[The ecological determinancy of development of bronchial asthma in adult population (as exemplified by the Republic of the North Ossetia-Alania].

The intensive impact of anthropogenic factors on health causes more than 40% of all human diseases. First of all, it has to do with respiratory organs and comes out as the main determinant of development of chronic respiratory pathology. The article presents an assessment of negative impact of environmental factors on dynamics of increasing of incidence of bronchial asthma morbidity in the Republic of North Ossetia-Alania. The indicators of the general morbidity that increased up to 75.6% and for the first time detected up to 97.5% over six-year period. The results of present study correspond with the results of similar studies implemented in various territories of Russia indicating at mediation of increasing of bronchial asthma morbidity by negative impact of environment risk factors. In the Republic, over a period of many decades, contribution of the metallurgical plant producing zinc, cadmium, sulfuric acid and zinc-aluminum alloys, to atmospheric air pollution made up not less than 40%. Only two out of eight rural municipal districts are relatively environmentally problem-free today. In rural areas, more than 50% of atmospheric air pollutants is related to carbon oxide. Nowadays, along with industrial emissions into atmospheric air and their accumulation, increases importance of motor transport in environmental pollution. The cars account for 50-70% of all harmful emissions. The presence of harmful substances contained in exhaust gases exceeds permissible standards by 2-3 times. According to the data of systematic analysis of urban air quality, most of the year citizens breathe atmospheric air not meeting normative requirements. The actual situation favors development of bronchial asthma. In the Republic, its morbidity has not decreased for many decades. To improve indicators of bronchial asthma morbidity can be achieved by leveling harmful effects of environment through identification of main sources of environmental troubles. The priority is both to decrease industrial emissions that pollute atmosphere and to transit to more ecologically safe modern power supplies of motor transport facilities.

[The analysis of opinions of pediatricians about organization and perspectives of development of primary medical sanitary care of children].

The analysis of opinions of district pediatricians about state and perspectives of development of primary medical sanitary care for children in the Kabardino-Balkarian Republic permitted to obtain competent assessment of quality of polyclinic medical care. The positive tendencies in activities of children polyclinics were established. However, the problem of achieving higher quality of medical care of children continues to be actual. According to survey results, character and direction of organizational managerial decision making concerning improvement of material and technical equipment of children polyclinics in accordance with modern requirements (37.6%), elimination of defects in organization of free medication support (63.6%), improvement of organization of free nutrition supply of children (50%), etc. Among the priority tasks of pediatric service is the solution of the medical personnel issue and full staffing of pediatric districts with physicians (66.7%), paramedical personnel (29.6%) and medical specialists (61.7%), as well as the need to include in staff of the polyclinic positions of child psychologist (54.0%) and social worker (31.5%). One of the main problems of primary medical sanitary care of modern pediatric service remains high work overload of district pediatricians that which undoubtedly impacts quality of medical and preventive activities. The low readiness of district pediatricians to active acceptance of innovative transformations in functioning of children polyclinic, requiring psychological readjustment of medical personnel is established. This was most strikingly manifested by process of implementing information technologies and the National project "Lean Polyclinic". All issues identified by sociological survey significantly strained during coronavirus pandemic in 2020. The pandemic inputted its own adjustments in medical care support of children in the region. Despite the fact that disease did not affect children to large extent, due to prolonged absence of physicians suffering from coronavirus, quality of dynamic monitoring and treatment of children suffered. Factually, no dispensarization activities were implemented and prevention measures as well. The results of survey contributes to the formation of monitoring of quality of out-patient care of children at the regional level and makes the research data highly relevant.

[The characteristics of morbidity of breast cancer in the Kabarda-Balkar Republic].

In the Kabarda-Balkar Republic during last decades, stable dynamics of increasing rates of primary breast cancer morbidity is established. The gaining rate of indicator made up to 40.7% over last 10 years. The prevalence indicator of breast cancer is characterized by high growth intensity twice higher than the national level. In the structure of malignant neoplasms morbidity, breast cancer (23.3%) takes position of leading oncologic pathology. The most of patients with breast cancer (33.0%) are in the age group of 50-59 years. However, higher oncologic alertness of medical personnel concerning young women, especially 20-29 years old is required since their percentage among patients with breast cancer is increasing. Noteworthy is the low indicator of active case finding of patients with breast cancer: only 31.8% of cases is diagnosed during prevention examinations. At the early stage of development of tumor process (stage I-II), the rate of identified patients with breast cancer is lower than in the Russian Federation. Especially low is the level of early diagnosis of the disease at stage I. The data testifies existing problems of organization of oncologic medical care in the Kabarda-Balkar Republic and indicates the need of strengthening preventive measures at the primary health care level. Their effectiveness will be assessed by the level of early diagnosis of breast cancer in women and by corresponding appropriate treatment.

[The satisfaction of parents with ambulatory polyclinic care of children in conditions of the region].

To identify the most effective areas of out-patient care of children, an in-depth sociological study was carried out in the Kabardino-Balkaria Republic. The questionnaire allowed to get answers on satisfaction of parents with the quality, volume and availability of out-patient care, as well as to study the social status of respondents. The survey included 495 mothers aged of 18-45 years. Out of them, 70.0% had 1-2 children, 30.0% had 3 or more children. The orientation of the majority of families to the birth of 1-2 children formed one of the lowest in the republics of the North Caucasus total fertility rate of 1.61. The results of the study of parental satisfaction with the level of medical care of children in out-patient settings established that the main problem is sufficiently correlated with the data of similar studies in different regions of Russia. According to the data obtained, 61.0% of the respondents were satisfied with the overall health care in the clinic, and only 12.0% of the respondents were fully satisfied. At the same time, a quarter of the respondents expressed their dissatisfaction with various aspects of medical care. The main reasons for dissatisfaction are the low level of examination, organizational issues that need to be addressed, a significant workload of doctors, often the lack of doctors of narrow specialties. According to parents opinion, the clinic is lacking continuity in the work and dynamic monitoring of a sick child, as well as awareness of patients about the ongoing therapeutic and preventive measures. The low efficiency of preventive work is established. The dissatisfaction with the availability and quality of medical care of children is the basis for the necessary measures to improve functioning of the children's clinic, including introduction of new and effective organizational and medical technologies, improvement of material and technical equipment, improvement of the professionalism of medical personnel. The prerequisite for the success of the clinic is also compliance with ethical principles in Pediatrics. The results obtained on the basis of the analysis of the parents' opinion are valuable for development of the perspective programs of development and improvement of primary health care of children in the Republic of Kabardino-Balkaria.

[The Priority Directions of Children Health Support in Conditions of the Region During the Great Patriotic War].

The article presents analysis of state of children health care in Kabardino-Balkaria during the Great Patriotic War (1941-1945). The significant hardships are demonstrated concerning children health support during German occupation in winter 1942-1943 and during post-occupation period. The significant increase of morbidity children infections, especially measles, undernourishment, hard domestic conditions were specific for this period. The main causes of high mortality among children were pneumonia, acute diseases of gastro-intestinal tract, whooping cough, scarlatina, diphtheria. The acute deficiency of medical personnel and untimely implementation of planned inoculations resulted indecreasing of the level of preventive activities among children population. The number of children consultations shortened twice. The special significance for development of pediatric service played organization of municipal and district pediatricians, preventive appointments of healthy children and home-nursing activities at the pediatric districts. The development of children health care characterized by increasing of load on medical institutions, implementation of emergency activities under guidance of departments organized by the Narkomzdrav of the Republic. A significant portion of activities was implemented by public organizations. The foundations of support of children evacuated ti the Republic and foundations of support of orphan children were organized.