[The experience of organization of combined screening of uterine neck cancer in the Republic of Bashkortostan].

The article considers organizational issues of cervical cancer screening in the Russian Federation. In particular, experience of implementation of the Project "HPV testing within the framework of combined cervical cancer screening (HPV and cytologic screening) in the Republic of Bashkortostan is considered. The cervical cancer is a widespread disease that requires early diagnosis and timely medical care. The main aspects of organization of medical care of patients with gynecological diseases in relevant normative legal regulatory documents are described. The algorithm and scheme of routing patients with suspected cervical cancer and with this disease are presented. The study covered more than 60,000 women aged 30-39 years from 14 medical organizations of Ufa. Such methods as sociological, statistical, analytical, content-analysis and organizational experiment were applied. The study permitted to substantiate and to approve both the Project "HPV testing as part of combined screening for cervical cancer (HPV screening and cytologic screening) and the algorithm of combined screening of cervical cancer during preventive examinations of female adult population aged 30-39 years of the Republic of Bashkortostan. The scheme was developed for routing patients with suspected cervical cancer or diagnosed disease to medical organizations for timely medical care support. By implementing developed routing and screening scheme for patients at risk of developing cervical cancer, as well as those who already suffer this pathology, it is possible to improve quality of organization and delivery of medical care, to reduce morbidity, mortality and disability because of this pathology and to assure early diagnosis and prevention of cervical cancer.

[The preferential strategies of programs of cervical virologic screening (publications review)].

Nowadays, the screening programs underwent global alterations due to low sensitivity and specificity against the background of significant increase of cervical oncopathology. The HPV testing became a major strategy of primary screening in many developed countries. The studies of organizational technologies of successful implementation of virologic screening are to bear on scientific justification of test choosing. To review scientific base of organizational technologies of primary virologic screening of cervical cancer with study of preferred criteria of selecting HPV test in world practice. The selection from scientific database PubMed and Google Scholar relevant publications over the past 15 years on organizational technologies of implementing methodologically validated virologic screening for cervical cancer was carried out. The world publications present evidence base of success in modifying organizational structure of cervical screening from PAP smear cytological screening to HPV testing. The necessary condition of efficiency was the organized screening covering at least 70% of female population of reproductive age, applying validated HPV assays as primary screening. The results of randomized clinical trials were the preferred strategies of selecting tests and primary screening programs. Currently, HPV testing is the preferred technology of primary cervical screening. The choice of specific HPV test is based on Mayer's criteria, including validation, information content, availability, identification of main HPV types of high oncogenic risk with typing, groups ranking for personalization of therapy and rehabilitation. To decrease subjectivity in organization of laboratory component in screening methodology, automation and standardization were applied in isolation of HPV DNA with cutting-off clinically insignificant results. The preferred strategies of selecting cervical virologic screening programs were results of multicenter randomized clinical trials, with significant evidence base of detection of cervical precancerous pathology and decrease of corresponding morbidity.

[PATIENT SATISFACTION AS AN INDICATOR OF PATIENT ORIENTATION IN ORGANIZATION OF PAID MEDICAL SERVICES].

Nowadays, the idea of the patient as the main subject of medical care is being established in the public consciousness. It is around the patient that all types of professional medical activities and all forms of relationships with other subjects of modern health care are organized.In the professional sphere, this idea is seen as a principle of patient focus. In the provision of paid care, this factor acquires special relevance and is largely determined by the compliance of the process and results of the provision of medical care with the expectations of consumers of medical services. In this regard, the study of the expectations of the contingent of people applying for paid medical services to state medical organizations, and the degree of their satisfaction with receiving paid medical care was the purpose of this study.

[EPIDEMIOLOGICAL FEATURES OF PAPILLOMAVIRUS INFECTIONS AND CERVICAL CANCER IN THE REPUBLIC OF BASHKORTOSTAN AND THE KALININGRAD REGION].

In the context of improving cancer prevention programs, it becomes relevant to justify the introduction of regional HPV cervical cancer screening programs based on a study of the prevalence of human papillomavirus infection and cervical cancer. Aim: to identify the main patterns of the prevalence of human papillomavirus infection and cervical cancer in Bashkortostan and the Kaliningrad region for the scientific substantiation of the criteria for the adoption of regional screening programs. A prospective analytical cohort single-stage observational examination of 3428 women of the Republic of Bashkortostan and 1246 women of the Kaliningrad region was carried out, as well as a retrospective observational analytical study of cervical cancer incidence in Bashkiria and the Kaliningrad region according to the official statistics from 2011 to 2020 compared to Russian indicators. In Bashkortostan and the Kaliningrad region, HPV DNA was detected in 48.7% and 54.2% of women of reproductive age, respectively, of which HPV of high oncogenic risk (HPV HR) was 51.7 ± 6.2%, and 23.4% were found to have PCM . In the Kaliningrad region, HPV DNA was detected in 47.2% of the women under study, HPV VR - 31.1%, in 25.5% accompanied by cervix uteri diseases. An increase in the incidence is noted in the Kaliningrad region by 38.6% over 10 years, with an annual increase of 3.8%. In Bashkortostan, the growth is demonstrated by 31.8% with an annual increase of 3%, which is significantly higher than in the Russian Federation (13.3%, р=0.001). For 10 years, the prevalence of cervical cancer has increased in the Kaliningrad region by 10.1%, with an average annual increase of 1.1%. In Bashkortostan, the prevalence of CSM increased by 4.7% with an annual increase of 0.3%. The high prevalence of HPV infection among women of reproductive age, the unfavorable dynamics of indicators of cervical HPV-associated oncopathology in remote regions of the Russian Federation (Bashkiria and the Kaliningrad region) is a scientifically based criterion for the reorganization of regional cervical screening programs. The implementation of Organized screening with primary HPV examination with mandatory separate genotyping of types 16 and 18 and the remaining 12 types of HPV HRC in a complex will enhance the effectiveness of ongoing preventive measures and meet international standards.

[The effect of the new coronavirus infection on the structure of children traumatism].

The traumatism, including children traumatism, is one of priority problem of health care in the Russian Federation. The indices of children traumatism and disability because of injuries are the most important indices of children health. They characterize quality of child care in family, depend on common norms of public behavior, reflect cases of aggression and violence in relationship of adults and children and in children communities. The available comparative data permitted to analyze impact of the pandemic on structure and level of children traumatism as exemplified by the Kursk Oblast.

[Models of community-based psychiatric care in Italy and England]. / Modeli vnebol'nichnoi psikhiatricheskoi pomoshchi v Anglii i Italii.

THE AIM OF THE STUDY: Is to study and compare models of out-of-hospital psychiatric care in different countries-Italy and England.In the Italian model of community-based psychiatric care, institutions have been created - homes for permanent residence with a security regime (REMS), the most common of which are intensive (or assertive) treatment in the community and mandatory outpatient treatment. The form of intensive treatment is an active and long-term maintenance and treatment of patients. The essence of the methodology is to provide assistance at home, which is carried out by specially trained multidisciplinary teams, including psychiatrists, nurses, psychologists, social workers. However, in the long term, there is a tendency to increase relapses and acute conditions. The English model of community psychiatric care is based on the practice of the method of «individual case management¼. After the acute attack is stopped, the main work program includes work with a psychologist and/or a psychotherapist in the form of a number of multidimensional group and family therapy activities, training of social skills and ways of independent living, development of communication, self-esteem and confident behavior, which is achieved through psychocorrective work, as well as drug therapy and didactic training on appropriate simulators.Special attention is paid to social recovery, work with the family, social and labor recovery and instrumental support.

[The ways of developing management of organization and caring of women with diagnosis of habitual non-carrying of pregnancy].

In Russia, in conditions of reproductive crisis of modern family, miscarriage IS one of the important problems, in particular habitual miscarriage as significant risk factor of development of maternal and perinatal pathology. The timely identification and medical care support of pregnant women suffering from habitual miscarriage is essential in ensuring and maintaining their reproductive health. To obtain reliable and objective information by control boards on effectiveness of organization and provision of obstetric care to women with diagnosis of habitual miscarriage is an actual task. The purpose of the study is to develop information support of management of organization and provision of medical care of women with habitual miscarriage, based on identification and use of specific risk factors of development and prevention of this pathology.

[The evaluation of efficiency of the project "Home Patronage" in Moscow].

In Moscow, the improvement of primary health care home support of patients with limited mobility is implemented since 2017, through the new organizational form "The primary health care support of groups of population with limited mobility" - "Patronage at home". In this regard, the "evaluation of performance efficiency" of this novation is of particular importance. The purpose of the study was to substantiate approaches to implementation of such an assessment applying developed with consideration of experts' opinions "The system of criteria and indices" as well as using the data of registry of patients in need of home patronage. The acquisition of information with specified mean will both allow to objectively assess in dynamics the effectiveness of functioning of new organizational form of "primary health care support of patients with limited mobility at home" in Moscow and contribute to improving its management.

[The development of management of medical organizations providing specialized primary medical sanitary care to mental patients].

Actually, in Russian health care, the organization of community-based medical care of patients with mental disorders is considered as one of requested problems to be resolved. The in-patient substituting forms of specialized primary medical and social care for mental patients create optimal conditions for treatment and rehabilitation of this group of patients without separation from familiar social environment, that in many ways reduces "personality stigmatization" and promotes returning of individual to full-fledged social life, decreasing the load on the most expensive hospital care. One of such organizational forms implemented in Moscow under the new model of provision of mental care is out-patient mental module that provides specialized primary medical and social care and is tested in conditions of basic medical organization. Hence, the purpose of the study is to develop system of indices for continuous information support of management of implemented innovations.

[The technology of enhancement of detection of chronic renal diseases].

The chronic kidney disease takes a special place among chronic non-communicable diseases because it is characterized by wide prevalence worldwide. However, its detection rate among Moscow adult population is 1%, though in the European countries this indicator is significantly higher and is made up on average to 6%. At the terminal stage of chronic kidney disease, quality of life of such patients decreases dramatically, that result in working capacity loss and disability. These patients often require expensive methods of programmed hemo- and peritoneal dialysis. The corresponding mortality is much higher as compared with total mortality. Among the frequent causes of hospitalization and mortality of such patients, complications of blood circulation system diseases are registered. The existing problem of low detection of kidney pathology in the population is the main cause of untimely treatment start. The rapid disease progression results in higher indices of premature mortality and increased costs of treatment of patients with this pathology. The timely diagnosis of disorders of carbohydrate and lipid metabolism permits to identify chronic kidney disease at an early stage and to start to carry out adequate treatment and prevention measures. The purpose of the study is to implement the technology of improving efficiency of detection of chronic kidney disease. Methods. The organizational experiment, analytical, mathematical and statistical research methods. Results of the study. The detection rate of chronic kidney disease amounted to 8%. Among the respondents with chronic kidney disease diagnosed, more than 80% had initial stages of disease (I-III). In this case, appropriate therapy and prevention can prolong kidney functioning and reduce velocity of disease progression. At the same time, 16.3% of patients at the late stage of diseases progression (stages IV-V) were identified.The detection rate for all stages of chronic kidney disease increases with age Conclusions. The level of detection of chronic kidney disease in the base territory is comparable with the indices established in the European countries. The need to improve quality of diagnostic and prevention of chronic kidney disease was proven. To improve overall prognosis and prevention of development of terminal renal failure is possible only in case of brigade approach to treatment including active interaction of cardiologist and nephrologist, endocrinologist and nephrologist or of all these three specialists. Scope of the results. The established higher detection rate of chronic kidney disease (8%), as compared to actual one (1%), permits to claim that with systematic improvement of diagnosis, the detection of chronic kidney disease will increase iteratively and population need for nephrologic medical care will significantly increase that will require increasing in resource support and revising of planned and normative indices for this type of medical care.

[The implementation of complex of measures targeting support of patient-oriented principle under organization of paid medical services].

To ensure financial stability of state medical organization in actual conditions requires focused consideration of various aspects of implementation of paid medical services in national health care. The analysis of publications demonstrated that experience of variety of models for providing paid medical care in state medical organizations and new directions of improving efficiency, availability and quality of medical services are mainly considered. The specificity of medical activity is conditioned by consumer-oriented activities because of direct relationship to life and health of patients. The success of medical marketing depends on achievement of loyalty of consumers of medical services. It is particularly important to ensure compliance with principle of patient-oriented organization of paid medical services. The article considers practical implementation of patient-orientated principle in paid medical services in state medical organization. The article presents elaborated and implemented set of scientifically based measures for main directions of medical activity. These measures are targeted to increase satisfaction of patients, to meet their needs and expectations, that contributes into ensuring of patient-oriented principle in paid medical services application.

[The methodical principles of quality management of medical activities on particular territory].

The article, on the basis of experience of development of the Republic's first territorial system of medical quality management, presents basic organizational systemic principles of building quality management of medical activity and organizational model of system functioning. The listing of criteria and indices of assessing effectiveness of territorial system of managing quality and safety of medical activity is presented too. The purpose of developing such a system is formulated. The evidence base for actuality and feasibility of its organization is presented.

[Antioxidant status in patients with paranoid schizophrenia and Alzheimer disease]. / Antioksidantnyi status pri paranoidnoi shizofrenii i bolezni Al'tsgeimera.

OBJECTIVE: To study the antioxidant profile of blood plasma in patients with paranoid schizophrenia and Alzheimer disease (AD). MATERIAL AND METHODS: Thirty-three patients with paranoid schizophrenia and 18 patients with AD were included in the study. Patients with schizophrenia were stratified into two subgroups by response to therapy. The indicators of the antioxidant profile were determined using methods based on chemiluminometry and spectrofluorimetry. RESULTS: Systemic oxidative stress due to insufficiency of low molecular weight plasma antioxidants is not determined neither in AD nor in treatment resistant schizophrenia. At the same time, a «thiol¼ oxidative stress, which indirectly indicates a deficiency of the glutathione system, is present in both groups. In patients with paranoid schizophrenia responsive to treatment, systemic oxidative stress is more pronounced and «thiol¼ oxidative stress is less significant. Among the antipsychotics studied, haloperidol, zuclopenthixol, risperidone and ziprasidone do not exhibit antioxidant properties, but periciazine, clozapine and especially chlorpromazine exhibit strong antioxidant properties, but they unlikely affect the antioxidant potential of blood plasma. CONCLUSIONS: The glutathione part of the antioxidant system is mostly affected, but systemic oxidative stress is not significant in patients with treatment resistant paranoid schizophrenia and AD. Oxidative disorders are more pronounced in treatment responsive paranoid schizophrenia.

[The functional activity of neutrophils in paranoid schizophrenia and Alzheimer's disease]. / Funktsional'naya aktivnost' neitrofilov pri paranoidnoi shizofrenii i bolezni Al'tsgeimera.

OBJECTIVE: To evaluate the radical-producing function of neutrophils in paranoid schizophrenia and Alzheimer's disease. MATERIAL AND METHODS: The study included 40 patients with paranoid schizophrenia and 22 with Alzheimer's disease. To assess the functional activity of neutrophils, whole blood samples were analyzed using the chemiluminescent method with two-step cell stimulation. Indicators of radical-producing activity of neutrophils in patients were compared to those in age-matched healthy people. RESULTS: The quantitative indicators of radical-producing activity of neutrophils in the paranoid schizophrenia group and in the Alzheimer's disease group correspond to reference intervals of healthy donors, however almost one third of patients with paranoid schizophrenia had an altered shape of the chemiluminescent curve. CONCLUSION: The neutrophil immune response might be involved in the pathogenesis of paranoid schizophrenia only in some cases.

[The organization of home-nursing medical care of patients with limited mobility].

The article analyzes topical issues of organization of patronage medical care of patients with restricted mobility in Moscow, considering ongoing organizational measures at various stages of implementation of new organizational form of medical sanitary care of patients of different age groups. The results of analysis of effectiveness of its functioning are presented.

[The evaluation of efficiency of medical organizations providing primary medical sanitary care in conditions of capitation financing].

The article analyzes the results of implementing per capita financing mechanism in medical organizations providing primary medical sanitary care. The comprehensive methodology was applied, including analysis and generalization of experience, statistical, analytical, sociological, monographic description, economic, comparative analysis, organizational experiment. The analysis demonstrated that in actual conditions number of subjects of the Russian Federation, being able to include in per capita standard only those volumes of additional medical care that can be directly impacted by primary health care unit decreased significantly.

[The Legal Issues of Conformity of Paid Medical Service with Expectancies of Patient].

The article considers particular aspects of legal regulation of conformity of paid medical service with expectancies of patient. A number of measures related to improvement of legal immunity of all interested sides during interaction with medical organization were proposed within the framework of the study.

[The actual issues of development of manpower potential in health care].

The analysis was implemented concerning main directions of development of health care manpower policy in Moscow. The activities are established related to improvement of actual situation with development of potential of medical personnel, increasing of motivation ofphysicians and paramedical personnel, improvement of conditions of development of manpower resources.

[THE MODERN TENDENCIES OF DEVELOPMENT OF SANATORIA AND HEALTH RESORT MARKET OF THE RUSSIAN FEDERATION].

The article presents the results of study of condition and tendencies of development of sanatoria and health resort market in the Russian Federation. The results of analysis of main indicators of activities of large sanatoria and health resort association «Russian Railways-Health¼ are presented. The percentage of involvement of «Russian Railways- Health¼ in total market of resort medicine is determined.

[THE DEVELOPMENT OF MEDICAL CARE OF POPULATION IN CONDITIONS OF SPECIALIZED DAY-TIME HOSPITALS OF NEUROLOGICAL PROFILE].

The article considers issues concerning increasing of quality and accessibility of medical care in Moscow neurological profile included at the expense of wide-spread implementation of specialized day-time hospitals in health care practice. The analysis applied was based on average Moscow indicators of functioning of public health institutions and characteristics of clinical course of diseases of the mentioned profile.