Volume 66, Nº 6 (2022)
- Ano: 2022
- ##issue.datePublished##: 14.12.2022
- Artigos: 18
- URL: https://modernonco.orscience.ru/0044-197X/issue/view/9558
HEALTH CARE ORGANIZATION
Determining priority socio-hygienic determinants of life expectancy at birth for the Russian Federation population
Resumo
Introduction. The study focuses on examining socio-hygienic determinants of life expectancy at birth as an integral health indicator at the federal level.
Purpose of study. To determine propriety socio-hygienic determinants of life expectancy at birth (LEB) for the population of the Russian Federation.
Materials and methods. Our initial data were taken from the statistical reports issued by Rosstat and Rospotrebnadzor in 2010–2018 in all 85 RF regions — 148 indicators of habitat and lifestyle factors were analyzed. The indicators were structured as a data matrix. Effects produced by them on LEB were calculated by using factor analysis and an artificial neural network based on a four-layer perceptron.
Results. We determined forty priority socio-hygienic determinants with the greatest influence on the existing level of life expectancy at birth. Seventy-seven point five percent of them were lifestyle indicators and socio-demographic ones; 12.5% described sanitary-epidemiological welfare of the population. The most significant effects on a LEB growth were produced by 1% increase in the following indicators: “Working hours per one employed person per week”, 7.32 days; “A share of population who have physical activity or do sports”, 4.52 days; “Equipment of housing with centralized water supply”, 3.71 days.
Limitations. This study has certain limitations including a limited set of the analyzed factors that modify LEB — 148 indicators over 2010–2018 as per region of the Russian Federation; an area within which initial statistical indicators were determined limited scenarios of changes in them, properties of the employed artificial neural network.
Conclusion. Planning activities aimed at improving the existing medical and demographic situation requires developing adequate approaches to determining priority socio-hygienic determinants given the effects produced on LEB by multiple environmental and lifestyle factors that are variable and heterogeneous as per their types and intensity of their influence.
Compliance with ethical standards. No approval by the committee on biomedical ethics was required to accomplish this study (it was based on free available data taken from the official statistical reports).
Contribution of the authors:
Zaitseva N.V. — research concept and design, editing, approval of the final version of the article;
Kleyn S.V. — editing, writing the text, approval of the final version of the article, responsibility for the integrity of all parts of the article;
Glukhikh M.V. — statistical data processing, collection and processing material, writing the text.
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 12, 2022
Accepted: September 07, 2022
Published: December 12, 2022
435-443
Value-based health care: alignment the tools and methods (literature review)
Resumo
The desire to solve the problem of efficient spending of funds in the public sector has been transformed into an understanding of values. The desire to reduce costs, maintain the proper quality and maximize the availability of medical care led to the emergence and formation of a new concept of effective functioning based on values — VВHC (Value-based Health Care).
Purpose. To systematize the criteria, metrics and methods for evaluating effectiveness in the context of the VHBC concept. To obtain the necessary information, a selective literature review was carried out. Electronic bibliographic databases in Russian (“RSCI/eLibrary”) and English (“Pubmed”) were used. Search queries were formed taking into account the MeSH nomenclature. To determine the effectiveness of the provision of medical services and the implementation of government programs (projects) in general, there are a number of methods. First of all, it is an analysis of costs, benefits, effectiveness and benefits. The most applicable performance measure is Quality Adjusted Life Years. QALY is a universal indicator of any health program. This expression of “utility” is by default the ultimate goal (final target unofficial indicator) of any government management decision in health care. Assessing the effectiveness of health care and developing a value-based model of health care through cost-benefit analysis is a time-consuming and important task. The study showed that it is necessary to use multidimensional tools for assessing the effectiveness of medical care.
Conclusions. As a result of the review, it was found that there is no unified information system that offers ready-made assessment tools, and metrics have not been developed to evaluate the effectiveness of value-based healthcare VBHC models. It seems possible to create a checklist with universal parameters, implement it into a ready-made information system available on the market today to any medical institution, and analyze the effectiveness of the VBHC model based on the developed checklist.
Contribution of the authors:
Kamynina N.N. — research concept and design;
Polishchuk N.S. — material collection and processing, writing the text.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.
Acknowledgment. The study had no sponsorship.
Conflict of interests. The authors declare that there is no conflict of interests.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
444-450
Assessment of shifts in mortality age profile of adult population in Moscow during pandemic
Resumo
Introduction. The COVID-19 pandemic induced the global crisis of mortality. Delayed medical care and reduced availability under quarantine restrictions have led to an increase in mortality not only from Covid-19, but also from chronic non-communicable diseases, affecting men and women of different ages to varying degrees.
The study purpose is to assess shifts in mortality age profile of population aged 20+ in Moscow during COVID-19 pandemic.
Materials and methods. Official vital statistics of Rosstat, operational information from civil registration database on death causes in Moscow.
Results. The gain in mortality rate caused primarily by deaths from COVID-19 interrupted in 2020 the positive demographic dynamics that had developed over the previous years. In 2021, the increase in the mortality rate continued, but the loss of life expectancy was lower due to a decrease in mortality in older ages and the return of most indicators to the level of 2019. However, from a socio-economic point of view, the situation in 2021 developed more negatively, since the age structure of life expectancy losses is younger than in 2020.
Limitations. The study results are based on operational information of the Moscow civil registration office and could be used for the development of managerial decisions for Moscow only.
Conclusion. Against the pandemic demographic situation in Moscow has worsened. Due to mortality gain in the Russia’s capital first in the past years recorded natural population decline.
Compliance with ethical standards. This type of research does not require examination by the local ethics committee.
Contribution of the authors:
Savina A.A. — research concept and design, statistical processing, text writing;
Zemlyanova E.V. — research design, text writing editing, translation;
Feyginova S.I. — concept and design of the study, compilation of the list of references;
Tarasov N.A. — collection and processing of material, statistical processing.
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 that there is no conflict of interest.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
451-458
Management of the activity of the Moscow pathology and anatomical service in the context of a pandemic of a new coronavirus infection in 2020–2022
Resumo
The management of the activity of the pathology and anatomical service (PAS) of the Moscow Healthcare Department (DZM) in the context of the COVID-19 pandemic and the provision of timely and accurate pathological diagnostics, as well as the receipt of reliable statistics on mortality rate, made it possible to provide timely management decisions to combat the pandemic.
Purpose. To present the successful experience of managing the activities of the Moscow Pathoanatomic Service of DZM in the conditions of a pandemic of a new coronavirus infection.
Methods. The paper analyzes and summarizes the features of the activity of PAS of DZM in the conditions of the COVID-19 pandemic, presents the main activities carried out to ensure timely and accurate diagnostics in anatomical pathology, and obtaining reliable statistical data on mortality, demonstrates the most important management decisions for organizing work aimed at combating the pandemic. Analytical, organizational, and statistical research methods are used in the work.
Results. In order to improve the organization of the work of PAS of DZM in the context of the COVID-19 pandemic and ensure timely and accurate pathological diagnostics, and obtaining reliable statistics on mortality from it, a number of important activities were carried out including reprofilation of the PAS and reorganization of the work of PAS of DZM, reorganization and optimization of the work of the organizational and methodological department for pathological anatomy (OMO PA) of the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, carrying out activities to establish interaction between the chief specialist in pathological anatomy and OMO PA with the DZM, the Rosstat and the egistry Office in Multiple functional Centres, connection of all Departments of Pathology by the new laboratory information system «LABFORS», development of continuing medical education.
Limitations. Limited time period for description; there is no comparison with other subjects; conditions of the COVID-19 epidemic.
Conclusions. Thus, the PAS of DZM, under the guidance of the chief specialist in pathological anatomy of DZM and OMO PA, showed its efficiency and effectiveness in the context of a pandemic of a new coronavirus infection, successfully implemented new technologies and organizational principles, improved the organization of its work, developed both post-mortem and intravital diagnostics of diseases in anatomical pathology.
Compliance with ethical standards: the study does not require the submission of the conclusion of the Biomedical ethics committee or other documents.
Contribution of the authors:
Kanibolotskiy A.A. — collection and processing of material, writing text, compiling a list of references;
Zayratyants O.V. — research concept and design, editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Gratitude. The authors express their sincere gratitude to the pathologists and other specialists working with COVID-19.
Acknowledgment. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
459-465
Principles of laboratory service management in modern conditions
Resumo
Introduction. Today, the medical laboratory is focused on operational efficiency and cost control. Our work presents the experience of transforming laboratory practice, its informatization and reorganization of the management model.
Purpose of the study. Creation of a management model for fast, economical and high-quality testing in laboratories of various levels to provide Muscovites with laboratory services in full.
Materials and methods. An assessment of the resource support of clinical diagnostic laboratories (CDL) of the Moscow City Health Department (MCHD) number of attached population and the need for tests, made it possible to develop and implement concepts for their centralization in the outpatient clinic link, unify the nomenclature of laboratory studies and tests, create a unified reference book of laboratory studies (IF) for the centralized laboratory service (CLS) of the unified medical information and analytical system (UMIAS), develop a plan for the development of a quality management system based on international standards and begin the activity on the standardization of laboratory services through accreditation of medical laboratories in the national accreditation system, manage centralized large-scale screening for SARS-CoV-2; implement sequencing technology (NGS) for genomic surveillance.
Results. The MCHD laboratory service is built according to a 3-level system. There is a complex IF EMIAS. Laboratory studies are computerized, test results are transferred to the personal account and the patient’s electronic medical record. A single information space has been created for all CDL MCHD. The tariffs for laboratory services of the registry of the Moscow City Compulsory Medical Insurance Fund (MCCMIF) have been changed, the list has been optimized. Under the control of spending, the productivity of laboratories has increased. Moscow’s needs for laboratory services have been met.
Research limitations. The scenario of managerial approaches was carried out in a strategic partnership with MCHD, proved to be viable only in the conditions of the city of Moscow.
Conclusion. The problems of precision medicine have been solved and the sustainable provision of laboratory services to the population by the clinical diagnostic laboratories of the MCHD has been ensured.
Compliance with ethical standards. The study was approved at a meeting of the Scientific and Methodological Council of the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, 115088, Russian Federation in Moscow, protocol No. 5 dated May 17, 2022, the materials of the completed study meet the requirements of the Code of Ethics for conducting research in the field of healthcare institutions and public health, developed in the, on compliance with ethical standards in the process of preparing a study, respect for human rights in relation to respondents and researchers themselves, compliance with a social portrait and the necessary training of interviewers.
Contribution of the authors:
Tsibin A.N. — concept and design of the study;
Latypova M.F. — collection and processing of material, writing the text;
Komarov A.G. — writing text;
Slutsky E.A. — collection and processing of material;
Ivanushkina O.I. — compiling a list of references.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. Organizational measures and logistical support of subordinate clinical diagnostic laboratories were carried out with the support of the Moscow Department of Health.
Conflict of interests. The authors declare no conflict of interest.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
466-472
Characteristics and analysis of the costs of drug provision of patients with non-alcoholic fatty liver disease in Moscow
Resumo
Introduction. The change in the classical etiological paradigm of hepatocellular carcinoma has led to the fact that non-alcoholic fatty liver disease is now the fastest growing cause of hepatocellular carcinoma in the world.
Purpose. To study the range of medicines and analyze the costs of drug provision for a determined population of patients with non-alcoholic fatty liver disease in Moscow over a three-year period.
Materials and methods. Based on data from the Moscow Department of Health on preferential drug coverage for the period from 2019 to 2021 the range of drug therapy and the economic costs.
Results. For 3 years, seventeen thousand two hundred ten patients with a diagnosis of non-alcoholic fatty liver disease received preferential drug coverage in Moscow, and the amount of costs minus payment by the patient amounted to 49,102,963.97 rubles. The most prescribed drugs were drugs from the group of “hepatoprotectors”. An increase in the population of patients with non-alcoholic fatty liver disease over a three-year period by 1.7 times, an increase in the cost of its drug provision. Along with this, the prevalence in the spectrum of drugs was revealed: glycyrrhizic acid + phospholipids; phospholipids; ursodeoxycholic acid; ademetionine is not found in international practice and is not funded under the nosology “non-alcoholic fatty liver disease”.
Limitations. When studying options for drug provision of patients with non -alcoholic fatty liver disease, we had an assessment of 17,210 observations, which is a sufficient reference sample.
Conclusion. Analysis of the qualitative and quantitative composition of the population of patients with non-alcoholic fatty liver disease can be an effective tool for predicting the social and economic burden of the disease and can be used for rational planning of budget expenditures of all levels.
Compliance with ethical standards. The study does not require the submission of the conclusion of the Biomedical Ethics Committee.
Contribution of the authors:
Kornilova E.B. — concept, research design, collection and processing of material, writing text, compiling a list of references;
Kholovnya-Voloskova M.E. — concept and design of research, writing text, statistical data processing.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
473-477
Assessment of the role of unhealthy diet and low physical activity in the development of diabetes mellitus and cardiovascular complications (literature review)
Resumo
The presented review is based on a generalization of epidemiological, demographic and country studies and expert materials of the World Health Organization (WHO), the European Observatory on Public Health Systems and Policies in the Field of Public Health and an analysis of existing and progressive medical and social problems associated with the growth of overweight, obesity and metabolic-associated diseases among the population, including diabetes mellitus. The search and selection of articles was carried out using the information databases Scopus, Web of Science, Medline, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI, materials published in WHO bulletins. Non-compliance with the principles of a healthy diet, low physical activity are considered risk factors for the development diabetes of type 2. The above analysis shows that such modifiable risk factors as improper, unbalanced diet, low physical activity are trigger risk factors for the development of obesity and metabolically associated diseases, in particular, diabetes mellitus type 2 with subsequent cardiovascular complications. At the same time, the five-year risk of developing new cases of diabetes type 2 is high, which entails early disability and, according to experts, the economic costs of providing medical care.
Strategies aimed at reducing risk factors for diabetes mellitus type 2 and cardiac vascular diseases should be focused on lifestyle correction, improving diet, and increasing physical activity.
Contribution of the authors:
Oynotkinova O.Sh. — the concept of the article, writing the text, editing;
Kuraeva V.M. — writing the text;
Esin E.V. — research concept and design;
Gusarenko S.A. — collection and processing of material, compilation of the list of literature.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.
Acknowledgment. The study was not sponsored.
Conflict of interest. The authors declare no conflict of interest.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
478-483
PROBLEMS OF SOCIALLY SIGNIFICANT DISEASES
The use of modern digital technologies in predictive analysis of risk factors for premature death due to socially significant non-communicable diseases (literature review)
Resumo
The effectiveness of the implementation of the Concept of predictive, preventive and personalized medicine is directly related to the development and scaling of the process of digitalization of healthcare with the leading position occupied by artificial intelligence technologies (AI technologies). This fully applies to the problem of predictive analysis of risk factors for premature death from socially significant non-communicable diseases (NCDs).
The purpose of the work was to summarize the current domestic and foreign experience of using AI technologies and machine learning (ML) in predictive analysis of risk factors for premature death from socially significant non-communicable diseases.
The search for publications was carried out in the RSCI, CyberLeninka, eLibrary, and PubMed databases containing domestic and foreign sources of scientific information. The search depth covered period from 2011 to 2021. More than 50 sources of scientific information were analyzed.
The article briefly reports on the global risk factors (RF) of premature death due to NCDs, the main place among which is occupied by diseases of the circulatory system. The disadvantages of calculators used in mass examinations to determine the total risk of fatal cardiovascular events (CVE) are considered ¾ Framingham scale and SCORE scale. It is shown that the individual predictive efficiency of calculators can be increased due to ML technologies that use big data on the health status of the population in certain regions, digitalization of medical images, and expansion of structured databases of the RF spectrum, which makes it possible to recognize and take into account complex relationships between multiple, correlated, and nonlinear RF and CVE outcomes. Examples of the predictive effectiveness of ML models are given. Special attention is paid to AI technologies and deep ML in the stratification of CVE risk and outcomes based on the analysis of images of the fundus the eye.
Conclusion. The introduction of AI technologies and ML in clinical practice opens up the prospect of achieving an effective individualized stratification of the risk of premature death due to chronic NCDs and their factor of personalized prevention through timely optimization of socially significant diseases modifiable by the F.
Contribution of the authors:
Bezrukova G.A. — research concept, collection and processing of material, writing the text, compilation of the list of literature, editing;
Novikova T.A. — collection and processing of material, writing the text, compilation of the list of literature.
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 12, 2022
Accepted: September 07, 2022
Published: December 12, 2022
484-490
PREVENTION OF NONINFECTIOUS DISEASES
Comprehensive analysis of the trend in main indicators of the health of the adult population suffered from chronic non-communicable diseases with the preventive activity of medical institutions
Resumo
Purpose. The relevance of the study is determined by the high incidence of chronic non-communicable diseases (CNCD) and the mortality of the working population.
Materials and methods. As part of an observational study, morbidity and mortality due to CNCDs in the adult population of the Saratov region, the trend in the medical examination index and medical prevention activity over 2011–2020 were analyzed.
Results. Analysis of trends in morbidity and mortality due to chronic NCDs for 2011–2020 showed the gain. Respiratory diseases are leading in their structure (chronic bronchitis, emphysema — an increase by 200 cases (+200%), obstructive pulmonary disease — 200 (+50%), asthma — 0 (0%)), obesity — 100 (+62,5%), diseases of the circulatory system (DCS) — 1330 (+35,5%), diseases characterized by high blood pressure — 460 (+39,3%), coronary heart disease — 750 (+98,7%) cerebrovascular diseases — 190 (+19,6%); type II diabetes — 50 (+17,8%), malignant neoplasms — 50 (+12,2%). In the structure of total mortality the share of CNSD in 2011 was 51%, neoplasms — 12,6%, and in 2020, CNSD of tumor formations amounted to 49,4% and 12,6%, respectively. Increase in deaths due to neoplasms (15,8%), CNSD (12,2%) in 2020 compared to 2011, and compared to 2019 due to diabetes mellitus (+90.8%), diseases of the respiratory system (+44,4%), CSD (+17,2%), in particular, coronary heart disease (+27,7%), cerebrovascular diseases (+2,7%), malignant neoplasms (–1,6%).
Limitations. The study has regional (Saratov region) limitations.
Conclusion. Primary morbidity and mortality rates reflect an unfavourable prognosis for CNCDs in the adult population of the Saratov region. This justifies the analysis of health care and the development of highly effective methods of prevention and treatment and rehabilitation measures aimed at maintaining health and extending the working longevity of the population.
Compliance with ethical standards. The study does not require submission the opinion of the biomedical ethics committee or other documents.
Contribution of the authors:
Zaikina I.V. — research concept and design, data processing, text writing;
Komleva N.E. — research concept and design, editing;
Mazilov S.I. — text writing, statistical processing;
Dolich V.N. — text writing, registration;
Medentsov V.A. — text writing, 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 no conflict of interest.
Received: 12.08.2022
Accepted: September 07, 2022
Published: December 12, 2022
491-498
CHILDREN AND ADOLESCENTS’ HEALTH
Clinical, laboratory and ultrasound characteristics of autoimmune thyroiditis in the children’s population of territories with the location of metallurgical enterprises
Resumo
Introduction. The combination of iodine deficiency and the negative impact of environmental factors determines the pathomorphism of thyroid diseases, including autoimmune thyroiditis (AIT).
The purpose of the study was to establish clinical, laboratory, and ultrasound features of autoimmune thyroiditis in children living under the influence of metallurgical production.
Materials and methods. AIT children residing in the zone of influence of the enterprises of the metallurgical industry (one hundred two cases) and outside the exposure zone (46 people) underwent a comparative analysis of the results of clinical and laboratory research, ultrasound imaging of thyroid gland tissues.
Results. During the period 2010–2020, the increase in the incidence of thyroiditis in the territory with metallurgical production enterprises exceeded the average indicator in the Perm region by 1.5 times. Children from the test group had concentrations of lead, manganese, nickel, chromium and zinc in their blood higher than the regional background level. These elevated concentrations were detected in them by 1.7–5.5 times more frequent than in their counterparts from the reference group.
The number of AIT cases elevated by 2 times in the exposed boys; diffuse lesions of the thyroid gland and combination of AIT with other diseases, by 1.3 times (р = 0.03–0.04). Levels of IgA and IgG in blood serum were by 2.7 times higher in the test group (р = 0.015–0.043); TSH contents, by 2.3 times higher (р = 0.096); free T4 contents, by 5.4 times lower (р = 0.057).
Limitations of the study. Children living at the only one subject of the Russian Federation; a comparatively small sampling; selected study of compounds with direct thyreo-cytotoxic effects
Conclusions. Incidence of thyroid gland diseases and thyroiditis in territories with developed metallurgic industry is higher than on territories with a relative favorable sanitary-hygienic situation. Children with elevated contents of metals in their blood had disorders of thyroid and immune status, thyroid gland disease and concomitant damage to other systems in the body. The mathematical relationships indicate the possible influence of metals on the formation of AIT.
Compliance with ethical standards. The study program was approved by the ethics committee of the Federal Scientific Center “Medical and Preventive Health Risk Management Technologies” (protocol No. 3 dated of March 01, 2017). All patients their legal representatives were informed about the purpose of the study, and voluntary informed consent was obtained from legal representatives.
Contribution of the authors:
Shtina I.E. — concept and design of the study, collection and processing of material, statistical processing, text writing;
Luzhetsky K.P. — text writing;
Valina S.L. — concept and design of the study, text writing;
Zenina M.T. — collection and processing of material, statistical processing;
Ustinova O.Yu. — text writing.
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 funding.
Conflict of interests. The author declares no conflict of interests.
Received: August 12, 2022
Accepted: September 07, 2022
Published: December 12, 2022
499-504
The prevalence of respiratory diseases associated with herpes infection under conditions of aerotechnogenic exposure to chemicals in children
Resumo
Introduction. Respiratory diseases consistently occupy a leading position in the structure of pediatric pathology.
Materials and methods. We performed clinical examination of 5–17 years four hundred ninety six children living at a large industrial center, on a territory with a relatively favourable sanitary-hygienic situation. The examination involved establishing markers of Herpes simplex, and chemical and analytical blood tests aimed at determining contents of technogenic chemicals in it.
Results. In 29.7–66.1% children living in the industrial center elevated blood levels of benzene, p-, m-xylene, manganese and zinc are recorded relative to background levels. Up to 77.6% of children in the observation group had markers of the virus Epstein–Barr, cytomegalovirus, 48.2% — Herpes simplex virus type 1.2. In ¾ of children, respiratory diseases are represented by inflammatory diseases of the nasal mucosa (53.4%) and chronic lymphoproliferative pathology of the nasopharynx (58.2%), associated with increased blood levels of chemicals and the level of markers of Herpes simplex type 1.2, virus Epstein–Barr. The risk of developing chronic lymphoproliferative pathology in children of the observation group is 1.3 times higher. In 39.8% of cases, an intrasystemic comorbidity of respiratory diseases is formed. In 29.1–48.5% of children with respiratory pathology, thyroid diseases, vegetative dystonia, functional heart pathology are registered due to the combined effect of elevated blood levels of aromatic hydrocarbons, formaldehyde, metals and the level of markers of Herpes simplex type 1.2, virus Epstein–Barr. Under conditions of aerogenic pollution with technogenic chemical factors, the risk of developing intra-system and inter-system comorbidity increases up to 1.6 times.
Limitations. The study was conducted in 5-17 years children on a representative sample.
Conclusion. In conditions of aerotechnogenic exposure to chemicals, the prevalence of respiratory diseases associated with herpes infection in children is higher, which must be taken into account when carrying out preventive measures.
Compliance with ethical standards. Clinical trials were approved by the Ethics Committee of the Federal Scientific Center for Medical and Preventive Health Risk Management Technologies (protocol № 2, 25.01.2021). Before the examination, voluntary informed consent was obtained from the legal representatives of the children.
Patient consent. Each participant of the study (or his/her legal representative) gave informed voluntary written consent to participate in the study and publish personal medical information in an impersonal form in the journal "Zdravookhranenie Rossiiskoi Federatsii (Health Care of the Russian Federation, Russian journal)".
Contribution of the authors:
Ustinova O.Yu. — editing;
Zaitseva N.V. — research concept and design;
Maklakova O.A. — material collection and processing, statistical processing, writing the text;
Valina S.L. — statistical processing, writing the text, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: August 12, 2022
Accepted: September 07, 2022
Published: December 12, 2022
505-512
TOPICAL ISSUES OF HYGIENE
Structural and functional features of the myocardium in residents of the industrial region of the Far North under the exposure to nickel and arsenic
Resumo
The study of the role of chemicals of industrial origin in the development of cardiovascular pathology determines the relevance of this study.
The purpose of the work is to study the features of cardiac structural and functional disorders in residents of the industrial region of the Far North under the exposure of nickel and arsenic.
Materials and methods. The study included one hundred fifty eight women living in the industrial center of the Far North with the location of large metallurgical enterprises (observation group) and 65 women living in similar climatic and geographical conditions, but without the location of industrial enterprises (comparison group). An echocardiographic study was carried out with the measurement of structural and doppler parameters of the heart on an expert-class ultrasonic scanner “Vivid q”.
Results. In the observation group the values of myocardial performance indices (MPI) values for mitral annulus (0.55 ± 0.09 vs. 0.48 ± 0.07, p=0.005) and tricuspid annulus (0.57 ± 0.10 vs. 0.48 ± 0.06, p=0.001) were higher than in the comparison group. A gain in the concentration of nickel in the blood is associated with an increase in isovolumic relaxation time (IVRT) of the mitral atrioventricular ring (p=0.0001) and systolic pressure in the pulmonary artery (p=0.00002). An increase in the concentration of arsenic in the blood is associated with an increase in the filling pressure of the left ventricle (E/Em) and end diastolic diameter of the left ventricle (EDD LV) (p=0.0001), the diameters of the right ventricle (RV) and right atrium (RA) (p=0.0001), and rate of late diastolic filling of the RV and MPI of the tricuspid atrio-ventricular ring (p=0.0001).
Limitations. This study did not include middle aged and elderly women, and also did not include male patients and did not include the population of other territories except the Far North.
Conclusion. The revealed changes in echocardiographic parameters indicate subclinical dysfunctions of the myocardium of the left and right ventricles, affecting both systolic and diastolic function in residents of the industrial city of the Far North, living under the influence of nickel and arsenic.
Compliance with ethical standards. The study program was approved by the ethics committee of the FBSI «Federal scientific center for medical and preventive health risk management technologies» (protocol No. 10 dated June 05, 2019).
Patient consent. Each participant of the study (or his/her legal representative) gave informed voluntary written consent to participate in the study and publish personal medical information in an impersonal form in the journal "Health Care of the Russian Federation".
Contribution of the authors:
Nosov A.E. — collection of material, statistical processing, text writing;
Ustinova O.Yu. — concept, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.
Acknowledgment. The study had no sponsorship.
Conflict of the interest. The authors declare no conflict of interest.
Received: August 12, 2022
Accepted: September 07, 2022
Published: December 12, 2022
513-520
OCCUPATIONAL MEDICINE
Features of the profile of the professional crisis of medical workers with professional deformities in the context of the COVID-19 pandemic
Resumo
Introduction. The specifics of the professional activity of medical workers in the context of the COVID-19 pandemic, in the presence of stressful factors of production situations, negatively affects the professional profile of specialists and leads to the opportunity of a professional crisis.
Purpose. To identify the features of the profile of the professional crisis of medical workers with professional deformities in the context of the COVID-19 pandemic.
Materials and methods. The study conducted on 816 medical workers with occupational deformities included questionnaires on the personality profile of the crisis by A.E. Taras and on burnout by C. Maslach & S. Jackson, K. Pearson’s correlation criterion, descriptive statistics and Chaddock’s table to reveal the tightness of correlation processes.
Results. The main features of the profile of the professional crisis of medical workers with deformities in the professional field include a high level of functional disorders of cardiac activity and the activity of the gastrointestinal tract; functional disorders of breathing, autonomic system, thinking, sleep; symptoms of anxiety and increased emotionality; attempts to escape from problems, and depressive mood coloring.
Limitations. When studying the characteristics of the profile of the professional crisis, a psychodiagnostic study was conducted using the author’s methods on a sample of 816 voluntarily participating medical workers with professional deformities in the context of the COVID-19 pandemic, which is a sufficient reference sample.
Conclusion. In the context of the COVID-19 pandemic, the grading of deformations in the professional field of medical workers will contribute to: normalization of the activity of the autonomic, respiratory and cardiovascular systems, and the gastrointestinal tract; harmonization of the sleep-wake cycle; reduction of depression, attempts to escape from problems, tension, complications of thinking, anxiety.
Compliance with ethical standards. Voluntary informed consent obtained from adult medical professionals. The study was managed and conducted in accordance with the Code of Ethics on February 14, 2012, and was also carried out in full compliance with ethical principles: competence, responsibility, respect, honesty.
Contribution of the authors:
Polyakova O.B. — concept and design of the study, collection and processing of material, writing text, compiling a list of references, statistical data processing;
Bonkalo T.I. — organization of research, scientific supervision, 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 interest. The authors declare no conflict of interest.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
521-528
PROBLEMS OF MEDICAL EDUCATION
Teaching of individual disciplines during the training of residents in the specialty «Health organization and public health»
Resumo
Introduction. In the interests of the formation of professional competencies (PC), several mandatory basic and variable academic disciplines are used, which educational organizations formulate independently in the volumes established by the educational standard.
The purpose of the study is to analyze the compliance of the professional competencies of the Federal State Educational Standard in the disciplines of the residency program in the specialty «Health Organization and public health», to propose the topics of some disciplines of the basic and variable parts of the training program.
Materials and methods. The material for the analysis was the professional competencies set out in the Federal State Educational Standard 31.08.71 «Health organization and public health», the labor functions of the professional standard «Specialist in the field of health organization and public health», the tasks and topics of some disciplines of the mandatory and variable parts of the residency program.
Results. The considered professional competencies (PC) fully correspond to the goals and objectives of the discipline «Healthy lifestyle and disease prevention» and are not directly related to the discipline «Microbiology». The most appropriate professional competence for the discipline «Emergency Medicine» is «readiness to organize medical care in emergency situations», does not fully correspond to the labor function defined by the professional standard.
Limitations of the study. Research is limited by the number and features of the disciplines taught.
Conclusion. For the discipline «Emergency Medicine», adjustment of professional competence is required in accordance with the requirements of the professional standard, and the proposed subject of the discipline «Microbiology» can be studied in other disciplines of the residency program, which will be relevant in connection with the introduction of the new Federal State Educational Standard in 2023, where it is noted that professional competencies are determined by the educational institution independently.
Compliance with ethical standards. Research does not require the submission of a biomedical ethics committee opinion or other documents.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The author declares no conflict of interest.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
Введение
529-534
New institutes for assessing the qualifications of medical specialists: functions and significance
Resumo
Introduction. Accreditation and certification for the qualification category are the main institutions that provide assessment of the qualifications of medical specialists. Nevertheless they are not effective enough. Therefore, hopes are pinned on new institutions, namely an independent assessment of qualifications and certification for obtaining the status of “Moscow Doctor”.
The purpose of the study is to identify to what extent the institutes of independent assessment of the qualifications (IAQ) of medical specialists and their certification for the status of a Moscow doctor correspond to the purpose based on the analysis from the point of view of the functions performed and the approaches implemented to the assessment of qualifications.
Material and methods. The study was based on regulatory documents of the Ministry of Health of the Russian Federation, the Ministry of Labour and Social Protection of the Russian Federation and the Government of Moscow. The statistical base was made up of data from Rosstat and departmental statistics of the Moscow Department of Health, and materials of sociological surveys conducted by the method of expert interviews.
Results. The institute of IAQ is at an experimental stage. The analysis of the pilot projects was carried out in two directions: what functions the institute should perform and what circumstances caused the delay in its implementation. It is established that this institute does not provide specialists with a significant social status. The prolonged terms of its development are caused by managing difficulties, including the long approval of professional standards. The certification for the status of “Moscow doctor” introduced into practice is similar in function to the certification for the qualification category and can be considered as its element of a higher level.
Limitations. The study of new institutions for assessing the qualifications of medical specialists is limited to an analysis of their functions. The expert interview method is not designed to obtain quantitative estimates.
Conclusion. New institutes of qualification assessment have actualized a number of controversial issues. This is a question of a preferred assessment based on a specialty (accreditation) or position (IAQ). The Institute of certification for the status of “Moscow Doctor” made a contribution to the discussion on the preservation or cancellation of certification for the qualification category.
Compliance with ethical standards. The study was approved by the Scientific and Methodological Council of the State Budgetary Institution «Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department», Protocol No. 5 dated of 17.05.2022.
Contribution of the authors:
Toksanbaeva M.S. — the concept and design, editing; compilation of the list of literature, writing the text;
Kolennikova O.A. — collection and processing of the material, statistical data processing, statistical data processing, writing the text.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.
Acknowledgement. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interests.
Received: August 12, 2022
Accepted: September 07, 2022
Published: December 12, 2022
535-541
DISCUSSIONS
International aspects of anti-vaccination attitude: implications for public health (literature review)
Resumo
Successful immunization programmes are the result of high vaccine effectiveness and timely use. Numerous studies have shown that immunization will be effective with government support, taking into account the local culture of the population, and approaches to vaccination to optimize results.
Purpose. Summarize the world’s data on existing immunization programs and their accompanying problems. Literature search methods included search queries, in the form of a set of keywords «vaccination/vaccine», «immunization», «anti-vaxxers», «pandemic», «public health» followed by full-text sources, Web of Science, Scopus, MedLine, The Cochrane Library. In the information retrieval systems, the analysis of the results was carried out, taking into account full compliance with the specified criteria of search among documents and sites.
Unlike most medicines, which have limited benefits, vaccines prevent serious diseases and their public health consequences. Immunization outcome is determined by assessing the impact directly on the vaccinated person, indirectly on the unvaccinated community. The success of immunization depends on a level of universal coverage sufficient to interrupt pathogen transmission. Declines in immunization coverage will lead to a resurgence of diseases and new outbreaks with significant gain in the morbidity and mortality rate. In many cases, refusal to vaccinate is the result of people listening to beliefs and copying the behavior of others. An important consequence of this misperception is the potential involvement in the spread of an infectious pathogen due to the false belief that “vaccination is harmful”.
Thus, ensuring the success of the continuity of immunization programs is the responsibility of citizens, health professionals and government, among others.
Contribution of the authors:
Pivovarova O.A. — research concept and design, collection and processing of material, writing the text, compilation of the list of literature;
Kuraeva V.M. — 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: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
542-548
LETTERS TO EDITOR
Histoscan-guided targeted biopsy of the prostate
Resumo
Introduction. Prostate cancer is the second most commonly diagnosed malignant neoplasm in men. The development of technologies requires the study of advanced research methods, an extraordinary, new limited-invasive method for diagnosing cancer — histoscanning of the prostate. Histoscan is an innovative imaging technique that is potent of differentiating between benign and malignant areas within the examined prostate tissue. With the new “True Targeting” software, it is possible to perform a “targeted” biopsy in real time.
Purpose. To determine the efficacy and safety of performing histoscan-guided targeted biopsy of the prostate.
Materials and methods. The prospective study with the inclusion of data from 2501 patients examined at the Clinic of urology of the Moscow State Medical University named after A.I. Evdokimov at the Municipal Clinical Hospital named after S.I. Spasokukotsky.
Results. The average age of the patients was 66 years, the level of prostate specific antigen was about 14,39 ng/ml, the volume of the prostate was 54,43 cm3. The overall incidence of prostate cancer was 53,38%, with a biopsy of 12 points — 52,1%, while with a targeted biopsy— 37,58%. Among the biopsy complications, hemospermia (Clavien–Dindo — I) was most often (33% of cases), hematuria (Clavien–Dindo — I–II) in 15% of cases. No serious complications were identified.
Limitations. As restrictions, the following were identified: prostate biopsy-subject, 2501 patients — a quantitative parameter, patients with suspected prostate cancer — a qualitative indicator.
Conclusion. The published results of the study showed that histoscan-guided biopsy ofthe prostate is safe, effective, and therefore has alarge potential in cancer diagnosis, as it helps both in choosing a treatment method and in planning the course of further surgery.
Compliance with ethical standards. The study was approved by the Interuniversity Ethics Committee of Moscow, extract from protocol No. 12-20, dated 11.19.2020. All patients signed an informed consent to participate in the study.
Contribution of the authors:
Kim Yu.A. — material collection and processing, writing the text;
Govorov A.V. — research concept and design, editing;
Vasilyev A.O. — research concept and design, editing;
Pushkar D.Yu. — research concept and design;
Khatkov I.E. — research concept and design.
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: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
549-554
Improving evaluations and management of the appropriate application of modern anticancer drug therapy
Resumo
Introduction. Evaluation and further improvement of the use of resources of the oncological service (including drug therapy) can lead to a subsequent qualitative gain in the availability of new types of effective antitumor technologies for a larger number of patients with severe oncological pathology. The experience of the Netherlands in managing the cancer care is useful for the local regional health services.
Purpose of the study. Study of approaches to economically and clinically feasible use of anticancer therapy in real hospital practice.
Material and methods. The scientific study was performed on the base of the search results in the databases of the Dutch digital educational platform, in the PubMed/Medline database and the Google search engine. The queries used the words: doelmatigheid, kanker, doelgerichte therapie, rationality, cancer, targeted therapy, etc. We analyzed the results published in 2021–2022.
Results. There hаve bеen studied methods for increasing the expediency of clinical application of therapeutic regimens in oncology including a) rationalization of chemotherapy regimens; b) ensuring the mobility of patients receiving chemotherapy: chemotherapy on the principle of “connect and go” technology, self-administration of anticancer drugs; c) lean use of immunotherapy: drug therapy shelf life extension, vial count rounding and immunotherapy hybrid dosing; justified reduction in the duration of the course of immunotherapy.
Limitations. In general, initiatives being put forward to improve the appropriateness of anticancer therapy should be previously tested in pilot projects.
Conclusions. If positive opinions are received from expert institutions and regulatory authorities based on the results of pilot projects, innovative schemes for the appropriate use of drugs can be included in the list of services and programs reimbursed by the health insurer on an ongoing basis.
Compliance with ethical standards. The study does not require submission the opinion of the biomedical ethics committee or other documents.
Contribution of the authors:
Andreev D.A. — material collection and processing, collection of literature data, compilation of the list of literature, writing the text;
Zavyalov A.A. — research concept and design, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: July 18, 2022
Accepted: September 07, 2022
Published: December 12, 2022
555-560
Регистрационный номер и дата принятия решения о регистрации СМИ: ПИ № ФС77-50668 от 13.07.2012 г.