Features of the organization of coloproctological care to the population taking into account regional indicators of incidence

Rationale. The article provides an analysis of the features of the organization of coloproctological care for the population of the Perm Territory, taking into account regional morbidity rates, which made it possible to identify a number of significant shortcomings. There is no connection between the volume of specialized coloproctological care provided and the real need of the population. It was revealed that 32.0 % of coloproctological patients are being treated by doctors of other specialties. In 2018, 47,172 cases of coloproctological diseases were registered, and only 30,900 specialized outpatient appointments were made in the region (11.7 appointments per 1,000 population). More than half of them (57.4 %) were held in Perm.The aim of the study. Determination of the features of the organization of coloproctological care for the population of the Perm Territory, considering the incidence rates.Materials and methods. An analysis was made of the distribution among the adult population of the Perm Territory of pathologies related to the profile of coloproctology according to official statistical reports and the report of the chief specialist of the region for 2018.Results. In 2018, 3.9 sigmoidoscopies per 1,000 population were performed and 1.7 fibrocolonoscopies per 1,000 population, which led to an insufficient level of diagnosis of coloproctological pathologies. At the same time, identified for the period 2004–2018, a significant increase in the incidence of colorectal cancer (by 48.1 %), with an average annual growth rate over 15 years of 7.8 %, which is 3 times higher than the national figure, requires a change in approaches to the organization of coloproctological care, incl. for early diagnosis.Conclusion. Thus, in order to improve the quality of early diagnosis of coloproctological, and especially onco-coloproctological diseases, it is required to optimize the outpatient specialized coloproctological care in the Perm region. It is proposed to reorganize the service with the aim of organizing a primary link on the basis of an outpatient coloproctology center with a daily stay hospital, separate or at the coloproctology department of the City Clinical Hospital

Age-sex model of mortality from cerebrovascular diseases among the Irkutsk Region population

Introduction. Cerebrovascular diseases are a medical and social problem for developed countries in the second half of the 20th century and the beginning of the 21st century. The study of special mortality rates makes it possible to study in depth the nature of this pathology, its intensity among the population and to formulate reasoned program solutions aimed at reducing its frequency in the population.The aim of the research is to identify trends and features of the dynamics of mortality in connection with cerebrovascular diseases in different age and sex groups of Irkutsk Region population.Materials and methods. The subject of the research is deaths from cerebrovascular diseases among Irkutsk Region population for the period of 2000–2020. A continuous method of statistical observation was used; the grouping of the material was carried out by distributing the deceased by sex and five-year age interval, with subsequent calculation of mortality tables. The dynamics of the quantitative measure of mortality was determined by calculating the matrix of time series indicators.Results and discussion. For the period of 2000–2020, in the Irkutsk Region, there was a decrease in mortality rates from cerebrovascular diseases both among the male and female population. Mortality rates by sex are higher among the male population, as indicated by the ratio of the ratio of mortality between men and women in all age intervals. The multiplicity of the ratio of indicators increases during the research period from the maximum values of 2.1 times in 2000 to 5.0 times in 2020. The maximum difference shifts from the age of 55–59 to the age group of 40–44. The intensity of mortality reduction in the dynamics of 2000–2020 among the female population is higher than the male. Based on the results of the analysis of the time series, it was found that the age-specific exponent of mortality in the content of 1 % of the mortality increase has a more pronounced quantitative measure for the male population.Conclusion. As the result of the research, for twenty-year observation period a decrease in mortality rates from cerebrovascular diseases was revealed. The age-specific mortality rate from cerebrovascular diseases in the male population is higher than in the female population. The maximum intensity of the difference in mortality between men and women is reached in the working age groups. The content of the indicator 1% of increase in deaths in the male population is higher than that of the female. State policy in the development and implementation of target-oriented programs for reduction of mortality should be based on thorough analysis of data of administrative districts

Improving the methodology for creating a medical service based on the costs of its production

Background. Currently, the multichannel nature of financial flows determines the multivariate methods of payment for medical services, which are also influenced by the type of medical care, conditions, form of its provision, and type of institution. As a result, the cost of a medical service can vary significantly not only in different, but even in one medical organization. The lack of a unified methodological approach puts healthcare organizations in unequal conditions, as a result, public sector medical organizations are forced to seek additional resources to provide medical care to the population that meets the standards. None of the current methods for determining the cost of a medical service reflects its actual cost, since it does not take into account the structure of production costs.The aim. To improve the methodology for the formation of the cost of public services in the health care system, taking into account their resource intensity.Materials and methods. The study included the analysis of the forms of state statistical observation of medical organizations of the Irkutsk region, reports of the federal and regional accounting chambers, industry regulations, materials of scientific periodicals, conferences, monographic studies, including on the Internet; comparison of the cost of medical services in various medical organizations of the Irkutsk region; modeling methods for calculating the cost of medical services using the Cobb – Douglas production function.Results. A unified classification of medical services based on their resource intensity and an improved method of forming the cost of medical services based on the Cobb – Douglas production function are proposed, revealing the dependence of the volume of production on two factors of production – capital and labor; the cost of medical services was calculated using the example of real services provided in one of the medical organizations of the public health sector of the Irkutsk region.Conclusions. The proposed method for determining the cost of a medical service based on its resource intensity makes it possible to determine the real cost of a medical service, the full reimbursement of which will increase the financial stability of medical organizations in the public sector, which will be reflected in the improvement of their material and technical base and, as a result, will increase the quality of medical services

The influence of subject learning on the skills of decoding autofluorescent images of the oral mucosa

Background. Despite the ease of implementation, harmlessness, painlessness and speed of the study, the method of autofluorescence does not belong to the routine and often used because of the dependence on the skill of the dentist in interpretation of the resulting visualization. Foreign and domestic researchers speak about the need for thematic training of dentists for the widespread introduction of the autofluorescence method into practice. There is no data proving the influence of training on the skill of interpretation autofluorescence images and showing the dependence of the skill on the duration of training and its frequency.The aim of the study was to conduct a comparative analysis of the results of interpreting autofluorescence images of the oral mucosa by dentists before and after thematic training.Methods. 308 dentists interpreted 20 images of autofluorescence of the oral mucosa before and after the thematic training, 10 of them were of potentially malignant diseases of the oral mucosa, 10 – of benign lesions and paraphysiological anomalies. Correctly identified mucosal changes presented in the autofluorescence image were considered positive results of decoding. The results were evaluated relative to the duration of training and its frequency, taking into account the duration of breaks, according to the average number of positive results.Results. Before the thematic training, dentists on average decoded 8.41 ± 4.89 images, after training – 12.11 ± 3.12 images. The difference before and after the thematic training between the number of positive results of interpretation autofluorescence images is statistically significant (t = –14.1, p˂ 0.001). There was no significant difference in the results of interpretation potentially malignant oral diseases (F = 1.67; p = 0.190) and benign lesions and conditions (F = 0.647; p = 0.524) between the three groups that studied for 6, 12 and 18 hours. There is a correlation to the duration of the interruption of training with positive results of decoding (r = –0.3376; p˂ 0.001). The positive results of interpretation of autofluorescence with regular monthly 6-hour training had significant increasing trends (12.11 ± 3.12 and 13.22 ± 1.76, t = –3.41, p = 0.001; 13.22 ± 1.76 and 14.40 ± 1.81, t = –4.74, p˂ 0.001).Conclusion. Thematic training improves the skill of interpretation autofluorescence images in dentists. The regularity of short-term training is more important for maintaining the interpretation skill than the duration of training

The readiness of dentists to use the autofluorescence method

Background. Head and neck squamous cell carcinoma are the sixth most common cancer in prevalence rate. Early diagnosis significantly reduces morbidity and mortality. Autofluorescence facilitates diagnosis the disease at the early stages, but it depends on the doctor’s skill in interpreting images. The aim of the study: to analyze the results of reading autofluorescence images of the oral mucosa by dentists.Materials and methods. The results of reading 10 autofluorescence images of potentially malignant diseases of the oral mucosa and 10 images of benign lesions and conditions were evaluated. The study involved 308 dentists. The assessment of the ability to recognize autofluorescence images was carried out with respect to gender, age, length of service, qualification category, academic degree, position of the head of the department.Results. On the average, dentists correctly differentiated the results of visualization of potentially malignant diseases of the oral mucosa in 3.85 ± 2.47 cases, benign lesions together with other benign conditions – in 4.56 ± 2.47 cases. Images of benign lesions and conditions were identified by dentists better than images of potentially malignant diseases of the oral mucosa (t = –17.0; p < 0.001). There is a direct correlation between the correct differentiation of visualization of potentially malignant diseases of the oral mucosa with the correct interpretation of benign lesions and conditions (r = 0.956; p < 0.001). The interpretation of potentially malignant diseases of the oral mucosa is not related to gender (t = –1.62; p = 0.306), work experience (r = –0.002; p = 0.977), department head (t = –0.11; p = 0.910), qualification category (t = –0.50; p = 0.574), academic degree (t = –0.34; p = 0.731).Conclusion. Dentists cannot recognize diseases of the oral mucosa well in autofluorescence images. The recognition skill is not related to general professional development

Ethnic characteristics of bone remodeling in female patients with type 2 diabetes mellitus

Background: Structural and metabolic disorders of bone tissue in women with T2DM have no clinical manifestations, but they are accompanied by the risk of fractures.Aim: To study the parameters of bone metabolism, BMD and microarchitectonics in female patients with T2DM in the Buryat population.Materials and methods: The observational single-center one-stage controlled study included 73 women with T2DM, which were divided into 2 groups depending on the functional state of the ovaries (reproductive and postmenopausal periods). In each group, subgroups of the Buryat and Russian populations were identified. The first group included 34 patients with T2DM of the reproductive period: 16 from the Buryat population and 18 from the Russian population. The second group consisted of 39 postmenopausal patients with T2DM: 17 from the Buryat population and 22 from the Russian population. The study of BMD in the lumbar spine (L1-L4), femoral neck (Neck), in the proximal femur (Total hip), trabecular bone score (TBS), serum osteocalcin (OC), N-terminal propeptide type 1 procollagen was carried out (P1NP), vitamin D 25 (OH), blood plasma type I collagen C-terminal telopeptide (β-Cross laps) and ionized calcium (iCa).Results: In female patients with T2DM of the reproductive age of the Buryat population, an increase in both markers of osteosynthesis P1NP (p=0.035), OC (p=0.047), and bone resorption β-Cross laps (p=0.040) was found relative to the similar group of the Russian population. In women with T2DM in the postmenopausal period of the Buryat population, there was also an increase in P1NP (p = 0.016), OC (p = 0.048), β-Cross laps (p = 0.020) compared with the group of postmenopausal women in the Russian population. Structural disorders, characterized by a decrease in TBS, were detected only in the postmenopausal period in female patients of the Buryat population compared to women in the Russian population (p = 0.029).Comparative analysis among women with T2DM of the Buryat population, depending on the functional state of the ovaries, showed that activation of bone remodeling with an increase in P1NP (p = 0.019), OC (p = 0.004) and β-Cross laps (p = 0.004) is characteristic of postmenopausal women accompanied by a decrease in BMD Neck (p = 0.006), BMD Total hip (p = 0.003), BMD L1-L4 (p = 0.049) and TBS (p = 0.020) relative to female patients with T2DM in the reproductive period.Conclusion: In women with T2DM in the Buryat population, both in the reproductive and postmenopausal periods, an increase in bone remodeling markers and BMD stability was found when compared with the corresponding groups of patients in the Russian population. The postmenopausal period was characterized by an additional decrease in TBS in patients with T2DM in the Buryat population relative to women in the Russian population

Cognitive status in older patients with limited mobility as a predictor of negative outcome

Background. Cognitive impairment (CI) is one of the important disability factors in the elderly. The role of CI in prognosis of the frailest patients with limited mobility is uncertain.The aim. To determine the influence of the initial cognitive status in the group of patronage patients aged 60 years and older on the risk of mortality within one year.Materials and methods. Study group consisted of 450 patients from patronage group with one-year period of observation (from July 2019 till July 2020). Initial physical, functional, neuropsychiatriac and social statuses were evaluated by comprehensive geriatric assessment. Cognitive impairment was screened by Mini-Mental State Examination (MMSE), with dividing patients into dementia group (MMSE ≤ 24) and no-dementia group (MMSE > 24). The mortality rate after one year was assessed.Results. Of the 450 patients included in the study, dementia was present in 44.2 %. Patients with dementia were more prone to greater severity of chronic pain, sleep disturbances, depression, malnutrition and anemia. After one year of observation 34 out of 196 patients (17.3 %) in the group of patients with dementia and 18 out of 248 patients (7.3 %; p = 0.002) in the no-dementia group died. According to multivariate analysis, independent risk factors for death in patients with dementia were anemia, hearing impairment and a history of bone fractures.Conclusion. Thus, the assessment of the cognitive status of frail patients with limited mobility is important for the purpose of identifying the most vulnerable individuals with a high risk of adverse outcomes