Problems of Social Hygiene,
Public Health and History of Medicine

The article presents the results of the analysis of indices of morbidity of children and adults in the Kostroma Oblast in 2000-2017. The main trends and changes during analyzed period are established. The high morbidity in such classes of diseases as respiratory diseases, injuries and poisoning, complications of pregnancy, childbirth and postpartum period are determined. The morbidity population in the Kostroma Oblast in the main classes of diseases increased by 14.3% in 2000-2017. The children morbidity in age group 0-14 years remains high.

The positive trend of decreasing mortality of elderly population in all countries of the European Region in 2000-2015 was observed. In the Russian Federation the mortality of elderly population decreased up to 3,798.3 per 100 000 population in the 2018, i.e. on 14% lower as compared with 2012 (4424.6), and on 45% lower as compared with corresponding indices in 1998 (6877.0 per 100 000 population). The purpose of the study is to identify characteristics of mortality and to compare with foreign data of mortality of population older than able-bodied age in the Russian Federation. The standardized indices of mortality in 2012-2018 were analyzed. The gender characteristics of mortality levels were established. The main causes and the structure of main causes of death were presented. The comparison of mortality rates. The contribution of particular age groups into total mortality of population of the Russian Federation over the years was described.

The encoding of cases of disease and death is the translation of clinical diagnoses into alphanumeric code with observance of certain rules. Properly selected ICD-10 codes ensure reliability of statistical data that undoubtedly affects quality of managerial decisions. The article considers results of analysis of information from primary medical documentation (in-patient medical record, discharged patient statistical record) and its comparing with the ICD-10 codes. The detailed analysis of encoding errors is presented. The structure of hospital morbidity and mortality of patients of palliative care department of multidisciplinary hospital is analyzed.

The methodological approaches to total birth rate prognostication based on the study of births order-predicted patterns. The article considers issues of forecasting total birth rate as key indicator characterizing intensity of demographic processes. This problem is also relevant to the Russian Federation, since birth rates are evaluation criteria of social economic situation governing in regions. The lacking of available data in scientific methodological publications describing forecasting methods complicates understanding of demographic processes and reduces management efficiency. The methodology of predicting total birth rate states construction of causal relationships for birth rates differentiated by mother's age and birth order. The forecasting technique involves construction of multiple regression models for dependencies between the births’ distributions for different birth order with the time lag parameters. To determine the delay values, iterative procedure using correlation analysis with data offset in 1-year increments was applied. To determine the time lag, offset corresponding to the maximum reliable correlations between the total birth rates depending on the children’s birth of the current and subsequent order was implemented.The results obtained via correlation and regression analysis as system of equations allowed to predict total birth rate for given sequence of births from previous ones. At the same time, frequency of first births must be set following statistical series of this data. The proposed methodological approach used extrapolation of previous period trend as exponential function. Methodical approaches were tested using actual data on birth rates in a large region of the Russian Federation with a population close to 3 million people. State statistical observation form was used to perform the forecast.The results of forecasting total birth rate revealed period of temporary increase and subsequent decrease of indicator. The forecast of temporary increasing of total fertility rate is based on time lag observed between birth of the first child and subsequent children. The decreasing of studied indicator is based on negative dynamics of first births, but if the process is managed it is likely to stabilize indicator that results in its subsequent increasing.

The article presents the results of studying state and trends of incidence of adult urban population in the city of Moscow by the classes of diseases of the genitourinary system. The purpose of study was to analyze urogenital morbidity of population of metropolis as compared with similar indices of the Central Federal Okrug and the Russian Federation in 2014-2018. The corresponding official statistical data of the Minzdrav of Russia and research publications were studied. It was established that permanent monitoring of dynamics of urological morbidity can be considered as important methodological and informational and analytical base for planning medical care of population, that makes it possible to develop in practice the basis of development and implementation of integrated system of measures of development of community-based and hospital care, which must be taken into account by the administration of medical organizations and health care management at various levels.

In Russia, in recent decades, there were regional gapping in terms of social inequality and high level of morbidity and mortality in comparison with European countries. The high morbidity and mortality of population in the Russian Federation from diseases of circulatory system on one hand, and regional differences in terms of social economic status on the other hand, determined the purpose of the study.In order to evaluate relationship between social economic status of regions of the Russian Federation and incidence rate of myocardial infarction, the analysis was applied to standardized data of adult morbidity in classes of acute myocardial infarction and repeated myocardial infarction. Also was evaluated a number of social economic indices that reflect state and conditions of life of population. The statistical analysis was applied using MS Excel and Statistica 6 software. The critical significance level of null statistical hypothesis was established as p=0.05.When analyzing morbidity of adult population of Russia with acute and repeated myocardial infarction, significant regional differences were established. The seven factors were identified that statistically significantly affect morbidity rate of the adult population with myocardial infarction, which made it possible to divide the regions into four clusters, between which differences in morbidity rate of acute myocardial infarction were revealed. The analysis of morbidity of acute and repeated myocardial infarction established significant regional differences such as in 2017 7.7 times for acute myocardium infarction and 61 times for repeated myocardium infarction. The allocation of regional clusters depending on their social economic status allows to supplement regional and federal projects with risk-oriented technologies with purpose of decreasing morbidity of diseases of circulatory system.

The article presents results of analysis of demographic indices in the Republic of Bashkortostan. The primary data for analysis was acquired from official public statistics. The dynamics of fertility and mortality indices in 1985-2018 is described. The prognostication of indices dynamics up to 2025 was made. The distribution of mortality indices by gender, age, causes of death, place of residence is proposed for 2012, 2015 and 2018. Four periods with increasing or decreasing of fertility and mortality was allocated. The linear correlation made up to r = -0.492, p <0.01, i.e., with decreasing of birth rate increasing in mortality occurred. The assessment of dynamics of mortality in 2015-2018 established that young age groups (15-29 years old) are characterized by significant increasing of mortality in every subsequent age group as compared with previous age group. Between 2012 and 2018, total mortality decreased from 13.2 ‰ to 12.4 ‰. Males and females aged 40-44 and females aged 45-49 and 50-54 had such negative trend as increasing of mortality as compared with 2012 and 2015. The decreasing of indices of overall mortality occurred only among males. In males, mortality rate exceeded mortality rate in females up to 1.33 times in 2012, up to 1.29 times in 2015 and up to 1.23 times in 2018. The mortality rate of rural population is 1.3 times higher than mortality rate of urban population. While mortality rate of able-bodied population is 1.4 times higher. The increasing of mortality occurred due to malignant neoplasms, while the growth rate was more pronounced among rural population as compared with urban population. The mortality of respiratory diseases is more than 2 times higher in rural areas and of diseases of the digestive system is 1.5 times higher among rural population. The established growth trends in mortality among rural population due to respiratory and digestive diseases and decreasing of mortality of diseases of the circulatory system and significant decreasing of such cases as “elder age” can be explained by probability of defects in encoding of causes of death.

To explore the factors potentially related to professional self-assessment of physicians, sociological survey on the basis of sampling of 223 respondents who underwent professional training in 2017 was organized. The physicians with the first qualification category more often assessed themselves as “good” than other respondents (p=0.049). On the contrary, physicians with no qualification category rated their work as “good” less often and as “satisfactory” more often than other respondents (p=0.041 and p=0.010, respectively). The rate of professional self-assessment as “excellent” significantly increased among physicians identifying themselves with highest stratum of society (p=0.00034). Statistically significant differences in age, total duration of service in profession between physicians assessing their work for “excellent”, “good” and “satisfactory” were not detected (p>0.05). The most frequent problems complicating life of physicians and their families were “Fatigue, overwork” (69.06%), “lack of free time” (60.09%), “low income” (44.39%). The reliable relationship between these factors and professional self-assessment was not detected (p>0.05). The relationship between professional self-assessment and availability of qualification category, as well as stratum of society to which they relate themselves, was established.

The decision-making management in health care organizations is one of the basic components of their efficiency. However, there is imbalance between requirements of everyday practice and scientific rationale of process under consideration, in particular lacking of appropriate criteria-diagnostic apparatus causing certain difficulties in decision-making. The purpose of the study was to design automated multi-criteria method of evaluating success of decision-making management in health care organizations. The survey of 62 experts, health care managers, was carried out. 23 criteria for evaluating success of decision-making management in health care organizations have been defined as well as their gradation and significance, integral model options, i.e. the multi-criteria evaluation method has been designed. The automation of method on “1C: Enterprise” software greatly facilitates assessment of not one but a number of health care organizations enabling their ranking. The machine processing results in integral evaluation and informative criteria determining it thus making possible search of case causes and ways of correction. The obtained results can be applied in daily procedures and training of executives of health care organizations.

The qualitative functioning of any medical institution depends on both professional competence of its staff and document management. The contemporary society is moving towards e-document management. The topicality of investigation stems from necessity to give scientific rationale and put into practice modern information systems and electronic technologies in the activities of head nurses. The article considers realization issues of the Decree of the President of the Russian Federation of May 7, 2018 No. 204 “On national goals and strategic objectives of the development of the Russian Federation for the period until 2024”. Among other “national development goals of the Russian Federation for the period until 2024, the Decree sets the goal to ensure the accelerated digital enabling in the economy and social sphere”. Therefore, it is no coincidence that the Federal project “Creating a single digital circuit in health care based on unified state health information system” takes central position in the National Health Care Project.The study used content analysis, expert judgment, sociological and statistical methods. The introduction of the AWP SMS program into professional activities of senior medical nurses allows optimizing documents processing. Its effectiveness was evaluated using mathematical modeling methodology.

The analysis of various needs in medical laboratory services among physicians of the Samara oblast is targeted to further improvement of laboratory service at oblast level. It is established that effectiveness of laboratory service depends on the needs of customer of service sector which are both physicians and patients. Ignoring their needs results in an increasing both of number of unsatisfied customers and level of mistrust individual operators and laboratory service itself. On the contrary, client-centric approach facilitates dialog of all participants of process of providing laboratory services.

The article discusses such issues of current state of staffing in medical sector as availability of health care system specialists, training programs for applicants to medical educational organizations and post-graduate programs for specialists, professional motivation and job prospects for graduates, prospects for development of medical education and training. In addition to professional sphere, modern health care system is also a market for medical services, which, according to expert estimates, is about 10 trillion US dollars per year. The participants in the field of medical services are not only organizations that provide medical care, but also manufacturers of medical equipment and medications. The medical sphere can't to effectively develop isolated from social structure. The staffing in medical field requires, along with professional motivation and job prospects in order to attract specialists in the field of medicine, and provide social support for their retention. The students entering medical university need decent salary after graduation and favorable conditions for further progression in professional field.

The article presents the results of study concerning improving medical care quality in rural areas. The purpose was to investigate the characteristics of medical personnel training in the framework of the “Zemstvo Doctor” program. The activities of the University were analyzed concerning implementation of professional training of medical personnel and including continuing medical education. To achieve this goal, efficiency of educational programs development considering contribution of the “Zemstvo doctor” program implementation was evaluated. The study was carried out in 2013-2019 on the basis of the Medical Institute of Belgorod State National Research University. The structured interview was applied as methodology of collecting primary data. The fact of decreasing of medical profession prestige that occurs against the background of implementation of the state program “Zemstvo Doctor” was established. The overcoming of this situation is necessary to improve medical care quality in rural areas. The focusing on existing regional features of medical care support and taking into account characteristics of health of population are required. In this respect the key factor is the training of rural physicians to employ high-tech technologies, including digital simulation and telecommunications equipment. The relevance of the state program “Zemstvo Doctor” is obvious, but the medical education system has no official instructions concerning the need of correcting educational programs. The efficiency of changes applied to educational programs was determined by subjective assessment of the need and the clinical experience of physicians-lecturers who are involved in resolving scientific and practical problems of health care in rural areas.

The article considers, on the basis of analysis of declassified archival documents, issue of the Soviet government regulating price of penicillin in the second half of the 1940s in conditions of continuing drug shortage. The factors that affected formation of selling and retail prices of antibiotic are considered. Based on the calculation of cost of treatment of a number of nosologies in different age groups and comparing it with the level of income of the population, the conclusion is derived that real availability of antibiotics for population in the USSR was achieved by early 1950s.