Vol. 4 No. 4 (2023): Archive

The study presents the data on incidence among infants in Moscow. The author analyzed the indicators of overall incidence, the characteristics of disease distribution, and the level of follow-up care in children of the given age group. The data was obtained from the open sources of Federal State Statistics Service of the Russian Federation (Rosstat) and from the Federal Statistical Observation Form No. 12 “On the number of diseases registered in patients residing in the service area of a medical organization” from 2016 to 2022.
The author evaluated the impact of COVID-19 pandemic on the pre-COVID incidence trends in general and by specific disease categories, as well as on the distribution of diseases common to infants. The results show a decrease in overall incidence and specifically of infectious diseases, respiratory diseases, injuries, poisonings, and other external causes in all age groups. While overall incidence was decreasing between 2020 and 2022, the number of cases requiring the follow-up care was constantly growing. The absence of herd immunity
and newborn vaccination due to the age characteristics of the group has led to an explosion of COVID-19 cases in the last three years. The study also revealed the variation in indicators for certain diseases, which warrants further investigation of the dynamics in these nosological groups.

Numerous observations have proven the influence of COVID-19 on the formation of comorbid pathology;
however, the patterns of this relationship and the epidemiological consequences have not been sufficiently studied. Combination of two or more diseases of the cardiovascular system is a predictor of adverse outcomes in stroke patients with coronavirus infection, both in the acute period and after hospitalization. Ischemic stroke in patients with COVID-19 is associated with an increased risk of severe post-covid syndrome. The negative impact of the obligatory lockdown on disease outcomes has encouraged the authors to search for new organizational solutions as well as to elaborate appropriate technologies aimed at optimizing medical and social care for people who had no choice but to follow lockdown rules. Obligatory self-isolation, anxiety-depressive disorders, and frequent negative outcomes among these patients require the adoption of new organizational decisions and the development of effective technologies aimed at optimizing medical and social care. The authors conducted an analytical analysis of post-infectious complications in patients with ischemic stroke complicated by COVID-19. The authors conducted a combined retrospective study. Measures for improvement of medical care in stroke patients with concurrent COVID-19 were presented.

An observational, ambispective, non-interventional study was conducted to compare the effectiveness of
introducing syndromic diagnostic according to the RP-2021 protocol on the basis of the pediatric departments of the Morozov Children's City Clinical Hospital. The study was carried out in two phases. The prospective phase (February–June 2022) was conducted using multiplex PCR tests (mPCR) – BioFire FilmArray respiratory panel – and routine diagnostic tests according to accepted standards for patient examination. The second phase of the study was a retrospective analysis of the comparison group’s (historical control group) primary medical records for standard test results from the same time frame, February to June 2021. Data on 40 patients on the historical control group were taken from the CIS EMIAS system.
The mPCR results of the prospective group were available to the doctor several hours later, at the very
beginning of the diagnostic algorithm. The length of the hospital stay in the prospective period following the introduction of mPCR testing was reduced by one day compared to the period before the introduction of this technology. The study showed that express methods of syndromic diagnostic testing allow to quickly establish the etiology of a respiratory infection for preterm infants, as well as children with bronchopulmonary dysplasia, bronchiolitis, comorbid patients, patients in the ICU with suspected influenza, whooping cough, and atypical
pathogens, which in turn optimizes antibiotics prescription and hospitalization time. This study highlights the importance of rapid diagnosis of respiratory pathogens in pediatric patients under the age of five in order to optimize patient management when admitting them to the emergency department with a suspected acute respiratory infection.
In the prospective observation group after the introduction of mPCR testing, patients were significantly less likely to receive antibiotics — 47.5% (n=19) compared to the historical control group of 72.5% (n=29). The study presents the advantages of the syndromic approach to the diagnosis of respiratory infections in children as one of the most effective tools for increasing the rationality of antibiotic use in a children's hospital.

Introduction. Monitoring and evaluation are an integral part of public health programs. Public health, in turn, is an important element of any society, and prevention programs play an important role in disease prevention and health promotion. In recent years, Krasnoyarsk Territory has shown a steady increase in the number of prevention programs aimed at improving the health and well-being of the population. Although these programs have been implemented to address specific health problems, they have also had a significant social impact.
Purpose. This article investigates the social effects of prevention programs and public health projects in
the Krasnoyarsk Territory.
Materials and methods. The article summarizes the results of sociological research on various aspects of
public health in the Krasnoyarsk Territory. The materials of sociological research conducted by the Krasnoyarsk Regional Center for Public Health and Medical Prevention were used. The results of some studies were presented in comparison with the results obtained in other regions of the Russian Federation.
Results. According to the data obtained, the study of the health literacy of residents of the Krasnoyarsk
Territory allowed us to conclude that a considerable part of the population is insufficiently aware of the main aspects of a healthy lifestyle. In addition, city residents of the Krasnoyarsk Territory are mostly dissatisfied with two aspects of the quality of life: the maintenance and management of the adjacent territories; the work of public utilities; and the availability of high-quality and safe pedestrian areas.

Background. The professional training of students has dramatically changed over the COVID-19 pandemic with new conditions of education: transition to online learning, partial isolation, and loss of some means of communication. In addition, there are challenges in recovering mental, psychological, physical, and physiological health of students in the post-COVID period. The result is that the emotions and volition of young students have significantly transformed and influenced well-being, activity, and mood as components of students’ emotional health.
Purpose. To define the specifics of well-being, activity, and mood as components of the emotional health of
young students in the COVID and post-COVID periods.
Methods and materials. 645 major students from Moscow universities were included on a voluntary basis in a sample. The authors applied five original methods for identifying the interrelation between personal problems’ impact on health status, health status itself, health self-assessment, well-being, emotional health, and body intoxication.
Results. In the COVID-19 period, there were observed a high correlation between the average level of activity and the average level of health status and body intoxication, a moderate correlation between the average level of activity and the below-average level of personal problems’ impact on health status, health self-assessment, well-being, mood and emotional health, a moderate correlation between the average level of health status and the below-average level of health self-assessment, mood and emotional health, and a moderate correlation between the average level of body intoxication and the below-average level of well-being, mood and emotional health. In the post-COVID period, there were observed a high correlation between the average level of well-being, activity and mood and the average level of personal problems’ impact on health status, health status, health self-assessment, emotional health and body intoxication.

Introduction. How many public health and healthcare organization professionals a health facility has on
staff has a significant impact on the integration of all functional units, the ability to successfully address
pressing issues, and the quality and safety of medical care.
Purpose. The goal was to conduct a comparative analysis of staffing dynamics in health facilities with
public health specialists in Moscow and Russia from 2017 to 2021.
Materials and methods. Statistical, logical, and analytical methods were used. Data on the number of public health specialists in Moscow and Russia, workforce density and quantity of health facilities were obtained from statistical data of the Central Research Institute of Organization and Informatization of Healthcare of the Ministry of Health of the Russian Federation from 2017 to 2021. The demand for chief physicians, deputy
chief physicians, methodologists, and medical statisticians was identified based on job vacancies on job search websites at the beginning of 2023.
Result. It was shown that there remained a negative trend in Moscow, Russia, between 2017 and 2021 in the number of heads of medical organizations and their deputies. Conversely, over the five-year period the number of methodologists have increased, and the number of medical statisticians remained virtually the same. There are open positions for experts in healthcare organization and public health in the Moscow healthcare system, despite the established network of academic and educational institutions for the training of medical
specialists.

Introduction. Medical tourism sector has become a multifactorial sphere and a rather complicated segment with complex structure. Countries and regions engaged in its development to more or less extent have seen its transition to one of stable sectors of tourism market that is fast-growing, income-generating and quite competitive worldwide. Thus, many countries and regions strive to develop this type of tourism; one of the strategies is the incorporation of integration elements at the intersectoral and intercompany level.

The purpose of the study was to consider the opportunities to create an integrated tourist product in the domestic medical tourism market.
Materials and methods. In order to determine the prospects of integration interaction between medical organizations and tourism entities on the formation and further promotion of a comprehensive tourist product in the domestic medical tourism market, an analysis of scientific literature was conducted. Then, an expert survey among specialists of medical and tourism sectors in form of a semi-structured expert interview was carried out.
Results. Expert assessment of opportunities to create and promote an integrated tourism product within the framework of domestic medical tourism is rather cautious; the need for interaction and cooperation in this process is recognized. In Russia, medical tourism is actually well-developed. Regions with various wellness and recreational resources seem to be promising due to no seasonal demand fluctuations.

Background. Despite being an unnoticed profession, feldsher is often the first point of contact for patients
seeking medical assistance. Thus, in order to minimize profession-related risks, it is crucial to study the image of a feldsher, as well as to understand the characteristics and trends of the feldsher image that have emerged in public opinion and the information space.
Purpose. To identify how Muscovites perceive feldshers and to assess social media coverage of their work.
Methods. The study used the data collected in telephone surveys conducted among a representative sample of 596 adult Moscow residents. The authors analyzed 1,057 images and conducted content analysis on a subsample of 169,975 social media posts.
Results. Collective consciousness mainly perceives the feldsher as an “emergency care practitioner” and a “rural physician” (as a specialist of a rural health post). 21 % of respondents are also unclear about the distinctions between feldshers and doctors or nurses, as well as their place in the medical hierarchy. The results of a quantitative poll are consistent with the social media content analysis about the perception of feldsher's responsibilities. The majority of messages (61 %) are neutral with a slight prevalence of negative (25 %) messages over positive (14 %). Positive messages are more often associated with personal qualities, particularly those that were made evident in dire circumstances during the epidemic, and negative messages are primarily
associated with systemic issues of the profession’s status.

Introduction. The implementation of project-based learning into programs of advanced professional education is one of the most relevant areas of development in the modern education system. Project-based learning significantly increases the efficiency of the educational process and the interest of students in the subjects studied and contributes to the development of their leadership qualities. The acquired skills can be successfully applied to professional activities. The article examines the successful implementation of project-based learning using the example of a military medical educational organization and determines positive aspects that can be used in other education sectors.
The purpose of the study was to identify the advantages and disadvantages of project-based learning in comparison to traditional forms of education.
Materials and methods. In the study, methods of sociological research were used. Students engaged in traditional and project-based learning were asked to fill out questionnaires. Then, a comparative content analysis was performed. Statistical processing and analysis of the data obtained were carried out.
Results and discussion. The study of students' satisfaction with traditional and project-based learning showed that the second group had better motivation, higher interest in the subject, and a higher level of academic performance. The average academic performance score in the project-based groups was 4.8, while in the group of traditional education it was only 4.2.
Conclusion. The implementation of project-based learning in academic departments is aimed at increasing students’ professional competencies, acquiring and improving additional professional skills, and creating and implementing innovative schemes that can be used later in a medical organization as independent projects.
Project-based learning is more effective than traditional learning in terms of critical thinking, communication and organizational skills, and teamwork experience. The practice of analytical, strategic, and planning skills as a team is an important skill difficult to acquire in traditional training.

Introduction. In the context of a declining birth rate, maintaining and improving the level of women's reproductive health is the main task in the activities of the obstetric service, the normal functioning of which is impossible without satisfactory resource provision.
Purpose. To conduct a comparative assessment of the resource provision of the obstetric service of St.
Petersburg with obstetric beds and medical personnel with indicators in the Russian Federation and the Northwestern Federal District in dynamics for 2017–2021.
Material and methods. Using the information obtained from statistical collections Federal State Budgetary Institution «Central Research Institute for the Organization and Informatization of Healthcare» of the Ministry of Health of Russia, a comparative assessment of the indicators of the provision of the obstetric service of the metropolis with obstetric beds and medical personnel in dynamics over five years was carried out. Statistical analysis of the obtained data was carried out using StatSoft STATISTICA 10.0.
Results. In 2017–2021 the obstetric service of the metropolis had a lower, compared with Russia and the Northwestern Federal District, availability of obstetric beds, more than half of which were beds for pregnant women and women in childbirth. In the dynamics of the provision of St. Petersburg with obstetric beds in general, beds for pregnant women and women in childbirth, and beds for the pathology of pregnancy, a trend of annual reduction in beds, common with the Russian Federation and the federal district, was observed. However, the rates for all obstetric beds have declined less significantly than the national and county averages. Provision of women of childbearing age in St. Petersburg with obstetrician-gynecologists exceeded
the average figures for Russia and the Northwestern Federal District. With the annual negative dynamics of the decrease in the provision of the obstetric service in the Russian Federation and the federal district with medical personnel, in the metropolis the increase in obstetrician-gynecologists for five years was 1.6 %, and the provision with midwives decreased less significantly. The contribution of the metropolis to the obstetric bed fund and medical personnel of the obstetric service of the federal district was more than a third and increased almost every year.

Background. Outpatient surgery is proven to be effective, but there are some issues in organizing the workflow of an outpatient surgery center, selecting patients, and developing a perioperative care system.
Purpose. To study the international experience in creating outpatient surgery centers.
Methods and Materials. The review was prepared using the reporting guidelines for systematic reviews and meta-analyses (PRISMA).
Results. The stages of an outpatient surgery development were defined as follows: firstly, minor surgery, then surgery under local anesthesia, and finally, laparoscopic surgery under general anesthesia. Modern surgery provides a wide range of interventions with minimal contraindications. In addition, it’s still unclear whether outpatient surgery services should be delivered within a multidisciplinary hospital, an outpatient
surgery center, or an outpatient and polyclinic institution. Treatment process should engage patients by giving a comprehensive education, standardizing processes, and setting clear expectations for recovery and
discharge. When complex patients who have already undergone a surgical intervention come to an outpatient institution, it is crucial to correctly select them. There is no established process of determining whether a patient is suitable for a surgical intervention; patient selection depends on multiple factors. Outpatient surgery centers face several challenges like increasing costs, attracting and retaining of qualified staff. The answer
could be to provide payments based on performance, and to focus on patient relevant indicators. The assessment of patient’s health condition after discharge is done, firstly, via telephones, then through messengers,
and now by digital cloud applications.

Introduction. Based on the results of clinical studies, considerable experience for the Dermatology Life
Quality Index (DLQI) has been accumulated worldwide. The Index can be integrated into the routine management of patients with psoriasis.
The purpose of the study was to systematically analyze exclusively recent data (from the last five years) on the use of the DLQI in the assessment of psoriasis severity.
Materials and methods. An extensive search for relevant sources was carried out using the PubMed/Medline bibliographic database. The search string used the keywords Dermatology Life Quality Index, Psoriasis. Works not mainly related to the DLQI usage as well as similar publications describing repeated properties and characteristics of the DLQI were excluded.
Results. The DLQI can be used in both clinical research and data analysis in clinical practice. The DLQI has been used in a number of studies to assess the effectiveness of novel types of therapy. The DLQI indicators usually correlate with the questionnaire results obtained from the Psoriasis Area and Severity Index (PASI) and the results of other quality-of-life scales. Most of the scientific publications discuss the use of the DLQI in clinical trials, including the analysis of the effectiveness of biological therapy.
Discussion. To obtain all the evidence concerning the applicability of the DLQI and its modifications in
various clinical situations, an integrated approach based on the combination of various scales in pilot studies could be expanded.