Категория "Социальное здоровье населения" в общественном здоровье и здравоохранении

Social management — is not only the area of practice all levels of government, social services, the object of which is the people and all areas of their life, but also an important element of the organization of health care and Public Health. Social management has a clear direction and a specific object of administrative impact in every area of public life, including the health care system.Социальное управление — это не только область практической деятельности органов власти всех уровней, социальных служб, объектом которой являются люди и все сферы их жизнедеятельности, но и важнейший элемент организации здравоохранения и общественного здоровья. Социальное управление имеет четкие ориентиры и конкретный объект управленческого воздействия в любой области общественной жизни, включая систему здравоохранения

Motivation of medical staff of dental organizations of various property types: data of sociological research

The searching of effective methods of staff management is the most important task for healthcare managers. The purpose of the study: to assess the degree of work satisfaction of doctors and nursing staff of dental organizations of various forms of ownership and to analyze the factors that determine it. Material and Methods. The survey was conducted using a specially developed questionnaire, which included blocks describing the following parameters: satisfaction with various aspects of the work; factors affecting labor activity; rating characteristics of work; motives that determine professional interest; conditions that stimulate activity. Results. As a result of the study, differences were found in the satisfaction with the professional activity and working conditions of medical and nursing staff of dental organizations of various forms of ownership. Factors determining the motivation of the work of the personnel of the modern medical organization are revealed. This allowed for a differentiated approach to the development of measures to improve the diverse motivation of the staff. Conclusion. It was established that the main directions in improving the staff motivation system may be: material and non-material promotion; optimization of work organization; involving staff in the management of organization and making management decisions; improvement of professional skills of employees, fair distribution of remuneration and social services.</p

Динамика мнений о мерах профилактики и лечения инфекций, передающихся половым путем, на фоне пандемии коронавируса

Objective: to analyze changes in the opinions of young people about measures to prevent and treat sexually transmitted infections (STIs) against the backdrop of the coronavirus pandemic compared to the pre-pandemic period. Material and methods. The research program is based on a comparison of data from a sociological survey of 400 respondents aged 16–21 in 2021 and an analysis of 838 questionnaires from participants in a similar study in 2017 of the same age. Research method — sociological (questionnaire). The author’s questionnaire was used, consisting of 46 questions, combined into five blocks: self-assessment of the relevance of the STI problem, the likelihood of infection risk, readiness to undergo preventive screening examinations, preferred directions for seeking help if STI symptoms occur, consent to examination and treatment together with a sexual partner. By gender, the distribution was as follows: in 2017 — women — 51 % (n=427), men — 49 % (n=411); in 2021 — 52 % (n=208) and 48 % (n=192). In processing and presenting the data, extensive indicators were used, compared with the assessment of the significance of differences according to Student’s t-test. Results. In 2021 an increase in the interest of young people in undergoing screening examinations (79.5 % versus 63 % in 2017, p=0.006) and seeking medical help (93.5 % versus 89.5 %, p=0.007) was noted. However, the number of cases of concealing the state of health from a partner increased significantly (from 8.3 to 32.2 %, p=0.003). Conclusion. The study revealed a change in the opinions of respondents regarding STIs during the pandemic, which consists in an increase in understanding of the need for regular examinations, seeking medical help when symptoms of the disease appear, but at the same time, a decrease in the sense of responsibility for the health of their partner.Цель: анализ изменения мнений лиц молодого возраста о мерах профилактики и лечения инфекций, передающихся половым путем (ИППП), на фоне пандемии коронавируса по сравнению с допандемийным периодом. Материал и методы. Программа исследования основана на сопоставлении данных социологического опроса 400 респондентов 16–21 года в 2021 г. и анализа 838 анкет участников аналогичного исследования 2017 г. того же возраста. Метод исследования — социологический (анкетирование). Использована авторская анкета, состоящая из 46 вопросов, объединенных в пять блоков: самооценка актуальности проблемы ИППП, вероятность риска заражения, готовность к прохождению профилактических скрининговых обследований, предпочитаемые направления обращения за помощью при возникновении симптомов ИППП, согласие на обследование и лечение совместно с половым партнером. По полу распределение было следующим: в 2017 г. женщин — 51 % (n=427), мужчин — 49 % (n=411); в 2021 г. — 52 % (n=208) и 48 % (n=192). В обработке и представлении данных использованы экстенсивные показатели, сравниваемые с оценкой значимости различий по t-критерию Стьюдента. Результаты. В 2021 г. отмечен рост заинтересованности молодежи в прохождении скрининговых обследований (79,5 против 63 % в 2017 г., p=0,006) и обращении за медицинской помощью (93,5 против 89,5 %, p=0,007), однако возросло число случаев сокрытия состояния здоровья от партнера (с 8,3 до 32,2 %, p=0,003). Заключение. Проведенное исследование выявило изменение мнений респондентов в отношении ИППП в период пандемии, заключающееся в возрастании понимания необходимости регулярных обследований, обращения за медицинской помощью при появлении симптомов заболевания, но при этом отмечено снижение чувства ответственности за здоровье своего партнера

Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Quality of life and health risk factors in officers departed from Armed Forces

Objective: assessment of quality of life, identify of health risk factors for officers discharged from the Armed Forces, and development of step-by-step system for medical and social assistance to reserve soldiers (retired). Material and Methods. Anonymous questioning of 358 officers in different time periods, including the last year of service before departure, with the subsequent processing of the data using the statistical program SPSS. Results. It was established that the highest indicators of quality of life were from the military in reserve (RET.) more than 3 years, and the lowest from the military a year before the departure from the Armed Forces and in the first year after the departure. Conclusion. The authors proposed a step system of health and social care for members of the military reserve (retired) and an algorithm for its implementation, including regulations of interdepartmental interaction and integration of all organizations providing medical care.</p

Основные направления совершенствования системы оказания скорой медицинской помощи пациентам с острым коронарным синдромом

Objectives - to develop the main strategies of emergency medical care improvement for patients with acute coronary syndrome, in order to to reduce the morbidity and mortality in the population of a large industrial region. Material and methods. The study was conducted on the basis of the Moscow regional ambulance station. We used the content analysis, logical, system analysis, the method of mathematical statistics. Results. In the period 2017-2018, in the region's population, there is a tendency for decrease in the number of calls for ambulance teams caused by acute coronary syndrome. During the analyzed period, we noticed the reduction of the number of cases of pre-hospital thrombolytic therapy (by 17.5%). The response time to the patient's call not more than 20 minutes was observed in 92.9% of cases, the number of lethal outcomes in presence of the ambulance team decreased by 4. 6%. The results can be explained by the dynamic development of the infrastructure of cities and districts of the Moscow Region, by the improvement of road networks, by the complete renewal of the service's motor vehicle fleet, and by the opening of a number of new specialized medical institutions. A set of medical and organizational measures has been developed and put into practice in the ambulance service of the region, aimed at further improvement of the system of ambulance care for patients with acute coronary syndrome at the prehospital stage. Conclusion. The mortality reduction, preservation and improvement of public health can be achieved only through the comprehensive sustainable development of the region’s infrastructure, improvement of the organizational structure of the emergency medical service, mandatory use of algorithms and standards for the provision of medical care to patients at all stages.Цель - разработка основных направлений развития системы скорой медицинской помощи пациентам с острым коронарным синдромом для снижения заболеваемости и смертности населения крупного промышленного региона. Материал и методы. Исследование проводилось на базе Московской областной станции скорой медицинской помощи. Были использованы следующие методы: контент-анализ, логический, системный, математической статистики. Результаты. Количество вызовов населением региона бригад скорой медицинской помощи с поводом «Острый коронарный синдром» за период 2017-2018 гг. имеет тенденцию к снижению. За анализируемый период сократилось количество случаев проведения на догоспитальном этапе тромболитической терапии (на 17,5%), показатель времени доезда на вызов до 20 минут возрос и составил 92,9%, снизилось количество случаев смерти пациентов в присутствии бригады скорой медицинской помощи на 4,6%. Это объясняется динамическим развитием инфраструктуры городов и районов Подмосковья, развитием автодорожных сетей и развязок, полным обновлением автомобильного парка службы, открытием ряда новых специализированных медицинских учреждений. Разработан и внедрен в практику работы службы скорой медицинской помощи региона комплекс медикоорганизационных мероприятий, направленных на дальнейшее совершенствование системы оказания скорой медицинской помощи пациентам с острым коронарным синдромом на догоспитальном этапе. Заключение. Снижение смертности, сохранение и укрепление здоровья населения могут быть осуществлены только за счет комплексного устойчивого развития инфраструктуры региона, совершенствования организационной структуры службы скорой медицинской помощи, обязательного использования алгоритмов и стандартов оказания медицинской помощи пациентам на всех ее этапах

The condition and trends of morbidity of diseases of urogenital system in adult population of Moscow

The article presents the results of studying state and trends of incidence of adult urban population in the city of Moscow by the classes of diseases of the genitourinary system. The purpose of study was to analyze urogenital morbidity of population of metropolis as compared with similar indices of the Central Federal Okrug and the Russian Federation in 2014-2018. The corresponding official statistical data of the Minzdrav of Russia and research publications were studied. It was established that permanent monitoring of dynamics of urological morbidity can be considered as important methodological and informational and analytical base for planning medical care of population, that makes it possible to develop in practice the basis of development and implementation of integrated system of measures of development of community-based and hospital care, which must be taken into account by the administration of medical organizations and health care management at various levels