[The evaluation by physicians of conditions of their professional activity].

The occupational safety is one of the important conditions of efficient work of physician. The purpose of the study is to analyze how physicians assess conditions of their professional activity. The sociological survey of 404 physicians working in state and commercial medical organizations of Voronezh was carried out using specially designed questionnaire. The analytical and mathematical statistical research methods were applied. The survey established that 52.6% of respondents considered their working conditions as completely safe and 35.2% considered that they were rather safe. At that, there were no significant differences in opinion on this issue among therapists and surgeons, as well as among ones working in in-patient and out-patient conditions. However, in private medical organizations, 62.5% of respondents working in-patient conditions and 33.3% working in out-patient conditions considered their work as completely safe. The main factor of possible violation of safety of their professional activities was intensity of labor process, associated, among other things, with greater responsibility for patients. The majority of respondents (89.1%) reported presence of certain stressful situations in course of their professional activities. This opinion did not depend on gender/ At that, surgeons indicated more frequently presence of these situations (63.2% and 51.3%). The surgeons more often than therapists indicated importance of such factors as personal qualities of character, level of motivation, specialty, age and work experience. The identified characteristics of assessment of working conditions by physicians are recommended to consider in development of improving measures.

The medical activity and satisfaction of geriatric care of Mongolia residents.

Nowadays, process of aging of population covers all countries of the world. In current conditions, an important moment is increasing medical activity of elderly population and old persons. The purpose of the study is to investigate social hygienic characteristics of medical activity and satisfaction with geriatric care of the elderly residents of Mongolia. The sociological survey of 726 residents of Mongolia older than able-bodied age, 75 out of which were in nursing homes, was carried out using specially designed questionnaire that included questions on assessing medical activity and satisfaction with geriatric care. The negative correlation was established between good assessment of one's own health and age of respondents. The study revealed that 90.9% of respondents noted presence of chronic pathology, but only 21.1% of them were registered in dispensary. In age group under 65 years, 75.8% of persons capable to serving themselves made up 75.8% and in age group 75 years and older only 48.1%. The analysis established that 50.2% of elderly and senile persons consulted geriatrician, while 48.3% of those who did not consult this specialist were unaware of its existence. The number of cases of respondents visiting geriatric doctor in place of their residence was higher in cities. The respondents who received geriatric medical care were completely satisfied with it in 52.7%. The causes of dissatisfaction with geriatric medical care in aimags (regions) were inattentive attitude of medical staff, low effectiveness of treatment and insufficient availability of free provision of medications. The identified social hygienic characteristics of medical activity and satisfaction with geriatric care of the elderly and senile residents of Mongolia should be taken into account in developing measures to improve this type of care in Mongolia.

[The development of health preservation technologies: from individual to family approach].

The actuality of considered problem is in the fact that many medical social problems of preserving and improving population health can be resolved by the family and with its support. The purpose of the study is to substantiate scientifically priority of family approach in development of National health preservation system in actual conditions. MATERIALS AND METHODS: The national and foreign electronic databases were investigated to find publications concerning transformation of matrimonial relations, effect of family on health and need in health preservation technologies at each stage of its development. RESULTS: It is demonstrated that implementation of family-oriented technologies of health preservation based on knowledge of trends in family health, matrimonial relations and demographic shifts in its structure is one of the priority directions of preserving and strengthening population health. Moreover, in modern socioeconomic conditions, the categories of families that are in special need of medical social protection and health preservation such as socially problematic families, families where violence is practiced, families of the unemployed and migrants are shown up. Hence, one of the priority scientific tasks is to substantiate conceptual model of health preservation technologies for various types of families. CONCLUSION: The family and its health should become priority object of medical observation and research studies from the standpoint of public health and health care.

[The medical social problems and methods of diagnostic of cognitive disorders in patients taking "Spice"].

The article presents the results of pilot study implemented to determine cognitive disorders in patients taking "Spice". The purpose of research is to identify targets of psychological correction interventions to prevent cognitive deficiency in patients addicted to synthetic cannabinoids. The pilot sampling consisted of 30 patients taking "Spice". The control group consisted of 30 healthy individuals. Along with social consequences, one of the important focuses of the study was investigation of cognitive sphere of patients. A number of pathopsychologic tests was applied. The study established that patients demonstrated disorders of various functions of memory, attention, mental pace and thinking. In particular, disorders of short-term, long-term and mediate memory and mental tempo were revealed. Also, reduced activity of attention took place. The distortion and decreasing of generalization and poor prehension occurred reliably more often as compared with control group. The established cognitive disorders in patients taking "Spice" can be considered as targets for psychological correction interventions to prevent cognitive deficiency in patients addicted to synthetic cannabinoids.

[The day hospitals as preventive hospitalization of patients of able-bodied age].

In accordance with the Russian Federal Law No. 350 of January 2019 the retirement age for Russians is increased for men from 60 up to 65 years, for women from 55 up to 60 years that requires implementation of organizational technologies of health-preserving, promotion of life and labor potential of population of late able-bodied age. In this regard, the role of day hospitals (DH) functioning directed at maximal possible prolongation of autonomous life and working capacity of elderly population increases. Besides, DH also presents additional reserve of optimization of medical care costs. The purpose of the study is to elaborate guidelines of improving activities of DH for population of late able-bodied age, for the purpose of preventive hospitalization. The study was organized on the basis of pilot medical organization of the Moscow Oblast, consisted of hospital of 600 beds and day hospital of 120 beds. The methods applied included sociological survey, expert judgment, statistical direct observation. The primary data was obtained from the forms of federal and sectorial statistical monitoring for 2014-2018. The analysis of medical documentation concerning pilot medical organization functioning during the year of the study was applied. The sociological surveys of patients of late able-bodied age (5 years before retirement according to the new legislation - men 60-65 years old, women 55-60 years old) who received treatment in day hospital. The results. The analysis of main indices of round-the-clock functioning in-patient and day hospitals in the Russian Federation in 2014-2018 established trend towards improvement of using hospital beds due to development of day hospital. However, bed capacity of hospitals is used ineffectively and experts assume that more than 1/3 of patients could receive medical care or aftercare in day hospitals. The experimental study of planning hospitalization of patients with chronic diseases at out-patient level demonstrated that 11.5% of population of able-bodied age need planned and preventive hospitalization in day hospital. The cost of treatment of patient with chronic pathology is 2-3 times lower in day hospital than in common hospital at the stage of exacerbation. It is reliable to apply at the out-patient level experience of planning hospitalization of patients with chronic pathology in day hospitals followed by performance control. The organization of functioning of day hospital and common hospital requires particular enhancement, including issues of succession, financing of the DS, the remuneration of medical personnel through effective contract determining interest of physician in early discharge of patient to aftercare in day hospital. The day hospital functioning is to be implemented in 2-3 turns. The day hospital is to be located in detached placement and the departments of base medical institution are to used in fullness. The day hospital is be used more actively for purpose of health preservation of population of late able-bodied age who. This contingent suffers of chronic pathology and is in need of preventive and health-promoting therapy in conditions of day hospital.

[The priority directions of forming and supporting healthy life-style in megalopolis conditions].

The activities related to formation and maintenance of healthy life-style of population are to be carried out in accordance with the Strategy of prevention of chronic non-communicable diseases. The purpose of the study is to analyze current trends in the formation of healthy life-style of Moscow residents and to determine priority areas of its maintenance. Materials and methods. The analysis of the lifestyle of the Moscow population in conditions of actual infrastructure of urban environment was carried out as exemplified by two administrative Okrugs. According to dispenasarization data the prevalence risk factors of chronic non-communicable diseases. in Moscow residents was investigated. The Results. It is demonstrated that in actual conditions, the population is be provided with recommendations concerning development of stress resistance, proper diet and physical activity enhancement using really existing integrated prevention space. The specialists involved into issues of citizens following healthy life-style in their professional activities are to rely on the results of both study of characteristics of self-preservation behavior of population and analysis of the state of prevention infrastructure in particular municipality.

[The medical specialists' evaluation of actual status of ultrasound diagnostic in pediatric practice].

The sociological survey of medical specialists is summoned to identify problematic areas of organization nature in functioning of ultrasound service and to elaborate effective measures to eliminate them. The purpose of research: to study opinions of medical specialists concerning state and priority directions of enhancement of ultrasound diagnostics in children. MATERIALS AND METHODS: The survey of 196 medical specialists in ultrasound diagnostics was carried out using questionnaire that included questions on evaluation of functioning of corresponding medical organizations, ultrasound diagnostics included, satisfaction with their work and means of improving ultrasound service. RESULTS: The majority of respondents were satisfied with their activities, functioning of ultrasound diagnostics their medical organizations in whole and in ultrasound diagnostics in particular. The main cause of dissatisfaction was condition of material and technical base. According to respondents, equipping medical organizations with devices of ultrasound diagnostics within the framework of implementation of program of health care modernization made no due contribution into increasing efficiency of functioning of ultrasound diagnostics service. CONCLUSION: Considering the high level of professional training, the responses of respondents are competent and permit to identify shortcomings, reserves and means of improving their professional activities.

[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 medical statistical characteristics of children received services in ultrasound diagnostic in out-patient conditions].

The purpose of the study was to estimate contingent of children that underwent ultrasonography in outpatient conditions of children hospital and to investigate reserves for improvement of actual ultrasonography service. The method of expert evaluation was applied to analyze medical documentation of 1171 children aged 0-18 years that underwent ultrasonography. The analysis was applied to demographic data, number of previous ultrasonography, specialty of physician involved into investigation, children chronic diseases and type of ultrasonography applied. The wide range of ultrasonic examinations were carried out in out-patient conditions of multidisciplinary children hospital was established. Their spectrum was determined by the age of patients. Children were most often referred to ultrasonography by cardiologist, pediatrician and gastroenterologist. In examined patients dominated diseases of digestive organs, congenital abnormalities, diseases of nervous and urinary systems, circulatory system. In the structure of morbidity, proportion of diseases of endocrine system, circulatory and digestive systems increased with age and the proportion of diseases of nervous, musculoskeletal systems and congenital abnormalities decreased. Among the types of ultrasonic examination, the first places in frequency took studies of circulatory system, abdominal organs, kidneys and retroperitoneal space. The large proportion of patients underwent ultrasound testing again. The comparative analysis demonstrated increasing of proportion of ultrasound studies of endocrine and reproductive organs and decreasing of musculoskeletal system and brain. It is proposed to apply received results in studying particularities of children that underwent ultrasonography in the inpatient and outpatient conditions. The received data can be used in planning of required volume of different diagnostic services at different levels.

[The medical social characteristic of patients of private stomatological clinics].

The article deals with results of anonymous questionnaire survey of patient in private dental clinics "LiderDent" (241 respondents of able-bodied age) and "GelioDent" (419 respondents of able-bodied age). The purpose of the study was to investigate peculiarities of medical and social characteristics. The questionnaire included questions concerning social status of respondents, their financial condition, self-assessment of dental health and its maintenance at the proper level for a number of parameters, as well as evaluation of work of private dental organizations. The assessment of dental health of elderly patients established that 58.1% of respondents rated their dental health as good, 27.8% as satisfactory; and 4.1% of respondents estimated their dental health as bad. The analysis included also evaluation of negative health habits of respondents resulting in dental diseases and afflict damage to teeth and oral cavity. It was found that more than half of respondents had higher education. They consider themselves as financially secure, they did not smoke and had good condition of oral cavity. They choose dentists according recommendation of friends and seek dental care only in case of obvious signs of disease. The analysis of possible reasons for seeking dental professional revealed that 75.5% of respondents seek dental care when there are "obvious signs of disease and deterioration of health", 21.2% "when first signs of disease occurred" and 3.3% "only in critical situation". It is concluded that dental professional of private medical centers should be more widely carried out sanitary and educational work with population in order to increase the medical activity of patient, as well as to increase their awareness of ways and means of maintaining the dental health.

[Making management decisions of oncopathology prevention based on monitoring of disease dynamics and trends].

The article deals with results of comparative analysis of the dynamics and trends of the incidents of malignant neoplasms in the population of the Moscow region. The Central Federal district and the Russian federation as a whole according to Rosstat data for 2009-2018. It was established that in Moscow region in comparison with other territories, the level and growth rates of the incidence of malignant neoplasms were lower. In the structure of the incidence of malignant neoplasms, the first rank places are occupied by breast, skin, lung, colon and prostate cancer. Attention is drawn to the fact that over the entire period of observation, the indicator of the number of people under medical supervision in the Moscow region was consistently higher than in the Russian Federation and the Central Federal district. Over the period of 2012-2018, the share of malignant neoplasms of the first stage of the spread of the tumor process increased by 23.4% in the region, and the share of stages III and IV decreased (by 16.9% and 12.3%, respectively).The increase in the number of newly detected malignancies seems to be due to increased diagnostic capabilities in recent times.

[The hospital-substituting technologies: condition and strategic tasks of their development].

The program of state guarantees of free medical care of citizens for 2019 and up to 2020-2021 plans to reduce volume of inpatient medical care through development of hospital-replacing technologies. The economic feasibility of hospital-replacing technologies is in significantly lower cost of medical services in a day hospital as compared with twenty-four hours hospital (UPC). However, the existing legislative framework and the lack of proactive financial mechanisms do not stimulate development of hospital-replacing technologies. The purpose of study is to analyze reporting data and results of SWOT analysis of rating of factors affecting introduction of day hospitals, On the basis of analysis the strategic objectives of development of hospital-replacing technologies are formed. The study applied statistical analysis, direct observation, sociological survey, SWOT analysis. The analysis was applied to data from forms of Federal statistical observation No. 14 and industrial statistical monitoring No. 14 for 2009-2018. Based on results of SWOT analysis, experts were interviewed by the heads of health care authorities and medical organizations regarding development of strategy of medical care of children with disabilities. The expert survey was carried out with health care managers in Moscow, the Moscow oblast, Orenburg, Chelyabinsk, Samara, Ivanovo, Ryazan oblasts and the Republic of North Ossetia-Alania. The analysis established that in 2018 the number of medical care organizations increased up to 6495, including medical institutions providing outpatient medical care (41.4%) and in-patient medical care (58.6 %). The analysis demonstrated that percentage of treated patients in day hospitals out of the total number of hospitalized patients (in hospitals was 29,1% in 2018, while in 2009 this percentage was significantly lower - 15,6%, which indicates the intensification of the use of the bed fund of the UPC, which to some extent is associated with increased development of hospital-replacing technologies. The results of SWOT analysis demonstrated that the strategic objectives of development of hospital-replacing technologies should be targeted to develop financial stability of health care, active position of the heads managers of health care institutions and medical organizations and introduction of innovations if needed. It is necessary to develop modern management methods, rational application of health care resources, implementation of economic incentives in all components of health care system, ensure functioning of the system, including effective contract.

[The awareness of patients with chronic dermatitis about rendering medical services and rights at their acceptance].

The information about disease, its cause, prognosis, methods of diagnostics, treatment and prevention is always very important for patient and relatives. The article presents the results of questionnaire survey of 412 patients with chronic dermatitis residing in Moscow. The purpose of study was to evaluate awareness of patients with chronic dermatitis and residing in the capital of Russia about medical services provided and their rights to receive them. It was established that the information most frequently provided to patient by physician relates diagnosis. According to the survey, physicians always provide information about diagnosis in 84.9% of cases. The second place is for information about treatment methods and possible complications during treatment (82.0%). More rarely, physicians inform patients about the examination methods, possible unpleasant sensations and complications, side effects of medications and patient's right to refuse examination and treatment, as well as the consequences of such a refusal. Absolutely all patients indicated the need to protect the rights of patients in case of their violation in the process of providing medical care. Moreover, 59.6% of them were sure about necessity to appeal to the administration of medical institution, 16.3% of patients considered it necessary to complain to insurance companies, 15.7% of patients to the Ministry of Health and 8.3% of patients to the court.

[Problem areas and opportunities of the "Moscow standard of the clinic"].

The article deals with the study of problem areas and prospects for the implementation of the «Moscow polyclinic standard¼ (SME). The aim of the work was to analyze the factors on the part of medical workers that affect the effectiveness of the implementation of innovative projects in health care. The assessment of the doctor's and nurse's attitude to the changes caused by the introduction and willingness to work in a new format was studied. During the pilot study, which covered 730 medical workers, including 358 doctors and 374 nurses working in outpatient medical organizations of the capital, a sociological survey was conducted on specially designed questionnaires. It was found that the introduction of SMEs contributed to the revision of a number of responsibilities and activation of medical personnel, focusing on meeting the needs and requirements of the population in health services. Thus, the SME fits into the WHO strategy of orienting primary health care institutions to integrate into the integrated model of care delivery. At the same time, the SME has significantly freed up the time of doctors to work directly with patients. The activity of nurses was changed, they received much more independence in the work. Therefore, the scope of the received results are the health authorities of Moscow and also the management of outpatient medical organizations. In General, doctors and nurses positively assesses the changes. New working conditions are to some extent stressful factors and need to be corrected, which should be taken into account by the heads of medical organizations.

[The Organization of Specialized and High-Tech Cardiologic Care in the Republic of Kazakhstan].

The article presents the results of analysis of indices of morbidity and mortality of diseases of blood circulation system of population of the Southern Kazakhstan oblast in 2004-2015. The analysis was applied to annual activities reports of the Regional cardiologic Center in 2013-2016. Thus, in 2016 the Center accepted 4237 patients and 80.7% out of them in emergence order. In overall, treatment in the Regional cardiologic Center was applied to 59.4% of respondents. All respondents were residents of municipal center an only 25.4% resided in rural area that is related to lower accessibility of cardiologic and cardio-surgery care for them. During analyzed period, increasing of rate of renunciation of hospitalization up to 15.8% was established. In 2016, the leading causes of renunciation were absence of indications for emergency hospitalization and common hospitalization, non-profile patients and self-repudiation. The article presents the results of sociological survey of 784 patients with diseases of blood circulation system addressing medical organizations of the Southern Kazakhstan oblast. It is established that main causes of dissatisfaction with medical care in the Regional cardiologic Center are long-term waiting for one's turn, inconsiderate attitude of personnel, low accessibility of planned hospital treatment, inadequate effectiveness of treatment, and poor free medications support.

[The medical social characteristic of patients with psychic disorders addressed to medical institutions with various forms of property].

The article deals with the issues of enhancement of the psychiatric service. The analysis of the results of medical social study of the patients addressed for the medical care to public and commercial structures is given. The substantiation of necessity in enhancing the quality and effectiveness of out-patient psychiatric care service are presented and the various alternative models of its development as well.

[Prophylactic requirements for sanitary and epidemiological surveillance in dentistry].

The paper outlines the requirements for sanitary-and-epidemiological surveillance to prevent dental diseases. The investigations pose tasks to medical prevention centers to solve the problems in tooth prophylaxis, such as organizational-and-methodological, sanitary-and-educational, health-improving, and others. The sanitary-and-hygienic requirements for therapeutic-and-prophylactic dental facilities are defined. A procedure for keeping a management protocol for the prevention of tooth diseases is described.

[The morbidity of physicians of pre-pensionary age].

The data research related to the investigation of the morbidity of the physicians of pre-pensionary age on the basis of medical check-up results. It is established that more than 95% of physicians suffered from chronic diseases. At that most of them had several diseases. Among the examined groups of physicians according their gender, age and duration of work in the medicine the most morbid were the physicians older than 50 years and with the period of probation 25 years and more. In the structure of the revealed pathology leading role was played by the cardiovascular diseases, the diseases of musculo-skeletal system, the diseases of the eye and its supplementary apparatus, the respiratory diseases and the diseases of urogenital system. The revealed characteristics of morbidity are to be taken into account at the development of the group and individual programs of preservation, rehabilitation and promotion of physicians' health.

[Cost availability and patient satisfaction of hospital care].

The results of sociological questionnaire of 1496 patients of oblast and region hospitals related to cost availability and patient satisfaction of hospital care. About 75% of respondents considered their treatment spendings as significant. It is established that degree of patients' satisfaction of hospital care depends on length of stay at the in-patient department. The longer it is the fewer patients satisfied with medical care are. It is proposed to organize in hospitals among socially unprotected patients evaluation of individual spendings for medical care to protect constitutional rights of the population and to reveal factual cost of medical care in the framework of the territorial program of public guarantees.

[Forecasting of prevalence of cardio-vascular pathology in children population].

Statistical modeling and forecasting of morbidity, disability and mortality of circulatory system diseases and congenital anomalies in children of Ryazan oblast was organized. Procedures of expotential smoothing and determination of statistical significance power of predicted values were applied. Application of expotential smoothing models with linear trend enables reliable forecasting of morbidity of circulatory system diseases and congenital anomalies in children. In Ryazan oblast, disability and mortality of children has higher variance which prevent to apply reliable forecasting. Increase in morbidity and disability rate of circulatory system diseases and congenital anomalies and widening of dispensary group is detected. Predicted increasing of morbidity rate of cardiovascular pathology in children and widening of corresponding dispensary group requires enhanced capacity of medical care supported by according financing.