DOI: 10.21045/2071-5021-2018-59-1-2

Contacts: Olenev Anton, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Acknowledgments. The study was supported by the Russian Federal Medical and Biological Agency.
Conflict of interests. The authors declare no conflict of interest.

Significance. Activity of medical organizations is under control of the Russian healthcare administrative bodies. Analysis of results of the control activities shows increased incidence of diseases and existence of illegal and non-efficient budgetary expenditures. Such trends suggest a low effectiveness of control activities and the need for new improved forms and methods to control performance of medical organizations.

Purpose: to scientifically substantiate the need for on-site pre-licensing of medical organizations in big cities.

Methods. This study used methods of analytical and historical analysis, survey and "Test-survey" method.

Results. The highest rates of beds reduction were registered in 2011-2014.

Reduction in the number of municipal beds was rather due to the reduced number of medical facilities than bed closure in active hospitals. 32.9% out of 10500 closed beds were in the shut down hospitals.

Except for 2008 the peak of shutting down the municipal hospital facilities was registered in 2013-2014 i.e. during licensing of the city medical organizations by the Licensing and Accreditation Commission.

On-site pre-licensing of municipal and state medical organizations contributes to improved quality of care by denying access to the "health care market" to those organizations that fail to meet sanitary and other technical requirements according to the survey of heads of medical organizations.

Conclusions. 1. Need for conducting a preliminary performance evaluation of medical organizations in a big city (exemplified by Moscow) when carrying out licensing and accreditation has been identified.

2. According to the survey of heads of medical organizations, on-site pre-licensing undoubtedly results in care quality improvement.

3. A small number of respondents who disagreed with this opinion (3.2%) had objective problems with licensing of their organizations.

Keywords: licensing and accreditation of medical organizations; pre-licensing; monitoring of activities; managers; opinion.

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DOI: 10.21045/2071-5021-2018-59-1-3

Contacts: Sabgayda Tamara, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Semenova V.G., http://orcid.org/0000-0002-2794-1009
Sabgayda T.P., http://orcid.org/0000-0002-5670-6315
Mikhailov A.Yu., http://orcid.org/0000-0001-9723-6228
Zaporozhchenko V.G., http://orcid.org/0000-0002-6167-7379
Gavrilova N.S., http://orcid.org/0000-0003-3572-0879
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Alcoholization of population and its related loss are the traditional and far from exhausted source of excessive mortality in Russia. The study purpose is to estimate scales of population loss due to alcohol-related causes as well as regularities of their variance by sex and age of the deceased in the 2000s.

Materials and methods. The authors used the Rosstat official data: 1) statistical form S51 (mortality) for 2012-2016 and 2) de-personalized database of death records for 2000-2011.

Mortality analysis was performed through calculation of age-specific and standardized rates for the selected death causes using descriptive statistical methods.

Underestimation sources and causes of population loss due to alcohol were determined and recommendations for their minimization were made.

Conclusions. Irrespective of age, cumulative alcohol-related mortality was on the rise until 2005 and then declined. Positive trends turned out to be exhausted by 2013; in 2013-2016 reduction rates in young working ages slowed down, visibly stagnated in older working ages, and even increased in elderly mortality rates.

Trends in mortality from alcohol poisonings in the 2000s were more positive compared to mortality from psychosomatic alcohol-related pathologies. As a result, pattern of the alcohol-related loss has changed dramatically: in early 2000s it was mainly determined by alcohol poisonings while currently it is mainly due to alcohol-related pathologies.

This makes it possible to assume with a high degree of probability that the level of alcohol-related mortality is determined by its structure with high share of alcohol poisonings predetermining high levels of cumulative alcohol-related loss.

Significant changes have taken place both in the structure of alcohol-related pathologies (decreased share of alcoholic cardiomyopathy against the background of increased input of alcoholic cirrhosis and decreased share of chronic alcoholism in the context of increasing importance of alcohol-related nervous diseases) and in the structure of alcohol poisonings (decreased share of accidental poisonings against the background of increased input of poisonings of undetermined intentions).

Keywords: mortality from alcohol-related causes; alcoholic cardiomyopathy; alcoholic cirrhosis; accidental alcohol poisonings; alcohol poisonings with undetermined intentions.

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DOI: 10.21045/2071-5021-2018-59-1-4

Contacts: Kirill Shelygin, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Shelygin K.V., http://orcid.org/0000-0002-4827-2369
Sumarokov Yu.A., http://orcid.org/0000-0002-6693-838X
Malyavskaya S.I., http://orcid.org/0000-0003-2521-0824
Acknowledgments.The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Significance. Considering the prospects of developing the circumpolar and arctic territories of Russia and a socio-demographic significance of mortality from suicide, it seems relevant to carry out an analytical monitoring of this mortality with the aim of developing preventive measures.

Purpose and objectives. To characterize death rates from suicide in the Arctic zone of Russia. Objectives included description of the dynamic trends in suicide mortality in 1993-2015, evaluation of the suicide mortality input into the total mortality from external causes, identification of seasonality and age-specific characteristics of suicide mortality, and determination of the connection between changes in death rates from suicide and alcohol consumption.

Methods. Official statistics on mortality in the Arctic zone of Russia were used. The indicators were standardized by the European standard of population by a direct method. For convenient description of trends, the dynamic series were smoothed using the 4253H method, the mortality cycle analysis was carried out using an autocorrelation function and seasonal decomposition by the Census I method. The time series relationship was estimated through constructing a cross-correlation function of the residuals of the "bleaching" models by the autoregressive method of the integrated moving average.

Results. The study showed that the overall dynamics in deaths from suicide in the Russian Arctic territories is consistent with the general one for the whole country, differing in a greater intensity of indicators; deaths from suicide in the Nenets and Chukotka autonomous districts contribute the maximum to the total mortality from external causes, while the infant mortality rates from suicide are regular in the Republic of Sakha and the Arkhangelsk region, otherwise, the age-specific distribution of mortality is similar to the average Russian indicators, differing in larger size of indicators. The gap in indicators is measured, in most cases, by hundreds of percent. Seasonal mortality, with the exception of the indicators of the Murmansk region and the Nenets Autonomous District (NAD), corresponds to the all-Russian trend with a maximum of indices in spring and summer and a minimum in autumn and winter. A significant correlation between death rates from suicides and alcohol consumption indicator has been established in the Chukotka Autonomous District only. Lack of communication in other territories may account for distortions and underestimation of suicide mortality rates.

The obtained results allow to evaluate effectiveness of measures aimed at improving the socio-demographic situation in the Arctic zone of Russia.

Key words: suicide mortality; Arctic; alcohol consumption.

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DOI: 10.21045/2071-5021-2018-59-1-5

Contacts: Tatyana Svetlichnaya, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Svetlichnaya T.G., http://orcid.org/0000-0001-6563-9604
Menshikova L.I., http://orcid.org/0000-0002-1525-2003
Smirnova E.A., .http://orcid.org/0000-0002-93830649
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Significance. Today the main public health hazards include modern lifestyle and environmental conditions. One of the characteristics of the modern lifestyle is a widespread of traditional chemical (substantive) and continuously emerging new types of non-chemical (non-substantive, behavioural, psychological) dependencies. Active engagement into this pathological process starts early in life, in childhood and adolescence.

Purpose. To generalize understanding of dependency from the perspective of the Western and Russian theoretical-conceptual biological, psychological and social approaches to its research and definitions to be used in the medical-social research in health and healthcare aimed at rationalizing and developing effective methods of primary prevention of various types of chemical and non-chemical dependency.

Methods. The study used analytical method combined with scientific and theoretical approach; 47 reference sources were analysed, including 16 scientific publications by foreign authors.

Results. Analysis of scientific literature on the study topic shows a detailed theoretical and empirical development of the dependency (addiction) phenomenon and availability of the well-established terminology for its research. However, dependency, being a well-developed medical and psychological scientific category, remains under-investigated as a social and spiritual phenomenon. Narrow medical thinking still predominates in definition of the essence of dependency – that is biomedical determinism.

Transfer to a broader view of dependency as a complex biopsychosociospiritual phenomenon will provide for a change in priorities in investigating conditions and factors of its formation and control, to become one of the most important contemporary problems of secular and theological discourse.

Conclusions. Studying dependency as a negative biopsychosociospiritual phenomenon and developing ways to deter it, not only controlling but rather effectively preventing its emergence and further spread remains most relevant.

Successful solution to the problem requires cooperation with major religious confessions as the subject-matter of dependency is interdisciplinary in nature. Studying dependency goes far beyond the scope of medicine, psychology, education science and sociology.

Scope of application: healthcare, addictology.

Keywords: dependency; dependence behaviour; dependent personality; biopsychosociospiritual phenomenon.

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DOI: 10.21045/2071-5021-2018-59-1-6

Contacts: Gatagazheva Zareta Magomedovna, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .
Information about authors:
Gatagazheva Z. M. https://orcid.org/0000-0001-8067-378X
Acknowledgments. The study had no sponsorship.
Conflict of interests. The author declares no conflict of interest.

Malignant neoplasms of reproductive organs account for 42% of the total cancer morbidity structure in the female population including breast cancer, cervical, uterine and ovarian cancers. Estimating effectiveness of reproductive cancer diagnosis, it is necessary to note that more than two thirds of the patients are diagnosed with cancer at the 2nd or even 3rd stage.

However, up to date, effectiveness of preventive interventions throughout the country remains low, greatly reducing chances for successful treatment.

The study purpose was to evaluate new organizational forms of early diagnosis of reproductive cancers and breast cancer within the context of developing the republican cancer service (exemplified by the model of the Republic of Ingushetia). Data on incidence of common malignant neoplasms of the female reproductive organs (uterus, cervix and ovaries) and breast in the Republic of Ingushetia served as the study materials.

Analysis of data for 2001-2008 and 2009-2016 showed that the share of reproductive cancers and breast cancer in the total number of malignant neoplasms in the female population of the Republic of Ingushetia in 2001-2016 tends to increase.

Standardized morbidity rates of cervical, uterine, ovarian and breast cancers tend to increase, standardized death rates from cervical, uterine and breast cancers reduced while mortality from ovarian cancer slightly increased. Active detection of malignant neoplasms of reproductive organs and breast cancer in the Republic of Ingushetia improved for all cancer sites.

A 16-year analysis of main indicators of cancer care provided to female population gives strong evidence of positive trends in care delivery. These trends are associated with the introduced “open appointment visits” for female population, new Algorithm of examination and selection of patients with high cancer risks using charts of diagnostic and prognostic coefficients in addition to measures implemented by the Ministry of Health of the Republic of Ingushetia.

Keywords: cervical cancer; uterine cancer; ovarian cancer; breast cancer; “open appointment visit”; epidemiology; Republic of Ingushetia.

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DOI: 10.21045/2071-5021-2018-59-1-7

Contacts: Ruziev Murodaly, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors: Son I.M., http://orcid.org/0000-0001-9309-2853
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

In recent years, Tajikistan has undertaken a number of measures aimed at developing a legislative framework to control spread of HIV/AIDS and reduce stigma and discrimination against HIV-infected people. However, the level of stigma and discrimination in the society remains high.

The purpose of the study was to analyze forms of stigma and discrimination in the society against people living with HIV.

Methods. Social survey was implemented in large cities and districts of the three regions of the Republic of Tajikistan. The data were collected using a standardized questionnaire containing both closed and open questions. The survey was conducted among health professionals; teachers of secondary education institutions; law enforcement and judicial authorities (lawyers and judges); service workers; religious figures; mass media specialists; representatives of administrative bodies of the local authorities (Khukumats) and people living with HIV.

Results. About 45% of the respondents noted that there are various forms of stigma and discrimination in Tajikistan now. The most vulnerable to stigma associated with HIV are children and women.

In the opinion of people living with HIV, they feel most discriminated by people around. A high level of discrimination towards people living with HIV, in their opinion, manifests itself while getting employment and receiving health care. About 40% of HIV-infected people noted that they experience different forms of discrimination in the family.

Discussion. The study showed that the existing high level of stigma in Tajikistan results in people living with HIV discrimination. The problem of stigma and discrimination of people living with HIV is yet to be solved by many countries of the world. It can be handled by implementation of programs aimed at restraining stigma to reduce social isolation and increase adherence to HIV treatment.

Conclusion. In general, there is a positive trend among population that people living with HIV have the right to work; however in those sectors that people deal almost daily with (education, health and social services), there is a relatively high level of discrimination.

Key words: stigma; discrimination; people living with HIV; social survey

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DOI: 10.21045/2071-5021-2018-59-1-8

Contacts: Stasevich Natalya, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Stasevich N.Yu., http://orcid.org/0000-0002-2965-4986
Acknowledgments. The study was supported by the Russian Federal Medical and Biological Agency.
Conflict of interests. The authors declare no conflict of interest.

Significance. Health education is an integral part of any treatment and preventive measures. Health education programs should focus on training patients in healthy lifestyles, clarify reasons of their current diseases and early diagnosis of complications, improve adherence to healthy behavior and treatment. Implementation of such education programs by doctors in their clinical practice is called patient health education.

The purpose: to work out principles to develop and implement a regional model of palliative care for the elderly and senile patients on the basis of the system view approach.

Methods. The study used methods of quantitative and qualitative statistical analysis with calculation of reliability of the obtained materials. Due to polymorbidity in the elderly and senile patients the inclusion criteria comprised leading syndromes of chronic progressive somatic and neuropsychiatric diseases and/or associated conditions that determine severity of the clinical presentation and future forecast, reliably confirmed by physical and instrumental examinations. The exclusion criteria included cancer and blood diseases.

Results. Study of peculiar features of palliative care delivery to the elderly and senile patients identified medical and organizational patterns. Expert evaluation was conducted thorough the analysis of each medical case and comparison of actually applied technology with the modern international clinical guidelines and regulatory documents of the Ministry of Health.

Expert evaluation analysis showed that frequency of encounters with the attending doctor in polyclinic in all medical cases of palliative care delivery (n=342) added up to 0.1±0,01. It positively correlated with the expert group opinion that focus of the of palliative care delivery is fully shifted to the place of care delivery r=0.76, p<0.05.

Analysis of the situation allowed to make proposals to optimize medical services for the elderly and senile patients with chronic diseases that are not cancers.

Summary. Private health education programs for internal diseases were developed, tested and introduced into practice to improve quality of life of the elderly patients. All programs are based on the developed principles.

Keywords: education programs; elderly; non-cancer; rehabilitation.

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DOI: 10.21045/2071-5021-2018-59-1-9

Contacts: Kharina Daria, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Significance. Respiratory allergic diseases have recently become not only a medical but also a social problem. On the one hand, there is a continuous trend towards disease aggravation in childhood, on the other hand – its prevalence is on the rise. Growing incidence of allergic diseases, their aggravated course, their significant impact on the development and course of chronic nonspecific inflammatory diseases of various sites makes investigation of this pathology a priority among other modern health care problems.

Purpose: to analyze medical and social factors affecting formation of respiratory allergic diseases of pollen etiology in children in the modern context.

Methods. To study impact of medical and social factors on respiratory allergic diseases of pollen etiology two groups of children were selected. The main group (I) consisted of 255 children who were under allergologist’s follow-up due to respiratory allergic disease. The control group (II) also consisted of 255 children who were under pediatrician’s follow-up in Moscow children's polyclinics and attended schools or preschool facilities.

To process study materials standard statistical methods were applied.

Results. Direct correlation between mother’s non-employment in the production industry and respiratory allergic disease in her child (I=3.17) was identified. About 15% of working women are exposed to occupational hazards; about one third of them were exposed to occupational hazards prior to delivery.

Direct correlation was found between respiratory allergic disease in a child and hereditary load in both parents (I=4.7), and in mother only (I=3.8).

Conclusions. 1. Correlation analysis of factors accompanying respiratory allergic diseases of pollen etiology in children, showed their different significance.

2. Among the variety of medical, biological, social hygienic and psychological factors the authors managed to detect a small share of factors that are directly related to the development of respiratory allergic diseases in children (significance test (r)>20%): hereditary load in both parents (r=40%); hereditary load in mother (r=36.4%); early toxicosis during pregnancy (r=24.8%); early toxicosis and gestosis in pregnancy (r=45.0%).

Keywords: medical and social factors; respiratory allergic diseases; pollen etiology; gestational age; childhood; diseases of the respiratory system.

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DOI: 10.21045/2071-5021-2018-59-1-10

Contacts: Manukhina Elena, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Uspenskaya I.V., http://orcid.org/0000-0002-3163-5688
Manukhina E.V., http://orcid.org/0000-0001-9784-9454
Yurina S.V., http://orcid.org/0000-0002-5107-3379
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Significance. In the context of complicated economic conditions activity of territorial compulsory health insurance funds on financial support for territorial programs of compulsory health insurance has been kept current.

Research subject: financial support for territorial programs of compulsory health insurance.

The study purpose. To determine dynamics in financial support for territorial programs of compulsory health insurance within the framework of activities aimed at optimizing health system funding at the regional level.

Methods. Using analytical method, including method of economic analysis, the authors evaluated implementation of the territorial programs of compulsory health insurance based on monitoring data of volumetric and financial performance indicators of the overall system and individual health organizations.

Results. The study identified areas for optimizing financial support for the territorial program of compulsory health insurance through priority funding of the resource-saving primary care provided at the outpatient basis and in day hospitals, with the reduced share of expensive hospital care from 51.4% in 2014 to 47.7% in 2016 in the cost structure.

The share of costs associated with outpatient primary care increased from 36.5% to 38.1%, while the share of costs associated with outpatient care provided at day hospitals increased from 5.5% to 7.8%, according to indicators of the regional road map. Because of the 1.3 times increase in the volumes of preventive dental care, care seeking reduced 2.0 times. Financial support for high-tech medical care increased by 2.4 times, expanding its access to the population.

Conclusions. Analysis of dynamics in financial support for the territorial program is an integral part of a comprehensive assessment of the healthcare and compulsory health insurance system. Positive dynamics in indicators confirms usefulness of measures to optimize funding at the regional level.

The scope of application: in the system of compulsory health insurance at the regional level.

Keywords. Territorial program of compulsory health insurance; financial support; primary health care for dental diseases; high-tech medical care.

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ßíâàðü 2018 ã.

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Ôåâðàëü 2018 ã. ¹

Òåìà íîìåðà – Ñîêðàùåíèå äåòñêîé ñìåðòíîñòè

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ßÍÂÀÐÜ 2018

Íîâûå ïîñòóïëåíèÿ â Äîêóìåíòàöèîííûé öåíòð ÂÎÇ

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ÔÅÂÐÀËÜ 2018

Íîâûå ïîñòóïëåíèÿ â Äîêóìåíòàöèîííûé öåíòð ÂÎÇ

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