Vol 64, No 5 (2020)

21 октября 2020 г. исполнилось 70 лет академику РАН, профессору Г.Г. Онищенко – главному редактору журнала «Здравоохранение Российской Федерации».

February 11, 2020, World Health Organization (WHO) declared a pandemic of the new coronavirus and assigned the official name of the infection caused by the new coronavirus - COVID-19 («Coronavirus disease 2019»). On February 11, 2020, the International Committee on Virus Taxonomy gave the official name to the infectious agent as SARS-CoV-2. A new coronavirus infection caused by SARS-CoV-2 has become a challenge for the healthcare system as in Russia as over the world. The medical community has focused its efforts on fighting the pandemic. On March 20, 2020, there the O. M. Filatov Municipal clinical hospital was decided to be redesigned, and this general hospital, including maternity wards, became an infection hospital. One of the main reasons for redesigning was multidisciplinary medical care, including working with patients with a new coronavirus infection, the presence of a maternity home with boxes and own reanimation, the presence of a transition connecting for all three buildings, a large area, with ability to organize routes and placements additional temporary buildings. In the first place there were solved problems as a device of sanitary systems with the gateway, division to the «red» and «green» zones in all buildings of the clinics, development of detailed routing the patients including infectious requirements, navigation inside buildings and on hospital territories for the separation of medical personal, transport, the realization of a plan with the requirements, submitted by Federal Service for Oversight of Consumer Protection and Welfare to medical institutions, working with a new coronavirus infection, in terms of sanitary standards: disinfection of areas and surfaces and transport, creation inventory curative diagnostic (including reanimation) equipment, sufficient number of oxygen points, medicines, disinfection products and personal protective equipment. One of the scale tasks were about care for the health safety of medical personal. Changes to the work concerned various aspects: legal regulation, ethical problems, features practical work and education, interaction with all of them structural departments of the hospital. Within a week task, which put the Department of health of the city of Moscow, was resolved by management of hospital, and on March 27, 2020, the hospital accepted the first patients as an infectious disease hospital.

The purpose of the study is to analyze mortality from suicide in the post-Soviet Russia in terms of its age-related changes and determinants.

Material and methods. The authors used data of the Federal State Statistics Service (Rosstat) calculated in the FAISS-Potential system (Factographic analytical information and statistical system) for the period 1989-2018 as well as age and standardized (European standard population) indices by death causes according to ICD-10.

Results. During crises, the age structure of mortality from suicide is highly gender-specific. In males, there is a plateau of super mortality in working ages with a local (and sometimes absolute) maximum in persons aged 50-59 years; the difference from the non-crisis periods is mainly determined by young working ages. In females, the “crisis” age structure of suicide mortality is characterized by a stable upward trend without any pronounced maxima.

Discussion. Comparing regions by mortality from officially registered suicide, on the one hand, and latent suicide (hanging, fall/jump from a height, and drug poisoning), on the other hand, substantiates objectivity of this problem - namely, a significant underestimation of mortality from suicide. The study shows the opposite groups of these regions to mirror each other, i.e. regions with low mortality from suicide are characterized by a significant latent suicide component.

Conclusions. Dynamics in suicide mortality in the post-Soviet Russia was determined by its social and economic changes. A social determinant of mortality from suicide is reflected by its age structure: there is a significant increase in the risk of suicide in working-age groups during the crisis and super mortality among the working-age population in the disadvantaged territories even during non-crisis periods, while there is an opposite trend in the structure of suicide mortality in older ages. The general determinant patterns of the age structure of suicide mortality are distorted by its under-registration.

Introduction. Prevention and treatment of glaucoma, which threatens the development of blindness, is one of the most important medical and social problems facing modern society in the era of value-based health care. However, against the background of a wide selection of prostaglandin-F2α analogs, which have an approximately similar level of decrease in ophthalmotonus, a clinical and economic argumentation is required for the approach when forming a budget for drug treatment of glaucoma.

The aim of the study. To assess the burden on the health budget of the city of Moscow when using the fluorinated prostaglandin-F2α analog as compared to other prostaglandin-F2α analogs for the treatment of adult patients with primary open-angle glaucoma.

Material and methods. There was studied data on the population of patients with a diagnosis of «glaucoma» receiving medication from the budgetary funds of the city of Moscow. The direct medical costs of healthcare in Moscow were calculated for preparations of prostaglandin-F2α analogs for the treatment of adult patients with primary open-angle glaucoma in various clinical options for 5 years.

Results. The use of the fluorinated prostaglandin-F2α analog drug Tafluprost in patients with primary open-angle glaucoma is economically justified, while budget savings in the 5-year horizon amounted to 196,777,224.60 rubles, 12,295,378.28 rubles in the baseline scenario (default appointment). and 116 084 865.02 rubles, and in alternative scenarios (appointment for adverse events on Latanoprost) - 125 113 646.70 rubles, 43 942 565.04 rubles. and 89,609,415.58 rubles, respectively.

Conclusion. The inclusion of the drug Tafluprost in the drug supply programs of the Moscow healthcare system will increase the efficiency of the use of financial resources and increase the availability of drug supply.

Introduction. Tuberculosis in Russia is one of the primary problems of epidemiology and public health.

The purpose: to analyze the epidemic situation of tuberculosis in high-risk groups of children and adolescents in the Tyumen region of Russia.

Material and methods. Were analyzed the annual reporting forms No. 33 «Information about patients with tuberculosis» for 2014-2018 in the Tyumen region.

Results. According to our research, research materials in the region, WHO recommendations for eliminating tuberculosis by 2035 the need to develop new approaches and practical recommendations for clinical dispensary observation of children with altered tuberculin sensitivity is justified.

Discussion. The epidemic situation among children with altered tuberculin sensitivity by 2018 in the districts of the Tyumen region is characterizing by its heterogeneity. In some districts of the region, the number of children with a turn of tuberculin reactions remains high or continues to increase. Such trends can be associated with the incidence of tuberculosis and the presence of patients with open forms of respiratory tuberculosis in these areas.

Conclusion. To improve the efficiency of preventing the development of active tuberculosis in Russian children in 2010, a mathematical model of immune response developed in the Tyumen Region based on the study of immunological indices in groups of children with high sensitivity and hyperresponsiveness to the Mantoux tests 2TE samples. The model can be successfully used for diagnostics and assess the characteristics of the course of tuberculosis infection.

Introduction. The stressful conditions of the occupational activity of medical workers lead to the appearance of symptoms of occupational deformations and psychosomatization in them.

Purpose. The purpose of identifying the features of medical workers with occupational deformations was achieved by interviewing 6830 medical workers, including 816 cases with pronounced deformations of a professional plan, and establishing links between the components of occupational deformations and psychosomatization.

Material and methods. There were used Maslach Burnout Inventory and its modification, Mental Burnout Definition Questionnaire, Questionnaire for Identifying Problems and Their Impact on Health, Psychosomatics of Our Lives, Giessen somatic complaint questionnaire. Mathematical and statistical processing included descriptive statistics, C. Pearson’s correlation criterion, and Cheddock’s table.

Results. Medical workers with a high level of exhaustion of emotional and psychoemotional species have a higher average level with a tendency to a high level of deformations of the occupational occupational plan, a higher average level of reduction changes in personal and professional achievements and motivation professional species and an average level of depersonalization processes and estrangement of personal and professional nature dominates exhaustion emotional and psychoemotional species, which determines a high level of complaints about the activity of the cardiovascular system (heart complaints) and intensity of complaints, above average complaints about the activity of the digestive and respiratory systems, gastric complaints, the average level of complaints about the activity of the musculoskeletal system, complaints negative skin reactions, pain in various parts of the body.

Discussion. The results of studies by domestic and foreign doctors and psychologists confirm the need for diagnostics, prevention, and correction of professional deformation and leveling of psychosomatic symptoms of medical workers in the context of health care reform.

Conclusion. Psychosomatization of medical workers with professional deformations develops according to the coronary type, which gives reason to recommend to medical workers systematic diagnosis, prevention, and treatment of disorders of the cardiovascular system.

The duration of the cycle of human capital accumulation in the workplace, as well as the need to constantly master new technologies and practices of medical and preventive care for the population, require professional development of healthcare professionals. The implementation of this need requires the provision of appropriate social protection of medical personnel.

The purpose of the study. Development of approaches to the analysis of social protection of medical professionals in the world of work concerning working conditions that contribute to the maintenance and development of their professional level.

Material and methods. The concept of social work-related security was used as the theoretical basis of the study. The methods of qualitative and quantitative analysis of the data of sociological and economic surveys were used as a methodological basis. The data were obtained based on the materials of sample questionnaires of medical specialists conducted throughout Russia and in Moscow.

Results. The ratings for assessing the characteristics of social protection of medical specialists have been determined. The highest rating was given to assessments of the stability of employment and wages, the lowest - assessments of labor safety (in terms of intensity), and wage size. Another group of reasons for the average rating was the identified advantages and disadvantages of the system of additional professional education.

Discussion. The main characteristics of the work, which contribute to and complicate professional development, have been identified. They create a basis for finding and justifying ways to improve them. A complex of objective and subjective factors has been formed that affect the participation of medical specialists in additional professional education and its qualitative results.

Conclusion. Many scientific prerequisites are presented for expanding the possibilities for a more successful integration of continuing education in health care into the general system of continuing professional education.