CONTENTS

HEАLTH АND SOCIETY

Kalininskaya A.A., Sul’kina F.A., Bayanova N.A. Analysis of the medical and population processes
and human resources of rural healthcare in Russia (2005 2016)......................................................................5

Smirnova T.L., Bogdanova T.G., Gerasimova L.I., Zhuravleva N.V., Barsukova E.V., Ivanova M.L. Prevalence rate and death rate in different eco-biogeochemical sub-regions of the Chuvash Republic in 2006–2016 ......................................................................................................................... 11 

Rostovtsev V.N., Romanova A.P., Terekhovich T.I., Marchenkova I.B. Minimax mortality constants..............19 

Sadykova T.I., Beybalaeva T.Z. The incidence of schizophrenia in the Republic of Tatarstan in 2005–2016.........24

HEALTH OF ECONOMICALLY ACTIVE POPULATION

Shulaev A.V., Yakupov E.Z., Mardiev A.A. Clinical and social aspects of sleep disorders in drivers
of road transport (review)................................................................................................30

HEALTH PROTECTION OF ELDERLY

Gadgiev R.S., Agalarova L.S., Ragimova R.Sh. Organization of medical care to citizens of elderly
and senile age and its quality in polyclinics of Makhachkala ....................................................34

HEАLTH CАRE SPECIАLIZED SERVICES

Markelova E.N., Perepelkina N.Yu. Organization of medical care for patients with myocardial infarction
and their satisfaction of its quality (case study of the Orenburg region) .......................................41 

Mikailova N.R. Predictors of unfavorable outcomes of coronary artery bypass surgery .............47

Yakupov R.A., Safiullina G.I., Burganov E.R., Asmanov R.F., Safiullina A.A. The results of the imple- mentation of the monitoring system and correction of myofascial disorders in competitive sportsmen............52

Plukhin S.V. History of standardization of the use of chemical studies of biological fluids of the bodies in pathoanatomical practice (a case study of Chuvash Republic) ........................................................................56

QUALITY OF MEDICAL SOCIAL SERVICES OF THE POPULATION

Dantsiger D.G., Kozhevnikov A.A., Andrievsky B.P., Chasovnikov K.V. Independent assessment
of the conditions of the services’ provision by healthcare institutions (organizational and legal
aspects of improvement)...................................................................................................62

Denisenko A.N., Kamaev I.A., Anan’in S.A., Grib M.N., Khlapov A.L. Analysis of life quality of patients
with breast cancer.....................................................................................................67

ANALYSIS OF THE MEDICAL AND POPULATION PROCESSES AND HUMAN RESOURCES OF RURAL HEALTHCARE IN RUSSIA (2005–2016)

Aleftina A. Kalininskaya, MD, Professor, Chief Researcher of medical-social problems’ department of Federal State Budgetary Institution «Central Research Institute of Healthcare Organisation and Automatisation» of Health Ministry of the Russian Federation [127254 Moscow, Dobrolyubov str., 11; ]

Fira A. Sul’kina, Ph.D. Biology, Leading research worker of medical-social problems’ department of Federal State Budgetary Institution «Central Research Institute of Healthcare Organisation and Automatisation» of Health Ministry of the Russian Federation [127254 Moscow, Dobrolyubov str., 11; ]

Natalia A. Bayanova, Ph.D. Medicine, Associate Professor of public health and healthcare sub-faculty No 1 of Federal State Budgetary Educational Institution of High Education «Orenburg State Medical University» of Health Ministry
of the Russian Federation [460000 Orenburg, Sovetskaya str., 6; ]

Abstract. The article analyzes the Federal State Statistics concerning the medical and demographic situation in the Russian Federation in the dynamics for 2005-2016 according to the data of the Federal State Statistics Service. The incidence of rural population in the Russian Federation is analyzed by class of diseases and in comparison with the entire population of the Russian Federation. Performance indicators of healthcare institutions in rural areas are presented; the staff of healthcare institutions located in rural areas is analyzed. The reforms of the personnel policy in the countryside are proposed on the basis of the research results.

Key words: rural population, morbidity, physicians, nurse, general practitioner, healthcare institutions.

PREVALENCE RATE AND DEATH RATE IN DIFFERENT ECO-BIOGEOCHEMICAL SUB-REGIONS OF THE CHUVASH REPUBLIC IN 2006–2016

Tatiana L. Smirnova, Ph.D. Medicine, Associate Professor of obstetrics and gynecology sub-faculty of Federal State Educational Institution of Higher Education «I.N. Ulianov Chuvash State University» [428015 Cheboksary, Moscow avenue 15, tel. 927-845-84-21, ]

Tatiana G. Bogdanova, Ph.D. Medicine, deputy head physician of LLC «Medical Center «Raduzhny» [428000 Cheboksary, Raduzhny str., 12, tel. (8352)-321-345, ]

Ludmila I. Gerasimova, MD, Professor, the head of public health and healthcare sub-faculty of State Autonomous Institution of Additional Professional Education «Physicians’ Continuing Education Institute» of Health Ministry of the Chuvash Republic [428018 Cheboksary, M. Sespel str., 27, tel. 937-373-41-66, ]

Nadezhda V. Zhuravleva, Ph.D. Medicine , Associate Professor of internal diseases sub-faculty of Federal State Educational Institution of Higher Education «I.N. Ulianov Chuvash State University» [428015 Cheboksary, Moscow avenue, 15, tel. 903-358-71-78, ]

Elena V. Barsukova, Ph.D. Medicine, head physician of Budget Institution of Chuvash Republic «Republican Clinical Hospital» of Health Ministry of Chuvash Republic [428000 Cheboksary, Moscow avenue, 9, tel. 927-668-52-51, ] 

Marina L. Ivanova, the head of editorial and publishing department of State Autonomous Institution of Additional Professional Education «Physicians’ Continuing Education Institute» of Health Ministry of the Chuvash Republic [428018 Cheboksary, M. Sespel str., 27, tel. (8352) 62-72-95, ]

Abstract. Very high prevalence rate is found in Cheboksary, Novocheboksarsk and in Yadrinsky, Ibresinsky and Yalchiksky districts according to the cartographic analysis. Very high mortality rate is found in Alatyrsky, Poretsky, Shumerlinsky, Krasnoarmeisky, Alikovsky, Krasnochetaysky, Yadrinsky, Vurnarsky, Mariinsko-Posadsky and Kozlovsky districts. It was found that the unfavorable situation with the highest indicator of total mortality and the lowest indicator of disease detection was identified in Poretsky, Krasnochetaysky, Shumerlinsky, Shemurshinsky and Kanashsky districts during the calculation of index Km/d in 2006–2016. The analytical index of effectiveness of the activities of municipal structures (Kanalysis in 2006–2016) was calculated using the correction index of Kage in 2006–2016. The grouping by the efficiency levels was carried out and the extreme low index of effectiveness was identified in Kanashsky district.

Key words: prevalence rate, mortality, effectiveness of the activities of healthcare institutions, microelements, eco- biogeochemichal sub-regions.

MINIMAX MORTALITY CONSTANTS

Vladimir N. Rostovtsev, MD, Professor, chief researcher of the laboratory of primary health care technologies of State Institution «Republican Scientific and Practical Center of Medical Technologies, Informatization, Administration, Management and Economics of Healthcare» of Health Ministry of the Republic of Belarus [220013 Minsk, Petrus Brovka str., 7А; tel. (37529) 613-93-15; ]

Anna P. Romanova, Ph.D. Medicine, Associate Professor of public health and healthcare sub-faculty of Educational Institution «Belarusian Medical Academy of Postgraduate Education» of Health Ministry of the Republic of Belarus [220013 Minsk, Petrus Brovka str., 3; tel. (37529) 176-76-15; ]

Tatyana I. Terekhovich, Ph.D. Medicine, Associate Professor, head of the laboratory of primary healthcare technologies of State Institution «Republican Scientific and Practical Center of Medical Technologies, Informatization, Administration, Management and Economics of Healthcare» of Health Ministry of the Republic of Belarus [tel. (37544) 799-68-50; ]

Irina B. Marchenkova, Chief researcher of the laboratory of primary healthcare technologies of State Institution «Republican Scientific and Practical Center of Medical Technologies, Informatization, Administration, Management and Economics of Healthcare» of Health Ministry of the Republic of Belarus [tel. (37529) 346-44-37; ]

Abstract. The work objective was the study of common factors of mortality and super-mortality of population using medical statistics of the Republic of Belarus for the period from 1959 to 2015. Methods of statistical data analysis have been applied. A functional linear dependence has been revealed between the minimum and maximum mortality rates in a series of age ranges (over 56 years old). The main regression coefficient turned out to be the characteristic constant of detailed sampling and it is called the minimax mortality constant; its value reflects the average life quality. The use of minimax mortality constants in practice make possible to obtain unbiased estimates of super-mortality. The population life quality’s calculation formula is proposed on the base of unbiased estimate of super-mortality. The application of the study’s results would be beneficial in the field of public health. The healthcare industry can not significantly affect the population life quality and, consequently, super-mortality.

Key words: mortality, super-mortality, life quality, functional spectral-dynamic diagnostics.

THE INCIDENCE OF SCHIZOPHRENIA IN THE REPUBLIC OF TATARSTAN IN 2005–2016

Tamara I. Sadykova, MD, Professor, head of public health, economics and healthcare management sub-faculty of Kazan State Medical Academy – Affiliated Branch of Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Continuous Professional Education» of Health Ministry of the Russian Federation [420012 Kazan, Butlerov str., 36; ]

Tanguel Z. Beybalaeva, Teaching Assistant of psychiatry sub-faculty of Federal State Budgetary Educational Institution of Higher Education «Kazan State Medical University» of Health Ministry of the Russian Federation [420012 Kazan, Volkov str., 80; ]

Abstract. The article presents the analysis of the incidence of schizophrenia of the population of Tatarstan Republic, one of the regions of the Russian Federation. New data on trends in primary morbidity and the prevalence of schizophrenia in 2005–2016 have been obtained in the main age-sex groups of the population of 0–14 years old, 15–17 years old, 18 years old and older, living in urban and rural areas. Intensive and extensive factors, time series indexes, ratios were used in the study; the certainty of the difference of intensive values was calculated using Student’s t-test. The primary incidence of schizophrenia decreased from 15,8±0,65 to 9,3±0,49 per 100 thousand within all population, from 17,3 to 11,6 per 100 thousand within men, from 14,4 to 7,3 per 100 thousand within women over 12 years. The prevalence of schizophrenia among the entire population decreased to 326,6 per 100 thousand in 2016; among 15–17-year-olds people significantly increased: among the urban population from 63,5 to 103,8 per 100 thousand, among the rural population from 16, 9 to 66,2 per 100 thousand. Primary morbidity and prevalence of schizophrenia among men exceed the comparable incidence of the female population in 1,2–1,9 times. These data are important for the planning and organization of specialized psychiatric and medical social assistance to the urban and rural population of the region, the system for the rehabilitation of schizophrenic patients, and their employment.

Key words: schizophrenia, primary morbidity, prevalence, urban population, rural population.

CLINICAL AND SOCIAL ASPECTS OF SLEEP DISORDERS IN DRIVERS OF ROAD TRANSPORT (review)

Alexey V. Shulaev, MD, Professor, head of general hygiene with a course of radiation hygiene sub-faculty of Federal State Budget Educational Institution of Higher Education «Kazan State Medical University» of Health Ministry of Russia [420012 Kazan, Butlerov str., 49; tel. 8 (843) 299-42-34; ]

Eduard Z. Yakupov, MD, Professor, head of neurology, neurosurgery and medical genetics sub-faculty of Federal State Budget Educational Institution of Higher Education «Kazan State Medical University» of Health Ministry of Russia[tel. 8 (843) 216-06-20; ]

Ayrat A. Mardiev, Postgraduate student of neurology, neurosurgery and medical genetics sub-faculty of Federal State Budget Educational Institution of Higher Education «Kazan State Medical University» of Health Ministry of Russia [tel. +7(927)426-46-65; ]

Abstract. Timeliness of road traffic safety is a pressing issue worldwide today. Near 45% of the world’s population experience sleep problems according to domestic and foreign sources. Causes of falling asleep at the wheel can be physiological, social, or due to sleep disorders, in particular, obstructive sleep apnea syndrome. Studies have been conducted to identify obstructive sleep apnea among bus drivers in a number of countries according to foreign sources. Insufficient attention is paid to sleep disorders in the conditions of rapidly developing technologies, constant emotional and mental tension in the rhythm of life of megacities. Special attention has not yet been paid to the problem despite the widespread representation of sleep disorders in the general population. Therefore, the problem of sleep disorders requires complex interdisciplinary research to prevent, diagnose and treat sleep disorders among motor vehicle drivers.

Key words: road traffic safety, sleeping and driving, falling asleep at the wheel, sleep disturbance, obstructive sleep apnea syndrome, insomnia, traffic accidents.

ORGANIZATION OF MEDICAL CARE TO CITIZENS OF ELDERLY AND SENILE AGE AND ITS QUALITY IN POLYCLINICS OF MAKHACHKALA

Rashid S. Gadgiev, MD, Professor, head of public health and healthcare sub-faculty of Federal State Budget Educational Institution of Higher Education «Dagestan State Medical University» [Republic of Dagestan, Makhachkala, Lenin sq., 1]

Louise S. Agalarova, MD, Associate Professor of public health and healthcare sub-faculty of Federal State Budget Educational Institution of Higher Education «Dagestan State Medical University» [tel.8 960-409-45-97; ]

Remida Sh. Ragimova, Teaching assistant of public health and healthcare sub-faculty of Federal State Budget Educational Institution of Higher Education «Dagestan State Medical University»

Abstract. The study for developing the system of measures to improve the quality of medical and social assistance to the elderly was conducted on the basis of polyclinics of Makhachkala in Dagestan Republic in 2016–2017. The level and structure of the incidence of outpatient visits have been analyzed according to the data of medical source records (47 886 cases). The quality of geriatric care has been studied according to the data of the expert evaluation of 805 outpatients’ cards (358 cards from geriatricians, 447 cards from primary care physicians). The first place is given to the diseases of the circulatory system (31%), the second place – to respiratory diseases (24%) and the third place – to the diseases of the musculoskeletal system (8,3%) in the structure of the incidence of outpatient visits of elderly and senile age. It was found that 34,9% of the patients were examined untimely and 27,9% of the patients – in incomplete volume during the visits to geriatricians; and, respectively, 41,4% and 34,5% of patients during the visits to primary care physicians. Treatment of patients by geriatricians was inadequate in 19,3% of cases, by primary care physicians – in 24,3% of cases. Methodical recommendations on improvement of medical and social care to the elderly and senile age persons have been developed on the basis of the study.

Key word: the incidence of outpatient visits, geriatrician, primary care physician, medical and social care, expert evaluation, quality of medical care.

ORGANIZATION OF MEDICAL CARE FOR PATIENTS
WITH MYOCARDIAL INFARCTION AND THEIR SATISFACTION OF ITS QUALITY (case study of the Orenburg region)

Elena N. Markelova, Post-graduate student of public health and healthcare sub-faculty No 2 of Federal State Budget Educational Institution of Higher Education «Orenburg State Medical University» of Health Ministry оf Russia [460000 Orenburg, Sovetskaya str., 36; ]

Natalya Yu. Perepelkina, MD, Professor, chief of public health and healthcare sub-faculty No 2 of Federal State Budget Educational Institution of Higher Education «Orenburg State Medical University» of Health Ministry оf Russia [ ]

Abstract. The article makes the assessment of the organization of medical care for patients with vascular accidents in the Orenburg region. It should be noted that there are regional vascular center, five primary vascular departments and ten inter-municipal medical centers in the region for patients with vascular catastrophes (myocardial infarction, stroke etc.). The article presents the results of the analysis of the activities of the regional vascular center and one of the five primary vascular departments. The article summarizes the results of the analysis of the activities of the regional vascular center and one of the five primary vascular departments. The article presents also the results of sociological study performed among patients with myocardial infarction, which showed high satisfaction with the provision of specialized medical care.

Key words: myocardial infarction, organization of medical care; availability and quality of medical care, regional vascular center, primary vascular unit.

PREDICTORS OF UNFAVORABLE OUTCOMES OF CORONARY ARTERY BYPASS SURGERY

Nigyar R. Mikailova, cardiologist of Central Oil Industry Workers Hospital of Health Ministry of Azerbaijan, Baku [AZ1025 Azerbaijan, Baku. Yusif Safarov str., 17; tel.(994) 050 320-51-00, ]

Abstract. The purpose of the study was the assessment of the frequency of the most common unfavorable outcomes of coronary artery bypass surgery (CABS) and identification of their predictors in municipal occupational medicine clinic. The study was held on basis of the Central Hospital of Oil Workers in Baku, where the CABS have been performed during 15 years. The data about all CABS in 2015–2016 (303 operations) have been examined. The frequency of unfavorable operation results and standard error was calculated according documented cases (per 100 patients). Co-morbidity index was calculated in accordance with Charlson comorbidity index. Assessment of heart operation’s risk (EuroSCORE) was realized taking into consideration recommendations of European Association of Thoracic and Cardiovascular Surgeons in 1998. According to the data of the general characteristics of patients before CABS, attention is drawn to the prevalence among patients with unstable angina (55,1%), at the age of ≤60years, males (83,8%), with three affected coronary arteries (86,5%), with chronic heart failure of functional class I (73,9%), with diastolic dysfunction of the left stomach (56,4%), with the Charlson comorbidity index 5,1 or more points (42,2%) and with an average level of EuroSCORE risk of operation (48,2%), with a violation of myocardial contractility (30,8% – hypokinesis, akinesis of the left ventricle – 28,9%). The hospital mortality after CABS was 4,0±1,1%. The most frequent complications of the CABS were: decrease of hematocrit less than 25% in 48,8% of cases, which caused the use of erythrocyte mass more than 1 time in 84,8% of cases. A significant change of the risk of CABS’ failure is revealed by comparing groups of patients formed by quartering the indicators of their condition before operations. Predictors of high risk of CABS’ failure are: age >60 years; co-morbidity index >3,1; EuroSCORE >2,5; diastolic arterial pressure >80 mm; creatinine content in blood > 1,1 mg/dl, reactive protein> 5,4 mg/dl, leukocy- tes> 8,3x109 / l, ALT> 43 ME, AST> 24 ME, left ventricular ejection fraction <54%, and others echographic indicators.

Key words: coronary artery bypass surgery, predictor, unfavorable outcomes, operation.

THE RESULTS OF THE IMPLEMENTATION OF THE MONITORING SYSTEM AND CORRECTION OF MYOFASCIAL DISORDERS IN COMPETITIVE SPORTSMEN

Radik A.Yakupov, MD, Director of Educational and Scientific Center for Sports Reserve Training Technologies of Federal
State Budget Educational Institution of Higher Education «Volga Region State Academy of Physical Culture, Sport and Tourism» of Ministry of Sport of the Russian Federation [35, Universiade Village str., Kazan, Russian Federation, 420010, tel. +7-843-294-90-53, e-mail: ]

Gulnara I. Safiullina, MD, Professor of neurology sub-faculty of Kazan State Medical Academy – Affiliated Branch of Federal State Budget Educational Institution of Additional Professional Education «Russian Medical Academy of Postgraduate Education» of Health Ministry of Russia [36, Butlerov str., Kazan, Russian Federation, 420012; tel. +7-843-278-97-28; ]

Emil R. Burganov, Head physician of Polyclinic of Kazan State Medical Academy – Affiliated Branch of Federal State Budget Educational Institution of Additional Professional Education «Russian Medical Academy of Postgraduate Education» of Health Ministry of Russia [6, Galeev str., Kazan, Russian Federation, 420061; tel. +7-843-273-46-58; ] Rustam F. Asmanov, doctor in sports medicine of Educational and Scientific Center for Sports Reserve Training Technologies of Federal State Budget Educational Institution of Higher Education «Volga Region State Academy of Physical Culture, Sport and Tourism» of Ministry of Sport of the Russian Federation [tel. +7-843-294-90-55, ]

Aigul A. Safiullina, Postgraduate Student of neurology sub-faculty of Kazan State Medical Academy – Affiliated Branch of Federal State Budget Educational Institution of Additional Professional Education «Russian Medical Academy of Postgraduate Education» of Health Ministry of Russia [tel. +7-843-278-97-28; ]

Abstract. The purpose of the study was the development of monitoring and correcting system of myofascial disorders (MMD) and its implementation into the practice of medical and biological support of competitive sportsmen. 93 athletes (45 women and 48 men) [mean age: 22,1±1,1 years old] representing various sports have been examined. The system consists of regular clinical electro-neurophysiological observation of the health status of the sportsman and preventive correction of MMD in order to exclude their influence on the success of the sport career. It was found that the offered system of monitoring and regular correction using the methods of manual therapy and acupuncture led to the significant decrease of clinical and electro-neurophysiological manifestations at local and generalized forms of MMD. It made possible to support optimal functional readiness of sportsmen, to exclude the development of relevant traumas and diseases of locomotorium during the year-round training cycle. Clinical monitoring and correction of myofascial disorders must be the indispensable element of medical and biological support of competitive sportsmen representing various sports.

Key words: monitoring and correction of myofascial disorders, medical and biological maintenance of sports, manual therapy, acupuncture.

HISTORY OF STANDARDIZATION OF THE USE OF CHEMICAL STUDIES OF BIOLOGICAL FLUIDS OF THE BODIES IN PATHOANATOMICAL PRACTICE (a case study of Chuvash Republic)

Sergey V. Plukhin, Correspondence postgraduate student of public health and healthcare sub-faculty of Federal State Budget Educational Institution of Higher Education «Izhevsk State Medical Academy» of Health Ministry of Russia [426034 Izhevsk, Kommunarov str., 281; tel.(8352)45-33-29, ]

Abstract. The purpose of the study was the identification of the effectiveness of chemical studies of biological fluids (blood and urine) in the formulation of pathoanatomical diagnoses in alcohol-related diseases. Materials and methods used in the study: protocols of autopsies and acts of forensic chemical studies in 2015-2017. Detailed statistics and comparison of the structural elements of clinical and pathoanatomical diagnoses was carried out. Pathologists had the opportunity to investigate biological fluids in all cases of nonviolent death of people who died at home, as well as cases of death of adults who were hospitalized for less than 36 hours after the concatenation of two services. Forensic chemical studies are important in the practice of pathologists in differentiating diagnoses, identifying alcohol-related diseases, followed by correct coding according to the etiological factor and obtaining more accurate medical and statistical information.

Key words: chemical studies, alcohol poisoning, alcohol-associated diseases, pathoanatomical service, bureau of forensic medical examination, mortality, Chuvash Republic, ICD-10.

ANALYSIS OF LIFE QUALITY OF PATIENTS WITH BREAST CANCER

Arkady N. Denisenko, PhD Medicine, head physician of State Budget Healthcare Institution of Nizhny Novgorod Region «Clinical Hospital No 35 of Nizhny Novgorod» [603105 Nizhny Novgorod, Respublikanskaya str., 47; 8(831)428-82-72 ] 

Igor A. Kamaev, MD, Professor, head of social medicine and healthcare organization sub-faculty of Federal State Budget Educational Institution of Higher Education «Privolzhsky Research Medical University» of Health Ministry of the Russian Federation [603005 Nizhny Novgorod, Minin and Pozharsky Square, 10/1; ]

Sergey A. Anan’in, MD, Professor of social medicine and healthcare organization sub-faculty of Federal State Budget Educational Institution of Higher Education «Privolzhsky Research Medical University» of Health Ministry of the Russian Federation [ ]

Maxim N. Grib, PhD Medicine, Associate Professor of social medicine and healthcare organization sub-faculty of Federal State Budget Educational Institution of Higher Education «Privolzhsky Research Medical University» of Health Ministry of the Russian Federation [ ]

Alexander L. Khlapov, PhD Medicine, Associate Professor of economics, management and medical law sub-faculty of Federal State Budget Educational Institution of Higher Education «Privolzhsky Research Medical University» of Health Ministry of the Russian Federation [ ]

Abstract. This article summarizes the data on the analysis of life quality of patients with breast cancer (BC) as the objective indicator, which is based on the subjective perception of the difference between patients’ expectations and its realization. At the same time the life quality of BC patients is an integral indicator which allows to analyze physiological, psychological, emotional and social problems of patients. The final task of the analysis is the promotion of the productive life, including the maintenance of capacity to work.

Key words: healthcare management, life quality, analysis of life quality, cancer incidence, breast cancer.