Possibilities of telemedical monitoring risk factors in patients with cardiovascular diseases: experience of using a patient-oriented model of remote rehabilitation care

Introduction. The modern system for the prevention of cardiovascular diseases and the creation of conditions for the formation and maintenance of a healthy lifestyle (coolant) includes activities in the development of monitoring systems for information on risk factors. Purpose: to assess the capabilities of telemedicine monitoring of cardiovascular risk factors in the structure of a patient-oriented model of distance rehabilitation care. Material and methods. The study included patients with coronary heart disease and/or arterial hypertension of the I-III degree, without cognitive dysfunction and contraindications to physical rehabilitation, with a mobile device with Internet access. The following groups were distinguished: remote cardiac rehabilitation, with the participation of patients in a 12-month program (28 patients, 86% of men, average age 55.2 ± 10.7 years), and traditional follow-up (30 patients, 80% of men, average age 64.7 ± 6.9 years). Remote cardiac rehabilitation model provided for office consulting using a decision support system, monitoring indicators based on digital recording devices, mobile applications and the electronic «Patient Diary» deferred telemedicine counselling. The effectiveness of the observation was evaluated by the trend of the modified risk factors; patient satisfaction with remote assistance - according to the «Client Satisfaction Questionnaire - CSQ-8» questionnaire. Results. After completion of the remote cardiac rehabilitation (RCR) program, a significant decrease in systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol and triglycerides were observed, and a tendency to increase physical activity. Upon completion of the RCR-program, a high level of satisfaction with telemedicine assistance was noted. Conclusion. The results of the pilot phase of the study, dedicated to the study of the possibilities of remote rehabilitation in the context of maximizing the benefits for cardiovascular prophylaxis, indicate the possibility of using a patient-oriented model of remote cardiac rehabilitation to monitor and modify risk factors in patients with cardiovascular diseases.

The impact of socio-economic indices on the incidence of the child population of the Republic of Bashkortostan

Introduction. Over the past two decades, a large amount of data has been accumulated that show the significant impact of social factors on the health of the population. The Republic of Bashkortostan is a large industrial centre and one of the most promising subjects of the Russian Federation. Purpose of the study. Ranking the territories of the Republic of Bashkortostan by priority socioeconomic indices, as well as determining their impact on the health of the child population. Material and methods. As the initial data, the materials of the socioeconomic state of the Republic of Bashkortostan, data on the number and morbidity of the child population for the period 2014-2018 were used. Correlation-regression analysis was carried out, and qualitative assessments of the results obtained were given. The principle of dividing the territory into seven socio-economic zones, taking into account climatic and geographical features, the development of industrial potential and the existing socio-economic ties, was chosen as the basis for the study. Results. The ranking of territories by socio-economic indices in the Republic of Bashkortostan showed that most of the municipalities (over 60%) have a low level of socio-economic development. The most favourable conditions in terms of social comfort for children were found in the southern, central and northwestern economic zones. So, as socio-economic indices improve by 2018, the incidence of the population tends to decrease. Conclusion. Thanks to the data obtained, a number of the most disadvantaged areas in socio-economic development and morbidity in the child population have been identified. In these territories, it is recommended to develop a set of measures to improve and stabilise socio-economic indices.

Promising measures to reduce the mortality in Russia: an analytical review

The purpose of the study was to identify promising measures to reduce mortality in Russia. Methods used included analysis of systematic reviews from PubMed, Web of Science, Scopus, and Google Scholar. Results. Many reasonable measures for reducing mortality in Russia include promoting healthy behaviour (tobacco control, alcohol control, support for healthy diet, physical activity) and preventing death due to external causes. It is necessary to increase the effectiveness of disease management, including arterial hypertension, hypercholesterolemia, diabetes mellitus, cardiovascular accidents, hepatitis C, HIV. This could require intensifying digital transformation of health care, implementing modern teamwork approaches to the patient’s treatment and follow-up with greater involvement of nurses and other personnel. In terms of screening, it is essential to expand coverage and introduce modern, effective screening methods for colorectal cancer, cervical cancer, and neonatal screening. It is necessary to expand vaccination against Covid-19, vaccination of the elderly from Pneumococcus, and adolescents from HPV. Prevention of mortality from external causes should include sets of measures targeted at the prevention of suicides, traffic accidents, fires, drownings, etc., in addition to alcohol control measures. Finally, increasing health care financing, including medication provision, can bring additional years of life. Conclusions. Russia has significant potential to implement new measures to reduce the mortality rate.

Causes affecting the working capacity of patients undergoing coronary bypass surgery (systematic review)

A review of the available domestic and foreign literary sources is presented concerning factors affecting the working capacity of persons after coronary artery bypass grafting. It was found that in Russia, after surgical treatment of coronary heart disease, there is an increase in the number of disabled people compared to foreign data. In recent years, there has been an increase in patients undergoing coronary bypass surgery. However, this did not reduce the increasing number of disabled people after coronary artery bypass grafting, which does not correspond to the initial expectations about the cost-effectiveness of this type of surgery. According to Russian researchers, the proportion of persons with disabilities referred for surgical myocardial revascularization was 39.0-42.5%. Subsequently, this indicator increased to 64.0%. In other countries, the dynamics are different. Among patients under 60 years of age who underwent surgical treatment of coronary artery disease, more than half returned to work. In general, labour activity was restored by 67.5%, and the number of disabled persons decreased from 56.0 to 42.0%. Social and medical factors were assessed to establish the causes of disability after coronary artery bypass grafting. World experience testifies to the critical role of state social support in preserving the labour status of patients, which ultimately justifies the economic costs of surgical treatment. To assess the degree of disability after coronary artery bypass grafting, social status before surgical treatment of coronary heart disease, and the severity of comorbid pathology. To increase the economic efficiency of coronary bypass surgery, it is necessary to organize an affordable and effective rehabilitation program, uniform criteria for referring patients to medical and social expertise.

Medical and organizational approaches to early diagnosis of skin melanoma

Introduction. The most significant problem is the early diagnosis of skin melanoma (SM). In many countries of the world, there is a constant increase in the incidence rate, and the organization of population screening can help solve this problem. Purpose of the study. Evaluation of the use of multi-agent technology in the diagnosis of SM. Material and methods. Study design: at the 1st stage, primary medical documentation was studied - Charts No. 090/y; 027-2/y, statistical reports of the Samara Regional Clinical Oncological Dispensary - Charts No. 7, No. 35, according to the results revealed at stage 2. There was developed and implemented multi-agent technology for SM diagnostics, including various agents of both qualified and specialized levels, these were both individuals and teams of departments who worked in close contact: a public relations agent; artificial intelligence secondary prevention planning agent; agent for training doctors and nurses, patients in the basics of early diagnosis and assessing their level of training; an agent for evaluating performance indicators. Results. After introducing the multi-agent system, the indicator of the share of 1-2 stages of MC in 2010-2019. increased by 48.3% compared to the period 2000-2009 and outpaced the growth in the total number of patients with SM by 6.96%; from 2010 to 2019 the proportion of patients with SM who were actively identified began to increase; one-year mortality rate from 2010 to 2019 decreased in waves (y = 0.0003x5 - 0.0104x4 - 0.2647x3 + 1.4818x2 - 1.8942x + 10.585; R2 = 0.554). Conclusion. The use of multi-agent technology makes it possible to reduce the one-year mortality rate, to achieve a faster growth rate of the newly detected number of patients with an early stage of SM (stage 1-2) compared to the increase in the number of cases, to improve the indicators of early diagnosis, active detection of skin melanoma, which is a positive result.

The seeking medical attention in the urban adult population prior and during the coronavirus pandemic (COVID-19)

Introduction. The appeal of the population for medical care in the conditions of a pandemic and strict quarantine measures has not been sufficiently analyzed in the scientific medical literature to date. The purpose of the work. Analysis of the urban adult population’s access to medical care before and during the COVID-19 pandemic. Material and methods. Based on the materials of the consolidated statistical reports of Krasnoyarsk, the indicators of the appeal and morbidity of the adult population for 2017-2020 were studied. The obtained information was analyzed using absolute and relative values. Results. The analysis of the adult population’s appeal indicators in the pre-pandemic period and the COVID-19 pandemic period showed a decrease of 43.8%. The decrease in the population’s treatment for preventive purposes occurred in all points, except for points Z20-Z29 (potential health hazard associated with infectious diseases), the indicators of which increased by 67.4% or 11.4%. The decrease in the overall morbidity rate during the pandemic was due to a decrease in the frequency of referrals with previously known diseases by 80.4%. The primary morbidity rate increased by 64.3%. Discussion. The indicators of the incidence of the adult population of COVID-19 obtained by us have differences but do not contradict the data obtained by other researchers. As our study showed, the measures taken did not lead to a significant decrease in the population’s appeal to medical institutions. Conclusion. The comparative data obtained allows assessing the impact of the COVID-19 pandemic and the ongoing anti-epidemic measures on the treatment and morbidity of the adult population.

Financing of the Program of state guarantees of free medical care: how to solve the deficit problem?

Introduction. The critical problem of Russian health care is the deficit of funding for the program of state-guaranteed medical care for citizens of Russia. Purpose of the study. To search for solutions to the problem of financing the deficit of the program of state guarantees of free medical care in the Russian Federation. Material and methods. Retrospective data analysis was carried out to analyse the reasons for the deficit in the financing of the program of state guarantees of free medical care and search for solutions in the experience of other countries. Results. The analysis showed that the reasons for the deficit of the program of state guarantees of free medical care are the shortcomings of the mandatory health insurance (MHI) income system: linking contributions for the working population to the wages fund; the vagueness of the definition of the non-working population and the payment of contributions for its MHI by the constituent entities of the Russian Federation; non-participation of the solvent population in the co-financing of medical care; deficit of economic integration between the payment of MHI treatment and the health care system; the absence of formalized mechanisms for reimbursing the expenses of the MHI system by the federal budget to pay for aid in catastrophic situations. Discussion. The authors see the solution to the problem of the deficit of the program of state guarantees of free medical care in the modernization of the MHI income system: replacement of the MHI contributions paid by employers with an additional “medical” part of the value-added tax; replacement of the MHI contributions paid by the constituent entities of the Russian Federation for the non-working population with a targeted “medical” tax on retail sales; creation of a system of additional income based on the principle “the guilty person pays for causing harm to health”; recognition of the cost of medical care to the population in catastrophic situations as an unconditional obligation of the federal budget. Conclusion. a systemic solution to the problem of the financing deficit of the program of state guarantees of free medical care for the citizens of Russia seems to be the modernization of the MHI income system.

Forecast of the birth rate and prevalence of the population of subjects of the Russian Federation from the position of assessment of their reproductive potential

Introduction. At present, negative trends in medical and demographic indicators continue to persist in the regions of the Russian Federation, which is seen as a consequence of a decrease in the number of young people due to the demographic “hole” of the late 20th century and an increase in the incidence of the population, especially adolescence. Therefore, to develop programs for the formation and protection of the population’s reproductive health, it is of no small importance to identify the patterns of morbidity rates in the population to determine the reproductive potential of the constituent entities of the Russian Federation. Purpose. Study the trend of population morbidity, assessment of the relationship and medium-term predicted values of the birth rate and incidence of the population of certain constituent entities of the Russian Federation to assess their reproductive potential. Material and methods: statistical materials of the Federal State Statistics Service (Rosstat) in the sections “Demography” and “Healthcare”. The analysis of the dynamics of birth rate indicators and morbidity of the population was carried out. Predictive models for fertility and morbidity of the population were built based on one-factor linear regression, where the birth rate was taken as the dependent variable, and the primary morbidity was taken as the independent variable. Results. The article presents a dynamic analysis of the birth rate, the morbidity rate of the adult, child and adolescent population in four studied territories: the Republic of Tatarstan, Sakha (Yakutia), Dagestan and the Kostroma region. It was revealed that in all regions, there is a decrease in fertility rates, starting from 2014-2015. Conclusion. Based on regression models, a forecast of the birth rate was compiled, which shows that if the existing trends continue, by 2024 relative to 2018, there will be a decrease in the birth rate in the Republic of Sakha (Yakutia) by 1.2 per 1,000 population, in the Republic of Dagestan - by 0.6 per 1,000 people, in the Kostroma region - by 0.5 per 1,000 people. However, in the Republic of Tatarstan, the indicator is forecasted to be higher than in 2018 - by 0.6 per 1,000 people.

Mariya Dmitrievna Kovrigina (1910–1995) — a prominent organizer and head of Soviet healthcare

The article is dedicated to Mariya Dmitrievna Kovrigina. She was a prominent organizer of Soviet healthcare, the Honoured physician of the Russian Soviet Federative Socialist Republic (RSFSR). During the Great Patriotic war and the post-war period M.D. Kovrigina for 17 years held many leading posts of Deputy Minister and Minister in the apparatus of Ministry of Healthcare of the RSFSR and USSR (1942-1959). Then for 27 years, she worked as the rector of the Central institute for Advanced Training of Physicians (1959-1986). The article provides some little-known facts from the biography of M.D. Kovrigina, which allows showing her contribution to the development of Soviet healthcare, as an experienced and professional organizer and as person sincerely sick soul for the work entrusted to her.

Activities of the Department of social hygiene and organization of healthcare of the Central Institute for Advanced Training of Physicians in training and improving management personnel in health care in the 30–80th of the XX century

Introduction. The training of management personnel is a priority task of the state policy in health care since the effectiveness and efficiency of the health care system depends on the level of competence of these specialists, both at the level of a particular territory entire state as a whole. In improving the potential of the leading personnel in the industry, the activities of Department of social hygiene and organization of healthcare of the Central Institute for Advanced Training of Physicians were of particular importance. Having this information will help understand the origins of the development of the foundations of the training health management personnel system. The purpose of the study is to identify the main features of the activity and the contribution of the Department of social hygiene and organization of healthcare of the Central Institute for Advanced Training of Physicians in the 30-80th of the XX century in the formation and development of the system of training health management personnel. Material and methods.Based on the scientific principles of historicism, consistency and objectivity, content analysis, comparative-historical, problem-chronological, typological research methods were used, which made it possible to establish cause-and-effect relationships connecting the identified individual historical events and facts. Results.The diligent work of the department contributed to the development of the basic principles and mechanisms for raising the level of professional qualifications of management personnel aimed at optimizing the activities of health authorities and institutions, improving health protection and improving the quality of medical care for the population, increasing the personal responsibility of medical workers for work results, the ability to work with personnel in conditions. Conclusion. The obtained results of the study, based on the context of the historical reconstruction of activities, indicate the significant contribution of the department to the creation of the fundamental foundations and a robust base for the training of health management personnel. The variety of completed forms and terms of training contributed to the prompt and flexible solution of problems related to territorial characteristics, conditions of professional activity, training needs, the formation of a school of advanced experience in training leading personnel in the industry.