning of the children's clinic, including introduction of new and effective organizational and medical technologies, improvement of material and technical equipment, improvement of the professionalism of medical personnel. The prerequisite for the success of the clinic is also compliance with ethical principles in Pediatrics. The results obtained on the basis of the analysis of the parents' opinion are valuable for development of the perspective programs of development and improvement of primary health care of children in the Republic of Kabardino-Balkaria.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1022-1026
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The medical demographic characteristics of health status of population of the Trans-Baikal Krai
Khodakova O.V., Koshevaya N.V.
Abstract
The demand for research in the context of identifying the relationship between socioeconomic factors and the medical and demographic indicators of individual regions is conditioned by continuing deterioration of the health status of population of the subjects of the Russian Federation, which occurs under the influence of unfavorable environmental factors.The purpose of research is to carry out comprehensive analysis of the medical and demographic indicators of population health of the region in 2012-2017, taking into account the influence of regional health factors.Materials and methods. The study applied such research techniques as the Pearson's correlation analysis with matrix construction. The processing was performed using the software Statistica 6.0. To test the hypothesis of normal distribution, the Shapiro-Wilk criterion was applied. The significance of differences was determined by the Student's criterion. The differences were considered statistically significant with p<0.05. The study used data of the State statistical Report of the Ministry of Health of the Russian Federation in 2012-2017.The results. The study established that the Trans-Baikal Krai is characterized by a decrease in population size up to 1.9%, a decrease in the birth rate up to 18.5%, a significant decrease in natural growth, an average mortality rate and an increase in life expectancy by 4.89%. According to the Human Development Reports, the Trans-Baikal Krai takes the 76th position among the regions of the Russian Federation.The comprehensive assessment of the socio-economic conditions of the region allowed to identify the factors with the maximum degree of influence on the condition of public health, among which the resource characteristics of the regional health system are of significant importance, that determines the need for long-term study of the effect of these indicators on the level of regional health.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1027-1031
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The medical social aspects of optimization of spine load in students of high educational schools
Kovaleva I.P., Zayarnaya I.A., Borodina E.V.
Abstract
The article considers the statistical justification of the need to minimize the load on the spine of students, both in Russia and in foreign countries and the main directions and multi-aspect regulation of optimizing the load on the spine, since this factor plays a key role in the formation of the health of the whole organism. The movement, correct posture, comfortable clothes and shoes, rationally selected chairs and beds allow you to maintain health of the spine, and the overload, in particular heavy school backpacks have a negative effect on its development and functioning. The issue of the load on the spine of schoolchildren attracts attention of the government, physicians, parents and teachers. The problem really exists and it is not solved yet, despite significant efforts in this direction. The numerous Russian and foreign studies carried out by medical experts, students and teachers confirm the facts of violation of SanPiNs, supporting actuality of research topic. The electronic textbooks can be a key point in solving this problem.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1032-1037
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The basics of health educational activities concerning vaccination in the Internet: “rational” advocates and “emotional” opponents
Bogdan I.V., Gurylina M.V., Chistiakova D.P.
Abstract
The Internet and social media are becoming an influential source of information regarding health care issues, including vaccination. The profound analysis of the Russian Internet discourse on vaccination demonstrated that nowadays there is no clear-cut understanding of adequate strategy concerning informational policy in this direction. The article defines the principles of information policy for pro-vaccine attitudes spreading on the Internet. Methods. The sampling consisted of the Muscovites Internet messages containing the keywords ‘vaccine’ and ‘vaccinations’ and their derivatives. The analyzed period of data export is the first quarter of 2019. The size of uploading was 19948 messages, the random sample of 800 messages and 280 images was taken. Veterinary and spam messages were excluded. Results. The topic of vaccines in our sample is discussed more frequently by women (72%). The average age of participants is 35. The algorithms of vaccination, complications, and necessity of vaccines are the most frequently discussed issues. In our sample pro and contra vaccines messages are of equal percentage (42% and 41% respectively) and there are 17% of those who are in doubt. The key argument for contra vaccines is post-vaccination complications. The visual propaganda of vaccine supporters is aimed at the ideas of common good, rationality, scientific knowledge, they are using lots of humor, and it usually requires the context awareness. The opponents apply more personal and emotional approach. their values are family and personal experience, common sense. Their approach is more appealing to the ‘common’ reader. Conclusion. The article describes strategies for argumentation and pro and contra vaccine propaganda on the Internet. The research offers its results to the segment users concerning their rational and emotional reactions. The work strategy with each group is proposed.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1038-1042
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The mortality of diabetes mellitus from the perspective of multiple causes of death: encoding problems
Sabgayda T.P., Tarasov N.A., Evdokushkina G.N.
Abstract
The statistics of causes of death is the informational basis for identifying public health problems. That is why the accurately accounting for mortality from diabetes mellitus, which is a global medical and social problem for society, is important.The study was carried out to analyze the correctness of coding death causes of diabetes mellitus and the frequency of alleged death.Materials and methods. The Moscow deceased population database of July 2018 - July 2019 was analyzed. Using the decision tables on codes linkages from ICD-10, incorrect codes for underline cause were established for 342 death cases from diabetes mellitus. Among 43044 cases of cardiovascular death the cases of presumed death from diabetes were detected. The analysis was carried out in the Microsoft Access 2007 software.The results. In 18.4% of cases, the cause of death from diabetes was encoded incorrectly. If a modification of the underline death cause is assumed due to the mention of certain diseases in any line of the Death Certificate, cases of coding for death from diabetes with wrong fourth character are more often detected when mentioning kidney diseases. If modification of the underline cause is provided for cases when information in the Death Certificate indicates that diabetes has caused the development of some diseases then the largest number of cases with incorrect coding was detected when mentioning circulatory diseases. Only in one medical organization the frequency of incorrect coding is 3.4%, in the rest it varies from 15.4% to 52.2%.Among all death causes, diabetes was only 0.41%. If to add cases of presumptive death from diabetes mellitus, then the proportion of diabetes in the structure of death causes will almost triple and reach up to 1.2%.Conclusions. The quality of diagnosis and coding of death causes from diabetes has not improved in recent years. To increase it, it is advisable to organize and establish the institution of coders. It is advisable to indicate the presence of diabetes mellitus in the Death Certificate without fail and use the information from the diabetes register. It is proposed to encode the death cause from diabetes mellitus with multiple complications use line D in the Death Certificate to indicate damage to various organs and systems if it is necessary.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1043-1048
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The remote results of treatment of ischemic stroke conditioned by atherosclerotic affection of carotid arteries
Kovalenko I.B., Chefranova J.Y., Poliansky V.D., Zuyeva N.S., Lykov Y.A.
Abstract
The ischemic stroke is a disease that leads to dysfunctions in life of any individual. The mortality rate of cerebral infarcts reaches up to 39%. Besides, the most acute period of an ischemic stroke, which lasts up to 5-7 days, is especially problematic and is characterized by the highest mortality. The first day of disease results in 21.74% of deaths (out of the total annual number of deaths). The article presents the results of the analysis of treatment of the patients with ischemic stroke caused by the atherosclerosis of brachiocephalic arteries. The role of endovascular technologies in the treatment of the acute cerebrovascular cases has not been fully revealed. The retrospective analysis of treatment of 171 patients with atherosclerotic subtype of ischemic stroke was carried out. The patients were distributed in two groups: in the first group (83 patients) the applied conservative therapy was supplemented by endovascular intervention during the acute period of ischemic insult; in the second group (88 patients) the conservative therapy alone was applied. Both groups were comparable in terms of gender, age and associated diseases. The risk factors of ischemic insult were analyzed such as IHD that requires surgery; hypertensive disease; hypercholesterolemia; ischemic insult in medical history; heart dysrhythmia; diabetes mellitus. All patients had more than one risk factor. There mortality, incapacitation, degree of neurological impairment, frequency of symptoms of hemorrhagic suffusion and of hemorrhagic transformation were analyzed. The remote results were analyzed in sampling of 54 patients: 32 patients from the first group, 22 patients from the second group. The quality of life was measured using technique of non-specific survey SF-36 when its 36 items were grouped into eight scales: physical functioning, role activity, body pain, general health, vitality, social functioning, emotional state, psychological health. The degree of incapacitation was measured with the modified Rankin scale, the quality of life was examined with the SF-36 survey, the survival rate was measured with the Kaplan-Meier estimator. The statistical analysis was carried out with the help of the Statistica 6.0 software.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1049-1052
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The main indices of functioning of the centers of social support of citizen of elderly age and disabled persons in Russia
Shliafer S.I.
Abstract
The main causes of aging of the population are decreasing of birth rate, increasing of life expectancy, increasing of mortality rate of population of able-bodied age. The continuing aging of population results in increasing of number of elderly people requiring social and medical care. The role of social service institutions is increasing. The purpose of study is to assess activities of the division’s centers of social services to elderly age and disabled citizen in the Russia for 2007-2017.The article presents analysis of the indices of functioning of the centers of social support of elderly population and disabled persons in the Russian Federation. In 2007-2017 in the conditions of aging of population most of the indices of divisions of the centers of social support of elderly population and disabled persons decreased except social rehabilitation divisions and divisions of social service at home.The methods. The normative documents regulating activity of the centers of social services and their structural divisions are investigated.The indices of functioning of divisions centers of the social support of elderly population and disabled persons such as day care, temporary residence, social and rehabilitation services, social services at home, specialized social and medical services at home, urgent social services in Russia, were analyzed according to the Federal State Statistics Service (Rosstat) for period of 11 years. The analytical and statistical methods were used.Conclusion. In the Russian Federation, the last decade has been characterized by significant increase in the total proportion number of persons over working age (from 20,8 to 25,0%). At the same time, decreasing of indices of functioning of divisions of temporary residences, day care, specialized divisions of social and medical services at home, urgent social services divisions, reduction in the number of social workers centers of social services to elderly age and disabled citizens was established.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1053-1057
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The modern characteristics of hospital medical care organization
Karpov O.E., Nikitenko D.N., Kamyshova D.A., Diachenko P.S.
Abstract
The article presents the results of identification and detailed issues of organization and control of rational pharmacotherapy in the framework of the provision of inpatient medical and diagnostic support. The regulatory mechanisms for managing the automated formation and execution of medical prescriptions for drugs and their subsequent performance by the nursing staff in the medical information system are analyzed from the standpoint of work optimizing and reducing the workload of medical personnel and risk of probable errors. The particular attention is paid to the system of controlled personalized and multiple writing off of drugs, targeted to generation of baseline data for rationing drug consumption, predicting their consumption and managing the procurement of drugs at the level of the medical organization.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1058-1063
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The on-line communication in organization of rehabilitation of patients of traumatological orthopedic profile
Fedonnikov A.S.
Abstract
The purpose of the study is to design and to prove rehabilitation process management for musculoskeletal system disorders with the use of on line communication technology between patients and medical institution.Material and methods. Medical and sociological study used sampling of 381 patients involved in hip-and-knee joint replacement program before the surgery and in rehabilitation period with the use of specially designed and implemented at the base of the V. I. Razumovsky Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University interactive system of monitoring and feedback (SMF). The results. The implementation of developed criteria of SMF performance confirmed its demand among the patients. It was revealed that more than 91% of them are ready for active rehabilitation after surgery and all the participants of the study consider as acceptable the distant communication with medical specialists. The performed trial test established that for the period of interaction with SMF patients have changed their attitude to the ways of communication preferring those which suppose on line communication.Conclusion. The developed organizational technology being patient-focused provided acceptable quality of informational interaction for health services access at the base of active feedback, interactivity and customization. It is shown that aged but able-bodied patients are impressionable for such practice, so using of on line communication influencing labor and social activity prolongation being both factor and instrument of health services accessibility.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1064-1069
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The sociological evaluation of commitment to treatment in re-hospitalized patients
Gaydarov G.M., Makarov S.V.
Abstract
The article presents the results of sociological assessment of commitment to treatment of repeatedly hospitalized patients in hospitals of the Irkutsk Oblast and the Republic of Buryatia, that permitted to study their medical and social characteristics, the level of awareness of their own health, their diseases and methods of their treatment are presented. Sampling was preceded by the selection of respondents with the support of experts that reduced the impact on the study results of various factors, along with commitment to treatment, which determines the effectiveness of the treatment process (effective treatment methods for the relevant nosology, quality of medical care, etc.). The reasons for re-hospitalization were studied. The factors resulting in incomplete implementation and rejection of medical recommendations, as well as factors contributing to increased commitment to treatment were analyzed. It was established that three out of four respondents are not committed to therapy, respondents were poorly informed about the normal and their own most important indices of their health. Only one out of five of respondents indicated that they comply with medical recommendations in fullness. The main reasons for commitment to treatment are the factors that are managed by the health care system: detailed information about the disease and prescribed treatment, attention given by the doctor to their patients in accordance with their needs.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1070-1074
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The study of manageability of medical organizations
Korshever N.G., Pomoshnikov S.N.
Abstract
The controllability (the grade of management decision implementation) is one of the integral indices of management efficiency for each company or organization. The purpose of the study is to investigate controllability of medical organizations and to stipulate the directions for its optimization.Material and methods. The anonymous questionnaire survey was carried on involving 92 medical managers selected by such criteria as professional experience, competence and agreement dimensions.The results. The controllability in medical organization management was assessed including differential estimation by medical areas with the following outcomes. Most regularly, the decisions are taken by management staff are associated with treatment and diagnostic process, economic and financial areas. The role of the structure of non-effected decisions (44.3±5.2% - unexpected adverse events, 31.8±4.9 - low-levelled executive discipline, 23.9±4.5 - decision-making defects) was emphasized and such corresponding optimization directions as executive discipline enforcement; professional retraining of decision-makers; retrieval of timely, and complete information for decision-making; reinforced control of decision quality and implementation; improved motivation system for executives; inclusion of executes into decision-making process; increased innovative decision segment; maximally avoided double organizing measures and exclusion for decision documentation of purely mobilizing appeals; the combination of various management styles in the implementation process; the improvement of coordination of organizing mechanisms as well.Discussion. The obtained results significantly contribute to the notion of medical institution controllability, directions and prospects of its optimization.Conclusion. The results of study can be implemented in everyday practice of medical institutions as well as in professional training of health care managers.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1075-1079
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The expertise of medical nurse care as a basis of medical care quality management
Bogush E.A., Dvoynikov S.I.
Abstract
The strategy focused on activating and strengthening human resources, including nurses, is extremely relevant in the modern health care of the Russian Federation. In this regard, the issue of the medical organization performance provides an emphasis on the problem related to the status of medical personnel, which is especially significant in the context of the need to implement new approaches and innovative management techniques. The purpose of study is to develop an expertise system for quality evaluation of nursing care. Three available approaches were applied: structural, procedural and end-point estimation. The structural approach was based on the quality indicators of the professional competence of nurses, their accreditation and certification, as well as personal qualities that determine the level of organizational culture and self-discipline. The procedural approach was based on the assessment of the technological processes carried out by nurses, consistency, timeliness and adequacy of their accomplishment. The result assessment approach was based on evaluation of the degree of compliance of the actual results achieved with the approved normative value.The article presents the elaborated genuine model of quality assessment, which allows to evaluate objectively all areas of the nurse’s professional activities, taking into account the proposed criteria to identify defects that influence the performance efficiency of the nurse; to determine the factors influencing the level of patient satisfaction with medical care, which resulted in the development a quality management system for nursing care, allowing to evaluate the resources, the technological process and the final result of nursing care.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1080-1085
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The system of epidemiological control of hepatitis E and complex of anti-epidemic, hygienic and veterinary sanitary activities in the Belgorod oblast
Polyakov A.D., Khmyrov A.V., Kyuregian K.K., Malinnikova E.Y., Mikhailov M.I.
Abstract
The Hepatitis E (HE) is a viral liver disease that is common on all continents at different rates and very frequently is not symptomatically distinguishable from other viral hepatitis, such as hepatitis A, B and C, as well as from other infectious diseases referred to as “acute jaundice syndrome”. The GE-anthroponosis (in the case of infection caused by genotypes 1 or 2 of hepatitis E virus) or anthropozoonosis (in the case of infection caused by 3 or 4 viruses) is predominantly propagated through fecal-oral transmission. The article presents the general characteristics of VGE, human risk factors and means of prevention. The particular attention is paid to the development of complex of anti-epidemic, hygienic and veterinary sanitary measures in the Belgorod Oblast.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1086-1092
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AUTOVENOUS REVASCULARIZATION OF THE LOWER EXTREMITY ARTERIES IN PATIENTS WITH VARIANT ANATOMY OF THE PERIPHERAL BLOOD FLOW AND THE PROGRESSIVE ATHEROSCLEROTIC PROCESS
Yudin V.A., Vinogradov S.A., Krylov A.A., Gerasimov A.A.
Abstract
Obliterating diseases of the lower extremity arteries occupy a high proportion in the structure of cardiovascular morbidity in the population among the developed countries. The steadily progressing course of obliterating atherosclerosis leads to the critical lower limb ischemia and causes an unfavorable prognosis for preserving the extremity, as well as the patient's life. Nowadays, there are two ways of surgical management of this pathology: endovascular and open reconstructive interventions. The choice of the method is based on a comprehensive keeping of the patient-specific records, including the anatomical characterization of the arterial bed lesions. In case of extended occlusion of the superficial femoral artery, the open reconstructive surgery using a large saphenous vein as a transplant is recommended. This circumstance is confirmed by the autovein patency in the long term compared with a synthetic prosthesis according to the results of randomized clinical trials. Therefore, with the formation of a distal anastomosis below the gap of the knee joint, the patency of the autovein and synthetic prosthesis after 5 years is 71% and 44% respectively. In this article, we represent a clinical case of successful treatment of a patient with progression of atherosclerotic lesions of the infrainguinal segment arteries. A staged revascularization of the femoral-popliteal segment arteries using technique of a reversed vein on both lower extremities after attempts of the conservative treatment and x-ray endovascular intervention was performed. A feature of this case is the creation of a new bifurcation of the popliteal artery during the formation of a distal anastomosis below the fissure of the knee joint under the contitions of a high discharge of the anterior tibial artery.The given clinical case demonstrates the advantages of invasive surgical tactics with the aim of preserving the limb and improving the patient's quality of life.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1093-1097
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The quality of life and accessibility of medical care in persons with bronchial asthma in the Republic of Kazakhstan
Gazalieva M.A., Zhumabekova B.K., Kozhanova R.T., Kasymbekova B.K., Koshkarbaeva B.S., Dedova O.I., Izmailovich M.R., Rahimzhanova G.K., Abdikalikova D.R., Andreeva O.B., Glushkova N.E.
Abstract
The access barriers to asthma basic treatment and medical care in many countries are an urgent problem and emphasize the need for population studies to examine the associated risk factors for barriers to health care, causes of severe exacerbations, disruption of life quality, and the development of preventive measures. The purpose of study was to evaluate the association of quality of life, access to medical care and emergency of severe exacerbation in persons with bronchial asthma in the Republic of Kazakhstan. The cross-sectional study was applied. The sample included 3,572 patients of both genders aged 18-59 years with bronchial asthma, registered in out-patient clinics of the Republic of Kazakhstan. The assessment of frequency of severe exacerbation in patients with asthma, depending on availability of medical care, demonstrated significant differences in groups of minimal, average and maximum decrease (χ2 = 160.66, 2057.06, 166.19, p <0.001). The most of patients in group with severe asthma exacerbations more than 3 times per year had signs of a maximum decrease in access to medical care - 53.5% and 42.11% were classified as a medium-level barrier of access. The indicator of quality of life was significantly lower in group of patients with severe exacerbation of disease more than 3 times per year in groups with severe access barriers as compared to group with similar number of exacerbations where the number of barriers was less than two - 10.85 vs. 15, 28 (t = 3.985, D.f. = 1, p = 0.003). The study permitted to conclude that improving quality and increasing availability of medical care of asthmatic patient is the key to managing course of asthma at stage of diagnosis and during treatment as well.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1098-1101
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The stages of history of national clinic of internal diseases: The Soviet medicine (stage 4)
Borodulin V.I., Banzeliuk E.N.
Abstract
The publication continues the topic of previous article and develops the theme of periodization of clinical internal medicine in Russia for last 200 years. The discussion covers the fourth stage - the Soviet period of internal medicine in 1920s - 1950s that resulted in crisis. The authors, using historical examples, illustrate the need to take into account historical and social processes in studying the development of medicine.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1102-1106
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The organization and activities of the Chief Board of State Health Care in Russia (September 1916 - February 1917)
Egorysheva I.V., Chalova V.V.
Abstract
The article is devoted to the history of the organization in Russia of the Main Department of public health management in Russia - the world's first Ministry of Health that was organized resulting the activities of the Commission headed by the academician G. E. Rein. The article considers aspects of opposing to its organization by the democratic medical community which was concerned about bureaucratization of medical and sanitary activities and which disappeared with liquidation of this institution on the eve of the February Revolution. The role of academician G. E. Rein in the organization of the Main Department, as well as the fate of the activities of his Commission in preparing reforms in the field of health is demonstrated.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27(6):1107-1110
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