The share of influence of factors determining the state of public health in the context of the COVID-19 pandemic

Background. The relevance of the study is explained by insufficient knowledge of the determinants of health in the context of the COVID-19 pandemic. Aim. To study the share of influence of factors that determine the state of public health in the context of a pandemic of a new coronavirus infection (COVID-19). Material and methods. A sociological research method was used - in 2021, an anonymous survey of 42 expert healthcare managers, who were asked to determine the share of influence of determinants on the state of public health in the context of the COVID-19 pandemic, was conducted. After the completion of the survey, its results were compared with those obtained without a pandemic in 2017. Since the data distribution corresponded to the Gauss-Newton binomial curve, the significance of differences was assessed using the parametric Student's t-test. Results. It has been established that the structure of the influence of health determinants in the context of the COVID-19 pandemic differs significantly from that without it. During a pandemic, the share of factors in the "Lifestyle” group decreases by 1.75 times, and it is no longer a priority, but occupies the third ranking place. Out-of-group determinants, which were in second position, take the first place. The second ranking place with a growth of 1.60 times is occupied by the "Conditions of life and work” group. The share of influence of each of the considered 37 determinants of health was assessed - multidirectional changes, for example, an increase in the responsibility of the authorities for actions and equity in relation to the health of the population from the "General Factors” group and a decrease in six of the seven determinants of the "Lifestyle” group, were identified. Continuation of the study is possible with regard to the formation of a separate block in the design of the appropriate optimization technology. Conclusion. A significant change in the structure of the influence of the public health determinants during the COVID-19 pandemic in comparison with the data obtained before the onset of this pandemic, has been established. © Eco-Vector, 2023. All rights reserved.

Determinants of health during the COVID-19 pandemic

Introduction. The relevance of the study is due to the expediency of implementing intersectoral interaction on public health protection in the conditions of the COVID-19 pandemic with an impact on health determinants that haven't been sufficiently studied. The aim of the work is to study the list and significance of health determinants in the conditions of a pandemic of a new coronavirus infection (COVID-19). Material and methods. An expert survey of forty nine healthcare managers was conducted. The criteria for the selection of experts included management experience in the field of health protection, the level of self-assessment of competence, and congruence of opinions. The list and significance of determinants of health in the conditions of the COVID-19 pandemic were compared with the data obtained before its occurrence. Results. The list of health determinants that are sufficiently significant for the COVID-19 pandemic was established to include the same 37 factors as without it. However, important differences were identified. The significance of most determinants of health (64.9%) in a pandemic exceeds the borderline level of 7.0 points on a 10-point scale, that is, significant (without a pandemic – 16.2%). At the same time, priority factors determining the health of the population are widely represented in all groups of determinants and among non-group ones (without a pandemic – only in the "Lifestyle” group and "heredity” determinant). The consequence was that during a pandemic, the significance of 70.3% of the determinants of health statistically significantly exceeds that of the same factors without it, the opposite picture was recorded only in relation to 5.4% of the factors (the rest don't differ). Limitations. In the study of the determinants of health in the conditions of the COVID-19 pandemic, the opinion of healthcare managers whose quantitative and qualitative parameters meet the requirements for experts was evaluated. Conclusion. The data obtained expand the understanding of the scientific apparatus for implementing health-saving activities in the conditions of the COVID-19 pandemic. © 2022 Izdatel'stvo Meditsina. All rights reserved.

[SECTORS INVOLVED IN PUBLIC HEALTH IN THE RUSSIAN FEDERATION DURING COVID-19 PANDEMIC].

The article develops a research agenda for cross-sectoral collaboration on the issues of public health. The aspects of this collaboration are not scientifically founded during the COVID-19 pandemic. The aim of the research is to study the inventory of the sectors involved in public health in the Russian Federation during the COVID-19 pandemic and to put in perspective their importance. An anonymous survey of 49 experts - health service managers was made. The respondents were asked to identify the inventory of the sectors involved in public health and to voice their opinion on their importance during the COVID-19 pandemic. The results of the survey were compared to the results obtained before the pandemic. The results of the study suggest that 23 sectors should always be involved in public health both during the COVID-19 pandemic and without it. The sectors are of relatively equal importance. However, the sectors of the inventory are ranked differently in the order of importance during the pandemic and without it. A statistically significant difference in the analysed characteristic feature is noted. The article develops a research agenda for further studies and provide implications for health-service managers.

[Risk factors for the early development of septic shock in patients with severe COVID-19].

AIM: In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19. MATERIALS AND METHODS: We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure. RESULTS: We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70). CONCLUSION: The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

An unusual course of COVID-19 infection with late increase in C-reactive protein (clinical case reports)

Clinical signs of COVID-19 infection are non-specific and diagnosis is typically based on comprehensive evaluation of the patient's history, clinical status, radiological and laboratory findings. A common finding in COVID-19 patients is increased C-reactive protein (CRP), though in some patients, CRP remains within normal range notwithstanding the presence of other criteria of severe disease. We describe two clinical cases of COVID-19 with severe bilateral pneumonia and late increase in CRP. Similar cases re quite challenging for making the diagnosis and indicating the antiinflammatory therapy. © 2020 Medical Education. All rights reserved.