[Development of digital competencies of medical staff in the context of the overall digitalization of the Russian healthcare].

The relevance of the study is due to the fact that the Russian healthcare in terms of the pace and quality of digitalization lags behind the healthcare systems of other developed and developing countries. The low level of digital literacy of medical staff does not allow them to develop the proper level of competencies for working with high-tech equipment, software applications and various telemedicine services. This, in turn, reduces both the quality and efficiency of medical care for the population. The purpose of the article is to develop a profile of digital competence of medical staff. The methodology of the article is based on the use of methods of statistical analysis of public data and sociological research. The sample of the sociological study was formed from medical staff in the regions of Moscow, Tula, Bryansk and Sverdlovsk. The pace and level of digitalization of the Russian healthcare is several orders of magnitude lower than the healthcare systems of the United States, South Korea, Japan and some other OECD countries. The development of digital competencies and a high level of digital literacy are observed among those medical workers who, firstly, operate in high-tech medical organizations, and, secondly, among those medical workers whose organizations are located close to regional economic centers. Russian healthcare needs additional investments, which can be directed both to digitalization and to the development of digital literacy of medical staff. To assess digital literacy, a special digital competence profile of middle and senior medical personnel was developed.

The development of organization of population medical care in conditions of digitization of public health.

The article discusses two main problems of organizing medical care in national health care of Russia: medical and social monitoring of morbidity and mortality; key performance indices of public health in the Russian Federation. Methodologically, the article is based on interdisciplinary scientific approach that allows to study medical, social and economic components of public health, considering observed trends: digitalization of health care and epidemic of new coronavirus infection. Based on statistical analysis of open data on morbidity and mortality of population in the Russian Federation over past few years, results were obtained indicating that collection of medical statistics is not built consistently that medical care in health care is not organized sequentially as cycle or process, but is presented in fragments. This leads to the fact that rural population has very limited access to multidisciplinary and high-tech medical services, and in structure of mortality there is high gender bias (males die more often than females in same classes of causes). Based on identified problems, two organizing solutions are proposed. The first solution is to create, on the basis of the Ministry of Health Care of Russia, special portal for complete, reliable and up-to-date medical statistics, which will be generated and processed using Big Data technologies. The second solution consists in transition from fragmentation to systematic organization of medical care in the "education and prevention-treatment-rehabilitation" continuum, while for each stage special set of key performance indices is established that allows to solve the tasks of improving public health, but also to develop harmonized social and economic public policy.

[IMPROVING THE QUALITY OF WORK OF MEDICAL WORKERS AND THE LEVEL OF ASSISTANCE TO THE POPULATION AS A NECESSARY CONDITION FOR MINIMIZING DEATHS IN THE COVID-19 PANDEMIC].

The article considers the key factors that negatively affect the quality of work of medical workers and the quality of medical care to the population in the context of the COVID-19 pandemic, which in practice leads to additional deaths from a new coronavirus infection. There are two key reasons that can have a negative impact on the quality of work of medical workers and lead to an increase in the death rate of the population: 1) lack of relevant scientific support; 2) lack of qualified psychological support. The first reason does not allow to increase the professional competence of medical workers, the second reason leads to their professional deformation and emotional burnout. To solve the problem, it is proposed to use modern information and communication technologies: 1) creation of a rapidly updated database and an online system for sharing experience in COVID-19 treatment, centrally accessible to all Russian health workers; 2) creation of a remote psychological support service, also centrally accessible to all Russian health workers.

Integrated assessment of back muscles bioelectrical activity and H-reflex research in AIS.

The study of the back muscles bioelectric activity in 216 children in the age between 10-15 years showed that the total paravertebral muscles bioelectrical activity on the convex side of the proximal curve and on the concave side of its distal part is higher compared with that on the opposite side. Analysis of H-reflex and M-responses in 302 patients in the age between 10-15 years created a normative database. This allows, in comparison with the total individual electrophysiological parameters, to determine patient's progression risk.

Peculiarities of brain functioning in children with adolescence idiopathic scoliosis (AIS) according to EEG studies.

Brain structures with bioelectric activity (BA) different from BA of the same structures in healthy peers were revealed using an original 3DLocEEG analysis of EEGs that solves so-called "reverse EEG task". These were the following structures: thalamus, pineal gland, hypothalamic area, including suprahiasmatic nuclei, and infratemporal cortex. The shift of BA focus to structures of the left hemisphere including left thalamus was recorded in patients with AIS; the shift increased both with worsening of deformation and increasing progression activity. This was not observed in healthy children (aged 7-14 years), although it is natural for older adolescents (15-17 years) and healthy adults. In other words, the interhemispheric asymmetry of brain BA in children with AIS becomes typical for the definitive brain much earlier. This phenomenon may be used for future development of a method for prediction of deformation progression patterns. A number of differences obtained in comparative analysis of EEGs, processed by 3DLocEEG method, between right-side and left-side AIS allow us to hypothesize about aetiology and pathogenesis differences of these two AIS clinical forms. Data obtained suggest that brain structures play a much more important role in aetiology and pathogenesis of AIS right-side forms compared with left-side ones. Primary subclinical dysfunctions of brain regulatory systems leading to disturbances of spinal cord and brain associated growth and subsequently to scoliosis development are supposed to play the main role in pathogenesis of right-side AIS forms (or their substantial part). Evidently, the major reason for manifesting these latent dysfunctions is an overstrain of central nervous system (CNS) adaptation-compensation mechanisms during the pubertal period.

Typical and atypical AIS. Pathogenesis.

AIS hypothesis has the right to recognition, if it explains the transition of "healthy" vertebra column into status of "scoliotic" one. AIS is the most investigated disease in the history of orthopedics, but up the present time there is no clear explanation of some its phenomena: vertebra column mono-form deformation along with its poly etiology character, interrelation of its origin and development and child's growth process etc. The key for authors' view at AIS was scoliosis with non-standard (concave side) rotation. On the bases of its' multifunctional instrumental investigation results (Rtg, EMG, EEG, optical topography, hormonal and neuropeptides trials, thermo-vision methods and other) in comparison with typical AIS was worked out the new hypothesis, part of it is suggested for discussion. In the work under observation is the sequence of appearance of typical and atypical scoliosis symptomatology beginning from the preclinical stage.

Neurohumoral regulation in children with idiopathic scoliosis.

Biotesting of blood serum in children aged 8-15 with adolescent idiopathic scoliosis (0°-60° by Cobb) showed the change of neurohumoral regulation in comparison with the age norm. The degree and direction of changes in the biotesting give the indication of the progression of spinal deformity. The effectiveness of treatment can be judged by control biotesting.

Photodynamic impact on the epiphyseal plates.

This study was carried out to prove the possibility of inhibition of long bones epiphyseal plates activity with photodynamic impact. Comparative analysis of the Chlorin E6 accumulation with transcutaneous and intraperitoneal administration mode, carried out on 175 laboratory mice showed the drug accumulates selectively in the epiphyseal plates of long bones, regardless of the mode of administration. 15 mice (males and females) at the age of active grownig were subjected to the single laser radiation impact on the knee joints area: 5 ones with transcutaneous Chlorine E6 administration, another 5 ones with intraperitoneal administration and the rest 5 without the drug. Histological samples of 15 experimental mice epiphyseal plates were examined by light microscopy, compared with 10 intact control mice. Influence of the laser radiation without administration of Chlorin E6 leads to intracellular swelling of epiphyseal plates chondrocytes. Influence of the laser radiation after transcutaneous or intraperitoneal injection of Chlorine E6 reduces significantly the total number of epiphyseal plates chondrocytes, without reducing the proportion of terminally-differentiated chondrocytes. Thus, the photodynamic impact inhibits the activity of epiphyseal plates of the mice.

Idiopathic scoliosis, growth zones, magnetic therapy.

BACKGROUND: The study has been performed to investigate the influence of pulsed magnetic field on the bone growth plates to get new grounds of magneto therapy in AIS treatment. MATERIALS AND METHODS: Were used methods of "strong" and "weak" pulsed magnetic fields influence. RESULTS: Application of pulsed magnetic field causes an authentic inhibition of chondrocytes' active proliferation processes, decreases the index of labeled nuclei, indicating the suppression of DNA synthesis, takes place an increase in the unit weight of the more "mature" differentiated chondrocytes. The final result of these effects is the accelerated synostosis of bones' growth plates. CONCLUSION: Regardless of the reasons that cause growth infringements, the operating organ in the chain is the body's growth plate. Therefore, the appliance of magnetic fields in AIS treatment can be considered as a perspective one concerning growth plates' functional activity local management. To our point of view, the potential of magneto therapy methods in child's orthopedic treatment is significantly higher compared with modern practice.

[Effect of the impulse magnetic field on the growth bone plates in experimental animals].

The influence of impulse magnetic field (1.5 T) on growth bone plates of the rabbit has been studied. It has been found that this field produces the inhibitory action on the functional activity of growth bone plates.

[Technique of X-ray computed arthro-tomography in the diagnosis of internal disorders of the temporomandibular joint]. / Metodika rentgenovskoi komp'iuternoi artrotomografii v diagnostike vnutrennikh narushenii visochno-nizhnecheliustnogo sustava.

141 patients suffering by internal derangements temporomandibular joint are surveyed with the help x-ray computed arthrotomography. The opportunity of reception of precise intra-articular elements after introduction of contrast substance allows treat results of researches with high reliability. X-ray's data received with the help CT are investigated and systematized. The features of x-ray's picture TMJ, capable to affect tactics of spent treatment, are revealed.

[Role of hormonal factors in the regulation of bone tissue metabolism in children with cerebral palsy]. / Rol' gormonal'nykh faktorov v reguliatsii obmena kostnoi tkani u detei s tserebral'nymi paralichami.

In the article are presented the results of examination of 98 patients (aged 6-16 years) with infantile cerebral paralysis. There were used X-ray and radioimmune investigations of bone age, enchondral ossification, state of foot bone structure and blood concentration of "osteotropic" hormones. Bone age corresponded mainly to the passport one; ossification rate overtake and deceleration have been revealed in a third of the examined children and concentric atrophy in 30% patients. Structural disturbances of osseous tissue as the different forms of osteoporosis have been detected in 89.5% cases. There have been stated direct correlation between the frequency of disturbances and the form of infantile cerebral paralysis. There have been noted reliable increase of hydrocortisone level and significant decrease of somatotropic hormone concentration (by 70% and 3.5-3.7 times as compared with the control) and sexual differences in concentrations of osteotropic hormones. The results are discussed from the point of view of neurohumoral relation disturbances and the presence of vegetative dystonia syndrome with predominance of sympathetic-adrenal system activity.

[Pathogenesis of degenerative-dystrophic changes in the hip joint]. / K voprosu o patogeneze degenerativno-distroficheskikh izmenenii tazobedrennogo sustava.

The authors have examined 43 children by the method of radiotropic angiography, 27 of whom had various diseases of the hip joint area. The blood flow in the iliac vessels and the regional blood flow in the area of the affected vessels was studied before and after the operation making use of an osteotropic radiopharmacological drug (RPD) 99mT-phosphon. Independent of the character of the degenerative and dystrophic process in the hip joints there was a reduction in the intensity of the blood flow on the affected side reaching 15-30%, which was more expressed at stage 111 of coxarthrosis with no considerable changes after the operation. In the control group this difference was +/- 5%. The regional blood flow (RBF) in the area of the operation was reduced down to 37% before the operation and increased by 17-35% 6-8 months after the operation with the exception of the cases of dystrophic lesions of the neck when no increase in the RBF was observed. The authors come to the conclusion about a relationship between the deviation from the normal conditions in the intensity of the blood flow and the degenerative and dystrophic processes in the hip joints.

[Scintigraphy in postoperative coxarthrosis in children and adolescents]. / Stsintigrafiia pri posleoperatsionnom koksartroze u detei i podrostkov.

To optimize the therapeutic tactics in 21 patients aged 7 to 15 with postoperative coxarthrosis the authors have studied some characteristics of the regional blood flow and the metabolic processes in the area of the hip joints. The results that have been obtained point at the incentive of the regional blood flow and the metabolic processes in this disease. The changes in the processes under study during the postoperative period have been demonstrated.