[The comparative analysis of dynamics of indicators of morbidity of adolescents in the regions of the Northern-Caucasus Federal Okrug].

The purpose of the study is to establish main trends in morbidity of adolescents (15-17 years old) in the regions of the Northern-Caucasus Federal Okrug in 2011-2020. The study is based on data of statistical reports on primary and general morbidity of population aged 15-17 years for 2011-2020. The results. The epidemiological situation concerning morbidity of adolescents in the Russian Federation and the Northern-Caucasus Federal Okrug is characterized by positive trend over the analyzed period. The deterioration of epidemiological situation is observed in the Karachay-Cherkessia Republic (KChR) where absolute increase in overall morbidity of adolescents comprised 105.3% and primary morbidity 49.0% and in the Stavropol Territory (ST) - 23.0% and 27.5% correspondingly. The decrease of morbidity of adolescents is observed in the Republic of Ingushetia (RI) (by 56.9% and 51.7%) and in the Chechen Republic (ChR) (by 34.6% and 45.0%). In the Republic of Dagestan (RD), an increase of overall morbidity (by 114.0%) is accompanied by decreasing of primary morbidity (by 13.2%) and in the Republic of North Ossetia-Alania (RNOA) (absolute increase in overall morbidity by 7.8% and decrease of primary morbidity by 7.0%). In the Kabardino-Balkaria Republic (KBR), there is absolute decreasing of overall morbidity (by 1.7%) with simultaneous increase of primary morbidity of adolescents (by 24.2%). However, there are features inherent in most of analyzed regions of the Northern-Caucasus Federal Okrug. The increase of overall morbidity of eye diseases in adolescents is registered in six out of seven regions with exception of the RI, the increase of primary morbidity occurred in four of them (KChR, RD, KBR, ST). The increase of general and primary morbidity of ear diseases is registered in five regions (KChR, RD, RI, KBR, RNOA). The increasing of morbidity of neoplasms registered as common for five regions (the KChR, RD, RI, KBR, the ST) and as primary one in four of them (with the exception of the ST). The conclusions. In the regions of the Northern-Caucasus Federal Okrug multi-directional dynamics of indicators of general and primary morbidity among adolescents was established with predominance of particular classes of diseases. This result testifies absence of unified policy in the field of public health targeted to maintaining healthy life-style in adolescents.

[Comorbid status of patients with hypertension].

AIM: To establish age and gender characteristics, nosological structure of comorbidity among persons 20-99 years with hypertension. MATERIALS AND METHODS: The study is based on data from 21 514 electronic health records of the population (20-99 years old) with hypertension, mean age 63.0 years, 68.2% women. Diseases associated with hypertension with a frequency above 10% were analyzed. RESULTS: In the sample of people with hypertension, concomitant diseases were detected in 82.7% of cases, 1 disease accompanies 21.0% of the sample with hypertension, 2 diseases 17.9%, 3 diseases 14.0%, 4+ diseases 29.8%. The frequency of association of hypertension with ≥1 concomitant disease at the 20-29 years is 60.8% of cases, at 30-39 years - 65.1%, at 40-49 years - 73.9%, at 50-59 years - 81.1%, 60-69 years - 85.8%, 70-79 years - 87.3%, 80+ years - 86.2% of cases. Among women with hypertension, the average number of concomitant diseases is higher compared to men (3.47 vs 2.4 cases; p<0.001). Among young and middle-aged people, hypertension in most cases is associated with osteochondrosis, osteoarthritis, chronic pancreatitis, gastritis and duodenitis, retinal diseases, thyroid diseases, the female with hypertension accompanied by benign breast disease and menopausal disorders. Hypertension in the elderly is most often associated with cerebrovascular disease, coronary heart disease, diabetes mellitus, senile cataract, but osteochondrosis and osteoarthritis also do not lose their relevance. CONCLUSION: The existing system of organization of medical care cannot meet the needs of patients with comorbidity, which indicates the need to reorient medical care towards patient-centered care.

[GENDER AND AGE FEATURES OF THE PREVALENCE OF HYPERTENSION IN THE POPULATION OF A MEDIUM-URBANIZED CITY OF CENTRAL RUSSIA].

THE PURPOSE OF THE STUDY: to establish gender and age characteristics of the prevalence and risk of developing hypertension (AH) among outpatients living in the city of Tambov, according to electronic medical records (EMR). The information from the EMC of 47,113 people aged 20-99 living in Tambov was used. The prevalence rate (per 100 people) and the relative risk of developing (RR) hypertension in different sex and age groups were calculated. The prevalence of hypertension among people aged 20-99 was 45.7 cases, in women it is higher than in men by 23% (50.1 vs 38.4 cases). With age, there is an increase in the prevalence of hypertension from 1.7% in 20-24 to 86.8% in 70-74 years old people. In the transition from a smaller age group to a larger one, the increase in the prevalence of hypertension among the female cohort averaged 22.5%, among the male cohort - an average of 17.2%. The RR for the development of hypertension among the female cohort aged 20-99 years is 1.2 times higher compared to the male cohort of the same age. At the age of 25-34, the OR for the development of hypertension prevails among the male cohort, at 45-89 years old - among the female cohort. The high level and established differences in the prevalence and risk of developing hypertension determine the need to develop recommendations for hypertension screening among the population, stratification into risk groups, prevention and treatment, focused on different age and gender groups.

[The determining factors of qualitative training of students in public health and health care].

The inclusion of public health and health care measures in labor functions of professional standards of medical specialists increased significance of mastering of these standards by students during specialty training, since on this depends their successful completion of primary accreditation of specialists and implementation of job descriptions in the course of daily activities. The purpose of the study was to analyze factors determining qualitative of mastering the discipline "Public health and Health Care" by students of medical educational organizations. The analytical, logical, statistical, questionnaire survey and direct ranking methods were applied. The sampling of 316 students of the Sechenov University was involved in survey using questionnaire of 17 closed questions. The study established that the determining factors effecting quality of mastering by students the discipline "Public health and Health Care" are the need to use by physicians this knowledge in the course of their daily activities; the need of students to pass profile exam; the determination of up to 40% of trainees to work as heads of structural units or professionals of health care and public health; the dedication of student; organization of educational process at the Chair; the professionalism of faculty; the application of active learning methods in classroom; organization of career guidance among students.

[Integrated indicator of the current assessment of the COVID-19 pandemic process in the subjects of the Russian Federation].

Information on the main indicators of the Pandemic COVID-19 is published daily for each subject of the Russian Federation. Of interest is the comparative ranking of regions in terms of new cases, active cases that have recovered from COVID-19, the allocation of homogeneous groups of regions in terms of the distribution of COVID-19. Since several indicators, respectively, the ranking of regions can be several options: the same regions with a high level of morbidity can be characterized by lower mortality from COVID-19 and vice versa, which will shift their position in the overall rating assessment. Such a state complicates the perception of the situation with the COVID-19 pandemic in the spatial-territorial context. In this regard, it makes sense to develop a certain latent integral indicator for assessing the COVID-19 pandemic process, which will allow comparing the subjects of the Russian Federation with each other in order to develop practical recommendations.

[The medical demographic and social characteristics of women that discontinued observation and infertility treatment].

The recovering of reproductive health of women is one of prospective means to stabilize fertility. The purpose of the study is to investigate medical, demographic and social risk factors of discontinuing screening and treatment of infertility in women of the Tambov Oblast. The materials and methods. The comparative data analysis of women who discontinued infertility screening and treatment prior to referral to auxiliary reproductive technologies (n = 239) and women who were factually referred to these technologies (n = 206). The results of the study. The risk factors for women of discontinuing screening and treatment of infertility included age (OR = 1.070; 95% CI 1,035-1,105; p<0.001), residence in rural areas (OR = 2.059; 95% CI 1.592-2.663; p<0.001), secondary education (OR = 2.593; 95% CI 1.767-3.805; p<0.01), low level of financial security (OR = 2.524; 95% CI 1,720-3,703; p<0.01), secondary nature of infertility (OR = 1.587; 95% CI 1.065-2.364; p=0.023), occurrence of sexually transmitted diseases in anamnesis (OR = 2.736; 95% CI 1,722-4,346; p<0.01). Discussion. The study results demonstrate that the most effective measures improving compliance of women to screening and treatment of infertility are the reorientation of medical care to the second-level regional centers from the regional center that will bring medical care, including active detection of infertility at younger age, more comprehensive regular preventive examinations and health education to preserve reproductive health, closer to remote areas. The conclusions. The medical, demographic and social risk factors of discontinuing testing and treatment of infertility in women are established to be applied in improving the organization of medical care for this category of patients.

[The attitude and awareness of students of medical university concerning issues of reproductive health and pregravid training from positions of "4P Medicine"].

The young generation aged 16-24 years is the main demographic national reserve for coming decades. Hence, the purpose of the study is to investigate attitude of modern youth exemplified by students of medical university to establishing family, marriage and birth of children, and also their awareness about issues of reproductive health and training of couple to birth of healthy progeny considering modern approaches of personalized "4P Medicine". The survey of medical students was carried out on the basis of sampling of 193 students in November 2019 to February 2020. The survey data was processed using software SPSS 21. The indices of descriptive and analytical statistics were calculated to analyze study results. The low awareness of medical students on issues of pregravid training and modern approaches of personalized «4P Medicine¼ was established. Despite the fact that significant number of students understand importance of improving their awareness of reproductive health and pregravid training from positions of "4P Medicine", about quarter of all respondents never pondered about these issues. The majority of respondents lead healthy life-style and understand its importance for their health, including reproductive health. The students have positive attitudes to establishment of family and birth of children. It is necessary to improve awareness of medical students of reproductive health, pregravid training and main principles of personalized "4P Medicine".

[The analysis of instruments of evaluation of quality of life of patients of elderly age in view of palliative medicine].

In quality of life research, it is very important to understand the concept and methodology of its implementation. The quality of life study should be organized in accordance with standard generally accepted requirements. In order to obtain comparable data and to apply it in clinical practice, standard quality of life assessment tools should be implemented. The questionnaires are common as the tools assessing quality of life. In the United States and Europe, as well as in Russia, special centers are organized to develop such questionnaires. There are General questionnaires that can be used to assess quality of life in case of various diseases and special questionnaires targeted to specific group of diseases. Currently, more than 400 special questionnaires are used in practice. In Russia, due to urgency of increasing propagation of socially significant non-communicable diseases, especially in elderly population, particular attention is focused on research in the area of quality of life in field of palliative medicine, assigned to alleviate suffering of incurable patient. Its main goal is to maintain optimal quality of life of patient.

[The comprehensive approach to examination of female patients in diagnostic of benign diseases and breast cancer].

The integrated approach to diagnosis and dispensary monitoring of women with high risk for breast cancer, the active detection of combined pathology of endometrium are promising directions in prevention and timely diagnosis of breast and uterus malignant neoplasms. The study established that particular correction of measures of secondary prevention of breast cancer is needed, including formation of risk group and organization of dynamic monitoring of women with high risk of breast cancer development. The comprehensive examination of reproductive system organs, including evaluation of risk factors, combined use of mammography and sonography methods to examine mammary glands and condition of endometrium, can to increase accuracy of differential diagnosis and to avoid unneeded invasive interventions with mammary glands and early diagnosis of endometrial pathology.

[The analysis of concomitant pathology in ophthalmologic practice based on electronic medical records data].

The study substantiates possibility of using data retrieved from electronic medical records (EMR) for analyzing comorbidity under diseases of the eye and its adnexa. The purpose of the study is to analyze prevalence and evaluate risk of development of comorbidity in patients with ophthalmologic pathology, based on the data presented in EMR. The total number of patients included into comprised 12 120 individuals. The 653 diagnoses were established and 122 703 requests for medical care were registered. The calculation was applied concerning prevalence, comorbidity index, relative risk of comorbidity. The study established prevalence and level of relative risk of development of opportunistic diseases characteristic for senile cataract and glaucoma. The obtained data on comorbidity may testify in-depth mechanisms of interaction of diseases at cellular, protein or genetic levels. The understanding of mechanisms of interaction of main and concomitant diseases can result in development of new methods of diagnostic, treatment and prevention of diseases. Thus, establishment of glaucoma diagnosis can induce physician to look for possible presence or high probability of development of prostate neoplasm that implies periodic control of prostate-specific antigen. The presented results demonstrate how EMR data can be used to identify, estimate prevalence and risk of comorbidity and also reveals pathogenic mechanisms of interaction between primary and recurrent diseases that can be applied in clinical practice.