[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.

[Sociomedical aspects of infertility (results of a questionnaire survey)]. / Mediko-sotsial'nye aspekty besplodiia (po rezul'tatam anketirovaniia patsientov).

Sterility is a pressing problem, and we therefore carried out a sociological study among patients consulted for sterility at the andrological department of the D.O. Ott Institute of Obstetrics and Gynecology. The nature of sterility is often mixed, and we therefore distributed questionnaires among couples (men and wives), a total of 160 patients. The results showed that many patients (particularly those aged 31-40 years) had problems in their social intercourse, which are closely related to the problem of sterility and the motivation of having a child. In almost half the cases men or both spouses were responsible for sterility. A long history of infertility (both treated and untreated) in many patients and inefficiency of its treatment, particularly in private clinics, are worthy of note. In addition, many patients suggest that both spouses be treated at the same medical institution, which is to be responsible for the final result.

[Organization of patient intake at private dental institutions]. / Organizatsiia priema bol'nykh v negosudarstvennykh stomatologicheskikh uchrezhdeniiakh.

Scientifically-based organization of consultations and treatment of patients at dental institutions is proposed, based on the balance between the time spent by patients in the queue and the equipment downtime. The proposed organization will decrease the total duration of treatment.

[Assessing quality in the conducting of seminars for the advanced training of dentists]. / Otsenka kachestva provedeniia seminarov po povysheniiu kvalifikatsii vrachei-stomatologov.

Regular analysis of questionnaires distributed among students of self-supporting workshops carried out at the Training Center is aimed at elucidating the students' opinions about organization of workshops in order to optimize it and at collection of marketing information on the training and medical activities of the firm. The majority (90%) of respondents gave a positive answer to the question: "Will you advise your colleagues to go to workshops at the Training Center?" Exhibitions of materials offered by the firm and training of students to use these materials demonstrate the advantages thereof. Analysis of questionnaires showed that just a little part of dentists know the true price of their work and that the major part of the market of dental service is oriented, judging by the proposed costs, mainly at the solvent population.

[Time course of various parameters of the health of the population and effects of these parameters on modern development of hospital care in St. Petersburg and Finland in 1995-1996]. / Nekotorye sravnitel'nye pokazateli zdorov'ia naseleniia v dinkamike i ikh vliianie na sovremennoe razvitie statsionarnoi meditsinskoi pomoshchi v Sankt-Peterburge i Finliandii(1995-1996).

Hospital care in St. Petersburg and Finland is compared. Approximately 4-6 times more patients are treated annually in medicosocial hospitals of Finland than in St. Petersburg; it is therefore evident that the reformation of hospitals of the city is to be paralleled by reforms of primary health care within the framework of universal public health system.

[The system of training future leaders in public health]. / O sisteme podgotovki budushchikh rukovoditelei v zdravookhranenii.

The authors analyze the present-day status of the system of training specialists in public health organization in Russia. Based on the experience gained in St. Petersburg, they demonstrate that full-time training combined with studies by correspondence is the most effective approach to preparing such specialists.

[Organization of urgent surgical treatment for complicated colonic cancers in a large industrial city]. / [Organizatsiia ékstrennoi khirurgicheskoi pomoshchi bol'nym oslozhnennymi formamy raka tolstoi kishki v krupnom promyshlennom gorode]

The study was concerned with evaluating the results of follow-up of 756 cases of complications of colorectal cancers urgently admitted for surgery to four hospitals of St. Petersburg. Most patients were hospitalized late when complications diagnosed as an acute disease of organs of the abdominal cavity were apparent. Frequent postoperative complications and poor results of treatment were due to advanced age of patients, their grave general condition, concommitant pathologies, frequent errors of diagnosis made before and during hospitalization and lack of a single strategy of therapy. No improvement in the results of treatment of these grave cases can be expected unless the quality of diagnosis and the standards of urgent surgical aid organization are improved and an efficient therapeutic strategy is developed.

[Experience in organizing hospice service in a large city]. / Opyt organizatsii sluzhby "Khospis" v krupnom gorode.

Analyzes the current models of the hospice service organization in St. Petersburg. Critical analysis of the service permits a conclusion that model 2 of this service organization is preferable.

[Fund for social development of regional health care coalitions in the conditions of collective bargaining]. / Fond sotsial'nogo razvitiia territorial'nogo meditsinskogo ob''edineniia v usloviiakh kollektivnogo podriada.

The introduction of economic incentives, the utilization of a fund for social development of institutions considerably increased the intensification of labour, improved health care indicators and the accessibility of health care for the population. The expedient form of work appeared to be collective bargaining which considerably expanded the rights of the leader and collective. ++ Interdepartmental cost-accountable relations with the future introduction of ++intra-structural cost-accountable relations is a prospective form of health services administration and management.

[Medical-genetic service and problems of prevention of hereditary diseases in the family]. / Mediko-geneticheskaia sluzhba i problemy profilaktiki nasledstvennoi patologii v sem'iakh.

The article provides the scientific substantiation of the economic effectiveness of early identification and treatment of patients with hereditary diseases proceeding from the example of patients suffering from mucoviscidosis. It was found that the degree of cost-effectiveness is closely related to the organization of early identification and timely treatment of such patients. The authors prove that identification and treatment of patients with mucoviscidosis is cost-effective.

[Economic attitudes in the activities of therapeutic-prophylactic facilities under the conditions of new economic mechanisms]. / Ekonomicheskie otnosheniia v deiatel'nosti lechebno-profilakticheskikh uchrezhdenii v usloviiakh novogo khoziaistvennogo mekhanizma.

For two years an experiment on restructuring of health services system is being conducted in Leningrad. The economic mechanisms are being introduced into the health services system which allow health authorities, using internal resources, to considerably improve the delivery of medical care for the population. The introduction of economic incentives into the system of payment for labour, the use of some economic mechanisms into the co-operation between medical institutions led to considerable intensification of labour, improved the discipline and performance indices of medical institutions. The most expedient form of work proved to be collective contract which allowed to considerably broaden the rights of doctors and staff. Institutions working on the basis of collective contract achieved much better results. Unnecessary hospitalization of patients has decreased and planned hospitalization increased, intensification of labour is going on which permits to significantly increase wages. Intra-sectorial cost accounting relationships is a progressive form of public health organization and management.

[Economic effectiveness of the introduction of a new method of conservative treatment of chalazion]. / Ekonomicheskaia éffektivnost' vnedreniia novogo sposoba konservativnogo lecheniia khalaziona.

The authors analyze the economic efficacy of a new method for chalazion therapy: corticosteroid injections deep into the pathologic focus. Such therapy may be carried out on an outpatient basis, the patients do not have to cease work for it. The authors emphasize high socioeconomic significance of introducing this method into clinical practice.