卷 63, 编号 3 (2019)

Since 2017, a new stage of depopulation has begun in Russia related to a reduction in the birth rate. The consequences of the “demographic gap” of the 1990s have reached the present time and there has been a sharp decrease in the number of women of active reproductive age, especially from 25 to 29 years old. Objective. The aim is the analysis of the dynamics and prediction of natural reproduction of the population in the Siberian Federal District and its individual administrative territories at the beginning of the second wave of depopulation. Material and methods. Data on the birth rate, mortality and natural increase (decrease) per 1000 population of the Russian Federation, the Siberian Federal District and of individual territories of the Siberian Federal District are obtained on the website of the Federal Service of State Statistics. To analyze the dynamics of natural reproduction of the population of the Siberian Federal District for 2000-2018 and for a short-term prediction of indices, the capabilities of the Microsoft Office application (MS Excel) were used and several variants of approximation of birth rate, mortality rate and natural increase (decrease) in the population were considered using the following trends: linear, logarithmic, and degree (third degree polynomial). Results. A short-term prediction based on the trends indicates a continuation of the emerging trend: the birth rate in the Siberian Federal District will decrease, and the natural decline in the population will increase. With this approximation, the mortality rate of the population will increase. Conclusion. In the coming years, the containment of depopulation in the Siberian Federal District is possible due to the favorable ratio of birth rate and mortality rate in the Republics of Tyva, Altai, Buryatia, and Khakassia. Of particular concern is the significant natural decline in the population in the Kemerovo Region and the Altai Territory. The problem of reducing mortality and, accordingly, increasing life expectancy can be solved only with an increase in the level of culture, education, medical care and with a wide spread of healthy lifestyles.

Qualitative medicine is a guideline in healthcare strategy. Few hospitals provide quality medicine. The study is devoted to the analysis of hospitals on the example of Tver Regional Hospital. Material and methods. Study was conducted in Tver hospital in 2016-2018 years using comparison and statistical analysis, systematization, modeling. Results. Tver hospital place in the healthcare in connection with the provision of medicine is indicated. The hospital work is analyzed using standards where Tver hospital has a high medical level. The criteria of «affordability», «quality» and «timeliness» are defined. Quality management system and Tver hospital structure are considered that way specialized high-tech medicine is provided. The interaction algorithm with patients is presented. The management methods, the organization structure, the quality criteria and the head physician’s tasks are identified. Factors and public procurement role affecting the quality are established. The oligopoly model was built reflecting the market impact on the quality Tver hospital services in competitive environment. Discussion. To provide quality medicine the hospital must use quality standards with a strategy. The quality treatment depends on the factors: number of patients, funding, competition. Conclusion. Results were conducted for hospitals in the regulations development and the choice of methods to provide quality medicine.

Introduction. The scientific basis for the safe use of pesticides are comprehensive sanitary and toxicological studies to study the parameters of their toxicity and biological action, hygienic regulation for the purpose of scientific justification of regulations and safety measures when working with them. Purpose of research. The study of parameters of acute and chronic toxicity, biological actions technical product derived chloracetamide, at oral intake of mammals (rats), the rationale of the acceptable daily intake (ADI) for humans. Material and methods of research. In acute experiments used white male rats weighing 210-220 g Tested doses 1000 and 4000 mg/kg of body weight. Statistical group for each dose consisted of 6 animals. Chronic experiment was carried out on male rats with body weight 180-190 g. Doses were tested: 3,5; 17,6 and 70,0 mg/kg body weight. Statistical groups of each dose and control group included 20 animals. In the dynamics of the experiment, the state and behavior of animals, water and food consumption were observed, the terms of death were fixed, changes in body weight, physiological, biochemical and hematological parameters were recorded. The value of the permissible daily dose was determined by the ratio of the maximum inactive dose to the reserve ratio. Results. As a result of the research it was found that LD50 of the studied compound is 2172 ± 370 mg/kg. In the chronic experiment, the dose of 3.5 mg/kg b.w. does not cause significant changes in all the studied parameters, at a dose of 17.6 mg/kg b.w. single changes, the dose of 70.0 mg/kg. had a polytropic effect on the body of experimental animals. Discussion. The studied technical product for acute oral toxicity refers to low-hazard compounds. It was found that multiple oral intake of the studied product at a dose of 70.0 mg/kg weight body revealed changes in the state of the Central nervous system, and the analysis of biochemical and hematological parameters of blood showed that changes in carbohydrate, lipid and lipoprotein metabolism, aminobelic metabolism occur in animals. Conclusions. The studied compound for acute oral toxicity according to the hygienic classification of pesticides (SanPiN 1.2.2584-10) belongs to the 4th hazard class. Dose: 70,0 mg/kg weight body - acting; 17,6 mg/kg weight body - threshold; 3.5 mg/kg weight body - inactive. The permissible daily dose (DSD) for a person is 0.035 mg/kg.

The authors address the problem of medico-legal literacy of practicing physicians in this paper. Permanent increase in the number of patients’ complaints related to the healthcare quality and management to various authorities proves the importance of this matter. Aim of this study was to investigate and analyze practicing physicians’ opinion on their own readiness (level of training) for legally sound implementation of current regulatory basis in their daily professional activities. Our respondents were also asked about desirable ways of improving the level of their legal awareness. Material and methods. Аn original paper questionnaire was used to estimate self-confidence in legal awareness related to the physician-patient relationship in 395 doctors practicing in Moscow and Moscow Region. The questionnaire included 15 items with Likert-like 10 point scale each as well as one complementary question regarding optimal ways to improve physician’s legal literacy. This instrument displayed high internal consistency with Cronbach’s ɑ = 0.90. Results. Factor analysis of the results confirmed 3 subscales of the questionnaire: (1) direct work with the patient, (2) protection of patients’ rights within the clinic and (3) communication with external organizations. Statistically significant gender and practice venue related differences in respondents’ self-confidence were shown. Discussion. More than 90% preferred practical training as an optimal way of legal literacy improvement. Conclusions. certain legal issues still remain problematic for respondents’ own interpretation therefore the physicians are ready to enhance their knowledge and skills at the practical training sessions.