Problems of Social Hygiene,
Public Health and History of Medicine

In Russia, the process of clustering institutions at the regional level is evolved. The analysis of scientific publications revealed only several examples of efficiently functioning medical clusters. As a rule, the publications present problems or projects and perspectives of development of medical clusters. At that, no information is available concerning organizational mechanisms integration of institutions.Purpose of the study is to evaluate the results of partnership between institutions of science and practice in resolving strategic health problems related to diseases of blood circulatory system.Materials and methods. The study applied such methods as monographic approach, data derivation, statistical technique, logical and system analysis.Results. The partnership between scientific and educational institutions and practical health care organizations was analyzed on the example of the system of medical care of circulatory system diseases organized in the Kemerovo region. The effective functioning of such a partnership is based on seven integration principles. Thus, the number of treated patients increased by 7.1% from 2011 to 2018. At the same time, the number of beds decreased by 9.2%. As a result, bed turnover increased by 18.1% over this period. The work of X-ray surgery service almost doubled the rate of percutaneous coronary interventions in case of acute coronary syndrome (from 22.0% in 2011 to 42.7% in 2018).The main organizational basics of successful cooperation of institutions are succession and interdependency in work of physians and departments, joint environments of quality management, knowledge management and personnel training, shared management of research and medical activity, common production and information environment, corporate culture and traditions.

The actual conditions of “physician-patient” interaction in hospital department presents high requirements to quality and rate of provided services. The development of conflicts because of misunderstanding of behavior motivation of physician and patient in hospital department determined purpose of actual study. The standardized psychological questionnaire “Big Five” and Myers-Briggs questionnaire were used to obtain needed data. The study results were statistically processed using Student's test. The statistical analysis established in physicians and patients’ reliable difference in indices of “attachment - isolation” (p=0.035), prevalence in physicians of mental processes (p=0.001) and sensuous component in social interaction of patients (p=0.025). The physician of orthopedic department seeks to keep exact logical sequence of actions. The patients fully rely on their feelings in their decision making. The established hypersensitivity of patients and inner strive to move “not according plan” results in disagreements concerning therapeutic strategy and failure in strict applications of all physician recommendations that frequently becomes a cause of uncoordinated actions and conflict situations.

The purpose of the study is to assess medical efficiency of family doctors involved in early detection of glaucoma.Materials and methods. The prospective observation was carried on in polyclinic No.3 (the basis institution of the University Department of family medicine) to provide experimental evidence of role of family physician in medical care of ophthalmic patients.The sampling included 1000 patients visited polyclinic for the first time. In total the cohort was formed from 250 patients of therapist (family physician), 250 patients of neurologist, 250 patients of dentist and 250 patients of other physicians.All patients initially passed Maklakov’s eye tonometry prior to visiting medical specialists. After tonometry, all patients have been observed by ophthalmologist and in the process of treatment also by therapist, neurologist, dentist and other medical specialists.The results. The percentage of patients with intraocular pressure <12, 12-16, 17-21, 22-26, 27-31, l32 mm/Hg in the right and the left eye correspondingly made up to 41.6±1.6 and 42.1±1.6%; 30.0±1.5 and 31.4±1.5; 18.4±1.2 and 16.2±1.2%; 5.6±0.7 and 5.2±0.7%; 2.4±0.5 and 2.9±0.5%; 2.4±0.5 and 2.2±0.5%. It is clear that, at of Among patients, visited polyclinics for the first time, in 10,5±0,97% an increase in intraocular pressure of more than 21 mm / Hg in the right and 10.3 ± 0.96% in the left eye was established.The percentage of patients with visual acuity l6/18; 6/18-6/60; 6/60-3/6 and <3/60 in the right and left eye made up to 72.3±1.4 and 76.7±1.3%; 22.4±1.3 and 18.4±1.2%; 4.4±0.7 and 3.8±0.6% 0.9±0.3 and 1.1±0.3%. The third category of visual impairment (visual acuity <3/60) was established шт small group of patients. The second category of visual impairment (visual acuity 3/60-6/60) was established in relatively larger group of patients.Out of 100 observed patients, visited polyclinic for the first time in 2016, number of undiagnosed diseases and firstly diagnosed due to active participation of family physician included 4.6±0.7 cases of myopia, 3.8±0.6 cases of hyperopia, 2.2±0.5 astigmatism cases, 1.4±0.4 cataract cases, 2.3±0.5 cases of glaucoma, 0.1±0.1 cases of diabetic retinopathy, 4.4±0.7 cases of other eye diseases.Conclusions. The family physician using professional knowledge and skills, can implement diagnostic and therapeutic measures during observation of patients with opthalmologic pathology. The family physician, while observing patients aged 40 years and older, can for the first time diagnose 18.8±1.2 % of eye diseases, including 4.6±0.7 cases of myopia, 3.8±0.6 cases of hyperopia, 2.2±0.5 astigmatism cases, 1.4±0.4 cataract cases, 2.3±0.5 cases of glaucoma, 0.1±0.1 cases of diabetic retinopathy, 4.4±0.7 cases of other eye diseases.

The article elaborates on research tasks determining the vector trends and key risks of actual models of self-preserving behavior of population in Russia on scale of national security level and searching the means of increasing effectiveness of regional demographic policy in area of developing effective self-preserving choices of life-style strategies. The results of sociological survey of the aspects of self-preserving behavior of residents of the central regions of the Russian Federation (the study was carried out on a quota sample, n = 1060) are analyzed. The study made it possible to answer the questions about the importance of health and to assess it identifying the groups of relative and absolute risk. The study provided following results: the importance factors affecting development of self-preserving behavioral patterns and choice trajectories among respondents, as well as motivation for health protection and for refusal to live longer. The most important factors turned out to be personal resources and family upbringing. The most powerful motivation was the desire for well-being, participation in children’s lives and self-fulfillment. The results of the study made it possible to identify self-preserving perimeter of residents of the central part of Russia. Though being aware of and understanding the importance and priority of health, almost half of the respondents waive their responsibility for their own well-being and life expectancy and at the same time displaying a clear distrust of medical institutions. Such a position of non-resource situation foregrounds all the possible risks associated with both loss of health and the failure to maintain it at satisfactory level. The results of study confirm the research hypothesis that the groups of relative and absolute risk correlate with the groups choosing external locus of control over their health. The obtained data is the basis for empirical verification of the indices of self-preserving strategies and the starting point for forecast calculations of possible risks of national demographic policy.

Among HIV-infected patients there are individuals with masked chronic diseases that affect life quality and life-span. Their timely detection and treatment can improve life quality of HIV-infected patients. The screening examination allows to establish prevalence level, structure and features of concomitant diseases under HIV- infection to provide timely medical preventive care.

The demographic and clinical data of 520 patients with infectious endocarditis treated in 2005-2017 was analyzed with the purpose to assess current trends in epidemiology and approaches to surgical correction of infectious endocarditis. The analysis established increasing of absolute number of patients with infectious endocarditis, their average age and number of female patients. The incidence of early prosthetic endocarditis and its hospital mortality decreased. The study determined increasing of number of emergency interventions, more frequent valve-preserving operations, increasing of number of interventions for perivascular lesions and more frequent application of bioprostheses.

The article considers medical and pedagogical prevention of deviant behavior of adolescents from dysfunctional families in conditions of rural school, related to the need of strengthening targeted joint interaction of medical and pedagogical institutions. The description and results of testing of diagnostic tools used to establish severity of deviant behavior of children in a selected group is discussed. The interaction of medical and educational institutions in preventing deviant behavior of adolescents from dysfunctional families in rural school is of key importance for combating prevalence of drug addiction, tobacco smoking, alcohol abuse and psychoactive substances consumption, and contributing to physical and mental health promotion of younger generation, development of healthy lifestyle. The study was organized to cover cognitive, behavioral, affective and value-motivational components. The qualitative characteristics of levels of severity of deviant behavior of adolescents from dysfunctional families were developed and proposed for practice application.

The article considers main indices characterizing development of medical services sector in regional market of the Krasnodar Kray. The statistical and analytical data, results of questionnaire surveys of residents, expertise results are presented. The conclusions are made concerning problems and perspectives of development of regional health care.

The article presents results of study of issues of psychiatric care organization in mental hospital in 2015-2017. The structure, age distribution and social status of patients are analyzed on the basis of data from Psychiatric Hospital № 13 of the Moscow Health Care Department.

The article considers topical aspects of formation of motivational and stimulating component of remuneration in non-state health care institutions. This organizational legal type of medical organization presupposes specific characteristics of financial economic functioning and processes of organization of remuneration fund. In Russia, state and municipal medical organizations provide own sources of motivational component, that much more depend on implementation of mandatory medical insurance territorial programs. In case of non-state clinics quite different sources of employees’ incentives of improving quality and productivity of labor exist. The non-state health care institutions occupy in-between position with their financial opportunities between state (municipal) and private structures. Most non-state health care institutions are of departmental subordination. The article deals with issues of development of motivational and incentive mechanisms as exemplified by JSC “Russian Railways”. The empirical research permitted to specify in detail algorithm of process of organization of remuneration fund with designation of system of indicators for bonuses distribution. The specific characteristics of development of motivational and incentive systems of remuneration fund in non-state health care institutions are identified.

Actually, the opportunity exists to obtain admittance to various data. The article presents the essence of approach to development of decentralized prototype of system managing medical records of patient using blockchain technology. The global analysis of cloud technologies using various experience of their implementation is given. The scientific novelty of study consists in step-by-step application of genuine prototype of patient medical data management system using blockchain technology. It is scientifically justified that applying cloud technologies in medicine permits to improve safety and integrity of medical data of patient and to support linking uncoordinated databases into one whole, making interaction of patients and physicians much more effective and comfortable.

The colorectal cancer is considered as the third most common malignant disease in the world. During last decade, the problem of colorectal cancer became especially urgent conditioned not only by increasing of number of metastatic tumors of colon and rectum, but also by implementation of high-tech methods of treatment that significantly improved the results of five-year survival period. Along with success of therapy, understanding of genomics of colorectal cancer and owing to extensive application of next generation sequencing, the opportunity of optimal choice of treatment options was offered.Methods. The sampling included tumor material of 332 patients diagnosed with colorectal cancer, fixed in formalin and enclosed in paraffin, and treated in oncology dispensaries and centers and in the Kazakh Research Institute of Oncology and Radiology in 2010-2014. After morphological evaluation of the material quality, the molecular genetic analysis was applied to establish mutation of the KRAS gene using polymerase chain reaction in real-time.Results. The study established that KRAS mutation rate in patients with colorectal cancer had no reliable dependency with the region of their residence, since statistical analysis of pair “region of residence - all KRAS mutations” had value of correlation coefficient rp = 0.1 (p = 0.05).Conclusions. colorectal cancer It was established that there is no reliable dependence of rate of KRAS gene mutation in patients with colorectal cancer in the region of their residence. The high rate of occurrence of mutated type of gene was detected in 3 regions (Kyzyl-Orda, North Kazakhstan and Almaty) within the range of 58.3-76.5% of cases. The wild type of KRAS gene was most frequently detected in patients from the Karaganda region (65.5%), South Kazakhstan (71.4%) and Almaty (60.7%).

The article considers the condition of medicine in St. Petersburg in 1827-1828 as presented in memoirs of English physician A. B. Granville about his visiting the capital of Russia. The prominent physician and naturalist, familiar with condition of medicine in main countries of Europe, he provided substantial and objective characteristic of condition of medicine and health care in Russia. This characteristic, coming from independent and competent observer, permits to correct conceptions about condition of Russian medicine during the period when the results of modernization of the Russian Empire of XVIII-early XIX centuries manifested in full measure effecting becoming of Russian school of medicine.

The article considers the features of the impact of epidemics on the course of hostilities and the fate of the states of Antiquity. Three cases are presented as examples. The first one is related to the invasion of the Assyrian King Sennacherib in Judea and the attempt of his troops to take Jerusalem. The second case is related to the epidemic in Athens in the early years of the Peloponnesian war. The third one - with the epidemic in the Roman Empire in the 2nd half of the 2nd century AD. The analysis, based on information from extant sources, permitted to conclude that the intensity and destructive effect of epidemics in the Ancient World increased gradually. To this fact is attributed the effect of “closing” the Oikumena into a single whole. However, the degree of influence of epidemics on the fate of ancient states is greatly exaggerated by the historical tradition, which developed under the influence of emotional descriptions of the tragedies and mass deaths of people.