The article presents comparative analysis of demographic, social and professional characteristics of general practitioners and district therapists in state and private medical organizations. Sociological, statistical and analytical research methods were applied. The study was carried out on the basis of polyclinics of both Moscow Health Department and Moscow private health care sector. The sampling consisted of 399 questionnaires subjected to statistical processing. It is established that in state and private medical organizations, in this group of physicians prevail women 36-55 years old, born in the Russian Federation, in Moscow, married, having children and assessing one's income level as average. Most of them received their higher education in Moscow, graduated residency in therapy and have no medical category or academic degree. The professional experience consists 10 years or more. All physicians in state polyclinics hold more than one position and in private polyclinics 8.6% of physicians are underemployment. In the state sector, paternalistic model of communication with patient is preferable, in the private sector - a collegiate one. In the state sector, the collegiate management style of CEO is convenient and in the private sector - collegiate or dynamic one. In both sectors, adhocratic organizational culture is comfortable. Against the background of readiness to proceed working in current conditions, work in another sector is not excluded. The material factor is considered as main driver of professional motivation. The social, demographic and professional characteristics of general practitioners and district physicians in both sectors of health care in the main are similar, but have their own characteristics.

The article considers social, demographic and professional factors determining choice by general practitioners and district therapists of place of employment and their professional motivation. The special questionnaire was developed to be applied in sociological survey. The sampling included general practitioners and district therapists of outpatient medical organizations of the Health Department and the private health care sector of Moscow. The final analysis included 399 questionnaires. It is established that possibility of job combining depends on number of children physician has. The significance of conditions for career growth increases with physician age and availability of adult children. The opportunities for research and education activities are of great value for physicians of private health sector who obtained higher education in Russia and having adult children. The preferred management style of line manager and model of communication with patient are affected by level of workload, working conditions and income level. The preferences regarding type of organizational culture are affected by place of birth. For physicians who graduated from Russian universities, significant factor of non-material incitement is possibility of additional rest. The physicians of older age working in private health sector more often consider career advancement as professional development goal. The factors influencing choice of place of employment and professional motivation in general practitioners and district therapists are summarized. The proposals for attracting, retaining and stimulating physicians are formulated.

The patient satisfaction is one of the key criteria of quality of medical care and indicator of patient-oriented approach and factor determining competitiveness of medical organization. The purpose of the study - the comparative analysis of patient satisfaction with primary health care provided by general practitioner and district physician, taking into account their gender, age characteristics, frequency and goals of visiting polyclinic. Sociological study was carried out on the basis of out-patient medical organizations in Moscow, Kemerovo and Belgorod. The final analysis included 415 questionnaires of respondents aged 18 years and older. The patients with different rate and purposes of visiting medical institution are equally satisfied with medical care provided by general practitioner and district physician. The satisfaction with general practitioner may have gender characteristics. The satisfaction with district physician may have age characteristics. The satisfaction with both specialists may depend on health status of patient. The model of providing primary health care according to principle of general practitioner may be more universal, while according to principle of district physician more acceptable for elder patients. In order to increase satisfaction with primary health care for all categories of patients, it is necessary to consolidate best organizational approaches of both models.

In conditions of active development of medical and pharmaceutical sciences and dynamically changing work environment the education of physician is to be both continuous and personalized. Purpose of the study. To investigate effect of gender, age and work experience on educational needs and on preferences of forms and methods of training in the system of continuing medical education of Russian general practitioners. The research bases were Chairs occupied with issues of personnel training for general medical practice in Moscow, Belgorod and Kemerovo. The sociological, statistical and analytical research methodologies were applied. The overall analysis covered 402 questionnaires for general practitioners. The sampling of respondents included 19.1% of men, 80.9% of women; 52.4% were aged 36-55 (60) years, 29.3% - 24-35 years and 18.3% - 56 (61) years and older; 45.0% had experience in general medical practice up to 2 years, 16.3% - 3-4 years, 27.0% - 5-6 years, 11.7% - 7 or more years. The results of comparative analysis of opinions of physicians of both genders and various age with different time of experience concerning level of significance for practice of various areas of competence within the framework of specialty and their preferences regarding organizational forms, training methods and its duration are presented. It is established that gender, age and length of service had no significant effect on the studied parameters. However, certain characteristics associated with these factors are identified. The further study of possible influence of other internal and external factors can contribute in the future into formulation of scientifically grounded approach to choosing personalized trajectory of education of general practitioner.

Significance. Patient satisfaction with medical care is one of the key performance indicators of the health care system. The purpose of the study: to conduct a comparative analysis of patient satisfaction with primary care provided by general practitioners (GP) and district physicians (DPh) in Russia and identify indicators that can be used to manage accessibility and quality of primary care, using the principles of value-based healthcare. Material and methods. The study used analytical, sociological and statistical methods. The survey was conducted by the method of sampling. The minimum sample size equaled to 400 observation units. The survey bases included medical organizations providing medical care on an outpatient basis in the cities of Moscow, Kemerovo and Belgorod, the places that have undergone reforming and introduced GP practices. Results. The final analysis included 415 questionnaires. Patient satisfaction with medical care, provided by GP equaled to 87.6%, satisfaction with care provided by DPh added up to 73.3% (p<0.001). Patient satisfaction with individual parameters of medical care related to the medical organization, doctor and doctor-patient relationship also turned out to be statistically significantly higher if provided by GP. The average score ranged within 3.8-4.2 and 2.2-2.4, respectively. For both the GP and DPh models of care delivery, the lowest satisfaction was reported for the parameters characterizing its organization. Based on the results of our own research and results of earlier papers, the indicators of primary care accessibility and quality that are of greatest value to the patient were identified. Conclusion. Based on generalization of the study results and data published in scientific literature, a set of indicators has been proposed to ensure continuous monitoring over quality and accessibility of primary care and make organizational and managerial decisions using the principles of value-based healthcare.

Витилиго – приобретенное хроническое заболевание аутоиммунной природы, характеризующееся появлением на коже депигментированных пятен вследствие уменьшения количества меланоцитов. Заболевание чаще развивается в детстве, но может возникнуть в любом возрасте. В ряде исследований показано, что у пациентов с витилиго распространенность аутоиммунных заболеваний щитовидной железы превышает таковую в общей популяции. Кроме того, имеются публикации о более высокой распространенности патологии щитовидной железы у пациентов с поздним началом витилиго, по сравнению с ранним дебютом заболевания. В отечественной литературе работы, посвященные данному вопросу, отсутствуют. Целью настоящего исследования явилась оценка частоты встречаемости аутоиммунного тиреоидита (АИТ) у пациентов с ранним и поздним началом витилиго. В исследование были включены 53 пациента с несегментарным и сегментарным типом витилиго: 31 пациент с ранним началом заболевания (до 12-летнего возраста) и 22 пациента с поздним дебютом заболевания (после 30-летного возраста). В результате проведенных исследований у пациентов с поздним началом витилиго выявлена высокая частота встречаемости АИТ (в 50% случаев), превышавшая аналогичный показатель в группе пациентов с ранним дебютом заболевания, а также показатель распространенности АИТ в общей популяции. При ассоциации витилиго с АИТ почти в половине случаев появление депигментированных пятен предшествовало манифестации эндокринной патологии. Полученные данные обосновывают целесообразность скринингового обследования пациентов с витилиго, особенно с поздним началом заболевания с целью раннего выявления сопутствующих эндокринопатий.

В патогенезе витилиго важная роль отводится аутоиммунным механизмам, о чем свидетельствует в том числе более частая, чем в популяции, ассоциация заболевания с другой аутоиммунной патологией. В то же время частота встречаемости аутоиммунных заболеваний кожи у пациентов с витилиго изучена недостаточно. ЦЕЛЬ ИССЛЕДОВАНИЯ Оценка частоты ассоциации витилиго с другими аутоиммунными заболеваниями кожи в когорте пациентов, наблюдавшихся в МНПЦДК в 2019–2021 гг. МАТЕРИАЛ И МЕТОДЫ Под наблюдением находились 137 пациентов с витилиго в возрасте от 3 лет до 71 года (средний возраст 28,7 года), которые составили основную группу больных. Контрольная группа включила 1 773 096 пациентов с различной патологией (за исключением пациентов с витилиго). РЕЗУЛЬТАТЫ В группе пациентов с витилиго в 3 (2,19%) случаях выявлена ассоциация заболевания с гнездной алопецией, в 2 (1,46%) — с псориазом, в 2 (1,46%) — с локализованной склеродермией, в 1 (0,73%) — с генитальным склеротическим и атрофическим лишаем. Ассоциаций витилиго с другой аутоиммунной кожной патологией не обнаружено. Частота встречаемости гнездной алопеции и локализованной склеродермии в группе пациентов с витилиго статистически значимо превышала аналогичные показатели в контрольной группе соответственно в 6,9 раз (ОШ 6,93, 95% ДИ 2,21–21,78; p=0,01) и 6,5 раза (ОШ 6,47, 95% ДИ 1,60–26,15; p=0,04). Статистических различий в частоте встречаемости псориаза в группах пациентов не установлено. ЗАКЛЮЧЕНИЕ Выявленная нами повышенная частота ассоциации витилиго с гнездной алопецией и локализованной склеродермией может служить одним из доказательств наличия у этих заболеваний общих патогенетических связей, что позволяет считать их коморбидной патологией.

There is evidence in the literature about more frequent association of vitiligo with autoimmune endocrine diseases (AEDs) compared to general population. No full-fledged studies aimed at assessing the prevalence of AEDs in the Russian cohort of adult vitiligo patients have been conducted. The study was aimed to assess the prevalence of AEDs in the cohort of Russian adult vitiligo patients. Patients with vitiligo monitored in two clinics, the Endocrinology Research Centre (Clinic 1; n = 39) and the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology (Clinic 2; n = 26), were enrolled. Along with clinical examination, screening laboratory tests were performed in all patients in order to reveal AEDs. The majority of patients (more than 95% of cases) had nonsegmental vitiligo. Among patients monitored in Clinic 1, AEDs were diagnosed in 85% of cases: isolated AEDs accounted for 39%, while multiple AEDs were found in 46% of cases. Autoimmune thyroid diseases were diagnosed in 69% of cases. Autoimmune adrenal insufficiency was found in 28% of patients, type 1 diabetes mellitus in 21%, hypoparathyroidism in 13%, hypergonadotropic hypogonadism in 10%, endocrine ophthalmopathy in 10% of patients. Among patients monitored in Clinic 2, AEDs were diagnosed in four patients (15% of cases): three patients had primary hypothyroidism in the outcome of autoimmune thyroiditis, one patient had Graves' disease. Thus, the prevalence of AEDs in patients with vitiligo may vary between 15–85%. Vitiligo is most often associated with autoimmune thyroid diseases (15–69%). Vitiligo patients should undergo annual screening aimed at detection of autoimmune endocrine disorders, especially thyroid diseases.

V literature imeyutsya dannye o bolee chastoj, chem v populyacii, associacii vitiligo s endokrinnymi autoimmunnymi zabolevaniyami (eAIZ). V rossijskoj kogorte polnocennyh issledovanij, napravlennyh na ocenku chastoty vstrechaemosti eAIZ u vzroslyh pacientov s vitiligo, ne provodilos'. Cel'yu issledovaniya bylo proanalizirovat' chastotu vstrechaemosti eAIZ v kogorte rossijskih vzroslyh pacientov s vitiligo. V nego voshli pacienty s vitiligo, nablyudavshiesya v dvuh lechebnyh uchrezhdeniyah: «NMIC endokrinologii» (centr 1; n = 39) i v «MNPCDK DZM» (centr 2; n = 26). Vsem pacientam naryadu s klinicheskim obsledovaniem provodili skriningovoe laboratornoe obsledovanie s cel'yu vyyavleniya eAIZ. U bol'shinstva pacientov (bolee 95% sluchaev) ustanovlen nesegementarnyj tip vitiligo. Sredi pacientov, nablyudavshihsya v centre 1, eAIZ diagnostirovany v 85% sluchaev: u 39% vyyavleno odno eAIZ, u 46% — mnozhestvennye eAIZ. Autoimmunnye zabolevaniya shchitovidnoj zhelezy vstrechalis' v 69% sluchaev. U 28% pacientov vyyavlena autoimmunnaya nadpochechnikovaya nedostatochnost', u 21% — saharnyj diabet 1-go tipa, u 13% — gipoparatireoz, u 10% — gipergonadotropnyj gipogonadizm, u 10% — endokrinnaya oftal'mopatiya. Sredi pacientov, nablyudavshihsya v centre 2, eAIZ diagnostirovany u chetyrekh bol'nyh (15% sluchaev): u troih — vyyavlen pervichnyj gipotireoz v iskhode v autoimmunnogo tireoidita, u odnogo — bolezn' Grejvsa. Takim obrazom, chastota vstrechaemosti eAIZ u pacientov s vitiligo mozhet var'irovat' ot 15 do 85%. Naibolee chasto (15–69%) vitiligo associiruetsya s autoimmunnymi tireopatiyami. Pacientam s vitiligo pokazano ezhegodnoe skriningovoe obsledovanie s cel'yu vyyavleniya autoimmunnoj endokrinnoj patologii, osobenno zabolevanij shchitovidnoj zhelezy.

The private health care sector in the Russian Federation is developing and its role in providing not only paid, but also free medical care is increasing. The issues of cooperation between state and private health sectors becomes more actual. The purpose of the study is to investigate current research and practical issues of private health care in the Russian Federation and to identify shared and specific problems with state sector and to develop proposals for evolution of intersectorial interaction and partnership. The study used analytical, sociological and statistical methodologies. The sociological survey covered 409 executives of state and private medical organizations. It was established that current and prospective research and practical problems of state and private health care are mostly shared. The statistically significant differences in opinions of respondents were determined. The list of most actual research and practical problems of private health care was composed. The commonality of derived valuations confirmed trend to integration. The identified sporadic differences are explained by greater social orientation of state health care and directness on competition of private health care. The generalization of national and foreign experience permitted to formulate proposals on partnership between state and private health care. The trend to integration of state and private health care can be transformed into active process of development of long-term partnership cooperation in health recovery and maintenance that will result in ensuring active longevity of population of the Russian Federation.

Atopic dermatitis is one of the most common diseases (20‒40% among skin diseases) that occur in both genders worldwide and in different age groups. The problem urgency is caused by an increase in morbidity, a chronic relapsing course that often leads to a decrease in the quality of life and disability, low efficiency of traditional treatment methods, and limited access to contemporary effective targeted therapy. The clinical guidelines, which aimed to optimize care for patients with atopic dermatitis, contain up-to-date information on epidemiology, etiological factors, mechanisms of development and pathogenesis, aspects of the clinical presentation and disease course, current diagnostic methods (including allergological examination methods), as well as approaches to treatment (including traditional methods and modern targeted therapy). The indications for allergen-specific immunotherapy are determined, and the aspects of its implementation are described. The procedure for the provision of medical care, prevention, and follow-up monitoring is outlined. Clinical practice guidelines for atopic dermatitis are intended for practitioners of all specialties, students, teachers of medical schools, residents, graduate students, and researchers.

A new SARS-CoV-2-associated coronavirus infection pandemic began in late 2019. The present article is devoted to the analysis of the mechanisms of COVID-19 impact on the course of psoriasis and its consequences. According to the scientific literature, patients with psoriasis are somewhat more likely to be infected with coronavirus infection than the healthy population, but tolerate it in a milder form. At the same time, cases of psoriatic process exacerbation during the active phase of the disease and after COVID-19 have been described. The negative effect of infection on skin disease can be explained by the common genome of the two nosologies, the «cytokine storm» and the prescription of COVID-19 drugs. In addition, both COVID-19 and psoriasis can cause liver dysfunction related to the specific pathogenesis of the diseases as well as the prescribed therapy. The article describes our own experience of monitoring patients with exacerbation of psoriasis against the background of coronavirus infection with pathological changes in liver tests. Inclusion of a fixed combination of glycyrrhizic acid and essential phospholipids in the complex treatment allowed to stop the exacerbation of the psoriatic process more effectively, to reduce the activity of liver enzymes without worsening the clinical conditions associated with COVID-19. Thus, in particular, a clinically significant improvement of the skin condition was recorded. In patient B., alanine aminotransferase activity decreased to 44.4 U/L and aspartate aminotransferase activity to 18.2 U/L. In turn, in patient M. the activity of liver enzymes decreased to 37.8 U/L and 34.7 U/L, respectively. The prescription of this drug can be considered pathogenetically justified, given the effect of glycyrrhizic acid on the production of key cytokines involved in the inflammatory process in psoriasis, coronavirus infection and liver pathology. In addition, the hypothesis of the ability of glycyrrhizic acid to prevent the entry of SARS-CoV-2 into the cell by reducing the expression of angiotensin-converting enzyme 2 is of interest.

Atopic dermatitis is one of the most common diseases (20‒40% among skin diseases) that occur in both genders worldwide and in different age groups. The problem urgency is caused by an increase in morbidity, a chronic relapsing course that often leads to a decrease in the quality of life and disability, low efficiency of traditional treatment methods, and limited access to contemporary effective targeted therapy. The clinical guidelines, which aimed to optimize care for patients with atopic dermatitis, contain up-to-date information on epidemiology, etiological factors, mechanisms of development and pathogenesis, aspects of the clinical presentation and disease course, current diagnostic methods (including allergological examination methods), as well as approaches to treatment (including traditional methods and modern targeted therapy). The indications for allergen-specific immunotherapy are determined, and the aspects of its implementation are described. The procedure for the provision of medical care, prevention, and follow-up monitoring is outlined. Clinical practice guidelines for atopic dermatitis are intended for practitioners of all specialties, students, teachers of medical schools, residents, graduate students, and researchers.

Одной из основных гипотез патогенеза витилиго считается аутоиммунная гипотеза. В литературе имеются данные о более частой, чем в популяции, ассоциации витилиго с другими аутоиммунными заболеваниями: аутоиммунным тиреоидитом, болезнью Грейвса, сахарным диабетом 1-го типа, ревматоидным артритом и др. Однако частота встречаемости аутоиммунной патологии у родственников больных витилиго менее изучена. Цель настоящей работы заключалась в оценке частоты встречаемости аутоиммунных заболеваний у родственников больных витилиго по данным семейного анамнеза. Анализ анамнестических данных проведен у 138 пациентов с витилиго (средний возраст 29 лет): 125 больных нсегментарным типом и 13 больных сегментарным типом заболевания. Отягощенный семейный анамнез по аутоиммунной патологии выявлен у 38,4% пациентов. Наиболее часто у родственников больных встречалось витилиго и аутоиммунный тиреоидит, распространенность которых оказалась соответственно в 11,9 и 4 раза выше, чем в популяции. Отягощенный семейный анамнез по витилиго и аутоиммунным эндокринопатиям был выявлен нами лишь у больных несегментарным типом витилиго, что свидетельствует о наличии некоторых различий в патогенетических механизмах развития несегментарного и сегментарного типа заболевания. Частота встречаемости у родственников аутоиммунных заболеваний щитовидной железы (главным образом аутоиммунного тиреоидита) была достоверно выше в подгруппе больных, имевших наряду с витилиго сопутствующие аутоиммунные эндокринопатии, чем в подгруппе пациентов, не имевших таких заболеваний. Полученные результаты свидетельствуют о возможности использования данных семейного анамнеза о наличии/отсутствии аутоиммунной патологии у родственников в качестве одного из критериев при определении тактики ведения больных витилиго и целесообразности обследования их с целью раннего выявления коморбидных эндокринных аутоиммунных заболеваний.

Nowadays, the key problem in health care management is manpower issue that is manifested as acute shortage and inadequate qualification of medical personnel; working conditions providing no modern standard of living and developing type of personality uninterested in the results and unready to bear responsibility for poor quality of medical care. Purpose of the study is to develop conceptual grounds of improving manpower management in medical organizations based on the study of actual state and specifics of functioning of medical personnel in actual conditions. Material and methods: analytical, historical, statistical, sociological. The main causes of inadequate application of professional and personal capabilities of medical personnel are tough regulation and exceeding formalization of labor, inadequacy of personal funds to satisfy personal requirements in training, increased fatigue at workplace, lack of needed conditions to apply actual knowledge and skills, disinterestedness of administration in ambitious self-starters. The causes of medical personnel dissatisfaction with professional work are closely related to causes of under-exploitation of their professional and personal potential. The main factors diminishing satisfaction of medical personnel with professional labor are low wages at significant workload. The system of organizational measures to optimize application of existing manpower in medical organizations is proposed. The strategic reserve of increasing efficiency of medical organization functioning is realization of need of medical personnel in effective application and development of their professional and personal potential.

Introduction. The prevalence of functional biliary disorders continues to increase with insufficient effectiveness of existing treatment approaches. Among them, functional biliary disorders of sphincter of Oddi account for at least 50%.Objective. To study efficacy, safety and tolerability of a fixed combination of glycyrrhizic acid and ursodeoxycholic acid (Fosfogliv Urso) in capsule form in patients with functional biliary disorders of sphincter of Oddi.Materials and Methods. The study included 32 patients diagnosed with functional biliary sphincter of Oddi disorders established according to the Rome Criteria IV revision (2016). Patients received Fosfogliv Urso (250 mg ursodeoxycholic acid and 35 mg glycyrrhizic acid) 1 capsule 3 times a day for 8 weeks. Prior to treatment, all study participants underwent a standard set of laboratory and instrumental examinations.Results. Against the background of Fosfogliv Urso treatment, statistically significant decrease of biliary pain prevalence up to 48.3% (p < 0.001); intense biliary pain up to 11.4% (p < 0.0001); intensity of pain syndrome on visual analogue scale down to 1.7 ± 0.9 cm was registered (p < 0.0001). Alanine aminotransferase activity significantly decreased to 34.0 ± 4.0 U/L (p < 0.001). There was a tendency of choledochal diameter decrease to 0.57 ± 0.01 cm. Treatment efficacy was rated by patients as very good and good in 83.4% of cases. The safety profile was assessed as favorable and tolerability as satisfactory.Discussion. The results obtained were superior to those previously obtained for ursodeoxycholic acid monotherapy and confirmed the data of the previously conducted phase III study. The rationality of the combination is due to the mutual complementation and possible synergism of the pharmacological effects of glycyrrhizinic and ursodeoxycholic acids.Conclusion. The results obtained allow to recommend the prescription of Fosfogliv Urso in the complex scheme of treatment and prophylaxis of functional biliary disorders of sphincter of Oddi.

Previously, a method of synthesis of trimethyl-substituted furodihydroquinoline (FDHQ), a putative photosensitizer for the therapy of psoriasis, was disclosed in patent RU #2614248. FDHQ was proposed for substituting derivatives of the psoralen (8-methoxypsoralen, 8‑MOP; 5-methoxypsoralen, 5‑MOP; and trimethylpsoralen, TMP) actually applied for this purpose. FDHQ exhibited an advantage over psoralens in safety for the patient. However, practical use of FDHQ was found to be impossible due to its insufficient solubility in any clinically permitted solvents. To solve this problem, a synthesis of six earlier unknown derivatives of FDHQ with side substitutes in position 5 of the benzene nucleus (carbamate, acetamide, and sulfuric moieties) were synthesized: N-(6,8,8-trimethyl-8,9-dihydrofuro[3,2-h]quinoline-5-yl)acetamide (W); tert-butyl (6,8,8-trimethyl-8,9-dihydrofuro[3,2-h]quinoline-5-yl)carbamate (K); tret-butylacetyl (6,8,8-trimethyl-8,9-dihydrofuro[3,2-h]quinoline-5-yl)-carbamate (WK); N-methyl-N-(6,8,8-trimethyl-8,9-dihydrofuro[3,2-h]quinoline-5-yl)acetamide (WС1); N-octyl-N-(6,8,8-trimethyl-8,9-dihydrofuro[3,2-h]quinoline-5-yl)acetamide (WС8); sodium acetyl (6,8,8-trimethyl dihydrofuro[3,2-h]quinoline-5-yl)sulfamate (S). In vitro testing on T-cell lympholeukosis (Jurkat), В-cell lymphoma (Raji) cell lines and immortalized human fibroblasts demonstrated optimal photosensitizing properties in compound S. The ratio between dark toxicity and phototoxicity of this compound (irradiation with UV light with λ = 302 nm) on the chosen model cell lines suggests it as a putative efficient and safe medicine for phototherapy of psoriasis.