Vol 28, No 4 (2024)
- Year: 2024
- Articles: 27
- URL: http://bulleten-nriph.ru/journal/issue/view/168
Abstract
The continuing shortage of medical personnel in the country, along with changes in pension legislation, make it very relevant to study the health of doctors and preserve their work activity. This is especially true of doctors of pre-retirement age, the morbidity and mortality among whom is high in the working age.
The purpose of the study is to study the structure, dynamics and mortality rate of doctors of pre-retirement age in the Republic of Tatarstan.
Materials and methods. The study was conducted in the period from 2018 to 2022. The pre-retirement age group corresponded to the age range of 50—59 years for female doctors and 55—64 years for men. The number of doctors of the studied age group was taken from the Federal Register of Medical Workers. The study of the mortality of doctors was carried out by copying the data into a specially designed card from the «Medical death Certificate». 295 cases were analyzed for the period 2018—2022. Statistical analysis was carried out by the Stattech 3.1.0 software package.
Results. Over a 5-year period, the number of doctors in the study group decreased by 1,190 people or by 31.6%. The number of male doctors decreased by 239 people or 21.9%, and female doctors by 951 people or 35.6%. Over the period from 2018 to 2020, the mortality rate among male and female doctors increased sharply against the background of the coronavirus pandemic by 3.8 times. From 2018 to 2022, 295 doctors of pre-retirement age died, which is 7.8% in relation to the entire study group and 24.8% in relation to those who left the register of doctors in 5 years.
Conclusions. The data obtained indicate a two-fold higher mortality rate of doctors of pre-retirement age compared to the population of this age group.
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Abstract
The evaluation of the quality of health care is considered by the World Health Organization (WHO) based on its defining factors: maximum performance of professional functions, optimal use of resources, least risk to the patient and high patient satisfaction from the interaction with the medical organization. In this regard, the need for clear, constant and positive communication of the medical subsystem with the population has increased to ensure satisfaction with accessible, coordinated, comprehensive and quality health care and to measure its correspondence between patients' preferences and their expectations. The choice of research method is still an important factor in evaluating the intra-organizational processes of medical organization management and, consequently, the effectiveness of the country's health care system. Purpose of the study: to conduct a comparative analysis of existing ways of studying patients' opinions and methodological techniques to confirm the validity and reliability of these designs. Materials and Methods. On the basis of literature data and regulated survey methods, the authors conduct a comparative analysis of different methodological techniques to measure patient satisfaction index using 6 questionnaires most widely used in international and Russian healthcare practice. Results of the study. The analysis of the methodological base of public health care on conducting a survey of the population receiving medical care at different stages of treatment and medical specialization allowed to show a wide list of applied questionnaires in the world and Russian systems of public health care and to reveal the mechanisms of achieving target indicators in different systems of evaluation scale. Conclusion. The issues of improving the methods of studying and assessing patient satisfaction with medical care and the quality of patient-physician interaction in scientific practice are not presented in a wide selection and using validation of informative Russian-language versions of international questionnaires for extended comprehensive assessment of indicators of change in the parameter of the controlled process.
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Abstract
The article provides an assessment of the satisfaction of healthcare workers with the organization of social-hygienic monitoring of the health status of patients at risk of developing bronchial asthma and patients with bronchial asthma. The most important measures for organizing social-hygienic monitoring that affect the quality of life of patients with bronchial asthma and the formation of the need for medical care have been identified
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Abstract
Purpose of the study. Develop strategic objectives for countering health risks for the rural population based on an analysis of the medical and demographic situation and morbidity of the rural population.
Methods and materials: analytical, statistical, data from Rosstat and the Federal State Budgetary Institution “TsNIIOIZ” of the Ministry of Health of Russia.
Over all 20 years (2003—2022) of the analysis, the mortality rate of the rural population was higher than that of the urban population; in the covid years (2020—2021) the figures increased, in 2022 they decreased and amounted to 13.8 and 12.6‰, respectively. . The birth rate of the rural population has been decreasing annually since 2013, in 2022 it was 8.8‰, lower than the urban population (8.9‰). The incidence rate (primary) of the rural population (in 2022) was 64755.2 per 100 thousand rural population, lower than in the Russian Federation as a whole (88748.5‰00). Lower rates are associated with poor access to medical care for rural residents. During the pandemic years (2020—2022), the incidence (primary) decreased for all classes of diseases, except for respiratory diseases, while the 2022 indicators did not reach the level of 2019 (pre-Covid year), which is the result of deterioration in preventive and dispensary work with the village population. In 2022, an increase in the pandemic was noted; the incidence rate of COVID-19 in 2020 was 2151.9‰00, in 2021 it increased to 6056.8 and in 2022 it increased to 6144.2‰00. The results of the analysis indicate that the pandemic in the Russian Federation will not weaken in 2022. The ranking of primary incidence rates of COVID-19 by constituent entities of the Russian Federation (2022) showed a difference of 12.1 times, which requires an in-depth analysis of the current situation in the regions of the country. Confronting the challenges and threats associated with coronavirus infection determines the importance of strengthening dispensary work and rehabilitation of patients. At the same time, it is necessary to reform primary health care in organizational terms and in staffing.
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Abstract
The article provides a comparative analysis of regulations governing the provision of paid medical services. It has been established that there is no specification of state guarantees for the provision of free medical care, and in practice, legal mechanisms for distinguishing between free medical care and paid medical services actually do not exist.
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Abstract
This study discusses ways to improve the risk management system in medical activities using digital technologies. The FMEA method is proposed as the basis, as the most effective from the point of view of assessing the onset, detecting and measuring the consequences of risky events. It is proved that the development of this method of risk assessment based on modern digital solutions makes it possible to form management decisions regarding risks affecting the effectiveness of a medical institution. The purpose of the study is to describe the experience of using digital technologies in risk management in the activities of a federal scientific medical institution.
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Abstract
Target. To study the etiology and pathogenesis of self-injurious behavior in humans, including identifying the features of the causes, forms of taking NSSIs, as well as tactics of its treatment in psychiatric hospital patients, taking into account legal conditions and practical materials on the problems of proper regulation of the use of NSSIs in Russia and all over the world.
Procedures and methods. The main content of the study is a narrative review of the scientific literature on the epidemiology of NSSI, an analysis of the legislative framework of the Russian Federation, as well as world judicial practice on the problem of legal regulation of NSSI, as well as the study and discussion of 27 clinical cases of autoaggressive summing up that occurred in the period from May 2022 to June 2024 in the Healthcare Institution «PKB №1» (branch PB 14).
Results. An analysis of clinical cases involving non-suicidal acts of self-harm by patients in a psychiatric hospital was carried out. As a result of the study, an anamnesis of patients of the State Budgetary Healthcare Institution «PKB №1 of the Department of Health, Branch PB 14» who required surgical care was collected, and a survey of medical workers monitoring these patients was also conducted. Features of acts of non-suicidal self-harm in psychiatric hospital patients have been identified, and methodological approaches to organizing surgical treatment of such patients, taking into account their psychosomatic state, have been proposed.
Theoretical and/or practical significance. The conducted research makes it possible to improve the traditional understanding of the features of non-suicidal behavior; the work touches on the problems of the relationship between NSSI and suicide, and examines the world practice of legislative regulation of actions of a self-destructive nature. The obtained results can be used for the prevention, detection and control of self-injurious actions in patients while in a psychiatric hospital, optimization of surgical care, as well as to improve legal regulation of sanctioning autoaggressive behavior.
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Abstract
The purpose of this study was to assess the dynamics of changes in the need for components of donor blood by medical organizations of the Republic of Tatarstan, including obstetrics and gynecology. Materials and methods. We studied the data from the AIST blood service information system on the issuance of blood components to medical organizations of the Republic of Tatarstan in 2019 — 2023. We conducted an additional survey of heads of transfusiology departments of medical organizations about the use of blood components in obstetric and gynecological hospitals (AGH). Results. During the study period, the need for blood components in medical organizations increased by 33.1%, and in AGH — significantly more, by 44.3 (p<0.001). For individual blood components, the increase in general and in the AGS in particular was: red blood cells: 29.2% and 48.5% (p<0.001), platelets: 50.4% and 520.0% (p<0.001), plasma: 31.1% and 1.1% (p<0.001), cryoprecipitate: 421.8% and 315.9% (p<0.03). Conclusion. In 2019—2023, the part of blood components received by the ACH was 3.04% — 3.37% of all blood components received by medical organizations of the Republic of Tatarstan. Compared to medical organizations in general, in the AGH the consumption of platelets and erythrocytes is predominantly increasing and less actively — plasma and cryoprecipitate.
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Abstract
This paper analyzes and presents the results of a study of objective and subjective reasons for leaving the place of permanent residence to another region of your country or a foreign country in order to receive medical care there, depending on the degree of influence of such reasons on the final decision. For this purpose, a survey of German-speaking, English-speaking and Russian-speaking respondents was conducted using the questionnaire method. The total number of respondents from different countries was more than 150 people.
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Abstract
In article the materials demonstrating to the disordered application in territorial subjects of the Russian Federation of mobile divisions of the medical organizations that demands improvement of legal regulation of their activity are stated analytically. The made analysis confirms also importance of use of the new strategy at the organization of delivery of health care based not only on growth of financing of health care and volumes of medical services, but also on estimates of the achieved results in preservation and improvement of human health at individual, group and (or) population level.
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Abstract
Background.Feedback from patients is an important source of information for improving healthcare. This study aims to investigate accessibility of gender-affirming and general healthcare for transgender people in the Republic of Belarus. Materials and methods. Thematic analysis of 16 oral interviews using the socio-ecological model. Results. Social factors complicating access to gender-affirming healthcare include: the lack of legal possibility to initiate hormone therapy before changing the gender marker; inaccessibility of medical transition for individuals under 18; psychopathologization of transgenderism; inability to change the identification number, which encodes gender; inability to enter marriage for individuals with the same legal gender. Institutional factors: centralization of gender-affirming healthcare in Minsk, which leads to geographic barriers and the system's instability; the need to pay for hormonal drugs out of pocket; long evaluation time and unpredictability; unnecessary evaluations; low quality of surgeries; the lack of connection between specialists; the lack of gender-neutral toilets; sex-based separation of specialists (gynecologist/urologist). Interpersonal factors: misgendering and deadnaming; the lack of properly defined diagnostic criteria; gender stereotypes of specialists; denial of service; breach of confidentiality. Intrapersonal factors: low awareness; psychophobia; the lack of self-confidence; concerns about the reactions of people around.
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Abstract
Patient compliance with medical recommendations is one of the main tasks of the medical community worldwide. Many researchers continue to study the structure of patient compliance and propose ways to improve it. In this article, based on the survey, we analyzed the medical tactics in relation to patients with age-related ophthalmological diseases, affecting the quality of medical care and, as a result, adherence to the recommended treatment. The relevance of this study also lies in the study of the organization of medical care for patients with age-associated ocular pathology, including senile cataract and concomitant diseases of the fundus. Existing studies are often devoted to the organization of medical care for patients with isolated ocular pathologies and are based solely on the results of patient surveys. This work demonstrates the data obtained during a survey of ophthalmologists. Currently, a survey is being conducted among patients with cataract and concomitant diseases of the fundus. The study is not completed.
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Abstract
The article analyzes the patterns of the influence of multiple sclerosis on the formation of comorbid pathology, as well as the reverse effect of conjugate pathology on the course of multiple sclerosis. Based on a comprehensive examination of patients with multiple sclerosis in various periods of pregnancy, childbirth and the postpartum period, some patterns of somatic, reproductive health and fertility were revealed. The risk factors for mother and fetus during pregnancy and childbirth, as well as for newborn and mother in the postpartum period, are systematized.
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Abstract
Railway transport workers, ensuring the safety of the operation of railway transport infrastructure, loading and unloading activities, passenger transportation, cargo baggage, are exposed to various industrial risk factors in the course of their professional activities, which determines the specifics of the organization of medical care in the sectoral healthcare system. The safety of railway transportation depends, among other things, on the health status of railway transport workers. The medical examination of Russian Railways employees, being a priority area of industry medicine, makes it possible to increase the period of active work and preserve the labor potential of railway workers, prevent and timely identify diseases of various types and the main risk factors for their development, and also determines the conditions for the development of a system of measures to reduce the risks associated with the health of Russian Railways employees. The purpose of this study was to assess the indicators of medical examination of employees of JSC «Russian Railways» on the Trans-Baikal Railway for the period from 2018 to 2022. According to the results of the study, a high indicator of the completeness of coverage of railway transport workers with medical examinations was established, which reflects the availability of primary health care and should lead to an increase in the detection of chronic non-communicable diseases and occupational pathology. However, the frequency of detection of diseases during medical examination and the indicator of timely registration of employees of JSC «Russian Railways» on dispensary registration tend to decrease. To improve the effectiveness of medical examinations and follow-up, programs have been introduced to combat cardiovascular and endocrine diseases. Based on the results of the medical examination, the health group of employees is determined, which doctors focus on when planning further tactics of medical supervision and developing a system of preventive measures. Employees of the I and III categories of work, as the most difficult, mainly have II and III health groups characterized by either the presence of risk factors or the presence of a chronic non-communicable disease, and requiring the establishment of dispensary supervision, as well as the provision of specialized medical care, including high-tech. The study of the indicators of medical examination of employees of JSC «Russian Railways» on the Trans-Baikal Railway for the period from 2018 to 2022. It allowed us to evaluate the results obtained and identify application points for the development of new structural and organizational measures, in particular, within the framework of the introduction of a three-level system of medical care, the formation of competence centers at the first level of its provision.
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Abstract
Telemedicine uses modern communication, electronic and computer technologies to facilitate the remote collection, storage, processing, transmission and query of various health information to expand patient access to health services by overcoming geographical barriers. Many studies have proven that telemedicine can help avoid long-distance patient transport, thereby saving time and costs for patients and improving the quality of care provided to them. To date, some information has accumulated on the possibility of telemedicine to improve the quality of patient care and reduce the rate of hospital readmission. At the same time, there are a number of problems in the telemedicine system.
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Abstract
Ear and mastoid diseases are not only a medical and social problem, but also an economic one due to their high prevalence, development of severe complications and decreased quality of life. The aim of the study is to investigate the gender and age characteristics of the economic burden of ear and mastoid diseases in the Voronezh region for 2018—2023. Material and methods. A retrospective analytical descriptive study was conducted. The economic burden of ear and mastoid diseases among the adult population of the Voronezh region was studied for the period 2018—2023. The source of information was data from accounts from the territorial fund of compulsory medical insurance (TFOMS) of the Voronezh region. Results. The results of this study showed the gender and age characteristics of direct economic costs for the treatment of ear and mastoid diseases among the adult population of the Voronezh Region for 2018—2023, which in total over six years amounted to 555,272.5 thousand rubles. The age group of 60—69 years is the most resource-intensive for medical organizations from an economic point of view, while this age group of patients ranks first in the structure of outpatient and polyclinic medical care and in the top three in the structure of inpatient medical care. The costs of providing medical care for diseases of the ear and mastoid process among women significantly exceed those among men. The study shows that 95.6% of all costs for diseases of the ear and mastoid process fall on seven groups of diseases, of which four groups are acute and chronic inflammatory diseases. Of the other three groups, the most significant is conductive and sensorineural hearing loss, due to the fact that, according to the literature, this disease is the most common cause of hearing loss among the older generation. Conclusions. The economic burden of ear and mastoid diseases in the Voronezh region for the period 2018—2023 amounted to 555272.5 thousand rubles. Gender and age characteristics of the economic burden of ear and mastoid diseases were identified, which showed that women predominate over men in the structure of expenses, and the age group of patients aged 60—69 years. 95.6% of all expenses for diseases of the ear and mastoid process are accounted for by seven groups of diseases, which include non-suppurative otitis media, purulent and unspecified otitis media, otitis externa, other diseases of the outer ear, conductive and sensorineural hearing loss, inflammation and obstruction of the auditory tube and vestibular dysfunction. The conducted assessment of the costs of providing medical care to patients with diseases of the ear and mastoid process will contribute to more effective economic planning in the public health system.
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Abstract
In 2021, in the Russian Federation, by Decree of the President of the Russian Federation, the “Circle of Good” Fund was created to support children aged 0 to 18 years with severe life-threatening and chronic diseases, including rare (orphan) diseases. According to the Program of State Guarantees for the free provision of medical care to citizens, financial support is provided from federal budget allocations in accordance with the procedure for purchasing medicines and medical products for a specific child with a serious life-threatening or chronic disease, including a rare (orphan) disease, or for groups of such children established by the Government of the Russian Federation. Noting the absolute feasibility of creating the Fund, it is necessary to raise the issue of organizing drug provision for children who received treatment with the help of the “Circle of Good” Foundation when they reach adulthood. This article analyzes the existing approaches to this organization, and also presents possible proposals aimed at improving this process.
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Abstract
The objective of the study was to develop an index of innovative readiness of the environment for the implementation of innovative technologies at the level of a healthcare organization. The following materials were used: legislation in the field of healthcare, including compulsory medical insurance: federal laws of the Russian Federation, decrees of the Government of the Russian Federation, orders of the Ministry of Health of Russia, and other methodological materials. Foreign and domestic scientific publications devoted to the implementation of innovative medical technologies in healthcare organizations were also used. Factors and parameters that determine the readiness of the environment of a healthcare organization for the implementation of certain medical technologies were extracted from regulatory legal acts and scientific publications in a structured form. Criteria for a comprehensive analysis of the possibility of implementing an innovative medical technology in a healthcare organization, combined into 8 main blocks, on key aspects of assessing the regional healthcare system in terms of implementing innovations: sufficient qualifications and motivation (interest) of personnel; readiness and interest of the management of the healthcare organization and the founder in implementing the innovative method; sufficient patient population for using the innovative method; availability of practical experience in using analogs of the innovative method in a healthcare organization; availability of the necessary equipment and/or drugs; availability of the necessary buildings and premises; preliminary assessment of the clinical and economic efficiency of implementing an innovative method in a medical organization; sufficiency of tariffs and volumes of medical care for the innovative method and its analogue (comparison method) in a medical organization. The environment of a medical organization is recognized as ready for implementing an innovative medical technology if the total number of points on the checklist is 8 or more points (there must be a «yes» answer to at least one item from each section of the checklist, +1 additional point for one more «yes» answer in any of the sections).
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Abstract
survey of viewers of the @psyhfarm-tv YouTube channel (89,000 subscribers) on the effectiveness and tolerability of 17 antidepressants showed that selective serotonin reuptake inhibitors, according to respondents, are more likely to help and are well tolerated., Serotonin and norepinephrine reuptake inhibitors were less likely to not help, and receptor-acting antidepressants were more likely to not help than other drugs. Groups of antidepressants with different mechanisms of action differ significantly in effectiveness and tolerability.
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Abstract
The biography, scientific and social activities of the prominent Russian epidemiologist and microbiologist, the recognized leader of domestic leptospirology, professor Vasily Vasilyevich Ananyin (1912—1969), have so far remained insufficiently researched and little known to the medical community. His contribution to the development of medicine and biology, as well as national healthcare, has not received sufficient coverage. Based on archival materials, generalized literary sources, the article for the first time provides updated facts of the scientist's biography, traces the stages of his life and scientific activity. The fact of world recognition of V.V.Ananyin's achievements in the development of modern parasitology is highlighted. His role in the development of the leptospirosis laboratory of the N.F.Gamalei Institute of Epidemiology and Microbiology of the USSR Academy of Medical Sciences and the creation of the reference and advisory center of the World Health Organization on its basis is noted.
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Abstract
Gennady Nikolayevich Trojansky is one of the iconic figures in the national history of medicine. Having worked his way up from student to vice-rector at the Moscow Medical Stomatological Institute (now the Russian University of Medicine), with no other entries in his labor book, he would establish a museum and one of the first chairs of the history of medicine in the USSR, develop the main sections of the history of stomatology in the USSR, and do many good deeds.
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Abstract
The article is dedicated to the 125th anniversary of the publication of ‘Russian Zemstvo Medicine’. For a long time this collection was one of the few reference books and methodological guides for zemstvo doctors, a source on the history of Russian medicine for domestic and foreign researchers, a testament of E.A.Osipov to zemstvo medicine and zemstvo doctors. A. Osipov to zemstvo medicine and zemstvo doctors. ‘Russian zemstvo medicine’ is a vivid example of medical press of the turn of the XIX-XX centuries, which embodied educational, enlightening and popularising functions.
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Abstract
The article presents brief biographical information about Doctor of MedicineN.S. Korotkov and his discovery of a simple, accessible and accurate sound method for determining blood pressure in a person, which has received worldwide recognition and its wide application in medical practice. The use of this method by doctors in their daily work made it possible to diagnose and treat cardiovascular diseases in a timely manner, including determining the tactics of surgical treatment of arterial aneurysms and measures to prevent their complications.
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Abstract
Digital health literacy among healthcare workers is rapidly developing due to the increasing integration of technologies into healthcare. However, it is still unclear what exactly digital literacy of healthcare workers should include and how it can be measured. The aim of the study is to expand the understanding of existing systems for assessing digital competencies of healthcare workers in global practice. Materials and methods. A scoping review was conducted based on the PRISMA checklist. Peer-reviewed scientific articles published in English over the past 10 years (2014—2024) on digital competence of healthcare workers were included. One of the selection criteria was maximum international coverage, so studies from not only leading countries in Europe and the world, but also most regional leaders, as well as developing countries, were considered. Based on the results obtained, a generalization was made of the most studied competencies of healthcare workers in the field of digital health to date, as well as the tools used to assess them. Conclusion. There is a wide variety of tools for assessing digital health literacy among healthcare workers, which depends both on the characteristics of national healthcare systems and on the capabilities and measurement criteria. While some general health literacy assessment tools could potentially be adapted for Russian users, the findings of this study indicate a lack of tools that are specifically designed to assess the multifaceted digital health literacy of healthcare professionals, taking into account the unique context, domains, complexity, and assessment methods required for this target group.
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Abstract
The aim of the study was to assess the state of social adaptation of students in the educational programs of specialist and residency of a medical university in connection with their gender, stage and specialty of professional training. Materials and methods of the study. The object of the study was a sample of 1007 students and residents of a medical university, studied using a set of applied sociological, psychological and statistical methods. Results of the study. The general state of social adaptation of students and residents of a medical university is characterized by the predominance of its average and high levels. Social adaptation of students and residents is characterized by a better state in female students, opposite dynamics in connection with the transition from the initial to the final stages of professional training, a higher general level in students majoring in Pediatrics compared to that of students in the specialties General Medicine and Dentistry.
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Abstract
Qualitative psychological and pedagogical correction of existing disorders in a child is possible during his virtual hospitalization. Remote methodology classes with children provide stimulation of their mental processes and develop their sensory apparatus and speech capabilities. During these sessions, children also develop the ability to plan their actions. Parents should also be involved as actively as possible in all creative endeavors, in constant contact with the child. This is the only way to achieve a high level of motivation to correct their child's impairments and to direct their development in accordance with their aptitudes.
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Abstract
The article presents the results of a telephone survey of Muscovites (N=1522) conducted to determine the important nuances of informing working-age residents of the capital about a healthy lifestyle. Additionally, 12 focus groups were conducted with the target audience. The majority of respondents speak about the sufficiency of information about healthy lifestyle in the foreign field (79%), the average value of interest in information about healthy lifestyle is 6.95 out of 10. In general, we should rather not talk about a lack of information, but about the need to improve ways to deliver reliable information to target groups. The main sources of information about healthy lifestyle are information sites — 76%, messengers — 68% and social networks — 65%. Format preference is given to social media posts (69%) and videos (63%). The majority of respondents (58%) noted that they had encountered potentially unreliable information about healthy lifestyle, mainly questionable information about the nuances of nutrition. The main markers of the reliability of information about healthy lifestyle for respondents are «the use of statistical data» — 63% and «the authority of the author» — 59%. Muscovites are more likely to trust their inner circle of friends and relatives in matters of maintaining a healthy lifestyle. The «rational», «accessible» and «media» models of informing about healthy lifestyle, which may conflict with each other, are highlighted. Based on the results of the study, a number of recommendations are given on the directions of information work in the field of healthy lifestyle.
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