Vol 32, No 5 (2024)
- Year: 2024
- Articles: 23
- URL: https://journal-nriph.ru/journal/issue/view/69
Abstract
The article considers main problems related to implementation of social protection of persons involved in medical care support during COVID-19 pandemic.
The purpose of the study is to identify organizational legal problems in implementing social protection of persons involved in medical care support during COVID-19.
The normative legal acts of the Russian Federation, the WHO documents, official data of Minzdrav of Russia, information from portals of “Stopcoronavirus.rf”, Constitutional Court of Russia, Inquiry Committee of Russia, office of Public Prosecutor of Russia and Trade Union of medical workers of Russia were analyzed. The study used as its methodology the dialectical method of cognition of social legal phenomena. The logical analysis, system analysis and comparative jurisprudence analysis were applied too.
The analysis of national legislation, court decisions, information from official websites of the President of the Russian Federation, executive authorities (state reports on sanitary epidemiological well-being of population of the Russian Federation in 2020–2023) demonstrated that in 2020–2023 additional social guarantees were provided for workers of medical organizations, including additional social payments.
Unfortunately, complicacy of establishing diagnosis, misinterpretation of clinical norms, lacking of explanations at instant of novels occurrence resulted in emergence of complaints of workers of medical organizations.
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Abstract
This study considers characteristics of attitude of medical workers to the disabled and persons with limited health capacities.The prerequisites of emergence of inclusive health care emergence were analyzed. The significance of documents of the UNO and the WHO considering both protection and conditions of granting human rights and freedoms to the disabled and reserving inclusive health care in society. The role of physicians in practical implementation of this phenomenon in the Russian Federation is determined from medical psychological positions.
It is demonstrated that personality characteristics of the disabled are non-specific regarding their nosology since even the mentally ill disabled can be psychologically healthy. On basis of this assumption the role of physician in inclusive health care is revealed that comes to awareness of one's contribution to medical social psychological support of the disabled and persons with limited health capacities. The physician is to come out as activator of mobilization of medical psychological resources of persons with physical or mental defects. The study considers positions and activities of physician in the process of minimization of aftermaths of health disorder by means of medical psychological recommendations containing determination of “challenge” of one's own inferiority and resulting in leading to its compensation.
The physicians are proposed to be guided by targeting this category of patients to lacking of sparing regimen in their life-style. This proposal means to resolve problem of integration of this category of patients into society (inclusion in fact) by setting tasks that are on verge of their resource capabilities.
The concept of inclusive health care is formulated. Its core is actualization by physicians humanistic professional and civic position towards the disabled and persons with limited health capacities with disabilities and handicapped persons.
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Abstract
For many years, the medications “outside of instruction” (the so-called “off-label” ones) had no single-valued legal status in the Russian Federation and other countries that entailed number of problems. Most of them had to do with schemes and tactics of treatment of patient, impossibility of proper medical care support, legal responsibility of physician for applying medications outside of attached instruction. The important move in resolving mentioned problem became adoption of the Federal Law “On entering changes in the Federal Law “On Fundamentals of Health Care of Citizen in The Russian Federation” that became first step on the path leading to acquisition by “off-label” its legal status. The analysis of relevant normative legal acts, the Criminal code of the Russian Federation was carried out. The basic conclusions related to application of medications in medical institutions in Russia, to physician strategy in cases requiring application of of medications “outside of instruction” were formulated. In case of applying medications “outside of instruction” without informed voluntary agreement of patient, without utmost necessity, single-handed instead of decision of medical commission or in situations which could be managed without this kind of medications i.e. under unfounded risk the physician can be prosecuted since treatment with off-label medications is considered as insecure according to legislative base currently in force.
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Abstract
The article presents results of primary researches of information field of non-profit medical organizations in Russia, carried out from January 01 to December 31 2019 in Yandex search engine and Medialogia media database. The analysis of results of the study with measurements of beginning and end of 2019 was carried out. The results are one of parts of a panel study of image of medical non-profit organizations in Russia and can be used in future by interested structures with purpose of its adjustment.
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Abstract
Nowadays, such digital devices as laptop, tablet, computer, smartphone are an important component of life in all age categories of population that differently affect their health. The article presents analysis of problems of digital behavior of children and youth as related to health. The materials of sociological survey were used to consider mutual effect of recommendations on safe use of digital devices and behavior indicators of health of students.
The purpose of the study is to analyze significance of digital behavior for health based on materials of normative legal documents, results of various studies exemplified by students using digital devices in context of various components of self-preservation behavior.
The normative legal documents regarding digital educational environment and research materials (including the study “Digital transformation in the life of students” carried out by Russian Society of Sociologists in 2023 in 29 cities of Russia (N=8,734) were analyzed.
The study was focused on importance of formation of communication human culture of communication with various types digital devices and advisability to begin this work from children age. The difficulties existing in this area are noted. Among students, almost half of respondents don't follow basic recommendations concerning working with digital devices important for health prevention. The rest of hygiene recommendations are ignored by up to 87% of respondents. The presence of students’ attitudes to healthy lifestyle, physical activity and increased self-estimation of health positively affect those who apply recommendations on communication with digital devices. The role of family and pedagogues as subjects in formation of hygienic culture of using digital devices is currently significant, but yet insufficient.
The increasing of culture of communication with digital devices among youth and more active orientation on positive health indicators can input into health amelioration.
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Abstract
The original methodology developed by authors for personalized registration and distribution of workload of pathologists is implemented into a number of departments of pathological-anatomic service of the Irkutsk Oblast, including pathological-anatomic department of the Oblast State Budget Institution “The Irkutsk Municipal Clinical Hospital № 1”. In order to evaluate efficiency of new methodology comparative analysis of workload volumes performed by pathologists with calculated standard workload was carried out for two periods i.e before application of new methodology and after its implementation. It is established that in 2017–2019 before implementation of new methodology, discrepancy between workload performed by physicians and its calculated value exceeded 40% in some specialists. The implementation of new methodology resulted in significant, up to 10-fold, decreasing of discrepancy between workload practically performed by physicians and its standard value. As a result, actually this discrepancy on average does not exceed 4% in most specialists. The application of the Student's t-test to compare value of discrepancy between workload performed by pathologists for two compared periods also permitted to establish statistical significance of given differences related to majority of physicians (p<0.05) that serves as justification of efficiency and reasonability of new methodology.
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Abstract
Mandatory labeling of medical items plays key role in establishing uniform standards and requirements for all market participants. This promotes increasing of protection of consumer rights, excluding possibility of buying unreliable or counterfeit products. The normative documents regulating labeling of medical items set important requirements to manufacturers, importers and retailers. The unique identifiers, information about origin and other data provided for inclusion in labeling ensure product identification and control of its quality. The article considers normative legal base regulating procedure of mandatory labeling of certain types of medical items from their production and putting into use up to moment of their sale and withdrawal from market turnover. Besides, mechanism of state regulation of procedure of labeling of medical items targeted to increasing of traceability of products, reducing spread of counterfeit goods, ensuring patient safety and improving quality of medical services in general is considered.
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Abstract
The article presents results of quantitative sociological surveys based on original on-line questionnaire that allows to assess professional competence of otorhinolaryngologists in prescribing antibiotics to patients with acute and chronic rhinosinusitis. The professional potential of otorhinolaryngologists within the framework of national security strategy in the field of public health. The pilot approbation was carried out in February-December 2023 by means of quantitative sociological on-line survey of 627 otorhinolaryngologists from 32 subjects of the Russian Federation. The results of sociological survey permit to obtain valuable data to detect problematic aspects of activity of physician.
To standardize survey data processing, automated system of collection and processing of information was developed. The proposed evaluation algorithm was successfully adapted for other profiles of medical care and taken as basis of methodology of studying professional potential of specialists of different profiles.
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Abstract
This article proceeds the topic of the article “The development of regulation of the circulation of medicines in the EU and the USA in 1992–2020.” The history of development of European pharmaceutical legislation in 2001–2020 is considered. The acts of indirect action adopted by EU Parliament at first stage of development of legislation concerning medications failed to fully harmonize normative base of the EU Member States in pharmaceutical market. Since 2000, the EU Parliament and the EU Council adopt laws of direct action — the Regulations. Alongside with the pharmaceutical Code, the Regulations for single segments of pharmaceutical market constituted set of laws related to turn-over of medications. The legislators, at developing EU laws, took into account the US regulatory standards. Despite differences in history, legislative traditions and structure, regulatory systems of the USA and the EU concerning medications turn-over were basically harmonized.
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Abstract
The purpose of the study is to consider social immunity as integral component of social health. It is determined that scientists recognize importance of natural, anthropogenic and social conditions of human residence for preservation and improvement of health. At that, most often life-style, professional activities, nutrition, physical activity and ecology are considered. However, it is noted that no less important for human health, especially for its social component, are influences of social environment, as well as stability and resistance of social subject itself to negative impacts of alien socio-cultural systems.
It is indicated that non-medical influences have daily impact on human social health. They originate from wide spectrum of social institutions that shape everyday life (authorities, family, education, sport, employment, culture). It is established that social immunity is a component of social health. It consists in human ability to recognize and to resist negative impacts coming from alien socio-cultural environment as an attempt of intrusion of alien images, norms, goals, values. The conclusion is made that social immunity acts as component of social health of every individual and thus it serves to ensure demographic security of entire country.
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Abstract
The accessibility of medical care plays important role in ensuring basic human needs and means unimpeded access to all services in national health care system. It is conditioned by: balance of necessary volumes of medical care of population, national medical and financial resources, availability and qualification of medical personnel, rendering of necessary types of medical care in territories, possibility of patient free choice of physician in charge and medical organization, available transport possibilities, level of public education on health promotion and diseases prevention. The availability of radiotherapy, as an integral part of oncological care, is determined by possibility of its timely delivery to all patients and is conditioned by total number of oncological centers equipped with radiotherapy equipment and qualified specialists. In this regard, availability of radiotherapy treatment is gradually introduced into priority state programs of health care modernization. The timely delivery of radiotherapy associated with increasing of numbers of oncology centers, improvement of their equipment and medical personnel staffing is crucial part of development strategy of state oncological care programs.
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Abstract
The article presents social hygienic characteristics of contingent of persons admitted to second stage of rehabilitation in specialized rehabilitation department after ischemic stroke at early recovery period. The attention is focused on necessity of multidisciplinary approach to rehabilitation measures, taking into account the International Classification of Functioning that permits to achieve more significant results in implementation of rehabilitation measures, to reduce the number of possible complications of this disease in later period, as well as to accelerate process of returning of studied category of patients to full-fledged life.
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Abstract
The problems of occupational injuries and morbidity are one of actual directions of scientific actually. According to the International Labor Organization, accidents, cardiovascular, infectious and cancer diseases are of original cause ones. Besides, sectorial characteristics of professional activity affect level of morbidity and mortality. The article reveals difficulties of medical care support of fishermen when performing professional functions in fisheries in regions of the Northern Sea Way in view of critical shortage of medical personnel and lacking of adequate medical equipment. The practical recommendations to resolve mentioned problems are proposed.
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Abstract
The article considers role of high-tech medical care in export of medical services from the Russian Federation. In conditions of globalization and increasing international competition, it acquires special significance since it includes advanced methods of diagnostic and treatment of complex diseases that attract patients from abroad. The economic and social aspects of high-tech medical care export are considered. The statistical data and trends of development of this sector are analyzed. The particular attention is paid to state support and implementation of technological innovations contributing to increasing of competitiveness of Russian medical services at global medical market.
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Abstract
The COVID-19 coronavirus pandemic significantly impacted processes of medical care support and medical personnel and managers. The article presents analysis of results of three-year (2019–2022) studying level of loyalty of legal representatives of patients of one of Moscow children polyclinics. The study covered both legal representatives of patients (more than 190,000 assessments collected over entire observation period) and randomly selected district pediatricians (n=31). It is established that value-intentional consistency of district pediatricians (ratio between individual priorities of medical specialist and his ideas about proper behavior e.g. general medical or corporate values and norms), i.e. degree of interpersonal conflict, significantly affects loyalty of patients to them during uncertainty phase that covered first months of coronavirus pandemic. The physicians with moderate level of consistency between individual priorities and normative ideals demonstrated higher rates of loyalty on part of patients as compared with specialists who had value-intentional inconsistency. It is concluded that in order to increase and maintain this indicator, regular monitoring of social psychological status of medical workers, their material and non-material support and stimulation, development of mentoring system in medical organization and training of medical managers to use social psychological tools for building favorable corporate climate and culture of relations between employees of medical organization and patients are necessary.
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Abstract
The purpose of the study is to assess dynamics of level of common and primary morbidity in class of diseases of ear and mastoid in adult population of the Russian Federation in 2018–2022.
The analysis of morbidity indicators was carried out on the basis of data from statistical collections of Minzdrav of Russia and the Federal State Budget Institution “The Central Research Institute for Health Organization and Informatics of Minzdrav of Russia”.
It is established that in the Russian Federation, level of common and primary morbidity in class of diseases of ear and mastoid in adult population in 2018–2022 was decreasing and reached its lowest values in 2022 (2875.3 and 1760.8 cases per 100,000 of population respectively). The similar trend is observed in all Federal Okrugs of the Russian Federation. The increasing of level of common morbidity is established in 18 Subjects of the Russian Federation, with maximal increase in the Ivanovo Oblast (+17.0%). The increase of level of primary morbidity was noted in 21 Subjects of the Russian Federation, with maximal increase in the Penza Oblast (+35.0%). The most of Subjects of the Russian Federation are characterized by decreasing of both level of common morbidity with maximal decreasing the Republic of Adygei (−48.0%) and primary morbidity of adult population in class of diseases of ear and mastoid with maximal decreasing in the Republic of Tuva (−54.0%) .
The presented trends of indicators of morbidity in class of diseases of ear and mastoid are results of complex and multi-factorial processes. heir identification will permit to develop measures improving otorhinolaryngological care of population.
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Abstract
The vitiligo is a cutaneous pigmentary disease. It is one of the most common skin conditions challenging most dermatologists all over the world. The purpose of the study is to shed a light on available data of this skin lesion regarding its epidemiology, pathogenesis, etiology and genetic causes. Additionally theories and hypotheses related to its occurrence and clinical characteristics of various distinguishable types are considered. The diagnosis and treatment of this skin disorder using different medications and management lines or procedures, particularly recently discovered ones, may positively input into treatment of these skin disorders. The article is based on comprehensive data obtained from such well-known scientific databases as Web of Science, Medline, EMBASE, Pubmed Central, PubMed, Scopus, and Cochrane Library.
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Abstract
The article presents analysis of measures targeted to increasing level of physical activity implemented in various countries. The state programs of prevention of hypodynamia are to be implemented at individual, group and population levels. The efficiency of such state programs in different countries are analyzed. The relationship between level of physical activity and quality and availability of such elements of urban environment as public transport, availability of bicycle paths, proximity of parks and stadiums to places of residence are considered. The further study of this problem is necessary, especially in the long term perspective.
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Abstract
The indicator of provision with medical personnel under primary health care support significantly varies in Subjects of the Russian Federation. This indicator is affected by such territorial characteristics as long distance of territory, poor transport accessibility, low population density, migration processes.
The purpose of the study is to analyze indicators of medical personnel resources in state health care system of the Transbaikal Krai.
The sources of information were data from forms of Federal statistical monitoring № 30 “Information on the medical organization” of the Krai medical organizations in 2018–2022. The span diagram was made for levels of provision with physicians over 5 year period in regions of the Krai. The cluster analysis was applied to classify municipalities according to level and dynamics of indicators of provision with physicians.
It is established that indicators of provision of district therapists and district pediatricians in the Transbaikal Krai remain below similar ones in the Far Eastern Federal Okrug and the Russian Federation. The making of span diagram demonstrated significant difference in indicators of provision with mentioned specialists in municipalities of the Krai over 5 year period that testifies instability of medical personnel situation in districts of the Krai. The maximal indicators of provision in certain regions are conditioned by higher wages and location of medical organizations in the Krai center.
The shortage in medical personnel of primary health care is marked in the Krai. In order to implement tasks of overcoming medical personnel shortage, disproportions in structure of medical personnel, uneven territorial distribution of medical specialists in the Krai it is necessary to improve mechanisms of human resources planning.
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Abstract
In Russia, over the past few years, long-term care system is developing as pilot project. Its main goal is to maintain habitual lifestyle of citizens of retirement age and the disabled who have functional impairments and who need help in household chores, sanitary hygienic procedures performance, medications intake, medical procedures execution and and physician prescriptions following in general. According to approved standard model of long-term care main sources of long-term care services are social security system, health care system, relatives and friends of service addressees. However, full-fledged and systemic implementation of program requires not only definition of these components, but also establishment of mechanism of interaction between them. For this, in most cases, elimination of normative inconsistencies impeding care and consideration of interests of elder citizens and the disabled is required. At the same time, it is necessary to foresee personnel staffing for long-term care, since this area is labor-intensive and is based on people interaction, model of person-to-person care. The problems with personnel staffing in medical and social sphere were present earlier, prior to development of long-term care system and without their elimination it is impossible to implement program in accordance with approved road-map. The training of medical specialists to working with older people, training of junior medical personnel to perform sanitary hygienic and medical procedures, provision with social and medical personnel rural areas are among tasks to be implemented. The article presents evaluation of compliance of components of long-term care system with program tasks, including medical personnel staffing and compliance of standards in force with interests of citizens.
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Abstract
The article presents results of analysis of quality of medical care of population in the Kyrgyz Republic. The calculated index of quality of primary health care organizations and structure of defects at primary level of health care by region are considered. The analysis of examination of quality of medical services at in-patient level demonstrated annual increase of unjustified hospitalizations and detected defects in examination and treatment of patients.
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Abstract
In the history of Russian pharmaceutical market, the year of 1993 became the year of both formation of rules of market relations and alteration of market landscape for changed conditions. The significant segment of state centralized purchases moved under responsibility of regional authorities and their health authorities. At that, authorizations of former three state organizations occupied with import purchases were distributed between new state companies of the Ministry of Health Care and commercial organizations and firms that entered pharmaceutical market. Pretty soon, this diversity gave rise both to competition for budget funds and Government experiments with market regulation. The traces of these clashes and attempts to make market manageable are found in the Ministry of Health Care archives and journal publications.The Report II uses informational potential of medications prices to decode rules of play in Russian pharmaceutical market with purpose to analyze distributions of power at playing table.
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Abstract
The article considers state of nutrition of population of the USSR during post-war recovery period in 1949–1954 after cancellation of standardized distribution of food cards and implementation of currency reform in 1948.The constant annual increase of quantity and quality of ingested food up to end of studied period is demonstrated. The explanations are given to contradictory assessments by various researchers of efficiency of measures implemented by authorities to improve dietary intake of citizens. It is established that characteristic given by authors, in many respects, is determined by time of study, availability of declassified archives, timeserving to dominated in those years of total negative attitude to Stalinism, proclaimed by N. S. Khrushchev. It is emphasized that administrative command method applied in establishing organization of diet of working population, for all its shortcomings, judging by results, allowed people with every following year to buy more food, was at the same time rather effective. The expectations of population related to hope of better life after devastating war, were reinforced annually by decreasing of prices of consumer goods and increasing of incomes of majority of population, having fair character. The people bringing maximal benefit to society — researchers, physicians, teachers — had more opportunities to consume balanced food. At the same time, even low-paid workers could afford oneself to buy high-calorie products. Despite constant improvement of nutrition structure, content of macro- and micro-nutrients in food did not meet requirements for saturating organism with full-fledged ingredients (proteins, carbohydrates, fats, vitamins). It is proved that Soviet model of development as exemplified by its implementation in sphere of nutrition of population was accepted by society in 1940s-1950s and requires further investigation and pondering to applied best Soviet practices nowadays.
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