[The evaluation of quality of immunization services of children in Primary Medical Sanitary Centers in Oron, Akwa Ibom state, Nigeria].

Nigeria, with its low routine immunization coverage and wild poliovirus reservoir, significantly contributes to overall regional burden of vaccine-preventable diseases. Since introduction of the EPI in 1974 (which later became the National Program of Immunization), Nigeria's immunization program suffered from declining coverage. The poor quality of immunization affects service utilization, even where they are provided for free, just as immunization services are. The quality assessment will provide both notion of degree of satisfaction of clients with services and framework for revision of program priorities, strategies and components Purpose of the study is to evaluate quality of immunization services provided to children in primary health centers in Oron, Akwa Ibom State, Nigeria. The study targets to identify strengths and weaknesses of immunization services, to evaluate level of compliance with national and international standards of immunization and to develop corresponding recommendations. The study seeks to contribute to body of knowledge about quality of children immunization services in Nigeria, particularly in context of primary health centers. The study may help to improve delivery of immunization services in the region and to ensure that more children will be vaccinated and protected against vaccine-preventable diseases. The cross-sectional descriptive study of quality of immunization services in primary health centers was carried on in Akwa Ibom State, Nigeria. The variables as indicators such as physical environment, resource availability, client satisfaction etc. were utilized and included into questionnaire. The study covered 402 caregivers and 152 medical workers in 12 primary health centers. The client questionnaire, facility staff questionnaire, facility checklist, personal observation,focus group discussion guide and client flow chart were applied. The results demonstrated that quality of immunization services was poor. The caregivers were dissatisfied both with reception by providers and too long waiting time. The attitude of health care providers was also mentioned as cause of dissatisfaction. This study demonstrated that community health extension workers constituted majority (39.4%) of immunization service providers. Out of 152 health care providers that participated in the study, 92 (60.9%) had attended in-service training on immunization within previous two years. The comparison of staff categories with attendance at in-service training established statistically significant difference (p=0.0072), suggesting that whether one attended in-service training or not depended on category of staff one belongs to. Of all staff, 112 workers (73.3%) knew proper vaccine storage temperature while 40 (26.7%) did not. The health care providers who do not know proper vaccine storage temperature may administer vaccines with compromised potency. Most of health care providers (149 or 98.0%) were aware that clients have particular rights that in overall is referred as client rights. Only by knowing rights of clients providers would be expected to respect these rights. The client right with which most of providers were agreed was right to information (105 or 70.2%). While right with which most providers were disagree (52 or 34.0%)) was right to choice of where and when access immunization services. The study conducted thorough quality assessment of children imunization services in primary health centers in Oron, Akwa Ibom State, Nigeria. The results revealed both strengths and weaknesses in delivery of immunization services to children in the region. While there were areas of average performance due to experienced and trained health care workers, there were also areas of concern with inadequate cold chain storage and insufficient record-keeping practices. The study recommends to improve quality of immunization services in the region, including strengthening cold chain system, ensuring adequate record-keeping practices and implementing regular training and supervision of medical workers. These measures are crucial to ensure that more children are vaccinated and protected against vaccine-preventable diseases. The results of the study contribute to body of knowledge on quality of children immunization services in Nigeria and emphasize importance to continue efforts improving delivery of immunization services to children. There is hope that proposed recommendations will become a basis for policy decisions making and ultimately will result in better health outcomes for children in Oron, Akwa Ibom State and beyond.

[The effect of applying clinical organizational telemedicine technology management of anti-tuberculous care on dynamics of tuberculosis morbidity and mortality].

The tuberculosis is the most important medical and social problem among globally dangerous epidemiological phenomena. the tuberculosis ranks 9th place in the structure of mortality and disability of population and 1st place among causes of death from single infectious agent.The purpose of the study was to analyze dynamics of total morbidity and mortality because of tuberculosis against the background of the implementation of telemedicine clinical organizational technology in phthisiology care 2007-2021.The official Regional and Federal data of Rosstat for 2007-2021 were used. The indicators of total morbidity and mortality of population caused by tuberculosis in the Sverdlovsk Oblast were established. The research methods were content analysis, dynamic series analysis, graphical analysis, statistical differences analysis.In the Sverdlovsk Oblast, the morbidity and mortality of tuberculosis exceeded national average indicators by 1.2-1.5 times. In 2007-2021, as a result of implementation of clinical organizational telemedicine technology in managing phthisiology care, total morbidity and mortality of population caused by tuberculosis decreased up to 2.275 and 2.97 times respectively. The rate of decrease of analyzed epidemiological indicators generally correlated with national average data with statistical validity of difference t≥2.In regions with unfavorable epidemiological indicators of tuberculosis, application of innovative technologies in management of clinical organizational processes is required. The development and implementation of clinical organizational telemedicine technology for managing regional phthisiology care contributes to significant reduction of morbidity and mortality of tuberculosis and optimizes sanitary and epidemiological well-being.

[The role of medical marketing in implementation of projects of value-orientated health care].

The modern health care is characterized by value-oriented approach. The changes in health care policy shifted research focus on studying patient behavior and emphasized role of marketing targeted on patients. The study of patient values is area of research going beyond the scope of medicine. The active interaction with consumer through analysis and prognostication is daily component of professional activity of marketer.The purpose of the study is to describe main methods of implementing value-orientated approach, to determine required competencies in implementation of projects of value-oriented health care and to value role of marketer in projects realization.The analysis of main techniques and methods of value-orientated approach and necessary competences was carried out. On the basis of the professional standard of marketer, possible areas of interdisciplinary interaction of specialists are identified. The important role in development of value-oriented health care belongs to studies of patient behavior and one's values system that requires good awareness of methodology of such studies. The competencies of marketer are required for implementing value-oriented health care projects: pricing, patient journey mapping, operational efficiency increasing, development of patient commitment to treatment, decision making about treatment shared with patient, quality assessment of medical services. The delegation to marketers part of tasks in implementation value-oriented health care projects will relieve medical personnel, improve quality of substantiation of projects implementation and increase persuasiveness of arguments at the expense of narrow specialization knowledge and competences in marketing.

[The development of prototype of "ideal" model of competences of executive manager in health care].

The formation of a prototype of the organizational functional model of competences of the "ideal" health care manager and availability of objective assessment of its activities are of considerable practical interest. In any medical organization there is a need for trained, experienced and motivated administrators - managers capable effectively achieve their goals. This need can be met by developing and improving managerial competencies in managers at all levels. The competences of manager can be developed on the basis of organizational functional model and in accordance with personal responsibilities, work status, goals of medical organizations and professional standard. THE PURPOSE OF THE STUDY: was to develop a prototype of "ideal" organizational functional model of competencies of administrator - health care manager. MATERIALS AND METHODS: On the basis of data content analysis, evaluation of experimental results and logical and comparative technique a prototype of the "ideal" organizational functional model of health care manager was developed and tested. The development of model of administrators competences was based on comparative parameters of the professional standard "The specialist of health care and public health," personal managership of administrators of medical organizations, in accordance with the work status and objectives proposed in the course of the study organized in the Chelyabinsk Regional Children's Clinical Hospital (n = 26). THE RESULTS: The analysis of the factors affecting quality of management functions performed by managers, presented in t professional publications and based on the results of competence model testing, permitted to conclude that the requirements of the professional standard "The specialist of Health Organization and Public Health" are not sufficient to completely assess the activities of administrator - manager. To improve comprehensiveness of assessment of managers and the development of "ideal" model of executive manager competence the listing of requirements in the professional standard is to be supplemented with "The necessity of satisfaction with own work", "The necessity of conscious motivation to work at managerial position", "The necessity of abilities to perform management activities".

[The social hygienic risk factors to be applied in acute endometritis prognostication].

The article presents the results of investigation of prevalence and prognostic significance of socio-hygienic risk factors of acute endometritis in 187 patients with this disease and 150 patients with non-complicated postnatal period. It is established that development of acute endometritis is associated more with quality of life indices, early (up to 14 years of age) onset of sexual activity, presence in anamnesis of medical and spontaneous abortion. These risk factors should be considered in the process of prognosticating development of acute endometritis.

[Clinical and organizational assessment of endovascular care accessibility at the regional level].

The world health care system´s concern of inequalities in treatment of receiving the necessary medical care. The purpose of article to evaluate the availability of endovascular care (EVC) for patients at regional level in Russia and to develop a system for its improvement. As a result the low availability of EVC for the population at the regional level in Russia with coronary heart disease, atherosclerosis of the brachiocephalic arteries and critical lower limb ischemia (CLLI) was funded. The main reasons for the difficulties in obtaining EVC in the regions of Russia are the low frequency of diagnosing a critical stage of cardiovascular disease (CVD) requiring surgical treatment, the absence of cardiovascular surgeons and cardiologists in the medical care organizations, the failure in information to patients attending a regular doctor´s appointment about effectiveness and safety of endovascular treatment technology. More old-school traditional methods remain in place like bypass or endarterectomy surgery. Further obstacles are prolonged waiting list at the regional level for the provision of high-tech care in cardiovascular surgery, choice of conservative treatment methods or amputation of lower limbs for patients with CLLI 3 and 4 st. (p<0.05). In Conclusion the Clinical and organizational assessment of the endovascular care accessibility in CVD for the population in regions of Russia elaborated. One way to improve the situation is the introduction of the cardiovascular care clinical management. A dual-circuit clinical and organizational system was developed and proposed to increase endovascular care accessibility in regions.

[The organizational clinical system of development of medical care based on electronic personified data of medical services under angina pectoris and myocardium infarction].

The article presents the analysis of quality of medical care of patients with coronary heart disease at the phases of the clinic, ambulance and hospital based on the data from electronic personalized records and registry accounts of the territorial mandatory health insurance foundation. The results of implemented analysis and application of principle of inter-agency information interaction, the clinical organizational system of managing quality of outputs of medical care provision to patients with ischemic heart disease has been developed. The developed medical care quality management system based on database of personalized electronic patient records was tested in practice and demonstrated positive results.

[The children morbidity of bronchial asthma in municipal and rural districts of the Belgorod oblast].

The bronchial asthma is a common pathology among children of different countries, Russia included. However, comparative studies of the incidence of bronchial asthma in children in urban and rural areas are factually absent. The purpose of study is to analyze children morbidity of bronchial asthma in urban and rural areas of the Belgorod Oblast. The official statistics data was used to analyze primary and total morbidity of children with bronchial asthma in cities and rural areas of the Belgorod Oblast in 2012-2017. The continuous retrospective technique was applied. The level of primary morbidity of bronchial asthma in children is factually the same in urban and rural areas (P>0.05). However, total morbidity of bronchial asthma in children population is significantly higher in cities of the Oblast.

[Laboratory diagnostics of ovarian cancer among the elderly in the parameters of immunoglobulins and phagocytic activity of blood.]

Due to the increase in the proportion of elderly women, the prevalence of ovarian cancer is increasing, which requires the search for new methods of its diagnosis. The aim of the work is to analyze the content and informativeness of immunoglobulins and phagocytic activity of peripheral blood to improve the diagnosis of ovarian cancer among elderly women. In 78 patients with ovarian cancer aged 65-70 years immunological and spectrophotometric methods studied phagocytic activity and the level of peripheral blood immunoglobulins. 42 women of the same age with no ovarian cancer served as control. The primary importance of circulating immune complexes, phagocyte migration inhibition index and neutrophil activity index for laboratory diagnosis of ovarian cancer among the elderly was established. The use of highly informative parameters of systemic immunity improves the diagnosis of ovarian cancer in the elderly.

[The methodology of complex social hygienic investigation of various groups of population and families (In memoriam of professor O. V. Grinina)].

The article expounds main principal positions of professor O. V. Grinina scientific educational methodological school of social hygienic investigations of health of population and family. The methodological analysis of scientific works of professor O. V. Grinina and her disciples was implemented to demonstrate key positions and results of studies constituting scientific school of program methodological basics of complex social hygienic studies of population health, health care and conditions of life of families. The purpose of publication is to characterize indications of the school of complex social hygienic investigations of priority population groups and families. These issues are covered by thematic fundamental works substantiating patterns of formation and estimation of health of families, program methodological issues of complex medical social studies of family and its individual members, availability of large group за disciples developing priority issues of investigation of population health at the level of family and organization of medical care based on the principles of per family observations, general (family) medical practice. The results are demonstrated and patterns are established containing in implemented complex social hygienic per family studies of various population groups, women, children and families in 1970s-1990s. The methodological significance of valid family-focused technologies in new social economic conditions of development of society and health care and principles of curative preventive activities in conditions of mandatory medical insurance are demonstrated. The professor O. V. Grinina substantiated and developed program of medical social characteristic of family. its sections and methodology of long-term continuous monitoring of family. She also determined characteristics of health of family as a group patient, principles of work of out-patient physicians with families directly at the polyclinic district.

[The Medical Activity and Satisfaction of Population Need in Medical Care].

The article considers phenomenon of medical activity as a determinant of population demand for medical services and needs in medical care. The medical activity is determined as both a criterion of formation of health of patients by force of active using medical care and a criterion of efficiency of functioning of physicians in satisfaction of needs of patients in medical care. The results are presented related to phenomenon of medical activity using methodology of analysis of opinions of patients and level of medical care appealability of population. Medical activity of population and level of satisfaction of demand and needs in medical services is to be considered as an evidence of commitment of population to treatment and prevention. The investigation of these issues acquires particular specificity in conditions of health care system of large municipal agglomeration with developed network of medical organizations of budget insurance, departmental and private forms of property. In these conditions, patients and population are provided with various possibilities of choosing different forms and types of satisfaction of need in medical care independently of cause and motive of using it that is an advantage for implementing medical activity.

[The prognostication of development of peri-apical abscess under chronic periodontitis by blood parameters and cell immunity in children].

The chronic periodontitis in children is frequently complicated by development of periapical abscess under inadequate conservative therapy. However, prognostic models of estimation of probability of its development are lacking. The purpose of study is to develop regression models of prognostication of periapical abscess under chronic periodontitis in children according indices of peripheral blood and systemic cellular immunity. The chronic periodontitis complicated with periapical abscess is analyzed in 120 children aged from 8 to 15 years. The prognostication of periapical abscess was implemented by stepwise regression technique using parameters of blood and systemic cellular immunity. The mathematical models are developed for prognostication of periapical abscess in children with chronic periodontitis on the basis of indices of peripheral blood and systemic cellular immunity permitting to prognosticate development of the given complication with needed quality. The prognostication periapical abscess requires using the given models, absolute number of lymphocytes, percentage of stab bond neutrophils, ESR, absolute number of T-lymphocytes in blood, T-helpers, T-suppressors and relative content of T-suppressors.

[The Occupational, Housing and Family Risk Factors in Prognostication of Myocardium Infarction Morbidity].

The results of prevalence and prognostic significance of occupational, housing and family risk factors for myocardial infarction are presented. The significance of the analyzed risk factors for predicting development of myocardial infarction is established. The myocardial infarction (MI) have to do with global social and medical evidential problems. The MI morbidity results in significant economic and social damage. The loss of the gross domestic product as a result of MI mortality in able-bodied age prevails in the structure of economic damage in the Russian Federation and makes up to more than 49 billion rubles per year. In MI patients such risk factors as tense psychological relationships at work, duration of workday more than 8 hours are highly spread. This is especially true for tensed psychological relationships at work, which are 5.6 times more likely to be detected in patients with MI as compared with other groups of patients. The study demonstrated considerable prevalence and significant role of particular professional, housing and family risk factors in the MI development. It is proved that physical overloads, unsatisfactory housing conditions and lack of one's own housing are of highest prevalence and prognostic significance. The study data permits to prognosticate possibility of MI development and to implement preventive and curative measures prior to onset of disease resulting in decreasing of MI morbidity, various complications and mortality.

[About the Issue of Organization of Primary Specialized Opthalmologic Care in Megalopolis].

The restriction of accessibility of primary specialized ophthalmologic medical care in polyclinics remains to be a main problem of its organization for population of large megalopolises. At that, similar medical services are actively provided by commercial optician's rooms. The purpose of study is to analyze perspectives of organization of primary specialized ophthalmologic medical sanitary care of population in large megalopolis. The questionnaire survey was carried out. The sampling included 4,248 patients of municipal polyclinics and 120 patients of ophthalmologic rooms of commercial opticians. The patients estimate higher accessibility of medical services in ophthalmologic rooms of commercial opticians as compared with municipal polyclinics (88.4% and 76% correspondingly). The most of patients (86%) argue in favor of receiving medical services in ophthalmologic rooms of commercial opticians at the expense of means of mandatory medical insurance. The sampling of 178 ophthalmologists of municipal polyclinics were included in survey concerning perspectives of involvement of ophthalmologic rooms of commercial opticians to provision of ophthalmologic services. This direction was supported by 28.4% of respondents. The article presents estimates of planning of volumes of medical care of patients being in need of optical correction of vision in case of its rendering by ophthalmologic rooms of commercial opticians in large megalopolis.

[The Dynamics of General Morbidity of Salpingoophoritis as a Problem of the Regional Health Care].

The article presents the results of studying dynamics of total morbidity of salpingoophoritis in the Belgorod oblast in 2009-2014 testifying negative tendencies. The maximal increasing of of total morbidity of salpingoophoritis among female adolescents and adult women in oblast rural districts was established. The obtained data can be used as a basis for developing target regional programs directed to improvement of functioning of specialized obstetrician gynecological service.

[Forensic medical criteria for the evaluation of the unfavourable outcomes of the roentgeno-endovascular operations on the arteries of the lower extremities]. / Sudebno-meditsinskie kriterii otsenki neblagopriiatnykh iskhodov rentgenéndovaskuliarnykh operatsii na arteriiakh nizhnikh konechnostei.

The objective of the present work was to develop the forensic medical criteria for the evaluation of the unfavourable outcomes of the roentgeno-endovascular operations (REVO) on the arteries of the lower extremities. The study included the analysis of the conclusions based on the results of the commission forensic medical examinations, attorney inquiry reports, query response, medical histories of the hospitalized patients who had undergone the roentgeno-endovascular operations on the arteries of the lower extremities. The criteria for the forensic medical evaluation of the unfavourable outcomes of the roentgeno-vascular operations on the arteries of the lower extremities have been proposed together with the indications for REVO, methods and tools for the performance of these surgical procedures. Particular attention was given to the identification of the signs and prognostics of the unfavourable outcomes of the roentgeno-endovascular operations (both intraoperatively and during the early postoperative period and the subsequent stay in the hospital) and to the risks of the development of the unfavourable outcomes of the surgical interventions following the technically adequate REVO. Special emphasis is placed on the cause-and-effect relationship between the actions or a failure to act on the part of an emergency physician and/or an attending surgeon/cardiovascular surgeon and the possibility of the unfavourable outcomes of the roentgeno-endovascular operations.

[The rationalization of laboratory diagnostic of acute salpingooophoritis according informative parameters of humoral immunity.]

The acute salpingoophoritis is a wide-spread pathology among gynecological diseases brining on significant disorders in the humoral immune system. The study was carried out to rationalize laboratory diagnostic of acute salpingoophoritis according to informative parameters of humoral immunity. The analysis of indices of humoral immunity was applied to 65 patients with acute salpingoophoritis and 32 healthy women using radial immunodiffusion technique. The significant increasing of both of circulating immune complexes in blood plasma and related correlation relationship of IgA, IgG is established. The high informativeness of the given indices is established. The leading diagnostic significance in laboratory diagnostic is related to IgA, IgG and circulating immune complexes.

[The diagnostic significance and clustering of parameters of systemic humoral immunity under acute endometritis.]

The acute endometritis is an actual medical problem in the structure of gynecological pathology and its complications result in incapacitation, infertility and lethality. The purpose of study is to ameliorate laboratory diagnostic of acute endometritis at the expense of selection of diagnostically significant and similar clusters of systemic humoral immunity. he analysis was carried out concerning parameters of systemichumoral immunity in 154 patients with post-natal acute endometritis and 103 patients with non-complicated post-natal period using the radial immunodiffusion technique. The selection of diagnostically significant parameters was implemented at the basis of indices of shifting, disintegration and cluster analysis method. The leading value for laboratory diagnostic of acute endometritis according indices of shifting, disintegration and cluster analysis among parameters of systemic humoral immunity keep content of IgA in blood, absolute number of SD20+ and circulating immune complexes. The selection of diagnostically significant and similar indices of humoral immunity permits to decrease number of detecting parameters at the diagnostic of acute endometritis.

[Orientation of university students to sources of information on rational nutrition].

In organization of sanitary education of students on issues of balanced diet it is necessary to be guided on positively perceived sources of information and forms of education. According to our data, the university student editions and health education carried out by doctors of policlinics, providing medical services to the students of the University are of most importance.

[Features of feeding behavior of students of the Peoples' Friendship University of Russia].

The feeding behavior of students of Peoples Friendship University of Russia from 55 countries (557 persons) was studied by questionary method. Most students (83%) recognized the changes in nutrition after admission to the university. A quarter of students noted the ill health. The adaptation to the new nutrition type of at 12% per a year of study. About third (31%) rated their nutrition as good, 39%--as satisfactory, 20%--unsatisfactory at the moment of research. 80% of students broke a diet. About half of students (51%) regularly miss a breakfast, 34% and 15%--miss a dinner and supper. More than 60% of students eat hot meals not oftener than once a day. Insufficient consumption of fish, eggs and bean by students also was noted in the course of research. Irrationality of the educational schedule and the high prices for foodstuffs are leading causes of breaking of nutrition according to students.