Vol 63, No 4 (2019)

Assessment of sufficiency of resources of medical organizations necessary for achievement of the target indicators declared in the state programs is important for decision-making on volumes of financing of the sphere of health care and the statement of expected results. One of the indicators that affect the satisfaction of the population with the quality of medical care is the “Average waiting time for a doctor's appointment by appointment” (SWAP), provided for by the State program “Development of health care in Moscow (Capital health care)”. The aim of the study is to develop a methodological approach to assessing the possibility of achieving the planned values of the indicator, based on data on the results of medical organizations and resources available to them. Material and methods. The object of the study were medical organizations in Moscow. The material for the study was the data on the organization of reception of patients by physicians. Information from the Unified medical information and analytical system of Moscow (UMIAS), forms of Federal statistical observation and other sources was used. Mathematical-statistical and comparative methods of analysis were used for data processing. Results. Studies have confirmed the presence of a number of factors that affect the achievement of the planned value of the SWAP indicator, including the duration of the patient's reception by the doctor. The dependence of the SWAP value on such indicators as: the share of failed appointments, the load on doctors and some others is confirmed. Discussion. Statistical modeling of the organization of the doctor's appointment confirms the need to monitor the indicators that directly or indirectly affect the achievement of the planned value of the SWAP indicator, which allows timely taking the necessary management decisions in the face of the risk of adverse conditions. Conclusion. The results of the study confirmed the practical and theoretical feasibility of using a methodological approach to forecasting the values of target indicators declared in state programs (national projects), taking into account the resource capabilities of each individual medical organization.

Introduction. The features of long-term dynamics of infectious mononucleosis morbidity and its territorial distribution remain not fully studied, which determined the purpose of this study. Material and methods. According to the form № 2 “Information on infectious and parasitic diseases” analyzed the incidence RATES in the Russian Federation for 1990-2018 years, ranking of average long-term levels of morbidity in the context of 85 subjects of the Russian Federation for 2009-2018 years. To process the information used conventional statistical methods. Results. In the long-term dynamics of morbidity of infectious mononucleosis the Russian Federation in 1990-2018, a tendency to increase, frequency with an interval of 5-7 years, a significant excess of the average long-term morbidity rates of children 0-14 years over persons over 15 years. Ranking of subjects of the Russian Federation by average long-term levels of morbidity for the period 20092018 revealed their uneven distribution within the country. Discussion. The obtained data do not contradict the results of other authors' research. The distinctive features of this study are: the study of long-term dynamics of morbidity for the entire period of its official registration with the establishment of frequency; analysis of morbidity of persons older than 15 years (in the available literature there is information only on the total and children's population); study of territorial prevalence of infectious mononucleosis the Russian Federation with the identification of its heterogeneity. Conclusions. Long-term dynamics of morbidity of infectious mononucleosis the Russian Federation in 1990-2018 is characterized by a tendency to increase and a periodicity of 5-7 years, the most pronounced in the age category “persons over 15 years”. The average long-term morbidity rate of children aged 0-14 years for 1990-2018 was significantly higher than that in the group of people over 15 years. The ranking of subjects of the Russian Federation by the average long-term levels of morbidity (2009-2018) revealed an uneven distribution of indicators within the country.

Studies of the impacts of pesticide mixtures on non-target organisms and public health are important in view of the increasing number of pesticide formulations containing two or more active substances entering the market, the widespread use of pesticides in tank mixtures, as well as multiple treatments of crops with formulations of compounds belonging to different chemical classes. Objective. To evaluate the genotoxic activity of combinations of technical grade active ingredients of pesticides. Material and methods. The genotoxicity of 4 combinations of technical grade products of pesticide active ingredients (generics) was evaluated: thiamethoxam/triticonazole; glyphosate/cypermethrin; ethofumesate/phenmedipham/desmedipham; imidacloprid/imazalil/thiabendazole/tebuconazole using the bacterial reverse mutation test (Ames test) and the cytogenetic test based on the assessment of micronucleus incidence in mouse bone marrow polychromatic erythrocytes in vivo. Results. The combinations of thiamethoxam/triticonazole, glyphosate/cypermethrin and imidaclo-prid/imazalil/thiabendazole/tebuconazole did not show mutagenic activity in the Ames test and clas-togenic and aneugenic effects on the erythrocytes of mammalian bone marrow, which indicates their genetic safety. A mixture of ethofumesate, phenmedipham and desmedipham caused a weak genotoxic effect, inducing a dose-dependent, statistically significant increase in the incidence of micronucleated polychromatic erythrocytes in the mouse bone marrow. Discussion. The observed genotoxic activity in vivo may be due to the synergistic effect of ethofumesate, phenmedipham and desmedipham, as each of the technical grade active ingredients separately did not induce micronuclei at doses up to 2000 mg/kg body weight. Conclusion. Studies have confirmed the genetic safety of the three assessed pesticide combinations. However, some technical products of the active ingredients of analogous (generic) pesticides included in the same formulation and non-genotoxic individually may have a genotoxic effect in combination. The data indicate the importance of testing not only individual active ingredients but also their combinations.

A large amount of scientific research has been accumulated on the health problem of the younger generation. The aim of the work was to analyze the characteristics of modern youth associated with age periodization. The article presents an informational and analytical review on the problem of the health of children, adolescents and youth, highlights the features of their growth and development when they reach adulthood. Health risks are shown and analyzed taking into account physiological, psychological, moral and social development. The characteristics of the age stages of development of children and adolescents, characterized by a certain level of preparedness of the body for the effects of various factors, are given. For example, a child's admission to a preschool institution, a change in her usual environment, day regimen, and nutrition can lead to overstrain and a breakdown of the child's adaptation system. The features of the teenage age group are considered. It is at this age that personality-psychological characteristics, stereotypes of behavior, bad habits and behavioral reactions are formed. The category of student youth is described with a description of modern issues related to the hygiene of the educational process and health. Issues of medical support for young people require revision in relation to the peculiarities of ontogenesis, taking into account the whole range of influencing risk factors. To determine the strategy of the planned measures aimed at improving the level of health, a review of the age periodization is required taking into account the peculiarities of the modern development of children, adolescents and youth. Certain laws governing the growth and development of children and adolescents and, above all, the heteromorphism of these processes provide the basis for constructing the scientific principles of age-related periodization. At the same time, psychological, biological, social and other criteria may act as regulatory mechanisms.

Introduction. The relevance of the consideration of the legal regulation of the ADG procedure in Russia is determined by a set of ethical and legal problems related to the specifics of the normative regulation of the procedure itself and the legal consequences of its implementation. Goals and objectives. The purpose of this study is to identify prospects for the development of legal regulation of the procedure of ADG in Russia, taking into account the experience of Germany; to achieve this goal, tasks were set and solved for the study of regulatory legal acts, judicial practice and doctrinal sources of these countries. Material and methods.Legislative acts, by-laws, judicial practice, doctrinal sources of Russia and the Federal Republic of Germany are studied. Methods used: general philosophical, general scientific, private scientific, special (structural-legal, comparative-legal, formal-legal). Results.A comprehensive assessment was made of the prerequisites for establishing the legal regime of the ADG in Russia, problems were identified that need to be addressed taking into account international law and the experience of the FRG. Discussion. It has been established that the discussion about the prospects for the legal regulation of PGD comes down to two questions - determining the legal status of a human embryo and setting the limits of its legal protection. Conclusions. For the first time, the authors substantiate the conclusion about the need to legalize PGD procedures in Russia, it is proposed to determine a number of basic conditions for this diagnosis: 1) at the embryo cultivation stage, a detailed medical consultation should be provided containing an explanation of the procedure, its legal consequences and the risks of false the diagnosis; 2) the general prohibition on the choice of the sex of the unborn child existing in Russian law should be maintained; 3) PGD should be carried out at the stage of embryo development, excluding the possibility of its use for stem cell donation.

The phenomenon of a doctors mistake (a mistake of thinking) is complicated, practically not studied. Therefore, there is no systematic scientific knowledge about the mistakes of doctors. The imperfection of the theory of doctors' mistakes leads to different and opposite positions even among doctors. Uncertainty about main concepts, like «medical error», leads to a complex and contradictory relationship between a doctors' error and the criminal code. The theory of a doctor's mistakes should be the status of a separate section of science.

For the implementation of allogeneic hematopoietic stem cells transplantations from unrelated donors it is necessary to have registers containing HLA phenotypes of potential bone marrow donors. Currently there are 16 registers in the Russian Federation, which are created on the basis of state medical institutions and non-profit organizations. However the concept of “potential bone marrow donor” is not defined in the legal documents. The article presents the definition of a potential unrelated bone marrow donor. The criteria for the inclusion of volunteers in the bone marrow donors registries were analyzed.