Vol 28, No 3 (2020)

Full Issue

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Articles
The complex evaluation of target indices population health in the Central Federal Okrug of the Russian Federation
Khabriev R.U., Schepin V.O., Mirgorodskaya O.V.
Abstract
The article presents the results of analysis of values and dynamics of changes in indicators of fertility rate, expected life expectancy, total and infant mortality, able-bodied mortality, mortality of circulatory system diseases, neoplasms, and road traffic accidents in 18 subjects of the Central Federal Okrug of the Russian Federation in 2015-2018.The results of comparative analysis of factual values of mentioned indicators with values of target indicators approved by the “Health care Development Strategy in the Russian Federation for period up to 2025" (2019) are presented. The necessary scope of correction of existing discrepancies are established. Reducing by 20% indicators of mortality of able-bodied age, circulatory system diseases and road accidents is needed to reach target values in more than half of the subjects of the Okrug for each cause of death.Based on the results of comprehensive ranking of analyzed health indicators, rating position of each subject in the Central Federal Okrug is determined.For the subjects of the Central Federal District, the analysis established significant differences in indicators values, volume of their changes, possibilities of achieving target goals, rating position and inter-territorial gaps.It is demonstrated that differences in extreme values of summing of ranks of the subjects of the Central Federal District increased up to 5.1 times in 2015, up to 5.5 times in 2016, up to 6.0 times in 2017 and up to 6.2 times in 2018 that substantiate marked tendency of increasing territorial differentiation.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):349-354
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The comparative analysis of coefficients of variation of standard regional indices of mortality and causes having and having not accurate criteria of diagnostics
Semenov V.Y., Samorodskaya I.V.
Abstract
The standardized mortality coefficients for different causes have significant variability between regions and depend on many factors. The purpose of study was to investigate interregional variation coefficients of standardized mortality of oncologic diseases as compared with other causes having no explicit diagnosis criteria. The 49 death causes were selected out of 295 causes of the Short nomenclature of the Rosstat. These causes were distributed by 2 groups: neoplasms and causes without explicit diagnostic criteria. The standard mortality indicator was calculated on the basis of the European standard. The significance of differentiations between the groups was estimated using one-factor dispersion analysis by pair comparison and Bonferroni amendment. The level of interregional variation coefficient of the standard mortality indicator from cancer was lower than from other causes with no explicit diagnostic criteria. Even the reasons of death from oncologic diseases which has no explicit criteria have the significantly less marked variation coefficient as compared to other two groups. There were reliable differences of the variation coefficients between the subgroup of oncologic diseases with precise location of tumor and the subgroup of oncologic diseases of other and non-explicit locations. The death causes due to “other diseases” and the death causes due to diseases with no-explicit diagnostic criteria had similarly high level of variation coefficient. The difference of the regional standard mortality indicator of concrete reasons is affected by uncoordinated criteria of diseases diagnostic and the main reason of death determination. The letter of the Minzdrav of Russia concerning the rules of application of notion “senility” as cause of death played certain role also. The different level of morbidity in regions had the influence as well. The harmonization of verification of all the cases of diagnosis, its “depth” and applied criteria is needed for proper analysis of data of death from separate causes is needed.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):355-359
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The public-private partnership in Russian health care: the regional aspect
Kovaleva I.P., Bajenova S.A., Ambaryan A.K.
Abstract
The health care problems are considered in detail both in the program and non-program activities of the sector state regulatory bodies. The public-private partnership, in particular, participation of private clinics in the system of mandatory health insurance can become one of the effective tools to cope with many problems. The article analyzes participation of private clinics in implementing territorial program of mandatory health insurance as exemplified by the Krasnodar Krai. This is to provide guaranteed free medical care by private clinics of municipalities in the Krai. The regional features of public-private partnership in health care are considered in fairly prosperous Russian region that allow to develop positive scenario. Out of the total number of medical organizations, potential participants of the mandatory health insurance system the private clinics were identified. The analysis of participation of private medical organizations in the mandatory medical insurance system was carried out in context of two main classification criteria: geographical location and the type of medical services. According to the study results, the structure of private clinics of the Krasnodar Krai participating in mandatory health insurance program on a territorial basis is determined. The types of medical care that are not carried out by the selected companies, as well as the types of medical services that are in demand by private clinics are established. The list of private clinics participating in territorial mandatory health insurance program with the widest range of services is determined. The matrix of participation of private clinics in mandatory health insurance system was developed on the example of the Krasnodar Krai.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):360-367
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The regional characteristics of road traumatism in the Arkhangelsk oblast
Baranov A.V.
Abstract
The article considers the results of continuous retrospective documentary study of regional characteristics of road traffic injuries with medical consequences on the Federal highway M-8 “Kholmogory” in the Arkhangelsk oblast in 2012 - 2018. The analysis was applied to 906 medical records of patients older than 18years hospitalized with urgent indications after road traffic accident and received in-patient treatment in medical organizations of the Arkhangelsk Oblast located in area of the Federal highway M-8 “Kholmogory”. The significant decreasing of number of accidents with medical consequences recorded in the covered area as well as significant decreasing number of victims and perished with minimal rate in 2018 was established. It is revealed that the largest number of victims of road traffic accidents was recorded in summer - 300 (31.1%) and autumn - 270 (29.8%) of this year. The Saturday and Sunday occurred to be the most dangerous days of the week in this respect. In day periodicity, maximal number of victims was recorded in the evening time (18-24 PM, 35.1%) and the smallest number in the night time (1-6 AM, 14.6%). Among injured individuals, significantly dominated males (p<0,001) and in total sampling young people under the age of 40.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):368-371
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The characteristics of life-style of population of Vladivostok
Malykhina A.I., Gertanova E.Y., Kaerova E.V., Juravskaya N.S., Dyakonova T.M.
Abstract
Over the past 10 years in the Russian Federation, the health of citizens has been steadily deteriorating: the level of natural population decline is increasing, and life expectancy is decreasing. When analyzing the causes of mortality according to the Federal State Statistics Service, it was revealed that most cases are noncommunicable diseases, their determinants are biological, the state of the environment, medical care, conditions and lifestyle of people. The aim of the study is to identify the degree of commitment of the population of the city of Vladivostok to a healthy lifestyle. A socio-hygienic study was carried out, which included a mass survey of residents of Vladivostok by random sampling. Issues related to the impact of conditions and lifestyles on public health have been studied.Results: Analysis of the research data showed that 19% of men and 6% of women (p <0.05) lacked interest in life. A study of the data showed that currently 66% of women and 44% of men use tobacco products (p <0.05), 53% of women and 59% of men use alcohol (p <0.05), which are factors risk of noncommunicable socially significant diseases. The motivation for maintaining a healthy lifestyle of the population can be strengthened through systematic preventive measures to promote and maintain health.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):372-376
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The indices of severity of disability because of malignant neoplasms in individuals of young age in Moscow in 2016-2018
Puzin S.N., Kovrizhnykh Y.A., Zapariy S.N., Filippov V.V., Kovrizhnykh M.V.
Abstract
The article presents the results of analysis of primary and secondary disability due to malignant neoplasms among young people in Moscow in 2016-2018. The study established that in the structure of young patients recognized as disabled for the first time made up the smallest percentage with tendency of increasing the level of primary disability. The study established the predominance of people with disabilities of group II with high level of primary disability. The second position is taken by patients with disabilities of group III with tendency of increasing their specific severity. The number of patients repeatedly recognized as disabled is much higher than patients recognized as disabled for with the first time. The study established prevalence of disabled patients of group III with tendency of increasing level of repeated disability.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):377-379
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About quality of life of individuals disabled because of amputation in the Russian Federation
Grinin V.M., Shestemirova E.I.
Abstract
The article presents characteristics of the factors affecting the quality of life of individuals with amputations of upper and lower limbs. The sources of the study were data of Rosstat, publications of Russian and foreign authors, the Federal Law “On social protection of disabled people in the Russian Federation”, the UN Convention on the rights of disabled people and the State program of the Russian Federation “Accessible environment”. On the basis of study results the actual characteristic of factors of quality of life of disabled amputees in the Russian Federation was presented.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):380-384
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The ethnic and family characteristics of choice between official, folk and additional (alternative) medicine
Tikhonova N.V., Shulmin A.V., Anafyanova T.V., Volkova O.A.
Abstract
The article devoted to consideration of ethnic feature of primary choice of subjects of health preservation by residents of the Republic of Khakassia. It is established that at equal consumption of medical care in out-patient and polyclinic organizations, among the ethnic population of there is higher demand of services of traditional healers, especially representatives of shaman practices. The primary effecting on decision making in choosing health care institutions is provided by folk customs and family traditions received from senior relatives that is especially expressed among the Khakass ethnos.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):385-389
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The dynamics of parameters of reproduction of Shor people - native small nation of the Kemerovo oblast
Doroshilova A.V., Luzina F.A., Palevskaya S.A., Smbatyan S.M.
Abstract
In Russia, in the conditions of ongoing demographic crisis and socioeconomic transformations, the reproduction of population, including indigenous minorities, is the urgent problem. The analysis of dynamics of the age structure and reproductive parameters of women of three generations was carried out in order to determine the characteristics of reproduction of the Shors, the indigenous minority of the Kemerovo Region. The statistical data of population censuses (1970-2015), questionnaire materials, records of household books were used as sources of information. The average indices of the main parameters of reproduction of the Shors were calculated and their comparative analysis was carried out. The analysis of the reproductive characteristics of Shor women: the average age of the onset of menopause and menarche (climacterium is from 46.9±1.95 to 46.5±0.70 years, menarche from 14.5±0.65 to 13.9±0, 21 years old, p>0,05), the duration of the physiological reproductive period and the age of the woman at birth of the first child (22.5±0.42 years, 21.02±0.41 years, p>0,05) in a number of generations varied not statistically significant. There had been tendency of acceleration of rate of of process of puberty in female representatives of the “young” generation. The reproductive-active period reduced in 3 generations by 2 times (from 14.0 to 6.7 years). The age of woman at birth of the last child decreased from 36.5±0.65 to 27.7±1.09 years. The number of live-born infants decreased from 5.8±0.33 to 2.4±0.16 children. In women of all generations, there was high frequency of induced abortions (3.4±0.35 abortions).The negative dynamics of reproduction of the indigenous Shor population was established. The number of the Shors decreased from 14,059 people in 1970 to 10,672 people in 2010. The disproportion in gender ratio increased and absolute and relative volumes of pre-reproductive and reproductive contingents decreased. The Shors are characterized by narrowed mode of reproduction and regressive type of population age structure.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):390-395
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The social hygienic characteristic of patients with osteochondrosis of spine
Motina A.N., Astaschenko Y.A., Masaleva O.I., Tretyakova E.E.
Abstract
The spinal osteochondrosis takes leading role among diseases of the peripheral nervous system, being a serious social problem in many countries. The significant prevalence of this disease among individuals of able-bodied age, high disability rates, large economic losses condition the urgency of this problem, its epidemiological and socio-economic significance. The purpose of study is to analyze the socio-hygienic and clinical features of patients with osteochondrosis in the Kursk Regional Clinical Hospital. The statistical analysis of 250 medical records with diagnosis of osteochondrosis was carried out in the neurological department. The gender and age-specific features of the disease, the frequency of manifestation of osteochondrosis in various parts of the spine, leading syndromes and the nature of patients' labor activity were considered. There are gender differences in patients of the Kursk Regional Hospital with diagnosis of spinal osteochondrosis: females 62.0% and males 38,0%. The most common neurological manifestations of osteochondrosis were found among middle-aged patients (45-54 years). The patients with manifestations of osteochondrosis in the lumbar (65.2%) and cervical (50.8%) parts of the spine are predominated. Among all the syndromes, the pain syndrome was the leading one and was detected in 96.4% of patients. The frequency of disorders of various parts of the spinal column depended on working conditions. Thus, intellectual workers suffered more often from osteochondrosis of the cervical spine, and manual workers - from the lumbar spine. It is necessary to optimize primary and secondary prevention of osteochondrosis, taking into account the age and nature of the patients' labor activity as well as to improve medical care and the rational employment of people suffering from this disease.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):396-399
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The characteristics of health condition of students of medical university
Shestera A.A., Kijunova V.Y., Kiku P.F., Kuzmina T.N., Sturova E.V.
Abstract
One of the priority areas of socio-economic development of Russia is concern about health status of young generation, as young people provide the near future and determine demographic economic and social potential of society. The purpose of the study is to implement comparative assessment of health status of students of Medical University and to identify risk factors of development of chronic non-communicable diseases. The article presents data of sociological survey and medical examination (indicators of systolic blood pressure, diastolic blood pressure, heart rate, capillary blood for glucose and cholesterol). The risk factors were determined by 7 parameters: high blood pressure (systolic and diastolic), tachycardia, hyperglycemia, hypercholesterolemia, smoking, lack of exercise.The comparative evaluation of the average functional and biochemical parameters of medical students made it possible to identify statistically significant increasing of systolic blood pressure and total cholesterol in female students in 2018. The evaluation of the structure of risk factors demonstrated that tachycardia is the most frequently detected functional deviation. It was observed in 61% of boys and 27% of girls in 2015 and of boys and 33% of girls in 2018. The evaluation of state of health and identification of risk factors of development of chronic non-infectious diseases of student youth in the learning process involves differentiated focus on the development of preventive measures to strengthen and maintain health with the formation of healthy lifestyle. The effective solution of this problem is possible with the interaction of health care, system of higher professional education and other interested structures.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):400-404
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The prevention of tobacco smoking and development of skills of healthy life-style in students of professional educational institutions
Lazurenko N.V., Podporinova N.N., Polenova M.E., Kovalchuk O.V., Koroleva K.Y.
Abstract
The purpose of the study is to analyze issues of prevention of smoking among college students and to reveal influence of social environment including influence of healthy lifestyle to development addiction. The study was based on value social model of health. The study covered student survey (n = 495, proportional selection by gender, age, year of study) and standardized interview with youth professionals (n = 21) to analyze in the youth the main motives for smoking, attitudes to healthy lifestyle and preventive social work methods that are implemented in colleges. The comparative analysis of data was carried out in subgroups of smoking and non-smoking students and experts. The results of study demonstrated the unformed negative attitudes to smoking. Among 25% of smoking students and 39% of non-smoking students smoking itself is considered as mean of communication and integration in youth community. Among 45.6% of respondents the exposure to and conformal behavior as reasons for starting smoking were declared. The analysis of results of the study concerning assessing attitude to smoking from the perspective of fashion and social recognition occurred to be unexpected: the number of non-smoking students who assume smoking is fashionable is 17 times higher than the number of smokers who share these beliefs. The comparison of the data permitted to establish possible causes of such a distribution of answers: in everyday life, smokers are faced with various legislative restrictions and social censure, while their non-smoking peers focus on social communicative and recreational effects of this habit.There are particular contradictions in the interpretation by students and youth professionals of causes of smoking. This testifies certain unawareness of professionals about age-related psychological characteristics and emotional conditions of students.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):405-410
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The dynamics of morbidity and mortality of malignant neoplasms of blood system а population of St. Petersburg
Jiguleva L.Y., Cherkasov S.N., Fedyaeva A.V.
Abstract
The morbidity of hematologic malignant neoplasms increases all over the world, while mortality rate decreases slowly that causes significant economic losses in society due to blood system tumors. It also proves relevance of research of morbidity and mortality of these diseases both in the Russian Federation and certain regions. The goal of the research was to analyze dynamics of indicators of primary morbidity and mortality of hematologic malignant neoplasms among residents of St. Petersburg in 1990-2017. the study was based on Federal statistical accounting forms and official state statistics. It was established that in 2017 St. Petersburg took the 2nd place among all territories of the Russian Federation in terms of primary morbidity and mortality of hematologic malignant neoplasms. Morbidity and mortality rates of males was higher than in females. The highest morbidity rates were established in the age group of 70-79 years. The same group also had the highest mortality rates. Over the research period, the incidence rate increased by 78.2%. The maximum increase in the incidence rate was registered for the group of active able-bodied age. The mortality rates decreased by 43.4%. The results of the research demonstrated that the need for oncologic hematological medical care will increase in case that actual tendencies of mobility and mortality continue. It proves that this type of medical care is be made more available to population through its active development. Also, comprehensive disease prevention program must be developed.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):411-415
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The evaluation of level of awareness of student youth of issues of HIV-infection
Artemenkov A.A., Varfolomeeva Z.S., Farber F.M., Shestakov V.Y., Krylova T.V.
Abstract
The article presents the results of study targeted to assessing the level of awareness of students about HIV-infection. On the basis of analysis of publications data, it was established that students of the Russian universities are generally informed about ways of transmission HIV-infection and means and measures of its prevention. It was demonstrated that Russian students are not sufficiently aware of the clinical manifestations of HIV-infection, they do not fully understand the danger of HIV infection as a fatal disease, and often experience phobias against persons living with HIV-infection.The article presented the results of empirical survey of students of the Cherepovets State University (n = 103). The methods of research included statistical analysis, questionnaire, Spirman's rank correlation coefficient. It was established that majority of respondents underestimate the risk of HIV-infection and lack reliable information about prevalence of HIV-infection in the territory of residence. The correlation analysis demonstrated that information about HIV-infection is more significant for students who believe that HIV-infection can concern them. In addition, such students tend to be more tolerant to virus carriers.Along informing students about HIV-infection, it is necessary to train them for responsible behavior in different life situations.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):416-422
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The social hygienic evaluation of condition of system of maternity and childhood care at the regional level
Khodakova O.V., Dudareva V.A.
Abstract
The maternal and child welfare system development is the priority target for state social policy. The strategic objectives of health care are targeted to preserving health of mother and child and are implemented through complex activities of various state institutions of maternity and childhood protection system with predominant focus on medical social and economic efficiency. The purpose of study is sociological hygienic evaluation of actual state of maternity and childhood health protection system at the Trans-Baikal Territory. The study used sanitary-statistical, sociological, structural, organizational, expert methods. The estimation of reliability of difference of dependent samples with qualitative indicators was carried out on the basis of the calculation of the non-parametric Cochran test. According to the results of expert assessment, the most significant problem areas in the system of maternity and childhood health protection at the regional level were identified: material and technical equipment of medical organizations, scarce staffing of medical organizations, lack of legal regulation, inadequate organization of medical care of children within the framework of implementation of procedures of provision of medical care, limited availability of medical care, declarative nature of the order of interdepartmental interaction of medical organizations with state social institutions in the system of maternal and child health protection. The established problem areas have negative impact on medical and demographic indicators, coefficients of health of the population in the region and result in decreasing in medical, social and economic efficiency of health care system. The current situation requires adoption of organizational and managerial decisions by executive authorities.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):423-427
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The social partnership in sphere of health care modernization
Nizova L.M., Kislitsyna I.G.
Abstract
The article considers the role of interdepartmental cooperation in modernization of health sector at the regional level exemplified by Mari El Republic. Based on data of study monitoring, the dynamics of medical and demographic indicators are determined. Over the past five years, life expectancy increased, patient satisfaction with medical care increased. Its accessibility increased in rural areas. The primary health care is provided in 49 outpatient clinics and in 207 paramedic and midwifery centers, that meets the established standards. Against this background, the birth continues decreasing of birth rate and increasing of mortality because of diseases of blood circulation system and neoplasms.In order to more thoroughly study the state of health care and and taking into account requirements of the National Health Care Project, the sociological survey of two categories of respondents (patients and medical staff of the district hospital) was carried out.The indicators of demographic development are restrained by negative alterations in demographic structure of population, its aging and regressivity, decreasing of percentage of women of most active reproductive age and high mortality of men of able-bodied age.The social partnership of interested bodies and organizations involved in the reform and improvement of health care system can reduce severity of the above-mentioned problems. Statistical monitoring of implementation of requirements to accessibility and quality of medical care was carried out. The article presents original scheme of interaction between twelve ministries and departments of the Republic. The proposals of to improve quality and accessibility of medical care, the prestige of medical profession and implementation of healthy lifestyles are proposed.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):428-432
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The development of organization and provision of medical preventive care of patients with chronic dermatitis
Zudin A.B., Chakhoyan L.R.
Abstract
The diseases of skin and subcutaneous tissue, despite the constantly improving methods of their diagnosis and treatment, continue to widespread in the population of the Russian Federation. Consequently, it is relevant to develop evidence-based measures of improving dermatological medical care for the population. The purpose of study is to develop and substantiate proposals for improving specialized medical care of patients with chronic dermatitis in megalopolis. The questionnaire survey of 412 patients with chronic dermatitis, residing in Moscow, and 197 dermatovenerologists from Moscow state medical institutions was carried out. The measures of improving dermatological medical care were proposed. The study identified lacking of adequate provision of therapeutic and preventive medical care of patients with chronic dermatitis and their relatively low medical activity. The article substantiates proposals for improving of organization and provision of dermatological medical care, provided by medical and organizational activities for patients and doctors. To select the optimal strategy for patients with chronic dermatitis, the appropriate algorithm was developed that included four consecutive stages: initial examination of patient; patient records filling in with data of additional laboratory diagnosis; prescription of drug and non-drug therapy; conducting of preventive courses of drug therapy and prescription of SPA-treatment. The results of study inputted into identification of risks associated with provision of specialized medical care in area of Dermatovenerology and medical activity of patients including subsequent development of proposals for their elimination.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):433-437
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The hospital-substituting technologies: condition and strategic tasks of their development
Kalininskaya A.A., Konovalov O.E., Merekina M.D., Shlyafer S.I., Sulkina F.A.
Abstract
The program of state guarantees of free medical care of citizens for 2019 and up to 2020-2021 plans to reduce volume of inpatient medical care through development of hospital-replacing technologies. The economic feasibility of hospital-replacing technologies is in significantly lower cost of medical services in a day hospital as compared with twenty-four hours hospital (UPC). However, the existing legislative framework and the lack of proactive financial mechanisms do not stimulate development of hospital-replacing technologies.The purpose of study is to analyze reporting data and results of SWOT analysis of rating of factors affecting introduction of day hospitals, On the basis of analysis the strategic objectives of development of hospital-replacing technologies are formed.The study applied statistical analysis, direct observation, sociological survey, SWOT analysis. The analysis was applied to data from forms of Federal statistical observation No. 14 and industrial statistical monitoring No. 14 for 2009-2018. Based on results of SWOT analysis, experts were interviewed by the heads of health care authorities and medical organizations regarding development of strategy of medical care of children with disabilities. The expert survey was carried out with health care managers in Moscow, the Moscow oblast, Orenburg, Chelyabinsk, Samara, Ivanovo, Ryazan oblasts and the Republic of North Ossetia-Alania.The analysis established that in 2018 the number of medical care organizations increased up to 6495, including medical institutions providing outpatient medical care (41.4%) and in-patient medical care (58.6 %).The analysis demonstrated that percentage of treated patients in day hospitals out of the total number of hospitalized patients (in hospitals was 29,1% in 2018, while in 2009 this percentage was significantly lower - 15,6%, which indicates the intensification of the use of the bed fund of the UPC, which to some extent is associated with increased development of hospital-replacing technologies.The results of SWOT analysis demonstrated that the strategic objectives of development of hospital-replacing technologies should be targeted to develop financial stability of health care, active position of the heads managers of health care institutions and medical organizations and introduction of innovations if needed.It is necessary to develop modern management methods, rational application of health care resources, implementation of economic incentives in all components of health care system, ensure functioning of the system, including effective contract.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):438-443
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The demand for medical technologies during provision of stomatological care to adult population in polyclinic
Babenko A.I., Kostrubin S.A., Babenko E.A.
Abstract
The high prevalence of dental diseases, increase of population exactingness to availability and quality of dental medical care predetermine the development of relevant management decisions. The purpose of study was to define the priorities of demand of medical technologies in dental polyclinic.The evaluation of importance of the technologies implemented in case of particular dental diseases was given based on analysis of 37.3 thousand visits of adult population to dental polyclinic and implementation of more than 200 thousand dental manipulations. The 13 groups of technologies applied were established. The calculation of the coefficient of relative importance and its integrated evaluation was carried out.It is established that most of implemented technologies in dental polyclinic were targeted to treatment of caries of teeth and other defects of tissues of tooth that made 37.4% of all dental medical care provided and also pulpitis (20.9%), periodontitis and periapiсal pathology (25.1%). The most demanded technologies are treatment of caries, restoration of crown of tooth, all-diagnostic procedures, anesthesia, survey and consultation. The preventive manipulations consisted 69.2% of all important for patient technologies.The established quantitative importance of dental technologies defines perspective of their demand and main positions of dental polyclinic in development of corresponding strategy.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):444-448
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On the issue of standards of organization of hospital psychiatric care
Ter-Israelyan A.Y.
Abstract
In the conditions of reforming psychiatric service in the Russian Federation, the procedure of organizing psychiatric care of patients in hospital, the effectiveness of treatment of patients in psychiatric hospital during 2015-2017 were analyzed. The article presents the results of study of organization of psychiatric care of patients in specialized hospital on the basis of Psychiatric clinical hospital № 13. The analysis covered number of patients treated in hospital by nosological forms; number of patients by gender. The age categories of mental patients and the format of professional status of patients were considered. The main indicators of psychiatric hospital activity were investigated: average duration of stay of patient in hospital, annual bed using, bed turnover, number of bed days. The attention was paid to primary output of patients with disabilities, number of re-hospitalizations and compulsory hospitalization. The analysis of financing of inpatient psychiatric care of treated patients for the study period of time was implemented. The vector of providing psychiatric care to patients at the stage of out-patient and hospital-replacing cases.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):449-453
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The organization of chemical toxicological service and medical examination of persons for condition of alcohol drunkenness, fact of consumption of drug and other psychoactive substances in the Khanty-Mansi Autonomous Okrug-Yugra
Novikov A.P., Gil A.Y., Savchuk S.A., Appolonova S.A., Khalfin R.A.
Abstract
The article presents the analysis of organization of chemical-toxicological service and in the Khanty-Mansi Autonomous Okrug-Yugra. The introduction of three-level system for provision of addiction medical care of population and implementation of the principle of zoning made it possible to organize three-level system of chemical-toxicological service that permitted to achieve equal access to chemical-toxicological and addiction care services in all territories of the region. The investments in chemical-toxicological laboratories, supply of modern equipment, advanced training of laboratory specialists, cooperation with leading research centers and professional communities outside of the region allowed timely and accurately identify psychoactive substances, prompt response in cases of mass poisoning with novel psychoactive substances, and quick introduction of advanced methods of chemical-toxicological examination to the medical organizations of the large industrial northern region of Russia.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):454-458
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The export of medical services as a driver of development of the National system of quality management and safety а medical activities
Grin S.I., Krukova K.K., Ivanov I.V., Matytsyn N.O., Schesyul A.G., Berseneva E.A.
Abstract
The article presents definition of concepts of exporting medical services in foreign and Russian practice. It includes overview of the elements of strategy of developing export of medical services (within the framework of the National project “Health Care”). The article considers the need to develop marketing strategy, information exchange system and conditions ensuring compliance of medical services with high standards of quality and safety of medical activities at the national level. The perspective direction development of the quality and safety system in Russia during implementation of the Federal project “Development of export of medical services” through improving the efficiency of medical organizations and their accreditation is determined.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):459-463
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The organizational clinical system of development of medical care based on electronic personified data of medical services under angina pectoris and myocardium infarction
Abramov A.Y., Kicha D.I., Nazarov A.M., Rukodayny O.V.
Abstract
The article presents the analysis of quality of medical care of patients with coronary heart disease at the phases of the clinic, ambulance and hospital based on the data from electronic personalized records and registry accounts of the territorial mandatory health insurance foundation. The results of implemented analysis and application of principle of inter-agency information interaction, the clinical organizational system of managing quality of outputs of medical care provision to patients with ischemic heart disease has been developed. The developed medical care quality management system based on database of personalized electronic patient records was tested in practice and demonstrated positive results.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):464-470
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The morphometric parameters of projection triangle of visceral cranium and infratemporal fossa under various degree of integrity of upper dentition
Gayvoronsky I.V., Gayvoronskaya M.G., Tcimbalistov A.V., Ponomarev A.A.
Abstract
In order to study the change in the morphometric parameters of projection triangles of the facial skull during tooth loss in adult patient, 185 categorized skulls were studied from the craniological collection of the Museum of the Department of Normal Anatomy of the Military Medical Academy. The skulls belonged to adults aged from 22 to 75 years and were separated into two groups - with complete set of teeth and complete absence of teeth on the upper jaw (100 and 85 skulls respectively). Based on standard points, the following projection triangles were developed: lateral front triangle, anterior maxillary triangle, lateral maxillary triangle, lateral infratemporal triangle. It was established that the morphometric characteristics of the proposed projection triangles of the facial skull and infratemporal fossa reliably change with tooth loss. In this case, only those sides that pass through the points located on the alveolar process of the upper jaw change. It is proved that the sides drawn through the alveolar point and the most lateral and posterior points on the alveolar process are most affected. The selection of the proposed projection triangles and the study of their features depending on the degree of preservation of the upper dentition is important for planning and anatomical justification of surgical access on the structures of the middle zone of the face.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):471-475
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The possibilities of forensic histology under expertise of defects of medical care provision
Galimov A.R., Bogomolova I.N.
Abstract
The article presents systematic analysis of the possibilities of forensic medical histology under examinations of defects of provided medical care and recommendations based on application of mentioned method.The analyzed data related to criminal and civil cases of defects of provided medical care which used conclusion of non-state forensic experts and forensic medicine experts. The following methods of investigation were applied: microscopic, logical-analytical, logical-synthetic, comparative, systematic and analytical.The proposed histological optimal strategy allows to determine the failure of which body functions was became crucial in the event of death and which of several pathological processes played major role in tanatogenesis. This information is indispensable for establishing causal relationships of defects of provided medical care with unfavorable outcomes. The defects of organization of forensic-histological examinations were established. For the first time, the proposed means of increasing informativeness of forensic-histological findings in cases of defects of provided medical care with involvement of non-state forensic experts. The number of concrete scientific and organizational approaches to improve the actual situation was proposed.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):476-479
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The marketing study of medical services market: factors and regional characteristics
Andriyanova A.A., Andriyanova L.S., Kornienko M.V.
Abstract
The article considers the relevance of marketing research in the field of paid medical services. Due to the fact that the market of paid services in Russia has increased significantly, medical management took neighboring position to medical marketing. The article emphasizes that in Russia annually the number of private medical institutions increases. This trend is directly related to to the fact that free medical care is not always able to provide necessary services vital for the patient. In turn, the existing increased competition pushes private medical institutions to actively fight for the client. The statistical data demonstrates that the loss of five customers per day results in losing of up to two million rubles monthly. It id established that due to increasing numbers of private medical institutions an urgent need for new logistics and marketing research of all medical production arises to have more comprehensive picture of the provision of a paid medical care.It is concluded that reaching these marketing and marketing research tasks determine the new special place of marketing technologies. The marketing in the health care system acts as basic system of principles targeted to creating and studying the demand and supply of medical services. In the health care market, the role of the consumer is played by patients whose needs must be met by medical clinics. The marketing in the health care system is the process of developing and providing medical services. The corresponding data and main conclusions related to provision of paid medical services in the Krasnodar region is presented.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):480-485
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On the issue of personnel support of medical organizations in conditions of structural transformation of health care system of the City of Moscow
Aksenova E.I., Kamynina N.N., Khetagurova A.K., Podchernina A.M.
Abstract
The article presents the results of analysis of the number and structure of physicians and specialists with secondary medical education in the Moscow health care system. The results of study demonstrated that in 2019, the support of the population with physicians and specialists with secondary medical education decreased as compared with 2014 from 39.4 to 37.1 and from 74.2 to 55.7 (per 10 thousand people) respectively. The number of occupied medical positions increased from 84.6% in 2014 to 87% in 2019, the staffing rates (for occupied positions of secondary medical personnel) also increased from 84.9% to 87.4 %. It was established that the staffing of individuals, both for physicians and paramedical personnel, increased from 66.8% to 79.8% and from 69.4% to 79.0%, respectively. The concurrency coefficient was 1.1 (for medical positions and positions of secondary medical personnel). The issues related to low staffing levels and high co-employment rates for individual medical positions and positions of secondary medical personnel require further resolution.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):486-490
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The principles of the Soviet medicine: history of establishment
Zatravkin S.N., Vishlenkova E.A.
Abstract
The article reveals the conditions for creation of concept of “the Soviet medicine” and traces the evolution of its principles i.e. the understanding of its key features. The source base was created on extracted their formulations from the program texts of Bolsheviks, journal publications of medical administrators, minutes of meetings of historians of medicine and textbooks on the organization of health care. The study demonstrated how during the hundred years (1918-2018) the semantics of formulations changed quite radically. The explanation is proposed concerning how and why the former meanings were lost and the form of statements sacralized.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):491-498
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The contribution of M. N. Akhutin in field surgery (to the 75th anniversary of Victory in the Great Patriotic war)
Egorysheva I.V., Morozov A.V.
Abstract
The article is devoted to M. N. Akhutin (1899-1848), one of the founders of the Russian military field surgery, lieutenant general of the medical service, professor, corresponding member of the USSR Academy of medical Sciences, chief of the Military medical Academy (1940-1941). M. N. Akhutin, disciple of V. A. Oppel, was active participant in the battles at the lake Hasan and the Khalkhin-Gol river (1838-1939). During the Great Patriotic War, he was the chief surgeon of the Bryansk, 2nd Baltic and 1st Ukrainian fronts. Since 1945 he was deputy chief surgeon of the Soviet Army. He is author of works on military field surgery. He was the first director of the A. V. Vishnevsky institute of surgery and the head of the department of faculty surgery of the I. M. Sechenov 1st Moscow medical Institute.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28(3):499-502
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