Vol 65, No 2 (2021)
- Year: 2021
- Published: 13.05.2021
- Articles: 12
- URL: https://modernonco.orscience.ru/0044-197X/issue/view/9529
HEALTH CARE ORGANIZATION
СOVID-19 pandemic in the context of the health and the life operational protection
Abstract
Introduction. So far, there is no reliable scientific basis for forecasting and preventing pandemics. Around the world, there is public dissatisfaction with the authorities’ insufficiently prompt and effective actions to prevent the spread of Сovid-19.
The purpose of the study is the formulation a significant problem of the complexity and effectiveness of the operational protective measures for the health and life of the population from COVID-19 in other epidemics and pandemics.
Material and methods. Based on the application of a systematic approach and the international methodology for the policy analysis, the author proposes the structuring of the emergency measures and the subjects of the socio-psychological factors analysis of the epidemics and the pandemics to determine a system of the quantitative indicators and the monitoring of the situation.
Results. During the epidemics and the pandemics, it is necessary to take emergency measures and also to strive to prevent them based on an in-depth study of the causal relationships, in particular, the risks of the recurrence as a result of the increased traffic flows, urbanization, agricultural intensification, environmental degradation and the continued development of new species biological weapons.
Discussion. Among the topical areas, it should be attributed the application of the restrictive measures both on the international and domestic air travel; the limiting the increase in population density in large cities with a focus on the standards of «social isolation»; more the adequate environmental protection, the reducing the risk of the infection transmission from the animals to the humans; the reduction of people infections with nosocomial infections.
Conclusion. The author proposes to significantly restructure the analytical and other functions of the operational protection of the population health and life during epidemics and pandemics.



Population movement in the Republic of Bashkortostan: a multi-factor analysis on panel data
Abstract
Introduction. The study deals with natural movement of the population in the Republic of Bashkortostan at the regional and municipal levels.
The aim of the study is to assess the factors affecting the natural movement of the population of the Republic of Bashkortostan (RB).
Material and methods. The information base was the official statistical materials of the Territorial Body of the Federal State Statistics Service for the Republic of Bashkortostan: collections “Demographic Processes in the Republic of Bashkortostan”, “Socio-Economic Situation of Municipal Areas and Urban Districts of the Republic of Bashkortostan”; Rosstat data: collections “Regions of Russia. Socio-economic indices”. We considered data consisting of observations on rural municipalities in RB 54 municipal districts and 21 cities (urban communities and urban settleme;ts), tracked in dynamics for 16 years (2002–2017). At the first stage, municipalities were divided into five groups using cluster analysis based on natural growth indices. Then, to study the influence of medico-demographic, socio-infrastructural, socio-economic factors on the indices of the population’s natural movement, multivariate regression analysis was used. Due to the panel nature of the data, models with fixed individual and time effects were used.
Results. In the studied groups of municipalities, formed using cluster analysis, the significance of individual factors in terms of their influence on the performance indicator is significantly different, which necessitates taking this spatial heterogeneity into account when developing socio-economic policy measures. To confirm the existence of a relationship between the rate of natural population growth and per capita money income, the general rate of marriages, divorces, the proportion of women of fertile age, unemployment, and the ratio of the population over working age, we based the constructed regression models with fixed effects on panel data
Conclusion. Analysis of the results obtained and comparing them with the literature data allow us to determine the priorities of socio-economic, demographic policy at the regional level.



System experience in the development and operation of information technologies in healthcare
Abstract
Introduction. Positive long-term system experience of development and functioning of information technologies in health care should find application in modern information systems.
The purpose of the study is to justify the principles of improving the efficiency of the use and creation of information resources in health and medicine based on previous experience.
Methods. The system approach’s methodology combines the methods of system, graphical and statistical analysis used in the study, methods of expert assessments, empirical modeling, epidemiological, socio-hygienic, and other methods. Identifying the main problems of Informatization, evaluating and analyzing approaches to creating information systems, including interdepartmental ones, are solved.
Results. The main problems of informatization of the current stage are identified. The principles of increasing the efficiency of using and creating information resources in healthcare and medicine are justified. The analysis of previously applied principles and methodological approaches to creating information systems is carried out. That is, the experience is evaluated. The study outlines the ways of development and principles of improving the efficiency of using information resources, in particular, through in-depth analysis and modeling of information from multi-year databases.
Discussion. The functioning of the “Health Protection” system makes it possible to increase the efficiency, reliability, and completeness of the use of information on the state of morbidity, disability, and mortality of the population and the environment. The fact that the system is interdepartmental allows improving the existing assessment methods, analysis, and control of the population’s quality of medical care and environmental safety.
Conclusion. The study results emphasize the need to apply and develop similar approaches at the current informatization stage in the health care system.



Analysis of the correspondence of the lists of drugs for cancer patients' treatment included in the territorial programs of state guarantees to the list of vital and essential drugs
Abstract
The aim of the study was to study the compliance of the list of drugs for the treatment of malignant neoplasms in the territorial state guarantee programs (TSGP) with the list of vital and essential drugs (VED) in the constituent entities of the Russian Federation and the practice of purchasing drugs at the expense of regional preferential provision (RPP) funds.
Material and methods. The analyzed territorial programs of state guarantees were compared with the list of drugs for RPP for the patients with malignant neoplasms with the VED. An assessment of medication procurement in 2019 and 2020 was carried out and compared with the current list of RLO in all constituent entities of the Russian Federation.
Results. Only 14% of the Russian Federation regions in 2019 and 20% in 2020 met the territorial state program of guarantees requirement. The average number of medications included in the territorial state program of guarantees was 73 INNs in 2019 and 100 INNs in 2020. The number of regions with a complete list of drugs accounted for 7% to 33% in the corresponding Federal Districts. In 2020 the number of regions with a complete list of medications in a territorial program of state guarantees did not change.
Discussion. Reduction of medications from the VED purchased at the expense of RPP reduces the number of possible treatment regimens, and limits oncologists’ ability to provide care on an outpatient basis.
Conclusion. Most Russian Federation regions violate the requirements of the territorial program of state guarantees do not harmonize the list of medications in the Program with EDL. The practice of purchasing medications from the territorial program of state guarantees indicates the absence of finance mechanisms for providing medications to patients at the outpatient stage of treatment.



Clinical trial through the eyes of patients: benefit or unjustified risk?
Abstract
Introduction. Clinical trials (CTs) are the footing foundation of evidence-based medicine. In Russia many aspects of CT implementation remain unexplored; one of them is the attitude of Russian society.
Aims. This study aims to determine the knowledge and perception of CTs by potential participants. Analysis of the perception of CTs through the eyes of patients: CTs – is it a benefit or an unjustified risk?
Materials. The primary method of research was a questionnaire. A total of 488 anonymous, voluntary surveys of patients from hospitals in Tomsk were studied.
Results. More than half of the respondents heard about CTs, while the primary source of information was the media. The participants adequately assess the importance of conducting CTs to develop medicine and medical care for society. The primary goal of CTs is to determine the effectiveness and safety of drugs, and respondents regard their engagement as an opportunity to contribute to the development of science. The primary motivating factor in participating in CTs is receiving treatment for an incurable disease and observing conditions by a qualified doctor. The central negative aspect is the possibility of causing a risk to own health. The questionnaire demonstrated the need and importance of all points of informed consent. Several questions concerned the public attitude to researchers. According to patients, medical researchers arouse trust and confidence in altruistic motives during the CTs.
Conclusion. This study revealed a low interest of Russians in participating in CTs, except for personal benefit. The behavior of the doctors, the ability to convey reliable information to the patient to adequately assess benefits and possible risks play an important role in deciding on the involvement of patients in the CTs. The results of this work will allow us to adapt the process of organizing CTs to the needs of patients in the local context.



LITERATURE REVIEW
Methodological outlines for assessing the costs of cancer patients care
Abstract
Introduction. The planning of funding in the public health system and specifically in cancer care remains a challenge for the medical community. Some issues of cancer cost analysis are still not entirely resolved.
Aims. To review the options for analysis of direct cancer costs based on registered follow-up data.
Methods. The targeting and consensus search methodology was applied to collect the relevant papers from PubMed, Cochrane, E-library (RSCI).
Results and Discussion. The following options have been identified: 1) using incidence data; 2) using prevalence data; 3) system net and total costs approach; 4) phase approach; 5) cost estimation using censored data. The incidence costs are related to the time of diagnosis. The prevalence costs represent the costs over a fixed calendar period. The net costs can be calculated by subtracting the mean costs across non-cancer patients from the total mean costs across comparable cancer patients. Total costs are defined as the summated costs for cancer patients regardless of whether they are associated with cancer or not. Phase analysis is a variant of estimates based on morbidity data and includes identifying specific periods from the diagnosis when the costs significantly change. Cost estimation using censored data provides for the application of mathematical modeling methods.
Conclusion. The availability of combined cost analysis methods makes it possible to obtain a comprehensive economic assessment for cancer treatment approaches.



Obesity paradox in patients with cardiovascular diseases and diabetes mellitus type 2 (analytical review)
Abstract
Obesity and overweight are severe problems in modern life. Research, clinical guidelines, and reviews present obesity as an adverse prognostic factor for cardiovascular disease and diabetes. However, there is growing evidence that an increased body mass index can be a prognostically favorable factor for some conditions. A lot of such works are related to diseases for which increased body weight is the most significant risk factor. This phenomenon has been called the “obesity paradox”. Although many studies show this paradox, there are no specific pathogenic mechanisms that could confirm this phenomenon. The research leaves more questions than answers. This review contains their analysis in the following nosologies: arterial hypertension, coronary artery disease, heart failure, diabetes mellitus type 2. The objectives of this study are to identify problems with existing research and find ways to explain the obesity paradox. A literature search was carried out on the databases of PubМed. To assess the problems of modern research, clinical studies were analyzed. To find the causes of this paradox, literature reviews were examined. The obesity paradox has been confirmed in heart failure.



MEDICINE AND LAW
The legal practice of intersectoral interaction for prevention of noncommunicable diseases in students
Abstract
Introduction. Children’s preventive healthcare legislation in noncommunicable diseases strictly determines departments’ interaction: there is a distinction in responsibilities, functions, and work standards for public health services and educational institutions. However, it is hard to distinguish which department or institution is responsible for preventive healthcare implementation in practice. This topic shows a lack of understanding of how to segregate responsibilities, establish effective communication channels, and create audit standards for preventing noncommunicable diseases and health literacy.
Our aim was to analyze the legal, practical, and social aspects of preventive healthcare.
Materials and methods. We studied correspondences in legal regulations and real-life healthcare activities, examined morbidity cases and affecting factors, and evaluated parental attitudes towards Russia’s preventive healthcare system. We surveyed national, sectoral, and regional statutory regulations. Regarding current laws, we analyzed children physical examination data (form № 030-ПО/о-12 (2017), form № 030-ПО/о-17 (2018)). We also questioned parents about children’s preventive healthcare and healthy lifestyle (1320 participants). All empirical data was collected in the 2017-2018 years in Moscow.
Results. As a result, inconsistencies in the legal regulations and practical realization of preventive healthcare activities have been found. The critical problem is that there were no adequate implementation mechanisms, no standard criteria, and control methods for specific healthcare events. There was a difference in statutory healthcare activities, treatment as it is, and parental expectations (the most noticeable discrepancies were in the healthcare sphere): there is a noticeable growth of children morbidity; parents mostly feel themselves dissatisfied with the healthcare system.
Conclusion. It is vital to develop control and implementation mechanisms of national legal regulations,
to adapt them in regional preventive healthcare programs, considering region peculiarities.



A scientific rationale for making changes to the law that governs cross-sectoral collaboration on the issues of public health
Abstract
Introduction. Interaction between different government sectors and society on the issues of public health and health promotion is not often sustainable. It has mostly a piecemeal and declarative approach. The aspects of this interaction are both not scientifically founded and adequately fixed in the legislation
The aim of the study is to establish scientific rationale and to develop proposals for changes to the law that governs cross-sectoral collaboration on the issues of public health.
Material and methods. A review and analysis of scientific literature and current federal and regional laws that govern healthcare industry tools and strategies were conducted. The study was undertaken in the Saratov region, which is a constituent entity of the Russian Federation, to study the following aspects of health care industry in the region: socioeconomic impact of the region on medical and social programs; health promotion activities of legislative and executive branches of the government, cross-sectoral Coordinating Councils, the department of Rospotrebnadzor (Federal Service for Consumer Rights Protection and Human Welfare), and the Center for Medical Preventive Measures. Health status and life style, preventive medical measures at 92 organizations, the results of anonymous questionnaire survey of more than 10,000 respondents (general public, healthcare industry officials, experts) were also analyzed. The obtained results have provided the underlying rationale for proposing changes to the legislation managing public health.
Results. Technique for optimization of cross-sectoral collaboration for assessment of health promotion activities has been developed and tested. This technique is based on the impact of 23 identified sectors on both the determinants of health (37 of them were established) and the simple and complex informative vectors of computer-controlled system of assessment of health promotion activities and other results of the study. The technique was instrumental in proposing changes to the law, which governs the issues of public health. The changes proposed concern the determination of health promotion, its guidelines, organizational principles, assessment, and quality control.
Conclusion. The study results provide the authors with the possibility to scientifically substantiate the necessity in making changes to the current legislation managing public health and developing improvement proposals.



DISCUSSION
Some aspects of the theory of errors of doctors
Abstract
The development of clinical thinking and the improvement of medical care largely depend on doctors and society’s attitude to medical errors. A balanced, rational perspective to medical errors is critical with an understanding of the main aspects of medication errors. The paper presents two important aspects of the problem of medical errors – their probability and, in a sense, their routine, as well as the role of collective relationships in shaping an objective attitude of doctors to errors.
The article argues that the correct action of a doctor does not mean that they are unmistakable. The factors that determine the complexity of medicine are listed.
The actual and ambiguous effectiveness of the medicine is considered.
It is argued that the development of evidence-based medicine is evidence of the relativity of knowledge in medicine. The basic variants of the relationship of doctors in the collective are given. The role of collegiality in improving the professional experience and quality of medical care is specified.
It has been shown that the absence of objective criteria of guilt or innocence of a doctor in error exacerbates the problem of errors. It emphasizes the flaw of equating all errors with misconduct and the unilateralism of such an approach in preventing mistakes. A vicious circle is presented, where the traditionally negative attitude towards doctors who made a mistake ultimately leads to concealment of errors, a decrease in the number and quality of error analysis, stagnation in the development of clinical thinking, an increase in the number of errors and, accordingly, the legal tightening of demand for medical errors.



On the necessity in unified normative medical lexicon within state language of Russia
Abstract
Introduction. Unlike other sciences, medicine has not developed a single consistent vocabulary equally understood by all medical specialists. It complicates corporate and professional communication between physicians.
Aim. To analyze the use of the Russian language as a state language in medicine and health care.
Material and methods. Analysis of publications on the problem, including existing regulations and laws and scientific articles and books. A survey of 75 medical doctors, including experienced specialists and novice physicians, on using medical terminology in their professional activities and corporate communication.
Results. The Federal Law does not explicitly stipulate the Russian literary language in professional scientific oral and written speech. However, difficulties inevitably arise in civil and social life when drawing up and reading medical instructions, advertisements, and health insurance contracts. Our survey of medical workers confirmed the reality and urgency of this problem. The absence of normative vocabularies of the professional medical Russian sub-language complicates physicians’ and teachers’ professional activities; negatively affects their communication with each other and with patients/students, reducing the effectiveness of clinical, scientific, and educational medical activities.
Conclusion. The lack of normative reference publications establishing uniform requirements for a medical sub-language at the state level complicates medical practice, reduces the research effectiveness, and affects the education quality. The task is to bring Russian medical terminology in line with the current global medical thesaurus and unify the interpretation of words and concepts by physicians of different specialties, generations, and schools.



HISTORY OF HEALTH CARE AND MEDICINE
Army medicine during the First World War
Abstract
The article explains the development and functioning of an essential military component - medical support wartime - evacuation system. Describes the concept of conservative evacuation, developed in the Russian army at the beginning of the last century, shows the military medical services’ efforts to expand military health care and improve the system of evacuation during World War I. It is noted that, despite significant efforts, the evacua-tion remained the weakest part of Russian military medicine and does not reflect the scale of sanitary losses.


