Vol 28 (2020): VOL 28, NOS2 (2020)

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Articles
INSTRUMENTS FOR INCREASING LABOR MOTIVATION OF MEDICAL ORGANIZATIONS EMPLOYEES
Aleksandrova O.A., Yarasheva A.V., Alikperova N.V., Vinogradova K.V., Aksenova E.I.
Abstract
The article is devoted to the study of motivation of medical organization employees to work. A competent system of motivation of medical personnel, focused on building long-term goals and development conditions, supporting the organizational climate and increasing the involvement of medical workers in their work, solves most of the problems that any medical organization faces. In addition, the policy of the medical institution, the values of the management itself and a favorable psychological climate are important factors in motivating doctors and nurses. In this regard, the purpose of this study is focused on identifying a group of motivational factors that encourage medical professionals to effectively perform their work duties. On the base of the developed sociological tool - a questionnaire for a mass survey - there were collected and analyzed data on the factors which affect the motivation to work of medical workers. As a result of the conducted research, the most significant motivational triggers were identified, which allow to assess the health of medical workers, as well as to identify problematic points that make it difficult to perform the duties in a high-quality manner. These data formed the basis of the method proposed by the authors, which allows any medical organization to identify a group of system-forming factors of motivation to work, on the basis of which the management of medical institutions has the opportunity to assess the motivation of the personnel for further decision-making in the framework of effective management.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1049-1055
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Moscow population awareness of stroke and educational policy (survey results)
Bogdan I.V., Gurylina M.V., Chistyakova D.P., I S.C., Shamalov N.A.
Abstract
Prevention of strokes and the fight against their consequences require not only the work of the healthcare system, but also the self-preserving behavior of the population, which is largely motivated by competence in this sphere. The study of public awareness on this issue and the development of recommendations on information policy were the main objectives of the study. In October-December 2019 two surveys were conducted in Moscow, the sample of each was 800 people. The study found an increase between the waves in the number of those who think they know the signs of a stroke (up to 65%). Despite the mainly correct answers, this self-evaluation is not always backed-up by real knowledge: e.g. a stroke was sometimes confused with an ischemic heart disease, a heart attack and epilepsy. Less competency is demonstrated by men and people with primary/secondary education, younger respondents. 94% of the respondents will call an ambulance when they see signs of a stroke, 16% will begin to provide assistance on their own, and in general their actions will be correct, although there are a number of misconceptions. Among the main risk factors of a stroke the respondents consider bad habits. The population receives information about signs of a stroke mainly from relatives/friends (25%) and on the Internet (22%). The study found necessity for the right information about strokes. There is a need for some greater presentation of peer-reviewed information materials in the information field.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1056-1061
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The relationship between doctors' points of view and indicators that characterize citizens' access to primary health care in Moscow
Budarin S.S., Nikonov E.L., Elbek I.V.
Abstract
This article presents the results of a study on the relationship between indicators of accessibility of citizens to primary health care (PHC), based on the data of the Unified medical informational analytical system of Moscow (EMIAS) and the results of the survey of physicians of medical institutions of the state healthcare system, providing primary care to adults. The analysis of scientific publications has shown that when assessing the availability and quality of medical care, taking into account public opinion, the main attention is paid to sociological surveys of citizens and less often the opinion of medical personnel who provide medical care to citizens is studied.The analysis of the information from foreign sources has shown that the availability of primary health care is a hot topic in many countries all over the world, including the countries with a high level of GDP per capita.The survey of medical men, which was attended by more than 500 doctors, was conducted in six medical organizations in Moscow that provide primary health care to adults. The questionnaire contained 26 questions, the answers to which reflect the personal opinion of doctors about their attitude to the improvement of their professional skills, satisfaction with working conditions, the organization of PHC and its accessibility to the population, etc. EMIAS The data were used to calculate individual indicators that characterize the population's access to PHC.The results of this scientific study confirmed the existence of a high correlation between the responses of doctors and indicators calculated on the basis of EMIAS data, which indicates the feasibility of using the opinion of medical personnel to make timely and effective management decisions aimed at optimizing organizational processes to ensure public access to medical care.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1062-1067
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WAGES AND ATTITUDES OF MEDICAL SPECIALISTS TO VOCATIONAL QUALIFICATION AND LABOUR MOBILITY
Kolennikova O.A., Toksanbaeva M.S.
Abstract
In the health care sector, due to a long cycle of accumulation of human capital, a change of profession often leads to a disruption of this cycle. Therefore, stable employment in the workplace for medical specialists is preferable and should be accompanied by permanent qualification growth within the framework of the profession. Labour mobility to a large extent contradicts this process. One of its most powerful incentives is dissatisfaction with earnings, and this article presents an analysis of the impact of this dissatisfaction on readiness for vocational and labour mobility, based on a questionnaire survey of doctors and nurses of Moscow health care system. A reference group of specialists with proactive attitude towards vocational and professional growth has been singled out. Its assessments of satisfaction with the size of earnings and with correspondence between earnings and labour contribution showed that the dissatisfaction with the inadequacy of earnings is widely spread. This dissatisfaction relates to both base salary and incentive payments against labour contribution. An increase in base salary and in incentive payments together with a simultaneous increase in the share of incentive payments should be the basis for adjusting the wage system. A more accurate accounting of the workload (which has grown as a result of optimization) in earnings is also relevant for paramedical personnel. Should the authorities fail to do this, the undesirable staff turnover, which is already high, may increase even further.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1068-1074
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Evolution of loss due to event of undetermined intent among the Moscow working-age population in the 2000s
Semyonova V.G., Ivanova A.E., Sabgayda T.P., Zubko A.V., Evdokushkina G.N., Gavrilova N.S., Zaporozhchenko V.G.
Abstract
Accuracy of statistical registration of mortality in Russia, especially in times of crisis, is a pressing and relevant issue; this problem was challenging Moscow in the 2000s: until recently, the capital was a complete outsider in terms of accuracy of statistical registration of mortality. The purpose of the study was to identify peculiar features of evolution and the structure of mortality from an event of undetermined intent among Moscow working-age population in the 2000s against the background of the processes taking place in Russia. The article analyzes mortality from an event of undetermined intent among Moscow population of young and old working age in the 2000s, as well as its nosological aspects in 2011-2018, when certain events of undetermined intent were separated as individual nosological units. A sharp decline in indicators in 1999-2000 and their growth in 2015-2017 have been identified. It is shown that these shifts were due to all leading events of undetermined intent (falls/jumps from a high place, hanging/strangulation/suffocation, medicament, alcohol and drug poisoning as well as specified and unspecified events). As a result, the structure of mortality after 2015 has significantly changed due to a sharp increase in the significance of alcohol, medicament and especially drug poisoning. It should be emphasized that in the 2010s the significance of latent suicide in all age and gender groups of Moscow working-age population is significantly higher than in Russia.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1075-1080
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ORGANIZATION OF MEDICAL CARE FOR ELDERLY PATIENTS UNDER THE CONDITIONS OF THE COVID-19 PANDEMIC
Vasilyev A.O., Sazonova N.A., Shiryaev A.A., Kim Y.A., Zaitsev A.V., Gabdullin A.F., Melnikov V.D., Revazova Z.V., Pushkar D.Y.
Abstract
The first report of the new coronavirus infection (COVID-19) appeared at the end of December 2019 and in March,2020 the World Health Organization announced COVID-19 a pandemic. The steady number of newly detected cases increase predetermined the modernization of the global healthcare system, shifting the paradigm of fighting with the COVID-19 pandemic towards maximum resource conservation. The change in the medical care provision for infectious patient’s approach led first to a gradual decrease, and then to a complete cessation of planned surgical treatment, outpatient examinations, as well as observation of high-risk patients, which primarily include elderly patients. As a result of this, the key objective of this systematic review was to analyze sources of existing practice of providing urological care to patients of the older age group in the context of the COVID-19 pandemic. In accordance with the search for the keywords, the study reflects world and its own experience of MSMSU Urology Department in the treatment of age-related patients in the current epidemiological situation. The analysis showed that infectious complications from the urinary system take a leading position among the common complications inherent in elderly patients with COVID-19. The development of catheter-associated infection, the occurrence of antibiotic-resistant forms of bacteria, asymptomatic bacteriuria are only a small part of the problems clinicians have to face in newly profiled departments.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1081-1086
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Mentoring in medicine: on the way to institutionalization
Nenakhova Y.S., Lokosov E.V.
Abstract
The article discusses the prospects for the institutionalization of mentoring in health care, including difficulties arising along this path and tools to minimize them. The relevance of the study is justified by the increased attention in recent years to the problem of insufficient use of mentoring by the government and the scientific community and plans to legislatively consolidate the possibilities of using this mechanism in medicine. The article is based on the results of a number of field studies conducted in 2019-2020 together with the NIIOZMM DZM team, including a mass questionnaire survey of Moscow medical workers, a series of interviews with experts, a questionnaire survey of experts and a case study of best mentoring practices in all regions of Russia. In 2019, a questionnaire survey was conducted among doctors and nurses (551 respondents) and a series of in-depth structured interviews with the chief doctors of the respective organizations, representatives of medical colleges, universities and institutions of additional professional education (15 interviews). In 2020, an expert survey was conducted (using a specially designed questionnaire) of the chief doctors of medical organizations subordinate to DZM (31 experts), a series of in-depth structured interviews with the head physicians (8 interviews), as well as a case study of the best mentoring practices in all regions of the Russian Federation . The research was aimed at identifying opportunities, limitations, and tools for institutionalizing mentoring in health care. The research results show that, despite a number of limitations - a high burden on medical staff, lack of regulatory support, etc. - nevertheless, it is possible to implement and consolidate an effective mentoring system, including the tools presented in the article.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1087-1093
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IMPROVEMENT OF ORGANIZATIONAL APPROACHES TO REGULAR MEDICAL CHECKUP SERVICE IN THE METROPOLITAN HEALTHCARE SYSTEM
Volkova O.A., Smirnova E.V.
Abstract
An adequate response to the challenges people face in the context of continuing urbanization, increasing life expectancy and, at the same time, falling birth rates, is to maximize the containment of chronic non-communicable diseases (NCDs) by high level of healthcare organization and medical services provided to the patients with such pathologies. Global economic losses caused by NCDs result in disability and early mortality among working population as well as in significant treatment costs increasing with the advancement of the disease. That is why outpatient care for NCD patients which includes behaviour factors monitoring is an urgent task for the world and Russian healthcare.In this regard, the goal of this study is to find organizational solutions to improve regular medical checkup service for NCD patients in the metropolitan healthcare system, relying on the data provided by medical organizations in the form of statistical observations.Thus, the results of correlation analysis have revealed a connection between the increased number of individuals in the second and third health groups and individuals scheduled for a regular medical checkup at the end of the year and its absence between the clinical examination results and the number of firstly diagnosed patients. It is also reported that the number of diseases registered for a regular medical checkup at the end of the reporting period (year) has increased, so patients with polymorbid conditions are supposed to prevail among the others on these days and require a special approach to their management.Taking into account the results obtained, possible ways for optimizing the organizational model of a regular medical checkup are the following: special hours (days) for such patients admission, permanent cooperation of a doctor (local general practitioner, GP, family doctor) and a health worker with a secondary medical education (to deal with organizational issues), etc.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1094-1100
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FEATURES OF THE MANIFESTATION OF REHABILITATIVE ACTIVITY IN PATIENTS WITH PRINCIPAL DISABLING PATHOLOGIES
Morozova E.V., Bonkalo T.I., Bonkalo S.V., Shmeleva S.V.
Abstract
The article presents the results of a psychological study of patients with principal disabling pathologies that form the main structure of disability in the Russian Federation due to malignant neoplasms: diseases of the circulatory system; diseases of the musculoskeletal system and connective tissue; diseases of the endocrine system and metabolic disorders (diabetes mellitus of the first and second types). The article presents the results of studying a sample of patients by various psychological parameters, provides statistical comparisons of psychological characteristics of patients depending on the specifics of their social situation, in which patients either claim to be disabled and are under conditions of medical and social expertise, implying the possibility of changing social status, or patients of the same nosological categories, who do not claim to be disabled and who are rehabilitating on the basis of their own personal and socio-environmental resources outside of the “disabled” status.Psychological techniques are presented, the specificity of emotional and personal parameters is analyzed and characterized, including personality frustration and experience of the significance of the disease in the spheres of life, self-esteem indicators, identification characteristics, strategies that provide rehabilitation adherence, which characterize the activity of patients in the compared groups in many ways. The conceptual position that defines the activity of patients as «rehabilitative» has been substantiated. The results of the study revealed statistically significant differences in psychological indicators in the compared groups of patients rehabilitating outside the “disabled” status and patients claiming to be disabled. The indicators obtained in the study indicate that the personal self-regulation of patients rehabilitating outside the «disabled» status qualitatively differs from the self-regulation of patients claiming disability, in terms of stable self-esteem and belief in the ability to realize life in significant areas of social functioning, in the ability of perspective planning of the future, in active self-realization of social roles, active participation in interpersonal, leisure, professional, household and other spheres, high responsibility for one's health, against the background of stable emotional perception of the current social situation of the disease.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1101-1107
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Quality of accounting of death causes for elderly people
Sabgayda T.P., Edeleva A.N., Tarasov N.A.
Abstract
Programs to increase the life expectancy of old people are becoming increasingly relevant in an aging society. Their adequacy depends on the quality of accounting death causes. Objective: To evaluate the quality of accounting of death causes for population over the working age. For 98 061 deaths of people over working age registered in Moscow dead database, the structure of underline and multiple causes of death were compared. To determine whether information on morbidity of elderly can improve the diagnosis of death causes the structure of death causes was compared with officially registered prevalence and detected prevalence. The last was calculated on the basis of the household survey of health of elderly population in Nizhny Novgorod Region (22 558 people). We find fundamental difference between the structure of causes for officially registered prevalence, detected prevalence and mortality. In the structure of death causes the nervous diseases are in the second place and the proportion of uncertain death causes is 6.7%. The difference in the structure of underline and multiple causes of death is not so great. For people over working age, the coding errors were detected in 9.8% underline death causes. Thus, morbidity statistics cannot provide informational support for diagnosing causes of death in full. To improve the quality of accounting of death causes, it is advisable to introduce the institution of coders and to give them the possibility of verifying death diagnoses in medical organizations where the diagnosis has been established.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1108-1112
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THE PREVALENCE OF SLEEPINESS IN THE POPULATION OF ONE OF THE REGIONS OF RUSSIA
Golenkov A.V., Shmeleva S.V., Bonkalo T.I.
Abstract
The aim of the study was to study excessive daytime sleepiness (EDS) among the residents of Chuvashia. 2161 residents of the republic were interviewed (men - 1007, women - 1154) aged 18 to 70 (average - 36.5 ± 13.8 years old). The Epworth Sleepiness Scale and NoSAS test were used to assess the risk of obstructive sleep apnea syndrome (OSAS). Mathematical and statistical processing included descriptive statistics, one-way analysis of variance and calculation χ2-distribution.EDS was detected in 846 people (39.2%), without any gender difference and their place of residence. The respondents with EDS were older and had a larger body mass index. With age, the number of individuals with EDS rate increased, reaching the maximum in the age group of 61-70 years. EDS was more often observed in respondents with diseases, sleep disturbances, regular alcohol consumption, smokers, as well as snoring, respiratory arrest in sleep, increased blood pressure and/or treatment for it, and tiredness during the day. The probability of OSAS by NoSAS was determined in 295 people (13.7%), in 21.4% of men and 6.9% of women; EDS was present in 45.4% of the respondents with OSAS.The spread of EDS in the population makes it possible to recommend doctors of various specialties to pay attention to this act as well as to the described risk factors in patients as highly probable grounds for qualifying OSAS, its targeted diagnosis and treatment, as well as comorbid pathology.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1113-1117
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History of aminoquinoline preparations: from cinchona bark to chloroquine and hydroxychloroquinon
Tolkushin A.G., Luchinin E.A., Kholovnya-Voloskova M.E., Zavyalov A.A.
Abstract
The article presents a review of the historical facts related to the discovery and introduction of chloroquine and hydroxychloroquine. The history of studying aminoquinoline preparations is associated with the discovery of the antimalarial action of the bark of the quinine tree, the isolation of quinine from other active substances - alkaloids and the determination of their structure. The structural similarity of quinine and one of the first chemically synthesized dyes - methylene blue-was an important factor at the beginning of the synthesis of molecules with antimalarial activity in the 1930s in Germany. Pamaquin (plasmoquin, plasmoсid), quinacrine (quinacrine, Atebrin, Mepacrine), sontoquine (sontochin), chloroquine, primaquine, hydroxychloroquine, and mefloquine (Lariam) were consistently introduced in medical practice. Many of these medications are no longer widely used. However, chloroquine and hydroxychloroquine have not lost their relevance. The scope of their use has been expanded.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1118-1122
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MODERNIZATION OF SOCIAL PROTECTION IN THE RUSSIAN FEDERATION: PROBLEMS AND PROSPECTS OF TELEMEDICINE IN THE PRACTICE OF MEDICAL-SOCIAL EXPERTISE
Mikhailov I.V., Shmeleva S.V., Khalilov M.A., Bonkalo T.I., Tuzov I.N., Lakhtin A.Y.
Abstract
One of the main duties of the Russian Federation is to respect and protect the rights and freedoms of its citizens. In addition, the Russian Federation as a social state the activities of which are designed to provide a decent life and a high level of social protection for all categories of the citizens, without exception, by regulating social, economic and other spheres of society provides social support to all segments of the population, paying special attention to certain categories of citizens which, due to life circumstances or health conditions, need social assistance and special support from the state. The main massif in the category of socially unprotected layers of the population are people with physical disabilities. Comprehensive support for the above category of citizens is carried out, among other things, based on the decision of the medical and social examination. However, the current situation has greatly complicated the on-site examination of disabled people and predetermined the correspondence order as the only possible mechanism for medical and social examination during the coronavirus pandemic. Thus, in fact, conditions close to emergency sent medical and social expertise to the path of telemedicine.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1123-1130
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PREDICTIVE MODEL OF THE PROBABLE CONTRACTION OF PSYCHOSOMATIC DISORDERS AMONG THE EXTREME PROFILE SPECIALISTS, A CASE STUDY OF SPECIALISTS IN UTILIZATION OF RADIOACTIVE SUBSTANCES
Kotovskaya S.V., Boncalo T.I., Bonkalo S.V.
Abstract
The aim of the study is to develop a predictive model of the probable contraction of psychosomatic disorders among specialists in the utilization of radioactive substances. The predictive model was developed in order to prevent occupational diseases and preserve the mental health of specialists.The development of the model was carried out on the basis of the results of empirical research focused on identifying biopsychosocial factors that determine or, on the contrary, block the development of vitality in specialists. The vitality is here understood by us as the ability to manage the internal personal resources in the professional situations of personal stress, thereby ensuring one`s professional health. 179 specialists in the utilization of radioactive substances were examined. The study was carried out using a set of specially selected techniques: Scale «Psychosomatic disorders» by V. V. Boyko, methods for studying psychophysiological status (data on the brain wave activity (EEG); assessment of the functional state of the nervous system based on a simple and complex visual motor reaction; the color test by M. Luscher), individual psychological characteristics (the method of colour metaphors by I. L. Solomin, diagnostics of latent motivation, the Mini-Mult questionnaire, «The dominant type of interpersonal relations» methodology) and social situation of life (the questionnaire by the authors).As a result of the study, there were identified 32 features that have a statistically significant relationship with indicators of psychosomatic disorders (p < 0.001). The identified features were included in multiple logistic regression analysis as independent variables. As a result of further processing of the empirical data, carried out with the help of the method of step-by-step exclusion of variables, a predictive model of the likelihood of psychosomatic disorders in radioactive waste utolozation specialists was constructed, which was based on a subjective assessment of the living standards, the presence of a distrustful-skeptical type in interpersonal relationships and manifestations of paranoia.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1131-1136
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ECONOMIC BURDEN AND CURRENT STATUS OF THE DRUG SUPPLY MANAGEMENT FOR IMMUNE INFLAMMATORY DISEASES (BY EXAMPLE OF ULCERATIVE COLITIS AND CROHN’S DISEASE)
Veselov A.V., Belousova E.A., Bakulin I.G., Uspenskiy Y.P., Dreval R.O., Shkurko T.V., Kashnikov V.N., Fominykh Y.A., Knyazev O.V., Romanov R.I., Skalinskaia M.I., Shipitsyn V.V.
Abstract
Aim: to estimate the quality and availability of medical care for patients with ulcerative colitis (UC) and Crohn’s disease (CD), to assess the impact of the economic burden of these diseases on the healthcare budget of Russia and to systematize the main problems in the organization of medical care and drug supply for patients with inflammatory bowel diseases (IBD).Regional IBD databases (2016-2018), official statistical databases, costs of treatment and results of expert interviews with specialists in IBD were used in the study.The analyzed databases showed 104,668 patients with UC in Russia in 2018 (prevalence rate 71 per 100,000 people) and 66,647 patients with CD (prevalence rate of 45 per 100,000 people). The economic burden including agents for biologic therapy (ABT) for the UC was 39.54 billion rubles a year (495 rubles per capita), and CD - 32.98 billion rubles a year (378 rubles per capita). It requires an additional 9.87 billion rubles annually for UC and 9.20 billion rubles annually for CD patients to provide the complete supply with ABT.The annual burden of IBD is 72.52 billion rubles, which is comparable to the costs of other socially significant diseases, including malignant tumors. It shows the high social and economic value of IBD for the country. The main problems of medical care and drug supply for IBD patients are the mismatch of official statistical data and real IBD prevalence in Russia due to absence of comprehensive register and the insufficient supply with ABT due to limited funding. A federal center for IBD should be founded for better quality of registration, for the precise monitoring and for the active management of personal drug supply.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1137-1145
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Organization integrated approach in treatment patients with aggravated comorbid background and lung abscess complicated by recurrent pulmonary bleeding
Kamynina N.N., Samorodov N.A., Sabanchieva J.K., Shmeleva S.V.
Abstract
The purpose of the demonstration of this clinical case was to show the effectiveness of an integrated approach to treating a patient with bacterial pulmonary destruction complicated by recurrent pulmonary bleeding. A patient with a complicated course of abscessed pneumonia of the left lung against a background of severe concomitant pathology, after a long course of antibacterial therapy for the underlying disease. Upon admission to the hospital the patient standard examination was carried out according to national clinical recommendations, non-specific antibiotic therapy was continued, indications for planned surgical intervention were determined. Against the background of the controlled treatment with broad-spectrum antibiotics for 4,5 months, the patient retained the clinical manifestations of the disease and decay cavity in the left lung, which was an indication for surgical treatment. After short-term preoperative preparation, tracheobronchial catheterization of an abscess of the upper lobe of the left lung was performed. When examining the patient 1,5 months after the operation, his absence of complaints and the closure of decay cavities in the lung were recorded, which is a criterion for effective treatment. The clinical example demonstrates the high effectiveness of the personalized approach to treating patients with a burdened comorbid background and complicated pulmonary destruction, which are threatened both by the development of surgical complications and by the occurrence of postoperative complications when using resection methods of treatment.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1146-1153
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ASSESSMENT OF THE ECONOMIC EFFICIENCY OF THE DRUG SUPPLY STRATEGY FOR PATIENTS WITH HEPATITIS C IN THE CITY OF MOSCOW
Kornilova E.B., Holovnya-Voloskova M.E., Kornilov M.N., Zavyalov A.A.
Abstract
Evaluate the cost-effectiveness of various options for the supply of direct antiviral agents for patients with chronic viral hepatitis C.An analysis of the data of Moscow Department of Health on the drug supply of patients with chronic hepatitis C antiviral drugs at the expense of budgetary funds in Moscow was carried out. The direct medical costs of the urban healthcare system for the use of direct antiviral action drugs for the period from 2017 to 2019 were calculated.For the period from 2017 to 2019, 6,936 patients with chronic hepatitis C received medication with antiviral drugs at the expense of budget funds in Moscow. An increase in the number of patients compared to the base (2017) year was noted by 76%, as well as an increase in the volume of interferon-free antiviral therapy sets against the background of an increase in budget expenditures by 212%. The average level of cost for all sets with direct antiviral drugs amounted to 689,844 rub. The most commonly used set is Dac + Asu. The average cost of this set per patient treated as part of the first-line antiviral therapy was 58,899 rub. cheaper than a set of 3D, and 58,861 rub. more expensive than the Grz/Elb set, while the need for retreatment for the Dac + Asu set was 8.4%, and for the 3D, Grz/Elb and Gle/Pib sets, 0.58%, 0% and 0%, respectively. An even greater excess of the average was recorded for the Sof + Dac, Sof + Sim sets: which naturally entailed the excess of the costs of treating one patient with this distribution of treatment sets and financial resources by 253,236 rub. and 189,173 rub., respectively, which is 1.36 and 1, 27 times the average cost of all prices for antiviral treatment sets. Most often, re-medication was provided to patients who were initially provided with Sof set (33%), followed by Sim + Dac set (18.6%), 8.4% of re-medication cases were registered in patients who received Dac + Asu set as the first line of therapy. Budget costs for the second and subsequent sets of therapy increased by 92,739,115.30 rub.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1154-1161
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PROBLEMS OF HUMAN RESOURCES DEVELOPMENT IN HEALTHCARE
Burdastova Y.V.
Abstract
This article is devoted to current issues of human resources development in healthcare. The article emphasizes that the effectiveness of the healthcare system and the quality of medical care delivery deeply depend on the results of the work of medical workers, which are determined by their knowledge, skills and motivation. Considering the necessity of providing the healthcare sector with highly qualified personnel, as well as replenishing the staff with young specialists, we can say that public health is directly dependent on their competence. In addition, the problem of reducing staff turnover and retaining young specialists in the workplace is important, this problem can be solved by the mentoring system in a medical organization. In the article documents of international organizations and the Russian regulatory framework are analyzed, the data from the author's studies conducted in 2019-2020 are presented. The results of the expert interviews and questionnaires indicate a positive attitude of the respondents to the mentoring system as an instrument for developing human resources in medical organizations. Analyzing the data obtained, the author comes to the conclusion about the need for a competent organization of the mentoring process. This article focuses on the legislative regulation of mentoring, as well as incentive measures for mentors.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1162-1167
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Comparative characteristics of types of medical technologies assessment
Holovnya-Voloskova M.E., Tolkushin A.G., Kornilova E.B., Zavyalov A.A.
Abstract
This article presents the results obtained during the analysis of different types of health technology assessment (HTA). In the world HTA agencies can be organized at the national (federal), regional or local levels; they can have various levels of dependence on public authorities (independent, public, dependent), various sources of financing (state, mixed). The nature of the tasks and the range of powers of the institutions for HTA differ: regulatory, organizational or advisory. They themselves can initiate HTA (proactive), or they can conduct HTA at the suggestion of the applicants and analyze the quality of the HTA reports provided (reactively). HTA can be focused on economic assessment, comparative clinical assessment, as well as balanced, both on economic and comparative clinical assessments. HTA may be conducted on drugs, medical devices, and other medical technologies. The methods for conducting HTA significantly depend on its subject. In terms of the scope of the assessment, it is possible to single out full OMT, mini-OMT and express-OMT, as well as fast-track-OMT, proposed by the HTA agency in the UK. The final users of HTA (administration, suppliers, patients) and its perceptions (instrumental, conceptual, or formal) are specified. The impact of HTA on decision-making is progressively increasing, as the number of medical technologies that should be assessed to maintain budget discipline is increasing. The versatility of HTA indicates its universality and can contribute to the further expansion of its application at various levels of medical care around the world.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1168-1175
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РROBLEMS OF MEDICAL SERVICES EXPORT IN RUSSIA
Aksenova E.I., Petrova G.D., Chernyshev E.V., Yudina N.N.
Abstract
The relevance of the study is due to the fact that the export of medical services as one of the areas of the national project “Healthcare” is determined by the level of involvement of the constituent entities of the Russian Federation in the implementation of this project.The aim of the study is to identify how many medical institutions in Russia need qualified personnel for the export of medical services based on a survey of students in the educational cycle “Export of medical services” and an online survey.The analysis shows that at the moment, in medical institutions both in Moscow and the whole Russian Federation, there is a shortage of qualified managers in this area. 25 students of the educational cycle on the export of medical services were interviewed. 100% of the respondents do not know where to start exporting medical services and want to gain knowledge on promoting medical services in their organization. An online survey of 70 regions of the Russian Federation showed that representatives of medical organizations in 64 regions want to receive knowledge on this program, which is more than 90%, the remaining representatives of 6 regions gave not very specific answers. This is a serious problem hampering medical institutions to occupy their segment in the international market.The results of the study show that 100% of the respondents do not know where to start exporting medical services to a medical organization, they want to gain new knowledge and skills in the learning process in order to form their own project for their medical institution, to organize and promote medical services both for domestic and international market. All 25 respondents (100%) would like to receive new knowledge from specialists in this industry who know this problem from the inside, solving the key tasks step by step.The conditions associated with the COVID-19 epidemic make it possible to recommend medical organizations in Moscow and the constituent entities of the Russian Federation to implement the educational program in a remote format, providing for a regional component and methodological recommendations taking into account regional specifics.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1176-1179
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Recreational potential of medical tourism of Russia
Aksenova E.I., Petrov G.D., Chernyshev E.V., Yudina N.N.
Abstract
Since January 1, 2019, the Russian Federation has entered the global medical tourism market thanks to the approved federal project “Development of the export of medical services”. The level of attractiveness of a country as a global destination for medical tourists is determined by a number of factors: the level of medical technology, transport accessibility, proximity to donor countries of foreign patients; the level of realization of export potential, international reputation, medical marketing; the level of healthcare organization, international staff training, etc. Among the factors determining the success of the country as the destination of medical tourism, a special place is held by the recreational complex, spa treatment. The level of development of the recreational complex within the framework of medical tourism performs several tasks at once: it provides a full cycle of medical assistance to foreign medical tourists - from outpatient admissions and in-patient treatment to rehabilitation and recovery; sanatorium-resort treatment and rehabilitation are considered not only as an integral part of the complex of medical services, but also as an independent promising direction for the export of medical services by domestic health resorts. Also, the fight against the consequences of COVID-19, when hundreds of thousands of neighboring states citizens need qualified rehabilitation, can become a driver for the development of the sanatorium-resort complex of Russia. The purpose of the study is to identify bottlenecks in the development strategy of the recreational potential of the regions of the Russian Federation and make suggestions for its improvement. The number of foreign patients who received medical care from January to May 2020 in the federal districts is 729,000. This indicator was achieved during the pandemic, and therefore does not reflect the true potential of rehabilitation as an element of the full cycle of medical care for foreign patients. The target audience for rehabilitation programs is up to 100,000 foreign patients.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1180-1185
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Evaluation of the export potential of the healthcare system of the Russian Federation on the example of a separate taken region
Chernyshev E.V., Yudina N.N., Melgunova M.S., Petrova G.D.
Abstract
The relevance of the research is due to the fact that the development of medical services exports in the Russian Federation is based on the eponymous Federal project «Development of medical services exports» of the national project «Healthcare». The Federal project is being implemented in the Russian Federation in the period 2019-2024 and is unique for two reasons. Firstly, the project has no analogues in the world: for the first time in one country, 71 regions were involved in a project related to the development of planned medical care for foreign citizens. Secondly, the main role in the project is assigned to medical organizations of state ownership. Due to the fact that the key outstanding issue of the project is to assess the export potential of the health care system of subjects of the Russian Federation, which is a Federal project, the goal of research to assess the export potential of the health care system of the Russian Federation (on the example of Tyumen oblast).A methodology for calculating the economic efficiency of the medical services export program in the region has been developed. As the criteria for evaluating the economic efficiency of testing the concept of developing the export of medical services in the above-mentioned regions, it is proposed to set certain parameters.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1186-1189
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Possibilities of application of modern training methods (project activities) in training health care organizers on the example of a military medical educational organization
Trishkin D.V., Makiev R.G., Sviridova T.B., Khan N.V., Kamynina N.N.
Abstract
The efficiency of health care and the quality of medical care can be improved by implementing modern management methods and technologies. It requires modern and high-quality training of medical management personnel. Qualified personnel are the key factor in the organization and transformation of the health system. Human resources ultimately ensure the efficiency and effectiveness of the entire health sector. Requirements to economic management methods are changing and increasing, and specialists with skills in managing medical organizations at different levels of the healthcare system are becoming in demand. At the level of the constituent entities of the Russian Federation, the role of medical personnel who possess strategic methods of healthcare management is increasing. Available training programs in leading higher educational institutions of medical profile do not fully fulfill these tasks due to limited time, a large volume of lecture material, and frequent changes in the conditions and tasks of health care. These problems can be solved by optimizing training programs for retraining and advanced training of health care organizers, introducing active training methods such as business games, case methods, and project activities into the curriculum. The paper describes the system of training students for training courses in the field of healthcare and public health through planning and implementation, project management in the context of military educational organizations of the Ministry of Defense of the Russian Federation, the statistical analysis of the training effectiveness, the factors that influence the success of development programs.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1190-1194
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Features of psychosomatization of medical PERSONNEL with occupational deformities
Polyakova O.B., Boncalo T.I.
Abstract
The purpose of the study is to identify the characteristics of psychosomatization of medical workers with occupational deformities. Of the 6,830 medical workers surveyed, 816 were selected with severe occupational deformities in order to further determine their psychosomatization characteristics. Used: Maslach Burnout Inventory (MBI), Modification Maslach Burnout Inventory (mod MBI), Mental Burnout Definition Questionnaire (MBDQ), Questionnaire for Identifying Problems and Their Impact on Health (QIPTIH), Psychosomatics of Our Lives (POL), Giessen somatic complaint questionnaire (GSCQ). Mathematical and statistical processing included descriptive statistics, C. Pearson's correlation criterion, and Cheddock's table for determining the tightness (strength) of correlation (weak - <0.3, moderate - 0.3-0.5, noticeable - 0.5-0.7, high - 0.7-0.9, very high - >0.9).Medical workers with a high level of emotional / psycho-emotional exhaustion (57.57) have a higher average level with a tendency to a high level of professional deformations in general (116.36), a higher average level of reduction of personal achievements/reduction of professional motivation (33.67) and an average level of depersonalization/personal distance (20.70) dominates emotional/psycho-emotional exhaustion, which determines a high level of complaints about the activity of the cardiovascular system (heart complaints) (16.93; high connection 0.83) and pressure (intensity) of complaints in general (77.85; high connection 0.67), above average complaints about the activity of the digestive (8.56; marked connection 0.59) and respiratory (8.29; marked connection 0.62) systems, gastric complaints (18.25; marked connection 0.59), the average level of complaints about the activity of the musculoskeletal system (6.04; moderate connection 0.43), complaints on negative skin reactions (5.69; moderate association 0.46), pain in various parts of the body or rheumatismal factor (13.98; moderate bond 0.48). The psychosomatization of medical workers with occupational deformities develops according to the coronary type, which gives reason to recommend medical workers to systematically diagnose, prevent and treat disorders of the cardiovascular system.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1195-1201
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TREATMENT AND DIAGNOSTIC ALGORITHM WITH THE APPLICATION OF MODERN BRONCHOLOGICAL POSSIBILITIES IN THE TREATMENT OF A PATIENT WITH INCREASING RESPIRATORY OBSTRUCTION OF UNKNOWN ETHIOLOGY
Samorodov N.A., Sabanchieva D.H., Shmeleva S.V., Kamynina N.N.
Abstract
More and more often, medical workers have to provide assistance to patients with HIV infection with acute disorders of vital functions who require intensive care and resuscitation. The main task of clinicians is to quickly stop the symptoms of secondary diseases that have led to the complications (specific and nonspecific) so that the patient can start or continue antiviral therapy. The aim of this work was to present the first experience of successfully treatment of a patient with progressive HIV infection using stenting of the main bronchi with their critical tumor stenosis in complex treatment. Conducting temporary endoscopic recanalization of the lumen of the large airways made it possible to avoid transferring the patient to artificial ventilation of the lungs, to carry out the necessary complex of diagnostic and therapeutic procedures, to restore ventilation and aeration of the lungs, which led to an increase in blood oxygenation and some improvement in the patient's general well-being.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1202-1207
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EMOTIONAL EXHAUST AS A FACTOR OF THE ORIGIN AND DEVELOPMENT OF NEUROTIC CONDITIONS OF MEDICAL WORKERS
Boncalo T.I., Polyakova O.B.
Abstract
The purpose of the study is to determine the specifics of neurotization of medical workers with emotional exhaust. Out of 6,830 medical workers surveyed, 1,012 were selected with severe emotional exhaust in order to further determine their specificity of neurotization. Used: Maslach Burnout Inventory questionnaire (MBI), modification of Maslach Burnout Inventory questionnaire (mod MBI), burnout questionnaire (BQ), neurotic level diagnosis technique (NLDT), clinical questionnaire for identifying and evaluating neurotic conditions (CQIENC), symptomatic questionnaire (SQ). Mathematical and statistical processing included descriptive statistics, C. Pearson's correlation criterion, and Cheddock's table for determining the tightness (strength) of correlation (weak - <0.3, moderate - 0.3-0.5, noticeable - 0.5-0.7, high - 0.7-0.9, very high - >0.9).Medical professionals with a higher than average level with a tendency to a high level of emotional exhaust (51.64) and emotional burnout (270.14) are dominated by stress (109.17), experience of traumatic circumstances (28.65), dissatisfaction with oneself (26.05), driving into a cell (29.10), anxiety and depression (25.37), which determine above the average level of anxiety ( 4.35, high connection 0.80), asthenia (4.20, high connection 0.74), anxiety, tension (51.57, high connection 0.76), neurotic disorders (40.28, high 0.74), hypochondriacal disorders (29.04, high connection 0.74), psychasthenic disorders (37.53, 0.76 high connection). The specifics of neurotization of medical workers with emotional exhaust affects, first of all, the emotional-volitional sphere, which gives grounds to recommend medical workers a systematic diagnosis and prevention of emotional exhaust as a component of professional deformations of medical workers.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1208-1214
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RISK FACTORS OF CHRONIC NON-INFECTIOUS DISEASES: ANALYTICAL RESEARCH OF DISPENSANIZATION RESULTS IN THE CITY OF MOSCOW
Kamynina N.N., Mylnikova L.A.
Abstract
The purpose of the study is to determine the relationship between risk factors for the development of chronic non-communicable diseases and first-time preliminary diagnoses during the medical examination of the adult population of Eastern and South - Eastern administrative districts of Moscow.Determine the risk factors that cause the most significant effect for the development of diseases of the endocrine system and eating disorders and metabolic disorders. The analysis of the medical examination data with a comprehensive assessment of the data from industry statistical reports, including the report form N 131, approved by the order of the Ministry of Health of the Russian Federation.It was found out that the risk factors identified during the medical examinations cause the development of chronic non-communicable diseases and the dynamics of indicators for the identified risk factors for obesity and established preliminary diagnoses of obesity from endocrine system diseases, eating disorders and metabolic disorders are equally directed.These percentages of preliminary diagnoses established during the medical examinations can be used for rapid assessment of the quality of the medical examinations and the adoption of cross-sectoral connections and measures aimed at preventing the development of this pathology at the regional level, with a broader implementation of preventive measures to improve public health, including monitoring and measures to reduce the impact of risk factors associated with insufficient physical activity, poor nutrition through the involvement of agencies, responsible for maintaining urban planning and transport policies and requirements for the urban environment, as well as the availability of medical care.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1215-1221
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Problems of implementing the concept of «lean polyclinic» in the practice of functioning of domestic polyclinic institutions
Metelskaya A.V.
Abstract
The article considers the first steps of the Federal priority project «Lean polyclinic», which is taking place in the Russian healthcare system, aimed at organizing a new model of medical care and the problems that stand in the way of implementing a new concept in the practice of functioning of domestic polyclinic institutions.The purpose of the study is to identify the results of a Federal priority healthcare project that started in Russia in 2018 and is aimed at organizing a new model of medical care in Russia.The article notes that the process of organizing «lean production» should not begin with installations launched from above, but with identifying problems and finding optimal solutions in the workplace. To implement the concept of «Lean polyclinic» in the practice of functioning of domestic polyclinic institutions in each Russian polyclinic, it is necessary, first of all, to identify the list of problems that exist directly in this particular polyclinic. The results presented in the article of the study allow us to conclude that the concept of «Lean hospital» aims to find a solution to the main problems arising in the organization of primary health care system and shows the high efficiency of this system with the introduction of medical institutions to optimize the process of medical care.
Problems of Social Hygiene, Public Health and History of Medicine. 2020;28:1222-1226
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