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2020г. №3 Print E-mail

C O NTE NTS

PROTECTION OF MATERNITY AND CHILDHOOD

Zargarova A. E., Karimova D. Yu. The main medical and social factors affecting the reproductive
behavior of adolescent girls in large city conditions (bases on Moscow example) ............................................5

HEALTH OF ECONOMICALLY ACTIVE POPULAR

Akhmetzyanova E. F.Garipova R. V.Berkheeva Z. M.Safina K. R.Yusupova N. Z. Analysis
of the occupational morbidity state and the tasks of the occupational pathology service
in the Republic of Tatarstan ................................................................................................................................9

HEАLTH CАRE SPECIАLIZED SERVICES

Konstantinova P. I. Assessment of the availability of specialized ophthalmologic medical care
for patients with corneal diseases.....................................................................................................................16

Lomakov S. Yu., Chernobrovkina A. E. Health care needs for radiation research methods
in diagnostics of oncology diseases (bases on St. Petersburg example).........................................................
22

INFORMATION SUPPORT OF HEALTH CARE

Bakirova E. A., Berseneva E. A., Kitaeva E. A., Doronina L. A. Modern expert and information
technologies on guard of rural population health..............................................................................................27

Gadzhiev R. S., Agalarova L. S., Omarova O. A. Awareness of outpatient organizations heads
in medical prevention matters (according to a survey) .....................................................................................32

ORGANIZATION AND IMPROVEMENT OF PROTECTION SYSTEM MANAGEMENT OF PUBLIC HEALTH

Khayrullin I. I., Gabitova S. E. The actions of the medical organization in the mass admission
of patients (Literature review and practical experience) ...................................................................................38

QUALITY OF MEDICAL-SOCIAL SERVICES OF THE POPULATION
Kharisov A. M., Shkitin S. O., Beresnikov A. V., Berseneva E. A., Lebedeva A. M.Efimov M. D.

Methodology of medical care quality expertise for arterial hypertension .........................................................48 

IN MEMORY OF EDWARD JAMES BURGER (1933–2020). Ziganshina L. E.,Titarenko A. F. ........................57


THE MAIN MEDICAL AND SOCIAL FACTORS AFFECTING THE REPRODUCTIVE BEHAVIOR OF ADOLESCENT GIRLS IN LARGE CITY CONDITIONS
(bases on Moscow example)

Ayten E. Zargarova, methodist physician of FSBI National Medical Research Center of Preventive Medicine of the Ministry of Health of Russia [101000 Moscow, Petroverigsky lane, 10, p. 3; e-mail: ]
Dania Yu. Karimova, Doctor of Medical Sciences, Full Professor of the Department of Public Health and Health Care of Biomedical University of Innovations and Continuous Development FSBI SRC A.I. Burnazyan Federal Medical Biophysical Center FMBA of Russia [123182 Moscow, Zhivopisnaya str., 46; e-mail: ]

Abstract. The results of the study of reproductive attittude of 468 adolescent girls in large city conditions, the analysis of the socio-hygienic characteristics of adolescents and their families with the identification of significant imperative in shaping their reproductive behavior were presented. The material was processed using the methods of classical variational statistics, using the χfitting criterion, the F-criterion, and Chi-squared test. It has been established that neither the social status of the parental family (r = -0,08), nor the rate of its parenthood status (r = 0,005), do not affect the formation of the desired number of children in adolescents. The main role in this process belongs to the social norm of parenthood status, which is accepted in society (r = 0,6). It is necessary to pursue a purposeful formation of reproductive attitude among the younger generation to change the demographic situation.

Key words: reproductive behavior, adolescent girls, medical and social factors, parenthood status.


ANALYSIS OF A OCCUPATIONAL MORBIDITY STATE AND THE TASKS

OF THE OCCUPATIONAL PATHOLOGY SERVICE IN THE REPUBLIC OF TATARSTAN

Elena F. Akhmetzyanova, head of the Department of Treatment and Preventive Care of the Ministry of Health of the Republic of Tatarstan [420111 Kazan, Ostrovsky str., 11/6; e-mail: ]
Railya V. Garipova, Doctor of Medical Sciences, Associate Professor of the Department of Hygiene, Occupational Health of Kazan State Medical University, the Ministry of Health of Russia [420012 Kazan, Butlerov str., 49;

e-mail: ]
Zukhra M. Berkheeva, Candidate of Medical Science, Associate Professor of Preventive Medicine and Human Ecology,
Kazan State Medical University, the Ministry of Health of Russia [e-mail: ]
Kadria R. Safinahead of the Republican Center of Occupational Pathology of the Ministry of Health of the Republic of Tatarstan [420036 Kazan, Lechebnaya str., 7; e-mail: ]
Nailya Z. Yusupova, Doctor of Medical Sciences, Associate Professor, head of the Department of General Hygiene, Kazan State Medical Academy, Branch of the Russian Medical Academy of Continuing Professional Education of the Ministry of Health of Russia [420012 Kazan, Mushtari str. 11; e-mail: ]

Abstract. The purpose of the study is to analyze the occupational morbidity in the Republic of Tatarstan from 2014 to 2018. The material and methods. The statistical analysis of occupational morbidity in the Republic of Tatarstan according to the medical history data and the registry of patients with occupational diseases in the Republic of Tatarstan from 2014 to 2018 years. Results and discussion. The level of occupational morbidity in the Russian Federation reached 1,17 per 10,000 workers in 2018, in 2017 – 1,31, in 2016 – 1,47. The level of occupational morbidity in the Republic of Tatarstan is higher than in Russia: 2018 – 1,67, 2017 – 1,85 per 10,000 workers, accordingly. Occupational diseases (OD) often appear in experienced workers, who have contact with harmful production factor during 10 and more years. In fact, the overwhelming number of patients at the time of establishing the connection of the disease with the profession has over 20 years of work experience. The low quality of periodical medical examinations leads to the diagnostic of occupational pathology at the stage of moderate and, sometimes, severe manifestations of occupational diseases with the presence of complications, which requires a medical and social examination since it is a persistent incapacity for work. Conclusion. The analysis of occupational morbidity in the Republic of Tatarstan from 2014 to 2018 revealed no changes in the long-term structure of occupational diseases. There is an increase in the number of workers older than 50–60 years at the time of diagnostic of occupational diseases. There is a high proportion of people directed to medical and social examination immediately after the establishment of the connection of the disease with the profession, due to the presence of contraindications to continue working with harmful production factors in 2018.

Key words: occupational diseases, medical support of workers, periodic medical examinations.


ASSESSMENT OF THE AVAILABILITY OF SPECIALIZED OPHTHALMOLOGIC

MEDICAL CARE FOR PATIENTS WITH CORNEAL DISEASES

Polina I. Konstantinova, postgraduate student of the Department of Public Health and Health care with a course of Economy and Health Care Administration of Pavlov State Medical University of St. Petersburg [197022 Saint Petersburg,
Lev Tolstoy str. 6-8; e-mail: ]

Abstract. The purpose of the study was to assess the satisfaction of hospitalized patients with corneal diseases with specialized ophthalmologic care. The study was conducted on the basis of ophthalmological hospitals in St. Petersburg by the method of anonymous sociological survey. It was revealed that the average age of patients in ophthalmological hospitals requiring surgical treatment of corneal diseases was (64,1±4,8) years, which confirmed the high prevalence of this pathology among patients in older age groups. The results of the study showed that 72,1% of patients were completely satisfied with the results of diagnostic and treatment in the ophthalmology department. Patients identified the following most significant, in their opinion, problems: high cost of drugs needed in the postoperative period at the outpatient stage of treatment; difficulty in finding an ophthalmologist at a polyclinic for hospitalization in an ophthalmologic hospital; long waiting times for a surgical procedure; insufficient information on the methods of treatment and diagnosis of corneal dis- eases; insufficient information for patients on the procedure for referral, admittion, and operation.

Key words: corneal diseases, keratoplasty, patient satisfaction, ophthalmologic medical care, availability.


HEALTH СARE NEEDS FOR RADIATION RESEARCH METHODS IN DIAGNOSTICS OF ONCOLOGY DISEASES
(bases on St. Petersburg example)

Sergey Yu. Lomakov, Candidate of Medical Sciences, Deputy Director of the A. M. Granov Russian Research Center of Radiology and Surgical Technologies, the Ministry of Health of Russia, doctoral student of I.P. Pavlov The First St. Petersburg State Medical University [197758 Saint Petersburg, Leningradskaya str., 70, village Pesochny;
e-mail: ]
Alla E. Chernobrovkina, Candidate of Medical Sciences, head of the Oncology Department of Saint Luke’s Clinical Hospital [194044 Saint Petersburg, Chugunnaya str., 46; e-mail: ]

Abstract. In order to determine the need for radiation diagnostics of malignant neoplasms, the data on the provision of medical care to 137 462 patients in Saint Petersburg in 2013–2018, including 347 174 cases of radiation diagnostic studies, were reserched using a continuous method. A quarter (23,8%) of all radiation tests are performed on cancer patients. The frequency of their conduct increased from 2013 to 2018 from 1897,5 to 2525,6 per 1000 patients (t = 3,4;p<0,05) and depending on the localization of the malignant process can range from 0,5 to 3,9 per patient per year. Significant needs in radiological research methods for cancer patients are justified by the need to detect pathology at an early stage, which will lead to a decrease in mortality. The increasing volume and expansion of the ranges of radiation research is accompanied by an increasing rate of growth in health care expenditures, which should be taken into account when optimizing the work of specialized oncological medical institutions.

Key words: radiation diagnostics, malignant neoplasms, instrumental diagnostic examination, oncology.


MODERN EXPERT AND INFORMATION TECHNOLOGIES

ON GUARD OF RURAL POPULATION HEALTH

Elza A. Bakirova, Candidate of Medical Sciences, senior researcher of the Center for Higher and Additional Professional Education FSBSI N.A. Semashko National Science and Research Institute of Public Health [105064 Moscow, Vorontsovo Pole str., 12/1; tel.: (495)917-48-86; e-mail: ; ORCID ID0000-0002-8221-9110]Evgeniya A. Berseneva, Doctor of Medical Sciences, head of the Center for Higher and Additional Professional Education FSBSI N.A. Semashko National Science and Research Institute of Public Health [tel.: (495)917-48-86;

e-mail: ; ORCID ID0000-0003-3481-6190]
Endzhe A. Kitaeva, Candidate of Medical Sciences, Assistant Professor of the Department of General Hygiene, FSBOI BO Kazan State Medical University of Ministry of Health of Russia [420012 Kazan, Butlerov str., 49; tel.: (843)612-21-63; e-mail: ; ORCID 0000-0003-2147-9025]

Lyudmila A. Doronina, Candidate of Medical Sciences, Associate Professor of the Department of Public Health, Economics and Health Management of Kazan State Medical University, Branch of the Russian Medical Academy of Continuing Professional Education of the Ministry of Health of Russia [420012 Kazan, Butlerov str., 36; tel.: (843)291-77-41;
e-mail: ; ORCID ID0000-0003-3552-4304]

Abstract. The purpose of the study is to evaluate the quality of medical care in rural central municipal inpatient hospitals for patients with arterial hypertension and diabetes mellitus and develop proposals to improve it. Material and methods. We examined 216 cases of rendering of medical aid to patients with diabetes and hypertension in the three rural central municipal inpatient hospitals on the basis of the evaluation criteria of quality of care, approved by the order of Ministry of Health of Russia from 10.05.2017 No 203n. The assessment of treatment and recommendations issued for the outpatient stage was carried out. Results. The analysis showed a high frequency of quality criteria non-conformance, especially in the treatment of patients suffering from diabetes. Defects in treatment, incorrect recommendations for outpatient monitoring, and insufficient continuity between the inpatient and outpatient units have been identified. In order to neutralize negative trends in the medical care quality, it is necessary to search for new forms of organization of medical care in outpatient settings and dispensary supervision. Conclusions. The results of research indicate that people with social priority diseases achieve improvement with follow up care treatment, but since the continuity between the inpatient and outpatient stages is low, the clinical effect is short-term. Taking into account the contribution of non-communicable diseases to the structure of death population causes, the framework of organizing medical care for patients with social priority diseases in rural areas should be based on principles of lifelong, active patient observation, monitoring the effectiveness of basic therapy and its timely correction. In order to improve the quality of dispensary observation, it is necessary to introduce modern information technologies in the Unified State Health Information System (USHIS). There is a long-standing need to create an information resource with a formation of «Medical Care History», which would include both inpatient and outpatient stages. An integral part of monitoring, especially in terms of correction of basic therapy, is the organization of remote specialist physicians’ consultations, which can be paid for by the Mandatory Medical Insurance (MMI) means. It is necessary to fully implement the Quality Assessment Criteria(QAC) for medical services in the practice of medical organizations within the framework of internal quality control and safety of medical activities. For monitoring and supervisory bodies, the assessment of compliance with the QAC should also become a priority. In the MMI system, the criteria for assessing the QAC can be integrated into accounts registries and evaluated in an automated mode.

Key words: non-communicable diseases, criteria for assessing the quality of medical care, universal electronic medical record.


AWARENESS OF OUTPATIENT ORGANIZATIONS HEADS

IN MEDICAL PREVENTION MATTERS (according to a survey)

Rashid S. Gadzhiev, Doctor of Medical Sciences, Full Professor, head of the Department Public Health and Healthcare of FSBEI HE Dagestan State Medical University of the Ministry of Health of Russia [367012 Makhachkala, Lenin sq., 1; tel.: 8(965)486-04-07; e-mail: ]
Luiza S. Agalarova, Doctor of Medical Sciences, Associate Professor of the Department of Public Health and Healthcare of FSBEI HE of Dagestan State Medical University of the Ministry of Health of Russia [tel.: 8(960)409-45-97;

e-mail: ]
Olesya A. Omarova, postgraduate student of chair for the Department of Public Health and Health Care of FSBEI HE Dagestan State Medical University of the Ministry of Health of Russia [tel.: 8(928)558-28-36; e-mail: ]

Abstract. The purpose of the study is to develop recommendations for improving the level of knowledge of heads of outpatient and polyclinic organizations in the field of medical prevention. Material and methods. The study was conducted in 2019–2020 on the basis of outpatient and polyclinic organizations of the cities of the Republic of Dagestan. The questionnaire examined the 107 managers’ level of knowledge in an area of medical prevention. To collect the material, a special questionnaire was developed, which included 35 questions. Sociological and statistical methods were used. Results. The study showed that, on average, 27,6% of respondents provided an incorrect definition for «primary prevention», «secondary prevention», «tertiary prevention» and «medical and social prevention». The main sources of information for managers are the Internet (42,6%), reading of medical literature (21,4%), advanced training courses (17,9%), and magazines and newspapers (14,3%). A comparative assessment of management awareness based on seniority showed that those who have worked for less than 10 years are more aware of prevention activities than those who have worked for more than 20 years. In current conditions, the relationship between outpatient and polyclinic organizations and medical prevention centers for the organization and conduct of preventive work is extremely weak, only 21,7% of the leaders surveyed correctly identified the main tasks of the medical prevention department (office) during preventive medical examinations and regular screenings. The study showed that 21% respondents could not identify which population was in the first health group during the dispensary observation, 29,3% in the second group and 31% in the third group of health during the dispensary observation. The study found that 28,6% of respondents could not list diagnostic criteria for factors increasing the probability of developing chronic non-communicable diseases, and 8,4% did not fully name them. Conclusions. The low efficiency of preventive work can be explained by insufficient level of managerial knowledge and skills of outpatient and polyclinic organizations’ heads. In the structure of proposals to improve the quality of preventive medical care, the first place of importance is given to the increase of the wages of doctors taking into account the volume and quality of preventive work (81,2%), the 2nd is to continuous training of doctors in preventive medicine (73,4%), the 3rd to a training of personnel in preventive medicine (46,7%), the 4th to a wide involvement of secondary medical personnel in preventive activities (44,1%). Based on the materials of the study, methodological recommendations have been prepared to increase the level of knowledge of managers on medical prevention issues.

Key words: head of medical organization, medical prevention, questionnaire, information sources, efficiency criteria.


THE ACTIONS OF THE MEDICAL ORGANIZATION IN THE MASS ADMISSION OF PATIENTS
(Literature review and practical experience)

Ildar I. Khayrullin, Candidate of Medical Sciences, General Director of the International Medical Cluster Foundation, [Moscow, Skolkovo Innovation Center, Bolshoy Boulevar, 46, bld.1; tel.: +7(495)280-08-80;
e-mail: ]
Svetlana E. Gabitova, Candidate of Medical Sciences, Medical Director of the International Medical Cluster Foundation [tel.: +7(960)045-12-29; e-mail: ]

Abstract. How to prepare a hospital for reception of patients with coronavirus: to rearrange processes, separate flows and organize distribution of patients? These are the questions most often faced by the heads of medical organizations when reprofiling the institution to organize the provision of medical care to patients with coronavirus infection. The article systematizes and presents the experience of leading clinics in Moscow, our foreign colleagues, and summarizes the experience of managers of previous generations (literature review). This review of recommendations is intended to help leaders of the Moscow Region to mobilize all resources as soon as possible, use them most effectively and efficiently to provide quality assistance to the required extent.

Key words: mass admission of patients, planning period, preparation period, assistance period, final period, reprofil- ing of medical organizations.


METHODOLOGY OF MEDICAL CARE QUALITY EXPERTISE

FOR ARTERIAL HYPERTENSION

Alsim M. Kharisov, Candidate of Medical Sciences, Head of the branch No 3 of FSBI A.A. Vishnevskiy Central Military Clinical Hospital of the Ministry of Defence of Russia [143000 Moscow region, Odintsovo district, Odintsovo, Marshala Biryuzova str., 1; tel.: 8 (985) 826 29 72; e-mail: ]
Sergey O. Shkitin, Candidate of Medical Sciences, the Deputy Head of the Medical Expertise Administration of AlfaStrakhovanie, LLC – OMS [115162 Moscow, Shabolovka str., 31, bld. 11; tel.: 8 (903) 963 39 32;

e-mail: ]
Alexey V. Beresnikov, Doctor of Medical Science, Associate Professor, Head of Medical Expertise Administration of AlfaStrakhovanie, LLC – OMS [tel.: 8 (916) 178 39 48; e-mail: ]
Evgenia A. Berseneva, Doctor of Medical Science, Head of t the Center for Higher and Additional Professional Education FSBSI N.A. Semashko National Science and Research Institute of Public Health [105064 Moscow, Vorontsovo Pole str., 12, bld. 1; tel.: 8 (916) 216 84 59; e-mail: ]
Anastasia M. Lebedeva, Candidate of Medical Sciences, the Deputy of Head of the Medical Expertise Administration of AlfaStrakhovanie, LLC – OMS [tel.: 8 (919) 764 93 30; e-mail: ]
Maxim D. Efimov, specialist of Medical Expertise Administration of AlfaStrakhovanie, LLC – OMS [tel.: 8 (977) 803 83 13; e-mail: ]

Abstract. The purpose of the study is to develop and test a scientifically based expertise method of medical care quality for arterial hypertension, which allows to assess an impact of violations in the provision of medical care on a achievement of a planned result and predict the most likely outcome of the disease. Material and methods. The subject of the study was a case of medical care with arterial hypertension. The degree of significance of violations on the outcome was determined using the indicator of informational content of violations. Results. A scientifically based methodology for evaluating the quality of medical care for hypertension was developed. The method allows to identify violations by assessing the degree of influence of deviations from the legally established requirements on the outcome of the disease. Conclusions. The method provides repeatability of expert opinion results in 96% of cases. The results of the expertise can predict the outcome in 95% of cases. The proposed method can be used both for quality control and safety of medical activities, as well as for conducting examinations and managing the quality of medical care.

Key words: expertise of quality of medical care, quality of medical care, arterial hypertension.


IN MEMORY OF EDWARD JAMES BURGER

(1933–2020)

Liliya E. Ziganshina, Doctor of Medical Sciences, Full Professor, professor of the Department of Pharmacology of Kazan State Medical University of the Ministry of Health of Russia, Director of Cochrane Russia [420012 Kazan, Butlerov str., 49;
e-mail: ]
Albina F. Titarenko, Candidate of Medical Sciences, Associate Professor of the Department of Biochemistry, Biotechnology and Pharmacology of FSAEI Kazan (Volga region) Federal University [420008 Kazan, Kremlyovskaya str., 18;

e-mail: ]

Abstract. Dedicated to the memory of Edward James Burger, Doctor of Medicine, Full Professor, a member of the Editorial Board of Public Health and Healthcare Journal, a foreign member of the Academy of Sciences of the Republic of Tatarstan, a founder of the Eurasian Medical Education Program (EMOP) for Russian doctors.

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Key words: Edward James Burger, Eurasian Medical Education Program.