Vol 68, No 2 (2024)

Standardization in the health care is necessary at all levels, in the field of structure, process, results, which positively affects the quality of medical care. Today, the issues of interaction between participants in the treatment and diagnostic process, both at the level of a medical institution and at the level of the health care system as a whole, have not been fully considered.

The purpose of the study: based on the data of current reports and regulatory legal acts on standardization in the health care system, to scientifically substantiate the need to propose mechanisms for improving this process within the framework of effective interaction between participants in the treatment and diagnostic process.

This manuscript presents data from scientific publications of such databases as Web of Science, Scopus, The Cochrane Library, MedLine, CyberLeninka, RSCI, etc., as well as official documents related to the regulatory framework governing the standardization process in health care system. As a result of the analysis of scientific publications, official documents of legal regulation; procedures and standards for the provision of medical care; clinical guidelines; medical and economic standards regarding various aspects of standardization in the health care system, data were obtained regarding the current state of the standardization process in health care; provisions were formulated on the need for improvement in this area within the framework of the interaction of participants in the diagnostic and treatment process. The main features of standardization in health care are analyzed and there is a scientific justification for the need to introduce measures to improve it. The development of the most optimal standardization mechanisms in the health care system in the future can significantly improve the quality of management in the health care system and social, medical, economic efficiency.

Cоntribution of the authors:
Timurziеva A.B. — research cоncept and dеsign, writing the tеxt, cоmpilation of the list of litеrature, еditing;
Lindеnbraten A.L. — writing the text, еditing.
All аuthors are rеsponsible fоr the intеgrity of аll pаrts of the mаnuscript and аpproval of the mаnuscript finаl vеrsion.

Acknоwledgment. Thе study hаd nо spоnsorship.

Cоnflict of intеrest. The аuthors dеclare no cоnflict of intеrest.

Received: March 2,2023 / Revised: March 27, 2023 / Accepted: April 26, 2023 / Published: April 29, 2024

Introduction. The trend of increasing cases of harm to health/life of patients in the provision of poor-quality medical services is of particular importance in the field of public health.

The purpose of the study. Analysis of the cause of death among the adult population in the provision of poor-quality medical services in public health institutions of the Republic of Tajikistan.

Materials and methods. The study was conducted on the basis of data on deaths among the adult population (over 18 years) of the Republic in the structure of hospital institutions of the Republic of Tajikistan 0ver period of 2019–2021 and 6 months of 2022.

Results. Over period of 2019–2022 there were registered 1881, 4119, and 2567 deceased patients older 18 years, respectively, the hospital mortality rate was 0.2; 0.6, and 0.3%. The frequency of respiratory diseases during 2020 compared to the previous year (n = 70; 0.2%) due to complications of COVID-19 increased by more than 15 times (n = 1577; 3.1%), and in 2021 decreased to 2.2 times (n = 541; 1.4%). In the structure of causes of death there were dominated complications of diseases of the circulatory system (39.5%), the consequences of surgical interventions (12.7%), followed by injuries (10.7%), tumors (3.8%) and the endocrine system (3.3%). The duration of the period before hospitalization of patients who died from surgical diseases was 8.5% — up to 1 day, 68.5% — up to 5 days and 22.8% — from 5 to 15 days.

Research limitation. Pathological anatomical examination of the corpses of deceased patients, which is of key importance in establishing the causes of deaths in healthcare institutions, is carried out in the republic at an extremely low number for religious reasons.

Conclusion. In state healthcare institutions of the Republic, the registration of deaths due to the provision of poor-quality medical services in the period before and after hospitalization does not correspond to reality, which requires the improvement of the reporting system in accordance with international standards.

Compliance with ethical standards. This study was approved by the local committee on biomedical ethics of the State Institution “Tajik Research Institute of Preventive Medicine” (protocol No. 4 dated 12.09.2022).

Contribution of the authors:
Olimov D.A. — concept and design of the study, collection and processing of material, writing the text, statistical data processing;
Tursunov R.A. — the concept and design of the study, writing the text, compilation of a list of references, statistical data processing;
Khojamuradov G.M. — concept and design of the study, editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interests. The authors declare the absence of obvious and potential conflicts of interest in connection with the publication of this article.

Received: November 1, 2022 / Accepted: January 12, 2023 / Published: April 29, 2024

Introduction. Malignant neoplasms of the breast are the leading oncological pathology among the female population of the Primorsky region. Identification of the relationship between the incidence rate and quality of life indicators, along with modern diagnostic methods, makes it possible to improve preventive measures to reduce the prevalence in the population at the regional level.

Purpose. Development of a regression model that describes the impact of socio-economic indicators of quality of life on the incidence of breast cancer in the population of the Primorsky region.

Materials and methods. The initial data sample consisted of seventeen indicators of the quality of life in the population of Primorsky region for the period from 1994 to 2020. To reduce the dimensionality of the data, the principal component method was used, and regression analysis was used to build the model. The quality of the constructed model was checked on the base of the calculation of the coefficient of determination, the standard error, and the approximation error.

Results. There were identified 15 indicators of the quality of life in the population that significantly affect the pathology of breast cancer in the Primorsky region. Principal component analysis has made it possible to group the quality of life indicators into three major compartments. The first component explains 80.8% of the variance, the second — 10%, the third — 4%. The first compartment included indicators characterizing the socio-economic aspects of the life of the population, the second — medical and social, and the third — statistical indicators of inequality in monetary incomes of the population, characterizing the social differentiation of society. A regression model has been developed on the principal compartments.

Research limitations. The research materials are limited to the results of statistical analysis of 17 indicators of the quality of life of the population of the Primorsky region for the period from 1994 to 2020 and the application of the developed regression model at the regional level.

Conclusion. The results of this study made it possible to identify the relationship between the incidence of breast cancer and risk factors and develop a predictive model, which can be useful in planning preventive measures to improve the quality of life and reduce the incidence at the regional level.

Compliance with ethical standards. The study does not require the submission of the conclusion of the biomedical ethics committee.

Contribution of the authors:
Ermolitskaya M.Z. — collection and statistical processing of data, building a model, writing a text, working with literature;
Kiku P.F. — research concept and design, writing the text;
Abakumov A.I. — research concept and design, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.

Gratitude. The authors are grateful to Professor V.I. Apanasevich for advice during the research.

Acknowledgment. The work was carried out within the framework of state assignment No. 0202-2022-0002 «Development of advanced methods and technologies for creating intelligent information and control systems».

Conflict of interest. The authors declare no conflict of interest.

Received: November 18, 2022 / Revised: February 10, 2023 / Accepted: March 2, 2023 / Published: April 29, 2024

Introduction. Mental health disorders in the world and the Russian Federation pose a serious problem, and their increase in childhood and adolescence is a determining factor in the development of diseases in later life.

The purpose of the study is to analyze the follow up data of official sources on the specifics of the incidence of mental disorders in Russia of a children 0–17 year contingent with a differentiation of 0–14 and 15–17 years.

Materials and methods. Materials from official statistics of the Ministry of Health of Russia and Rosstat were used in dynamics for various sections of the study as a whole for the 7-year period over 2015–2021, highlighting the years 2019–2021 to potentially identify the impact of COVID-19 on mental health. The analysis was carried out using statistical, analytical, and other methods.

Results. The terminology on the problem was discussed. According to the analysis materials, among the reasons for taking in the Russian Federation under observation with a diagnosis for the first time in life (per 100 thousand population) in the “Mental and behavioural disorders” class. The leading reason for the entire population was “psychosis and dementia” — 55.1%; in children (0–14 years old) and in children, especially adolescents — “non-psychotic mental disorders” — 38.5% and 50.2%, respectively. An increase in childhood disability was revealed, both in general and for the studied reasons. Recommendations substantiated.

Research limitations. The research materials are limited to the results of the analysis of official statistical information (indicators of morbidity, disability of the population) for the period of 2015–2021.

Conclusion. Based on the research materials, we can conclude that the presented characteristics of the incidence of mental disorders and behavioural disorders in the population of Russia, certain negative trends cannot but cause concern, indicating the need for adequate decisions to be made by all levels of the organization and management to provide effective medical care with preventive measures for the adult and child population in Russia.

Compliance with ethical standards. The study does not require submission of a biomedical ethics committee opinion or other documents.

Contribution of the authors. All authors made an equivalent contribution to the preparation of the publication, including the approval of the final version of the article, responsibility for the integrity of its parts.

Acknowledgment. The study did not have financial support.

Conflict of interest. The authors declare that there is no conflict of interest.

Received: April 27, 2023 / Accepted: May 19, 2023 / Published: April 29, 2024

Introduction. The list of factors determining the confidence in the healthcare system, the vector and the strength of their influence are mediated by the social circumstance (place of living).

The purpose of the study is to quantify the level of confidence in the healthcare system in residents of the Arkhangelsk Region and the Komi Republic and to determine its territorial determinacy.

Materials and methods. A sociological survey was conducted in a group of one thousand seventy five residents from 20 municipalities of two northern regions. The multilevel modelling was used to confirm the hypothesis on the combined impact of factors of individual and group (municipal) levels on the confidence of citizens in healthcare system.

Results. The average “index” of confidence in the healthcare system of residents of the Arkhangelsk Region and the Komi Republic was 40.8 points (95% CI: 38.8–42.8) and 47.1 points (95% CI: 44.7–49.5), respectively (p < 0.001). The average values of the index of confidence in the healthcare system differ statistically significantly in the groups of residents in municipalities. Health Literacy is the most important determinant of the confidence in the healthcare system. Other major determinants are the respondents’ age, self-assessments of health status and well-being. Health Literacy, age and self-assessment of the well-being of Northerners living in different municipalities have a different impact on their confidence in the healthcare system.

Limitations of the study are due to the peculiarities of its design, — the lack of the possibility of verifying the respondents’ answers to the questions.

Conclusion. The confidence in the healthcare system of residents of the municipalities of the Arkhangelsk region and the Komi Republic is determined not only by their personal qualities, but also by the social (territorial) circumstance (place of living).

Compliance with ethical standards. The study was approved by the Independent Interdisciplinary Ethics Committee of the Northern State Medical University (Protocol No. 08/10-21 dated 10.27.2021). All respondents signed an informed consent to participate in the study.

Contribution of the authors:
Mordovsky E.A. — research concept and design, writing the text, statistical data processing;
Baranov A.V. — writing the text, editing;
Sannikov A.L. — collection and processing of material;
Monogarova Yu.Yu. — processing of material, editing;
Losev V.R. — collection and processing of material, compilation of the list of literature;
Shalaurova E.V. — collection and processing of material.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: April 4, 2023 / Accepted: April 27, 2023 / Published: April 29, 2024

Introduction. Pharmaceutical workers (PW) being exposed to adverse physical, chemical, and biological factors are responsible for the performance results and experience psycho-emotional stress. This contributes to the emergence of diseases associated with professional activity, and, therefore, it is necessary to find ways to prevent them.

The purpose of the study: assessment of the state of health in the pharmaceutical workers; determination of factors affecting morbidity, search for ways to preserve and strengthen the health in specialists.

Materials and methods. To study the health status in PW, data were collected by using the questionnaire method, which made it possible to identify symptoms of diseases of the nervous, respiratory, cardiovascular, digestive, musculoskeletal, immune, genitourinary, and reproductive systems. The level of anxiety in PW was determined by the method of CD Spielberger.

Results. In PW there were found symptoms of diseases of all body systems, but the greatest number of complaints were about disorders of the nervous (25.3%), digestive (18.1%), and respiratory (16.0%) systems. The majority of respondents revealed medium and high levels of situational anxiety as much as 46.7% and 36.5%, respectively. Almost half of the respondents have a high level of personal anxiety. The influence of age and work experience on the health status in PW was noted. The highest level of personal anxiety is observed in women. Situational anxiety is expressed among workers who have bad habits. Employees with high situational anxiety have more symptoms of nervous system diseases.

Research limitations. A total of 107 questionnaires were evaluated, when studying the health status of PW in pharmacy organizations.

Conclusion. Most PW maintain a healthy lifestyle: they do not have bad habits, follow a healthy diet, have sufficient sleep, and an active lifestyle. However, 80% noted non-compliance with the work-rest balance when performing occupational activities (working). In this regard, it is important to pay attention to the labour optimization, ensuring a favourable socio-psychological climate at work, and the use of relief techniques.

Compliance with ethical standards. Conclusion of the ethical committee No. 9186 from 28.07.2022: the documentation is presented in full and does not contradict the requirements of the Ethics Committee.

Contribution of the authors:|
Nagornyak Yu.G. — research concept, collection and processing of material, writing the text and compilation of the list of literature;
Kanakina T.A. — research concept, collection and processing of material, writing the text and compilation of the list of literature;
Ruzlyaeva E.A. — research concept, collection and processing of material, writing the text and compilation of the list of literature;
Fokin V.A. — statistical data processing;
Ratkin A.V. — editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: August 30, 2022 / Revised: November 3, 2022 / Accepted: January 12, 2023/ Published: April 29, 2024

Introduction. First aid is a special type of assistance, is the primary measure in the chain of survival of the victim in emergency situations. The scope of the first aid in this edition of regulatory legal acts is not sufficient in situations where the victim is in a remote, inaccessible area and without the possibility of providing emergency medical care, which significantly reduces the chance of survival.

The purpose of the work is to determine the list of measures for the provision of the extended first aid and develop proposals for improving the regulation of relations in the field of the first aid in an expanded volume between the participants of these relations to protect their legitimate rights and interests.

Materials and methods. Research material: regulatory legal acts regulating relations in the field of the first aid and determining its scope. Research methods: analytical, logical, and information modelling.

Results. The analysis of the studied normative legal acts showed the presence of a legal gap in the field of regulation of first aid including the uncertainty of the volume of the extended first aid. To improve the regulatory and legal regulation of first aid activities and contribute to the current legislation, the author has developed and proposed a draft volume of the extended first aid for discussion.

Research limitations. In the study of issues related to the provision of the extended first aid, 18 regulatory legal acts were selected and analyzed: the Constitution of the Russian Federation, 7 federal laws, 10 orders of relevant ministries; as well as 2 technical acts (GOST).

Conclusion. The developed project of the expanded first aid is proposed for consultations and discussions with state structures and officials defining health policy, as well as representatives of scientific institutions of the medical community to develop management decisions aimed at achieving a high level of preservation of human and citizen life and health in emergency situations.

Compliance with ethical standards. The study does not require the submission of the conclusion of the biomedical ethics committee or other documents.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 21, 2022 / Accepted: January 12, 2023 / Published: April 29, 2024

Introduction. The health of the working-age population is determined by many indicators, including life expectancy, mortality in working age, and morbidity. An objective analysis of the incidence of the working-age population, depending on the place of residence, professional affiliation and other factors, has a crucial role in building logistic models for maintaining health.

The purpose of the study. The study of indicators and characteristics of the primary morbidity of people of working age in the territories of the Volga Federal District (PFD) in 2014–2019.

Materials and methods. The analysis was carried out on the basis of federal statistical observation data on the incidence of the population of the Russian Federation for 2014–2019.

Results. Statistical analysis showed that the main causes of primary morbidity in the Volga Federal District and the Russian Federation coincide. In some subjects of the district, pronounced regional features were revealed in the structure of nosological causes of primary morbidity. Average long-term levels in the subjects of the district have multiple differences for individual classes of ICD-10. The most stable annual incidence rates were in class X (J00–J99), unstable annual incidence rates were in class IV (E00–E90). A statistically heterogeneous set of indicators for the entire range of subjects of the Volga Federal District was found in classes VI (G00–G99) (Cv_o = 37.0%) and III (D50–D89) (Cv_o = 32.8%).

Research limitations. The indicators were studied in the scope of federal statistical observation forms No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”

Conclusion. Indicators of primary morbidity among the working-age population in the subjects of the Volga Federal District have pronounced regional characteristics, which must be taken into account when developing and implementing measures to manage the health risk of this category of the population.

Compliance with ethical standards. Compliance with ethical standards. The study does not require submission of the opinion of the biomedical ethics committee or other documents.

Contribution of the authors:
Shaikhlislamova E.R. — writing a text, compilation of the list of literature, editing;
Shastin A.S. — collecting material, writing a text, the concept and design of the study, statistical analysis;
Valeeva E.T. — the concept and design of the study, writing a text, compilation of the list of literature;
Malykh O.L. — the concept and design of the study, the collection and processing of the material;
Gazimova V.G. — the concept and design of the study, statistical analysis;
Tsepilova T.M. — the concept and design of the study, statistical analysis, editing;
Distanova A.A. — writing a text, compilation of the list of literature.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: October 27, 2022 / Revised: December 12, 2022 / Accepted: January 12, 2023 / Published: April 29, 2024

Based on the analysis of declassified documents of the State Archive of the Russian Federation and the Russian State Archive of Economics, the article considers the issue of measures taken by the USSR government in the second half of the 1940s to ensure economic and physical accessibility for the population of the country of a new drug — penicillin. The author provides information on the number of enterprises that produced antibiotics in the USSR during this period, the total volume of their production. It is shown that the capacity of domestic enterprises for a long time did not allow covering the calculated healthcare need for the drug, which determined its acute shortage. The article considers the process of pricing and government regulation of the price of a domestic drug. Based on a comparison of the cost of penicillin therapy and the income level of the population, it was concluded that the drug was affordable for the country’s residents by the end of the 1940s — beginning of the 1950s. In the conditions of an acute shortage of penicillin in the USSR in 1947, a system of centralized distribution of an antibiotic, paid for from the state budget, was introduced in medical institutions of the country. The Ministry of Health of the USSR developed a special distribution coefficient that determined the share of a particular republic in the total volume of drug supplies. The same principle was also translated to subsequent levels of distribution: by regions and cities. The article reflects the problems that accompanied the process of managing drug turnover within the country. The author showed that the introduction of penicillin into wide clinical practice, accompanied by state support measures, even despite the continued shortage of the drug, quickly and positively affected the health of the population of the USSR.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 24, 2022 / Accepted: January 12, 2023 / Published: April 29, 202

14 марта 2024 года научному руководителю проекта «Актуальные вопросы амбулаторной, поликлинической и консультативной медицинской помощи в Республике Коми» доктору медицинских наук, профессору Константину Альбертовичу Шаповалову исполнилось 70 лет.