DYNAMICS IN INCIDENCE OF DISEASES OF THE CIRCULATORY SYSTEM AMONG ADULTS IN THE RUSSIAN FEDERATION IN 2007-2019

Significance. Diseases of the circulatory system remain one of the leading causes of death and morbidity of the adult population. Over the years, the efforts of the State aimed at controlling diseases of the circulatory system have made the contribution of this disease class to the total mortality in Russia gradually reduce. Nevertheless, diseases of the circulatory system remain the leading ones among diseases, characterized by a steady growth and rapidly increasing prevalence among the population. The purpose of the study is to analyze dynamics in incidence and prevalence of the diseases of the circulatory system among the Russian adult population in 2007-2019. Material and methods. The study used data of the statistical collections of the Ministry of Health of the Russian Federation and the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of Russia: "Morbidity of the adult population of the Russian Federation" for 2007-2019. The study, which is a continuous statistical observation, used the method of direct ranking, calculation of indicators of time series. Results. Diseases of the circulatory system in 2019 ranked fourth in the incidence structure of the adult population (8%), while its prevalence ranked second to none (21%). Over 13 years, the incidence of diseases of the circulatory system in adults increased by 42% (2007-2019) while its prevalence increased by 24%. The highest levels of incidence of diseases of the circulatory system in 2019 are registered in the Krasnodar Territory (9,024.3 per 100 000 population, + 324%), the Kurgan Region (7,404.2, + 103%) and the Karachayevo-Circassian Republic (7 286.2, + 268%), and prevalence - in the Altai Territory (52 557.6, + 2%), the Chuvash Republic (51 814.6, + 38%) and the Voronezh Region (45 339.4, + 59%). The maximum rates of increase in morbidity with diseases of the circulatory system from 2007 to 2019 are registered in the South Federal district (incidence - by 119%, prevalence - by 56%), among the constituent entities of the Russian Federation: incidence - in the Krasnodar Territory (by 324%), prevalence – the Karachayevo-Circassian Republic (by 136%). According to the state statistical reporting, on average, every 7th acute myocardial infarction is complicated by recurrent heart attack in Russia. Conclusions. Throughout the study period of 13 years, the leading nosological forms include: Hypertensive diseases (35%; 45%, respectively), Ischemic heart diseases (22%; 21,6%) and Cerebrovascular diseases (23%; 20%). Over half of the diseases of the circulatory system are registered in the older working ages (55-60 and over). Scope of application. The study results can be useful to regional authorities in public health in planning and implementing regional programs aimed at controlling diseases of the circulatory system.

CAUSES OF CONFLICTS IN DENTAL PRACTICE, WAYS TO PREVENT AND RESOLVE THEM

Significance: the number of conflicts related to realization of the right to health and medical care especially in such specific branch of medicine as dentistry has recently been on the rise in Russia. Furthermore, among the main fields of social interaction, a large number of interpersonal conflicts does relate to professional activity. Subject of research: conflicts and conflict situations in dental practice. Purpose of work: to identify main groups of causes of conflict situations and conflicts in dental practice and suggest ways to prevent and resolve them. Material and methods: questionnaire survey of dentists with additional interview of the respondents, mathematical and statistical data analysis using the SPSS Statistics software (Pearson chi-square tests, Kruskal-Wallis tests). Results: The majority of the respondents (59.0%) say that they have never had any conflicts with the administration. The leading cause of disagreement is dissatisfaction with the material base and supplies (35%). The prevailing share of the dentists (61.5%) indicate that conflicts between them and a colleague / nurse have never occurred. The main cause of the conflict communication is insubordination or lack of subordination, especially in rural areas and public facilities. Doctors of public healthcare facilities and dentists working in rural areas were more often in conflict with a colleague or manager. Almost all health workers (98%) note that they have encountered conflict patients. The main cause of the conflict communication is long waiting for a dental appointment (33.3%). Out of all factors influencing the relationship, about half of the respondents (53.0%) mentioned the emotional state of the patient. Out of all behavior strategies in conflicts, the majority of dentists (44%) prefer cooperation. Conclusion: Almost all (98%) dentists came into conflict with the patient. The main causes of these conflicts included: long waiting times for admission (33.3%), irrational work of the registry, the administrator (23.1%) and complaints about the quality of services (22.2%). Medical workers with average work experience (10-29 years) were more likely to conflict with the patient about claims to the quality of treatment (31.3%).

DYNAMICS IN ABORTIONS AMONG MINORS IN THE RUSSIAN FEDERATION IN 2015-2019

Significance. Analysis of literary sources indicates the need and importance of preventive work among minors on adherence to healthy lifestyle, which is one of the fundamental factors for preventing pregnancy in children under 18. This work has a number of features and involves cooperation between many specialists, while organization of this work in healthcare facilities is rather tricky due to legislation and requires appropriate competencies of the doctor and challenges his or her professional performance. Preventing pregnancies in minors requires special competencies and skills to work with minors and their families and is a criterion for care organization in the subject of the Russian Federation. The purpose of the study is to analyze dynamics in abortions among minors in the Russian Federation in 2015-2019. Material and methods. The analysis included data from literature sources (n=101 for the last 5 years, including 13 sources included in the reference list). The study analyzed statistical indicators for 2015-2019 from collections of the Department of Health Monitoring, Analysis and Strategic Development of the Ministry of Health of the Russian Federation and "Basic indicators of maternal and child health, performance of Mother and Child services in the Russian Federation of the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation. The growth/decline rates of indicators were calculated. Results. Analysis of the dynamics in abortions among minors in 2015-2019 showed that the lowest rates were registered in the North Caucasus and Southern Federal Districts, while the highest ones - in the Far Eastern, Siberian and Northwestern Federal Districts. The Sakhalin, Magadan and Amur regions lead in high rates of abortions among minors. Conclusion. Prevention of abortions in minors calls for a comprehensive doctor’s work aimed at preventing pregnancy and an integrated approach in medical organizations. Therefore, the abortion rate in minors should be considered as a criterion for organizing preventive work in healthcare facilities when providing medical care in outpatient settings.

Patient satisfaction with rheumatological outpatient care in the Republic of Bashkortostan

Due to high prevalence of rheumatic diseases, which are often characterized by a chronic, progressive course and early patient disability, the problem of health care quality in rheumatology remains extremely relevant. The purpose of the study was to analyze patient satisfaction with availability and quality of rheumatological outpatient care provided by health care facilities of the Republic of Bashkortostan. A survey of 289 adult patients who visited a rheumatologist for outpatient care at health care facilities of the Republic of Bashkortostan was conducted from May,1 to December,1, 2019 The study results show that in general patients expressed high satisfaction with the services provided and conditions of health care facilities (77% and 78%, respectively). At the same time, satisfaction with doctors’ professional skills was moderate (54%), while satisfaction with the organization of making a rheumatological appointment and official website of the facility was low (37% and 29%, respectively). In general, the data obtained indicate that patients highly appreciate quality of rheumatological outpatient care in the Republic of Bashkortostan. However, the need to further improve professional competencies of doctors, organization of scheduling appointments and official websites of health care facilities call for a special attention.

WHICH HEALTH FINANCING MODEL IS BETTER: TAX-FINANCED OR SOCIAL HEALTH INSURANCE? WHAT DOES INTERNATIONAL EXPERIENCE PROVE?

In Russia disputes on the need to abandon Compulsory Health Insurance (CHI) and return to the tax-based financing are yet to subside. At present, after the statement of the President of the Russian Federation V. Putin about the possibility to establish a state health care corporation, discussions on the issue have only escalated. Purpose. To conduct a comparative assessment of the public health financing model impact on the access and structural characteristics of health care delivery in the developed countries. Material and methods. Assessment of the potential impact of public funding models on the health system performance is carried out by analyzing variations in the main indicators of financial access, health care uptake and health status of the population, achieved in the developed countries with different health financing models. Results. Health care expenditures in countries with CHI are higher than in countries with the tax-based financing model. In countries with CHI the share of administrative expenses is slightly higher than in countries with the tax-based financing system. The share of spending on preventive care is slightly higher in countries with the tax-based financing system. There is a slightly lower level of outpatient and inpatient care uptake in countries with the tax-based financing system compared to countries with CHI. The premature mortality rate in countries with CHI is slightly lower than in countries with the tax-based system. Conclusion. The obtained data indicate that there are no significant differences in the access and structural characteristics of medical care in the health care system of the developed countries with different financing models. The main difference remains the level of health expenditures. In countries with CHI, the level of health expenditures is higher than in countries with the tax-based financing, which is largely due to the existence of a separate source of funding. The level of administrative costs in countries with CHI is also higher than in countries with the tax-based system.

CONCEPTUALIZATION OF THE DIAGNOSED CLINICAL SITUATION COMPONENTS FOR ELECTRONIC MONITORING OF THE TREATMENT QUALITY

Significance. Free care delivery within the framework of the State Guarantee Programs substantiates the development of electronic platforms for information support of doctors in prescribing medicines and monitoring quality of treatment. Conceptualization of the unified information environment of clinical practice, unified interpretation of the terms and components of the diagnosed clinical situations are important conditions for effective performance of the medical electronic platforms. Purpose: to conceptualize the scheme of information environment of clinical practice to support decision-making and monitor quality of treatment. Material and methods. The conceptual schemes of the information environment of clinical practice have been developed in accordance with the system principles. The methodology for constructing conceptual schemes is based on the general principles of philosophical foundations of science. Results. The conceptual schemes, conceptual apparatus, and information environment of structural elements of the model of information environment of clinical practice have been developed. A glossary of general terms and concepts of the information environment of clinical practice has been created. The structural model of information environment was tested at the prototype electronic platforms across different medical specialties. Conclusion. The use of ontologies and intelligent systems based on the expert knowledge in combination with digital coding of the diagnosed clinical situations serve a promising approach to monitor and control quality of care delivery and cost accounting within the framework of the State Guarantee Programs implementation. Scope of application. The concepts of the components of the diagnosed clinical situations meet the requirements of the interdisciplinary level of the information environment and are applicable for creating electronic platforms in various specialized areas of clinical practice.

IMPROVING HEALTH PROTECTION STRATEGY OF THE NUCLEAR INDUSTRY ENTERPRISE PERSONNEL AND POPULATION LIVING WITHIN ITS CATCHMENT AREA

The purpose of the study is to develop approaches to improve the health protection strategy of the nuclear industry enterprise staff and population living within its catchment area in the context of the national project “Healthcare”. The material for the study was information on dynamics in population indicators characterizing health status of the nuclear industry enterprise staff and population living within its catchment area in 1970-2017. Results. The study shows that the analyzed population is characterized by a significant decrease in the birth rate, increased mortality (including people of working age) from diseases of the circulatory system, malignant neoplasms and external causes, population decline, and decreased life expectancy. Conclusion. On the basis of the results obtained, approaches have been developed to improve health protection strategy for the above contingents in the context of the National Project “Healthcare”.

THE STRUCTURE OF EXCESS MORTALITY DUE TO THE NOVEL CORONAVIRUS INFECTION PANDEMIC IN URBAN AND RURAL RESIDENTS

Significance. The pandemic of the novel coronavirus infection has further exacerbated the demographic problem in the Russian Federation, which was especially acute in rural areas. However, according to official data, only one third of the excess mortality in 2020 is accounted for by COVID-19. Purpose: to compare the structure of mortality growth in urban and rural residents and determine differences in loss associated with the COVID-19 pandemic. Material and methods. Based on the Rosstat preliminary data, the author has analyzed increase in the number of deaths per 100,000 population in 2020 compared to 2019 among males and females residing in urban and rural areas of the Russian Federation. The indicators were compared by major classes of death causes and individual diseases across the following three age groups: 15-49 years, 50-64 years, and 65 years and older. Comparison was carried out by the Chi-square test. Results. Among the urban and rural population the death rate increased by 20.6% and 15.4%, respectively; the COVID-19 mortality equaled to 109.4 and 67.5 per 100,000 population; the share of COVID-19 in the increased total mortality added up to 44.6% and 33.0%, respectively. Among urban residents, the frequency of deaths from COVID-19 in males exceeds the female one 1.8 times in population aged 15-49, 2.0 times in population aged 50-64 and 65 +; among rural residents, these values equal to 1.2, 1.4 and 1.8, respectively. Conclusion. In the structure of excess mortality associated with the spread of the novel coronavirus infection that accounted for almost one fifth of deaths in 2019, the share of direct loss due to COVID-19 is underestimated. The direct loss associated with co-infection with SARS-CoV-2 virus can be traced at the population level, starting from the age of 65 in males and 50 years in females, in case of deaths from diseases of the nervous system, coronary heart disease, chronic diseases of the lower respiratory tract and diseases of the pancreas. With a lower level of excess mortality among rural population, its quarter is accounted for by indirect loss due to the pandemic associated with the decreased access to medical care. In the structure of excess mortality among urban population, indirect loss accounts for about one tenth, and is mainly due to consequences of stress associated with the pandemic and forced isolation. Signs of incomplete examination of the deceased in older age groups to determine the death causes, especially among rural residents, have been identified.

DETECTION AND CONTROL OF ARTERIAL HYPERTENSION IS AN EFFECTIVE TOOL FOR REDUCING MORTALITY FROM DISEASES OF THE CIRCULATORY SYSTEM

Significance. Over the last two decades, Russia has been regestering the increased prevalence of high blood pressure among adults. The relationship between blood pressure and mortality from diseases of the circulatory system has been proved. Reducing morbidity and mortality from diseases of the circulatory system calles for improved efficiency of the state health system to detect and control blood pressure at the population level. Purpose. To improve organization of measures aimed at detecting high blood pressure and enhancing control of arterial hypertension in order to reduce adult mortality from diseases of the circulatory system in Russia. Material and methods. The authors have conducted a content analysis of regulatory and legal documents regulating activities of individual structures of the public health system on medical examination and follow-up of patients with chronic non-communicable diseases, registration and reporting forms of the federal statistical surveillance (FSN No. 12) and industry statistical surveillance (No.131/o), including information on the number of adults with arterial hypertension residing within the catchment area of the healthcare facility in dynamics from 2010 to 2019, as well as information on the number of newly diagnosed cases of arterial hypertension during medical examination of certain groups of the Russian adult population in 2015-2019; and the number of patients taken under medical follow-up with the detected (including newly diagnosed) arterial hypertension. Results. During the period from 2010 to 2019, the number of registered patients with arterial hypertension in Russia increased by 5.4 million (46%), from 11.7 in 2010 to 17.1 million in 2019. The rate of growth in the detection of new cases of arterial hypertension actively increased with initiation of the state program on medical examination of certain groups of the adult population (state checkup for non-communicable diseases). Coverage with follow-up of patients with arterial hypertension increased from 905.7 thous. in 2015 (69.5%) to 1321.4 thous. (77.0%) in 2019, including among newly detected cases during medical examination from 74.9 to 83.4%. Decrease in mortality from arterial hypertension, diseases of the circulatory system and total mortality over the period under study (2010-2019) in Russia is primarily associated with the improved detection of arterial hypertension, increased effectiveness of drug treatment and control of arterial hypertension. Conclusion. Improved detection, drug treatment and control of arterial hypertension have contributed to the decrease in mortality from arterial hypertension, diseases of the circulatory system and total mortality in the Russian adults.

COMPARATIVE ANALYSIS OF MACRO- AND MICRONUTRIENT PROFILE OF YOUNG MALES IN THE RUSSIAN NORTHEAST

Significance. According to WHO, unbalanced diet is one of the leading causes of chronic diseases. Adolescence should be considered a person’s life most important period in terms of developing eating habits that define the body macro- and micronutrient intake. The purpose of the study was to assess diet type and balance and specify region-related macro- and micronutrient diet profiles among young Caucasian and Aborigine males in the North-East of Russia. Material and method. ASPON-nutrition software program was used to analyze the availability of proteins, fats, carbohydrates, fiber, vitamins, as well as macro- and microelements in diets of young males residing in the Magadan Region and Chukotka Autonomous District (mean age equals to 17-21 years, n = 278). Results. The study has identified a clear imbalance in the diet characterized by a low intake of the protein-lipid component, a shortage of polyunsaturated fatty acids, and a complete lack of fiber intake against the background of the increased share of mono- and disaccharides as well a deficiency of macro-, microelements and vitamins in the diet. The deviations have proved to be typical of people residing in the city of Magadan, primarily of the young indigenous population who experience a 100 percent nutritional deficit for a number of components.