[The studying of public health and health care as obligatory component of program of residency training].

The article considers the teaching of the discipline "Public Health and Health Care" to residents of all specialties. For analyzing attitude of residents to studying the discipline "Public Health and Health Care", as well as improvement of training physicians at the stage of residency and their full mastery of necessary competencies, survey was carried out on sampling of 424 residents of the second (graduate) year of training. The number of questions were formulated to be included into questionnaire to obtain data about respondents (age, gender, region of study, citizenship, experience of working at medical position) and to identify their attitude to the study of the discipline "Public Health and Health Care" " in residency (sections of program as practically applicable, assessment of form of teaching the discipline and use of educational technologies, including remote and digital learning, choice of universal and general professional competencies). The majority of residents (65.1%) plan to be engaged not only in direct clinical activities in the future, but also to undergo additional training in health care management and work in positions related to organizational managerial activities from position of head of department to of head of medical organizations and administration of regional health care services.

[The relationship of stomatological health of disabled children with hearing and vision impairment].

The issue of preventing various diseases in children with disabilities is relevant around the world. The purpose of the study: to investigate the oral health of disabled children with hearing impairments and with visual impairments and to determine problematic issues of their dental care support. The individual face-to-face questionnaire survey was carried out covering parents (legal representatives) of students of special general education school for children with hearing and visual impairments. The analysis of results of preventive examination of students was implemented by stomatologist. Two categories of students were covered by the study: children with hearing impairment (first group) and children with visual impairment (second group), their families included. The first group consisted of 61 families with disabled children (37 boys (60.7%) and 24 girls (39.3%). The second group included 63 families with disabled children (35 boys (55.6%) and 28 girls (44.4%). The comparable structure of compared groups by age was established. The children aged 10-14 years dominated in both groups: 39.3% in the first one and 57.1% in the second one. The comparison of dental status of disabled children with various disorders of the senses was implemented according number of stomatological indices: caries activity, hygiene level, need for consultation by orthodontist. The patients with poor hygiene were significantly more common among children with visual impairment (38.1%) as compared with children with hearing impairment (3.3%). Also. 77.0% of patients with hearing impairments and 79.4% of patients with visual impairments needed advises of orthodontist. The families of 28.8% and 38.1% of patients in corresponding compared groups resorted to fee-for-service dental services. The first group characterized by statistically significantly higher percentage of dissatisfaction with quality of treatment and prevention (59.0% vs. 38.1%). The second most important problem was dissatisfaction with attitude of stomatologist to patients and their parents, which was noted in 16.4% and 28.6% of cases correspondingly. The stomatological health problems are very relevant for disabled children as they often suffer from oral diseases and have difficulties in accessing quality dental care. The prevalence of caries, especially sub- and de-compensated, in disabled children with visual and hearing impairments is significantly higher than in children population as a whole.

[The Medical Care of Patients with Chronic Dermatitis in Conditions of General Medical Practice].

The morbidity of chronic dermatitis continues to be permanently high in Russia, Europe and USA. the development of dermatitis is impacted by heredity, diseases of internal organs, environment. The medical social significance of dermatitis is high. The exacerbation of this disease results in deterioration of life quality of patients, emotional stress, decreasing of working capacity. Besides, special target financial expenses are required too. The interaction between primary medical care physicians and dermatologists plays significant role in treatment of dermatitis. To increase quality of medical care to patients with chronic dermatitis development and amelioration is needed concerning new models and principles of organization of treatment and diagnostic processes in the system of out-patient medical care in conditions of development of medical practice. The results of sociological survey of general practitioners were used to evaluate completeness of physicians implementing their function during management of patients with skin diseases. more than a half of physicians always prescribe to patients' examination prior to referral to dermatologist and one third of physicians always independently prescribe a treatment. Only one third of respondents declare confidence in independent diagnostic and treatment of patients with skin diseases. At that, more than two third of physicians being uncertain in diagnostic and treatment of patients, nevertheless are engaged in that. Therefore, nowadays general practitioners incompletely implement their functions in case of visit of patients with skin diseases.

[The Evaluation of Necessity of Individuals Older Aged 50 Years and Older in Outpatient Polyclinic Services].

The department of X-ray diagnostics of the out-patient center was used to carry out a sociological survey with the purpose of studying such social demographic characteristics of patients as level of education, material condition, benefits availability, degree of employment. The patients of advanced age visit the out-patient center most often for X-ray examinations because of diseases of nervous system, neoplasms and diseases of musculoskeletal system. In average, the patients wait their line for examination during up to three days. In both cases of implementing examination by appointment of hospital physician or by initiative of patient oneself (for fee) waiting time decreases. The main causes of using of paid medical care is the queue for free-of-charge examination and lacking of needed physician in polyclinic. The most of patients characterize scope of services provided in out-patient center as inadequate. At that, less than a half of respondents are agreed for broadening of paid diagnostic services. The readiness of patients for broadening of scope of paid services at the pre-hospital stage of treatment depend on their economic condition and employment status. The maximal readiness is expressed by working people with good economic condition. The application of obtained data provides an opportunity of optimizing of diagnostic care optimization.

[Analysis of the results of a questionnaire survey among the patients presenting with nasal cavity and paranasal sinuses diseases concerning organization and quality of specialized medical assistance].

The objective of the present study was to evaluate the influence of the medico-social factors on the development of nasal cavity and paranasal sinuses diseases and satisfaction of the patients with the quality of the provided specialized medical assistance. The approaches to the treatment of such patient at the pre-hospital and hospital levels are discussed.

[THE MODE OF CLARIFYING DIAGNOSTIC OF PROGRESSING FORMS OF OVARIAN CARCINOMA].

The ovarian carcinoma is the most frequent cause of death because of malignant neoplasins in women. At that, there is no pathognomonic symptoms permitting diagnosing stage of process with sufficient degree of confidence. This is a determinative not only for choosing treatment regimen but also for correlation of expected results of treatments with economic factors with purpose to evaluate cost effectiveness under monitoring of these patients. The study was carried out to develop mode of clarifying diagnostic of progressing forms of ovarian carcinoma on the basis of evaluation of oxidative modification of proteins in blood plasma. In 100 female patients with primary ovarian carcinoma (stage III and IV according FIGO,) in blood plasma 21 indicators were determined in blood plasma using standardized techniques: absolute number of leukocytes, absolute and relative number of neutrophils, products of oxidative modification of proteins of basic and ketonic character (under wavelength of 356, 370, 430, 530 nm), Her-2/neu CA-125, matrix metalloproteinase 2 and 9 in blood serum and neutrophils, interleukin-6, interleukin-10, interleukin-1ß, interferon-γ, tumor necrosis factor-α, malonic dialdehyde, catalase, glutaihione transferase, glutathione reductase. The least squares method was applied to every parameter to appmximnate relative rates by density of Rayleigh distribution. For every indicator likelihood ratio functions of likelihood ratio were constructed and intervals at every stage were determined. The reliability of approximation was proved under testing with Pirson criterion hypothesis of compliance of practical values of parameters to theoretical law of density of distribution. The results permit to assert that level of oxidative modification of proteins cab be used as a reliable indicator for differentiated diagnostic of stage III and IV of ovarian carcinoma.

[The dispensarization of population and the content of prevention activities of physicians in primary health care system].

Nowadays, positive trends in the development of priority principle of public health organization in Russia are observed. The dispensarization of large groups of population, declared by Minzdrav of Russia, made it possible to detect a large percentage of diseases. The implemented measures produced incontestable positive effect, though necessity is obvious to intensify involvement of citizen and families in health promoting activities. The article presents the study results providing important information concerning awareness of population and families about health and necessity to be concerned about health status. The means to enhance population health are in the areas of motivation of personal responsibility and public support from the state.

[Redox-dependent processes in blood plasma, neutrophils and erythrocytes of patients with ovary cancer after polychemotherapy by CAP scheme].

The dynamics of the redox-dependent processes in blood plasma, neutrophils and erythrocytes of the patients with ovary cancer of the IIIrd clinical stage by FIGO after polychemotherapy according to the CAP scheme is considered. In the blood plasma and erythrocytes there were estimated the values of protein oxidative modification: carbonyl derivatives at λ = 346 nm, 370 nm, 430 nm and 530 nm; the lipid peroxidation parameters: malonic dialdehyde, dienic conjugates, ketodiens, shiff's bases; the fermentative chain of the antioxidant system: activities of catalase, glutationtransferase and superoxide dismutase. In the peripheral blood neutrophils there were cytochemically determined the myeloperoxidase activity and the number of the active neutrophils in the spontaneous NBTR-test. After the polychemotherapy there were detected higher levels of the protein oxidative modification products and the products of the lipid peroxidation in the blood plasma and erythrocytes of the patients. Simultaneous increase of the activity of the antioxidant enzymes in the blood plasma could be evident of a high level of the lipid antioxidants peroxidation system functioning, whereas the simultaneous decrease of the activity of the antioxidant enzymes in the erythrocytes was indicative of passible development of oxidative stress in them. After the chemotherapy there was observed a significant and reliable decrease of the total number of the neutrophils. After the second course of the chemotherapy the activity of myeloperoxidase in them in the spontaneous NBTR-test as well decreased. Such a dynamics of the redox-depended processes in various components of the blood in the tumour carrier was characteristic of the tumor biological picture and required the use of differential multicomponent antioxidant therapy in patients with ovary cancer.

[Cytokines profile and metabolic activity of neutrophils of peripheral blood when progressing neoplasma].

The neutrophil is considered as the peculiar monocelled sekretorny gland realizing the effector potential including by secretion of soluble products - cytokines and for today. Influence of a tumor on functional activity of neutrophils depends on type, localization and a stage of its development. In our research dynamics of metabolic and of neutrophils of peripheral blood, the contents in a lysate and serums of blood of cytokines of IL-1ß, 1Ra, 2, 6, 10, 18, TNF-α, IFN-γ and is studied when progressing a cervical cancer. Cytokines and metabolism indicators - activity of, determined by an immunofermental method, level of cationic proteins, a share of active cages in the spontaneous NST-test were cytochemical. It is shown that when progressing cervical cancer against increase in total of neutrophils significant decrease in their, aerobic and anaerobic bacterial action, decrease in the IL-1ß and IL-1 Ra level, and also IFN-γ takes place at TNF-α increase, increase of production of matrix metalloproteinas-2 on Ib-IIa of a stage of a disease that allows to assume emergence at this stage of cervical cancer of pro-tumoral effect of neutrophils.

[Family health-improving potential as a basis for developing the preventive programs].

The paper provides rationale for the ways of preventing the population's diseases, by attracting a family. It presents the results of examining the health-improving possibilities of a family in the area served by a practitioner (a family physician). The results of assessment of the medical activity of a family and its performance of medical function and participation in preventive programs are given.