[The Post-Operative Complications as an Evaluation Indicator of Efficiency of Functioning of Three-Level System of Medical Care Support According to Urology Profile in the Voronezh Oblast].

In the Voronezh Oblast, the modernization of system of medical care support of patients with urological pathology was implemented with the purpose of increasing efficiency of the urological service functioning. This action affected all levels: early active detection of urological pathology, standardization of examination and treatment, routing of patients, strict control by way of monthly reports of medical institutions of the Oblast at the level of hospital and out-patient services, supervisory visits of specialists to districts and efficient control on part of the Oblast Chief Out-of-Staff Urologist. In the course of study it is established that key indices characterizing efficiency of functioning of the regional system of urological care of population are admitted the levels of unreasonably prolonged conservative treatment and also reasonably application of low invasive and high-tech intervention, implementation of standardization of the curative diagnostic process, rate of post-operative complications, level of economic costs of diagnostic and treatment, level of medical competence of personnel and degree of early detection of urological pathology that is validated by statistically reliable positive effect at the expense of their adjustment. The detection of advanced forms of diseases results in increased disability, increased economic costs per each patient in need of several operative interventions and highly qualified care. The number of post-operative complications is considered as an indicator of timeliness and adequacy of provided medical care to patients. The article presents an analysis of efficiency of the three-level system of medical care support according indicator of post-operative complications.

[Effect of anthropo-technogenic load on medico-social aspects of primary morbidity and disability of population.]

Population aging is a global social phenomenon that affects the most important health indicators of the population. The older generation is particularly vulnerable in the current conditions of urbanization and the associated environmental situation. The comprehension of indicators of disability and morbidity of the population, the study of the factors that determine the negative processes of health damage, taking into account regional features of these processes are necessary for the planning of preventive measures. In the age structure of the primary disability of the adult population in the Voronezh region elderly disabled people make up 53,3%, middle and young people with disabilities are less - 30,1 and 16,6%, respectively. These indicators are higher than the average Russian. The results of non-carcinogenic risk and primary morbidity analysis in population of Levoberezhniy district of Voronezh under permanent anthropotechnogenic load have presented. It has been established that non-carcinogenic risk coefficients were bigger that acceptable level (HQ>1) by for nitrogen dioxide, acrylonitrile, acrolein, 1,3-butadiene, copper oxide, chromium+6. Unacceptable level of non-carcinogenic risk is typical for respiratory organs pathology, pathologies of cardiovascular system and endocrine system. Analysis of the primary morbidity of these nosological forms shows their high distribution in adult population morbidity. Under rehabilitation measures in patients with respiratory organs diseases, circulatory system and endocrine system diseases it is necessary to consider anthropotechnogenic load and relationship between agents and disease development.

[Gerontology and geriatric service in Voronezh region: from the origin into the future.]

The article concerns demographic situation in Voronezh region. The authors have analyzed morbidity and mortality from various diseases in senior age groups. Geriatric service quality in Voronezh region has been estimated.

[The Indices of Common and Early Detection of Urological Pathology as Criteria of Efficiency of Urological Care Rendering].

The comparative statistical and logical analysis of curves of dynamics of common and early detection of urological pathology was implemented with purpose of evaluating efficiency of functioning of regional urological service in the format of developed three-level system of medical care as exemplified by the Voronezh oblast. The obtained statistical data testify a significant increasing of common detection and detection at early stages of urolithiasis, benign hyperplasia and prostate cancer. This outcome is an evidence of partial or complete realization of transition from model of medical care by appealability to model by detection at the expense of implementation of developed three-level system of medical care of population in the region.

[Characteristics of Voronezh schoolchildren physical development and nutrition behavior].

Physical development and nutrition behavior of schoolchildren in Voronezh depending on their age were studied. Research included 484 children aged 8-17: 236 (48.8%) girls and 248 (51.2%) boys. The children were divided into 3 groups: aged 8-10 (174 children), 11-14 (196 children) and 15-18 (114 children). The children were interviewed, their height and weight were measured and body mass index (BMI) was calculated. Questionnaire was focused on milk intake and hot meals received at school, frequency of meals per day and frequency of breakfast. Z-score values for height and weight for certain age (HAZ & WAZ) and BMI (BAZ) were calculated using WHO ANTHRO Plus program. HAZ values from -2 to +2 and BAZ from -1 to +1 were ranked as age norms. BAZ from -1 to -2 were considered slight malnutrition, BAZ less -2 - malnutrition, BAZ from +1 to +2 as overweight, BAZ equal and over +2 as obesity. Average Z-score height, weight and BMI values were higher than WHO standards, maximal differences in boys aged 8-10, minimal in teenagers aged 15-18 (p=0.042). Z-score height values in girls aged 8-10 were 0.43±1.02, in boys - 0.74±0.99 (р=0.000), in girls aged 11-14 - 0.29±0.99 and boys 0.39±1.06, aged 15-18 - 0.13±0.68 and 0.13±1.00 respectively. Children aged 8-10 had higher height and weight, but also higher BMI (0.36±1.13 in girls and 0.96±1.44 in boys, р=0.000). Z-score BMI in schoolchildren aged 11-14 was 0.12±1.27 in girls and 0.19±1.37 in boys, aged 15-18 - 0.25±1.17 and 0.09±1.07 respectively. Overweight frequency in children aged 8-10 was 23.0% (in boys - 26.1%), obesity - 15.5% (in boys 21.6%). Growing older, overweight and obesity frequency decreased (till 12.3 and 4.4% at age 15-18), whereas malnutrition increased (from 9.8 at age 8-10 till 18.9 at age 11-14 and 17.5% at age 15-18). Half of the schoolchildren had 4-5 meals per day (75.3% at age 8-10), and 19.6% - 2 meals per day (37.2% at age 11-14). Teenagers aged 15-18 had 3 meals per day in 61.4% cases, however frequency of their breakfasts decreased (82.5 compared to 91.4% in children aged 8-10). 68.9% of children aged 8-10 had regular meals at school canteens compared to 29.8% of teenagers. Less than 50% of children (41.9%) drank milk at school regularly. Preventive measures should be taken for children aged 8-10, especially boys, to prevent overweight and obesity increase, and girls aged 11-14 and 15-18 should be paid special attention to prevent malnutrition.

[Gingerbreads of enhanced nutritional value with the non-traditional raw materials].

The results of the research on quality indicators and nutritional value of gingerbreads made from non-traditional raw materials are presented. The flour from whole-hulled chickpea seeds, whole-wheat flour, flour from the buckwheat bran and mustard oil has been used. Non-traditional types of flour were added in the form of flour composite mixture instead of wheat flour (50%) according to the recipe of glazed gingerbread, mustard oil - 8% to the total weight flour. It has been shown that the usage of unconventional materials can improve the organoleptic and physic-chemical parameters, increase the antioxidant activity, and enhance the nutritional value of gingerbreads produced according to GOST 15810-2014. It has been found that the consumption of 100 g of enriched gingerbread products satisfied the average daily requirement of protein by 10%, fat by 2-6%, carbohydrates by 19%, dietary fiber by 14%, calcium, potassium and selenium by 5-8%, magnesium, phosphorus and iron from 15 to 30%, vitamins B1, B2 and PP by 8-11%, vitamin E by 3-18%, essential amino acids from 9 to 20%.

[TYPE 2 DIABETES MELLITUS AND DEPRESSION].

The clinical significance of type 2 diabetes mellitus is not confined to metabolic disorders. A serious problem is also affective pathology that occurs in the majority (30-70%) of patients. However, diagnostics and correction of anxiety and depressive disorders associated with diabetes are often given insufficient attention. Many studies showed relationship between affective disorders and low adherence to the prescribed treatment resulting in general deterioration of clinical prognosis of diabetes. This review article describes the basic mechanisms behind the interrelation of affective disorders and diabetes. The role of persistent subclinical inflammation in diabetes and depression is discussed. The influence of emotional stress on the activation of the hypothalamic-pituitary-adrenal axis on the overproduction of cortisol is emphasized. The similarity of some structural changes in the brain tissue in diabetes and depression is discussed. Effect of endocrine disruption in the emotional sphere is demonstrated. Mechanisms responsible for the development of diabetes and its complications provoked by depression are considered.

[ANEMIC SYNDROME IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA].

Community-acquired pneumonia remains a most widespread acute infectious disease of socio-economic significance all over the world. Up to 30% of the patients present with anemia responsible for the unfavourable prognosis and elevated mortality. Not infrequently, anemia is not diagnosed during the hospital stay und therefore remains uncorrected. Severe anemia results in enhanced hypercapnia and slowed maturation of red blood cells in the bone marrow which facilitates the development of ischemic syndrome. Hepcidin, a mediator of inflammation and iron-regulatory hormone, plays an important role in the clinical course of community-acquired pneumonia. Hepsidin production increases during inflammation; it suppresses erythtropoiesis and depletes the iron depot leading to so-called anemia of inflammation. Hypoxia and anemia activate erythtropoiesis, and the released erythropoietin inhibits hepsidin production. During pneumonia resolution, hepsidin promotes recovery from anemia by activating iron absorption. The curreni literature contains few data on the use of hepcidin as a diagnostic marker of anemia. The necessity oftreating anemia in patients with pneumonia under hospital conditions is a matter of discussion. Direct involvement of hepcidin in iron metabolism creates a prerequisite for the treatment of anemia. Medicamental suppression of its activity by stimulating erythtropoiesis can facilitate normalization of iron metabolism and restoration of hemoglobin level.

[Anemias in chronic obstructive pulmonary disease].

According to different studies, anemia occurs in 8--33% of patients with chronic obstructive pulmonary disease (COPD). The paper describes the most important various causes of anemia in COPD, such as systemic inflammation and endocrine disorders, the use of some medications (theophylline, angiotensin-converting enzyme inhibitors), frequent COPD exacerbations, and long-term oxygen therapy. Lower hemoglobin levels in COPD patients are accompanied by increased shortness of breath, reduced exercise tolerance, and lower quality of life. Furthermore, some investigations have shown that anemia is an independent predictor of death in patients with COPD. In spite of the fact that anemia may be successfully in these patients, the evidence suggesting the importance of its impact on the prognosis of COPD is limited.

Occupational risks in occupational morbidity structure and possibilities to reduce them.

The article presents results of occupational morbidity analysis in a region, with assessment of trends, levels, dynamics and structure of morbidity, factor dependency of occupational diseases, identification of occupational conditions of its occurrence. The information obtained helped to specify a system of occupational risk management, that increases efficiency in solving problems and better work safety in production.

Evaluation of work conditions and transitory disablement morbidity among paramedical personnel.

The studies revealed that work of paramedical personnel can be assigned to 2 jeopardy class in chemical factor, noise, vibration, illumination, work hardiness; in unfavorable parameters of microclimate in summer period and work intensity - to 3.1 class, in biologic factor - to 3.1-3.3 class. According to totality of factors, the work of paramedical personnel corresponds to 3.2-3.3 class of work conditions. Morbidity level of medical nurses is <> with minimal level of occupational risk. With that, more detailed analysis in 4 length of service groups revealed that in a group with over 15 years of service the morbidity level reaches high and extremely high (from 104.0 to 244.4 cases per 100 medical staffers). This evidence could be explained by exposure to occupational risk factors and worse health state with longer length of service and ageing.

[Differential diagnostics of febrile conditions in an emergency care clinic].

We undertook the analysis of 157 cases of fever at the stages of polyclinic - admission department - hospital treatment for the purpose of elucidating the structure of febrile syndrome. Pneumonia developed in 45 patients, infectious endocarditis in 34, chronic alcoholic hepatitis in 21, rheumatoid arthritis (pseudoseptic variant) in 2, systemic lupus erythematosus in 1, polymyositis in 2, acute pyelonephritis (exacerbation of chronic pyelonephritis) in 15, tumours of different localization in 37 patients. We evaluated the informative value of some acute-phase blood characteristics obtained, results of X-ray and ultrasonic studies for early diagnostics of pneumonia and infectious endocarditis.

[STUDY OF THE IMPACT OF WHEAT GERM CAKE OIL AND FLOUR ON INDICES OF ENERGY EXCHANGE IN STUDENTS AND TEACHERS OF HIGH SCHOOL].

There were obtained data which confirm the increase of efficiency of gas exchange processes in students and teachers of the engineering high school in the daily use of at least 3.5 g of wheat germ oil and 50 g of wheat germ cake flour without the correction of the basic ration. The study of the exhaled gas-air mixture showed in all age groups the gain in the concentration of carbon dioxide and the decline of concentration of oxygen by the 0.20-0.30%. There was established the increase of blood oxygenation level in all subjects. There was demonstrated the relationship between the depth of the alteration of these parameters with age, and regular physical activity in studied cases.

[Application of extremely high frequency (EHF) therapy as a method of complex therapy of the elderly patients with mixed form of bronchial asthma].

The effectiveness assessment of using EHF-acupuncture to prevent the attacks in the patients of mixed forms of bronchial asthma is given. The article presents the special scheme of treatment of patients of different age groups in different phase of the disease using the points of acupuncture with the application of EHF.

[Effectiveness of laser puncture in elderly patients with bronchial asthma accompanied by chronic rhinosinusitis].

We apply laser puncture to influence biological active points with infra red laser ionizing at scheme with effect of treatment of asthma bronchial with chronic accompanied by rhino sinusitis. The clinical effectiveness of treatment was seen in positive dynamics of clinical, instrumental and spirographycal indices regarding bronchial asthma and concomitant rhinitis as well, which was confirmed by X-ray examination. Application of laser punctureto treat the elderly patients with asthma bronchial accompanied by rhino sinusitis is an effective method having no side effects that can be used in an ambulatory and in a hospital.

Oxidant stress in the pathogenesis of multiple sclerosis.

We report here an analysis of measures of the intensification of lipid peroxidation and the state of the non-enzymatic and enzymatic components of the antioxidant defense system in different clinical forms and stages of multiple sclerosis. The data obtained support the role of oxidant stress in the development of the pathological process in multiple sclerosis.

[Oxidative stress in the pathogenesis of stroke].

Free radical oxidation of lipids and proteins is the universal process constantly proceeding in cells, tissues and organs during the lifetime of organism. In certain conditions, this process can be a basis of pathology, one of the mechanisms of disease development, including stroke.