DOI: 10.21045/2071-5021-2018-61-3-2

Chizhova V.M., Gavrilova I.S., Tokina V.A.
Volgograd state medical university of the ministry of Healthcare of the Russian Federation, Volgograd, Russia.

Contacts: Tokina Valeria Alekseyevna, Email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Chizhova V.M., https://orcid.org/0000-0002-4661-1187
Gavrilova I.S., https://orcid.org/0000-0002-4175-5499
Tokina V.A., https://orcid.org/0000-0003-2968-4875
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract. The study analyzed stages of life situation of cancer patients within the concept of medical sociology. It was proved that cancer in the current Russian society represent a difficult life situation demanding, among other things, engagement of social workers for solutions.

The study purpose: to define major problems specific to each life stage of cancer patients and identify professional tasks to be fulfilled by a social worker in medical and social case management.

Methods: narrative method of life situations presented at the internet forums for cancer patients such as “Rak pobedim (We’ll kill cancer)”, “Bor’ba za zhizn (Fight for life)”, etc.

Results. Life situation is a segment of the patient and their family and friends social life that is taking place within time and space and considering the unity of interrelations (external circumstances and internal reaction of the subject to them).

The main stages of life situation of cancer patients include diagnosis, treatment and rehabilitation.

Discussion. Rehabilitation stage is important for both health recovery and prevention of backsets as well as patient’s return to active and productive life.

Conclusions. Functions of the social worker would be different at all stages of life situation of cancer patients due to changing needs of the patient and their family and friends.

Keywords: cancer; life situation; event of life situation; stages of life situation; agents of difficult life situation; social worker.

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DOI: 10.21045/2071-5021-2018-61-3-3

Gerasimova MA
Northern State Medical University, Arkhangelsk, Russia

Contacts: Gerasimova Marta, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Gerasimova M.A., http://orcid.org/0000-0002-5304-1653
Acknowledgments. The study had no sponsorship.
Conflict of interests. The author declares no conflict of interest.

Abstract

Significance. Diseases of the circulatory system top the mortality structure in the majority countries of the world, including Russia. Acute cerebrovascular diseases make the greatest contribution to the adult mortality. Within this medical and social problem, it is issues related to outcomes and organization of care delivery that remain under-investigated rather than diagnosis and treatment.

Development and implementation of measures aimed at reducing mortality from diseases of the circularity system including acute cerebrovascular diseases constitute an important component of the national population policy. The purpose of the study was to carry out a comprehensive analysis of social and demographic characteristics of deaths from cerebrovascular diseases and their sequelae (I60-I64, I69) in the Arkhangelsk region in 2011-2015 depending on the place of death with regard to the structure of death causes.

Methods. The author conducted a documentary analysis of 7962 Medical certificates of death (Form 106/y-08) of all people died from cerebrovascular diseases and sequelae (I60-I64, I69) in the Arkhangelsk region from 01.01.2011 to 31.12.2015. The following data have been copied out from the registration forms: sex, life expectancy, locality, place of death, marital status, education, employment, primary cause of death. The author used the following statistical analysis methods: χ2-Pearson test and multinomial logistic regression analysis.

Results. In the Arkhangelsk region elderly and senile people living in rural areas, not married, with a low education as well as after an acute phase of the disease have higher relative chances of dying from cerebrovascular diseases and their sequelae at home than in the hospital (with regard to death causes structure).

On the other hand, able-bodied people have high relative chances of dying at the place of accident (in the ambulance, in other place).

Conclusions. The study identified characteristics of the potential reserve for reducing mortality from cerebrovascular diseases and their sequelae in the Arkhangelsk Region. Scope of application. The study results can be used to plan programs on organizing care for acute cerebrovascular diseases.

Keywords: social and demographic status; mortality; stroke; sequelae of stroke; place of death; primary cause of death.

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DOI: 10.21045/2071-5021-2018-61-3-4

Kislitsyna O.A.
Federal State Institution of Science Institute of Economics of Russian Academy of Sciences, Moscow

Contacts: Kislitsyna O.A., email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Kislitsyna O.A., http://orcid.org/0000-0002-4144-237X
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract

Studies demonstrate that there are significant socioeconomic inequalities in access to health services in many countries. However, practically nothing is known about attitude of people towards such inequality.

The purpose of the study: to evaluate perception of social and economic inequality in healthcare by the Russian citizens; and to identify factors determining perception of injustice of inequality in healthcare and willingness of people to contribute to healthcare improvement for all.

The information base of the study was the International Social Survey program (ISSP), the 2011 round. Statistical analysis was conducted using the logistic regression model of the SPSS package.

The study shows that a significant share of the Russian citizens (67.7%) think it is not fair that people with higher income can afford better health care than people with lower income. However, people are reluctant to commit themselves to improve healthcare for all in the country; the share of those willing to contribute ads up to 14.6%.

People with low socioeconomic status, poor health, those who consider coverage with compulsory health insurance insufficient, people with children under 18 years of age, and people with radical political views are more likely to perceive injustice of inequity in access to health services. Willingness to pay higher taxes to improve healthcare for all is associated with other factors: old people, people with poor health, people with low education, low socioeconomic status, and the unemployed are less likely to contribute to healthcare improvement.

The results obtained help to conclude that further withdrawal of the State from the healthcare and expansion of payments for medical services can result in the growing public discontent.

Key words: inequality in access to health services; public opinion; perception of injustice.

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DOI: 10.21045/2071-5021-2018-61-3-5

^1,2Bogachevskiy A.N., ^1,2Bogachevskaia S.A., ^1,2Bondar V.Y.
¹ Federal Center for Cardiovascular Surgery, Khabarovsk, Russia
² Far Eastern State Medical University, Khabarovsk, Russia

Contacts: Bogachevskiy Alexander, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Bogachevskiy A.N., https://orcid.org/0000-0002-5319-027X
Bogachevskaia S.A., http://orcid.org/0000-0001-7150-2620
Bondar V.Y., https://orcid.org/0000-0002-6708-9025
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract

Significance. Atrial flutter is one of the most common rhythm disorders. The cost of treatment of this arrhythmia is expensive and similar to the cost of atrial fibrillation care. Effectiveness of recurrent atrial flutter catheter ablation is lower compared to the primary atrial flutter. Intraoperative visualization with intracardiac echocardiography helps to decrease the number of recurrent tachycardia. Clinical and economic analysis is relevant for high-cost methods of treatment and helps to evaluate applicability of new technologies.

Purpose: to assess clinical and economic efficiency of radiofrequency catheter ablation of recurrent atrial flutter with intracardiac echocardiography.

Methods. A prospective single-center study was performed. Results of ablation in 50 patients, operated according to the standard technique (under fluoroscopy) and with intracardiac echocardiography were analyzed. Clinical and economic analysis of the ablation outcomes was carried out using the "cost-effectiveness" method and modeling of economic cost of a five-year treatment of patients.

Results. Comparison of the cost-effectiveness ratio of the two technologies showed that technique with the intracardiac echocardiography was characterized by a higher coefficient than the standard technique. Cost of increasing the efficiency of ablation by 1% using intracardiac echocardiography added up to 19959.7 rub. Modeling of the disease cost per 100 patients per year showed that a 12.4% increase in the ablation effectiveness will reduce the cost of hospitalization and drug therapy 1.8 times in five years.

Conclusion. Intracardiac echocardiography is a highly effective method of cavotricuspi isthmus visualization ensuring better outcomes of catheter ablations. High cost of ultrasound catheters restricts their routine use in all ablations. Intracardiac echocardiography in ablations of recurrent atrial flutter is an appropriate and economically reasonable method of treatment.

Key words: clinical and economic efficiency; catheter ablation; recurrent atrial flutter; intracardiac echocardiography.

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DOI: 10.21045/2071-5021-2018-61-3-6

I.P. Vitkovskaya
Research Institute for Health Organization and Medical Management of the Healthcare Department of Moscow, Moscow

Contacts: Vitkovskaya Irina Petrovna, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it è This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about author
Vitkovskaya I.P., http://orcid.org/0000-0002-0740-1558
Acknowledgments. The study had no sponsorship.
Conflct of interests. The author declares no conflict of interest.

Abstract

Significance. Care delivery to children with orphan diseases and their parents calls for improvement with due regard to regional peculiarities.

The capital’s model of care delivery to children with orphan diseases has won the Prize of the Moscow Government; however, head pediatric external experts of the Moscow Healthcare Department are focused on its continuous improvement to increase rehabilitation potential of families with children with orphan diseases, develop an effective system of continuous professional education of primary care pediatricians, coordinate activities of head pediatric external experts, and organize information space to ensure access to quality health care.

The purpose of the study was to analyze opinions of head pediatric external experts of the Moscow Healthcare Department about care improvement to children with orphan diseases and their parents.

Materials and methods. The study base: Reference center of inborn hereditary and genetic disorders, orphan and other rare diseases of the Morozov children’s clinical hospital of the Moscow Healthcare Department. The study was conducted using specially designed questionnaire that included 20 questions.

The expert review criteria included quality indicators evaluated by a five-score scale, rating of responses, and concordance method with calculation of the Kendall’s coefficient (W).

Results. The study showed the following innovative directions: development of personified rehabilitation system for children with orphan diseases; need for a new information format for training pediatricians and primary care physicians as well as educating patients and their parents; development of monitoring criteria and implementation of continuous analysis of monitoring results as an integral part of the head external experts work; input of additional information about the child and the family into the regional segment of the Federal register of patients with orphan diseases to improve quality of medical care; and development of an electronic platform for translational medicine and telemedical counselling.

Keywords: children; orphan diseases; patients’ experience; head external experts.

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DOI: 10.21045/2071-5021-2018-61-3-7

¹Koloskova TP, ²Gorbach NA, ³Zharova AV, ¹Fefelova VV, ¹Ovcharenko ES
¹ Federal Research Centre «Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences» - «Scientific Research Institute for Medical Problems of the North», Krasnoyarsk
² Prof. V. F. Voino-Yasenetsky Krasnoyarsk State Medical University» of the Ministry of Healthcare of the Russian Federation; Krasnoyarsk
³Reshetnev Siberian State University of Science and Technology; Krasnoyarsk 

Contacts: Koloskova Tatiana, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Koloskova T.P., http://orcid.org/0000-0003-3847-1994
Gorbach N. A., http://orcid.org/0000-0003-2436-9112
Zharova A. V., https://orcid.org/0000-0002-9213-4190
Fefelova V.V., http://orcid.org/0000-0002-2865-866X
Ovcharenko E.S., http://orcid.org/0000-0001-6884-7871
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract

Significance. Demand for a system of health formation, active maintenance, rehabilitation and health promotion in Russia to ensure active business, social and private life substantiates an ongoing study and analysis of factors that determine health and factors with adverse effects on health.

Purpose. To identify social hygienic, social and living, socio-economic factors affecting the health status of young men (exemplified by the Krasnoyarsk Territory)

Materials and Methods. The authors conducted an anonymous survey of 439 healthy men aged 17 - 21, permanent residents of the Krasnoyarsk Territory, using representativeness and randomization. The obtained information was analyzed using absolute and relative values with 95% CI. Significance of relative qualitative indices was estimated using the χ²criteria.

Results. The majority of the healthy young men were raised up in two-parent families (62.07% of those questioned), and in satisfactory living conditions (82.64%), but very often they combined studies and work (71.26±2.17%). The number of the young men who prefer passive rest is rather high, adding up to 39.15%. The questionnaire identified that the rural young men were more frequently offered to try drugs (ð=0.0132) than their urban peers. At the same time the urban young men tend to drink more alcohol and less frequently think of giving up their harmful habits (ð=0.027).

Conclusions. The authors identified the following health risk factors in young men: over-exploitation of own physical resources, exposure to developing harmful habits, tendency towards sedentary lifestyle. Such factors are manageable and require optimization of measures aimed at disease prevention in young men with due regard to their place of living.

Key words: public health; health risk factors; healthy young men; Krasnoyarsk Territory; harmful habits; preventive measures.

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DOI: 10.21045/2071-5021-2018-61-3-8

¹Chigisova A.N., ¹٫²Ogarkov M.Y., ¹Maksimov S.A. 
¹Research Institute for Complex Issues of Cardiovascular Diseases, Russian Federation, Kemerovo
²Novokuznetsk State Institute for Further Training of Physicians – Branch of the «Russian Medical Academy of Continuous Professional Education» of the Ministry of Healthcare of the Russian Federation, Novokuznetsk

Contacts: Chigisova Antonina Nikolaevna, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Chigisova A.N., http://orcid.org/0000-0001-8147-925X
Ogarkov M.Y. http://orcid.org/0000-0002-7252-4845
Maksimov S.A. http://orcid.org/0000-0003-0545-2586
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract

Significance. Negative working conditions result in health deterioration in workers; onset of arterial hypertension becomes an obstacle to continuation of work.

Purpose. Comprehensive assessment of risk factors of arterial hypertension in coal miners in the Kemerovo Region.

Methods. Total load of risk factors and additional risk of arterial hypertension in coal miners have been calculated (n=1915). Results were compared with the sample of the male population of the Kemerovo region within the framework of the ESSE-RF study (n=700).

Results. The studied population is characterized by better health status compared to the reference group. Workers had a low incidence of additional intake of salt, apnea, obesity in young age, and living alone without family in older ages. Workers are also characterized by high prevalence of smoking and, in older ages – by alcohol abuse. In workers aged 18-35 maintenance technicians of mining equipment and electrical equipment aged, underground miners and drifters had the least load of risk factors of arterial hypertension (1.6%).

Additional risks of arterial hypertension change with age across all occupational groups. In workers aged 36-45, the risk of arterial hypertension among maintenance technicians of mining and electrical equipment equaled to 0.5%, and among underground miners and drifters – to 0.4%. In the group of managers, there was a gradual increase in the additional risk of arterial hypertension (0.9%). In people aged 46-69, the additional risk increased to 0.2% among underground miners, sinkers and managers.

The additional risk remained unchanged among maintenance technicians of mining equipment and electrical equipment (0.5%).

Conclusions. Miners are characterized by a low prevalence of risk factors compared to the general population, as well as the total additional risk of arterial hypertension. However, with age, the difference between workers and the general population is narrowing due to negative impact of the working conditions. The results indicate a need for a differentiated approach to standard activities aimed at preventing arterial hypertension depending upon intensity of the negative occupational factors.

Keywords: arterial hypertension; risk factors; population risk; miners; negative working conditions.

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DOI: 10.21045/2071-5021-2018-61-3-9

¹Morozova E.A., ¹Luzgareva O.I., ²Danil'chenko Ya.V., ²Kryuchkov D.V., ²Karas' D.V., ²Artamonova G.V.
¹Kemerovo State University, Institute of Economics and Management, Kemerovo, Russia
² Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia

Contacts: Karas’ Dmitriy Victorovich, e-mail:  This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Morozova E.A., https://orcid.org/0000-0003-2215-9808
Luzgareva O.I., https://orcid.org/0000-0002-9829-9156
Danil'chenko Ya.V., https://orcid.org/0000-0001-8308-8308
Kryuchkov D.V., https://orcid.org/0000-0002-5408-6562
Karas' D.V., https://orcid.org/0000-0002-6506-2769
Artamonova G.V., https://orcid.org/0000-0003-2279-3307
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract

Significance. Problems of productivity, efficiency and performance in Russia have been receiving much attention in recent years due to the priority need for improving economic potential of the country in the modern context. Development of approaches to measure impact of social factors on performance is of practical importance as one of the scientific management tools for improving performance.

Purpose: to present results of the assessment of social factors affecting staff performance of the health research institute using the original sociological methodology.

Methods. The sociological methodology was based on the assessment of different social factors by staff of the organization (working conditions, scope of work, moral and psychological environment, social policy of the organization, qualification and carrier, incentives, organization of work, organizational culture, management style, and organization loyalty) and assessment of their impact on performance. All indicators were measured in scores on a scale from one to five.

The methodology was tested in three stages (in 2012, 2014 and 2017) at the Research Institute for Complex Issues of Cardiovascular Diseases through a continuous questioning of the organization’s employees.

Results. According to the 2017 data, the following social factors affecting performance received the heighest scores: scope of work (4.28 points), management style (4.13 points), working conditions (4.06 points) and organization loyalty (4.05 points). The lowest score received social policy (2.72 points). The average score for all factors added up to 3.64 points. Over the last three years the scores for all parameters without exception have increased with the highest increase of the “social policy” factor.

Score comparison in the three groups of employees (“high performance”, “average performance” and “low performance”) revealed a direct correlation: the higher the factor score, the higher performance. The following factors make the highest impact on the Institute staff performance: incentives, organization of work, moral and psychological environment, qualification and career.

Conclusions. The three-staged testing of the developed methodology ensures feasibility of its application for estimating social performance factors and their impact on staff performance of the scientific medical organization.

Key words: scientific medical organization; performance; social factors of performance; sociological methodology.

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DOI: 10.21045/2071-5021-2018-61-3-10

Vladimirov A.V.¹, Tsybikova E.B.^2
1 Khanty-Mansi clinical TB dispensary, Khanty-Mansiysk
² Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow

Contacts: Erzheni 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.  https://orcid.org/0000-0002-9131-3584
Vladimirov A.V.  https://orcid.org/0000-0003-1534-3295
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract.

Significance. During the last 15 years the share of deaths from TB has reduced from 78% to 39% while the share of deaths from HIV-infection increased from 6.8% to 45% in the Russian structure of infectious deaths.  Increasing HIV mortality in Russia is largely conditioned by high prevalence of TB-HIV co-infection. Therefore,  analysis of the death cause structure of HIV-infected patients with due regard to age including external causes of death, as well as changes that occurred during the past years seems well-timed and relevant.

Purpose: to study dynamics in the structure of death causes in HIV-infected patients by age groups in the Khanty-Mansi Autonomous Area (Yugra) in 2003-2016.

Materials and methods: data from death certificates (form #106/u-08) and Rosstat reporting form #61 of the Khanty-Mansi Autonomous Area (Yugra) for 2003-2004, 2008-2009, 2013-2014 and 2015-2016, as well as Rosstat data on population number by sex and age. Statistical and comparative analyses were applied using Statistica and BioStat packages.

Results. Over the last years the Khanty-Mansi Autonomous Area (Yugra) has seen an increased number of deaths among both newly diagnosed  cases and HIV infected cohorts with a shift to older age groups (35 and over). Such situation is indicative of a substantial HIV prevalence in population reaching beyond the major risk groups.

The increased share of HIV cohorts with the most severe 4^th stage of HIV infection up to 29.8% suggests a late HIV diagnosis and low access to ART.

Analysis of the death cause structure in HIV patients showed that in 2016 the number of patients died from HIV 4.6 times exceeded the number of deaths from external causes.

HIV patients over 35 years constitute the main “risk group” of premature mortality due to both HIV-infection and external causes.

Analysis of the structure of external causes of death showed that intentional self harm (ICD-10 X60-X84) and event of undetermined intent (ICD-10 Y10-Y34) accounted for the highest shares totaling up to 90.4%±11.4%.

The causes of high lethality from HIV-infection included late diagnosis, low access to ART as well as low effectiveness of TB-HIV treatment.

Keywords: HIV infection; death causes in HIV patients; external death causes in HIV patients; lethality; age structure.

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