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Main

Dear colleagues,

By Decision of Presidium of the Higher Attestation By Decision of Presidium of the Higher Attestation Commission of the Ministry of Education and Science of the Russian Federation from January, 27th 2016 Online scientific journal "Social aspects of population health" was included into the "List of the leading peer-reviewed journals and editions where main scientific results of dissertations for the degree of Philosophy Doctor and Doctor of Science should be published".

 
Main
COMPARISON OF COSTS FOR INPATIENT TREATMENT OF VASCULAR SURGICAL DISEASES THAT ARE INCLUDED AND NOT INCLUDED IN THE LIST OF DISEASES IN WHICH HIGH-TECH MEDICAL CARE IS PROVIDED (EXAMPLED BY MOSCOW REGION)
Tuesday, 01 August 2017

DOI: 10.21045/2071-5021-2017-56-4-1

Sabgayda T.P., Zubko A.V.
Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow

Contacts: Tamara Sabgaida, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Sabgaida T.P., http://orcid.org/0000-0002-5670-6315
Zubko A.V., http://orcid.org/0000-0001-8958-1400
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Summary

Relevance. The increase in mortality from vascular surgical diseases continues in Russia after development of the network of regional vascular centers. Less than half of these diseases are included in the List for expensive treatment and provision of high-tech medical care.

Purpose: Comparison of the average costs for inpatient treatment of vascular surgical diseases which are included and not included in the List for provision of high-tech medical care.

Methods. We analyzed the "unfinished cases of inpatient treatment" in terminology of health insurance, i.e. the first stage of providing emergency or planned care on the late stages of vascular disease. Depersonalized data of Rosstat death register and database of compulsory medical insurance fund were used for Moscow region in 2014. We compared indicators for vascular surgical diseases which are included (group 1) and not included (group 2) in the List for provision of high-tech medical care for medical institutions of different levels.

Results. In Moscow Region in 2014, cardiovascular mortality was 733.3 per 100,000 population and 6.1% of this death was due to arterial and venous diseases, while in Russia these rates were 611.7 and 3.5%, respectively. Among the unfinished cases of inpatient treatment of vascular surgical diseases, the diseases of group 1 consist 4.9% and 64.3% of them were treated in the third level hospitals while 18.6% were treated in the first level hospitals. In medical institutions of the first and second levels, the cost of treatment of vascular surgical diseases of group 2 is substantially greater than the cost of treating diseases of group 1.

Conclusions. Later detection of vascular surgical diseases leads to increase the expenses of medical insurance funds: the average cost of a bed-day for deceased from diseases which included in the List of provision of high-tech medical care is close in organizations of different levels; for patients who are transferred to other departments or organizations, it is three times higher than the cost of a bed-day in hospitals of the first and second levels and only on one-third less than the cost of a bed-day in hospitals of the third level with provision of high-tech medical care.

Inclusion of vascular surgical diseases into the List of provision of high-tech medical care improves the quality of medical care for patients with these diseases.

If atherosclerosis of extremities arteries (I70.2,), embolism and thrombosis of arteries (I74) is included into the List of provision of high-tech medical care, then the mortality from these diseases will significantly decrease.

Keywords: Mortality from vascular surgical diseases; the List of provision of high-tech medical care; cost of hospital bed-day; unfinished cases of inpatient treatment; medical institutions of different levels; atherosclerosis of extremities arteries; embolism and thrombosis of the arteries

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POPULATION LOSSES OF THE ARKHANGELSK REGEON FROM EXTERNAL CAUSES OF MORTALITY: STRUCTURE, TRENDS AND CODING FEATURES
Tuesday, 01 August 2017

DOI: 10.21045/2071-5021-2017-56-4-2

Varakina Zh.L.
Northern State Medical University, Arkhangelsk

Contacts: Varakina Zhanna Leonidovna, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about author:
Varakina Z.L.http://orcid.org/0000-0002-8141-4269
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract.

Significance.Considerable society losses from excess mortality of men, especially from external causes, are one of the basic problems of modern Russia. Expenses examination for health maintenance has great value for justification of investments volume on health promotion programs realisation. Distortion of mortality causes presented in the official statistics blanks the violent causes.

The purpose of the study: to assess the potential years of life lost of the Arkhangelsk region population and to calculate in the region the economic losses of premature mortality from external causes, to analyse the subregistration of mortality from external causes.

Methods. Calculation and analysis of potential years of life lost and economic losses from external causes of mortality were conducted. Number of died due to external causes (by sex, causes, territory) were obtained from the vital record tables of the Federal State Statistics Service on Arkhangelsk region and the State Archives of Arkhangelsk region (19802012). Data on a population (by sex, territory) with recalculation on the basis of population censuses also have been given by Federal State Statistics Service. The gross regional (19942012) and overall social products per capita (19801993) were used for the economic analysis. The analysis of mortality causes distortion presented in official statistics was conducted.

Results. The proportion of potential years of life lost from mortality of external causes in structure of total mortality losses among Arkhangelsk region male population is 24,5%, among females - 6,8%. Level of losses from suicides, accidental alcohol poisoning and homicides is the highest. The Arkhangelsk region had the maximum economic losses from external mortality in 1980-1983, 1992-1998, 2000-2006. For the 33-year period the proportion of injuries with indeterminate intentions in the structure of external mortality is increased (among male population of a rural area from 1,9 to 8,0%, urban area - from 3,0 to 15,0%, among female population of a rural area - from 2,5 to 9,8%, urban area - from 1,9 to 13,8%). The proportion of unknown mortality causes was increased.

Conclusion.Results of the study estimate the contribution of external mortality in decrease in level of northern region public health, and also define appropriateness of coding optimisation of initial death cause.

Scope of application. Received results had been used by elaboration of the three-level program on monitoring optimisation and injury and external mortality decrease in the European North of Russia.

Keywords: potential years of life lost; external causes of mortality; distortion of mortality causes; economic losses.

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HEALTH OF THE WORKING POPULATION OF THE SIBERIAN INDUSTRIAL CENTER IN 2008-2015
Tuesday, 01 August 2017

DOI: 10.21045/2071-5021-2017-56-4-3

Zhilina N. M.
Novokuznetsk State Institute of Postgraduate Medical Training, Ministry of Health of the Russian Federation, Novokuznetsk

Contacts: Natalya M. Zhilina, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about author:
Zhilina N.M., http://orcid.org/0000-0001-7871-3885
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract. Significance of the issue is substantiated by importance of the research subject, namely health of the city workers with the developed metallurgical and mining industry, unfavorable environmental situation and working conditions. Reproduction of healthy population, efficient productivity and high quality of life are highly dependable upon the state of health of workers. Identification of risk zones of the workers ' health in relation to environmental factors contributes to adoption of adequate solutions to reduce preventable loss of population in terms of health. The purpose of the study was to conduct a dynamic analysis of the existing situation, identify risk zones of the workers ' health and find causal relationship between "Health environment".

The study considered the following indicators of the workers health: incidence by care seeking at health care facilities, morbidity with temporal disability, indicators of prophylactic medical examination for chronic diseases, disability and mortality of employees; the integrated indicator of the workers health was analyzed.

The study used methods of system analysis, expert assessments and statistical methods.

The automated system "Health workers" developed with the participation of the author is one of the components of the socio-hygienic monitoring of the environment and public health and is kept up to date by the Novokuznetsk medical information and analytical center. The output of the system for 2008-2015 was converted into series data and analyzed using the licensed statistical package IBM SPSS Statistics (version 19.0); data from the regional and Federal state statistics were used. The analysis helped to identify problem situations, to calculate significant correlation in the system "Health-Environment".

Recommendations to eliminate risk factors of workers health were developed.

Results of this study can be used to identify problems and develop priorities to reduce preventable loss in terms of workforce health at the federal and regional levels.

Key words: workers health; automated monitoring; integrated indicators; risk zones; environmental factors; correlation.

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MAIN DIRECTIONS FOR OPTIMIZING EMERGENCY, FIRST AND URGENT CARE TO RURAL POPULATION AT THE REGIONAL LEVEL
Tuesday, 01 August 2017

DOI: 10.21045/2071-5021-2017-56-4-4

Ivaninskiy O.I.
Novosibirsk State Medical University, Ministry of Health of the Russian Federation, Novosibirsk

Contacts: Oleg I. Ivaninskiy, 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.

Abstract

Background. Healthcare Development Strategy within the context of integrated medical and social care to population requires improved performance of its primary level of care delivery focused among other things on continuity of emergent, first and urgent care.

Purpose of the study. To substantiate priorities for optimizing organizational and methodological approaches to development of the territorial logistic model system for urgent care delivery to the rural population on the basis of territorial and transport zoning.

Methods: statistical, cartographic, sociological, expert methods, situational analysis and organizational modeling.

Results. Optimization model system for providing urgent care to the rural population includes: priorities for optimizing urgent care delivery to rural population; structural re-organization; implementation of regional target programs and healthcare modernization program; monitoring performance of the system of urgent care delivery. On the basis of the territorial matrix a medical zoning was undertaken to identify the best locations for urgent care centers. Analysis of transport accessibility between regional centers of the Novosibirsk region helped to develop territorial logistic model of urgent care delivery.

Discussion. Despite a sufficient deal of attention to organization of urgent care delivery, there is a lack of comprehensive studies on the performance analysis of urgent care delivery as a comprehensive care to the rural population.

Conclusions. 1. Optimization model system for providing urgent care to the rural population at the regional level includes priorities for optimization; structural reorganization; implementation of regional target programs and healthcare optimization programs; and performance monitoring.

2. Implementation of priorities for optimizing urgent care delivery to rural population includes the following: advanced training of care providers; timely care delivery and patient transportation; development of standards and protocols for urgent care delivery; development of telecommunication system of urgent medicine; development of the system of self and mutual assistance to patients in urgent conditions; cooperation with other regional services.

3. Structural reorganization of the system of urgent care delivery to the rural population at the regional level involves creation of: emergency care facilities in rural areas; interregional and regional specialized centers to provide urgent care at the regional hospitals and federal centers, development and implementation of regional target programs.

4. Organizational and methodological approaches to develop the territorial logistic model of the system of urgent care delivery to rural population on the basis of territorial and transport zoning include the following: identification of the remote rural settlements for a special procedure for emergent and first care; development of the inter-regional center of urgent care.

5. Implementation of the optimization model showed its efficiency.

Keywords. Urgent medical care; optimization model; territorial and logistic model; rural population.

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MEDICAL AND SOCIAL ASPECTS OF INFECTION CAUSED BY HERPES SIMPLEX VIRUS TYPE 2
Tuesday, 01 August 2017

DOI: 10.21045/2071-5021-2017-56-4-5

1,2Balaeva .V., 1Samodova .V., 1Sannikov A.L.
1Northern State Medical University, Arkhangelsk, Russia
2Center of hygiene and epidemiology in Arkhangelsk region, Arkhangelsk

Contacts: Tatiana Balaeva, e-mail This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Balaeva .V.,
http://orcid.org/0000-0003-2072-3452
Samodova .V., http://orcid.org/0000-0002-6730-6843
Sannikov A.L., http://orcid.org/0000-0003-0405-659X
Acknowledgments. The project was funded by the Research Council of Norway and the Ministry of Foreign Affairs of Finland.
Conflct of interests. The authors declare no conflict of interest.

Abstract

Infection caused by herpes simplex virus type 2, is of interest of researchers all around the world because of its high prevalence in the population, high number of asymptomatic carriers and severity of possible consequences in pregnant women and newborns. Herpes simplex virus is a marker of sexual behavior in the population, as well as a frequent co-factor of HIV infection. In Russia epidemiology of virus herpes simplex type 2 is under-investigated.

The purpose of the study was to determine prevalence of herpes simplex virus type 2 among adult population in Arkhangelsk and to evaluate social and behavioral factors associated with this infection.

Methods. The conducted population-based cross-sectional study combines investigation of biological indicators (determination of blood immunoglobulin G to herpes simplex virus type 2) with data on behavioral risk factors. We used a quota sampling method to create a representative sample of the adult population in Arkhangelsk aged 18-39 years.

Results. The majority of 1243 participants were females (56%), 44% were men. According to the laboratory tests, 18.8% of the participants were positive on immunoglobulin G to herpes simplex virus type 2. In multiple logistic regression analysis for men the increasing age, marital status and history of sexually transmitted infections were significantly associated with seropositivity on herpes simplex type 2. In multiple logistic regression analysis for women the increasing age, high income level, lifetime number of sexual partners were significantly associated with herpes simplex type 2 seropositivity. Sexual debut at the age of 18 years and over was significant as a protective factor for women only.

Conclusion. Factors associated with herpes simplex type 2 infection in our study do not significantly differ compared with the results in other countries. High prevalence of infection among women of childbearing age reveals the potential risk of transmission from mother to child, and suggests an increased risk of HIV infection in women. Our findings will be useful to develop multilateral strategies aimed at preventing herpes simplex type 2 and other sexually transmitted infections in the North-West of Russia.

Keywords: herpes type 2; social factors; behavioral factors; population-based study.

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TELEMEDICINE. NEXT STEP TELEPHARMACY?
Tuesday, 01 August 2017

DOI: 10.21045/2071-5021-2017-56-4-6

1Svistunov A.A., 2Olefir Yu.V., 1Lebedev G.S., 2Koshechkin K.A.
1First Moscow State Medical University named after I. M. Sechenov,
2Scientific Centre for Expert Evaluation of Medicinal Products, Ministry of Health of the Russian Federation, Moscow

Contacts: Konstantin A. Koshechkin, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Svistunov AA., http://orcid.org/0000-0003-1592-5703
Olefir Yu.V., http://orcid.org/0000-0001-7652-4642
Lebedev G.S., http://orcid.org/0000-0002-4289-2102
Koshechkin K.A., http://orcid.org/0000-0001-7309-2215
Acknowledgments. The study had no sponsorship.
Conflct of interests. The authors declare no conflict of interest.

Abstract. Significance. Modern technologies provide for a quantum leap forward in meeting needs of the public health. In particular, the stage of medical use of prescribed drugs can be completely automated based on available introduced telemedicine and healthcare information systems.

The study purpose is to analyze capabilities of telemedicine development towards integration with distant drug sales and subsequent development of telepharmacy.

The authors used system, concept-based, process-oriented and situation modeling approaches, methods of historical, marketing, structural, functional and logic analysis.

Results. Transition to telepharmacy requires integration of telemedicine systems, systems of doctors prescriptions, pharmacy information systems and monitoring of package flows and their inclusion into a unified complex allowing to minimize both time and financial costs.

Approval of relevant legal norms is also required to ensure legal use of internet-technologies for developing telepharmacy as a new direction including distant prescription of drugs and services on distant sales of drugs.

Discussion. Implementation of the CALS/PLM-technology for informational support for the vital cycle results in development of the information systems accommodating different participants of the drugs vital cycle.

Application of the unified regulatory and reference information as well as comprehensive list of drugs is of great importance in achieving those tasks.

Incorporation of all components of the Integrated national information system into an integral technology complex will allow to create a fully integrated system of distant prescription and sales of drugs.

Conclusions. Integration of telemedicine services with best practices in distant sales of drugs with due regard to the development of the necessary support systems for the vital cycle of drugs will help to move to a new stage of pharmacy development telepharmacy.

Keywords: CALS/PLM-technology; vital cycle; information system; unified information space; healthcare informatics; telemedicine; electronic medical history.

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SIMULATION FOR OUTPATIENT MEDICAL ORGANIZATION MANAGEMENT
Tuesday, 01 August 2017

DOI: 10.21045/2071-5021-2017-56-4-7

1Shcherbakov S.M., 2,3Teplyakova E.D., 4Rumyantsev S.A., 4,5Vasilenok A.V.
1
Rostov State University of Economics
2
Rostov State Medical University
3
Municipal Childrens polyclinic 4 city of Rostov-on-Don
4
Pirogov Russian National Research Medical University
5
Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology

Contacts: Aleksandr Vasilenok, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Shcherbakov S.M.,http://orcid.org/0000-0001-8001-0214
Teplyakova E.D., http://orcid.org/0000-0002-3585-7026
Rumyantsev S.A., http://orcid.org/0000-0002-7418-0222
Vasilenok A.V., http://orcid.org/0000-0003-0512-9949
Acknowledgments. The study had no sponsorship.
Conflct of interests. The authors declare no conflict of interest.

Abstract.Significance. The introduction of information technology into the work of medical organizations on different levels is one of the urgent tasks of health care system modernization. The simulation method allows to estimate labor costs for the execution of medical care processes and to find ways to increase productivity of the ambulatory medical organization work while conducting medical check ups.

Purpose of the study. Evaluation of the effectiveness of various options for automating the processes of conducting medical check ups and clinical examination in an ambulatory medical organization based on the use of simulation models to reduce the cost of resources.

Methods. Visual and simulation modeling of the processes of an ambulatory medical organization was carried out by means of the unified UML language.

Results of the study. A set of visual and imitation models of the process of medical check ups and clinical examination in an ambulatory medical organization is constructed allowing to visually reflect these processes at different levels of use of information technology and to quantify the labor costs for their implementation depending on the parameters of the ambulatory medical organization. As a result of the simulation experiment a comparative assessment of the labor costs of pediatricians, specialists, nurses and support medical personnel was carried out for five alternative ways of organizing the processes using medical information systems taking a pediatric ambulatory medical organization as an example. Basing on the results of the simulation experiment, decisions are taken on making changes in the organization of the processes that are most optimal for the specific tasks of the medical organization.

Conclusions. The application of the proposed methodology of visual and simulation modeling in the ambulatory medical organizations allows to estimate the labor costs of doctors, nurses and support medical personnel; to highlight the most time-consuming processes and operations; to find ways to improve efficiency, including through the use of information technology; to compare alternative ways of automation. The simulation modeling conducted in accordance with the proposed methodology demonstrates the possibility of its wide use to improve the management efficiency of an ambulatory medical organization of any organizational form.

Keywords: medical organization; business process; information systems; simulation; SIM-UML

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CHARACTERISTICS OF TB FOCAL POINTS AND ANALYSIS OF THEIR GEOGRAPHICAL DISTRIBUTION TO ESTIMATE POPULATION SUBJECT TO CHEST X-RAY TESTING
Tuesday, 01 August 2017

DOI: 10.21045/2071-5021-2017-56-4-8

Tsybikova E.B.1, Zubova N.A.2, Midorenko D.A.3
1
Federal Research Institute for Health Organization and Informatics of Ministry of Public Health of Russian Federation, Moscow
2 Regional TB dispensary, Saransk
3 Tver State University, Tver

Contacts: Erzheni B. Tsybikova, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Tsybikova E.B., http://orcid.org/0000-0002-9131-3584
Zubova N.A., http://orcid.org/0000-0002-1223-4141
Midorenko D.A., http://orcid.org/0000-0002-6056-1745
Acknowledgments. The study had no sponsorship.
Conflct of interests. The authors declare no conflict of interest.

Abstract.

Background. Timely detection of TB among contacts of TB sputum smear-positive patients requires testing not only close and long-term contacts but people living near TB infection focal points and people at high risk for TB due to accidental contacts with TB focal points.

The study purpose: to analyze geographical distribution and boundaries of TB focal points to estimate population subject to X-ray testing (exemplified by Saransk).

Materials and methods: data on 34 patients with sputum smear-positive chronic pulmonary tuberculosis under follow-up at the Regional TB dispensary in Saransk and data on 198 newly diagnosed patients with lung TB in 2014-2015.

Data were extracted from the Rosstat (Federal State Statistics Service) reporting forms #8 and #33 and from the Order #50 of the Ministry of Health of the Russian Federation. For each patient information about sex, age, date of birth and residence address (street and house number) was obtained. Data on Saransk population number and density, and housing in each district of Saransk were also used for the analysis.

Results. Currently, the main source of TB infection in Mordovia is patients with chronic lung TB with unclosed cavities and bacterial excretion after treatment.

Using cartographic methods based on geo-information systems allowed to extend definition of TB focal point to include both actual place of residence of patients with chronic lung TB as well as ambient environment within boundaries of which infection spreads via accidental contacts of the infection source with population.

Comparison of addresses of permanent residence of patients with chronic lung TB with addresses of newly diagnosed TB patients during two years showed that newly diagnosed TB patients lived in the vicinity of chronic TB focal points including buffer zones.

Using cartographic methods based on geo-informational systems allowed to identify location and boundaries of chronic TB focal points helping to estimate population subject to chest X-ray testing due to high risk for TB.

The analysis showed that 11952 people or 10% of the population residing within the area covering the three epidemic clusters and one large epidemic focus required a compulsory chest X-ray testing.

Keywords: chest X-ray testing; lung TB; TB focal points; cartographic method based on geo-information system.

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