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.

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.

The success of adaptation of students to conditions of educational process in Medical University is determined by complex of accompanying socio-psychological factors. The level of personal anxiety determines severity of impact of these factors on psychosomatic state of student. The high level of anxiety among students in conditions of educating in Medical University can significantly and multi-componently impact their physical organism, success in teaching and social well-being. The purpose of the study is to determine prevalence of high levels of anxiety and their impact on health and social well-being of students of different genders, periods of study on budgetary and commercial basis. There is significant prevalence of high levels of personal anxiety among students of first year of education (57.0%), which tends to increase by fourth year (75.5%). The increased anxiety has significant impact on morbidity (correlation with anxiety levels τ=0.69 and τ=0.40 for men and women, respectively) and social well-being of students, their behavior and lifestyle. The female students are the most affected by anxiety factor. The belonging of students with high level of anxiety to budget or commercial group determines specificity their response to conditions of education in the Medical University. The obtained results should be used to improve efficiency of adaptation and psychological support of students in the process of education in Medical University. The high level of anxiety in students should be taken into account in preventive activities of preserving health of students as separate factor, impacting similarly with strong health risk factor on their physical organism and social well-being, considering gender and period of study on budgetary or commercial basis.

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.

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.

Objective: to conduct an analysis of the provision of beds and medical personnel of medical institutions in the region that render medical care to patients with circulatory disorders. Material and Methods. Calculation of the optimal volume of inpatient medical care, the required number of beds and staff units of cardiologists in the region was carried out in accordance with regulatory legal acts. Results. In medical organizations, an excessive number of round-the-clock beds on the "cardiology" profile (more for 186 beds) and insufficient number of cardiac beds in day hospitals (less than 40 beds) were deployed; the number of cardiologists working in cardiological rooms of polyclinic medical organizations, dispensaries for cardiology and daily hospitals has been identified. Conclusions: Redistribution in the region's medical organizations of the bed fund, material, and financial resources leads to the optimization of patients' referrals and promotes rational use of resources of health care, increasing the availability and improvement of quality of medical care to adult population of the region.

Demographic situation at the global and regional levels is designated by social context and social mechanisms. The probability of a certain pathological state may increase under the influence of factors, most of which can be considered as socially determined. Poverty and health care limited availability are considered by the authors in the context of the risk of the formation of a marginal situation for patients with chronic diseases, which is manifested in adaptation crisis, disability of the patient in a situation of chronic disease.

The process of institutionalization of healthcare, which is considered as one of the basic social institutions, is realized in qualitative changes in its structure. The authors note that changes in the social structure, the social differentiation increasing, crisis and dysfunctional processes in the healthcare institution in modern Russia have led to a change in status, social mobility descending and marginalization of the social and professional groups of the healthcare institute. In the authors' opinion the process of marginalization of the social and professional groups of the healthcare institute is explained by the «concept of status inconsistency» proposed by G. Lensky.

The article presents the legal provisions containing the rights of children and duties of medical workers in providing medical care to children in the Russian Federation. It is shown that these legal provisions set out in the relevant legislative documents do not exist in isolation, but in conjunction with other legal norms, which complicates the possibility of their implementation by medical workers in full. It is stated that special responsibility and the cost of failure in modern conditions require medical staff to use not only professional knowledge, but also legal aspects accompanying their work. This suggests the need to focus attention to the learning process of students and listeners of faculties of improvement of professional skills and professional retraining of specialists of universities on peculiarities of realization of children's rights in providing them medical care.

The analysis of legislative acts in the regulation of palliative care has been made, which has determined for the first time this area as complex medical interventions pain relief and relief of other severe manifestations of the disease in order to improve the quality of life of terminally ill citizens. The article presents the causes, predisposing factors and main symptoms of the syndrome of emotional burnout of health workers who provide palliative care. Palliative care can be provided by health workers if they have skills of emotional stability obtained with appropriate training to work with palliative patients. This requires the development of special educational programs for use in the process of postgraduate education and advanced training of these specialists.

В результате проведенного исследования были выявлены структурные диспропорции при оказании стационарной медицинской помощи пациентам с эссенциальной (первичной) артериальной гипертензией и стабильной стенокардией. В ходе проведения исследования использовались методы: контент-анализа, системного анализа, аналитический, статистический, социологического опроса. Отмечено невыполнение параметров стандарта стационарной медицинской помощи больным со стабильной стенокардией и эссенциальной (первичной) артериальной гипертензией в медицинских организациях разного уровня подчинения. Отмечается рост выявления дефектов при оказании медицинской помощи вышеуказанным группам больных экспертами СМО. В целях улучшения качества оказания медицинской помощи пациентам с болезнями органов кровообращения, уменьшения экономического ущерба, получаемого медицинскими организациями региона в результате неэффективного использования имеющихся ресурсов, предложены пути преодоления выявленных проблем.

Purpose: the study of trends in overall morbidity and primary hypertension in the Saratov region over the period from 2002 to 2013. Materials and methods. The official statistics Ministry of Health and the Federal State Statistics Service were used, which is processed using analytical and statistical methods. Results. The article has been providing the analysis of total and primary arterial hypertension morbidity of the population of the Saratov region, which is in accordance with the degree of the Government of the Russian Federation from December 1, 2004, N 715 to the group of socially significant diseases. During the period from 2002 to 2013 in the Saratov region, as well as in the Russian Federation in Volga Federal district, the tendency of growth of the overall incidence and the decrease in the primary incidence of arterial hypertension. Conclusion. The dynamics of incidence of hypertension suggests the need for careful analysis and optimization of medical care for patients with hypertension

Purpose: the study of trends in overall morbidity and primary hypertension in the Saratov region over the period from 2002 to 2013. Materials and methods. The official statistics Ministry of Health and the Federal State Statistics Service were used, which is processed using analytical and statistical methods. Results. The article has been providing the analysis of total and primary arterial hypertension morbidity of the population of the Saratov region, which is in accordance with the degree of the Government of the Russian Federation from December 1, 2004, N 715 to the group of socially significant diseases. During the period from 2002 to 2013 in the Saratov region, as well as in the Russian Federation in Volga Federal district, the tendency of growth of the overall incidence and the decrease in the primary incidence of arterial hypertension. Conclusion. The dynamics of incidence of hypertension suggests the need for careful analysis and optimization of medical care for patients with hypertension