ОБЪЕКТИВИЗАцИЯ ОТДАЛЕННОГО пРОГНОЗА пАцИЕНТОВ С пЕРЕНЕСЕННОЙ чЕРЕпНО-мОЗГОВОЙ ТРАВмОЙ Ю. Г. Анников 1 , И. Л. Кром 1 , м. В. Еругина 1 , м. м.Орлова 2 , Е. м.Долгова 1 , Г. Н. Бочкарева 1 1 Саратовский государственный медицинский университет им.В. И. Разумовского, Российская Федерация 2 Саратовский национальный исследовательский государственный университет им.Н. Г. чернышевского, Российская ФедерацияThe study included 414 working-age patients with a history of PTBI, of which 93.6 % were men.Respondents underwent an examination of their neurological status and an assessment of the quality of life (QOL) using the WHOQOL-100 questionnaire annually during 2020-2022.In 64.7 % of patients with PTBI, clinical deterioration was noted, accompanied by a decrease in QOL.In 6.3 % of respondents, the clinical picture remained stable, and QOL indicators remained unchanged during repeated studies.In 24.9 % of cases, there was a clinical improvement accompanied by an increase in the dynamics of QOL.In 4.1 % of patients, an inverse relationship was noted in the form of a decrease in the overall quality of life and an improvement in the clinical picture (a reduction in the severity of cerebral symptoms, asthenic syndrome).Thus, in the absence of specific laboratory markers in clinical practice and insufficient information content of neuroimaging research methods in patients after PTBI, QOL should be considered an additional personalized criterion for predicting patients with this pathology.

Chronic diseases, which form the somatic and social deprivation of patients, imply the provision of integrated medical and social care. National health care systems are actively pursuing processes aimed at overcoming the fragmentation of health care delivery and forming a model of integrated health care. The purpose of the study. Analysis of interaction of medical organizations and continuity in the treatment of patients in rural health care in the Saratov region. Material and methods. The authors conducted a comparative sociological study, which involved 319 physicians working in the district medical organizations of the Saratov region. The study was preceded by the construction of the medical and social portrait of the respondents. Results. The majority (73.7 %) of the respondents assessed the degree of continuity of patient care between inpatient and outpatient facilities in the district of the region as average. Conclusion. The study reveals the peculiarities of the organization of medical care for the rural population, which consist in the limited implementation of the principles of continuity in the management of patients, the presence of barriers to digitalization. The analysis of the degree of interaction between doctors when providing medical care to the rural population in inpatient and outpatient conditions reveals the fragmentation of rural and regional health systems.

The epidemiological monitoring of morbidity, mortality and disability is one of the important mechanisms of studying population health. The purpose of the study is to carry out comparative analysis of health status of population of the Russian Federation and the Republic of Uzbekistan. MATERIALS AND METHODS:The demographic indicators as well as indicators of morbidity, mortality and disability of adult population of the Russian Federation and the Republic of Uzbekistan in 2010-2020 were analyzed. The statistical, analytical and mathematical methods were applied. The statistical significance of differences in relative values was calculated using the Student's coefficient and was considered as significant at p<0.05 and t>2. THE RESULTS:During the study period, an increase in population size of the Russian Federation and the Republic of Uzbekistan was established. The population age structure was of regressive type in the Russian Federation and of progressive type in Uzbekistan. In the Russian Federation, significant decrease of natality up to 12.8% and statistically significant increase of mortality up to 34% occurred. The natural population loss in the Russian Federation raised three-fold. In the Republic of Uzbekistan, there was statistically significant increase both of natality and mortality indicators up to 11% and of positive values of natural population growth by 14% (p<0.03). In the Russian Federation, there is statistically significant (p<0.006) decrease of indicator of primary disability from 7.7 cases per 1000 of population in 2010 to 5.6 cases in 2020. In the Republic of Uzbekistan, significant increase (p<0.009) of indicators of primary disability from 0.1 cases per 1000 of population to 2.2 cases per 1000 of population was established. THE CONCLUSION:The different types of population in the Russian Federation (regressive) and in the Republic of Uzbekistan (progressive) predetermine differences in demographic indicators of both countries. The high level of mortality and increasing of morbidity of circulatory system and neoplasms in both countries justify need in improving measures of primary and secondary prevention at the state level.

In conditions of societal transformations, social institutions undergo significant alterations that are manifested by institutional inconsistency and dysfunctionality. The transformation of social professional structure of health care system resulted in change of status and trends of social mobility of social professional groups. The purpose of the study is to typologize social predictors of professional activity of physicians in health care of the Russian Federation. The social economic transformation and reforms of the National health care system of recent decades initiated trends of deprofessionalization in medicine, status inflation and marginalization of professional groups. The phenomenon of professional marginalization of physicians is discussed from perspective of the "concept of status inconsistency" by G. Lensky. In aurhoring typology low income of physicians, financial deprivation, reducing of prestige and relative status inflation of medical profession, professional stress, social frustrations and professional burnout are considered as social predictors of professional activity of physicians. The destructive consequences of status inflation are considered as social threat to preservation of manpower potential of health care of the Russian Federation.

In Russia, the oncological diseases significantly impact public health. The study of oncological medical care organization in the Saratov Oblast, that has a number of territorial demographic and medical social characteristics, affecting oncological situation, was carried out. The purpose of the study is to verify systemic factors determining specific characteristics of the oncological medical care organization in the Saratov Oblast. MATERIALS AND METHODS To elaborate objective comprehension of specific characteristics of the oncological medical care organization in the Saratov Oblast medical and sociological focus groups study was carried out, involving sampling of 12 experts oncologists and health care organizers. THE RESULTS The original guide scenario developed for the focus group study included expert discussion on trends in oncological medical care organization at the Oblast level and directions of improving continuum of oncological care. The study data analysis was implemented in accordance with specified scenario. CONCLUSION The focus group study elaborated objective understanding of the specific characteristics of oncological medical care organization in the Oblast and predetermined verification and ranking of systemic factors that significantly impact the continuum of oncological care.

Doctors’ health is seen as a sign that a public healthcare system is efficient. Authors of the present work aimed to review occupational health risks for doctors in contemporary public healthcare systems; to do that, they analyzed publications taken from both domestic and foreign databases. Multiple research works indicate that doctors’ health and their efficiency are closely connected with peculiarities of their working conditions. Literature contains convincing evidence that unfavorable working conditions exert their influence on doctors’ health; induce occupational diseases, occupational stress and burnout. Specific attention paid to occupational burnout is due to its high prevalence as well as impacts exerted by it on individual health and occupational efficiency of doctors. The authors note that researchers’ interest to occupational stress occurs due to its negative effects on doctors’ health and occupational efficiency and clinical safety as well. Some research works dwell on clinical context of occupational stress that includes strict requirements to work and adverse conditions that stimulate burnout and can result in a threat to a patient’s safety. In researchers’ opinion, specific development of occupational stress syndromes is predetermined by essence and peculiarities of occupational activities performed by doctors with different specialties. Prevalence of occupational burnout among doctors is associated with dysfunctional practices adopted in national public healthcare systems, conditions for medical aid provision, medical specialty, age and gender characteristics, and a stage in career development. It is noted here that doctors’ health is discussed in modern Russian research works not only within the context of unfavorable working conditions. An overall crisis and dysfunctional practices adopted in contemporary Russian public healthcare system have determined status inflation and marginalization of doctors’ occupational group; it influences their individual health directly via financial deprivation and relative deprivation such as stress related to social comparison. In the authors’ opinion, this stress ultimately results in occupational one.

Because of the optimization of the clinical and social prognosis of patients with cancer in recent decades, the possibility of incorporating rehabilitation in the continuum of cancer care is considered. Therefore, this study presents a comparative analysis of the quality of life among 427 working-age respondents with breast cancer in disease situations using the WHO QOL 100 questionnaire. Based on the results, a statistically significant decrease in the quality of life among the respondents in the physical and the level of independence spheres in the non-terminal situation of the disease was found, whereas in the group of incurable patients, a statistically significant decrease in the quality of life among the respondents in the physical, psychological, and level of independence spheres was found. Through the findings of this study, the rehabilitation of cancer patients in disease situations can be personified, and recommendations for improving the continuum of cancer care can be developed.

The achievements of modern medicine resulted in an increase of number of patients living with chronic diseases that turned out as significant burden for national economics. The oncologic diseases are one of the most widespread ones, determining patient vital prognosis. The modern achievements in medicine determine possibility of optimizing clinical prognosis and chronic course of disease. In modern Russia, the health care system functions in accordance with model of urgent, fragmented medical care that does not meet current needs of patients with chronic diseases. In Russia, actual procedures of medical care of oncologic patients do not consider interdisciplinary continuum scenario. Therefore, the need for its conceptualization. The article proposes model of continuum of oncologic care of patients in the context of an integrated health care system, that presupposes complex interdisciplinary follow-up of patients with chronic disease in situations of disease.

Онкологические заболевания относятся к числу наиболее распространенных хронических заболеваний, определяющих жизненный прогноз пациентов.В большинстве регионов онкологическая помощь до настоящего времени представлена в основном стационарной специализированной медицинской помощью.Приводится новый подход в оказании паллиативной помощи в Саратовской области, позволивший улучшить качество жизни и помощи пациен

The specificity of functioning of health care institutions presupposes high determinacy of efficiency and quality of their organizational behavior and level of motivation of employees. The purpose of study is to determine the degree, determinants of manifestation and means of management of level of in-depth motivation of activities (work) and its outcomes in different professional groups of personnel of medical organization. The study was carried out on the basis of 6 military hospitals using technique of continuous anonymous questionnaire survey of sampling of 583 respondents. The sampling was allocated to such professional groups as "Administration", "Specialists", "Nursing Personnel", "Others" and "Paramedical Personnel". The answers to questionnaire questions presupposed evaluation according 7 points scale named by degree of expression of analyzed characteristics. The "Indicator of Potential of Activity Motivation" was calculated for representatives of professional groups. The character of its relationship with social characteristics of individuality of employees was determined. The professional groups of medical organization are characterized by significant characteristics of manifestation by employees in their work the in-depth motivation of activity. Its highest level is established in respondents from professional groups "Administration" and "Specialists"/ The average level is established in respondents from professional groups "Nursing Personnel" and "Others". The low level is established in respondents from professional group "Paramedical Personnel". The factor is established effecting manifestation of in-depth motivation of activity: exceeding of controlling work of employee over one's autonomy. The attractiveness of implemented work is determined by social characteristics of individuality: need in career development, correspondence of knowledge and skills to implementing work, satisfaction with work context. The elaborated questionnaire can be applied as a tool for analysis of motivation sphere and attitude of health care employees to their professional work.

The article is devoted to autonomy of patient as applied to postmortem donors of organs. The conclusion is made on the basis sociological approach and analysis of legal concepts of «medical service», «medical intervention» and «patient» as related to postmortem organ donorship, about priority of assessment of this particular issue. The attempts of applying regulations of the law on funeral business to postmortem organ donors is inadmissible. The suggestion is developed to consider consent presumption of posthumous organ donorship as a form of transition from autonomy of particular patient to autonomy of society given population support.

The chronic kidney diseases are recognized as one of leading problems of modern health care due to high prevalence and unfavorable prognosis. The article considers modern classification of predictors of chronic kidney diseases. It is emphasized that none of known modern classifications of chronic kidney diseases predictors don't take into account medical care accessibility to patients in disease condition as a predictor. It is proposed to consider accessibility of medical care from perspective of macrolevel social factors that represent the most widely background health predictors. The original typology of accessibility of nephrological medical care to patients with chronic kidney disease is proposed, which is implemented through prevention and/or minimization of predictors of the onset of chronic kidney diseases, management of disease progression and nephroprotection modifiable predictors, and renal replacement therapy for patients with chronic kidney disease. The one of reasons of limited accessibility of renal replacement therapy for patients with chronic kidney diseases is transportation problem that is solved in the Saratov region through organization of transportation of dialysis patients and development of domiciliary methods of renal replacement therapy. The restriction of medical care accessibility to patients is considered as an obligatory predictor of the onset, progression and unfavorable prognosis of chronic kidney diseases.

According to the WHO, social responsiveness is associated with non-medical indices of health care system functioning. The integral index of responsiveness of health care system at providing specialized medical care to children in rural areas of the region was applied for assessing the degree of concordance of regional health care system to expectations of population. The most positive appraisals of respondents were given to indices of social responsiveness determined by professionalism of the medical personnel of the Oblast children hospital. The survey results demonstrated that main problem of respondents is transport accessibility of specialized medical care for children in rural areas of the region.

The article presents analysis of accessibility of medicinal treatment according to standards of medical care for able-bodied patients with arterial hypertension. The inadequate medicinal support in case of out-patient treatment of population not included to benefit categories turned out one of problems in the area of circulation of medications in the Russian Federation. Until now, arterial hypertension positioned to be among diseases without any public compensation of costs for outpatient treatment. The actual study substantiates that out-patient treatment with its average costs according established standards makes up to 964.2 rubles per month is inaccessible for 78% of respondents of able-bodied patients included into study.

The actuality of problem of quality of life of patients with craniocerebral trauma is involved with high prevalence of the mentioned pathology and uncertainty of medical social prognosis. The outcomes of craniocerebral trauma, even in case of its light degree, for the first time can be manifested after many years being besides not always adequate to severity of course of acute period of craniocerebral trauma and having deteriorative course. The article presents the results of original study of quality of life of patients of able-bodied age with old craniocerebral trauma. The degree of severity of old craniocerebral trauma is considered as an obligate predictor of quality of life of patients.

The article is devoted to the 75th birth anniversary of the Honoured Doctor of the Russian Federation Professor Natalya Grigoryevna Astafyeva.

The societal transformations and reforms of the Russian health care of last decades-initiated changes of professional status and stability of social professional groups of the institute of health care. The physicians occupied the lowest status grade level among the poorest stratum of population as a result of dragged out crisis and inefficient health care reforms. In modern Russia, alterations of social structure, increasing social differentiation, crisis and dysfunctional practices of Institute of health care resulted in marginalization of social professional groups that is discussed in the context of "concept of status non-consistence" developed by G. Lensky. The article presents the results of study concerning effect of financial deprivations to quality of life of physicians of the region. The evidences are presented related to socially determined and conditioned mainly by financial deprivations decreasing of quality of life of physicians working in medical organizations of various level in the Saratov oblast.